Abortion Gang

Columbia makes all egg donors take a “course” prior to officially entering the program. The course consists of the process and risk information, a question and answer time period and learning how to give yourself the ‘trigger” shot (a shot of hCG that prepares the body for the release of the developed eggs). It was really interesting to learn about how the process works, but it was nothing I hadn’t already heard about either from friends who have donated in the past or from the coordinators. And the risk information was the same as what you’re told when you decide to investigate becoming an egg donor int he first place, just reiterated.

The most surreal part is learning how to administer the shot. I walked into a room that had a vial of sodium chloride solution, a sterile syringe with two needles (one for mixing, one for injecting), and, best part, a fake butt-cheek. So, we were walked through the process of preparing the solution for injection, as well as how to keep everything clean, and then we injected the fake butt with the sodium chloride solution. And that was it. Now, I’m not squeamish about needles… hell, I’ve pierced my own ears before… but for some reason, the idea of giving myself an intramuscular injection of something is kind of nerve wracking.

I was then taken for blood work (that genetic panel and STD test from my previous post) and met with a doctor to sign consent forms. The consent forms agree to HIV testing, receiving IVF medication and treatment, and agreeing to the surgical removal of the eggs at the end of the cycle. Basically, blah blah blah, do you know what you’re getting into? blah, blah, blah, yes. No big deal. The doctor also asks you if you’re nervous about anything, and you get the opportunity to talk to them in a counseling setting briefly. That part was nice and set my mind a little at ease about the genetic stuff. She clarified that testing positive as a carrier for SMA or cystic fibrosis isn’t a death sentence on donating like it’s made out to be. It is only one if the man tests positive as a carrier as well, and even then, it’s still up to the couple to decide if they’d like use your eggs. The idea that it’s not the “Worst Thing Ever in the History of Ever” and isn’t a death sentence was really what I needed to hear.

Luckily for me, I happened to be on the second day of my period, so I was taken for a cervical culture and for a baseline transvaginal ultrasound so that I could get started on the synchronization process (the part where you’re on birth control to sync your body with the recipient). So, essentially, I began the egg donation process last night when I took my first pill. If you’re not on the 2nd day of your period, you must wait for your next period so that you can start. I don’t have the science behind why it needs to be the 2nd day, but it seemed to be super important that it be exactly that day.

10 vials of blood, 1 transvaginal ultrasound, 1 cervical culture, and 1 package of birth control pills later, I walked out the door having officially started the process. At this point, pending the results of my genetic panel and STD tests, I’m pretty much good to go (my ovaries were called “beautiful,” containing 18 active follicles for this next menstrual cycle. Oooooooooo!)

I’ll write again once I have the results of my screenings!

As I wait to take my egg donor “course” at Columbia tomorrow, I’m suddenly stricken with panic. Now is the time to face the STD and genetic screening panel. So, STD tests are old hat. I’ve taken one almost every year since I turned 18 (wow, 10 years of tests…) but, true confession, the HIV/AIDS test always makes my heart flutter because… what if? Thankfully all of those have quickly come back negative, but still, a little piece of me is always nervous to get those results.

The behemoth that is the genetic screening panel is upon me, and it’s like the HIV test times 1,000. And of course, I’m the type who incessantly researches that sort of thing, so I looked up the more common types of panels. The Universal Genetic Test, more commonly known as Counsyl, is likely similar to the panel that Columbia will administer. After clicking around on their website, I noticed a tab labeled “Minorities at Greatest Risk.” Obviously I clicked on it, and to my surprise, found Caucasian listed. I say “my surprise” because when we, in America, are discussing race, “white” is usually not considered a minority. Even the label on the page doesn’t lend itself to the colloquial definition of minority; “One Test for One Billion People,” it proclaims. So anyway, I’m like… crap. Because I’m sure that “One Billion People” can harbor a ton of genetic variations, all of which, in my head, I’m suddenly harboring as a carrier. And sure enough, Italian and Irish are listed in the first paragraph as being especially prone to some more dramatic and awful genetic disorders. Double crap.

Clicking around the site isn’t helping me feel any better. What if I’m a carrier for SMA, or PKU? Or what have you? Do I really want to know? I mean, yeah, of course I do, because if I someday want to have my own kids, I think it’s better to know than to not know. But at the same time, isn’t ignorance bliss? Do I want to know and then maybe decide not to have children because it would be irresponsible based on the results of this genetic test? I know this doesn’t seem terribly dramatic to those of you reading, but I’ve sort of always pictured myself having kids, even if I’m not 100% certain that I will. So the idea that it could no longer be a possibility is jarring to my world-view.

As I think about this possibility, I’m also struck by the comforting (but probably totally wrong) idea that… PUNNET SQUARES. XY would be more likely to demonstrate X linked genetic variations and my dad doesn’t, as far as I know, have anything genetically weird going on (out of 5, we’re a generally healthy bunch). So, I’m genetically female, and I may have a normal X gene masking an X variation, but the Italian and Polish genetic disorders are less likely to show up because they’d have to have come from my dad, who, as I just said, appears to be genetically “normal…”

And I fully realize that I’m using 8th grade biology to set my frantic mind at ease. But I don’t need to be corrected at the moment because it’s the thing that is making me feel ok about opening Pandora’s box.

I’ll have another post about the class tomorrow. Wish me luck!

Disclaimer: It’s been a while since I’ve been able to write a post about the egg donation process, and I’d like to take a moment to remind you that I am not an expert on egg donation. I am merely documenting my experience with it as it is happening. If you would like more information about egg donation, please seek out information appropriate to your state (NYS information can be found here) or contact a major hospital with a fertility specialist in your area. Thanks for reading, and good luck!

Here we go again. I just got word that Utah passed a bill through their state house that would require a 72-hour waiting period before a woman can have an abortion. This is by far one of the most restrictive abortion waiting periods bills short of a personhood amendment and it is scary to think it will likely become law. In fact, only one other state, the infamous South Dakota, thinks so little of women to require a 72-hour waiting period.

Forget for a moment that making a woman wait for a legal medical procedure for three days is likely to induce mental anguish and unnecessary suffering, let’s talk about how fucked up it is that these conservative state houses around this country keep passing these bills. You know the bills I speak of, the ultrasound requirement bills, the waiting periods, the parental consent. Each type of bill is presented under the auspice that women need a legislator to help them make a tough decision because women really don’t know what they are getting into when they elect to terminate a pregnancy.

Well, guess what? Yes, women are actually entirely capable of deciding to terminate a pregnancy without a waiting period, viewing a screen, or hearing a heartbeat. Women know what they want and what they feel is right for their bodies, their families, and their lives.

Utah law-makers may say this is about “helping women making tough choices,” but really, it is about creating more restrictions to a legal medical procedure in order to please their voters, religious sponsors, and narrow-minded moral agenda.

There is no way in hell mandating a 72-hour waiting period is about doing what is right for women, because if they really cared about women’s mental health and ability to make tough choices, they would LET THEM MAKE THOSE CHOICES WITHOUT STIGMA, WAITING PERIODS, OR JUDGEMENT.

No Utah woman should have to wait for three. fucking. days to have a procedure that is her personal right to legally obtain. Yet, Utah wants to make her wait, cause her pain, and probably undue suffering in order satisfy their belief systems. There is nothing moral, helpful, or good about Utah’s stance because making a woman wait three days is cruel.

Let us not be silent.

Just like we have all come together to stand up to Rush Limbaugh’s misogyny and are pressuring his sponsors to stop funding his hate; just as we worked so tirelessly to keep Mississippi’s personhood amendment from passing by massive voter education and get-out-the-vote-efforts , we have to stand together once again to get rid of Utah’s attempt to legislate women’s right to obtain a legal medical procedure.

Please know that no act is too small. This bill is not yet law because it still has to make it through the Utah State Senate. Tweet, email, or call Utah’s Senators and voters. Tweet, facebook, and speak your outrage. Get the word out, NO 72-Hour Waiting Period for Utah Woman!

If you are looking for another way to help: donate to a national abortion fund to help Utah women maintain access to abortion. Better yet, start an abortion fund in Utah so that women can afford to get the care they need!

Women everywhere want, need, and deserve to know if their contraceptive method increases their risk of acquiring HIV.  This question is not new; for years, there have been equivocal studies on the topic, some pointing towards a potential association, others showing no association.  The topic got new attention in July 2011, when results were presented at the annual AIDS conference in Rome that indicated a potential two-fold increase in HIV infection rates among women using an injectable form of contraception, DMPA (brand name Depo-Provera, a kind of contraceptive that uses a hormone called “progestin”) compared with women who used no hormonal contraception and again in October 2011 when it was published in The Lancet Infectious Diseases. (The study failed to show a significant increase in risk of HIVamong women who used oral contraceptive pills, but it’s not clear if that has more to do with a lack of effect or was simply because so few women in the study were using pills).

In response, a meeting was convened by the World Health Organization (WHO) from January 31st – February 2nd, 2012 to reassess the state of the evidence and to determine if recommendations about the utilization of hormonal contraceptive methods should change for women at high risk of HIV.  Currently, there are no restrictions on the use of any hormonal methods for women at high risk of HIV.

At the meeting, the expert group determined that there was insufficient evidence to change who is eligible for using all methods of hormonal contraception, including “progestin-only” methods like DMPA, although they did add a strongly worded clarification statement reminding health providers and programs that women at high risk of HIV must use condoms consistently and correctly in order to decrease their risk of acquiring the virus.

So, does hormonal contraception, and specifically DMPA, increase HIV risk?  Unfortunately there is no clear answer to that question.  There have been studies in animals that have pointed to potential biological mechanisms for an increased risk of getting HIV while using injectable progestin contraceptive methods like DMPA, so there is a plausible reason to expect an effect.  However, many animal studies of HIV have led us astray in the past.

Looking at the research that has been done looking at humans, some studies show a connection, some show none.  Further muddying the water is that all the studies are observational, not randomized controlled trials (Wikipedia has a good explanation of what a randomized controlled trial is here, but for our purposes it’s a study where people are randomly assigned to a treatment group, in this case either DMPA or oral contraceptives, or an IUD, or condoms.  The main strength is that all the many variations in behavior and biology that can impact results should be equally distributed between the groups and in a way cancel each other out).

When we rely on observational studies, it is much harder to feel confident that we’ve taken into account all the individual factors that can affect the results.  For instance, perhaps women who choose to use DMPA as their contraceptive method are less likely to use condoms than women who use only condoms as their contraceptive method (in fact, we have good evidence that this is true).  When you compare the two groups, you may find more HIV infections in the group using DMPA, but it could be because they are less likely to use condoms than the group of women who rely solely on condoms to avoid pregnancy. There could also be other factors of which we are unaware that are different between the two groups and explain the difference.  The researchers often try to “control” for factors like this statistically, but it is extremely hard to know whether data on condom use (or other sexual behaviors, like number of sex partners or frequency of sexual activity) has been accurately reported.  Just like I exaggerate how often I floss my teeth every time I go to the dentist, and my diabetic patients don’t always spontaneously report the cookie they ate right before coming to the office and having their blood sugar checked, women who are seeing medical staff may not give an accurate description of how often they use condoms and with how many partners they have sex, especially if they have been told over and over how important condom use and having fewer sexual partners is to reduce their risk of HIV.

So where does this leave us?  The disappointing news is that, in 2012, science still doesn’t have a clear answer for us on whether use of hormonal contraception, and specifically DMPA, increases a woman’s risk of contracting HIV, although the experts at the WHO were reassured enough by the evidence that we do have to continue to recommend unrestricted use of hormonal contraceptives for women at high risk of HIV.  Also on the bad news front, many women in high HIV
prevalence settings have few or no other contraceptive options, so they can’t simply hedge their bets and switch to something else with a more clearly established safety profile (like oral contraceptive pills), or to non-hormonal methods (like copper IUDs or sterilization).

However, there is lots of good news.  What we lack in clear answers regarding injectable contraceptives and HIV acquisition is made up for in knowledge of other ways to impact the epidemic of sexually transmitted HIV.  We know that people who know they have HIV are more likely to use condoms, so we need to work on getting voluntary testing for everyone, everywhere.  We know that people who are on treatment are much less likely to transmit the virus to their partners, so we need to get everyone access to treatment; shockingly, less than half of people in need of treatment worldwide currently get it.  And we know that consistent, correct use of condoms greatly reduces the risk of HIV transmission, so we need to work much harder at helping people get over the many barriers that exist to using condoms all the time.

We need to keep offering women as many options as possible for family planning.  Women can safely continue to use DMPA.  The bottom line is that, whether DMPA increases HIV risk or not, condoms are an absolute necessity for all women at high risk of HIV, whether or not they are using hormonal contraceptive methods.

It always comes up. Usually the argument goes as follows: why do men get Viagra paid for by their health insurance, while women are stuck paying out of pocket for birth control? Senator Janet Howell’s recent proposal to require a rectal exam and cardiac stress test prior to offering prescriptions for erectile dysfunction drugs in order to highlight the invasiveness and over-reach of a Virginia law that proposes to require a woman undergo and view an ultrasound is the most recent and creative iteration of this theme.

While I heartily agree that a state legislature has no place telling doctors which procedures their patients must undergo, and I recognize that the Senator is trying to make a point in a political theater, I think in the end making comparisons such as these do us a disservice. They minimize what a pregnancy truly means in the life of a woman.

Sexual dysfunction is a serious matter that can affect a man’s emotional and sexual well-being in important ways. However, pregnancy affects women in a more profound way. It affects not only a woman’s emotional and sexual well-being, but also her general physical health, and her financial health. If she continues the pregnancy and gives birth it affects every minute of her day for many years to come.

The idea that medical treatment for male sexual dysfunction is a fair analogy to medical treatment to prevent or treat undesired pregnancy has always bothered me. It minimizes the profound impact pregnancy has on women’s lives. I can’t think of any event common to the male experience that compares. And perhaps that is exactly the problem.

Mississippi’s “personhood” amendment – up for a vote on November 8th – would certainly be damaging to women’s reproductive health and rights. But the media has consistently reported its implications incorrectly. Even if passed, emergency contraception using levonorgestrel (Plan B) and IUDs should still be accessible.

According to the New York Times, the amendment, if passed, “would declare a fertilized human egg to be a legal person.” The Times goes on to report that abortion, in-vitro fertilization, and even IUDs and emergency contraception might become unavailable as a result. The Guardian relays the same message.

But here’s the thing. IUDs and emergency contraception do not do anything to fertilized eggs. All the most recent science shows this. Both contraceptive methods prevent fertilization (the mainstream media has continued to repeat this flawed interpretation). In fact, just this week yet another study showing that Plan B works by preventing ovulation was published. The study measured women’s hormone levels to determine where they were in their menstrual cycle at the time of unprotected sex. They identified 103 women who had sex in the 5 days prior to ovulation, and 45 who had sex in the 5 days after ovulation. Among the 103 who had sex prior to ovulation and took plan B, none got pregnant, though statistically if Plan B doesn’t work 16 should have gotten pregnant. Meanwhile in the other group 8 got pregnant, while statistically 8.7 should have gotten pregnant. In other words, Plan B only works if you haven’t ovulated yet. If you’ve ovulated, the hormones don’t do anything to prevent sperm and egg from joining and implanting in the uterus. It has no effect on fertilized eggs.

The IUD is a bit more complicated because it works in multiple ways, and there are 2 different kinds of IUDs. However, the preponderance of evidence shows that the IUD also does not do anything to fertilized eggs. Rather, it prevents fertilization. The copper IUD alters the cervical mucus, making it nearly impossible for sperm to enter the uterus to meet an egg. If sperm do enter, their motility and ability to fertilize an egg are reduced due to the inflammatory reaction induced by the IUD. Those few studies that have looks at intra-uterine sperm after IUD placement have found that there are many fewer sperm and that they aren’t able to move like those sperm found in the uterus of a woman without an IUD. The copper IUD works by keeping sperm from getting to and fertilizing the egg; no evidence suggests it has any effect on fertilized eggs. The levonorgestrel IUD (Mirena) is less well-studied than the copper IUD, but evidence suggests it also impacts the cervical mucus, decreasing the number of sperm that enter the uterus, and decreases the chance of ovulation by releasing levonorgestrel into the bloodstream. In other words, it prevents fertilization. No fertilization means no blastocyst, which means no embryo, which certainly means this amendment has no bearing on IUDs.

Yes, there are some unanswered questions. What happens if you insert an IUD between the time an egg has been fertilized and it has implanted, or if it has just implanted? Nobody knows, and nobody ever will know, because it’s just too hard to study. It’s possible that there are some little embryos out there that get dislodged without anyone ever knowing it during IUD insertions. We also don’t know nearly as much about the new emergency contraception pill, Ella (ullipristal), as we do about Plan B, and it’s possible it works by preventing implantation of a fertilized embryo. Probably because of these uncertainties, and because it was approved by the FDA years ago before we had this recent research, packaging for products like the IUD and emergency contraception often perpetuates misconceptions about their mechanism of action. But all the recent science points away from any effects on fertilized eggs, and frankly, I’m not losing a lot of sleep about those rare situations where a fertilized egg might be affected. Every medical procedure or drug has the possibility of a negative impact. If I were to lose sleep about things like this, I’d never be able to practice medicine. I’d always be worrying if the person I recommended a cholesterol-lowering drug to was one of the rare people who would develop liver failure as a result, or if the person I recommended to start biking to work for more exercise would be one of the few people to get hit by a car. I’m certainly not going to worry about the theoretical possibility of disrupting a fertilized egg.

In medicine, we can’t allow speculation and worry about what might be to overshadow the facts. The facts are that, based on the most recent science, IUDs and emergency contraception do nothing to fertilized eggs, much less embryos or fetuses, and the mainstream media needs to stop repeating tired, disproven theories in reporting on this amendment.

The ongoing shortage of abortion providers is blamed on many culprits: the stigma attached to abortion provision, the hostile and sometimes dangerous practice environment, and even a perceived lack of interest in abortion provision. One of the less known problems, however, is the lack of training opportunities. If medical students and residents don’t have the chance to learn how to provide abortions, they simply aren’t going to be providing them when they’ve finished their training.

Prior studies have shown that an increased amount of abortion training in residency is associated with an increased likelihood of abortion provision in the future. A recent study showed that, in addition to having training available, integrating abortion training into residency training for obstetrician-gynecologists may be key to reducing the abortion provider shortage.

The study followed residents at two different programs. At one of the programs, OB/gyn residents had the normal exposure to family planning (contraception and abortion). In the other program, a structured specialty family planning rotation was instated. Those who participated in the structured program were much more likely to report planning to perform abortions after graduating from residency than the other group. In addition, at the beginning of the rotation only 1/3 of residents planned to perform abortion after residency, while after the rotation all of them stated they would perform abortions.

Results like these show us that although many in the abortion community attribute the decreasing numbers of abortion providers to lack of interest on the part of younger doctors, the situation is much more complicated than that. There aren’t enough training opportunities for those who seek them out, but clearly even those who don’t seek out training find they are interested in providing abortions when they have a high-quality experience with family planning. Abortion training needs to be a regular, structured part of all OB/gyn and family medicine residency programs.

Unfortunately, political resistance to abortion education is only growing. In May, the House approved the Foxx Amendment, which would have prevented residencies receiving federal funds from providing abortion training. Since all residency programs are almost entirely funded by money from Medicare, such a restriction could essentially end all abortion training in residency programs, shutting down the pipeline of new abortion providers. (The Foxx Amendment was not approved by the Senate, granting programs a temporary reprieve).

Several programs are working assiduously to improve training opportunities. If you are a medical student interested in training, Medical Students for Choice has resources to help you increase training at your school, externships you can apply to (some with funding), and guides to help you pick the right residency. Residents can contact the National Abortion Federation for help finding training opportunities if such opportunities are unavailable at their residency. Such initiatives are, however, a drop in the bucket. As the studies above show, leaving residents on their own to pursue abortion training leads to few if any choosing to be abortion providers. Routine training leads to doctors who want to perform abortions after graduating residency. If we want to fix the abortion provider shortage, we have to focus more closely on training opportunities.

A friend of mine, and fellow blogger here, gave me some words of wisdom a short while back regarding this whole egg donation business. She said “The coordinators are always enthusiastic about placing people. I was more realistic about how long I thought my placement would take, since I’m very short. Honestly, the process took about 6 months before a match was confirmed.”

A lesson in realism and patience. It’s been 3 months since I started working with Columbia, and 2 months since I had my physical. I’ve been matched with potential recipients twice. So far, no takers. It’s tough to sit and wait. And it is worse when they call you and tell you that in 2 weeks, you may be starting the process. Then 2 weeks go by with no news, and it’s a huge let down.

Part of what sucks is how excited my coordinator was. She told me flat out that there would be “no issues with placing me really quickly.” What she didn’t specify is what she meant by “really quickly.” My old coordinator suggested that “quickly” could be a matter of weeks. I was already skeptical heading into Columbia, but still. It’s frustrating, because you can’t talk to the recipients and tell them how awesome you really are. And it’s humbling, because these families are choosing someone else, and you will never know why.

I’m lucky to live in a huge city where there are lots of places for me to try to get matched. And I plan on applying to NYU next. The more locations that I can use, the better my chances are. But at this point, I’m getting a little downtrodden about the whole thing. It’s not like I dwell on it everyday or anything, but once a week or so, someone who knows that I’m trying to do this asks about my matches. It sucks to tell them that I wasn’t chosen.

So, for those of you out there who are thinking about becoming egg donors, consider the waiting game. And for those of you somewhere along in the process, good luck! I hope that you are matched soon.

When I went to college, I was like a kid in a candy store. Finally away from the watchful eyes of mom and dad, no curfew, no one to tell me what to do, and boys, boys, boys to choose from.  And I’m sure I was not alone. This first taste of freedom can be so liberating….but it also can lead to some sticky situations.   So, in honor of back to school, I would like to bring you the Top Five Tips for Safe Sex in College to guarantee that you have the most fun (and safe) freshman year possible.

Student Health Services is Your Friend.

Whether it’s Student Health Services, the Health and Wellness Center, or the College Clinic, every University has one. When you first arrive on campus make sure you know where it is located, and stop in for a visit! If you haven’t yet had your first gynecological exam, make one. If you are sexually active, and going to continue to be, get yourself tested. Testing (and treatment) for sexually transmitted infections (STIs) on college campuses is usually very reasonable priced, or even free…and you won’t have to worry about your parents finding out. Sexually active men and women should get tested every three months, and Student Health Services is there for you. They should also have lots of helpful information and pamphlets there for the taking, whether you need advice on how to avoid the Freshman 15 or help deciding which birth control method is right for you. And don’t forget to stock up on the free condoms on your way out!

Condoms, Condoms, Condoms.  

And about those condoms, always keep some on hand. They are (at most schools) free for the taking at Health Services.  Even if you are on another method of birth control, keep in mind that barrier contraception methods (male condoms, female condoms, dental dams etc.) are the only way to protect yourself from STIs.  And make sure you know how to use one properly.  If you need some advice, don’t be embarrassed to ask one of your new found friends or your new doctor at Health Services, and steal some dining hall bananas to practice on!

No One Loves a Roommate who Sexiles.

It’s only natural to explore your sexuality when you get to college, whether that be with a partner or by yourself.  Speaking of masturbation, a recent study in the Archives of Pediatrics and Adolescent Medicine actually found that boys who masturbate are more likely to use a condom when having sex. Yay masturbation! Know your own body and enjoy your orgasms, but also know your surroundings and be respectful to those you are sharing the very cramped quarters with.  If you’re going to have a partner over to your room or just want some alone time, let your roommate know ahead of time or arrange a secret “signal” for one another. A hair thing on the door knob, or a secret code written on the white board can do wonders for your sex life and your roommate relationship….just don’t abuse the power.

Have a Party Plan.

Drinking and sex, especially unsafe sex, seem to go hand-in-hand in college.  And binge drinking (hello college frat parties) is universally linked to risky sexual behavior, which can be especially dangerous for women. Before you go to a party, make sure you have a ride home lined up, whether that be the number for a local cab company, a campus service that gives free rides home, or a designated driver.  And make a pact with your friends to stick together. This way, you can prevent each other from disappearing into a dark room, walking home alone, or going home with a stranger. Acquaintance rape is a reality, so you have to watch out for yourself, your new friends, and your drinks (never leave one unattended!).  If you are going to drink and party in college, drunken hookups may seem inevitable or even ideal; however, you can make thoughtful and careful decisions and still have fun.

Stick to Your Guns, No Means No.

College is going to throw lots of curveballs your way. Lots of new books to read, new friends to meet, and lots of new (and potentially uncomfortable) experiences await you.  You may feel pressured to do things you aren’t ready for based on the people you are surrounded by, I know I did. But don’t do anything you aren’t ready for or comfortable with…no matter what your friends say and do, no matter what your partner wants or says he/she “needs.”  This may be sexually, or just socially, but either way, stay within your comfort zone, know your own personal limits and expectations, and trust your gut.