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The Parents Via Egg Donation Organization: November 2011

Tuesday, November 15, 2011

Fat: the biggest infertility issue?

There is a big debate among physicians who specialize in treating infertile people all around the world today: Should we treat people who are severely overweight? Or should we require them to lose weight before they conceive? I was just reading a very interesting article on this topic by Vahratian A. and Smith YR, published in the prestigious journal of Human Reproduction (Vol 24, No 7, pp 1532-1537, 2009), titled "Should access to fertility-related services be conditional on body mass index?" The following is a discussion based upon this interesting and provocative article.

The authors point out that there is significant data to demonstrate that obesity has a negative impact upon reproduction. Obesity is defined by the World Health Organization as a BMI of 30 or above. For a woman who is 5 foot 4, that is a weight of 174 pounds or more. Extreme obesity is defined as a BMI of 40 and above – for that 5 foot 4 woman that is a weight of 232 pounds and above. As you may know, more than half the population of the United States is overweight and well over a third are obese or extremely obese. The authors cite numerous international publications discussing the debate over providing infertility services to obese patients. They cite numerous studies demonstrating that obesity and infertility are linked. Obese women are much more likely to suffer from infertility than women who are normal weight. One study quantified the risk of infertility as three times higher in obese women compared to normal weight women! We also know that obese women are less responsive to fertility medications – for the same drug dose, obese women produce less eggs than normal weight women.

Bottom line – fat makes you less fertile.

The problems do not end there. Once pregnant, obese women have much higher rates of miscarriage, their babies have higher rates of birth defects, and there are higher rates of neonatal death as well as maternal death. All other factors being equal, obese patients and their babies are much more likely to die sometime during pregnancy, delivery and post-partum than their normal weight counterparts.

Death is pretty seriousYet most of my overweight patients want me to ignore their weight issues. Most of them just want me to prescribe pills, or shots or anything to help them conceive as quickly as possible. I know how desperately they want a baby. I know how important it is and how painful it is to struggle with infertility. However, I took the Hippocratic Oath to first, do no harm. What would Hippocrates do in this situation?

The answer is not at all clear. Most states, including my home state of New Jersey, have laws against discrimination. Some would consider not treating someone because they are obese a type of discrimination. Some would consider not treating an obese patient the medically and ethically correct thing to do. No one seems to agree.

Outside the United States, some countries have decided that there is enough data to limit access to services based upon success rates. In countries where the government pays for health care, some governments will limit fertility treatments to obese patients. Given much lower success rates in the obese population, New Zealand citizens can only obtain fertility services if their BMI is relatively normal – from 18 to 32 kg/m2 (normal is 18.5 to 24.9, overweight is 25 to 29.9, obese is 30.0 and above). The UK has many guidelines surrounding assisted reproduction and at this time, does not have formal policies, but does recommend that infertility patients be provided with lifestyle advice such as recommendations for quitting smoking and obtaining a normal weight. Many UK clinics will not provide assisted reproduction – IUI or IVF – services to patients outside certain BMI limits.

But what is a person to do? While the ethicists and other experts debate, the biological clock is ticking. You have tried a bazillion diets and you are still overweight and you wanted to have a baby yesterday.

Let’s be practical. Acknowledge the risks. Putting your head in the sand is not helping anyone – not you, not your doctor, not your baby. Sit down with your doctor. Have a serious talk with her or him about your weight. See what ideas your doctor has for helping you. Remember – you do not have to be model-thin to be healthier. There are significant, measurable improvements seen with just 10 pounds of weight loss. Yes! Just 10 pounds! If you weigh 200 pounds that may seem like a drop in the bucket, but it is not. Think about seeing a professional nutritionist. Think about signing up for a program like Weight Watchers, Jenny Craig, Curves, etc – structured programs can often make the overwhelming task of losing weight a little easier, and provide much needed emotional support.

Walk! Move! You don’t have to run a triathlon to be healthy. The more you move, the better off you are. Exercise can help you lose weight and lower stress levels – both of those things will improve your chances of conceiving.

Healthy weight loss while trying to conceive is ok. Just make sure you discuss the plan with your doctor and get the help and support you need. Weight loss can dramatically improve your chances of success regardless of treatment – whether it be medications and IUI or IVF, every pound you lose, gives you a better chance of success.

Some women – ones who are young and have normal ovarian reserve – who have failed diet and exercise and have a bmi over 35 to 40, should consider bariatric surgery. Although this usually requires not conceiving for 1 or 2 years, the improvement in pregnancy rate and overall health for both mother and baby may make that extra 1 or 2 years very worthwhile. For some women, this can mean the difference between life and death.

At this point, given that overweight affects over 50% of people and other common causes for infertility like endometriosis, PCOS, diminished ovarian reserve, sperm problems, blocked tubes each account for much less than 50% of infertile patients – FAT really is the biggest fertility issue!

The good news is that you really can do something about it. Please call today to make an appointment to talk with your doctor!


Copyright Serena H. Chen, MD. 2011.
reprinted with permission

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Marquardt's off the mark

14 November 2011
By Susan Kane
DI-adult and parent by DI

Appeared in BioNews 633

I have no doubt that Elizabeth Marquardt's report reflects the feelings of the donor-conceived people that she studied. However, since true scientific study of donor-conceived people is not currently possible, her claims must be qualified. 
Unlike adopted people, the vast majority of donor-conceived people alive today do not know that they differ from anyone else. It is impossible to say what most donor-conceived people think. They do not know who they really are – certainly, we cannot find or study them.

Lacking a true random sample, we can only study those DI (donor insemination) adults who were told the truth by their parents. This minority falls into two further significant groups – those who were told the truth as young children and those who were told as teenagers or adults. Most DI adults alive today fall into the latter category.

We know from adoption research that 'late discovery' of genetic origins is traumatic for children and the adults they become. It is because of this documented trauma that adoption practices were changed from the secrecy that prevailed before the 1960s to the openness (at least about the fact of being adopted) that we see today.

At the present time, in the United States, if you apply to adopt and state that you plan to lie to your children about their origins for their entire lives, you will be told to learn more about adoption and the best interests of adopted children. Indeed, from my experience of American social workers, most would consider your intention to lie to your children about their origins a form of child abuse.
And yet, the infertility industry considers this a perfectly reasonable stance for parents using donor gametes. I can only conclude that infertility specialists, as a rule, are not friends with psychologists. Whether this is a by-product of their busy lives or perhaps an intentional rejection of the social sciences is difficult to say. However, the result of this highly unfortunate miscommunication between people who understand cell structures and people who understand human beings is that donor-conceived people are back where adoptees were fifty years ago – confused, traumatized and angry. And rightly so: confusion, trauma, and anger are appropriate psychological responses to being lied to by those closest to you.

I know from the stories of those in PCVAI (People Conceived Via Artificial Insemination online group) that late discovery often occurs in traumatic contexts. In our group, it is not at all uncommon for people to report that they were given the information that their father is unrelated to them during warm family moments, including after a divorce, during a vicious family fight or within days of their father's death. The absolute idiocy of keeping these kinds of secrets from children is well highlighted by these examples.

If Marquardt wants to isolate the effect of donor conception on outcomes, she must compare apples to apples. You cannot compare the psychological outcome of a 20-something donor-conceived adult who was told about DI two days after her father died to an adoptee who has known his identity from birth.

You cannot compare a donor-conceived adult raised in a family where assisted conception was considered a shameful secret to an adoptee raised in a family that affirmed adoption as a positive choice.

The data tables at the end of this study are inscrutable. Data is supposed to be stated in percentages, but at least one critical question ('at what age did you learn?') has 'percentages' that add up to 198. Almost 14 percent of the 'donor-conceived' participants were included because they 'thought they might be' donor-conceived. Marquadt did no regression analysis to examine the effect that late discovery might have had on participants' feelings about donor conception. These are the kinds of basic data problems that peer-review and the formal publishing process are meant to address.

It is entirely possible that the intentionality of DI is a problem for DI adults. A study that compared apples to apples might find this result. A peer-reviewed study that was not paid for by an advocacy organisation dedicated to preserving the traditional family would be even more helpful. This particular study is so rife with other possible sources of trauma and political bias that I could not support its conclusions even though I welcome the data collected on the feelings and experiences of its participants.

In some areas, such as whether lying to your children is harmful, the answers are known. Other areas, such as the question of 'intentionality', are truly new frontiers. We must remain curious and open to whatever the data tells us, but poorly executed social science only clouds the waters.

It is a loss for all of us that Marquardt chose to write a politicised report with questionable conclusions rather than doing the real research that is so badly needed in this area.

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Thursday, November 10, 2011

Attention Ivy League Grads: Looking for Egg Donors To Help Create Families

More and more our organization is contacted by intended parents who are looking for egg donors from top tier schools.  Because we are as service industry our goal is to meet the needs of our intended parents.  After much thinking and brainstorming about how to find top tier grads or top tier students from schools like Harvard, Yale, Stanford, Duke, Brown Cornell, etc... I thought why not put an advertisement here -- it's free to our parents. 

Looking for women between the ages of 20 and 28.  Height and weight appropriate, accomplished, driven, and who are Ivy League students or grads.  Attractive and articulate.

Compensation is variable beginning at $10,000.00 and negotiable between yourself and your intended parent.  Travel expenses are paid in full for yourself and your travel companion.

Help others create their family and help another fulfill their dream of becoming a parent.

email: marna@pved.org for more information

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