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Today's Family Magazine

Paving a path to parenthood

Apr 24, 2019 05:54PM
By Nina Polien Light

Alison and Shane Brennen tried to conceive for a year before turning to doctors for help. The Chesterland couple learned Alison ovulates irregularly and Shane has abnormal sperm morphology, or misshapen sperm. Alison took three rounds of Clomid, an oral medication that stimulates ovulation in some women, but it didn’t work. Frustrated, the couple visited a fertility clinic where doctors placed the chance of conceiving without medical intervention at just five percent.

“The reproductive endocrinologist said, ‘If you want a baby, you’ll need IVF, and even with IVF, there’s only a 40 percent chance you’ll conceive,’” Alison says, referring to in vitro fertilization, or the process of fertilizing an egg and sperm outside the body and later transferring the resulting embryo, at a stage known as blastocyst, to the uterus. “We talked dollars and it’s just horrifying and scary.  We did a lot of crying, praying and talking to really figure out if this was the way to go.”

The couple started the IVF journey in fall 2016, which resulted in four embryos.  One embryo didn’t survive to the blastocyst stage and one rushed embryo transfer (performed because doctors were concerned about the embryo’s viability if not used immediately) was unsuccessful.  Devastated, the Brennens didn’t attempt another transfer until the following March.

“This transfer was more calm and it was scheduled,” Alison says.  “I had acupuncture before and after the transfer.  It was very chill, it was lovely and it took.”

The couple’s son, Liam, was born on December 12, 2017.

IVF technology has improved significantly since Louise Brown, the first baby conceived through the process, was born in England on July 25, 1978.  The then-experimental method is now a go-to treatment for couples, like the Brennens, experiencing infertility.  It’s also an option for women with blocked or missing fallopian tubes, women who have frozen their eggs because of illness, single women who wish to become mothers through donated sperm, women whose partner has a low sperm count and other reasons.

“Nothing has a higher pregnancy rate than an in vitro cycle,” confirms Cynthia Austin, MD, medical director of in vitro fertilization at the Cleveland Clinic.  “The success rate for women under age 35 is 60 percent.  For women (ages) 35-37, it is 50 percent.”

Some women are hesitant to try in vitro fertilization because of a mistaken belief it works too well—inevitably resulting in twins, triplets or higher multiples.  But preliminary 2017 data from the Society for Assisted Reproductive Technology, the latest statistics available, indicate 86.6 percent to 93.1 percent of in vitro patients, who use their own eggs and achieve pregnancy, give birth to singletons.  Of the remaining live births, only 6.9 percent to 13.1 percent are twins and fewer than .3 percent are triplets or higher multiples.  Further, more than 82 percent of deliveries occur at full term.

IVF is divided into five steps:
  1. Ovarian stimulation.  This takes a week or two and involves using medication to coax the ovaries to produce follicles.  “At the beginning of the menstrual cycle, there’s a group of follicles that could continue to grow, but in a natural cycle, only one does and the rest die,” Dr. Austin explains.  “In IVF, we try to get more of that initial group to grow instead of just dying.”
  2. Egg retrieval.  About 36 hours after the woman receives her final injection to trigger ovulation, the doctor performs a low-risk procedure using transvaginal ultrasound.  While the woman is under sedation, fluid is aspirated from the follicles.  It usually takes about 10 minutes.
  3. Sperm retrieval.  Sperm is collected from the woman’s partner or donor.
  4. Fertilizing and culturing the embryo.  Egg and sperm are united and cultured in the hopes of forming an embryo.  If successful, five days later the embryo will reach a stage known as blastocyst, when the fertilized egg is in its second growth phase.
  5. Freezing or transferring the blastocyst.  At this point, the doctor can gently glide the blastocyst, which is encased in a syringe with a little fluid, through a catheter and into the woman’s uterus.  If it “takes,” the embryo will implant several days later. Alternately, blastocysts can be frozen for future use.  "Once frozen, they have no shelf life," Dr. Austin says.  "They remain as good as the day after they are frozen as they would be 10 years later.
But IVF will not work for everyone.  Fortunately, there are other options for a woman to have a child who is biologically her own.

“If a woman is able to make her own eggs but does not have a uterus, or her uterus is damaged, or she can’t sustain pregnancy, she can have a friend or hire a person to carry the pregnancy for her,” Dr. Austin explains.  “We create the embryo and transfer it to a third party.”

By Ohio law, this third party is called a gestational carrier.  Both she and the biological parents-to-be are required to retain separate attorneys to protect their interests.  A legal document, signed before the IVF cycle begins, addresses a host of issues, such as spelling out the identity of the legal parents, determining who is in the room during the embryo transfer and mandating who makes medical decisions if complications arise during delivery.

Women may turn to a trusted friend or relative to serve as a gestational carrier, or reach out to an agency that specializes in screening candidates.

“We also screen the gestational carrier for the couple to make sure we think, medically, this is a good person,” Dr. Austin says.  “That’s a lot of trust to put in a person.  You’re not going to hire just anybody to do it.”

With or without the use of a gestational carrier, IVF takes its toll physically, emotionally and financially—often running up bills of tens of thousands of dollars, depending on the number of cycles a woman undergoes.  But for couples, like the Brennens, the payoff is priceless.

“When I held Liam in my arms, I told Shane it was worth every penny, every tear, every shot,” says Alison, who hopes to one day transfer the one remaining embryo.  “There’s something to be said for a struggle.  I appreciate this process.  The knowledge the doctors have to give a baby to a couple with a five percent chance of having a baby on their own is a great miracle.”

To read more about the Brennens’ path to parenthood, visit their blog at  www.thebrennens.com.