Swimming in the Gene Pool - Without Floaties!

OctoMom Backlash in Georgia - Would Result in No IVF There, Would Endanger Moms and Destroy Human Embryos and Eggs

2009-03-05T07:48:00.000-08:00

The Georgia Senate has proposed two new bills in an overt attempt to reduce multiple births and a covert attempt to ban IVF in that state. The bills, if passed, would limit the fertilization of only 2-3 eggs, would ban any embryo freezing, would allow only 2-3 embryos to be transferred and would ban monetary compensation for egg donors.

As a clinical embryologist with over 20 years of experience (and a staunch Republican) I take issue with these two bills that will severely compromise the ability of infertile couples to become pregnant and to even afford pregnancy. These bills are probably in response to the mother of octuplets in California, but they will not reduce significantly the incidence of multiples and they will significantly reduce the chance for infertile couples to becoming pregnant, endanger the lives of IVF patients and make IVF more expensive. (Most high order multiples result from inseminations while on hormones.)

The physician that transferred the 6 frozen embryos was an aberration. His alternative was to transfer 2 frozen embryos and then wait to see if the woman became pregnant before transferring any more embryos. By transferring six he endangered his patient's life and the well-being and lives of the resulting children. SB 169 would only allow 2 to 3 eggs to be fertilized. This would result most commonly in 1 or two embryos and in many cases would result in 0 . A patient would pay about $10,000 yet have a very low chance for a pregnancy. Only the wealthy would even consider this option. This is because although fertilization rates are about 70%, this 70% rate is made up of many with low fertilization rates (below 50%) and many with high fertilization rates (above 70%). If you look at the distribution then, there would potentially be a large proportion of patients that would have no embryos due to lack of fertilization. Second, current methods of IVF depend on having many embryos to culture and then after 5 days culture, selecting only the best 1 or 2 to transfer. The probability of an embryo (fertilized egg) resulting in a good embryo on day 5 is about 30 to 40%. So in order to even have one embryo to transfer, you must begin with at least 5 or 6! The most common scenario with only fertilizing 1 to 3 eggs is maybe having 1 or 2 fertilize and then none developing to day 5. I would estimate that the percent of patients becoming pregnant with this method would be about 5%, compared to the current average of 30 to 40%.

To reiterate, very few eggs are capable of making a good blastocyst. The only way we can find the best eggs is to have many eggs, fertilize them and let them sort out which ones are the best and will survive to day 5. This incidentally also decreases the incidence of high order multiples as we have great pregnancy rates with transferring only 1 or 2 day 5 embryos. These day 5 embryos have about a 50% chance of implanting while day 3 embryos have a bout 15 to 20% chance of implanting. (Maybe a better solution would be to require the culture of all embryos to day 5, with a maximum of 2 to transfer!)

Another significant flaw in this bill is not allowing freezing. Freezing is what allows IVF clinics to transfer fewer fresh embryos. One can transfer fewer fresh and rely on frozen embryo for transfer. It also is an integral part to IVF safety. If a woman gets a serious condition called severe ovarian hyperstimulation syndrome, that can be lethal, her risks can be reduced to almost zero by freezing all of the embryos on that cycle. If this law were passed, it would encourage the transfer of embryos in this risky condition as the only other alternative would be to discard them. Is this truly what the people of Georgia want - embryos discarded because it would be too dangerous to transfer them? Another scenario when we rely on freezing of embryos is if the woman's uterus contains fluid. If we transfer into this type of uterus the pregnancy rates are diminished. We would transfer no fresh embryos in this case and freeze all the embryos for a frozen transfer where here chance of a pregnancy would be much higher. With this bill, the clinician would have to either transfer the embryos into a poor environment (basically causing the demise fo the embryos), or they would have to be discarded (demise again).

Also, as has been shown in other countries, when tissue donors are not compensated for their time and suffering - which is extensive - the donor pool will dry up and the business will move to other states without these restrictions. Why would we allow men to be compensated for sperm donation (which is less intrusive) and not allow women to be compensated for their gametes (eggs)? I think all too often we confuse the issue of tissue donation (which is a renewable item) with organ donation, an irreversible and risky process.

Finally, regarding SB 204: it will greatly increase the costs of embryo donation and most likely will result in more embryos being discarded than being used to help infertile couples that can't afford IVF obtain a family.

I find it strange the a right-to-life group would even sponsor such an ill-though out bill that would actually result in the destruction of embryos, the destruction of eggs (potential life) and would endanger a female undergoing IVF. What a disregard for life!

Is Eight Enough? How About 14? Octuplets

2009-02-13T09:39:00.000-08:00

This week's news regarding the lady (Suleman) with octuplets has started a lot of discussion, unfortunately I think it together with the economic stresses has stirred up a hornet's nest of prejudice passion. Suleman gave birth to octuplets after "successful" IVF treatment. She is a single mother with 6 other children, also conceived through IVF. Three of her older children (ages 2-7) have disabilities. It seems that the octuplets were conceived via frozen embryos from a previous IVF cycle. (Probably the ones where she had her first 6 children.)

First, at issue is not how many children a single mother should have. For some, one is too many; while others would like 10 or 12. There are two big issues here (but I will not discuss the second issue which is how much will all of this cost the public who will be paying for most of this and the associated problems?):

How could a physician who takes the Hippocratic Oath ("I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.") risk the mother's life and the potential children's lives and well-being by transfering 6 embryos into a woman that previously had little problem getting pregnant via IVF??

Steven Orry, president of the American Society for Reproductive Medicine has said, "Infants born as multiples are almost always premature and have higher rates of low birth weight, cerebral palsy, developmental delays, birth defects and death. Even twins, who usually survive, are hospitalized twice as long as singletons and have much higher medical costs over the first five years. Cost of multiple births can easily top $100,000."

Complications
The most important complications to the mother are pre-eclampsia, preterm labor
and delivery, and gestational diabetes. As the number of fetuses go up, thes risks of these complications soars. Other complications include cholestasis, dermatoses, excess weight gain,
anemia, hyperemesis gravidarum, exacerbation of pregnancy-associated gastrointestinal symptoms including reflux and constipation, chronic back pain, intermittent dyspnea, postpartum laxity of the abdominal wall, and umbilical hernias. (Source: ASRM Practice Committee Guidelines on Multiple Pregnancies).

Complications for the babies (according to the ASRM Practice Committee) include complications from pre-mature birth: "cerebral palsy, retinopathy of prematurity, and bronchopulmonary dysplasia as well as those of fetal growth restriction (polycythemia, hypoglycemia, necrotizing enterocolitis). It is unclear to what extent multiple gestations themselves affect neuro-behavioral development in the absence of these complications. Rearing of twins and high-order multiples may generate physical, emotional, and financial stresses, and the incidence of maternal depression and anxiety is increased in women raising multiples. At mid-childhood, prematurely born offspring from multiple gestations have lower IQ scores, and multiple birth children have an increase in behavioral problems compared with singletons."

Alternatives?
The potential outcome (a healthy child) was not worth the risks (including death of the mother and the babies). Was there an alternative? Sure! Thaw fewer embryos and transfer only 2 and then if the woman did not get pregnant, thaw another 2 and transfer.

The physician is lucky Suleman survived her pregnancy. Now she must wait to see what this will cost her children. How many will survive? How many will have life-altering consequences for the rest of their lives?

Hunter's "Friend"

2008-12-24T10:00:00.001-08:00

Hunter has been hanging out with a friend that happens to be a girl named Janie (and no, she doesn't have a gun - yet). We like Janie. She is very kind, bubbly and active. We also like her family. Last night she came over to eat dinner, play with Legos and watch WallE. Here is a photo of her as she was dodging the camera.

Gina! Gina! Gina! Galaxy Traveler

2008-12-21T09:12:00.000-08:00

Gina has expressed concern that I have very few photos of her on this blog, so this blog is dedicated to the beautiful image of my fantastic wife.
Here she is right before eating this tasty rock. This was a cold afternoon of camping up on the Mogollon (mogeyon) Rim. It was a windy night but we had a nice afternoon kayak.

Gina and I both enjoy kayaking. BUt Gina is by far the more skilled kayaker. Sure there are some that surf the wakes of oil tankers in the ocean. Gina is the real exploer though. She has invented a sport called shark wake kayaking. You just toss in a baby seal in front of your kayak in hopes that a large great white will explode from the ocean and make a wake big enough to play in. Here is Gina with the move that won her the World Shark Wake Play Boating Championship.

Yes Gina is an explorer. She has been to many places in her earlier career as a fight attendant. She keeps track of all of the states she has visited as well as each planet or satellite. Gina is more than a world traveler - she is a galaxy traveler.

Here is a photo from one of Gina's favorites trips to the moon where she stopped to relax for a while just as another flight of tourists arrived.

Of course she has photos when she visited Mercury and Jupiter. And who can forget that wonderful trip to the Planet X!

Gina has truly done it all! We love you Mrs. rock eating, shark flipping, moon romping woman!

And Thanks For All the Fish!

2008-12-02T16:48:00.000-08:00

We had a great Thanksgiving with Colton and Hunter home, and Rachon, Jared and Max coming to visit for several days. We went to the zoo at night and watched all of the people marvel at how cute and happy Max was stumbling around the zoo. Gina and I took Rachon and Jared to a Coyotes hockey game, which was fun - especially since we won. Afterwards we ate Japanese food.

Thanksgiving day was huge. I made a mince meat and an apple pie, but the best menu item was Wayne's sausage stuffing. I could hae eaten all of it - in fact, I almost did. All of the young cousins had a blast playing together. Summer remembered that I used to jump with her on the trampoline so she got me jumping with her and about wore me out.

The next day, we went to the arboretum (plant zoo) outside of Superior, AZ. It was the most crowded I have ever seen it. Max had a blast running around and it was just a perfect day for a little hike. As a grandpa now, I think I figured out why grandparents like their grandkids so much. I think it's because it wasn't too long ago we remember their parents as teenagers and so the contrast to such a loving, humble, always happy, undemanding child is such a contrast to the typical teen.

Max Loves His GiGi

2008-09-17T08:43:00.001-07:00

BUNDLE OF JOY?

Max just loves his GMa Gigi - except when he wants his Mom.

Munching Max

2008-09-17T08:43:00.000-07:00

Summer 2008 - Lots of Traveling

2008-08-18T08:53:00.000-07:00

This summer has been full of traveling. Between my extra job at the University of Kansas, obligations to professional groups and vacation, I feel like I have been doing nothing but traveling - and fixing our medical practice.

WORK
We have grown so large at work that we have been in need of a major overhaul. I have learned one important thing - I do not like being an owner and having to manage a small business that has grown into a large business. So as of a few weeks ago we have partnered with IntegraMed, a company that manages IVF practices nationwide. This should take a lot of the load off of me eventually, but the 6 months of negotiations have about wiped me out. Now I just have to get through all of the transitions. All in all, it will be good for us.

This is my last year on the SART Executive Board. It has been a big responsibility as SART is the member organization of 90% of IVF practices. I have had to work with helping to design new database entries for embryo quality, a controversial ethical guideline for PGD and a modification of our advertising policy for member clinics. I have also served on the web site committee and the quality control committee. I will be glad when November comes and I can step down. I intended to then relax with no more voluntary positions, but I was talked into being next year's President of the College of Reproductive Biology. I was promised it would be fairly easy with mainly putting together an embryology program for next year.

VACATIONS
Now to the family! We had a couple of great vacations. Most of us went to a time share in Sedona and spent time hiking and playing. Shane, Gina, Colton and Hunter were there for a few days. And Rachon, Max, Hayley and I were there for the whole time. Then one of Gina's friends, Carrie, came up from Barstow to spend a few days in Sedona with us. We had a blast with the highlights being a hike to Devil's Bridge, swimming at Slide Rock, and a hike into West Fork.

Later, we all went to Dad's time share at Snowbird. Shane, Hayley and I went first to a photography class at the Grand Canyon. Then we went fly fishing on the Colorado at Lee's Ferry. (Not to be confused with Lee's Fairy.) We had an awesome time with Dad and Ann. We spent time on the zip line there, the alpine slide and we saw lots of deer and even a moose and her baby. One of the highlights was going to the 24th of July Parade in SLC and seeing the Prophet. Colton, Shane and I also went to Temple Square one day.

We just returned yesterday from a quick 3 day trip (Gina and Kim) to Aaron Gardner's home to attend his daughter's wedding reception. It was great seeing all of the Gardner Family, the Smith Family (Aaron's wife), several old friends from BYU and Max, Jared, Rachon, Shane, Brett and Hayley. Why did I say Shane? Well, he has moved to Torrance and is living with Kelly while going to school. We have missed him so much, but we know that he wanted to just experience a different place and spend some more time with his mother.

HAYLEY TO PA
Another piece of news is that Hayley will be moving to Pennsylvania in a few weeks. She got a job as a nanny with a family in PA and she is very excited about the year or more she will spend there until she gets accepted into graduate school.

OTHER
Colton and Hunter have started school already with Hunter at Jr High and Colton at Mt View High. They are enjoying their new classes - so far. Gina begins her classes next week. She hopes to apply to the deaf interpreter's program next year. Oh yes, I almost forgot, Gina really did a lot of traveling while the boys were at their dad's in Idaho. She went to visit her sister in Montana, visit her best friend in Spokane and spent 1 week at a deaf immersion camp where she sould not speak!! (She made up for the week in the first day back.)

Gina and I also went to see White Star. It is a musical with the first part being Saturday's Warrior and the last part being what happened to the main character Jimmy Flinders. We loved it.

Scott and I went to Mom's grave site on the anniversary of her passing. We had a great time there with our wives - reminiscing about mother and then we went to one of her favorite places to eat, the old Rosa's.

Just Some Little New News

2008-04-01T10:41:00.000-07:00

Update
Things have been going well for the Pomeroy/Erhart Family lately. Shane has been working at LA Fitness and has been doing great in his sales position. He also spends quite a bit of time working out and is almost as chiseled as me. We all love his girlfriend Courtney (the good Courtney). She graduates from High School this semester and then is looking at going to a junior college and playing softball. She brings out the best in Shane.

Shane was in a minor fender bender and has been stressed out a little trying to help an uninsured driver not get in trouble while trying to get his car fixed. Dad is involved as the driver only speaks Spanish.

Colton is still the "Paris Hilton" of Stapley Junior HIgh - Mr. Socialite. He just turned 16 and has been driving on his permit. For his birthday, he asked me to teach him and some friends how to play Dungeons and Dragons. Now, even Hunter wants to play. I hope to teach one of them how to be the dungeon master as it has lost its thrill for me. Colton also is close to finishing his Eagle Requirements. He loves to hang out with friends and take his snake Athena for a slither.

Hunter will turn 14 soon. He has turned into our academician. He is doing very well at school and for once even enjoys it. Mr. Cammo, as we call him still loves watching all of the Myth Busters episodes and palying RuneScape on the internet.

Gina is working very hard with some difficult classes as school. She is taking a sign language class that combines two semesters of class into one. I still can't understand what she means when she talks to me with her hands - except for that one thing she does with her finger. She spoke in Church two weeks ago and did a great job from what I heard - I was in the great tourist city of Green Bay, WI inspecting and IVF lab. Everyone at church comes up to me and tells me how much they love her and how lucky I am. Duh! I know that!

We have two summer trips planned. Our first one is a week in Sedona at a time share and then in July we all go to Dad's place at The Cliffs at Snowbird Utah. We also have Hayley's graduation coming up April 25, Maximus getting blessed April 13th, I have a lecture to give in Madison, WI on May 3, and a meeting in Las Vegas in the middle of May. I am tired just writing the dates down. I still work in Phoenix, but I am also the Lab Director for the University of Kansas IVF Lab (Go Jay Hawks!!!). I work there with a very good friend of mine Sam Kim. I knew him in Miami where he was a fellow and my kids and I have spent time at his house when he use to live in Long Beach.

Life is busy, but we try hard to find times to have lots of fun.

Hawai - Kauai, the Perfect Isle

2007-09-24T18:10:00.000-07:00

Gina and I had a great trip to Kauai. We left the kids at home with a summer sausage hanging on their bedposts and the TV remote (not really) for 9 days while we relaxed in Kauai. It was my second time and Gina's first. Our first day, we stayed at a hotel not far from the airport in Kapaa - the Hale Plantation. It was nice and we really did not have much time to do much as we arrived in the afternoon. (Fortunately I remembered my driver's license this time so no last minute rush - thanks Jake.)

The next day we spent the time kayaking and hiking on the Wailua River. We rented kayaks at the Hawaiian Village and paddled up stream in a downpour to the trail head of Secret Falls. It was like hiking in the Amazon - muddy, thick vegetation, Tarzan vines and even a cute frog. I must warn you though, the secret is no longer a secret. When we arrived at noon, there were about 50 people (and twice as many of the ever present chickens) at this photogenic site.

After a short lunch of papaya, pineapple and other fruit, we swam out to the fall to get under its head beating current. After taking a few pictures, we turned around and everyone was gone. I guess it's only a secret after noon. When we got back to the kayaks, we paddled a little further up the river to "the swimming hole" near Fern Grotto. The soaring of the tropicbirds reminded me of little angels flying overhead.

For the rest of our trip, we stayed at a timeshare in Princeville. On our first day there I won one of the door prizes: a free luau at the Grand Hyatt. I was asked to go on stage with three other amateurs to learn several of the dances. Needless to say, they asked me if I would consider staying on Kauai and becoming a regular dancer there but I explained that if I did that I would endanger my amateur status.

One day, Gina and I found the "lost" beach near the end of the road at Kee Beach. We had the entire beach to ourselves. He payed homage to Hurley and Said, after which we flew my kite surfing trainer kite. It was a blast as the wind was raging. Gina's first try resulted in her getting slammed into the beach. After removing the embedded sand, she insisted on getting back on the horse and she did an awesome job of flying a tricky kite in tough conditions. We were just lucky we didn't get hauled out to sea. We would spend another day at this nice secluded beach. On one of those days, we walked around the corner to Kee Beach and had a great time snorkeling. Gina was a little unnerved though when she would swim over cave-like holes in the reef but the brave wahini hung in there and and enjoyed seeing all of the fish - especially the many humuhumunukunukuapuaa (a type of cute trigger fish).

On another day, we went to Anini Beach (near Kilauea Lighthouse) where I met my windsurfing instructor. When I first began, I felt like a clutz, but after an hour (the lesson was 3 hours long) I was comfortable enough to sail away and I cruised within inches of a large basking sea turtle. (I think I caused him to leave some skidmarks in his underwear.)

We also spent a day driving up Waimea Canyon - great vistas with deep canyons and tall, thin waterfalls. The shaved ice in Kekaha was a great treat near the end of the day. We even had time to see Spouting Horn where the waves rush into a small opening in the lava and cause sea spray to shoot high into the air with a loud Whuuuump!

One of our favorite days was taking an all day catamaran cruise to the Na Pali Coast and its sheer cliffs. For lunch, we boated off shore of Niihau - the Forbidden Island. Just offshore from Niihau is a small island called Nhua. It is an old volcano and looks like the back of a giant turtle. There are no plants on this small island. We ate a lunch of sandwiches and fruit and then I geared up for one of the best SCUBA dives ever. The divemaster took us under a huge undersea arch that must have been about 20 feet tall and was about 40 feet down. We saw lots of fish and a very small (about 1 inch long) colorful nudibranch (sea slug). On this day trip we saw monk seals, several species of dolphins and many turtles. The trip back was not very pleasant for over half of those on board as the seas became a little rough. (Lots of chumming.)

We also spent a few days on the north shore, near Princeville, to visit Kilauea Lighthouse and see all of the many birds: shearwaters, tropicbirds, red-footed boobies and the huge Great Frigate Birds with their bright red throat bags. Gina wanted me to get a t-shirt that said "I love to look at boobies" with a drawing of a red-footed boobie on the front, but of course I thought it would be in poor taste for someone of my sophistication.

All in all, the trip was great. I got back just in time to sleep a few hours and then head off to the Bahamas to do some IVF cases.

Trolling for Shark in the Bahamas

2007-08-22T17:21:00.000-07:00

I just got back from a business trip in the Bahamas. This is the first attempt at in vitro fertilization (IVF) there. The treatments were set up by an old friend of mine Juergen Eisermann from South Florida. He and I worked together at Mt. Sinai Hospital in Miami Beach about 15 years ago. With the unexpected death of his laboratory director a few months ago, he called and asked if I would fill in for her. So with little notice I went to the Bahamas and did some IVF work there. Now lest you believe these trips are fun, I should state that they are a lot of work in a very stressful situation, using equipment and methods that I usually don't use. But there is always a little fun.

After we completed the several cases in several days, Tony, the Bahamian infertility specialist whom I was working for, asked me if I would like to go spear fishing with him and his buddies. I said sure, but I had left my equipment at home. He said not to worry he could get me some I could use. Tony and I met his brother and two friends at one of their homes that is on a canal near the sea. There we boarded the large twin engine boat and we sped off for the reefs nearby where we would spear fish. Little did I know that these guys were fanatics about spearfishing. And that Tony and his brother were mermen

We jet out to the water just East of Providence Island. The day is perfect - a flat sea, no wind and no swells. THe day is probably around 90 degrees with not a cloud in the sky. After about a 45 minute cruise going as fast as the twin 225 hp engines would go, we get to the spearfising site just off of some tiny, plantless islands. The guys tie two long ropes on the back of the transom with two loops in them - one about half way from the end and the other at the end. Cool, I thought, maybe we are going to troll for fish.

Next thing I know, Tony and his brother have on their rash guards, they jump over the side with 5 foot Hawaiian slings, grab onto the loops and the boat begins to pull them slowly through the water. Their style of spearfishing is cover the greatest area of water by being slowly trolled through the water. If you see a fish, one of you peels off and the other follows. If there are two others on the other side of the boat, you are left in the ocean to spearfish until the second group drops off. To me, it looked like we were the bait being trolled through the water.

It also seemed like Navy SEAL tactics, but boy did it work. And boy did we see a lot of ocean and coral and sealife in those first four hours. We speared a huge Hogfish - orange with big eyes and large fan-like dorsals, a few trigger fish and later a barracuda. (Tony ambushed it and his brother followed silently behind to give the coup de grace.)

Now I thought you spearfished for fish, but I soon learned there were more valuable creatures as lobster season had begun just two days earlier. So as you are being trolled behind the boat (and trying to avoid being shark bait or having your mask ripped off) you look for little caves or shelves and the tell tell signs of "whips", or as we know them antennae. Then you would point your spear at the creature, pull back and let it fly.

Usually we would do our cruising in about 20 or 30 feet of water, but several times we saw lobster in about 30 to 40 feet of water. No way could I dive down, peer under a ledge, shoot and then retrieve the spear with the sea roach attached. Tony and his brother were different creatures. They were in their element. Sometimes I would wonder as they roamed around on the bottom if they were having a convention. Two and three minutes under water is par for them.

After about 4 hours of this tactic, we decided to go to "The Banks", a relatively shallow area about another 45 minutes away. When we got to the banks, you could see the white sandy bottom through the clear water. There was no sign of land anywhere. We could just have well been in the middle of the Pacific Ocean, as just an hour or so from Nassau and the hedonistic Atlantis Resort. The water was about 70 feet deep, but appeared shallow due to its clarity. We were searching for coral heads - small, maybe 1/2 acre reefs about 15 to 20 feet below the surface. This was the prettiest and most colorful place we had been two. A wide variety of tropical fish, sponges, sea fans, corals and - lobsters!

By about 5 pm we were sea logged (but Tony and his brother wanted to stay another few hours) and the captain (an anesthesiologist in Nassau) needed to get back, so we all jumped in the boat and sped off back to Nassau. What a day! It was probably the best day I have ever spent diving (except for maybe the night manta ray dive off of Kona). The damage? We got 4 large conchs, about 6 fish and 42 lobster (a few the size of my thigh.)!! Unfortunately, this was my last day in the Bahamas and they would be enjoyed by others.