Kind: captions
Language: en
[Music]
this
is what ivf looks like
wow this is what my life is going to be
consumed of
all these meds in 20 days thousands of
dollars
this is ivf
infertility just feels like a special
little corner of hell
that just goes on and on and on
every community has that taboo subject
that thing they just don't talk about at
the dinner table infertility is ours
black women are struggling with
infertility at almost two times the rate
as our caucasian brothers and sisters i
think there's an infertility pandemic
and i think it's getting worse
infertility rates are quoted as one and
eight but i think it's much higher
men from the general population we found
that their sperm counts
had dropped 50 in 40 years
there's no embryo that has all normal
cells mother nature is all about
spectrum
if you want to see the belly i'm
actually wearing a full like
belt underneath my shirt one thing that
people would always say is that two men
can't make a baby and so i'm sort of
like
watch us no one likes hearing that you
take
black women from america put them in
other countries that are supposedly
lower resourced and they do better that
is shocking
[Music]
i don't like to say that it's a miracle
because that doesn't have the smack of
truth to it
she is the spoils of war
[Music]
i met zach and he was a guy that i just
found myself
falling in love with and he brought out
the best
of me you just get excited about the
prospect of having a family and
you meet the girl of your dreams and
then you decide you know to get married
and you hope that kids are the next step
[Music]
in my family my sisters got pregnant
right away my mom got pregnant right
away
so i never thought that infertility
would be a word that i would have to use
in my own personal life
and we tried for years everybody gave us
advice well you just need to relax
and you know it'll happen just you guys
are just too stressed
and we kept trying and eventually we
both
reached a point where we said
something's wrong
after a year i went in to the doctor
they took my labs a few days later they
called me back and said you know you
ovulate regularly
all your labs hormonal wise are in check
and so the next step would have zach go
in of course
my husband did not want to go in to the
doctor
so he waited for about six more months
so i thought
there's nothing wrong there can't be
anything wrong
that would be crazy that something was
wrong
the doctor called me and he told me the
news that
zach had zero sperm in his semen
analysis
and that was the first time
[Music]
we heard it
[Music]
having no sperm is not very uncommon but
most of the time there's an obvious
cause
man has had a vasectomy men who are
taking testosterone
so in zack's case unexplained no sperm
with no blockage
is relatively uncommon sometimes we find
genetic reasons
that's not the case in zack's case when
you're told that you don't have sperm
you feel like you're less of a man
you feel like well why am i different
than all the other guys that are out
there and how am i less qualified
you're in good hands well i know you
have to have faith that everything's
gonna work out
i was diagnosed with non-obstructive
asospermia which by definition means
that there are
zero sperm the doctor proposed that we
go in
surgically and look in the testicle and
see if there is sperm there
in a patient who has non-obstructive
isospermia
what that means is that the sperm
production is likely very compromised
and so in order to get sperm the
urologist is making an incision in the
testes and pulling
out some of the little tubules that will
contain small amounts of sperm
contrary to popular belief male
infertility is as common as
female infertility and has many causes
including abnormal sperm production
chronic illness
injury or lifestyle choices
all right jeff find something good okay
so we want sperm that has a normal shape
to it
the sperm that has most normal shape is
usually going to have a better chance
for fertilization
than sperm that has abnormal shapes
yeah there's a few sperm in here nice
this is a sperm that really has a
nice head midpiece and tail you can see
it right kind of here at the center
so if you think in terms of what zach's
chances are of having a child without
any intervention it's zero
we have moved him from zero percent
success
to at this point with sperm in the lab
probably about a 50 chance of of having
a child that is
genetically his love love you too
i'm of course happy that they did find
sperm
but you still have all those questions
about what is next
[Music]
if we take an average man today and look
at his sperm
his father's sperm his grandfather's
sperm
we see that he has on average
about half the number of sperm as his
grandfather
so what we found when we looked in
western countries
that is men from the general population
who didn't know whether or not they were
fertile we found that their sperm counts
had dropped 50 in 40 years
because it's not likely to be genetic
why because it's too fast it's too fast
to decline for a
genetic change so then it's
environmental
lifestyle factors like smoking too much
binge drinking stress a man's
body weight his obesity is directly
related
to his semen quality another
is the chemicals in our daily life
that have the ability to interfere with
the production
distribution and utilization of
testosterone
and they are part of a category called
endocrine disruptors endocrine means
hormone
testosterone is a hormone so chemicals
in plastic soft plastic in particular
have the ability to decrease
testosterone
we know that the chemicals in personal
care products include
many endocrine disruptors the chemicals
come into the mother's body they get to
the feeders there's no question that
they get to the fetus
so this is a really critical link to the
picture
these chemicals can reduce testosterone
in the developing fetus
and that can affect male's sperm
production and health later in life
the consequences one of which is
lowered sperm count and we see a lot of
that
in all over the united states it's not
just the number of sperm that we care
about we also care about the shape of
the sperm
which has gone downhill as well it's got
to swim
straight circles won't do it's got to
get to the target
so what we're seeing is that the sperm
are
failing the test in lots of ways
but healthy sperm are just one piece of
the fertility puzzle when it comes to
making a baby
in order for natural conception to occur
there are actually a lot of things that
need to go right
so the very first thing that needs to
happen is there needs to be ovulation
which means that one mature egg is
released from the ovary
that egg then needs to be picked up by
the fallopian tube and it lives there
for about 24 hours
if there's sperm around the sperm needs
to find the egg in the fallopian tube
and then they join together which we
call fertilization
the egg now transforms and becomes an
embryo
reproduction is really exciting because
it's the best example of multiplication
you'll ever see
so the embryo goes from one cell to two
to four and it just keeps doubling so
that by the time
the embryo gets into the womb it's
hundreds of cells once it's in the
uterus that blastocyst needs to send
signals to the uterus and the uterus
needs to send signals back until there's
a connection which we call implantation
even when a couple has no fertility
issues whatsoever
the chances that all of that will go
right in a given month is only about 25
to 30 percent here we are yeah my turn
approximately one in eight couples
suffer from infertility in the united
states
i think it's a private issue where a lot
of people who are struggling with
fertility issues
don't really talk about it but i think
it's important that we all acknowledge
one in eight as a lot of people
each year about 160 000 americans
turn to in vitro fertilization or ivf
in the coming weeks cassie will take
drugs to stimulate the development of
multiple eggs
in hopes that they can be fertilized
with zack sperm in the lab
this is what ivf looks like these are
all the meds and
they come in a package a big box um and
you open it up and you're like wow
this is what the next 20 days of my life
is going to be consumed of
all these meds in 20 days
thousands of dollars this is ivf
[Music]
it hurts to give yourself shots it hurts
when your
spouse has male factor infertility
it hurts when you and your spouse don't
see eye to eye
it hurts because no one knows the silent
tears that
you cry at night it hurts because you
don't have insurance or
money to cover treatment or adoption
services
it hurts because it seems like god
it's silent it hurts because of the
crazy comments people say to you like
just relax it hurts because
the baby you've always dreamed of
seems like a distant reality that may
not ever happen
[Music]
in the african-american community what i
would hear is that
we were fertile and that we were hyper
fertile
much of this is steeped in a number of
breeding myths particularly during
slavery
black women in particular we didn't
struggle with infertility that's what we
were told
and for those women that were
experiencing
fertility challenges it was a secret you
know
no one was talking about it reverend
stacy edwards dunn was 37 years old when
she married her husband earl
they planned to have a child right away
but were unable to
and turned to ivf i think one of the
key issues with a lot of couples
especially minority couples
is financial it's financial it's
expensive
assisted reproductive technologies or
art
does relate to socioeconomic status
because
fertility treatments are relatively
expensive
ivf can cost anywhere between ten
thousand dollars and as high as twenty
five thousand dollars
if using your own eggs in terms of who
gets to have a baby
it's whether you can afford it whether
you have access to it
we know that unfortunately just simply
looking at geographics in terms of
locations of fertility clinics they tend
to be
located in the more affluent
neighborhoods
for many people it's cost prohibitive
ivf is usually not covered by either
private insurance
or by the state health care program for
the poor the state federal program
medicaid we're one of the few rich
countries that doesn't think of it
as part of basic health coverage the
good news is
more and more states in the united
states now
provide what we call mandated coverage
which is
a strong requirement or recommendation
that employers
and other insurers provide fertility
coverage
for six years stacy and earl poured
their life savings into multiple ivf
treatments
finally a doctor alerted stacey that she
had a rare condition that no one had
ever told her about
so i went to go see the doctor she said
had anyone ever told you that you had
one fallopian tube i said absolutely not
has anyone ever told you that you have a
unicorn
uterus that your uterus is much smaller
than the average users i said absolutely
not
now although i have been diagnosed with
unexplained infertility
they still never told me that i had one
fallopian tube or had a unicorn uterus
which could have been a you know a major
game changer for
every doctor that has seen me for
african-american women there has been a
long-standing history
of reproductive coercion of
sterilization that we know that's gone
on in
the history of the united states and
there is a concern about trust across
the board
there are disparities clearly
disparities in the medical system for
the treatment of african-american men
and women
and i think that's true in the world of
infertility as well
in our community i hear it all the time
when we go to
doctors many doctors do not take it
seriously many doctors have provided
diagnosis oftentimes that's incorrect
reverend stacy came to see the first six
years of her private fight for fertility
as her season of delay
a lot of people struggle with this idea
of delay
and you wonder when your time is coming
and so i had to get to the point that
you know as each time that i got a
negative pregnancy test or that the ivf
wasn't successful
i had to eventually arrive to the point
that delay didn't mean
denial believing she would become a
mother
reverend stacy decided to break her
silence
the moment that i was willing to open up
and publicly share about my story
what happened is that women and couples
began to come out the woodworks
because they were like my god she gets
it
she she's she's going through what i've
what i'm going through or she's now
been through you know what i'm going
through
black women are struggling with
infertility at almost two times
the rate as our caucasian brothers and
sisters
i knew when i was about 25 years old
what they kept telling me you have a
uterus full of fibroids
and so i didn't know if that was going
to impact my fertility i had just
graduated from law school
i wasn't interested in having a baby at
that point and so i kind of i didn't
have symptoms i kind of let it go on and
go on and go on
fibroids are benign tumors of muscular
and fibrous tissue
that typically develop in the walls of
the uterus
fibroids cause a disruption inside the
uterus
such that it becomes not only hard to
get pregnant it also becomes harder to
stay pregnant
black women experience miscarriages at a
much higher rate
i think it's almost always do to
fibroids
[Music]
when tiffany married and was ready to
start a family
she struggled to get pregnant but did
not know where to turn for help
i think every community has that taboo
subject that thing they just don't talk
about at the dinner table infertility is
ours
i didn't have a voice i was just
struggling i'm a lawyer by trade and so
i'm used to advocating for people
but in this i couldn't advocate for
myself i didn't know how
and i had i had too much pain too much
shame and that's when i came across
fertility for colored girls
it's so difficult um
and it's very difficult to be like
told this basically lie your whole life
then it's just everything's gonna work
out it really isn't
i do believe that god called me to start
fertility for color girls
to create the safe space for women
particularly african-american women who
were struggling at insurmountable rates
because there was no place for them to
go
[Music]
i went to the meeting and i was
shocked because there were so many
black and brown women there like me who
were struggling
and it was the first time that i didn't
feel alone
we're believing and we're cheering you
on to the end
black women in particular we have
experienced
generations of oppression we carry
generations of stress it's someone that
says that you know this stress and this
trauma is also
cellular and it particularly impacts us
on this infertility journey
women particularly african-american
women
have experienced long-standing
social economic and environmental
stress that has really placed a burden
on their bodies in a way
that translates into more adverse
reproductive health outcomes
and that term is called weathering that
this weathering
in a way prematurely ages
black women your stress hormones
cortisol your flight or
fight hormones known as catecholamines
or epinephrine norepinephrine
those hormones actually should only be
present at low doses
overall in your general day-to-day and
only spike
when you truly have a new short-term
scare or anxiety for people who
find themselves in societies where
there's maybe institutional racism
structural racism their catecholamines
and their cortisol levels are way higher
than they should be
and so if someone is constantly under
stress
or their body is weathering that has a
lot of
long-term impacts on all your organ
systems
and over time we see that manifesting in
earlier ages of diagnosis with disease
earlier
ages of diagnosis in terms of high blood
pressure
diabetes stress-related tension and
even birth outcomes in women
the black community is often described
as the most religious community in
america
and there's a big push to just pray
about it ref stacy because she's a
reverend
really kind of demystified that and said
god made the science too
i had gone through one round of ivf and
when they went in to retrieve the eggs
they could not really get to
my ovaries because they've got these
fibroids all over the place
and upwards of 80 of black women suffer
from fibroids and we don't do anything
about it unless it's
life-threatening and rev stacy just
really gave me the push i needed
and and the permission to to remove the
fibroids and move forward on my path to
motherhood
after surgery to remove her fibroids
tiffany embarked on more
rounds of ivf ivf doesn't seem to be
any more efficient than nature still
most ivf embryos do not become babies
just as most embryos that are produced
the old-fashioned way
don't become babies but if you've got
blocked fallopian tubes
or if your sperm for some reason won't
fertilize an egg
for a variety of other reasons there are
a lot of people out there for whom
the old-fashioned way just won't work
and for them
ivf amazingly outperforms nature
this is the second time cassie and zach
have tried to conceive a child through
ivf
using sperm extracted from zach their
first attempts did not produce viable
embryos
within 24 hours of zach's procedure
dr april batchelor will attempt to
collect eggs from both of cassie's
ovaries
we give women like cassie extra follicle
stimulating hormone
so that instead of just growing one egg
maybe we can get 15 or 20 eggs
from the ovary
the goal is going to be to place a
needle into each one of these follicles
here
and aspirate all of these beautiful eggs
that cassie spent the past two weeks
growing
follicles are the tiny sacks inside the
ovaries that nurture and release a
woman's eggs
during an egg retrieval a doctor will
place a probe inside the vagina
and through a needle-guided procedure
follicles are drained of follicular
fluid
in the room next door the embryologist
will isolate cassie's eggs
and try to fertilize them with zach's
sperm
fertilization is probably our biggest
hurdle that we have here because
of zach's sperm challenge
in this case because zach's firm were
surgically
extracted they lack the ability to swim
and so we have to give them a bit of a
boost by injecting
the non-swimming sperm into the egg with
a needle called
a ixi needle intracytoplasmic sperm
injection
this revolutionary technology was
developed to assist fertilization for
men with weak or few sperm
today it is widely used in ivf
laboratories
okay i know right within 18 hours
zack sperm and cassie's eggs create
three
embryos from there it is an anxiety
provoking five or six days while we wait
for the embryos to grow and divide
[Music]
i think being faced with infertility
is extremely hard it's emotional
you have the steps of grieving you're
trying to accept and you're trying to
what you know predict what's going to
happen everybody has such a unique
story and when you have a child of your
own
and you say why not adopt
that's their opinion you know they
decided to be parents themselves they
have biological
children and it's it's really hard to
hear that
you look into your future what does that
look like for us
who's going to be with us for our family
christmases
[Music]
like who's gonna be with us like
when we're saying our last words i think
like
we want to have the joys of children
there are a lot of causes for
infertility so big items are male
factor where there's something going on
with the sperm
tubal factor where there's something
going on with the fallopian tube
and on ovulation where there's an issue
relating to
ability to release an egg from the ovary
one condition that affects a woman's
ability to ovulate regularly
is polycystic ovary syndrome or pecos
a hormonal disorder that if left
untreated can have long-term
consequences
we know that people with pcos because of
insulin resistance also
struggle with their weight and so in the
united states where we're facing an
obesity
epidemic and thus a diabetes crisis
as well it's really important to
diagnose picos
even in teenagers an even more common
illness affecting a woman's fertility
is endometriosis an inflammatory disease
of the reproductive system
that can begin in puberty it afflicts at
least 10 percent of women
and takes an average of six to eight
years to diagnose
one of the biggest downsides to
endometriosis progressing without
diagnosis or treatment
is that it can cause really bad scarring
of the fallopian tubes but it also can
cause the eggs to die
some women may stop ovulating regularly
and some may even go into menopause
prematurely
as a result but one of the major
challenges for women who are struggling
to conceive
is the age of their eggs we as a society
all need to know
that there are issues with having babies
when we're older and
we need to be thoughtful about planning
our fertility it's not a popular message
and it does create anxiety which no one
wants to do but
on the other hand you know i can't tell
you the number of women who've said
no one told me this stuff i can't
believe i'm 44 and thinking it's easy to
get pregnant
and now you're telling me i almost have
no chance as a woman ages
not only does the quantity for eggs
decline but so does the health of her
eggs
get out of here there's a crucial moment
during fertilization
when the egg needs to eject exactly half
of its chromosomes
with perfect precision eggs are aging
as you get older and they don't release
the chromosomes till they're ovulated
and fertilized and that's
you know this graphic here um which
shows a sperm
and an egg this is the egg kicking out
half the chromosomes
when this egg is 25 it's moving the
chromosomes around with 25 year old
machinery
versus 40 year old machinery you're
going to see more mistakes where a
chromosome goes where it shouldn't
and for instance chromosome 21 there
should be one copy here and one copy
there
but sometimes an egg especially an older
egg
fails to eject its extra copy now all of
a sudden you got an embryo that has
three copies of chromosome 21 trisomy 21
that's down syndrome
in the last decade egg freezing has
become increasingly popular for women
interested in delaying childbirth
or who are going to undergo chemotherapy
i'm asked all the time what is the ideal
age to freeze eggs and i think that
somewhere between 28 and 34
that's because in that window the
quality of the eggs and the quantity of
the eggs is still optimal
after 35 it is possible to freeze eggs
but the outcomes are not quite as
successful
egg freezing is one of the greatest
discoveries
in modern times it is a
huge game changer it allows women to
donate eggs to themselves
at a time when they may not have as many
options
it allows women to choose partners based
on
things that are not related to their
biological clock
when i first saw him in the hospital and
everyone's screaming at me to push and
they're swimming at me to slow down
and then everything goes completely
silent
and then i hear him come out
and then they lift him up in the light
and i get to see him for the first time
and he opens his mouth and he just
starts to cry
which was the most amazing sound i've
ever heard
[Music]
creating a baby was the last thing on
tristan's mind
as he searched for his identity i
like many people always did feel that
there was something different about me
and i think tragically i actually felt
that there was something wrong with me
that i was broken
for me it was just excruciating and it
came to the point where i didn't believe
that i could continue
to live a kind of life that i was living
and it really wasn't until i was 18 or
19 when
i realized oh my god i'm not broken at
all i'm just transgender
when i finally did tell my mom
specifically you know i'm transgender
i'm going to be transitioning
you know i just watched her face fall
and it's not that she's transphobic
she just truly believed that it meant
choosing an unhappy life for myself
for people who have gender dysphoria
what that means is that they have
a really distressing discomfort because
there's a discrepancy
in their gender identity and how they
appear on the outside or the
sex they were assigned at birth so by
matching their physical appearance to
their gender identity
that allows the world to perceive them
as they already perceive themselves
trying to match his appearance to his
identity tristan turned to testosterone
looking back on it now i'm like oh i
took testosterone from the black market
and that is a really really really dumb
idea
because your whole endocrine system is
a very delicate constellation it's like
a spider web you know you pull on one
piece and everything else goes
there's a complex signaling that occurs
naturally in men and women where there's
hormone signals that come from your
brain that speak to the ovaries and
speak to the testes
when you take testosterone or you take
estrogen
those hormones then take over the
signaling that would normally be driven
by the brain
and that can have implications for
reproductive health
for example testosterone therapy can
lead to increased risk of stroke
heart attacks blood clots you should
really be under doctor supervision or if
not a doctor but a nurse
or a naturopathic doctor but someone who
has advanced training in
hormone management but a lot of lgbtq
people take risks with their health
because they're scared
discrimination towards the lgbtq plus
community
has hindered access to health care and
led to misperceptions
the message has always been that like
gay people are dangerous to children
you know that gay people shouldn't raise
children that like we are the opposite
of family we destroy family
when it became clear that lucas and
haley my
biological niece and nephew were gonna
need a home it was pretty clear that we
were gonna be the only people that could
take them
or they would need to go into foster
care and so
you know we had a discussion and tristan
was like very supportive he was like yes
let's do this let's take them let's
concentrate concentrate it never
occurred to me until i met biff
i started thinking you know i would love
to have a family with him and seeing him
with kids i was just like that door
could open
for us we could have a physical
manifestation of this
you know profound and true experience of
love we have for each other
many people like me don't ever have the
opportunity to have
a kid that is biologically connected to
them
either because the reproductive systems
don't match up or they don't have the
resources
in many cases i think people don't even
imagine
that was one thing that people would
always say is like two men can't make a
baby
and so i'm sort of like watch us
how do two men make a baby hormone
treatment can suppress the reproductive
system
so for example a transgender man who is
taking testosterone
will experience a cessation of menses so
periods will stop coming and that's
actually an intended consequence of the
treatment
but in addition it will suppress the
ovaries
so that he is no longer ovulating when
they come off of testosterone
there are reports that the menses will
return testosterone
really acts to the ovulatory system the
same way that any hormonal birth control
that stops
ovulation menstruation impacts the
system it just hits past
on the sort of egg maturing factory and
when you go off of testosterone as i did
it takes a few months
and then the egg maturing factory kicks
back into gear and you ovulate and
menstruate just as you had before
there have been reports of pregnancies
but what we don't know
is if a person has been on testosterone
for a long period of time
is that return of ovarian function going
to actually occur
if you want to see the belly i'm
actually wearing a hole tristan had been
taking testosterone for 12 years before
trying to get pregnant
after experiencing a miscarriage he soon
became pregnant with leo
gigantic giant leo looks so much like
you that people just assumed that i
wasn't involved at all
they do assume that we had a surrogate
and just used my sperm
for that we did have a surrogate we did
use my sperm
it was me i was my own surrogate
[Music]
how do you navigate pregnancy as a
transgender man
maybe you felt conflicted about or even
negative about having
breasts but now that's being used to
nourish a human
maybe you felt conflicted about having a
uterus to begin with now it's being used
to grow a person you're building a
family
tristan felt grateful that he was able
to become pregnant and give birth but
for patients about to transition
there are steps they can take to
preserve their fertility
in patients who are undergoing gender
affirming therapy
i think it's important that they are
presented with the option to either
freeze eggs or freeze sperm
before they start those treatments
fertility preservation is invasive
it is very expensive and it takes a long
time
it can take weeks or even months
depending on how successful the first
retrieval is
and a majority of trans adults who say
they wish they'd preserve their
fertility they said that they were not
counseled they didn't think about it
counseling the younger group about
fertility preservation before
gender affirming therapy is particularly
challenging because these are teenagers
and many times they're so distraught by
their
gender dysphoria that they're really
eager to start their gender affirming
treatments honestly if you had told me
at age 22
you know you have to choose between
transitioning and ever having a
biological child
it would not have taken me one second
to make that decision i would have
chosen transition i thought i was
choosing transition over
ever having a family ever falling in
love ever having community support
ever getting married what the research
has shown is that
at least 50 of transgender men and women
do wish to have children or have a
family in the future
okay leo change comes from
moving into the place that's hard and
looking for the light
often when you say like well why don't
you just
adopt it's rooted in this belief that we
shouldn't have access to the same things
as everyone else i don't want to be
like men who are not transgender i feel
like what i am is unique it's powerful
it's a gift
if i'd been assigned male at birth i
never would have had leo
so when i look at me pregnant you know
i'm just one of the many men
who happen to be unique in that we can
create life
and i think that's pretty cool
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hi cassie it's dr bachelor calling i was
just calling you with some
excellent news this morning i wanted to
call and let you know that we have your
ccs results back
and that both of these embryos are
normal and available for transfer which
is pretty exciting
we got that call and it was two
embryos and they were both normal and
they're both baby girls
so we're super excited at least i am
about the girl part
both of cassie and zach's embryos were
frozen and one has been thought out to
be transferred today
our embryo today is a 5bb that's the
great of it and
frozen embryo transfer and it's a baby
girl
um and then just baby joseph january
2020. so today's the day
we waited four years for this so we're
over the moon excited
are you guys ready all right i'm ready
too so we're here today doing cassie and
zach's transfer
after a long road of going through
several ivf cycles to get here so we
warmed up their embryo a few hours ago
and then transferred it successfully
everything went very smoothly today
so now we're just in the nine day
waiting period
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it's been five years four embryos
three transfers zero pregnancies
for me and then
one mosaic embryo one surrogate
and our baby
infertility just feels like a special
little corner of hell
that just goes on and on and on and you
can keep throwing money into it
and time and sadness and blood and sweat
and tears and you may end up with
nothing
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i don't like to say that it's a miracle
because that doesn't have the smack of
truth to it
she is the spoils of war
she is the result of many years of
battle
and she is our victory after four years
and three failed cycles of ivf
aaron was diagnosed with recurrent
implantation failure
meaning her embryos were unable to embed
themselves into the wall of her uterus
erin came to me she was frustrated she
wanted answers she didn't have a
diagnosis
testing pointed to an issue with aaron's
immune system
it was identifying her embryos as
foreign
that's why we decided as a team
to consider using a gestational carrier
before transferring any of aaron's
embryos to the gestational carrier
or surrogate dr amy avasaday
used pre-implantation genetic testing or
pgt
to make sure they had the correct number
of chromosomes
offered at most ivf clinics the test is
used by about 35 percent of patients
and can cost between 1500 to 5500
this test is typically done when an
embryo is about five days old
and has divided to roughly 300 cells
the inner cell mass is what could
develop into a fetus
the outer layer of cells called the
trophectoderm
is what could develop into the placenta
an embryologist plucks just a few cells
from this outer layer
and a lab performs a genetic test on
them to count how many chromosomes each
cell contains
based on this test the embryos are
generally classified as abnormal
or normal but if the sample contains a
mixture of genetically normal and
abnormal cells
then the embryo is considered mosaic
we had four embryos left one of them was
abnormal
two of them were normal and one of them
was mosaic
so you think i want to get my best
chance and so i want to use the embryo
that looks the best that has the highest
grade and that has
really good genetic testing results and
i don't want to use
these garbage embryos that have tested
abnormal or partially abnormal like a
mosaic
one of the normal embryos did not
survive the thaw
so aaron and her husband gary considered
transferring the mosaic embryo with the
remaining normal one
we knew we would transfer this one
healthy one that we had left but then
the question was what do we do
with the mosaic embryo that's left we
also didn't want to discard it
because there was a certain percentage
chance that it could result
in a healthy pregnancy in the end one
normal embryo
and one mosaic embryo were transferred
into the surrogate
soon after aaron and gary got good news
fortunately we got positive pregnancy
results
so we knew that our surrogate was
pregnant the two embryos were different
sexes so the healthy one was a male
embryo and the mosaic
embryo was a female when we were told
that
there was just one and it had implanted
we assumed
that we were having a boy
a blood test revealed a girl the mosaic
embryo had implanted
in discussing the risks associated with
transferring a potentially abnormal
embryo we talk about three
possible scenarios one is that the
embryo just wouldn't implant
the second scenario is that that embryo
would implant
and it would result in a miscarriage the
third possible scenario though
is that if the embryo truly is abnormal
and in plants it could result in a baby
with genetic abnormalities due to
abnormal cells being present before we
will transfer
a mosaic embryo in any patient they need
to have genetic counseling
that throws you into a whole other world
that you have to get
expertise in to decide if that's going
to be a viable pregnancy and how do you
find out if it is and will we need to
look at early termination or what are
the odds that this
is a miscarriage and if it's not what
are the odds that this is a baby who
will be born with special needs
there have been several case reports of
patients who have had
pregnancies from transfer of mosaic
embryos
and i think it's too early to say
whether any of these
embryos actually translate into birth
defects for the baby
maybe later in life as we follow these
babies as they grow older there might be
something that's identified that's
related to the mosaicism
we're in this world of testing
everything and going through ivf
we're getting all this information that
most couples that have natural
pregnancies never even have to face
what we really care about is whether the
baby is going to have the proper amount
of genetic material
but what we're testing is a small
portion of the trophectoderm which we
know
is the portion of the embryo that's
destined to become the placenta
so there is some controversy over how
accurate this test
is and whether we are at the point where
we should be doing it for all of our
patients
go go mother nature is all about
spectrum
all about continuum so there's no embryo
that has
all normal cells if seventy percent of
the cells are abnormal
those are called high level mosaic
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if only 30 percent of the cells are
abnormal those are low level mosaics
when fewer abnormal cells are present
miscarriage rates are predicted to go
down and the chances for a live
birth increase there seems to be a
better outcome
with the lower level mosaics over the
high level mosaics but we're still
learning that
there is actually a lot of research that
suggests that the embryo may be
capable of correcting itself once it's
inside
but how researchers
including dr sean chavez have found
evidence that suggests that on day four
the embryo performs a self-inspection
i like to liken it to a card game so
that you can actually
share information with your neighbor and
so you can start to decide
based on your card game who looks good
to become a placental cell part of the
placenta
and who looks good to become part of the
inner cell mass which is going to become
an embryo at this developmental stage
dr chavez has noticed embryos discarding
cells
or fragments of cells that are
chromosomally damaged
they have a significant amount of dna
damage
and we think that the embryo actually
knows that it's there and
and basically has a signal to it that
says you are not going to divide because
you're chromosomally abnormal
and your dna is highly damaged i really
like to point out your attention
is this large excluded cell
so you can see based on its size it
probably came from
very very early in development besides
being excluded
it is never allowed to divide again
more needs to be understood about mosaic
embryos but some couples
especially those who are running out of
options are deciding that the prospect
of having a healthy child
is worth the risks if a woman
only produces mosaic embryos most
clinics
don't want that liability i think the
tide is turning i think they're finally
starting to realize if that's the only
thing a woman has is a mosaic embryo
that they should give it a shot and so
i'm hoping that more clinics are gonna
accept
that responsibility finally in august of
american society for reproductive
medicine came out with a committee
opinion saying that every single clinic
needs to have a policy in place for
mosaic embryos and patients need to be
told about it as well
don't let a clinic or a testing lab tell
you you shouldn't use these embryos
keep them and maybe if you're more
comfortable
use them as a lower priority but they
really could
be a real baby
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we transferred baby girl a few weeks ago
we got a positive pregnancy test which
we were over the moon about
and a few days later my hcg
level which is the indicator of your
pregnancy
went down and then it was confirmed that
i
we had a miscarriage one in four women
of reproductive age
will experience a pregnancy loss at some
point in her reproductive lifetime
that means 25 of women
it is quite natural and very common for
women to blame themselves
and the first way to help someone
understand it's not their
fault is to let them know how common
this is
through this journey we've come closer
and closer and closer to being able to
actually have a child
and it feels like it's within reach it's
just
just barely out of reach are you
sleeping
cassie and zach have one remaining
embryo to transfer
for the next frozen embryo transfer i'm
nervous
i have one more embryo left this needs
to work
and if this doesn't work what's next we
haven't talked about what's next
if this doesn't work because we're just
praying
that it does ivf succeeds only about
half the time for couples
cassie and zack's last embryo resulted
in another miscarriage
they planned to try again with ivf
starting with another surgery for zach
to hold on to hope means to look beyond
what might be negative or what might not
be working out
in a way that you desire to happen in
that time and know
that something better is going to come
i went through my third round of ivf in
may of 2018. they retrieved two eggs
they fertilized my doctor
came into the room and i'll never forget
she said tiffany
they look great um
and i remember thinking
you know no one's ever said that to me
no one's ever said they look great like
this is
i have a shot and so we put them both
back in
and the rest is history i gave birth to
my son nine months later
and he is everything that i prayed for
everything that i've been waiting for
everything that
like i didn't know i needed
reverend stacy edwards dunn and her
husband earl
decided to try one last time after seven
years
i just told her i said let's try one
more time because i think i had a good
feeling our bonding together our faith
together
that that whole collectiveness
on january 2nd we received the call from
the doctor
around 2 30 everything like the world
seemed to stop
the doctor the nurses everybody was on
the phone
said we call with good news we want you
to know that you are pregnant
our daughter that shiloh that was born
on september 11th
she's a gift to so many
whether your path is becoming pregnant
naturally
or becoming apparent through ivf donor
eggs donor sperm
surrogacy embryo adoption or
adoption there is a plan or a path for
you
that's what you hold on to and know at
the end of the path
there is a miracle waiting for you and
whatever path that is
the path isn't deficient it's just
different
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you