Many newspapers are running the story of what they’re calling the “twiblings”: two babies born days apart to the same parents via surrogacy. In other words, the parents worked with two surrogates simultaneously in order to transfer embryos to both at the same time which resulted in each surrogate carrying a child, delivering them within [...]
Blogger and managing editor of AfterElton weighs in on the recent boom of gay celebrity parents through surrogacy. and the varied reactions from the media and society on both the right and the left.
http://www.afterelton.com/people/2011/01/making-babies-gay-celebrity-dads
Hello again, today we are going to talk more about blockage of the cervical canal: Cervical Stenosis. We will concentrate on the most common causes of cervical stenosis; scaring that results from the treatment of an abnormal pap smear.
Please refer back to the previous post on the cervix to get some background for this blog.
Treatment of an abnormal pap can cause scarring of the lower part of the cervix, the external os. This type of scar is a problem for 2 reasons. First, it reduces the number of mucus producing cells, sometimes lowering natural fertility. Second, it may make fertility procedures, such as insemination or embryo transfer, more difficult.
Most cases of cervical stenosis occur as a result of improper healing from a surgical procedure. It may not be that the procedure was done improperly; it’s just that the healing did not cooperate
It is cells in the area of the external os that are tested during a pap smear. When these cells look abnormal, we need to remove them before they progress to cervical cancer. We treat the abnormal cells by either by destroying them or removing them: both processes can cause scarring. Examples of destroying the tissue include cauterization (basically burning away with electricity or a laser) and Cryo.
Cautery just basically fries the cells away, some abnormal and some normal tissue. Cryo literally freezes off some of the tissue of the external os, removing abnormally growing cells and some normal tissue. Cryo and Cautery are not popular because they do not give you any tissue to send to the lab.
Rather than destroying cervical tissue, there are other procedures that remove a small piece. Examples of tissue removal include a cone biopsy or a LEEP (Loop Electrosurgical Excision Procedure). The cone procedure and LEEP are basically the same thing, however if necessary the LEEP can be a little more precise and remove a smaller amount of normal tissue. The LEEP and the cone biopsy cut away pieces of tissue that can be further evaluated under the microscope.
A cone involves and old fashioned scalpel, and takes away a larger piece in the shape of a cone (pictures to follow). The LEEP uses a thin wire loop that scoops out a little piece. However, sometimes using a LEEP the doctor needs to take a larger area as if a cone were being performed. Today, most procedures are LEEP procedures because the biopsy can be directed; in other words, only a small area can be removed if necessary. In addition, the LEEP can be performed in the office as opposed to the hospital. Finally, there is a lower chance of bleeding with a LEEP.
No matter which of these procedures is performed, a small percentage of people can have post-op scarring that leads to cervical stenosis. The more tissue removed or destroyed, the greater the chance of a scar.
Why do some people scar an others not? Some people are just more prone to it. Scaring is the normal way we heal. For some women, the scarring is more robust and progresses enough to cover over the cervical canal. Certainly, if any of these procedures are followed by infection, scarring will be more likely.
Let’s go through the pictures.
Here is our uterine drawing showing the uterus and cervix.
The next picture is a drawing of what your doctor sees when she puts in the speculum. It’s the cervix, actually the very bottom of the cervix.
Let’s say your pap comes back abnormal. This usually means that there are some cells around the external os that are abnormal. Depending on the severity of the pap, these cells may need to be removed. Using some special techniques, you doctor would look very carefully at your cervix under magnification to try to determine the extent and location of the abnormality.
This picture is an example of abnormal cells in a very small area.
Here, the doctor does not need to remove much tissue, and this is not likely to lead to scarring. The doctor will probably use the LEEP procedure, but only a small amount of cervix needs to be removed. This picture shows a cervix with a small abnormality and a small LEEP.
This picture shows a case where there is a larger amount abnormal cells and they take up a larger area on the cervix.
In this case, the abnormal cells are all around the external os. Here, the doctor needs to take away much more tissue.
You can see that the shape of the removed tissue is in the shape of a cone, thus the term cone biopsy. A larger LEEP will also make a cone shaped biopsy. While the odds of scaring remain low, if it does happen, it is more likely to come from taking more tissue. The next picture shows a post-LEEP scar.
The good news is that in most cases, scarring at the external os is the easiest to deal with. Unlike scar tissue that forms higher up in the cervix, scarring at the external os can be seen with a speculum and the scar is usually shallow. The scar is usually on the thin side and can be easily opened, usually in the office.
After opening, the scar may have a tendency to return, but re-opening is not that difficult. In the case of fertility treatments such as insemination and embryo transfer, the scar can be opened just prior to these procedures without much difficulty. Unfortunately some women can have more serious scarring after these procedures that is not so easy to deal with. Additionally, some women need to have multiple biopsies, and this will increase the scar risk.
More on Cervical Stenosis next time.
Thanks for reading and please read disclaimer 5.17.06.
England: Penny Jarvis, intends to freeze her own eggs so that, daughter Mackenzie, born without ovaries can use them someday to start her own family, the Daily Mail reported
Read the article:
http://www.cbsnews.com/8301-504763_162-20027989-10391704.html
Hello Again to Everyone.
I hope the holidays treated you as well as possible.
Today I will go through some past comments and answer some of the frequently asked questions that I have not yet answered on my previous blogs. I will enter one more cervical stenosis blog later. I realize that topic is very narrow; only applying to a small percentage of you. Like some of my other entries,the topic is not common but the information vital to some and very lacking on the web.
Hyperstimulation: I have not yet addressed this topic and will do so in the very near future. In many, but not all cases, hyperstimulation can be avoided or at least reduced in severity. I’ll discuss how.
Should you hatch your embryos? Don’t get hung up on this one. We really don’t know the details about the benefits of hatching. At NYU we hatch in selected cases, and we have a “sense” that we are doing the right thing. If a clinic has good pregnancy rates, take their advice on hatching. They may never do it, they may always do it, both are acceptable in today’s fertility world.
The pros and cons of septum surgery: also to be addressed. I have written a bit about septums and septum surgery, but I will add another post later. I recently have had the privilege to perform surgery on some women with large septums.
42, high FSH and no response to the IVF fertility drugs. Should you try again? If you need to try again, go ahead. Worst case scenario is that you are where you are now. Your odds of success are very low and you may lose money, and the unemotional answer is that you should consider stopping. So first get informed, including getting a second opinion, then you can decide and proceed as you wish.
Could a low vitamin B level increase the FSH level? I have not read anything supporting that, but increase your B levels and repeat the FSH.
PCO and low sperm morphology. If one doctor recommended clomid, and you agree, the approach is reasonable. Going straight to IVF is not crazy, but less commonly the first step.
Clomid for the treatment of unexplained pregnancy loss. Clomid may be prescribed for women with pregnancy loss, usually to increase the progesterone levels. If you are taking progesterone, clomid may not be needed. I am not aware that clomid will increase the viability of an egg or embryo. It may give you more than one egg, which may help in one of the eggs is abnormal. However, in general, clomid is not on the list of treatments for recurrent pregnancy loss. As you know there is not much on that list anyway. I don’t think it will hurt.
Fluid in the uterus at the time of transfer. This usually can be detected prior to transfer.
An estradiol level of 7,000 on the day of hcg is very high. I’ll talk more about this in my hyperstimulation bog. Starting on a lower dose of medicine is the fundamental issue.
What if you have one blocked tube, became pregnant with IVF and now want to try for a second child? Should try on your own first? If that was your only known problem, talk to your doctor. Waiting at least for a few months may be ok.
7 years of trying and your only workup consists of an hsg? Yes, get your partner checked and get to a fertility doctor.
Odds with injectables at 34. It’s about 15-20%. Twins? If you are anovulatory, get on a very low dose. This should produce 1 egg. Check with the ultrasound, if there is more than one follicle, you would have the option to cancel the cycle. One egg can not be guaranteed every time.
Spotting and PCOS? Get an endometrial biopsy if you have not already had one. And a hsg and maybe a sonohysterogram to rule out a polpy. If that’s all ok, then discuss progesterone or alternative treatments with your doctor.
A good sonohysterogram should pick up a septum.
Do women increase their odds of pregnancy after a HSG? I have not seen that frequently. I do so many, that occasionally someone gets pregnant afterwards, but I don’t think the test was the solution.
To my “twice as nice” patient (double cervix etc who happens to be very nice too) thanks for writing and keep me posted. Dr. Licciardi
The best test to diagnose fibroids is the ultrasound. If your ultrasound is normal, you do not have fibroid.
Will egg freezing work with an FSH of 15? This is not good. For more details, refer to the egg freezing blogs.
Are embryos that are transferred on day 5 better than the embryos that were frozen on day 6? Yes they are, but it was still worth freezing. Obviously you make a good “batch”. Give them a chance, at least one of them may do just fine.
How telling is the antral follicle count? It’s a guide but not the final say. I have seen 6 resting follicles turn into 15 eggs, and 4 turn into 1. You can’t ignore your count, but don’t make any important decisions based on the antral follicle count only. Age, FSH, and possibly AMH are more important. Many people feel you can measure the antral follicle count anytime in the cycle.
Does the fertilization rate, or number of polyspermy embryos, or number slow growing embryos have any impact on your chance of pregnancy if in the end you have a couple of nice embryos to transfer? Maybe. At the most recent meeting of the American Society of Reproductive Medicine, there was one report showing a higher pregnancy rate when the fertilization rate was very high. However my overall feeling is that if you can get to a couple very nice embryos, the quality of the remaining unused eggs and embryos is not that indicative of success.
29 years old, an estradiol level on the hcg of 2993, 6 eggs, one embryo for transfer. The main issue here is the disconnect between your age/estradiol level and your egg number. I have seen a few women from other centers who come to me with a similar history. When I repeat their stimulation, they get many more eggs. I don’t know if it was something we did better at NYU, or the first cycle was just a fluke.
If you have follicles on ultrasound, at least one of which is 16 mm or greater, and take an hcg shot, you will almost always ovulate. An progesterone level of 7 confirms ovulation.
What if you have only one vial of sperm remaining, is there something you can do to conserve your resource? You can thaw and refreeze, talk to your doctor about the pros and cons. At NYU, our embryologists sometimes scrape some of the frozen specimine to get just enough sperm for the case, leaving most of it unthawed. ICSI would be required. Ask you doctor about that too.
What if your only sign of PCO is a blood test? I wouldn’t worry too much about it. If you are getting regular cycles an abnormal blood test should not impact your fertility. If the test is indicative of other medical issues make sure you get that checked out. You will have to ask your doctor for the details.
What if the first cycle of clomid did not work? If you are OK with the concept of clomid for your situation, it’s ok to try a few cycles. Now the plan should never be written in stone, so if you are getting nervous about another cycle it’s ok to change course. But I would not worry that it will never work based on a failed first try; stick with it a little longer.
That’s it for now, I’ll write again soon. Thanks for reading and please read disclaimer 5.17.06.
Shanghai: China will set up an egg bank for women suffering from cancer to store their ovum in freezer so that they can have babies before undergoing chemotherapy or a surgery, which could damage their reproductive ability.
The authority has plans to set up the bank in three years, China Daily reported, quoting the Shanghai Morning Post.
Read the article: http://ibnlive.in.com/news/egg-bank–to-open–for-women-cancer-patients/138608-17.html?from=tn
(Reuters Health) – Laughter may not be the best medicine, but it might help women who are trying to become pregnant through in-vitro fertilization (IVF), a small study suggests.
Read the article:
Nicole Kidman and her country singer spouse Keith Urban revealed yesterday they had become parents through surrogacy – and made a point of effusively singling out ”our gestational carrier” for her efforts.
In a statement confirming the birth of Faith Margaret, their second daughter together, the Australian expatriates said they were ”truly blessed” and ”just so thankful”.
Read the article:
By Robin von Halle
I don’t know whether to put it down to the general public’s prevailing ignorance about gestational surrogacy and egg donation or shoddy and sensationalist reporting, particularly by the British press.
But the news coverage, especially in Britain, of the birth-by-surrogate over the holidays of a baby boy to rocker king Elton John and his partner David Furnish was pretty stunning on all counts.
The revelation that the child actually had (gasp!) two “mystery” mothers! And now, two fathers! The fact that nothing is known about either “mother,” like their background, religion, marital status or rights to the child. That it’s not illegal for millionaires like Sir Elton to “buy” a baby in California, which, one piece proclaimed, had the most forward-thinking surrogacy laws in the U.S.
With all the exaggeration by the U.K. popular press when a celebrity utilizes assisted reproductive technology (ART), it’s a small wonder that the laws there concerning these advances remain restrictive.
We’ve been in this business nearly 20 years, and have watched the possibilities with ART, attitudes and the legal landscape change dramatically in that time, at least here in the States. Yet the misconceptions just seem to hang on.
Of course, the background, religion, marital status of the surrogate are largely irrelevant, at least in terms of the child and its future. With gestational surrogacy, the woman who carries the child has no biological connection to it. In terms of the egg donor, what’s typically most important to intended parents are the donor’s genetics. She has no more “rights” to the child than a sperm donor would, and understands that going into the process.
In California, case law has provided some guidance as to children born of gestational surrogacy. Illinois, which truly has been at the forefront with its surrogacy friendly laws, has provided protection for all parties in this arrangement. Intended parents are recognized as a child’s legal parents from the moment that child is born without an adoption or court proceeding so long as the requirements of the act have been followed and at least one of the parents is the genetic parent of that child.
Right now, we’re seeing a substantial increase in prospective parents who can only achieve parenthood with the help of a surrogate. It’s a challenge. It takes a very special person to agree to carry someone else’s child for them. And there are never enough surrogates to meet the demand.
The media scrutiny and its role in perpetuating myths only compounds the problem. Maybe it will take more first-person stories, like the New York Times’ “Meet the Twiblings” piece, to help put it all in the proper perspective.
Every week my husband and I tune into Bill and Guiliana on The Style Network, and this week as usual did not disappoint. I have said it so many times, but I just LOVE them! They are so cute together and are just a great couple.
I have to say kudos to Bill for that ring he got Guiliana, it was amazing! I told John I expect that at our next anniversary!
In this episode Guiliana and Bill have decided to move forward and do a second round of IVF, and she also had to break to news of her miscarriage to the public. As I was watching this episode I was holding my perfect 11 month old daughter in my arms, and I could not help but tear up.
IVF and infertility is so hard to go through in private, I cannot imagine going through it in the public eye- my heart just goes out to them as we have been there done that. Guiliana was telling Bill how going through this has made them a closer couple and that God has a plan and this is all happening for a reason.
I told myself that for years, but I remember sitting in my bed praying that I would get pregnant and for God to bless us with a child, then I would cry and cry and ask God, why was this happening to us, what had we done that was so bad that we deserved all this heartache? Now looking back it all makes sense. Nothing was meant to work, because we had to wait for our little angel to be born and to come into our lives. Even writing this I am fighting back the tears, because now I know she was meant to be ours, we just had to wait for her, and it was all worth it- every tear, every heart break, every minute was worth it.
