Blogging at 36,000 Feet

Well I am on my way back to Boston to spend the day with my Mom. She is really going downhill fast and I really hope that she is awake enough to know that I am there with her. It is funny to think that back when I was born that a woman over than 35 years old was considered high-risk just because of her age. We are not talking about the risk of genetic issues...simply being pregnant at 35 was considered problematic! Now I consider a 35 year old to be pretty darn young considering my average patient is 38.5 years old.

My Mother conceived me when she was 40 years old. My Dad diagnosed her as being in menopause. That's what happens when General Surgeons provide RE opinions. She was a lot older than the most of my peers' mothers and yet I never felt that she was somehow less involved or moving slower. She was always there for me during those summers on Cape Cod and she frequently planned excursions to Mystic Seaport or the Boston Museum of Science and even a trip to Washington DC with a two of my classmates and their Moms.

Yet to even have any children was a miracle for her. She had a bicornuate uterus with a rudimentary horn. She and my Dad were told that it was hopeless and they needed to adopt. Clearly I am evidence to the contrary...as are my 2 older brothers!

Well, here's to mothers everywhere. We are heading down into Boston Logan. Wish me well...

Addendum 5/22/12: Back now in DC and I spent all day Monday with my Mom. She had moments of lucidity and at other times she had what my sister-in-law calls the "100 mile stare." Still she knew who I was and enjoyed watching the photos and videos that I streamed from my iPhone to her TV. We will just take it day by day. I appreciate all the support shown by my staff and by my patients. My mother has been one of my biggest supporters over the years and when she stopped reading this blog it was a sad day for me. The natural order of life is for children to go on after their parents but that doesn't make it any easier. I am too open from an emotional standpoint to practice in a field of medicine where end of life issues are common....I am glad that I am blessed to practice in the field of Reproductive Medicine.

Having a Back Up Plan

Yesterday my son Seth (see photo of him with his Grandparents before my Mom's recent turn for the worse health-wise) experienced the Mac equivalent of the "blue screen of death." His MacBook Pro started behaving unpredictably and then refused to boot up at all. Earlier I had made an appointment at the Genius Bar but Seth had reassured me that all was well and I didn't need to bring his laptop over to the Clarendon Apple Store (25 min from our home). Then the meconium hit the fan and at 7:40 pm he declared an emergency and I grabbed the defunct machine and hopped in the car to make the voyage back into Virginia. I called ahead and the gang at the Apple Store told me that my genius would wait for me….is that great customer service or what?

The laptop was apparently experiencing a "kernel panic" or is it "Colonel Panic" ?? Beats me. in any case the system folder was corrupted and the only solution was a clean reinstall of the OS following erasure of the hard drive. BUT he uses Time Machine and should be able to nearly completely resurrect his machine once he returns to college this PM to start exams. Crisis averted….I hope.

It always helps to have a back-up plan. In fertility treatment this back-up plan could be the use of donor sperm, donor egg, donor embryo, gestational carrier or adoption. Although we can never know who will achieve success, we can often give good advice to those patients who need to consider alternative paths to parenting.

The use of donor sperm is the most common issue that we face in these discussions. In certain cases of severe male factor I think that considering the use of anonymous donor sperm is appropriate. In stimulated IVF we often consider splitting the eggs between husband and donor in cases of severe male factor BUT this makes no sense to me unless the couple is accepting of the concept of parenting a child born from fertilization with donor sperm. Don't waste the eggs if you are uninterested in using those embryos.

I currently have a patient who is successfully pregnant after IVF using this concept of a back-up plan that fortunately was not needed. Previously her attempt at stimulated IVF had resulted in very poor quality embryos. We were uncertain if this was an egg issue, a stimulation protocol issue or a sperm issue. We adjusted the protocol, used donor sperm to fertilize some of the eggs and the cycle was much more successful with fertilization from both husband and donor . Ultimately we had a bunch of embryos from the sperm donor and even two nice blastocysts from the husband. We cryo'd the donor sperm embryos and used the two from the husband. We were all ecstatic to see cardiac activity on sonogram recently and they are off for obstetrical care...

Having a back-up plan can make all the difference.

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