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It seems that posthumous reproduction is in the news ALOT this last week, and here is another case taking place in Russia.  It involves a mother who has already used her son’s sperm after he died from cancer.  She is now fighting for guardianship of the children.  As I have stated before, on a personal level, I believe that this is much different then when a man or a woman uses their deceased spouse’s/partner’s gametes with their consent.  But, again, I have never walked in this woman’s shoes.  What do you think?

A Russian woman is keeping her late son’s legacy alive by using his frozen sperm and surrogate mothers. But she is battling the courts and society’s attitude to be recognized as the guardian of her four baby grandchildren.

It was only at 57 that Lamara Kelesheva understood the true meaning of having her hands full. An accomplished scientist, a wife of three decades and also a devoted mother, but none of these roles kept her as busy as she is now.

Her tragedy is she became a grandmother only after she had lost everything else.

“The death of my son created a hole in my life that will never close,” Lamara told RT.  “But the birth of my grandchildren certainly provides some solace. It’s God’s gift to me”.

Lamara’s son died of cancer three years ago. But before his first chemotherapy session, doctors conserved his sperm. With the help of surrogate mothers, two sets of twins were brought into the world.

Lamara’s husband left her. Her scientific career was put on hold. Yet, Lamara says they are all trifles compared to the bereavement brought about by her son’s death.

“It is love which is fed by grief but it’s love nonetheless, “she explains. “Three years ago I couldn’t imagine myself even smiling, let alone laughing or singing songs, but the little ones pulled me out of this abyss of despair.”

With her large family’s support, Lamara says she has no financial or parental concerns about raising her grandchildren. Her main problem now is the reluctance of the Russian state to recognize her as the mother of these children and her deceased son as their father.

Lamara has taken the issue to court, with a ruling expected on Wednesday. Her lawyer Konstantin Svidnev believes the law is on their side.

“According to Russian law, there are no limits on who can become a parent through the use of surrogate motherhood,” Svidnev told RT.  “Of course cases like this one are still very unusual in Russia. That’s why some registration offices or court officials may be baffled and refuse to register children but the law is definitely in our favor.”

Lamara is the third woman in Russia who used the sperm of her deceased son to continue the family’s lineage. Yet, whether it is due to her age or the sheer number of children involved, her story has got many Russians questioning the ethics of this kind of parenting.

“All these exercises in biomechanics ultimately lead to this very ambiguous situation when you can’t really tell the difference between a son and grandson,” says pro-life activist Andrey Khvesyuk. “There are so many orphans in Russia so if she just wanted to be a mother, she could’ve easily realized her maternal instincts…  I think ultimately it’s a very selfish drive to pass your genes, no matter what”.

But Lamara could not care less about societal attitudes. Too much suffering from the loss of her only son persuaded her that there was no such thing as too many grandchildren.

Russian law has no age cap for people willing to adopt children; the only caveat is that a potential parent should be at least 16 years older than the child. In Lamara’s case, this age difference is almost 60 years, which doesn’t sit easily in a country where most people become parents before they turn 30 and where raising even two kids is often seen as a handful.

Having a child can be an incredibly rewarding experience that some women sadly do not get to experience. This could be due to a number of different aspects or events that could have taken place throughout her lifetime. Some women never seem to find the man that they can fall in true love with and start a family with, which can be difficult but this certainly does not mean that a woman cannot have her own children. Even couples are finding that they can increase their chances of having a baby when they sign on with egg donor agencies. These locations offer a number of different options as well as helpful information that will point anyone in the right direction.

Before going through or even starting with the process, be sure that this is being done for the right reasons. It is not uncommon for people to act on impulse and individuals will need to make sure that they sit down and they weigh out all of the options that are currently available to them. Couples who are considering this option need to discuss everything with each other and ensure that both are going to be there for the new child as well as for each other 100 percent. This is a very big commitment that is being made and when one person starts to self doubt or even second guess the other, it might be best to wait it out or keep thinking about looking into options. Single mothers have to bear all of the parental work on their own, which could be nice for those who want to parent in their own way, but it can also be exhausting. Make sure that now is the proper time to be taking this step before actually doing it.

When the search begins for the actual egg donor agencies, there are a few different ways to get in touch with various services. Referrals from friends and co workers might be the best way to seek an agency. Knowing someone who has already gone through the process will make it easier as well as less stressful or nerve wracking. There are also various support groups and even online help that will give individuals the tools that they will need to go through with the process and find a location that they will be able to come to know as well as trust throughout the entire process, up until the child is actually born.

If there are no referrals to take advantage of, then look through online directories for all sorts of help. These directories will list off all of the egg donor agencies that are currently available as well as where they are currently located. Searching by the city and state, or even by the zip code will make the search go by much quicker and will plug people into the proper lists and other helpful resources. Take note of the ones that might be closest as well as the locations that are highly rated. The ones that are known for caring and effective or even successful service are typically the companies that people will want to work with. Certain directories might also offer reviews to show newcomers what they might be in for or what to expect when signing on with a specific location.

The costs can be quite staggering when it comes to getting set up with a donor. However, couples who want to have the child bad enough will be able to have a much higher chance when they go through the entire procedure. Talk with various offices in order to get an idea of what is actually involved as well as what it will cost. Certain offices might take payments, but they will need to be paid within close proximity to each other. Insurance is usually out of the quest as well, depending on the policy that the couple has taken out. Look into the various options and costs and then start making the proper financial plan after that.

As for the overall reputation of the agency, that is where these reviews will come in. Talk with various individuals about the process and which agencies are currently rated the highest. Caring agencies are often easy to get into and will offer numerous features as well as special care options that will make everyone feel comfortable as well as ready to go. Getting a firsthand look and talking face to face with the directors of some of these facilities is going to shed some light on which route to take, and will enable individuals to ask questions and interview as needed.

Once the process has begun, the results should start shortly after that. It is important to remember that it might not take the very first time around with some women, which can be very frustrating but do not get discouraged. Go for it once more and make sure to continue to see the right practitioner for help and support. The agency will be very encouraging as well as supportive so that should make the individual feel much more comfortable with going through with the process again. It might not be easy at first and there will surely be some ups and downs, but supporting each other and implementing proper forms of outside support will make the process and the tough times easier.

Trying to have a baby can be a challenge for some couples, but most have been able to get over the hurdles alright. Checking out different egg donor agencies will enable anyone to learn about the process as well as what is will take to not only have the baby but to become a donor as well. Millions of women are stepping up to donate their eggs so that another woman will be able to have the child that she has always dreamed about. Take some time to look into reliable and reputable companies in order to receive the right kind of care and service that is expected

The whole world has changed in the last fifty years or less.  At one time, people just got married and had a family and that was all there was to it.  Families came in all sizes, and since contraception was in its infancy, as we knew it of course, most used a bit of the rhythm method to either have babies or to not have babies along with rubbers.  All of that was hit or miss at best, but once a child was born into a family it was loved and taken care of.  If a woman had a baby out of wedlock, it was a shame on her whole family, and many just went away to an aunt or another relative and had the baby and gave it up for adoption.  Sometimes there was someone in the family who could not conceive, and the baby was adopted within the family.  And if you could not conceive within a marriage, adoption was your only recourse, and at best it was hard to do with social workers examining every aspect of your life.  Many older children were simply put into orphanages  if their parents divorced or one died and the family could not take care of them.  It was a much simpler time even if it could be harsh and unforgiving.  Many infertile couples simply longed for children they could never have.

Then oral contraception for women was finally a reality.  It was only given by doctors to married women with a husbands consent at first.  The first pills were very strong and would never be used now and had some side effects, but it did free couples that wanted to plan and space their families or have no more children at all.  The pills did not work for all women and some could not take them because of side effects, but it was the first step in controlling pregnancy.  The pills, however, did nothing to help a couple who wanted to have a family.  Those couples still only had adoption as an option and in some parts of the country, babies were even sold to the highest bidder by unscrupulous doctors wanting the line their pockets with cash.  In many cases, unwed mothers were kept from seeing even family members and never even told the sex of the child they had delivered.  Sometimes even their signatures were forged on papers by the very same doctors who were selling the babies.  In these cases, the adoptive parents had no social workers to interview them and decide on their abilities to parent.  The babies had birth certificates made in the adoptive parents names without what should have been the original birth certificate even being registered with the county where the child had been born.  Those children, when they were grown, had no way to find out any information on their birth parents at all, not even health questions.  Many were never told they were adopted, or, in some cases, only knew from hearing a discussion among family members.  Sometimes not even the parents knew anything about the birth mother.

A married couple sometimes did not know which one of them was responsible for not being able to conceive.  As time went on, there were tests that could be done, mostly on the woman.  It was mainly male doctors who did these tests and it could have been that they did not want a man to feel less of a man by being told he was infertile.  When the male tests were used, and the man found out he was infertile, the couple did no more about having children.  Next came sperm donations.  Some couples used this method, and in many cases, it was just intelligent young men in college who donated sperm.  The techniques were in their infancy and the sperm was just placed in a woman’s vagina when a doctor found her to be in her most fertile time.  More often than not, no pregnancy resulted.  They would try month after month until the woman got pregnant or the couple just got tired of trying.  There was very little information given about the sperm donor, but sometimes, if a couple had enough money, certain specific traits in the donor were guaranteed so that the baby would look more like its parents.

Now the whole area of medicine is specialized.  If a couple is having problems getting pregnant, the man is usually the first one tested because the test is so easy.  If he is fertile, then further testing is done on the wife.  Even if he is infertile or has lazy sperm or a low sperm count, a husbands own sperm can now be used after his wife has undergone several months of medication for her to ripen as many eggs as is possible.  The lab then picks out the best sperm and injects it into an egg.  No longer is just a petri dish used for fertilization.  If enough eggs become fertilized, several are put into the wife’s uterus at the same time, as some may not attach in the right way and be lost.  This whole procedure has made many families happy.  Now there are even ways for young women, many who need money for college, to donate eggs through egg donor agencies.  Usually in this case, a couple will use the father’s sperm and employ a surrogate to carry the child to term.  There are more serious legal ramifications of this process, but in many cases it works to everyone’s satisfaction.  There is a health history taken and given to the parents for the child to have, or barring that, the information is available if needed for the future.  In some cases, children born with the same sperm donor have found each other on line and have met.  And some of the fathers have met their offspring also.  But if they have requested that their names never be known, their privacy is closely guarded and the children are only given a number assigned by the sperm donor bank.  It really is a brave new world.

As many of you know I cannot get enough of Bill and Guiliana Rancic. They have been so brave and have been so open and honest in the media about thier struggles to get pregnant. They are featured on the celebrity baby blog discussing their next steps to building a family.

http://celebritybabies.people.com/2011/02/09/bill-and-giuliana-rancic-taking-a-break-from-babies/#comment-387752

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.

Dr. Licciardi

Go to Infertility Blog

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.

Dr. Licciardi

Go to Infertility Blog

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.

Bill and Guiliana Rancic opened up to the ladies of The View about their recent IVF. Now I have been impatiently waiting for their pregnancy announcement. Sadly, their first IVF ended in miscarriage. It is discussed in this weeks People Magazine, but you can see their heart breaking interview below. This breaks my heart, I know what they are going through and how hard of a journey infertility is. I just love them, I know they will be great parents when the time is right.

Visual aids and representations of procedures allow for a better understanding of IVF.

Here are some High resolution of fertility, and IVF operations as they take place within the medical view.