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In Vitro Fertility Goddess
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Just when you think the odds are against you, think again. This true story is a triumph over everything that shouldn't have happened and did, an extraordinary beating of the odds. It's along the lines of a person cutting off their own head, eating it and surviving - just as strange, but in this case true.
Right. Take a seat while I try and work out where to begin. Pour yourself a drink if you're in between IVF cycles. OK, here goes.
A 57 year old woman, Susan Tollefsen from Romford, East London walks into an IVF clinic in Russia, hoping to have a child with her 46 year old partner. At this point her odds of achieving a pregnancy with IVF are zero with her own eggs, and, using the rates of success in Britain at private clinics treating women over 50, roughly twenty five percent with donor eggs.
She has already tried a few other ‘foreign' clinics over several years without success. She undergoes treatment and has 2 embryos implanted.
The first miracle occurs - she achieves a pregnancy but less than four weeks after transfer starts bleeding and miscarries. The odds of miscarrying at 45 or over are greater than fifty four percent.
Her GP confirms the miscarriage as does a negative home pregnancy test. (HPTs are 99% accurate in the lab but do have a higher rate of false negatives than positives).
Susan reluctantly relinquishes her dream.
Fast forward to twenty-four weeks later when she has been suffering from a swollen abdomen and presents at hospital with what her GP cited as a ‘hard abdominal mass'.
The fear is that she has ovarian cancer - the odds being high for a 57 year old with a swollen abdomen who has never been pregnant. It is the fourth leading cause of cancer death in women of this age.
She is fully expecting the sonographer to relay some grave news but instead he says, "Congratulations. You are pregnant." Thirty weeks pregnant to be exact and the baby is healthy.
Susan has now given birth to her first baby, a girl she has named ‘Freya'.
And if that's not a miracle, I'm not sure what is.
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Wednesday 5 March, 2009
Pictures of the frail Suleman octuplets, born nine weeks early and only as heavy as 1½ pounds, have been beamed into lounge rooms around the world. The newborns who came from six embryos, two of which split into twins, have sparked a heated debate as to whether the US should follow the cue from lead of Sweden and Belgium and replicate their laws that limit the number of embryos that can be transferred during IVF.
Lawmakers in two states have already introduced bills to limit embryo transfers: Missouri will demand that fertility clinics follow American Society for Reproductive Medicine or ASRM guidelines which allow for one or two embryos in patients under 35 and up to five in women 40 and over. Georgia has upped the ante by limiting women under 40 to two embryos and those +40 to three.
Pictures of the frail Suleman octuplets, born nine weeks early at weights as low as 1½ pounds, have been beamed into lounge rooms around the world. The newborns who came from six embryos, two of which split into twins, have sparked a heated debate as to whether the US should follow the cue from lead of Sweden and Belgium and replicate their laws that limit the number of embryos that can be transferred during IVF.
Lawmakers in two states have already introduced bills to limit embryo transfers: Missouri will demand that fertility clinics follow American Society for Reproductive Medicine or ASRM guidelines which allow for one or two embryos in patients under 35 and up to five in women 40 and over. Georgia has upped the ante by limiting women under 40 to two embryos and those +40 to three.
But a growing number of women who have concerns about multiple births are opting for a relatively new approach called elective single-embryo transfer or eSET.
While 10 years ago, transferring a single embryo would have been deemed inappropriate given the slim success rates, progress made since then have significantly improved the chances of younger women achieving a successful pregnancy with only a single embryo transferred. The journal Fertility and Sterility recently reported that eSET patients had the same pregnancy rate (65%) as those who transferred two embryos. But the big difference was that while only 1% of eSET patients had twins compared with 44% of the women who had received two embryos.
But the incentives faced by American patients to transfer more than the recommended number of embryos are too great to be ignored because large numbers of IVFers lack appropriate insurance for a procedure that costs about $12,500 a cycle. Many view twins as "two for the price of one" or see multiple transfers as increasing their chances of conceiving at least one healthy baby. And for fertility doctors, there's the incentive to boost transfer numbers in a bid to increase their success rates and their clinic's appeal to future clients.
Barbara Collura, the executive director of the infertility group Resolve, believes there is necessity to encourage women to take out insurance first because restricting embryo transfers without first addressing the insurance issue "is going to create more trauma and more problems. When you get to the point where this is covered by insurance, you have a completely different attitude, you're not as desperate."
Sean Tipton from the ASRM says that in Connecticut, health plans that cover maternity care must pay for IVF, but they can limit the number of embryos transferred to two. Governments can also intervene directly as is the case in the Netherlands where while there is no strict legislation on the number of embryos transferred, the government says that the transfer of more than two embryos shouldn't be reimbursed by national healthcare. And that's a strong disincentive.
Resolve urges women to consider their health and their baby's health when contemplating the transfer of more embryos than recommended by the ASRM.
But that is easier said than done as it's often hard to deal with them in a rational way when they're in perhaps the biggest crisis of their life.
And at the end of the day, while some fertility clinics support eSET, it's not always the case because fertility doctors only have to deal with patients up to the time they become pregnant, that's it. After that, they are out of their hands and they don't have to deal with the consequences of multiple births.
Sarah Williams
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Hollywood has been embracing it for years, although they still don't care to admit it, and now it's catching on throughout the rest of the western world. It's IVF and it's coming to a place near you, if it isn't there already.
While existing IVF clinics are expanding and upgrading to bigger and better premises, in the downtown of some cities they're popping up on every street. Pop out for a carton of milk and there's an IVF clinic where the 7/11 used to be.
Once the domain of a few well-heeled older career women, now women of all ages and socio-economic backgrounds are turning to it as fertility rates fall and infertility rates climb.
In previous times it was a hush hush thing, not to be discussed, now the internet is awash with woman trawling the infertility sites at all hours of the day and the night. Entire communities, even societies, are being formed in cyberspace and IVF is the hot topic, the strongest link.
There was a saying, when your taxi driver starts talking about share investment it's time to sell. Well now there's every chance your taxi driver knows something about IVF as his niece/cousin/wife is having it. So it's time to sign up or stop, you decide.
IVF is like the little black dress, the one size fits all approach to infertility although, like the little black dress it cannot compensate for all ills. Like the LBD, what you resort to when nothing else suits, IVF is what women turn to when in doubt or when all else fails.
And did I mention that it can also burn a considerable hole in your wallet?
Similarly, its status in the infertility field is dominant. On the sites it outnumbers the other topics in hits and posts significantly.
Most importantly, what black is to fashion - a main stayer that has been around for a long time, is here to stay and getting bigger every year - IVF is to fertility treatment. If you don't believe me ask your taxi driver.
Jodi Panayotov author of In Vitro Fertility Goddess »
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There are many ways an IVF cycle can fail, too numerous and non-refundable to mention here so I'll focus on the less obvious ones, namely WHEN THE DRUGS DON'T WORK.
Notwithstanding the cries that can be heard in any late night venue pulsing with scantily clad young people and Doof Doof electronic music when they realize they've been sold a dodgy pill, every day there are cries on the line to long-suffering IVF nurses when women find the drugs they've been faithfully injecting or swallowing have not achieved ovarian and hormonal responses.
I was one of the latter when I attempted to have my second child via a frozen embryo implant. Surely, I thought at the time, this will be easier than the first go with the fresh embryo, like doing simple arithmetic when you've already passed Advanced Calculus.
There was no injecting, just a pill to take, and then after the implant some pessaries to insert. How easy could it be - this time I was designing nursery friezes in my head by the morning of the blood test and ultrasound. I happened to be getting a toenail removed at the doctor when the IVF clinic called that afternoon with the news that the drugs hadn't worked and the cycle was to be cancelled.
For a while I felt as numb as my toe, then the questions flowed in. Firstly, how could I not have responded when I did so well with the first try? Was it that I was two years older and therefore part of another set of less successful statistics?
Yet my doctor had assured me that as the embryo was of the same age as my first successful IVF implantation - now my daughter - the chances were only slightly less than they'd been then. But I didn't even get to first base and now I'd have to wait till a new cycle to try again.
The doctor didn't have any explanation for what had (or in this case hadn't) happened, but suggested we try the next cycle without drugs, just using my natural hormones, then after the implant, the pessaries. See, this is why I'll never begin to understand Assisted Reproductive Techniques (and I suspect doctors understand them less than they let on), they defy logic just as infertility itself largely does.
Surely, if the drugs hadn't worked that meant that my own hormones were simply trotting along their merry dysfunctional way, resulting in the cancellation of the embryo transfer, so why were we now leaving it up to them to do it correctly on their own? What evidence did we have that they could be trusted?
Anyway I had no choice but to trust my doctor, who, it was true, had been largely responsible for the beautiful one year old we now shared our house with.
Three weeks later I fronted for my blood test and that afternoon got the OK. I'd achieved what I needed to without drugs. And frankly there should be more of it.
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One night I will never forget, no mater how much I've tried, was the wine and cheese night at my IVF clinic. It was the potentially life-altering evening where a whole bunch of us hopefuls turned up to hear the doctors and nurses talk about the IVF process so we could decide whether we would be joining the club.
I recall little of what was said, other than the statistics for my age group, but I do remember that it was the most sombre gathering I've ever been to (that includes funeral wakes). And that I spent most of the time pretending to nibble on the same bit of Brie whilst looking around wondering which of us would get the prize and which of us wouldn't.
The statistics were not on our side. A lot of us would be walking away empty-armed, although at 38 I had a better chance than some. And of course if you were one of the unlucky ones you'd be repeating the process over. And possibly over.
I was fortunate enough to be one of the thirty percent of my age group who achieved a successful (although at times dodgy bordering on hair-raising) pregnancy on the first round. After that I became trapped in the revolving door of the clinic, with three further attempts that failed. Still, blessed to have one healthy child I was able to move on.
For every success there are numerous failures and some women are forced to sit back and watch while friends and acquaintances come, fall pregnant and leave. Like the woman who watches as one by one all her friends get married and she is still waiting for Mr Right and wondering if it will ever be her.
Meantime the IVF bridesmaid has to pick herself up, smile for her successful friends and try all over again. It would have to be one of the hardest things you could do, unimaginable to those who get to become mothers.
Yet the persistence can and does pay off for some, if you can put up with it. I know a woman who finally, unthinkably, had a child after fifteen tries of IVF.
I often think back and wonder about those couples from that evening and wonder how many of the women gave up, how many succeeded and how many are still there courageously playing bridesmaid. And how many of these, like my friend, will eventually catch the bouquet and have a happy ever after.
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Parents and parties, I find, are like oil and water, in that they don't mix. The good thing is, that usually parents themselves have realized this by about 9pm when, not speaking to each other because one drank too many cocktails, they leave in a flustered rush so they don't have to pay the babysitter overtime.
However in the short time they've been at the party there will have been few guests if any who have been spared the gory details of Montenegro's breech birth or Jezebella's toileting mishaps.
Which is why it's always a good idea to arrive late at parties. Otherwise you run the risk of being subjected to the words placenta, perineum, and runny poo before you've enjoyed a second sip of wine. And after that there's no chance you'll enjoy it.
If you're really unlucky you may even hear that Montenegro was conceived on ‘our first try', which short of ‘what a fertility god and goddess you must be' has no response that you can think of saying. Meantime you are busy fighting the involuntary image offered of Montenegro's conception.
So, with all of this free-flowing intimate and personal information, available on tap at any gathering of parents, and I must say, particularly female parents, why is it that you will never ever hear somebody say, ‘Jackson was an IVF baby?'
Having worked with groups of mothers over a fourteen year period and having had all types of personal bordering on pornographic descriptions of sex, births and other unwelcome information involuntarily foisted upon me by people who didn't even know my name, the fact that IVF is ‘personal' doesn't cut it.
I suspect the reason is that, despite more than one percent of births in developed countries being a result of IVF and one in six couples seeking some type of assisted reproduction, nobody wants to admit they have or had a problem. Which leads me to believe that there is still a stigma associated with having a baby in this way, or indeed being fertility challenged.
Why? What is wrong with seeking help to have a baby? People will readily tell you they're having treatment for a heart condition so why not a reproductive condition?
I have had women give me feedback that they are reluctant to go on my site In Vitro Fertility Goddess on computers at work or in view of the public due to the nature of the site.
I can understand this on one level but on another I fight it. If we are too embarrassed or ashamed to talk about having IVF, what message does this send to our children who are the result of IVF? That there is something about themselves that is wrong because we don't talk about it?
I think back to the days when it was a shameful thing for a woman to have a child out of wedlock, how it wasn't talked about and covered up and the result was that the child felt the brunt of it, as if he/she was somehow tarnished for having been born in this way.
Now when I go to parties I seek out other parents and before the conversation gets to bed wetting or episiotomy stitches I slip in that I had trouble having a child and feel blessed to have had my daughter through IVF.
This has the effect of sending a few rushing off to find the hors'd'oeuvres platter/toilet, never to return, but most will want to chat about it and some, I find, have relatives or friends going through it or contemplating it. Often these relatives and friends aren't talking about it so they are happy to learn more.
And these days almost invariably I hear someone say in a relieved voice, ‘Oh Tristan is an IVF baby and we have a couple of embryos on ice. Hopefully one day he'll have a sister.'
Then we talk a little more about embryos, how painful the egg extraction was etc. Time flies until someone realizes it's nine o'clock. Time to get back to the babysitter and let everyone else have fun.
Hedge your bets and increase the odds of success.
With IVF success rates shrinking faster that Victoria Beckham as you approach forty, not to mention the associated risks and costs, the whole thing can seem like an enormous gamble. And of course it is.
If there was a casino of fertility treatment, the IVF clinic would be the High Roller's room, where you outlay astronomical sums of money you must be prepared to lose as there is a high chance you will.
Meantime downstairs people wander around betting fifty on a bottle of herbs here, or a packet of Chlomid there, hoping with each outlay to hit the jackpot.
Usually IVF is the last option for people, often after years of dabbling in other treatments with no success and this also places the stakes incredibly high.
I have never been a gambler as I hate to have a one in a large number chance of winning, which is why the only horse race I went to I bet on every horse.
So when I unwittingly found myself at 37, with the odds of achieving a successful pregnancy stacking up against me, I started punting on all types of treatments - basal temperature taking, mucous analysis, laparoscopies, Chlomid and eventually herbs.
All the while I was battling my own kind of infertility trifecta - hyperthyroidism, endometriosis and blighted ova.
Yet I believe that it was being on fertility herbs » for months before undergoing IVF*, along with lifestyle moderations that optimized my chances of success, overcame the odds and helped achieve pregnancy on the first try. My book In Vitro Fertility Goddess » discusses this further.
* At no time did I attempt to combine herbs with the IVF treatment. The IVF clinics absolutely forbid it, the penalty for doing so being the seizure of an embryo or the repossession of your first-born, whichever is applicable. For more on this go to our News link above and have a look at new research published in July 2007 which found that IVF patients who use alternative medicines during their treatment could reduce their chances of having a successful pregnancy.
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I have it on good authority, from one of the IVF Goddess site members, that there is one distinct advantage to combining air travel with IVF.
Apparently when carrying all the necessary paraphernalia you get VIP treatment, bordering on that of a rock star with his/her instruments, as you get individually searched and waved through before the madding crowds.
And of course it's the only time in your life you get to say to Customs, "Yes sir, I have drugs in my hand baggage," without being escorted off to spend the rest of your life in prison.
Unfortunately the VIP treatment ends there and doesn't translate to an upgrade or anything, though surely this should be included in the price or at least be an optional extra wouldn't you think?
I remember flying interstate for my frozen embryo transfer and at the time I felt like I was on a top secret mission involving the couriering of a special package. That the package happened to be in my womb didn't matter, it still felt as if there should some kind of be protocol surrounding it - an embryoguard escort for instance.
But should you fly when undergoing IVF? Probably not if you have a crippling fear of flying and require heavy sedation before the plane leaves the aerobridge. Medically though, doctors have no objection, just as they have no objection to pregnant women flying and there is no documented reason why you shouldn't.
Even if you're on a long-haul journey you can still inject yourself, as diabetics do, in the toilets and most modern airliners have needle disposal bins in the toilets for that purpose.
If, like me, you need your partner's assistance to inject you'll just have to take him in too although not if he bears a striking resemblance to Ralph Fiennes or you'll have the crew banging on the door wanting their turn.
In fact it would be a good idea to let a crew member know what you need to do, after which there's a good chance you'll be escorted to a less grungy and more spacious Business Class toilet.
Flying after the embryo transplant is fine too, according to medical journals, provided the plane is pressurized. Translate to no DC-3 nostalgia dinner flights over Botany Bay or flying World War II U-boats off the Atlantic but any modern jet is fine. Of course there is the teensy risk of a depressurization but there is a far higher risk of having a traffic accident on the way back from the clinic.
Which brings me to an issue for the traffic authorities. Now that so many women are having IVF shouldn't we be getting ‘Embryo on Board' stickers to counter all the smug ‘Baby on Board' ones?
So really while there is no compelling or any evidence to suggest you shouldn't fly when having IVF there is a case where it might in fact be a good idea. If you can fly off somewhere where you can relax or take a break during this time it may take the pressure off and that can only be good for both you and the embryo.
. Well it goes without say that many "older" women in our situation need and demand URGENT SOLUTIONS to their fertility problems. So as time is really of the essence here, I've reviewed what I believe are some of the best instantly downloadable infertility eBooks around for the +40s. By best, I don't mean in a literary sense - for that you should read my book I have received a huge amount of very positive feedback about this book. What I particularly like about it is that it is a natural fertility program which works for both the mother and father. It is also specifically tailored for women over 40 (the author being 42 when she conceived. My pick of the bunch really It's basically a guide to overcoming infertility naturally, containing useful, well researched, practical and genuine tips to improve the chances of achieving a natural pregnancy. I found it invaluable for women over 40. My second pick For more on this eBook click here » This is what I would call a must read for women in their 40s. It follows the journey of Michelle Adams who decided to undertake her own path to pregnancy when everything else failed. And against the odds, she gave birth to a beautiful baby boy at 39! This one really spoke to me and many of my readers. For more info click here » And if you know of a fertility eBook which has ticked all the boxes for you, I'd love to have a look at it so please drop me a line by clicking on the Contact link above. 
- no, the books featured below stand out because they meet one essential criteria: they all contain NEW & PRACTICAL SOLUTIONS, not just meaningless lists of facts and figures. 
Susan Tollefsen, IVF Mother at 57 »
Within the IVF culture there lies a two-tiered system, a kind of class system if you like.
Whilst everyone is barrelled together under the substantial umbrella of assisted reproductive techniques there are two very distinctive groups - the Have-Maybes and the Have-Probably-Nots. And the problem is, until you sign up and get all the info you don't know which of these you will likely belong to.
IVF success rates, attached to the various clinics, are generalized and tend to be based on the rates for the 25-35 year groups. This is where wonderful statistics like 48% come in. Until you realize you're nowhere near the age group being touted.
Then you become like the child looking down the exam result charts for your name, moving through the high marks and distinctions and your heart sinks as you move lower and lower and eventually find yourself at the bottom.
Even the 40 and over stats can look slightly encouraging, maybe a ten percent success rate and you think that's OK. But ask for a break-down, say the age 42 rate and it'll be six percent then after that it dwindles to about one by 45.
And those statistics are for pregnancies, not live births and in the over 40's there is an increasing discrepancy with the higher rate of miscarriage.
Then, if you haven't already slit your wrists, you have a meeting with a stony-faced doctor who does little to encourage you and practically tries to discourage you from going ahead with it. But what about my one percent chance? you scream. It's better than nothing, surely we can try.
This is where you think, when does hope, even if it's a flicker, surrender to hopelessness? I'll always remember a work colleague, a single woman in her fifties, who'd yet to meet her mate and her motto was, "Where there's life there's hope."
And she's absolutely right. Did Adriana Iliescu, the Romanian 66-year old mother of a baby girl give up? Never. There are ways to still have a baby, more difficult in Australia with the egg donor laws but a lot more common in the US where eggs are available approaching the way sperm is. You have to be prepared to try whatever it takes.
Even worse, though, than the lack of encouragement and hope surrounding IVF in your forties is the attitude that somehow it's all your fault, that you were greedy and wanted a career instead of children or something. While for a small percentage of women delaying having a child was a deliberate decision (and let's face it, until recently nobody knew what problems this would create), for many it wasn't. It was simply due to not finding a mate or one who wanted children in the near future.
Unfortunately by the time these women found someone who had evolved to the Homo Sapien stage and wanted to commit to them and having a family, they were approaching or in their forties.
Just as images of female celebrities having children in their mid forties has done nothing to help the situation, nor have the images of people like Rod Stewart who manages to combine paunch and raunch, acting all virile with a thirty something wife and having a baby when he's sixty two.
Why rush, men say, when you can have the kid at sixty two and have the young glamorous wife to boot? The problem, of course, which they will find out in twenty years or so is unless you've already been a sex symbol/pop star and are currently a billionaire to any young fertility goddess you will simply be a disgusting paunchy old man.
Still, where there's life there's hope.
Jodi Panayotov
Forty may be the new thirty and fifty may be the new forty but nobody told our reproductive systems.
And never has society provided more assistance in convincing us of our new younger status, via the mega industries of cosmetic enhancement and reproductive assistance.
Botox is to the face what IVF is to the ovaries - they both involve needles, both hurt like hell but one has a far greater success rate. No prizes for guessing which one. It's far easier in your forties to look like Nicollette Sheridan than to reproduce like Cherie Blair. And the success rates with IVF, the most assisted of assisted reproductive techniques, is negligibly more than natural rates.
For instance at 45, there is a one percent chance of getting pregnant at all and then at least a fifty percent chance of miscarrying. The chances of IVF success between 40 and 45 is averaged out at ten percent but really starts at this and diminishes dramatically each year which is why many clinics will not perform a cycle for women over 42 using their own eggs.
They say it's due to not wanting to take large sums of money in return for little or no hope but possibly they don't want to deflate their own success rates as it isn't good for business and this is understandable - they need business in order to improve their services.
By the time I was ready to embark on fresh rounds of IVF at the age of 41, having succeeded at 38, my potential success rate had practically halved and the potential miscarriage rate had risen by fifty percent - hardly encouraging. Yet had I not been lucky enough to conceive a child already, no doubt I'd be in California now, having mortgaged my house and busy organizing an egg donor.
We can turn back the clock in so many ways but our eggs remain the same. I can only assume that in future more women will freeze their eggs when young, having learnt from a generation of women who found themselves, via modern circumstance, able to rid themselves of frown lines but unable to conceive a child.
Also read IVF Over 40 here »
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