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Posts Tagged ‘ivf vacation’

I often get asked why people choose to go to the Czech Republic for IVF, donor egg IVF, and donor embryo treatments.  My friends Kathryn Kaycoff-Manos, MA and Lauri Berger de Brito over at Global IVF have recently been traveling in Europe speaking at a conference on cross border reproductive care. Their travels also included Prague and Brno and they kindly invited me to write a guest post for their blog on the subject of why people choose to go to the Czech Republic for their IVF Vacations.

Please stop by and let me know what you think, or tell me if I missed any key factors that made it appealing to you: http://www.globalivf.com/blog/?p=745

 

One last reminder…..this blog is has now been moved.  Please come over to our new home at www.ivftraveler.com/blog so you don’t miss out on new posts and hopefully many more lively discussions about traveling abroad for IVF treatments.

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Over many years and many cycles, I started compiling a list of things to help maintain sanity while enduring the excruciatingly long 2ww (2 week wait – the wait from when you have an IVF transfer until when you can test).  

The good news is that often if you are doing IVF abroad as part of an IVF vacation, you are still relaxing and then traveling home for at least the first part of your wait.  But then you get home, get unpacked, and bam!, it hits you.  The embryo obsession.  So, here are some ideas for the rest of your wait. 

I’ll share what I have – and feel free to add your own ideas.   The goal is to have enough non-stressful things going on that you don’t get obsessively focused on “am I?” or “am I not?” pregnant. 

Things to do to distract yourself during the 2 Week Wait:

  1. Drink 96 oz of water every day!
  2. Limit yourself to XX number of minutes a day to think about your embryos, then say STOP and distract yourself – visualize the embryos snuggling in for a long hibernation (around 9 months)
  3. Plan activities to distract yourself – such as:
  • Play games (board games, card games, video games, crosswords, sudoku, solitaire)
  • Do some crafts (knit, crochet, sew, beading, stamping…)
  • Art therapy: write a song or an essay or a book or draw a picture…
  • Organize your photos into albums
  • Organize your CDs
  • Listen to your favorite music or meditations on CD
  • Read something light and funny
  • Watch a video or go to the movies (take DH to a drive-in if you have one)
  • Listen to stand-up comedy
  • Chat on the phone, email all your friends
  • Go to acupuncture
  • Sit on a park bench and people-watch
  • Go for a long drive
  • Go for a walk in the botanical gardens
  • Make a list of things you’ve never seen in your town (stores or tourist sites you haven’t been to) and then go see them
  • Visit with nature (beach, lake, forest, mountains, waterfalls…)
  • Walk a dog (yours, a friends, or volunteer at a local rescue)
  • Get a pedicure
  • Retail therapy
  • Cooking therapy (there’s gotta be something you love to make or would like to try)
  • Invite a friend over for tea (decaf). You can include a fruit salad that just happens to have fresh pineapple, for the bromelain…
  • Spend an hour at your local bookstore or library
  • Visit a planetarium
  • Research a place you’d like to vacation
  • Go out to brunch
  • Go for a picnic
  • Go to a club and listen to live music
  • Pick berries
  • Plant some flowers
  • Sunbathe at a lake, beach or in your backyard
  • Go camping, build a campfire, roast some marshmallows
  • Watch a sunset
  • Go to church or wherever else your spirit can draw strength
  • Walk to an ice-cream shop
  • Go to a comedy club
  • Visit a museum or art gallery
  • See a play
  • Watch a live sporting event
  • Play mini-golf 

Surely, you all have some to add to this list?   I look forward to hearing your ideas!

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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.

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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?

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Flights are booked.  Hotels are confirmed. Plans are in place, and I’ve started the good medications.  

It seems like I’m forgetting something…or lots of things.  This seems too easy this time – far less stressful than my last trip to Reprofit.   

But maybe it’s just so much easier to go back to a foreign city for IVF when you’ve been there once before?  I can’t believe it is 12 days until I leave and I haven’t even started thinking about what I need to pack or take with me.   I think by this time last trip, I had a folder of stuff ready to go, knew the average daily temperature each day I would be in Brno, had researched the hotels and restaurants and was chomping at the bit feeling like the departure date couldn’t come soon enough.  

In contrast, today, I feel wonderfully calm and relaxed – even more so after aunt flo arrived earlier this week and I started the meds to build myself a thick and fluffy lining for those embryos to nestle in and take up residence.

It’s so interesting how things fall into place.  I was trying to figure out how I would handle my luggage on the return trip…keeping in mind that I’m not supposed to lift anything more than 5 pound for the two weeks after transfer.  Asked and answered. A friend of mine is going to be at the clinic at the same time I am and by chance (or divine intervention), I found out a few days ago that she and her husband are booked on the exact same flights back that I am, and her dear husband has offered to help with my luggage.  God bless him! 

I even had fun booking my hotel for Prague – I’m spending a couple of days there before heading on to Brno and the clinic.  It appears to be a lovely historic little hotel near Old Town and Wenceslas Square.  It truly sounds delightful, and not a bad price either.  One of the great things about the Czech Republic is that they still have their own currency, so the exchange rate is still pretty good for Americans traveling there.  Currently, it’s around 18 CZK for $1.  A far better exchange rate than traveling to the countries that have the Euro as their currency. 

I’ve been in contact with the Grand Hotel in Brno–asking for a nice quiet and non-smoking room away from the noise of the streets.  Their staff have been wonderfully responsive so far – I hope that is a sign of good things to come. 

I even have some plans for relaxing and letting the days go by as I’m waiting for my embryos to grow big and strong and start hatching. I’ve pre-arranged for massage and acupuncture in the days prior to my transfer, and I’m hoping to spend a little time in a delightful little tea room that I’ve heard good things about.   Perhaps even a visit to the salt cave (the one built in an office building just off of Freedom Square).

It’s official – I’m excited about the trip (oh, what the heck, let’s call it a vacation) and relaxed all at the same time.  What a great mindset to be in – I hope my body continues liking these drugs and lets me keep this happy mood throughout the trip and even when I return.

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When I was a teenager, LEI was a brand of jeans.  Today, I found out what it means as an IVF patient, 

Luteal phase endometrial injury.  Big ominous sounding name, right?

Actually, it’s a rather new technique that is gaining some support in the Reproductive Endocrinology circles.  My doctor referred to it as a little science and a little voodoo.  They don’t seem to be too sure why it works.

Briefly, there have been two recent studies that showed a significant (about 3 fold increase) in patients getting pregnant through IVF if they have had an LEI prior to the cycle.  Apparently, the technique was “discovered” sort of by accident, when they realized that women who had an endometrial biopsy prior to an IVF cycle had an increased likelihood of having the embryo implant and create a pregnancy.  More details about the study can be found here: http://clinicaltrials.gov/ct2/show/NCT00837733

So, in the interest of never feeling like I left a rock unturned, I set out to my RE (reproductive endocrinologist – i.e. fertility doctor) for my LEI this morning.  The doctor comes in the room and goes over the procedure with me, then says, “you know this hurts, right?”  I said, yes, they did tell me it would be painful, but when I asked how painful it would be, I was a bit shocked to hear the doctor say “probably about an 8 on a scale of 10”.  Yikes.  I was really happy I took 4 Advil before that appointment.   He was right, it hurt like heck, but just for a few moments, so if it works, it was worth it.  And if it doesn’t, I’ll never wonder if that would have been the thing that made the difference. 

I have to say, I left there with more hope for success in this cycle than I have had in awhile.  It was a good to have that back.

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Life really has been getting in the way of my travel planning lately.  I think it is time to get serious though and get my hotels booked at the very least.  It is hard to believe that I’m leaving in just two weeks. 

Thankfully, I used Kayak to track airfares for over a month and last week finally got a reasonable fare into Prague with only one connection each way.   I’m planning to spend a few days in Prague before going to my final destination, Brno (the city where the clinic is located). 

I had booked my hotel in Brno months and months ago when I first received my confirmed treatment date.  But, my plans have changed, and GTA hotels is not being very good about letting me changing the arrival date.  They are basically making me cancel the entire original reservation and re-book it at the current room rates.  Grr, I had expected to just be credited for the nights I won’t be there – not having to start with a whole new reservation.  Oh well, live and learn. 

At least I know what hotel I want to stay at in Brno – that was easy – the Grand Hotel Brno – near the main square, walking distance to theatre, restaurants, and right in front of the main tram stop that will take you pretty  much anywhere in town. 

Now, I just need to research and make a final decision about my hotel in Prague.  Suggestions anyone?

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