In vitro fertilization
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After years of trying to get pregnant with in vitro fertilization treatment, Heidi Krupp-Lisiten has learned a lot about herself and the pitfalls of fertility treatment.

Now, she shares the emotional roller coaster of meeting with a Las Vegas-based specialist—Dr. Geoffrey Sher—for her eighth attempt at getting pregnant.

In the years I've been trying to get pregnant, I have tried everything. I have spoken to psychics, healers, energy workers and astrologists—among others—to help me attempt to "control" the situation. I met with an acupuncturist almost every day. In one case I carried a fertility photo from a tomb in India in my underpants, close to my uterus, to bring about what I still so desperately want—my very own living, breathing baby. I would try anything to help make it work. My doctor thought I was completely out of my mind.

When I finally realized none of that stuff was working or giving me what I hoped for, for the first time I let go and said, "Not this time." I surrendered to the universe, hoping for the best, but having walked down the road of the worst—keeping in mind there is a way I can and will have a baby, and allowing this journey to get me closer.

Sunday Morning: Leaving for Las Vegas
I've completed 10 days of follicle stimulation meds, and now I am off to Las Vegas by myself.

I haven't really focused on the cycle the way I would have in the past. I think maybe I am getting wiser, so keeping my focus on getting lost in work helped me pass the 10 days of shots that I had to give myself. My protocol this time was different in a very important way—fortunately, for both me and my husband, I didn't have to take Lupron every day. This drug, which affects estrogen levels, has the ability to turn me from nice "Heidi Jekyll" into savage "Heidi Hyde"—or at least some other alternative much-less-fun-to-be-around version of myself.

Over the past days I really committed to getting to sleep early, cutting out wine and watching what I was eating, and continuing my morning exercise as I usually do. I figured if I didn't allow myself to totally concentrate on the cycle and told myself I was just going with the motions this time around I would prevent myself from becoming carried away.

As always with IVF, I was taking the various meds and injections each night as though they were part of my routine—no matter whether I had a hot flash or a moment of exhaustion or a feeling of defeat, I just keep moving forward. I just did not allow myself to emotionally engage in what I was doing for fear that it would hit me suddenly, "What if it doesn't work?" In the past I relied on positive thinking, focusing on being extremely optimistic, just "knowing" that failure wasn't an option.

When I get into the car to take me to the airport, I realize that I have to let go. I made a commitment to myself, to Darren and to our doctor that I understood the risk that a woman my age isn't likely to have quality eggs. For once in my life, I allow myself to feel that instead of racing through it and pretending to myself that by doing so, I could deny this reality.

I burst into tears as I hug my husband and asked him if he will still love me if it doesn't work. I am as vulnerable as I have ever been, yet feel so protected at the same time. I let it out, I let it go. As least for now, I am able to release my fear—I face it head on, off I go to the airport, and now it's on to the beginning of the Vegas journey. I hope that what happens in Vegas, leaves Vegas—and grows for nine months into a healthy baby. Our baby.

Sunday Evening: Arrival in Nevada
I want to count on two things: believing I will be a mother, and not being afraid to be a mother. Perhaps these two points were blocking me all along?

Since after the last IVF cycle we had utilized all our frozen embryos, Darren and I no longer have our three banked embryo "insurance policy," which we had created and frozen before we were married. We thought these embryos represented a last resort. And since they were created when we were both younger, we thought they would be of better quality. We never knew that variations in IVF practice can improve—or degrade—the quality of embryos.

We now know that the stimulation meds were off, and the embryos' ratio of stimulated follicles to retrieved eggs is not particularly good. Also, these embryos were slow-frozen instead of "fast vitrified" after having been alive only three days (instead of at least five days). None of these are best practices.

At the time of that retrieval I was only 39, and the chance of high-quality eggs was much better, which is why Darren and I had decided then to have a retrieval even though then we were not married and were not ready to have a baby. We wanted to give ourselves the best chances at a child in the future. Unfortunately, we did not know IVF best practices at the time. I now know we cannot ever go back in history, but I so wish we had been as informed then as we are now.

So, a few years later when we finally decided to complete an IVF cycle we used both embryos from that cycle, and those we had kept guarded, and one of the three survived thawing. That embryo along with another were transferred into my uterus leading to that moment of celebration at the words "You are pregnant." But as I've shared, those glorious words were only fleeting, lasting a mere few days and unfortunately that "pregnancy" was what I am told is called "chemical," one that would not result in a healthy pregnancy.

Those embryos did not work and so here we are, and here I am—the night before we find out if and how many possible follicles a woman at 43 can make this time around.

Monday: First Sonogram
I thought that during this time I would be ready for anything, but I was sure nervous about the unknown. It began to hit me—the fear.

"What if I didn't have any follicles?"

"What if I couldn't make any eggs?"

"What if it didn't work?"

I was anxious and knew that I couldn't do a thing to fix it. That was a hard one to swallow.

Before leaving for Vegas, Darren had packed me a suitcase for what could be two weeks or more. I had never completed an IVF cycle in Vegas before, so this was a first. All of this was a first. This was the first time I didn't tell everyone, the first time I surrendered to the outcome (as much as I could ever surrender). I was watching this all go by as if it were a movie in which I wasn't playing the starring role. I began to shut down. It was easier to do that than to get myself into the state of obsessing about whether it would work. I had done that before so many other times and the disappointment and pain afterward was a kind I had never felt before—and I never hope to have to feel again. It would paralyze me and I would lose faith in everything.
This time, I am turning it over to a higher power, attempting in the process to resist my ever-present need and desire to control everything. I was hoping to find that which will guide me, protect me and support me. I began to pray. I began to go into my intuition and just let go. I began to know that I would have a baby no matter what and how and if this didn't work, the next time would.

As I waited for Dr. Sher to come into the room to view the follicles, I prayed again. I asked God to please give me a chance to make this happen. I wouldn't race through life, and I would be a present wife, and most of all I would be present as a mother for my child. I would embrace every moment and I would be a wonderful mother. I was as ready as I guess I can be, or anyone can be with IVF.

The doctor was really pleased with our first sonogram. I had 12 follicles—the most I have ever had. (By comparison, one of the first times I was with Dr. Sher I had four or six.) I lost it. I hadn't realized that some women don't make any, or make just one. It only takes one. I learned that no matter how many you have, it doesn't matter. You need a good egg inside these follicles for this to be a success.

There was a glitch though—my uterine lining wasn't what it needed to be. It was at 6.8 millimeters, and to implant a healthy embryo it has to be 8 millimeters or more. We hadn't had this happen before. Fortunately for me, my doctor pioneered, tested and documented the success of using Viagra to improve a woman's lining prior to transfer. He prescribed Viagra for me, along with other meds, to give the lining a go. I found a Las Vegas acupuncturist named Sharon Poon to calm me and to help improve the size of the lining. Acupuncture is key during a cycle for so many reasons. I missed Dr. Frank Lipman and Ming Jin from New York—my voodoo needle docs, as I lovingly call them—but Sharon was on the case.

Tuesday: Good News
I can happily share that, after Viagra and acupuncture, my lining is at 9 millimeters. I had called upon some of my most spiritual guides in Canada and New York to dial into the number 9. I knew it needed to be at least at 8, but I wasn't focusing on "at least." I wanted to increase my odds. This wasn't the same as believing I could control it; I was surrendering and letting and allowing others to help—all life lessons that I needed and need to be aware of in my growth.

Wednesday: A Day Off
No sonogram. No appointments. Just time to relax and catch up on work.

Thursday: The Follicles Are Growing
Based on their size, we have at least 12 good follicles. There are more, but for now we are staying focused on those that seem large enough to produce mature eggs. My lining is now at 9.3 millimeters, which is very good. Dr. Sher decides to trigger my ovaries to release an egg by giving me a shot of Human Chorionic Gonadotropin. He wants to prepare me for the retrieval of the egg on Friday night instead of tonight so that my lining and follicles can get bigger. He says he is pleased with the follicles so far, and wants the best outcomes. He is no longer a doctor: he is my friend, he is family, and just being here in Vegas with him makes me know I am in the best care.

Dr. Sher is a pioneer in this science and has the best bedside manner. He treats each patient as though they are special. I was able to watch and see what was happening in the waiting room. He passionately believes in what he does and he is committed to helping empower women to achieve their dreams. Maybe even more so, he thrives on helping women overcome the feeling of powerlessness they so often easily get when faced with the fear of not being able to have a baby.

I saw a woman in the waiting room whose husband is in a wheelchair. Another woman had uterine cancer and she wanted to freeze her embryos before her uterus had to be removed. Despite her cancer, she now has a chance to mother her own baby. Another woman was donating her eggs to a family for them to get their chance. For so many people, including myself, Dr. Sher provides hope.

We let Darren know that he is to come to Las Vegas by Saturday. The trigger will be done on Friday night—coincidentally, the first night of Hanukkah—and we need Darren on Sunday when the retrieved eggs will be mixed with his sperm. I'm a romantic, so I inform Darren that he needs to create a sperm sample tonight—doctor's orders. We both giggle a lot during this phone call—which makes it all feel a lot lighter.

I am relieved that Darren didn't need to come sooner. We had a big client party in New York on Thursday night for our client GAIAM, at Donna Karan's Urban Zen studio, with Trudie Styler and Sting. Trudie has a new series of lifestyle DVDs, and we were throwing the launch party and doing all the media for the products. Knowing that Darren would be there gave me comfort and assurance that he now can take care of my first child—my business.

This was the first time in my career that I had no choice but to give up this important business thing for my own personal thing—I am anxious but have faith and confidence in my team and Darren to make us shine. And they do—which puts me at peace, knowing that the business can work without me since I will need it to when I have a baby.

This is what it will be like when I am a mom—I will need to say no to things with work, I will need to balance my own needs and those of my husband and life to take care of this angel of god. This was that lesson, and one that I treasured: I can count on others—another great life lesson.

Friday: The Trigger
When I stop taking Viagra I get a terrible headache—I need to get some sleep but I had to be up at 11 p.m. for my shot. The timing is exact: you cannot be off by even a little. I went to bed at 7:30 p.m., exhausted from the medication and the reality of the coming week. I know Darren will be here on Saturday. I can't wait to see him and know he will calm me and support me and together we will do this—no matter what.

Sunday Morning
It is 7:15 a.m. My procedure is at 10:30.

We need to get there an hour early for pre-op—retrieve Darren's sperm and get my IV ready for anesthesia. I like this part of it.
Here is what I am feeling: We've been here before, and we always do well at this stage. We have gotten almost an egg out of every follicle and in 24 hours will know how many embryos have started to develop. We do this part well—it's the quality of embryos that we need to make sure is good.

I am ready. I am not as scared as I usually am. In fact, I am excited. I believe, for the first time, that today is a day I will know forever—it is the day we will conceive our baby.

My egg and Darren's sperm are joined—and possibility awaits us.

What are Heidi's chances? Her doctor, fertility expert Dr. Geoffrey,explains how IVF works.

Are you left wondering what was happening during Heidi's IVF procedure? The fertility doctor treating her, Dr. Geoffrey Sher, explains.
Heidi received her hCG shot on Friday evening at 11 p.m. This trigger shot causes the eggs to mature. The genetic process of maturation, or "meiosis," which takes about 30 to 34 hours, involves a reduction of the normal quota of 46 chromosomes in the egg to 23. The egg is now primed to be fertilized by the sperm. This essential prerequisite is the critical step in human reproduction. If following meiosis the egg ends up with even one more or one less than 23 chromosomes, it will not (upon fertilization) be able to develop into a "competent" embryo—one that is capable of producing a healthy baby. In fact, in most cases such an embryo will not even attach to the uterine lining or will be lost as an early miscarriage.

So I again reminded Heidi that it will be the quality of her eggs, rather than Darren's sperm, that will determine the success of this IVF cycle, and that at 43 probably only about one in 10 of her eggs will end up with precisely 23 chromosomes. She needs to have rational expectations. But Heidi is not the type who will easily accept failure as an alternative.
Of course she has blocked all of this "overload information" from her conscious mind. But then again, she and Darren are so ready for parenthood and have dealt with some heartbreaking disappointment in the past, so who can blame them? For my part, I just pray that somewhere among the eggs she produces will be at least one capable of taking her and Darren from infertility to family.

The fact, however, is that no one other than the great croupier in heaven"shuffles the deck or deals the hand—and that's quite a cliché since this is all happening in Las Vegas. If we are blessed with being dealt a "good hand" and eggs can be obtained, and we play it properly with the best intent, expertise and humility, we are likely to win. But if we are dealt a "poor hand" we will lose—no matter how well we play it.

Today Heidi underwent egg retrieval. Darren, her husband, was present in the procedure room and observed the entire process. Heidi was super nervous, but who could blame her?

Heidi was attended by Dr. Sharon Poon, who administered her anesthetic. Heidi and Darren both drew considerable comfort from the fact that Sharon has also done two IVFs with us and both times she was successful (with 8-year-old Charissa and 6-year-old Blake). What is more, Sharon is also our resident acupuncturist and also gave Heidi her acupuncture. So everything seems to be going well for Heidi and Darren at this time.

After Sharon administered Protocol anesthesia, Heidi went straight off to sleep. Darren could hardly believe how tranquil she appeared in her somnolent state. With Darren watching on and clearly somewhat emotional and in awe, we aspirated 10 eggs from Heidi's ovaries. Nine out of the 10 were mature. At Heidi's age of 43 only about 1 in 10 mature eggs are likely to be chromosomally normal, so with 9 mature eggs she has a real shot—all we need is for one of those nine to be chromosomally normal.

Another bonus was the fact that at egg retrieval, Heidi's uterine lining measured 12 millimeters, which is excellent. So the Viagra-and-acupuncture treatment seems to have been worthwhile.

Now we head over to our IVF embryology laboratory. If all goes well we would expect seven or eight of Heidi's nine mature eggs to fertilize. Of these, hopefully four or five would make "potentially viable" embryos (i.e. those that reach six to nine cells by the third day after fertilization), and for half of these embryos to develop into blastocysts (the most advanced, 100-plus cell preimplantation stage embryos), five to six days from now.

We have found and have reported on the fact that embryos that do not make it to blastocyst stage are almost invariably chromosomally abnormal and not worthy of being transferred anyway. Who are we fooling by transferring embryos before they reach this stage of development?

Even more potentially good news today! Heidi has seven fertilized eggs out of the nine retrieved. That is a pretty good yield. Tomorrow we will perform a genetic test that measures a gene known as human leukocyte antigen-G (HLA-G) in the culture media surrounding Heidi's two-day-old embryos. This test, although not as conclusive as CGH testing, will provide us with a good measure of the embryos' potential to produce a viable pregnancy.

Two days from now, we will grade the embryos microscopically. The method we use is called the Graduated Embryo Scoring (GES) system, which we introduced in 2000. We culture and assess each embryo separately, determining if they reach daily developmental milestones—and we give them a score of up to 100 points. The GES method differs from other traditional grading systems in which a single assessment is made on groups or clusters of several embryos.

Heidi herself seems to be in a good place. I believe that she understands that everyone, including Darren, is doing their very best for her and that we are all guardedly optimistic. She is doing so well that she went off with Darren to a business meeting today.

Now we need to wait for a few days so that we can better assess embryo quality. Heidi's embryos will ultimately get the opportunity to prove themselves by reaching the blastocyst stage of development before being transferred to her uterus. By allowing embryos to develop to this stage, many of the poorer quality ones are culled, making it unnecessary to transfer too many at one time.

If you've ever wondered why it is so difficult to answer questions relating to success rates with IVF, this is the reason: It is truly a work in progress. But as each embryo reaches a milestone, the future becomes clearer.

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As a reminder, always consult your doctor for medical advice and treatment before starting any program.


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