Archive for February, 2010

Whether you are traveling across your state or across the world for IVF, it is likely you will be flying with medications.  And that can prove to be challenging – but nothing you can’t handle, as long as you plan ahead. 

First, make sure that you have enough medication in your carry on bag to last for several days.  After all, airlines do lose luggage – and it isn’t fun (and certainly adds to unwelcome stress) if you have to try to to replace medication that is lost somewhere between Cleveland and Paris in your luggage.   Of course, it can often be replaced, but not without a lot of stress and hassle – so save yourself from that potential stress! 

Since you will be traveling with medications that may have special handling (needles, swabs, temperature requirements, etc.) make sure you also plan ahead for this.  Check with your pharmacy for special cooling packs designed for air travel if you have to keep medication chilled.  According to the TSA, gels or frozen liquids to keep medications chilled are okay, so you might be fine with a small cooler and frozen gel pack or limited amounts of dry ice, depending on how far and long you are traveling.  It is also okay to carry more than the 3oz. maximum of liquid or gel if it is medically necessary.  The full TSA guidelines can be found here: http://www.tsa.gov/travelers/airtravel/specialneeds/editorial_1059.shtm

 It is usually also a good idea to keep the original boxes or bottles that the medication came in (with your prescription written on it if possible).  Additionally, I recommend getting a letter from your IVF clinic or pharmacy listing the medications you are carrying for your personal use and the medical necessity that they are in your carry on luggage.  You may never need it, but better to have it than not if you are asked. 

And don’t forget, if you do put any medication in your checked luggage, make sure it is not something that needs to be at a stable temperature.  The heat or cold in luggage holds of an airplane (boiling hot in summer or actually freezing in winter) may be well outside of the recommended guidelines for your medications – so be sure you know in advance whether it will potentially impact any of your medications–usually the liquids and gels are most susceptible.

Another important thing to consider is adjusting your medication schedule for your new time zone.  This might not be a big deal if you are only one time zone away, but when it is a 6 or 8 or 10 hour time zone difference from your home to the clinic destination, you need to be able to adjust the timing of when you take the medication to stay on schedule and keep the medication levels in your body stabilized.  Sometimes, you can adjust by one hour per day until you are on a reasonable dosing schedule.  Sometimes it is easier to just start your medication timing based on your destination time zone.  It is always a good idea to discuss this with your clinic so you have a solid plan and understand whether it is important to take a medication at a specific time, or within some time parameters (such as within one hour before or after your regularly scheduled time).

One last word of advice….if you happen to be traveling with the medication Crinone (which comes in an applicator) and need to insert a dose while you are in midair, be aware that altitude can have a funny impact on those applicators and you might be surprised by the “eruption” of gel when you twist off the cap.  Just imagine what happens to those yogurt cups and salad dressing packets that always seem to explode on your clothes during a flight….well, you get the idea.   Better to be prepared than surprised!  🙂


Read Full Post »

So many doctors have differing opinions about which type of progesterone is best for your IVF cycle.  Each doctor seems to have their favorites or the ones they use for their practice.  But have you ever asked your doctor why they prefer one over the other?  Some may give you a choice of options – so how do you choose?

Many US doctors are strong proponents of the PIO (progesterone in oils) shots.  These are the intramuscular shots that hurt like heck!  But, the benefit of them is that the progesterone can be measured in your blood stream.  And with a little preparation (ice/heat/massage), for many patients, it isn’t nearly as bad as the initial anticipation of the shots. 

An alternate source of progesterone that is gaining some popularity with US and European doctors is Crinone 8% gel.  Inserted vaginally once (or sometimes twice) daily, most studies have shown it to be as effective if not more effective than the PIO shots or other vaginal forms of progesterone (measured in studies based on numbers of patients getting pregnant- aka implantation rates, and staying pregnant- aka loss rates).  If you like reading all of the details, here’s a link to two of the more recent studies:

A third common type of progesterone prescribed is the oral or vaginal capsules such as Prometrium, Endometrin, Utrogestan, etc.  These are widely used in Europe, and are also used by many reproductive practices in the US.   They tend to require more daily applications (sometimes up to 4 or 6 doses per day) than the PIO or Crinone 8% gel, so for some patients – this may have more of a nuisance factor.   Some doctors recommend use of the oral capsules vaginally – to essentially get the progesterone directly where it needs to go without having to be processed by your liver, and to minimize some of the side effects that are more prevalent when the medications are administered orally (such as sleepiness).  On the other hand, if your IVF medications (and stress) are causing insomnia, perhaps an evening oral dose of progesterone making you sleepy would be a welcome side effect.  

In the case of both Crinone and the Prometrium/Endometrin types of progesterone, you can expect to see a lower level in blood tests than you would with PIO, and that level may vary at different times during the day. So if you have a local doctor doing your monitoring for your cycle abroad, make sure they are aware of the type of progesterone you are using so they can advise you accordingly.

Also, if you are doing IVF abroad (aka an IVF vacation) remember that taking your progesterone on a consistent time schedule is important – so keep that in mind while you are traveling.  You may need to plan ahead, or slowly adjust the timing of your progesterone dose as you travel through many time zones.  Discuss this with your doctor and have a plan for making sure you get the progesterone you need when you need it. 

Also, if you are traveling with your medications, you need to do a little advance planning.  Make sure you have them with you in your carry on,  so that lost luggage doesn’t interrupt your medication administration and create a panic of trying to replace the medication while traveling.  You may also want to carry a letter from your doctor or pharmacy in case TSA or airport screening questions the needles, vials, or gel applicators you will have in your carry on luggage. 

The bottom line is that there are several very good options for progesterone support – and it is best to discuss the options with your doctor to decide which is the best choice for your case.

Read Full Post »

After someone decides to do donor egg IVF, one of the very first decisions to make is anonymous donor, known donor, or something in between (sometimes called semi-known).    This one question will help determine which clinics you can use and what your next steps will be.

As in all things fertility-related, there is no single “right” answer to this question.   It is a very personal choice that should be made thoughtfully. 

Let’s explore factors that might help you decide:

I think the PVED (Parent’s Via Egg Donation) website does a terrific job of describing each below:

  • An anonymous egg donor is an egg donor you do not meet, selected with the help of a clinic or an agency. You do not know her name or anything else about her that is not stated on her profile. You may or may not see a photo of the donor. The donor would know nothing about the recipient/intended parent(s) or the cycle other than how many eggs were retrieved, and in some instances, whether or not a pregnancy resulted.
  • A semi-known egg donor is an egg donor who knows the recipient/intended parent(s’) first name(s) and the state in which they live. The donor and recipient/intended parent(s) might exchange emails and photos; however, no specific personal information is provided about the donor or the recipient/intended parent(s).
  • A known egg donor can be a friend, family member, or someone selected by the recipient/intended parent(s) with the intention of meeting face-to-face. The donor may know the recipient/intended parent(s’) first and last names and/or where they live, and in addition the two parties may be willing to exchange email, telephone calls, and personal information as well as to continue to keep in contact with one another. The donor and the recipient/intended parent(s) may agree upon the child meeting the donor at a future point in time. The recipient/intended parent(s) may or may not send photos of their child with updates to the egg donor as well. The arrangement regarding exchange of information is agreed upon and put into place between the egg donor and recipient/intended parent(s) at the time of the cycle. In many instances, information is shared for medical purposes.

Now comes the hard part, deciding which of these is best choice. There are a variety of factors that can help make it easier to decide. 

Anonymous – this means you do not get to personally pick the donor and will not have any relationship with this donor.  Someone else–usually the RE or clinic–is making the selection for you, generally based on criteria that you provide.  That criteria could include height, weight, hair & eye coloring, ethnicity, age, education and a variety of other factors – you may even see a baby or adult photo in some cases (although generally not allowed in many clinics abroad).  And even though it is anonymous, you will likely receive some limited information about the donor.  This may range from the most basic stats to pages of detailed information.  Often the laws of the country where you are doing IVF will determine how much information is made available to you.  Be sure to ask this in advance and make sure you are comfortable with the level of information you will receive.  There is something to be said about eliminating all of the angst of making the donor selection yourself – you aren’t paying for testing of a donor that might not be approved, and you aren’t getting attached to a donor only to find out she’s no longer available. 

One consideration with an anonymous donor–particularly in most cases where you will never see a photo–is that you will never look at your chld and see the donor’s characteristics or say to yourself – I see the donor’s eyes, chin, smile, etc.     For some, that alone may be worth giving up the option to see a photo of the donor. 

Also, in most cases you won’t have to deal with the details of a donor contract.  The contract will be between the clinic and the donor, you will not be a party to that contract. Nor will you have any liability for the donor’s future medical care for anything related to the cycle (this clause is included in many donor contracts).

Of course, it also means that your child will never have the opportunity to learn more about the donor.  For some people, this is a deal breaker, for others, it is a blessing. 

Semi-known – More and more I see a move toward semi-known donors here in the US.   It is sort of a hybrid between known and anonymous – with some of the benefits of a known donor (photos, detailed profile, etc.) without full information disclosure or the worry about having an on-going relationship with the donor.  Perhaps we are kidding ourselves though if we believe that with a first name, college information, age, photo and other lmiited imformation a prospective parent wouldn’t be able to find out full information about a donor in about 15 minutes with Google and Facebook.  And the opposite is also probably true that many intended parents could be tracked down just as easily. 

Some clinics or agencies will allow you to have a face to face meeting with a semi-known donor, and some will not.   If this is important to you, discuss it with the agency or clinic in advance.  Semi-known donation  does generally require that you have a contract with the donor, which may allow you to negotiate some of the terms of the donation, your obligations, and potential future contact.  However, keep in mind that you really cannot legally make someone fulfill their commitment to allow contact with you or your child 18 years down the road. They may commit to keep a 3rd party notified of their contact information, but realistically, a lot can happen in a donor’s life in 18 years.  So, while you can set the expectation of a potential exchange of information, legal experts seem to agree that it would be difficult if not impossible to enforce.  Yet, it still provides the potential of your child obtaining more information (health history, etc.) about the donor if all parties agree.     

Known– Often a known donor is a friend or family member, but it can also be someone you’ve never met before.  The characteristic of a known donor is that full information is exchanged between parties.  A legal contract spelling out all of the details of the agreement is a must!  Even if this is a family member or best friend, it is best to keep everything outlined in writing so no misunderstandings occur.  If this person is a family member or close friend, it is a very good idea to have counseling together to explore all aspects of the process and make sure you are in sync with what will happen regarding frozen embryos, disclosure, and many other aspects.

Some clinics outside of the US will allow you to bring your own known donor,  but some countries have laws that prevent any known donors.  So be sure to verify this in advance with the clinic if you are looking at DE IVF abroad and want to bring your own donor.    And if you do bring your own known donor to another country, you should still have a legal contract in place in the country where you live and do the psychological evaluations to help ensure that everyone is in agreement about key aspects of the process. 

Is there one “right” choice?  No.  You have to decide what is most important to you, and that will help you narrow down your options of where you can go for your treatment.  That’s why this should probably be one of the first decisions you make. 

But aren’t we lucky to have so many choices available to us?

Read Full Post »