The Reproductive Years

I found this article, posted below, on Fertility Neighborhood. As women, especially ones who want to be surrogates or egg donors, we often ask what are the "reproductive years"? I hope that this post answers some of your questions. (please note that it was reviewed in 2005)


The Reproductive Years

A woman's reproductive years, approximately ages 15-44, are the years in which she can become pregnant and bear children. The defining characteristic of this stage is the presence of regular menstrual cycles, which generally indicate that a woman is ovulating. Cycles usually become regular within two years of the first menstrual period (menarche).

Reproductive ability peaks around age 29 and then gradually decreases. After age 35, reproductive potential wanes rapidly, and by age 44, the chances of conceiving and bearing a child are slim.

The Menstrual Cycle

The menstrual cycle is designed to prepare the endometrium (the lining of the uterus) for pregnancy. The average length for a menstrual cycle is 28 days, but individual women can have cycles as short as 25 days and as long as 32 days and still be considered in the range of normal. In general, you can expect your period to begin approximately two weeks from the date of ovulation. In a 28 day cycle, ovulation typically occurs between the 13th and 15th day. Each month's cycle can be divided into three phases. There are two ways to look at these three phases. One way, called the ovulatory cycle, is based on the function of the ovaries, as follows:

In the follicular phase, many oocytes (immature eggs) begin to go through the maturation process. The oocytes are housed in follicles (fluid-filled sacs) on the ovary. By day 5-7, one follicle becomes dominant. The chosen follicle continues to develop, and secretes increasing levels of the hormone estrogen (in a form called estradiol). The follicles that were not selected recede.


In the ovulatory phase, the egg in the dominant follicle completes its final stages of maturation. At midcycle, the increasing estrogen level prompts a surge of luteinizing hormone (LH) from the pituitary. At that signal, the follicle ruptures (breaks open), releasing the egg, which begins traveling toward the uterus.


In the luteal phase, the remnant of the ruptured follicle transforms into the corpus luteum. Instead of estrogen, it now produces the hormone progesterone.
At the same time that the ovulatory cycle is proceeding, the menstrual cycle is also occurring. From this point of view, it's possible to define the three phases of the cycle based on the activity of the endometrium, as follows:

The menstrual phase occurs if there is no pregnancy already growing in the uterus. The uterus sloughs off the mature endometrium, causing a menstrual period.


In the proliferative phase, the endometrium begins to develop and thicken, in response to the estrogen secreted by the developing follicles. The number of glandular cells and surrounding stromal (support or structural) cells in the endometrium increase.


In the secretory phase, the endometrium continues to develop, responding to the progesterone secreted by the corpus luteum in the ovary. The endometrium is mature for eight to nine days after ovulation. If fertilization does not occur, the endometrium begins to regress.
During the luteal phase and the simultaneous secretory phase, one of two things happens. If the egg was fertilized and succeeds in implanting in the uterus, a pregnancy begins. The implanted embryo begins to develop a placenta, the organ that will nourish the fetus during pregnancy. The early placental cells begin to produce a hormone called human chorionic gonadotropin (hCG). This hormone signals the corpus luteum to maintain its progesterone production through the first six to nine weeks of pregnancy. The progesterone, in turn, signals the endometrium to stay in place in the uterus.

Alternatively, if the egg is not fertilized, there is no embryo to implant in the uterus. About 14 days after ovulation, progesterone production by the corpus luteum falls to the point that it no longer sustains the endometrium. The uterus sheds the endometrial tissue, causing a menstrual period. The first day of menstrual bleeding counts as the first day of the cycle.

The 14-day lifespan of the corpus luteum is determined by a preset clock, allowing enough time for implantation to occur. Therefore, the luteal phase is generally a constant 14 days. In women whose cycles are longer or shorter than the typical 28 days, the variation occurs in the first half of the cycle.

The Menstrual Period

The endometrium consists of two layers. The top layer, called the spongiosum, contains blood vessels, fluid, and tissue. The lower layer, called the basalis, contains special cells that are capable of regenerating the spongiosum. When estrogen and progesterone levels fall at the end of the menstrual cycle, small blood vessels within the endometrial lining go into rhythmic contractions called vasospasm. This separates the two layers. The spongiosum drops off, creating menstrual bleeding, while the basalis remains in place.

Because there is so much variation among individual women, there is no one definition of a normal period. In general, though, menstruation is considered normal when bleeding occurs every 21-35 days and lasts between three and seven days. Menstrual flow normally starts out light and is rusty in color, becoming heavier and brighter red for a few days, then lessening and darkening again toward the end. Typically less than 80 milliliters (about 5 tablespoons) of blood is lost during a typical menstrual period, although it often may appear to be more.

Ovulation

If you have a regular menstrual cycle, that usually means you are ovulating. However, it's possible to have vaginal bleeding that looks like a period without releasing an egg. Determining if and when ovulation is occurring is an essential step in fertility treatment. Your doctor can help you choose the best way to detect ovulation so that you can increase your chances of becoming pregnant.

It is not uncommon for many women to feel ovulation as lower abdominal discomfort in the middle of their cycle. This discomfort, called mittelschmerz, may be due to irritation of the lining of the pelvis and abdomen from the chemical substances released by the ruptured follicle.

Other cycle-related signs and symptoms that are likely to mean you are ovulating include:


• breast tenderness
• fluid retention
• menstrual cramps
• back pain
• mood changes
• a midcycle increase in cervical mucus
• a midcycle increase in your basal body temperature
Reviewed on January 3, 2005 by Gina Paoletti-Falcone, RN, BSN.


Sharon
http://infertilityanswers.org/

Slective Reduction: Who Chooses?

Q~~ I have a question that may be a sensitive one regarding Selective Reduction. Who makes the reduction decision? (where there are no medical issues compelling a reduction)Can the IPs and surro make the decision together? What if they disagree?
It's her body but it's our baby - such a difficult issue. ~EM




A~~ Selective Reduction should be talked about before the first transfer takes place and it is often mentioned in the contract as either something that would be considered and what the fee for the surrogate (for recovery, pain and suffering) would be if she had to endure such a procedure. Your RE/Clinic should have the discussion when first meeting a surrogate as well. If she is petite and obviously would have a physical problem carrying anything over triplets then they may highly recommend that you reduce anything over twins. Even if the RE only transfers 2 embryos they could split into triplets or more. It seldom happens but its always good to be aware. So for the health of the surrogate, Selective Reduction could be highly recommended under those circumstances.

Another issue would be what the Intended Parents want to raise. They may not be financially or emotionally capable of raising more then twins (and I am using twins here because it is very rare for twins to be reduced down to a single fetus because the entire pregnancy could be lost). If the Intended Parents are set on having no more then twins, they have to find a like minded surrogate that doesn't have a religious or ethical issue with selective reduction.

The bottom line here is that the surrogate can change her mind in either case. She can decide that she isn't able to selectively reduce when she is faced with the actual fact of multiples and decides to carry them even against Dr. orders or what she previously agreed to in the contract OR she decides not to selectively reduce because of a change of heart and the reality of an abortion is too hard for her to consider. On the other hand she may keep the entire pregnancy even against the 'carrying more then twins' issue as stated in the contract when faced with a 'litter' of babies and considering all health risks, continues to want to keep the pregnancy in tact, although at the time of the contract she was sure that she would want to reduce. In either case it is ultimately her decision as Selective Reduction is, in reality, abortion and any pregnant woman has the right to choose under Row vs Wade.

Sharon
www.InfertilityAnswers.net

EDSPA Comments on the California Octuplet Case

Over recent years medical research has pointed out the benefits of reducing the number of embryos transferred during the IVF cycle with a marked reduction in the number of higher order multiple births. ORLANDO, FL, February 22, 2009 /24-7PressRelease/ -- The Egg Donation and Surrogacy Professional Association (EDSPA), as a multidisciplinary organization that promotes cooperation, education and professional ethics in the matters of gestational carriers, traditional surrogacy, egg, sperm and embryo donation, and related areas, would like to support the further investigation by the medical and legal community into the circumstances surrounding the conception of the octuplets and ethical practices that were involved.

Over the last decade, the American Society of Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) have worked diligently to reduce the number of high order multiple births resulting from IVF treatments. They have produced guidelines restricting the number of embryos transferred during IVF. Published research confirms that these guidelines have led to fewer embryos being transferred and a marked reduction in the number of high order multiple births.

EDSPA Board of Directors:
Robert T. Terenzio, Esq., Chairman of the Board
Evelina Weidman Sterling, Chair Education/Consulting
Souad Dreyfus, Chair Egg Donation
Sharon LaMothe, Chair Surrogacy
Andrea Bryman, LMFT, Chair Medical/Psychology
Marna Gatlin, Chair Non-Profit
Theresa M Erickson, Esq., Chair Member at Large

About EDSPA

The Egg Donation and Surrogacy Professional Association accomplishes it's mission by providing a forum for education, communication and advocacy on behalf of patients, physicians, attorneys, agencies and affiliated professionals in the field of Third Party Family Formation.

Weekend

Women warned not to freeze their eggs for social reasons

I wrote about this topic a few articles ago but wanted to share this one out of the UK with you. What are your thoughts?

Sharon
www.InfertilityAnswers.net

Women warned not to freeze their eggs for social reasons

William Fletcher
Progress Educational Trust
09 February 2009

The UK's Royal College of Obstetricians and Gynecologists and the British Fertility Society have released a joint statement expressing serious concerns about women who freeze their eggs for non-medical reasons such as pursuit of their career. The success rate for pregnancies involving eggs that were frozen is very low and babies conceived in this manner may be less healthy than those from fresh eggs.

'The image that's portrayed is that a woman in her late 20s or early 30s can establish a relationship 10 or 15 years later and then take the eggs out of the freezer, fertilize them with the partner's sperm and have the baby', says Professor Bill Ledger, a professor of obstetrics and gynecology at Sheffield University and a member of the Human Fertilization and Embryology Authority (HFEA). 'The chance of a baby from a frozen egg with vitrification is less than 6 per cent per egg. By doing the egg freezing for social reasons, they are taking a huge gamble for their future', he added.

As well as low success rates Professor Ledger pointed out that babies that are born from frozen eggs could be less healthy than those conceived from fresh eggs and warned that: 'We should be very careful about performing medical procedures on healthy people'. He believes that is ethically questionable for women to freeze their eggs purely for 'lifestyle reasons' but added that it was legitimate, for example, for a young woman with cancer to have her eggs frozen before chemotherapy seriously damaged her potential to bear children.

The draft regulations to implement the Human Fertility and Embryology Act, as amended in relation to the storage of gametes, state that gametes (oocytes in this scenario) can only be stored for ten years. Unless during that period the person for whom the eggs are stored has, or is likely to develop, significant and premature infertility, this period cannot be extended. Egg freezing beyond this time at any of the 41 infertility clinics in the UK where this service is offered is therefore excluded for any non-medical reason.

Despite this time limit, 33 women chose to freeze their eggs for non-medical reasons in 2006, according to official figures from the HFEA. However, this figure more than doubled to 78 in 2007, even though the procedure is expensive at a cost of about £5,000.

"One can't believe impossible things." Oh Really?

Alice laughed. "There's no use trying," she said. "One can't
believe impossible things."
"I dare say you haven't much practice," said the
Queen. "When I was your age I did it for half an hour a day.
Why sometimes I've believed as many as six impossible
things before breakfast."

-Lewis Carroll, Through the Looking-Glass


Hey out there. You know who you are...don't give up hope. Just remember that if one way doesn't work out all you need to do is keep an open mind and look at a different prospective. You can get what you want. Impossible is just a word.

Sharon
www.InfertilityAnswers.net

DJ Holix @ Leftbank This Friday!!!

Leftbank
2424 18th St NW Adams Morgan
Washington dc 20008

(red line metro station Woodley Park/Adams Morgan)

21+ for guys
18+ for girls

VIP Reservations @ 646 595 56 38 or ottomannights@gmail.com

Doors Open at 10pm - 3am