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For fertility nurse Teresa Majers, NP, RN, empathy is
natural when providing treatment, but what patients
at Carle Clinic Reproductive Medicine in Urbana, Ill.,
may not know is that this compassion was born out of
her own struggle with infertility.
Majers was diagnosed with endometriosis at 22. She
married eight years later, but was unable to conceive
after a year of trying. She used fertility drugs for
a year, then finally stepped onto the roller-coaster
ride of in vitro fertilization.
The first four IVF attempts failed, but on the fifth
try, she conceived Patrick. Three attempts later, she
conceived Nicholas. In the end, she and her husband
had shelled out about $30,000 to have their two sons.
This experience is one reason why Majers understands
patients who make radical decisions to deplete their
401(k)s and mortgage their homes in their effort to
become pregnant using assisted reproductive technology.
She is one of many nurses who staff the growing number
of infertility clinics throughout the United States.
Between 1989 and 1999, the number of babies born per
year using assisted reproductive technology mushroomed
from 4,800 to 31,000, and the number of clinics offering
these services more than doubled, according to the Society
for Assisted Reproductive Technology.
And nurses are claiming a range of posts throughout
the infertility field. Some, such as Majers, work in
clinics that offer treatments such as IVF, while others
facilitate matches between egg donors and their recipients.
Still other nurses work primarily in counseling programs
to help couples navigate the emotional land mines that
infertility can create.
Majers credits an ob/gyn doctor with introducing her
to the infertility field. After graduating from nursing
school, she started working in an ob/gyn unit, where
this physician took an interest in her and suggested
she study to become a nurse practitioner. After earning
her NP, the physician recommended that she explore the
infertility specialty.
"I fell in love with it," Majers said. "It's
like a big puzzle. Often, couples feel so out of control,
and it's important to show them they can be proactive
and have a sense of control."
When patients arrive, Majers works with a doctor to
determine the cause of infertility, which usually is
one of three things: a hormonal problem in the woman
that interferes with functions such as ovulation, an
anatomical issue, such as a defect in the uterus or
fallopian tubes, or a sperm problem in the man.
The most frequent cause of infertility, Majers said,
is a hormonal abnormality in the woman, and the treatment
plan she typically suggests is to start with oral drugs
that stimulate ovulation. This costs between $1,000
to $1,500 per cycle and results in pregnancy about 20
percent of the time at her clinic, she said.
If this method fails, she'll often suggest a more expensive
drug, such as Gonadotropin, a hormone that helps women
ovulate. This drug has to be injected and costs about
$3,000 per round. The chance of pregnancy using this
method is about 25 percent to 30 percent, she said.
If a couple fails to conceive after several rounds
of these less-invasive treatments, Majers said the next
option usually is IVF. The advantage of this method
is that it has the highest chance of resulting in pregnancy-40
percent. But it requires injected drugs, frequent trips
to the doctor and a procedure to retrieve the egg.
If the doctor is able to retrieve more than one egg
during the initial procedure, the physician can attempt
to fertilize all the eggs and store extra embryos that
aren't transferred to the woman's uterus. This allows
a couple to make additional attempts to conceive without
requiring another egg retrieval procedure.
Although the majority of the patients in her clinic
eventually become pregnant, Majers said the most difficult
phone calls to make are the ones in which she has to
report failure in fertilization.
"It's very emotional," she said. "We
cry with our patients. It's a sad moment, but it's important
to come up with another plan."
M-Lyn Butterfield, MS, RN, specializes in one of these
alternative options for couples. At the Family Fertility
Center in Walnut Creek, Calif., she works in a program
that provides couples with egg donors and, if needed,
a surrogate mother.
She recruits egg donors and screens each one to find
ideal candidates. Donors have to be 21 to 30 years old,
have a good health history, take a personality test,
pass a psychological test and undergo a face-to-face
interview. Less than 10 percent of applicants are accepted.
The pregnancy success rate in her program, Butterfield
said, is about 60 percent, with 37 percent conceiving
twins.
"I just think there's nothing more gratifying
than helping someone build their family," Butterfield
said. "You see how this alters people's lives in
an earth-shaking way."
The majority of the women who come to her clinic to
receive eggs are 40 or older, and their own eggs usually
no longer are viable.
Like Majers, Butterfield has personal experience with
infertility. She tried IVF four times, and each time
the embryo wouldn't implant. At 43, she adopted a child
and, two years later, decided to try again using a donor
egg and sperm. By this time, technology had improved
and made it possible for the embryo to attach.
While most fertility nurses work with patients in clinic
settings, Amity Carriere's niche in the field helps
patients in a more indirect way. Carriere, RN, works
as a field training manager for Ivpcare, a Texas-based
company that provides pharmaceutical drugs for infertility
clinics. Carriere said infertility clinics often struggle
to find pharmacies that carry the drugs needed by their
patients. She had firsthand experience with this when
she worked at Emory Clinic in Atlanta.
"I was so busy on a day-to-day basis making sure
patients were having egg retrievals at the right time
that it was hard to juggle that with helping patients
find their medications at a pharmacy," she said.
Carriere teaches the sales representatives about the
infertility field and develops training programs for
nurses. One of these programs, for example, teaches
how to instruct patients to inject themselves with infertility
drugs.
Deidra Rausch, Ph.D., MSN, a licensed marriage and
family therapist, also has pioneered a nontraditional
path in the infertility field. She worked as a private
nurse in reproductive endocrinology, but as the practice
grew, she had less time to talk with patients.
She decided to pursue further education and open a
counseling practice. About one-third of her patients
cope with infertility.
After years of counseling couples, she's discovered
that men and women usually have different coping mechanisms
with regard to infertility. "Men often feel that
their first concern is their wife's welfare," Rausch
said. "They can put their own emotions on the back
burner. And their wives often need someone to listen,
and not someone to fix them."
For women, the inclination is to feel guilty if they
are the source of the fertility problem. Even in this
modern era in which many women pursue careers, Rausch
said women's identities still are connected to having
children, and infertility can be a painful blow to their
confidence.
Rausch counsels couples to carve out time to talk about
their feelings with one another. She suggests that they
establish routine times to talk.
"Couples can set aside 10 minutes for each person
to talk every night," she said. "If this time
is defined, then they know they won't talk about it
too much or too little."
She also tells couples who aren't able to conceive
to be intentional in the way they grieve. For some,
a formal ritual can be helpful, such as holding a funeral
for the child that will never be or planting a tree.
"Too often, relatives and friends want to help
them and say, 'Well, just adopt,' " Rausch said.
"But there has to be a break between loss and what
they try next."
She admits that one of the most difficult parts of
her job is working with couples who would be wonderful
parents, but simply are unable to conceive. But at the
same time, offering hope to these clients is one of
the most deeply satisfying parts of her job.
"I love helping couples see that, whether or not
a child is conceived, you can be successful," Rausch
said. "Success means staying married, adding new
tools to cope with tough things in life and gaining
a sense of appreciation for what is. It's very rewarding
to see them walk through this journey."
Contact
Heather Stringer at heathers@nurseweek.com.
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