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Postponing parenthood through in vitro fertilization

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Gillian E. St. Lawrence
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Tuesday, July 6, 2010; 11:00 AM

Gillian E. St. Lawrence discusses why she and her husband chose to freeze their embryos until they are ready to be parents, and the research they did before making this decision. To learn more about her experience with IVF, visit her Web site.

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She was online Tuesday, July 6, at 11 a.m. ET to take questions.

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Gillian E. St. Lawrence: Hi, everyone. Thank you for joining the chat this morning. I'm looking forward to answering your questions about Preservation IVF. If you would like more info after the chat, please visit my Web site www.preservationivf.com.

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DC: Why, at the ages of 30 and 32, did you know "that time was running out, we resigned ourselves to the fact that we probably would not have children"? I am dumbfounded by that statement, but maybe it is because almost every mother I know had their child or children well after age 35.

Abandoning hope for a natural pregnancy before you have even tried, and well before you are anywhere near the outer limits of fertility, does not make sense. For those with the means, your argument for delaying parenthood makes good sense, and would be much stronger if it were simply premised on a wish to wait to become parents, rather than on a misplaced sense of futility.

Gillian E. St. Lawrence: By age 30, women have lost almost 90 percent of their eggs. See the Wash Post article by Carolyn Butler http://www.washingtonpost.com/wp-dyn/content/article/2010/02/22/AR2010022203639.html

After age 35 there is a steep drop off in fertility and the risk of down syndrome increases by over 500 percent (versus the risk in our early 20s). So, my husband and I knew that if we weren't going to start having kids in the next couple years then we should look for other options. While many women do have healthy babies after age 35, I can tell you there are many, many women in fertility clinics in their late 30s who cannot conceive naturally.

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Washington, D.C.: Gillian, for others looking to do what you did, about how many trips to New York and how much time off did you take? Did you find any doctors in the DC area willing to help you?

Gillian E. St. Lawrence: It takes about four quick visits (like 15 minutes) to the clinic prior to the egg retrieval. I was able to combine visits with frequent work visits to NY that both my husband and I had. I felt most comfortable with the doctors that I found in NY but there are many fertility clinics in D.C.

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Baltimore, Md.: Who gets the embryos in the event of a divorce? What happens to them if one or both of you dies?

Gillian E. St. Lawrence: Our wills say who gets the embryos if we both die. My parents would inherit them. Personally, we did not address divorce because after nine years we don't see that happening.

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Northern, Va.: With money being such a relative thing, have you set a specific financial goal or mark to know when you'll be ready?

Gillian E. St. Lawrence: Having enough time is most important to us. Both my husband and I really want to be there for our kids. My husband wants to be able to coach little league, and we both want very reduced work hours so we never have to look at day care or a nanny. Yes, we have a financial goal in mind that will enable us to do that but it will take a lot more hard work and probably until age 40+ to get there.

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New York, NY: What should we look for in a fertility center that will maximize the chance of actually getting pregnant when we unfreeze the embryos years later?

Gillian E. St. Lawrence: First, find a clinic that will do fertility preservation for a couple that doesn't actually have fertility problems. Next, research their freezing technology -- vitrification is key. Then look at a clinic's success rate per embryo transferred. The info should be on the clinic's Web site. Make sure the clinic doesn't just take the easy cases because it will skew their statistics. Finally, and most important, meet with the doctors and find the right fit for you.

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Harrisburg, Pa.: Will you need to be implanted with multiple embryos? What are the odds of success and how do they change over time?

Gillian E. St. Lawrence: We will chose to do what is called a Single Embryo Transfer. This means that only one embryo will be transferred to the uterus each time. Since we have five embryos, then it means that we can try again if the first transfer does not result in a pregnancy. This choice greatly reduces the chances of twins or triplets which comes with pregnancy complications and potential dangers to the baby.

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Washington, DC: So these days it takes so long for young couples to achieve financial independence that they need to take out infertility insurance. In the big picture, this isn't a sustainable model for a society. For you and your family, Gillian, I hope all goes according to plan! Good luck.

Gillian E. St. Lawrence: It is a personal choice but from what I have seen it is better than dealing with infertility down the road. My husband and I just want to give a future child every bit of our time that we can without dealing with financial stress (coming from families that weren't rich it would be nice for a child to not have to worry about that). This is not for everyone but we cannot ignore that so many career minded people are choosing to wait and taking a big chance that they will be sitting in a fertility clinic at age 38 or 39.

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Washington, D.C.: How can anyone at age 30 think that time is running out to have children? Did you or your husband have any diagnosed fertility problems? How do you know that you will want to wait until 40 to get pregnant? I'm with the doctor who suggested trying to get pregnant at 32.

FWIW, I got pregnant the old fashioned way at ages 35 and 38.

Gillian E. St. Lawrence: I'm very happy that you are one of the lucky ones that got pregnant (and had healthy babies) after age 35, but that is not the case for many women (see my earlier post). It is a very personal choice when a couple decides to have kids. Not everyone chooses the same timing. My husband and I cannot offer a child enough of our time and financial support by age 32. But with more time we are going to try as hard as we can.

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D.C. Area: How have people reacted to the term "Despiration IVF?" I would imagine some may take offense.

Gillian E. St. Lawrence: Some may see the term Desperation IVF as harsh, BUT infertility is harsh. It is common for couples in their mid-30s to have trouble conceiving and for those who just assume they can get pregnant and have a baby free of genetic abnormalities after 35, it is taking a real risk. Preservation IVF now is a cakewalk in comparison to the emotional and financial toll of Desperation IVF.

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Good for you!: I'm sure you'll get a lot of posts from people saying "you should adopt" and all that jazz, but I think what you and your husband are doing is smart. I am 40. I got married at 37. We have been working on kids for three years and don't have them (male infertility issues). I didn't know until faced with this issue that there were SO MANY COUPLES struggling with this and I think if at least some of them had used a plan like yours they may not be facing heartbreak right now. So continue to ignore the haters and I wish you all the best!

Gillian E. St. Lawrence: Thank you so much for your encouragement. I hope I can help couples by providing information on this.

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Washington, D.C.: Hi, Gillian. For medical reasons my husband and I will need to do something somewhat similar to what you did: extract, create and freeze embryos and then use a gestational carrier. If you could give people in this situation just one piece of advice as they begin to prepare, what would it be?

Gillian E. St. Lawrence: Do as much research as you can. The Washington Post has published a list of sources that I used. Start with that list. Depending on your medical situation (talk to your doctor about this) I would strongly encourage that you look at natural and minimal stimulation IVF (with little or no fertility stimulation drugs). It is much safer, and it worked well for me and caused less interruption in our lives.

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Rockville, Md.: Wow, "Desperation IVF" is certainly a loaded term. Yes, IVF is usually the last chance for a woman to have a biological child who has most likely gone through many other painful/expensive procedures. But it would be nice to get a little bit of compassion, especially from those like you who know a little more about the procedure than the average person.

Gillian E. St. Lawrence: This term is more about conveying to those younger couples what they may be facing if they assume they can wait. I'm trying to show them that yes, what couples go through is painful and expensive. But now there is a better option than just waiting and rolling the dice. People could choose to have children earlier but the fact is that this is not going to happen in our society. Parenthood is getting delayed.

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Atlanta, Ga.: What will you do with your left over embryos? This is something I did not consider when undergoing IVF. We made eight. That was too many for us. Some were not implanted. We let them expire. I have to live with that for the rest of my life. It is among my deepest regrets.

I have one boy from that batch of eight. After you have kids, the embryos become children, not just cells in a petri dish. You'll see. My advice is to only make embryos you will use, not a lot of extras "to be safe". Freeze each one separately. Be emotionally prepared to give them up for adoption if you do not want to have them implanted.

Gillian E. St. Lawrence: We did freeze each one separately. Statistically, with five embryos, we may only be able to achieve one or two successful pregnancies so it is likely we will use them all. If not, we plan to save them because with advanced technology, 20 or 30 years from now one of us could get a bad disease and those embryos could save one of our lives because of the DNA being from us.

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Washington, D.C.: I had my baby at 40, and I am tired of running after a toddler. You should consider having them earlier. Money isn't everything.

Gillian E. St. Lawrence: My husband and I were both athletes and still train at a similar level so we certainly hope that after teaching Spinning classes and running 10ks we don't suddenly lose our impressive stamina in less than 10 years. We plan on staying in top shape so we can run after a toddler (and will some extra savings maybe we won't have to work so much anymore).

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Bethesda, Md.: Why is adoption not a viable alternative for you and your husband?

Gillian E. St. Lawrence: Actually, if I had not found out about fertility preservation and my husband and I reached our goal of having tons of time to spend with a child then adoption is exactly what we would consider. We think adoption is one of the most wonderful things a couple can do -- especially if they have the time and money to do so.

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Washington, D.C: Regardless of how a child is conceived, there are substantial health risks associated with pregnancy in older women. Have you considered the increased risk of complications for both yourself and your children if you wait until over the age of 40?

Gillian E. St. Lawrence: One of the first things I did was schedule an appointment with my obgyn, Dr. Heather Johnson, and discuss the risk of having a child at age 40. Now, keep in mind, that genetic abnormalities are tied to the age of the mother and father at the time the embryo is created so our risk with that is still that of age 30 and 32. At age 40, there is a slight increase with problems with the uterus or blood pressure but for someone like me who was an athlete and still maintains that fitness level, the increased risk versus say an average 34 year old is minimal (and not to the level that most people would not have a baby over it).

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Boston: The author indicates that these IVF procedures might be covered by health insurance. She should have provided more information. Here in Massachusetts, by law health insurance companies are required to cover three cycles of IVF for infertile women. That is a very generous benefit relative to the rest of the country. But note: The benefit is available only for infertility. Not for women who just want to do IVF as in this case, nor for lesbian women, unless they are also infertile.

It is irresponsible to imply that insurance will cover any unnecessary procedure. Doing so would help drive up the cost of health care for everyone. The author should have done more research and had better information to offer about insurance coverage.

Gillian E. St. Lawrence: Given the thousands of health care plans out there, I cannot say exactly what each person's plan will cover. The required pre-screening tests that test you for STDs or hormone levels or underlying health problems or a standard ultrasound to check to see if your ovaries are normal may be covered by some policies. People can look into flex spending or health saving accounts and see if that is an option. Given how complicated health insurance is these days, each person needs to look at their individual options.

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Arlington, Va.: I was surprised and disappointed that your article did not touch on any of the complex moral issues regarding the creation and long-term storage of frozen embryos. For someone who seems to have done a very thorough job researching IVF it would seem that you must have encountered these issues, and it is a glaring oversight by you and the Washington Post that this was not even mentioned.

There are currently an estimated 500,000 frozen embryos in the US alone. "Abandonment" of embryos by couples like yourselves (who create them and then never use them) has become a significant problem. What are your thoughts on this? You mention that you had five created and are only planning to try in future with one at a time. Are you planning to use all five? What will you do with the others?

Gillian E. St. Lawrence: What to do with leftover embryos is definitely a big issue I would tell people about -- I just did not have enough space to do so. This is a very personal decision, and there are a lot of options for people. I will expand on this in the future.

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Bethesda: I understand your wish to give a child financial security and your time, but it's not only infertility that increases with age. If you postpone your childbearing until your 40s, your child will have to deal with older parents with decreased energy and greater gap in their cultural references and losing a parent at a younger age; you will be becoming grandparents at an advanced age, etc. That's assuming neither of you has to deal with cancer, heart attack or other diseases that can hit as early as the 50s. Parenthood is a huge adjustment and if you plan to give up your professional identity at the same time, you may not be prepared for the shock of that. You may well have thought these things through already, but the perspective you have at 30 may not be the perspective you have at 50. Finally, nine years of a successful marriage is no guarantee of permanent success; lots of people divorce after 20 years or longer; you should indeed consider what happens to the embryos in the event of a divorce.

Gillian E. St. Lawrence: We have given an enormous amount of thought to these issues. Ideally, if we had tons of time and lots of savings this would be the ideal time to have kids (and I know there is never a perfect time to have kids but there are definitely really bad times to have kids) but we are not alone in this. It is tough to be a parent and we know what we would be taking on and we really, really want to be ready to give those kids everything we can. I know it sounds naive about the divorce but if you knew us you would know why we say that. But, that said, couples should consider an agreement or post-nup to deal with the embryos if they question their marriage at all (but it is not like divorcing after having kids is easy either).

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Arlington: What would you do if pre-natal testing revealed that your baby had a genetic defect or other problem? This seems to be all about having the perfect baby, so would you carry a less-than-perfect baby to term?

Gillian E. St. Lawrence: I read that 92 percent of parents abort when they find out about genetic abnormalities such as down syndrome but they never talk about it or admit it most of the time. No kid is perfect and I don't want that. I love my husband more than anything even though he is not perfect (but I even like most of those imperfections).

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Bethesda, Md.: Hello. I was wondering why you decided to go public with your "personal choice." Are you trying to draw attention to this as a cause? Thanks!

Gillian E. St. Lawrence: I wish someone told me about this when I was even younger because it has opened up a whole new world for me and for my husband.

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Arlington: Did your health insurance cover any of the costs you incurred during this process? Given rising health care costs, I am horrified to think that insurance would pay for any of this when you have no diagnosis of infertility and really just a bad case of entitlement. Incidentally, I conceived naturally at 34 and 37, after being diagnosed with infertility at 32. Your argument that at age 30 time was up is absurd.

Gillian E. St. Lawrence: My husband and I chose to NOT take any insurance from an employer. We have catastrophic individual plans that did NOT pay one cent for this. This is a very rare situation but the it was worth every penny to keep this option open.

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Gillian E. St. Lawrence: Our time is up. Thank you for all your questions. Please visit my Web site for more info at www.preservationivf.com.

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Editor's Note: washingtonpost.com moderators retain editorial control over Discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. washingtonpost.com is not responsible for any content posted by third parties.


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