Patient tools for finding the best IVF clinics, infertility care and support

May 3, 2017Carole 10 Comments »

Chapter 10: Patient Tools (from e-book Fertility Lab Insider, available on Amazon,)

Questions for the RE and Clinic
About the Reproductive Endocrinologist:
Board certified in Reproduction, Endocrinology and Infertility? Years experience? How many years has this program been open?
Number of REs in the group?
Do patients see same physician, nurses each time?
Where does the physician have hospital privileges?
Is physician/lab “in network” for patient’s insurance plan?

Communication questions:
How do patients reach the doctor to ask questions? Email? Phone? or messages relayed through the nurse?
How are emergency after hour calls handled?

Questions at first consult:
What diagnostic tests will you order for patient? partner? How much will these tests cost?
Next steps questions:
Based on the diagnostic work-up , what treatment plan do you recommend?
For patients just like me (age, diagnosis), what kind of success rate can I expect?
Do you recommend ovulation induction cycles for me? If so, how many OI cycles do you recommend before you typically recommend IVF?

Questions about the Lab:

Is the lab accredited by CAP or Joint commission?

How many Andrology techs do you have?

How many Embryology techs do you have?

Are techs cross-trained? Try to determine if backup techs are available for emergency absences.

When is the lab closed for down times?

Does you lab offer ICSI, assisted hatching, donor egg or embryo? or embryo biopsy for PGD?

Are your success rates reported to SART or CDC?

Do you perform procedures (IUI and IVF) on weekends?

What is your rate of twin? triplets? With IVF?

What has been your experience with elective single embryo transfer?

Questions about Payment for Services:

Will I receive a written estimate of my self-pay costs?

Are these costs inclusive (physician fees, medications, ultrasounds, blood work, lab fees)?

Will you provide me with CPT codes I can use to discuss with my insurance company?

Do you offer financial assistance, payment plans or Shared Risk programs?



Ask your doctor to provide the CPT codes with your itemized estimate for each lab procedure or test that is ordered for you. The codes below are the procedure codes you can reference when identifying your covered procedures with your insurance company for your treatment plan. The bottom of the second page has a space for various additional codes your physician will submit for office consults, ultrasound exams, physician surgical procedures and other physician prescribed interventions that are not on the lab procedure list.


89254 Oocyte Identification From Follicular Fluid. This code refers to the work of identifying the oocytes contained in the follicular fluid aspirated at the time of the oocyte retrieval.

(Note that physician codes for retrieval also exist. For example 58970 for follicle puncture for oocyte retrieval, (any method)

89268 Insemination of Oocytes.This code includes the work involved in conventional in vitro insemination of oo- cytes.

89280 Assisted Oocyte Fertilization, Microtechnique; Less Than or Equal to 10 Oocytes (89281; Greater Than 10 Oocytes)

89250 Culture of Oocyte(s)/Embryo(s), Less Than 4 Days

89251 With Co-Culture of Oocyte(s)/Embryo(s). This code includes all of the work described by culture of oocyte(s)/embryo(s) (89250) with the additional work of co-culturing the embryos with feeder cells (granulosa, endometrial, tubal, etc.)

89272 Extended Culture of Oocyte(s)/Embryo(s), 4–7 Days. This code applies to the continuation of oocyte/embryo culture in excess of 3 days and is reported in addition to the culture of oocyte(s)/embryo(s), less than 4 days (89250, 89251).

89255 Preparation of Embryo for Transfer (Any Method). This code includes the following work: removing the embryo(s) from culture, preparing the embryo(s) for transfer, loading the embryo(s) into an appropriate catheter, transporting the embryo(s) to the transfer room for transfer to the patient, and examination of the catheter after transfer to ensure that no embryo(s) are retained.


89290 Biopsy, Oocyte Polar Body or Embryo Blastomere, Microtechnique (for Preimplantation Genetic Diagnosis); Less Than or Equal to 5 Embryos

89291; Biopsy, Greater Than 5 Embryos


89300 presence and/or motility of sperm including Huhner test (postcoital)

89310 semen analysis; motility and count

89320 semen analysis; complete (volume, count, motility, and differential)

89280, 89281 assisted oocyte fertilization, microtechnique (any method)

89257 sperm identification from aspiration (other than seminal fluid

89264 sperm identification from testis tissue, fresh or cryopreserved



Patient Tools: Searchable CDC Databases of Annual Outcomes Reported by US Fertility Clinics

CDC pregnancy outcomes: CDC Introduction page- What is ART?

CDC ART Reports for previous years List of links to reports for previous years for both national summaries and individual clinic reports.

Link to searchable fertility center results Select the State, Clinic, and Report Year to generate custom report for each reporting clinic.

Link to National Summary Table for all US CDC Reports, select the year for the National Summary Report you want. SART reported pregnancy outcomes: subset of CDC reports

Patient Tools: FDA Searchable databases

Warning letters issued to non-compliant FDA facilities including ART clinics

Searchable list of registered FDA screening facilities, Find registered facilities that perform eligibility screening of tissue donors.

Reproductive Health:

American Society for Reproductive Medicine (ASRM) The main professional society for physicians, nurses and lab technicians who provide ART services. Professional Guidelines can be viewed here as well as various patient resources for couples struggling with infertility.

Association of Reproductive Health Professionals Professional Society for Reproductive Health Care Professionals; not specific for infertility.

CDC Reproductive Health page Main page for reproductive health: ART is only one of eight broad areas, including ART, Infertility, Sudden Infant Death Syndrome, Unplanned Pregnancy, Global Reproductive Health, Maternal and Infant Health, and Teen Pregnancy.

Infertility Support Groups:

RESOLVE “The National Infertility Association, established in 1974, is a non-profit organization with the only established, nationwide network mandated to promote reproductive health and to ensure equal access to all family building options for men and women experiencing infertility or other reproductive disorders.”

Fertile Hope “Fertile Hope is a national LIVESTRONG initiative dedicated to providing reproductive information, support and hope to cancer patients and survivors whose medical treatments present the risk of infertility.”

INCIID “The InterNational Council on Infertility Information Dissemination (INCIID – pronounced “inside”) is a nonprofit organization that helps individuals and couples explore their family-building options. INCIID provides current information and immediate support regarding the diagnosis, treatment, and prevention of infertility and pregnancy loss, and offers guidance to those considering adoption or childfree lifestyles.”

Fertile Thoughts “the leading online community for women and men to talk
about fertility, infertility, pregnancy and parenting.”

Fertility Preservation before Cancer Treatment:

My Oncofertility, website filled with patient support resources

Oncofertility Consortium, NIH supported initiative to advance research and patient options for fertility preservation.

Your Healthcare, Your Way: Participatory Medicine

The Society for Participatory Medicine The Society was founded to learn about and promote Participatory Medicine through writing, speaking, social networking, and other channels. A blog for patients and physicians who agree that working together makes the best healthcare.

More Information on Adoption and Infertility treatments:

Creating A Family Website offers some great links and information on adoption and also on IF.

Support for dealing with grief and loss

Grief, Interrupted, Meet Michelle Buzgon, certified life and grief coach and read her blog which is about recognizing and honoring all kinds of loss.

When ART Works: Pregnancy Resources

Preconception Care: March of Dimes Website

Safe Pregnancy Advice: MotherRisk Website, a pregnancy counseling, education and outreach program created by the Hospital for Sick Children in Toronto, Canada


Personhood bills may end clinical In Vitro Fertilization in the US

February 2, 2017Carole 3 Comments »

On January 17th, 2017, HR586 was introduced by Jody B. Hice (R- GA) into the House of Representatives.  Full text of the bill here:, and summary is below:

Sanctity of Human Life Act

This bill declares that: (1) the right to life guaranteed by the Constitution is vested in each human and is a person’s most fundamental right; (2) each human life begins with fertilization, cloning, or its equivalent, at which time every human has all the legal and constitutional attributes and privileges of personhood; and (3) Congress, each state, the District of Columbia, and each U.S. territory have the authority to protect all human lives.

How could this end the clinical practice of IVF?

If life is legally defined to occur at fertilization, then every fertilized egg in the IVF lab is a human being, by legal definition.

Here are some non-negotiable facts.

Not all fertilized eggs survive past day 1, or day 2 or day 3, or day 5 and so on. Embryos die both in the human body and in the lab for lots of reasons. Genetic issues can arise during the final stages of egg maturation or sperm production, and the resulting fertilized egg can end up with more or less than the normal number of chromosomes, which can lead to it’s demise at some stage of development, before or after implantation. The danger is not over after fertilization. As the embryo continues to undergo cell division, more chromosomal abnormalities can be introduced every time a cell divides. Nothing about this process is foolproof. The fertilized egg and embryo is subject to these same dangers inside the body or in a dish in the IVF lab.

In the lab, there are even more dangers. Errors that arise in the lab environment from technical issues or equipment failure can also cause embryonic demise, unintentionally.

So, bottom line, fertilized eggs and embryos die in the lab, frequently. Let that soak in. So now if these dying embryos are people, and they die in the course of the time they spend in the lab, the lab staff are now liable for punishment for causing the death of human beings, namely:

  • Involuntary manslaughter, punishable by a fine or up to 8 years imprisonment
  • Voluntary manslaughter , punishable by a fine or up to 15 years imprisonment
  • Second degree murder, punishable by terms of years to life
  • First degree murder, life imprisonment or death sentence.

Would you step into the lab the day after this law passes, knowing that you could be criminally liable for what happens naturally in the course of development to fertilized eggs? No?  Me neither. And I bet most embryologists would find alternative employment in the animal industry or other locations that don’t have ignorant laws.  Most embryologists love their jobs but they won’t go to jail for helping people.

So if you’d rather not see the demise of IVF — maybe because you need it in the future or benefited from IVF in the past, please call your representatives and tell them that no, you are NOT okay with this. Here are the names of the 25 co-sponsors of this bill if you want to give their offices a call. Click on the links below for their contact information. Let’s try to save IVF for the 1 in 6 couples who might need it.

Rep. Allen, Rick W. [R-GA-12]*
Rep. Carter, Earl L. “Buddy” [R-GA-1]*
Rep. Collins, Doug [R-GA-9]*
Rep. Crawford, Eric A. “Rick” [R-AR-1]*
Rep. Duncan, Jeff [R-SC-3]*
Rep. Farenthold, Blake [R-TX-27]*
Rep. Ferguson, A. Drew, IV [R-GA-3]*
Rep. Franks, Trent [R-AZ-8]*
Rep. Graves, Tom [R-GA-14]*
Rep. Grothman, Glenn [R-WI-6]*
Rep. Johnson, Bill [R-OH-6]*
Rep. Latta, Robert E. [R-OH-5]*
Rep. Long, Billy [R-MO-7]*
Rep. Loudermilk, Barry [R-GA-11]*
Rep. Olson, Pete [R-TX-22]*
Rep. Roe, David P. [R-TN-1]*
Rep. Russell, Steve [R-OK-5]*
Rep. Scott, Austin [R-GA-8]*
Rep. Wilson, Joe [R-SC-2]*
Rep. Woodall, Rob [R-GA-7]*
Rep. Brat, Dave [R-VA-7]
Rep. Pittenger, Robert [R-NC-9]
Rep. Rokita, Todd [R-IN-4]
Rep. Labrador, Raul R. [R-ID-1]
Rep. Gohmert, Louie [R-TX-1]




Why infertility insurance for everyone matters

November 13, 2016Carole 2 Comments »

If you have been reading this blog, you probably need help building your family.  There are many reasons you might turn to IVF or other infertility services:

  1. you are infertile and sex won’t make you or your partner pregnant.
  2. you are in a same-sex relationship and sex with your partner won’t make you pregnant.
  3. you are not in a relationship but still want to be a parent to a genetically related child.
  4. you are fertile, but you have suffered recurrent pregnancy losses and/or you or your partner have an underlying genetic condition and need genetic analysis to find healthy embryos for transfer.
  5. you are facing a cancer diagnosis and want to preserve your fertility by recovering and storing egg, sperm or embryos before cancer treatments destroy or severely reduce your fertility.

But for some reason, society does not recognize that these reasons are legitimate and should be covered by medical insurance just as medical services are covered for all other non-reproductive medical problems. Imagine having to fight for medical insurance coverage for a heart condition or cancer or a broken limb?

If you are affluent, you can afford IVF, even if your medical insurance plan does not cover IVF. You simply can.

If you are NOT affluent, and you have no insurance, you will have to sacrifice something else or decide not to have a family. You simply must.

That’s not fair but arguing for justice is not always a winning argument, so let’s look at another reason to support widespread insurance coverage–because it drives the quality of services rendered.

Physicians who want to be included as a provider on a insurance plan must meet certain requirements and can have claims denied if they are practicing medicine in a way that is outside the standard of care. Insurance companies keep track of whether physicians are properly credentialed, have a current medical license and are generally providing good quality care. If a service falls outside this insurance coverage safety net, anything is fair game.

Leaving IVF in the “optional services” category –like cosmetic surgery– means that even if you can afford it without insurance, you may not be getting the best infertility services available in your area. The clinic that spends a fortune on advertising and front office amenities may have dirty incubators in the lab, poorly trained or understaffed lab personnel. When driving patient volumes and making a buck is the main focus of a clinic because everyone is fighting for the few self-pay patients that can afford it, spending money on things that drive quality long term (better lab equipment, better qualified, better trained staff, adequate staffing) is often not a top priority.  Because patients , especially first time patients, don’t have enough information to be able to select the better providers, they don’t have the clout to insist on superior health care.

Insurance companies do have that clout and can set a bar for better quality services.

The outcome of the 2016 election does not bode well for more health care insurance for more patients, since Obamacare will  likely be repealed. Although it did not support infertility services directly, it supported reproductive health care and generally increased the participation of patients in the insurance pool.

So now, more than ever, we need to support insurance benefits for all, especially for the controversial services like IVF services, because coverage brings oversight and oversight drives improvements in health care services.

If you agree  in principle or if you need help right now in getting insurance coverage- head on over to Fertility Within Reach .

Fertility Within Reach is a non-profit organization that is working with patients, employers, and legislators to increase access to infertility health care for everyone. As you consider how your end of year charity can do the most good- consider donating to Fertility Within Reach and supporting high quality infertility treatments for everyone.



Information on Zika Virus infection- Source list

August 25, 2016Carole 2 Comments »

Over the last few months, the information about the risks of ZIKA virus infection have been accumulating. Below are some reputable sources for information.

See all CDC fact sheets and posters on Zika here:

ASRM’s statements on Zika Virus dangers:

Bottom line:

Zika infection is one cause of microcephaly in infants in utero. Microcephaly is a condition in which the brain fails to develop normally and causes various levels of cognitive impairment. In some cases, it is not compatible with life.

Zika virus is transmitted to humans by mosquitos which are infected with the virus.

Once infected, men may harbor the virus in the semen for multiple months, even after it is non-detectable in blood. Zika virus can be transmitted via sex and or transmission of bodily fluids. See CDC info here:

Zika infection is also a concern for those who have no intention of becoming pregnant or causing a pregnancy. There is evidence that Zika infection can cause Guillain-Barré syndrome (GBS) .

From the CDC website Guillain-Barré syndrome (GBS) is an uncommon sickness of the nervous system in which a person’s own immune system damages the nerve cells, causing muscle weakness, and sometimes, paralysis.

  • Several countries that have experienced Zika outbreaks recently have reported increases in people who have Guillain-Barré syndrome (GBS).
  • Current CDC research suggests that GBS is strongly associated with Zika; however, only a small proportion of people with recent Zika virus infection get GBS.

Research by the CDC is ongoing but it underlines the need for EVERYONE to use mosquito repellent and other precautions to reduce their risk of mosquito bites- particularly in know active areas of ZIKA infection- which now includes the Miami area, until we better understand the implications of infection.

Prevention of Zika Virus infection:

Call to action to protect federal medical IVF benefits for veterans

July 13, 2016Carole No Comments »

ASRM SENT OUT THIS ALERT TODAY. ASRM has worked to extend Dept of VA medical coverage to include IVF services to veterans. This amendment will prohibit federal funding of IVF for veterans. Details are below.

URGENT TODAY: Calls needed to Capitol Hill on IVF amendment

Take Action!

ASRM has learned this a.m. that an amendment will be offered during a committee mark up that is happening NOW on Capitol Hill. The amendment is being offered by Rep. Harris (R-MD) and Rep. Fortenberry (R-NE) and is supported by several right to life organizations opposed to the federal government paying for IVF care.
The amendment is being offered during the House Appropriations Committee’s consideration of a bill to fund the Labor-HHS- and Education Departments. It will prohibit federal funding of IVF in which any embryo is discarded or destroyed. This is in direct response to our lobbying efforts to lift the ban at the Department of VA on coverage of IVF services and to allow wounded veterans to receive this care.
We need you to call the Members of Congress who serve on the House Appropriations Committee and ask they vote NO on the Harris/Fortenberry IVF amendment. If you practice medicine in a state that is represented by a Member of Congress on this committee please call the Capitol Hill switchboard ASAP 202 225-3121 and ask to be connected to the Member(s) of Congress on this list from your state. You should ask to speak to (or leave a vmail for) the Appropriations or Veterans Affairs staff person.
These Members of Congress need to hear from you that:
  • IVF, like all medical procedures, involves some risk.
  • Not all embryos are suitable for transfer
  • Even those embryos that are frozen may not survive the thaw process
  • Couples should not have to pay indefinately to freeze embryos that they will not consider for family building purposes
  • The goal of IVF is a healthy pregnancy outcome, not the transfer of every embryo created or the transfer of embryos that are not viable
  • Why is it in the government’s interest to force couples to transfer all embryos or freeze them all indefinately?
Questions? Contact Erin Kramer at 202-863-4984. Also please send Erin an email with feedback you receive from these offices to
Thank you!

Zika Virus: What should infertility patients do?

January 31, 2016Carole 2 Comments »


Open pdf from this link:

The guidance  in the pdf is for providers but I think patients should be aware of the recommendations that professional societies are giving to medical providers so that they can be sure they are getting the best treatment and know what questions to ask.

Original post: The Zika virus has been in the press recently. It is a virus that is carried by a type of mosquito (Aedes aegypti )  that is found in much of the Americas. The CDC has posted a map of active infections areas here.

Currently, the most active zones are in South and Central America. For most persons infected with the virus, it’s not a big deal. The virus is usually cleared from the blood by the body within a week after infection and the person may have either no symptoms or may have some fever, rash, conjunctivitis that might be associated with a mild flu or cold.

Infection with the Zika virus may be of much greater concern to pregnant women because there may be a connection between being infected with the virus and an increased risk of having a child born with a birth defect called  microcephaly (small head).  This birth defect is particularly scary because it causes life-long issues with brain function including :

  • Seizures
  • Developmental delay, such as problems with speech or other developmental milestones (like sitting, standing, and walking)
  • Intellectual disability (decreased ability to learn and function in daily life)
  • Problems with movement and balance
  • Feeding problems, such as difficulty swallowing
  • Hearing loss
  • Vision problems

Currently, because there is no vaccine to prevent infection or medicine to treat Zika virus infection– the best option is to take steps to prevent exposure to the virus.

Until more is known, CDC recommends special precautions for pregnant women and women trying to become pregnant (copied below from the CDC website) :

Pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing. Pregnant women who do travel to one of these areas should talk to their doctor or other healthcare provider first and strictly follow steps to avoid mosquito bites during the trip.

Women trying to become pregnant or who are thinking about becoming pregnant should consult with their healthcare provider before traveling to these areas and strictly follow steps to prevent mosquito bites during the trip.

Because specific areas where Zika virus transmission is ongoing are difficult to determine and likely to change over time, CDC will update this travel notice as information becomes available. Check CDC’s Zika Travel Information website frequently for the most up-to-date recommendations.

Q: I am pregnant. How will Zika virus affect me or my unborn baby?

A: CDC has issued a travel notice (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing.

This notice follows reports in Brazil of microcephaly and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. However, additional studies are needed to further characterize this relationship. More studies are planned to learn more about the risks of Zika virus infection during pregnancy.

Q: Is it safe to use an insect repellent if I am pregnant or nursing?

A: Yes. Using an insect repellent is safe and effective. Pregnant women and women who are breastfeeding can and should choose an EPA-registered insect repellents and use it according to the product label.

Q: If a woman who is not pregnant is bitten by a mosquito and infected with Zika virus, will her future pregnancies be at risk?

We do not know the risk to the infant if a woman is infected with Zika virus while she is pregnant. Zika virus usually remains in the blood of an infected person for only a few days to a week. The virus will not cause infections in an infant that is conceived after the virus is cleared from the blood. There is currently no evidence that Zika virus infection poses a risk of birth defects in future pregnancies. A women contemplating pregnancy, who has recently recovered from Zika virus infection, should consult her healthcare provider after recovering.

Q: Should a pregnant woman who traveled to an area with Zika virus be tested for the virus?

A: See your healthcare provider if you are pregnant and develop a fever, rash, joint pain, or red eyes within 2 weeks after traveling to a country where Zika virus cases have been reported. Be sure to tell your health care provider where you traveled.

Q: Can a previous Zika virus infection cause someone who later becomes pregnant to have an infant with microcephaly?

A: We do not know the risk to the baby if a woman is infected with Zika virus while she is pregnant. However, Zika virus infection does not pose a risk of birth defects for future pregnancies.

Q:Is it safe to get pregnant after traveling to a country with Zika virus?

A: If infected, Zika virus usually remains in the blood of an infected person for about a week. The virus will not cause infections in a baby that is conceived after the virus is cleared from the blood. (CW Note: That is true if the virus is not harbored in the semen, but there are a couple of cases which suggest that it may linger in the semen after being cleared from the blood- see the bottom of the post for more information).

Q: Can a pregnant woman be tested for Zika weeks or months after being in a country with Zika?

A: At this time, and for several reasons, we do not recommend routine Zika virus testing in pregnant women who have traveled to a country with known transmission. First, there can be false-positive results due to antibodies that are made against other related viruses. Second, we do not know the risk to the fetus if the mother tests positive for Zika virus antibodies. We also do not know if the risk is different in mothers who do or do not have symptoms due to Zika virus infection.

Q: If a woman who has traveled to an area with Zika virus transmission, should she wait to get pregnant?

A: We do not know the risk to an infant if a woman is infected with Zika virus while she is pregnant. Zika virus usually remains in the blood of an infected person for only a few days to a week. The virus will not cause infections in an infant that is conceived after the virus is cleared from the blood. There is currently no evidence that Zika virus infection poses a risk of birth defects in future pregnancies. A women contemplating pregnancy, who has recently traveled to an area with local Zika transmission, should consult her healthcare provider after returning.

Perhaps most troubling for couples trying to conceive is that there have been several cases in which the Zika virus was found in the semen of men infected with the virus. Most troubling, the virus persisted in the semen long after it was cleared from the blood so a blood test would have shown negative for Zika. This New York Times article, Zika Virus: Two cases suggest it could be spread through sex; raise the specter of a much longer time of caution – perhaps several months- to allow the infected sperm to be cleared from the body, before conception should be attempted.

Bottom Line for couples trying to get pregnant:

  • Avoid traveling to areas that have active areas of infection, if possible. Note that the mosquito that carries the Zika virus is currently very active in South and Central America,  but the same mosquito is found in some more tropical regions of the southern US, but so far the spread of infected mosquitoes has not become a public health issue in the US- due to aggressive mosquito control measures.
  • If you must travel to hotspot areas, use preventive measures (DEET sprays, mosquito netting etc.)  to avoid exposure to mosquito bites.
  • Check the CDC site for updates at ; and consult with your physicians before traveling to these areas, or after your return if you think you may have been infected.
  • If you are a man who has traveled to these hotspots, and you know you have been infected with the virus, or have been bitten by mosquitos, it may be advisable to have only protected sex with your partner for a couple of months after your return. Alternatively, you might consider having your semen cryopreserved in advance of your travel, if you anticipate travel to highly infectious regions and plan to conceive a child soon after your return using IVF/IUI.

Other articles about the Zika virus:

Scientists are Using Genetically Modified Mosquitoes to Fight the Mosquito-Borne Zika Virus

Zika Virus “spreading explosively” in the Americas, WHO says

A new blog: Smart Fertility Choices

November 15, 2015Carole 1 Comment »

If you are looking for a smart, empathetic blog about current IVF information written by someone who is still on their infertility journey – look no further. A months old website, Smart Fertility Choices , written by Kym Campbell,  is an inspiring mix of blog posts and pod casts. What makes her blog different from most is she is diligent about digging into the scientific basis for all questions IVF and is not afraid to speak to experts directly on her podcasts. She reads and references published journal articles to back up her summaries on various topics. I also like that her blog does not currently post advertisements and all the info is free. In her podcasts, she interviews experts in the field for their perspective on best practices.

Kym starts her second pod cast with her own infertility journey. In future podcasts, Kym  plans to interview women who are still on their infertility journey. I think it is so very important to have a place to share these stories so that women know that they are not alone in these experiences. Kym realizes that it is important to share not only the “had a baby” success stories but also show how couples have found a meaningful life after infertility treatments even if the original path to parenthood took a zig-zag or if that future life is child-free.

The other thing I like about Kym’s approach is that she is not passive about her healthcare –she asks questions of her doctors, and other experts to better understand what options she has and the pros and cons of different options. Her story of seeing 6 specialists is very instructive because it illustrates that not all specialists are equal in quality–and that if your gut tells you something about the treatment plan does not make sense or your doctor’s style of communication is not a good fit- it is perfectly fine to move on and talk to someone else.

On her website, Kym provides resources for working toward your best physical and mental health prior to and during your infertility treatments. Starting with good overall health is important not only because it might shorten your infertility journey, but supporting your emotional health as you undergo the rigors of treatment makes it easier to tolerate the inevitable emotional roller coaster that are a side effect of treatment. Being in your best physical condition also prepares you for the actual physical demands of pregnancy. Kym shares information about mindfulness exercises, acupuncture and other adjunct therapies which were very useful for her and may be useful for other patients. These resources are intended to  help patients take the long view because everyone needs to find happiness in life, however the infertility journey ends.

Kym knows a little something of taking life by its tail and living it to the fullest. She grew up in Seattle, Washington, moved to  California for college to study Economics, then traveled to Australia for a study-abroad program in 2001. Returning to Australia for a Masters in Accounting in 2004, she fell in love with the sun, surfing and musical inspiration she found in Australia. She picked up a guitar and began writing songs, her music career culminating with international success, including touring in Japan. You can hear her beautiful island inspired music on You tube, and every podcast “cheekily” ends with one of her songs.  As an admitted “Type A” personality, when she and her husband ran into obstacles with starting her family, she plunged into this new fertility challenge with the same amazing (to me) energy and enthusiasm she’d shown for economics, surfing and music.  I think you will enjoy meeting her and joining her on her journey as she works through various options, without losing her sense of humor and her love of life. You may find her attitude inspirational. I do.



Financial Assistance Grants for Infertility Patients

October 17, 2015Carole 2 Comments »

As the technology for infertility treatments improve more and more- the bigger issue for many couples is not finding a good treatment option for them but finding a means to pay the costs of those treatments. Did you know that there are foundations and organizations that offer grants to patients with financial need to help with costs associated with infertility?

You can find an up-to-date list of grants  to support infertility treatments, adoption, fertility preservation, fertility medication discounts and military discounts on the Fertility Within Reach website. The following foundations offer grants to pay for infertility treatments: AGC Scholarship Foundation, The Angels of Hope Foundation, BabyQuest Foundation, The Kyle and Samantha Busch Bundle of Joy Fund, The Cade Foundation,
The Fertility Foundation of Texas, 
INCIID IVF Scholarships, Journey to Parenthood, Kevin J. Lederer Life Foundation, The Life Foundation, New York State Infertility Demonstration Program, Pay-It-Forward Foundation,  Sparkles of Life.

Other foundations offer grants to pay for the costs of adoption:  National Adoption Foundation Financial Programs, Gift of Adoption Fund,  Help Us Adopt.ORG, Show Hope.

You can also find grants to pay for fertility preservation prior to undergoing cancer treatment or for infertility treatments for cancer survivors: Sharing Hope Financial Assistance Program, and Fertile Action.

The non-profit organization Fertility within Reach also offers grants through its Banking on the Future grant program to pay for preservation and storage of gametes for young patients  (under 21) faced with cancer treatments.

There are also programs that offer grants or discounts to cover the costs of fertility medications including IVF Greenlight offered by Ferring Pharmaceuticals Inc. , Compassionate Care by EMD Serono, or the First Steps Program offered by DesignRx pharmacies.

You should also know that your fertility clinic is likely to be open to offering you a discount for cash or military service discounts if you or your partner are in the military. It never hurts to ask your clinic or your pharmacy directly about unadvertised discounts they may have.

For military veterans and their spouses, The Compassionate Corps Program provides free fertility medication to those who are eligible. 

Feeling overwhelmed by the options? Each program has varied eligibility requirements and it may seem daunting to search through them all. Fortunately, Fertility Within Reach has summarized the eligibility requirements for each of these programs on their site. To find the eligibility requirements for each of these,  visit Fertility Within Reach’s website financial assistance grants page to find the  grants that you can apply for. Also, check out Fertility Within Reach’s   Financial Assistance Application Guide.  This page provides tips on how to properly fill out a grant application to ensure you have an opportunity for consideration.

You are Stronger, Braver, Smarter than you think…..

September 13, 2015Carole 2 Comments »

Post from 2012- but still an important message for patients struggling with the emotional toll of infertility….

Sometimes wisdom can be found in the oddest places. I came across this quote from Winne the Pooh.

“Promise me you will always remember: You are stronger than you seem, braver than you feel, and smarter than you think,” — Christopher Robin to Pooh.

This is the message I hope to pass on to all of you struggling with infertility. Infertility can take control of your life, darkening your spirits and making you question your  entire life, your choices and decisions, past and future. It can make you question everything, even your place in the world. Don’t let it. You will get through this. The ending may not be written the way you expect but you will find an answer for yourself. You will do the best you can with what you have. You are stronger than you seem.

Don’t give up hope that a better day lies ahead. No one can promise you a biological child. Even the best science can’t guarantee that. But you will get through this. There is a morning after infertility where you either face the brand new challenges of parenthood (one way or another)  or find another path to nurture the future, your way. You are braver than you feel.

Don’t let someone else push you to do something that  you don’t understand or that troubles you for some reason. Ask questions until you feel confident about your choices and can make the best decision for yourself and your family. If your  doctor can’t or won’t explain something, find another who will.  If something sounds too good to be true, it probably is. You are smarter than you think.

Promise me you will always remember: You are stronger than you seem, braver than you feel, and smarter than you think.

Q from U: if I transfer this embryo, will I get pregnant?

June 6, 2015Carole 51 Comments »

One question that comes up again and again from IVF patients is: If I transfer this embryo, will I get pregnant?  Patients send me their pictures of embryos and ask me to evaluate them and predict whether this embryo is “the one” that will become their longed for child.

I deeply understand this need to see into the future and gain the knowledge to make the right decision in the present, but it is impossible to predict with certainty an outcome from IVF- especially from a photo. It might help to understand why this is still impossible to do.

Embryologists are tasked to recommend embryos for transfer based on information they can collect while they have the embryos growing in the lab. The 3 main indicators used by embryologists to determine the best embryos are:

1. Does the embryo look “good”? This was the first tool embryologists used but it has been eclipsed by two other tools I’ll talk about in a little bit. Even with only a weak correlation between appearance and implantation/pregnancy success, embryologists were desperate to identify some measures to predict which embryos were most likely to implant and go to term. Some traits –such as an even number of same sized cells at each cleavage stage –seemed advantageous for implantation. Likewise, very little fragmentation of cells also seemed like a good trait for an embryo to have. So regular, even embryos with no or few fragmented cells received higher scores than embryos that had irregular shaped cells and/or lots of fragments. It might have spoken more to our bias regarding beauty- we like symmetrical things and even numbers- and was not based on compelling science that these traits always correlated with pregnancy success. This lesson was brought home to me with two IVF cases very early in my career. One patient was 40 years old with perfect-scoring textbook-looking 8 cells on day 3. The other patient was in her twenties, had a large number of embryos, with each one scoring worse than the next due to large amounts of fragmentation. In fact, it was hard to tell for some embryos if a cell was actually a cell or a large fragment. Based on scoring, we had higher expectations for the 40 year old, but it was the younger patient who got pregnant and this lovely baby was the first IVF baby I was privileged to hold when the patient brought her into the office when she was a couple of months old. This taught me that embryo scores alone could be misleading.

2.  Did the embryo hit certain developmental stages on time or did it stall or lag? This is a functional question which is more directly tied to whether an embryo is likely to keep growing, than an embryo score. Our first real chance to evaluate embryo function was with the advent of sequential culture systems which allowed embryologists to grow embryos for 5-6 days, allowing them to determine if the embryo was able to reach blastocyst stage- the stage just before implantation. We now know that for some patients, a significant number of embryos get stalled at cleavage stages. When embryos were routinely cultured to day 3 to transfer embryos at cleavage stage – and the cycle failed- there was no way to know if this particular embryo would have also stalled out in culture. Now, this embryo has a chance to fail in culture and not be selected for transfer. With the advent of time-lapse continual video monitoring of embryos, and mathematical analysis of these videos- embryologists are able to determine the average times to reaching developmental stages for embryos that go on to implant.  This analysis of an embryo’s functional capacity to grow– has been taken to another level.

3. Does the embryo have a normal number of chromosomes? Chromosomes are twisted strands of DNA that contain all the genetic information passed on from the parents. With only a few exceptions, having an abnormal number of chromosomes is incompatible with continued embryo growth, implantation, pregnancy and live birth. For instance,  Trisomy 21 (an extra Chromosome 21) is compatible with life and these kids are born with Downs Syndrome. With pre-implantation genetic screening (PGS) of embryos, we can tell if an embryo has a normal number of chromosomes. This is a big deal. While aneuploidy testing does not rule out the possibility that an embryo could be harboring smaller stretches of DNA sequences that could doom it along the way- it does rule out really big problems like the absence or addition of entire chromosomes. It is also possible to use pre-implantation genetic diagnosis (PGD)  testing to look for abnormal gene sequences that are harbingers of severe medical conditions later on- but these usually don’t impact implantation potential- in the way that most kinds of aneuploidy do.

The good news is that embryologists have more and better tools at their disposal to evaluate embryos for their potential to implant- and these are certainly evolving and existing tools will improve and new tools will be added as time goes on- but even if your embryologist can find your “best chance” embryo, it still does not guarantee your pregnancy.

IVF is a team effort, not just in the clinic, but also between the patient and the clinic. The physician has to be aware and counsel the patient of other issues that may also be reducing the patient’s chances of conception and a healthy pregnancy.

  • Endocrine problems (eg. thyroid conditions)  that effect reproductive function. If a patient is hypothryoid or hyperthyroid, these conditions must be brought under control first.
  • Insufficient (thin) uterine linings that are inhospitable to embryo implantation. In some cases, a frozen embryo transfer may be more optimal because it separates the IVF case into a ’embryo production” phase in which egg quality and selection can be optimized hormonally and an “embryo implantation” phase in which the uterine lining can be optimally hormonally primed for implantation. The best hormonal protocol for each are often not the same and the lining gets short changed to get more eggs at retrieval.
  • General health of the patient. Patients that are at the extremes of weight (over or under) may have more difficulty conceiving. Patients who smoke also reduce their fertility- this applies to both males and females. There are lots of factors that go into good reproductive health- these are just a few. It is important to share all your medical information with your doctor so they can try to help you optimize your reproductive health before you spend a lot of emotional and financial resources on IVF.

Bottom line, getting pregnant should be easy, but it often isn’t. Even high tech procedures can’t guarantee pregnancy. You can, however,  position yourself for the best possible outcome by finding a highly effective IVF team (look at for  best pregnancy rates in your area)  that will work with you to diagnose the problem (look for good two-way communication between the patient and clinic), grow and find the best embryos to transfer (look for a good lab that uses modern tools) and helps you optimize your fertility before you even get started (good physician practice).

I have a lot of faith in patients to make the right decisions if they have all the information they need along the way. I choose patient education over a crystal ball any day to get a happy answer to the question: Will I get pregnant if I transfer this embryo?