Here’s a letter from the opposing view.

My view is this. The couple is free to make their own choice regarding doing IVF or not. They are also free to express their opinion against IVF loud and clear.

However, I find it hard to stomach an outside third party (the city politicians) actually taking physical action to come between a doctor and his/her patients. If the doctor wishes to help the patients have babies via IVF and if the patients wish to have the doctor help them have a baby with IVF, what place do outsiders, who are not friends of the patients and not friends of the doctor, have in blocking them?

Can we first agree on a simple and obvious observation? We all choose our actions to maximize our happiness. Sometimes, we sacrifice short-term happiness for the expectation of greater long-term happiness. Right? If so, then our choice of career should take into consideration how likely it is to improve our long-term happiness. Before we can decide that, we need to define what will make us happy. Correct?

So, everyone has their own subtle preferences as to what they need to be happy, but I’ll volunteer some ideas and see if you agree.

- MEANING AND FULFILLMENT: Few people realize how important this is. You can be mega-rich and powerful, but without meaning and fulfillment, you run the risk of being a Mr. Burns. How would I define meaning and fulfillment? One way is to ask, “Do your actions make a positive difference in the happiness of others?”. The more strongly you answer YES, the more likely your life is meaningful and fulfilled. This is where I think the career choice of medicine hits a grand slam (in many cases). In my own example, the happy feedback I get from my past patients when they come back and visit with their baby reassures my staff and me that our hard work makes a difference in their lives. In my opinion, this is why some rich and powerful people are not happy when they get rich by stealing, suing or otherwise inflicting misery on others. They are still rich and powerful, but they are not happy.

- FINANCIAL FREEDOM: The second thing that contributes to happiness is financial power, which I loosely define as the ability to pursue options and to downplay bad fortune. It’s nice if you can pursue your dream of traveling through Europe without enduring extreme hardship. The part about downplaying bad fortune is very important also. Imagine what would happen if you car breaks down. Your happiness would be seriously hampered. However, if you have the means to get a temporary rental and if you can afford to get your car fixed, or even buy a new one, then more of the inevitable bad fortunes that come into all our lives are going to be solvable than if we are super poor. How does medicine fulfill this criterion? It all depends. For the most part, medicine still has more financial reward than the average job, BUT it’s not as nice as it used to be before so much power was seized into the hands of insurance companies and politicians.

- PHYSICAL AND MENTAL HEALTH: A third factor necessary for happiness is being energetic and healthy. This depends heavily on the ability to exercise and to pursue fun. As a physician, your career is going to require many hours of commitment and can seriously hinder your pursuit of leisure and your ability to take good care of your health. However, it is within our own power to find ways to balance. This is definitely a challenge, but it is certainly feasible.

- QUALITY RELATIONSHIPS: Another factor for happiness is the development and nurturing of good relationships. This refers to romantic relationships as well as to friendships and bonding with our families, and maybe even with our animal families. Medicine consumes a lot of time and attention. It can create a challenge for finding time for relationships. Again, individual cases will differ.

So in summary, when comparing two different career choices, it might help to analyze these four areas that contribute to happiness and see how each career choice rates in each of these areas. Good luck!

So, in the past, there were Google-sponsored ads placed on this blog which generated a bit of revenue. This partially subsidized the maintenance of this blog. It wasn’t very much at all, but it was still something. Then one day, I received an email from Google, notifying that they were taking all their ads down from my site. Why?

“Hello,

During a recent review of your account we found that you are currently
displaying Google ads in a manner that is not compliant with our program
policies…………..
EXAMPLE PAGE:
http://fertilityfile.com/2007/12/23/how-long-does-sperm-live/

Please note that this URL is an example and that the same violations may
exist on other pages of this website or other sites in your network.

VIOLATION(S) FOUND:

ADULT/SEXUAL HEALTH OR SEXUAL TIPS: As stated in our program policies,
AdSense publishers are not permitted to place Google ads on pages with
adult or mature content. This may include some treatments of topics such
as sexual health and sexual tips or advice. More information about this
policy can be found in our help center.”

————————

Apparently, discussion of human reproduction falls under their definition of sexual health. Sure, I can agree with that. However, according to their policy, discussion of sexual health is forbidden for their authors, even if it’s medical in nature and even though the overwhelming majority of my Google advertisers were fertility-related business entities.

I can imagine the devastation that a blog author would feel if this involved his/her livelihood. But for me, because the advertising revenue was so small anyway and because I got spiritual reward out of providing my blog and podcast, I was not so much upset, but rather more annoyed. And since I was busy with many other things, I got distracted from blogging for a while.

Now, here’s the GOOD NEWS. I’ve been newly inspired. Very shortly, within 1-2 months, I will be launching a new project that will greatly excite some of you and mildly interest the rest of you. Meanwhile, this blog is at an all time high in monthly traffic and it certainly lives on. I’ll foot the bill of maintaining it myself, with the help of anybody who wishes to donate, although I don’t want anybody to donate unless they got great great value out of this material and are 100% excited to do so out of their free will. I’m doing OK financially and my podcasting and blogging will go on regardless. Stay tuned!

Finally, after I spoke with him directly, he consented to get tested this week. He has zero sperm. When I broke the news to them, he was still not convinced and insisted on getting a repeat test at an outside lab. I agreed that it would be a good idea. At least he was acknowledging the possibility of having a problem.

The good news is that we can now start moving forward in the right direction. The lesson is that unless a man has proven fertility, no matter how healthy and virile he may seem, the only way to confirm for sure that he has sperm is to do a semen analysis.

Today, officers from ASRM sent a public letter to the Iowa politicians:

February 15, 2011

Representative Kraig Paulsen
Speaker
Iowa House of Representatives
1305 Cress Parkway
Hiawatha, Iowa 52233

Dear Speaker Paulsen:

On behalf of the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART), we are writing to express opposition to HF 153.

ASRM is a multidisciplinary organization of nearly 8,000 dedicated to the advancement of the art, science, and practice of reproductive medicine. Distinguished members of ASRM include obstetricians and gynecologists, urologists, reproductive endocrinologists, embryologists, mental health professionals and others. SART is an organization of nearly 400 member practices performing more than 95% of the assisted reproductive technology (ART) cycles in the United States. SART’s mission is to set and help maintain the highest medical and professional standards for ART. SART works with the ASRM to create practice guidelines and minimum standards of care. SART also serves as the governmental watchdog for ART and is actively involved in the collection of data outcomes from its member programs.

ASRM and SART strongly support the rights of patients to seek necessary medical treatment for diseases of the reproductive system and assistance in becoming pregnant. ASRM and SART also strongly support the availability of contraception and family planning services.

HF 153 not only threatens the reproductive rights of women, it also thwarts the ability of those who suffer from infertility to seek treatment appropriate for their disease. Because this bill gives constitutional rights to embryos, it would unduly restrict an infertile patient’s right to make decisions about embryos created as part of the in vitro fertilization process. While assisted reproductive technologies are employed to assist infertile patients in their hope of achieving a successful pregnancy outcome, embryos in excess of a patient’s clinic need may result. So too, embryos may be created that are not chromosomally suited for transfer to the patient’s uterus. While these embryos are created for the purpose of the creation of a human being, it is a biological fact that not all embryos will become human beings.

Our position is that an embryo is neither a person, nor property, but an entity deserving special respect. However, we believe that the responsibility for determining what happens to an embryo lies with the progenitors of the embryo. An embryo, in vitro or in vivo, is a cluster of cells with a unique potential to grow into a full-fledged individual. However, in human reproduction, even as undertaken without medical assistance, fewer than 20% of fertilized eggs implant in the uterus. Given the uncertainty that any particular embryo will develop to become a person, it is unreasonable and imbalanced to give constitutional rights to fertilized eggs or embryos. HF 153 would result in a requirement that all embryos be used for procreation purposes, or be kept in a frozen state forever. We question whether it is the intent of the authors of this bill to grant those frozen embryos the right to vote upon reaching 18 years in frozen animation?

HF 153 was drafted and introduced without consultation from anyone in the infertility community. We strongly urge you to oppose HF 153.

Sincerely,

Rogerio A. Lobo, MD
President, ASRM

R. Stan William, MD
President, SART

So keep your marital bed as a place for love and romance and playing. If your LH test turns positive and it’s time to do the baby dance, assess your mood. If you both feel happy and amorous, then fine, enjoy the experience in bed. However, if either of you is tired, not in the mood or otherwise harboring any negative feelings and begrudgingly going to go through the mechanical motions for the sake of the fertility goal, then find another location such as the guest room or the couch. This way, the sacred marital bed remains the place for good things.

Lakita from Massachusetts

This is a very interesting question. Whenever we do IVF, we hope to have embryos from which to choose. Just as with other things in life, it’s always good to have a choice. So for example, a patient undergoes egg retrieval and gets 4 eggs and only 1 fertilizes. We put that sole embryo in because we have no choice. Her chance of pregnancy is not that good. As another example, let’s consider a patient who produces 15 eggs and 12 fertilize. Then out of those 12, we wait and wait until day 5 and choose the best-looking one. Even though we are still transferring just one embryo, her odds of success are much higher than for the first patient. So back to your question of day 3 vs day 5, the general answer is that the optimal day of transfer depends on how many embryos the patient has. Why? Because in general, the earlier you get the embryos out of the lab and into the woman’s body, the better, at least on a “per embryo” basis. This means that for any given embryo, it’s better to put that embryo back sooner than later. However, the advantage of waiting is that we get more information. Let’s go back to this second patient who had the 15 eggs and 12 embryos. Suppose on day 3, we see that she has 12 embryos. If we wanted to do a single-embryo transfer on that day, we would have to estimate and guess which one of the 12 are the best, based on how they look that day. However, if we waited two more days, then we might see that out of those 12, 4 look excellent, 6 look average and 2 died on day 3 and stopped growing. Now we are able to narrow down the choices to those 4 excellent embryos. So overall, D3 transfers can result in higher survivability and D5 transfers enable better selectivity. Also in general, patients with good prognosis (younger, more eggs, non-egg diagnosis) will do better with D5 transfers while patients with poor prognosis (older, fewer eggs, egg quality issues, previous failed cycles) would do better with D3 cycles. Therefore, you should really have a detailed discussion with your RE before doing a 2nd cycle, so that you are in agreement about the plan. Good luck!