VIEWS: 6 PAGES: 4 POSTED ON: 6/16/2011
The waiting womb Coping and hoping when dealing with infertility By: ARLENE FINE Staff Reporter One family's struggle and success As Steve and Jodi Marton and their four energetic sons, Jordan, 15, Ethan, 8, Zacha ry, 5, and Brent, 1, ju mp into the family van to head downtown for a Cavs game, you would never imag ine that behind this lively family scene is a dramat ic and inspiring story. The Martons' saga begins with the couple's painful in fertility problems; it end s 18 years later with their bountiful family of six. The Pepper Pike residents credit their success in having a thriving family to medical advances, a dogged determination to "never give up," and their strong Jewish roots. First the raw statistics: Jodi Marton had 22 inseminations, 2 in vitro fertilizations (IVF), 3 miscarriages, 1 emb ryo transfer, and 5 frozen emb ryos. And after age 40, she had two natural pregnancies. When Steve and Jodi, then both in their 20s, were married in 1984, they never imagined that they would have trouble conceiving. But, three years into their marriage with their nursery still empty, they knew so mething was wrong. A visit to Jodi's family gynecologist eventually led to four insemination attempts. The last one resulted in the successful birth of their son Jordan in 1990. Two years passed, and although the Martons longed for another child, they could not conceive. Jodi endured additional costly infert ility treat ments that included blood work, hormone shots and ultrasounds. None of these procedures was covered by insurance, and with treat ment cycles running at almost $2,000 each, the drain on family finances was enormous. "We moved into a new house at that time but did not have money for drapes," says Jodi. "My skin was raw fro m Pergonal (fertility hormone) shots admin istered by Steve, and my depression was deep. But Steve was always there for me. He even spoke to the nurses and doctors and told them not to mention money issues to me because I was under enough stress." Because insemination was not working, the couple opted for the more costly (around $10,000) high -tech IVF procedure in 1995. But this, too, failed. At that point the Martons switched doctors and contacted Cleveland Clin ic infert ility expert Dr. Jeffrey Goldberg. J odi said she chose him because her mother Eleanor's maiden name was Goldberg, and "I thought it was beshert." The first thing Go ldberg did was perform routine testing and discovered that Marton had a septate uterus (tissue down the middle). Once she had surgery to remove the tissue, Goldberg performed a second in vitro, using the then - experimental Intra Cytoplasmic Sperm Injection (ICSI) method. This is a procedure in which the eggs and the sperm are fertilized in a laboratory by direct injection of a sin gle sperm into each egg. Three days later the resulting embryos are placed into the uterus with no surgery. Ext ra embryos are frozen for later attempts at pregnancy. The IVF procedure led to Ethan's birth in 1996. Son Zachary was born in 2000 fro m a froze n emb ryo transfer. After the Martons had put away their charts, pills, needles and calendars, their bonus baby Brent was born, "conceived the old fashioned way," in August 2003. "The reason I am so open about my fertility issues is to give other people h ope," says Jodi, 44. "Each month when you are trying to conceive seems like years, but as I reflect on those years, I realize that everything happens for a reason." She adds that the role the doctors and nurses played in the process was also crucial. "A k ind word on a bad day could change my attitude and maybe even the results of that month's tests," she notes. Faith has played a strong part in the Martons' support system. "We met with Rabbi Moshe Garfunkel of Congregation Zichron Chaim (Orthodox) who counsels relig ious couples with infertility problems," says Jodi. "He took our desperation to heart and sent a prayer to the Western Wall. He also led us to the ICSI method. I tru ly believe God answered our prayers with the miraculous birth of each of our son s." Jodi also credits her pregnancies to attending two different britot ceremonies. It is believed in some circles that attending a ritual circu mcision ceremony will bring mazel (good luck) to a wo man t rying to conceive. "Before I became pregnant with Jordan, I went to a friend's bris," she says. "I was standing at the back of the room all choked up, and my friend whispered to me, 'I would like you to be part of our bris. I will hand you my son, and then you will pass him back to me.'" The next month Jodi became pregnant. She attended another bris three months before she conceived Ethan. Following the birth of their first son, three of the Martons' four parents passed away, and each child subsequently born is named after these beloved relatives. "By keeping their memo ries alive, their births are a double blessing," says Jodi. Although Jodi admits the stress of their infert ility problems was enormous, it brought the couple closer together. "Adversity bonded Steve and me," she says. "Our family is our greatest joy. I thank God every day." Infertility from a professional viewpoi nt When Dr. James Go ldfarb, director of the Cleveland Clin ic Fertility Center at Beachwood, walks through a mall, goes to a restaurant or stops at a gas station, he often is approached by a grateful, smiling parent who either points to a child in tow or to a wallet full of photographs. The parent then proudly says, "This is one of yours." Co mments like these are never routine, says Go ldfarb, who has been an infertility specialist since l979. "I am still humbled each time I help a family have the child they so badly want," he says. The need for fert ility doctors' expert ise has never been greater," says Goldfarb. The chances of conceiving are sharply impacted by a wo man's age. While wo men's fertility peaks in the early t wenties, fertility rates decrease very little until the early 30s. During the 30s and especially in the late 30s, fert ility rates decrease rapidly. By age 40 at least 40% o f wo men who start trying will not be able to conceive easily or at all, and by 45 over 90% of those who start trying will not be able to conceive, maintains Gold farb. In young women with fertility problems, med ical interventions can often vastly increase their chances for pregnancy. Medical interventions are much less likely to improve the already lo w fertility potential as wo men get older, he adds. "This decline in fertility is the result of the natural aging process of the ovaries and emphasizes the need for timely evaluation and treatment," says Goldfarb. Assuming they have the patience, wo men are advised to turn to an infertility specialist when they are under 35 and have been trying to conceive for a year, or between the ages of 35 and 40 and have been trying to conceive for six months. "A woman who has mild hormone problems at age 30 may be able to be treated with simple fert ility pills and have a very good chance of getting pregnant in 6 or 7 months," says Goldfarb. "On the other hand, if a wo man at 40 has the same type of hormone problem, the co mbination of the hormone problem and the intrinsic decrease in fertility at age 40 will make her much less likely to conceive with even much more aggressive therapy." The med ia, he adds, does not do us a favor by publicizing wo men who get pregnant in th eir 50s. "Chances are they are using someone else's eggs," he says. "Also the media never publicizes the failures and bad outcomes." When couples first meet with Gold farb, he performs a series of routine tests and hopes the solution is as simp le as a fertility pill that addresses a mild hormone problem involving ovulation. This pill costs $35 monthly and is usually taken for 3 to 6 months. Depending on a woman's age, up to 40% of wo men may get pregnant this way. Another treatment may involve a minor surgical p rocedure for blocked fallopian tubes or a uterine problem, or the removal of cysts, fibroids, or scar t issue that has prevented conception. When this does not do the job, or if the male's sperm count is lo w, insemination of the sperm into the ovary is the next option. This runs about $1,200 for three cycles. About one third of the wo men who undergo this procedure may get pregnant. The third and most costly step is in vitro fertilization (IVF). Go ldfarb, one of the early pioneers, has been involved with in vitro for 20 years. Currently, h is Beachwood practice performs 500 of these procedures each year. While at Mt. Sinai, Goldfarb directed the program responsible for Ohio's first IVF in 1983 and the world's first IVF/surrogate birth in 1986. When the first so-called test-tube babies were born, Go ldfarb remembers scathing attacks by various groups for his profession's attempt to "play God." The IVF option runs fro m $10,000 to $11,000 in Oh io, with price vary ing throughout the country. "If one of the sp ouses is older and they want a child quickly, and the other options have not worked, this is probably the best way to go," says Go ldfarb. "Before I advise IVF, I lay out all the choices for a couple and let them make the final decision. There are trade-offs with each method. The cost and wear and tear on a wo man's body is certainly among the deciding factors." IVF often puts a huge financial burden on a family, and very few states cover the cost of treatment through insurance policies. In Oh io, diagnostic tests are often covered, but not the treatment. "This is like telling a patient he has a bad heart, but not paying for corrective treat ment," says Goldfarb. "When we first began in vitro in 1983, the success rate was about 10%," says Goldfarb. "Because IVF is basically a bypass of the fallopian tube, it was first used only for wo men with damaged fallopian tubes. With time, IVF was shown to be efficacious for other types of infert ility." Until 1991, the only way to fertilize an egg with IVF was to surround the egg with 50,000 to 200,000 sperm and hope that one sperm penetrated the egg. However, if not that many sperm were available or there were abnormalit ies in the sperm that made it very unlikely for sperm to penetrate the egg, the couple could not expect success from IVF. Since 1991, couples with these severe male factor problems have been able to get comparab le pregnancy rates through a procedure called ICSI. Now in a process similar to in jecting jelly into a doughnut, one sperm is injected direct ly int o an egg that is removed fro m a wo man's body. The egg and sperm mixture, o r a 2 to 3-day-old embryo, is then placed in the wo man's uterus. If a man has a low sperm count, this solves the problem since only one healthy sperm is needed to fertilize the egg. The IVF process takes 40 days from start of medications to the pregnancy test. A woman must undergo mult iple injections of hormones for 20 days, visit the doctor's office for ultrasounds and blood tests every two or three days, and undergo a minor surgical procedure to retrieve eggs from her ovaries. Eggs are then fertilized with the father's sperm in the lab, and the resulting embryos are transferred back to the mother's uterus. Then after two weeks, a pregnancy test is performed. "Success rates are determined by multip le factors, the most important of which is the wo man's age," says Gold farb. "Over the years, success rates have improved, especially for young women. Wo men under 35 can expect success rates of over 50%. Conversely, in wo men ages 43 and older, the live birth rate fro m IVF nationwide is less than 5%. Because mu ltip le births are not a goal but a healthy, happy family is, doctors are always working to lower the number of transferred emb ryos per cycle to reduce the risks of mult iple b irths. Studies have shown that multiple pregnancies can be harmful for mothers and their children." Despite Goldfarb's and his colleagues' many successes, the gynecologist grimly recounts the failu res. "When IVF does not work, when the hormone drugs do not do the trick, and we have no medical exp lanation as to why a couple cannot conceive, that is when it really hurts," he notes. "I have seen women age ten years in the span of two, as they try every known method to get pregnant and fail. Yet, we cannot explain why. Th e strain on these couples is enormous, and often changes their personalities completely." That is why Goldfarb is so passionate about Partnership for Families (see accompanying article). It g ives couples who qualify one more chance to have a family they s o desperately want. Despite all the scientific advances and the work done at the fertility center, says Go ldfarb, a member of Anshe Chesed Fairmount Temp le, nothing can compare to Mother Nature. "We have many highly skilled people operating in a lab equipped with high-tech equipment, and all of this is designed to imitate an exqu isite work of nature - a slim fallop ian tube where the egg is fertilized," he says. "Yet, despite all the years I have been doing this, everytime I look at an emb ryo, I am awed. F ro m one microscopic dot a human being is formed." As he points to a drawing of an emb ryo, he says, "It never ceases to amaze me that these little round cells become a person." Partnership for Families Fund gi ves couples a second chance "Just relax and you will get pregnant" is often the most well intended, but can also be the most annoying, frustrating advice a wo man struggling with infertility can hear. Today, some fortunate couples are hearing wo rds that offer real encouragement - thanks to Partnership for Families Fund. This is a program, under the auspices of the Cleveland Clin ic Fertility Center that enables qualified couples a second chance at in vitro fertilizat ion (IVF). Since its inception, Partnership for Families Program has provided the fund ing for nine couples to have a second IVF cycle. So far, five are p regnant, two of them with twins. "In November of 2003, a friend of mine called me and said she wanted to donate money to help infertile couples in an effort to pay back for the successful birth of her children," says Dr. James Go ldfarb, d irector of the Cleveland Clinic Fertility Center in Beachwood. That same week Go ldfarb had received a poignant, heart wrenching letter fro m a couple, both school teachers, who had recently gone through one unsuccessful attempt at IVF. They had mortgaged their home and borro wed money fro m family members to pay for the procedure. Yet, that one attempt failed to produce a viable pregnancy. "Suddenly I knew what to do," says Goldfarb. "I realized the need for a fund for families who had one unsuccessful IVF procedure and could not afford one more attempt - one last effort to have a family." With IVF treat ments prohibitively expensive for most couples, costing approximately $10,000 per treat ment cycle and with fewer than 20% of couples having insurance to cover the procedure, Go ldfarb's idea made perfect sense. Moreover, it provided that essential element of hope. Within months, Goldfarb and an enthusiastic committee created the Partnership for Families Program, co mprised of a volunteer corps of former patients and joyful parents. "Once we exp lain why we are raising money, private individuals and corporations welco me the chance to give," says Go ldfarb. "The response from the commun ity was greater than we ever imag ined." Each recipient of a Partnership for Families Fund grant receives $8,000 worth of IVF medical services. In addition, Serono Pharmaceuticals' Co mpassionate Care Program provides medications for couples going through the program. Board members Toni and Don Scherzer are great cheerleaders for Partnership for Families thanks to their personal experience. "Our daughter Gabrielle, 20, a student at the University of Mich igan, was the first girl born in Ohio through IVF," says Toni who was a patient of then Mt. Sinai doctors, James Gold farb, Wulf Utian and Robert Kiwi. "We know what a difficult t ime it can be for infertile couples trying to start a family," she says. "The emotional and financial issues can be devastating. We got involved with Partnership for Families because we did not view having a family as a privilege, but a fundamental right. This program gives a couple a second opportunity for an IVF procedure they would not have otherwise." Mindi A xner, 39, who also serves on the Partnership for Families board along with her husband Michael, gave birth to twins Sam and Emily three years ago via IVF. "Infertility is not fun, and it affects people in all walks of life regardless of age, race, cu lture, educational level or income," says Axner. "Today couples are waiting longer to get married and have children, and they are finding it more difficult to conceive. Th is program gives them one more shot to have a family." Partnership for Families Fund board members are exuberant about the results of their efforts. As one member states, "I continue to believe that infertility is to my generation what breast cancer was to my mother's - it touches so many lives and has been in the closet for too long and received too little in terms of resources." For informat ion on Partnership for Families Fund or to learn if you qualify, call Denise at 216 -839-2929 or e-mail her at Davisd3@ccf.org. The organization is having a special benefit called "A Night of Firsts" on Sat., May 7, with CNN anchor Paula Zahn as the guest speaker. Call 216-839-2929 for information.
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