Meetings in the Mauve Room:
Women and Fertility Issues
By Connie Thompson

It was 1999, and the meeting room at the hospital patient education center was decorated in soft mauve and muted turquoise. Five women sat in chairs, along with a facilitator from the clinic. These women were there to discuss one issue: the inability to have children, the treatments they were pursuing, and the effect it was having on their lives.

Sheri was 31 and just married. She was concerned about whether she could get pregnant. Sheri was a special education teacher and was grateful her insurance would cover part of the costs of infertility treatments for her and her husband. She knew they would either have children of their own or adopt.

Carmen, 43, had been married for two years. She admitted that she married primarily because she wanted a family. Carmen was recovering from her second failed in vitro fertilization (IVF) procedure. Although her husband had cooperated for the second procedure, he said it was too difficult emotionally for a third IVF. Although her doctor warned that, given her age and her husband’s low sperm count, her chances were slim, she felt sure that the money borrowed for the treatments was worth the investment.

Sue was 40 and married for three years. The first year she and her husband were married, her doctor suggested she try to get pregnant immediately due to her age. After a year, Sue hadn’t conceived. Since her insurance covered infertility, she and her husband moved directly into pursuing testing and treatment. The doctor could not determine the cause of her infertility after two years of tests and procedures and suggested in vitro fertilization. Sue was told that most infertility issues were generally resolved in one to three years and that her insurance would only cover treatments until age 43. Sue felt like time was running out.

Jocelyn was 38 and married for 14 years. She had experienced three miscarriages in five years. Although she had no trouble conceiving, she always miscarried before the beginning of the second trimester, even while on the drugs her doctors prescribed. Her doctors were not positive as to why this was happening. Jocelyn wasn’t sure if she was in the right place in attending the group, but she had been encouraged by a friend to check it out.

Linda was 32 and had just married Paul, who was 34. Paul had told Linda from the beginning that he had a low sperm count due to having the mumps as an adult. Before they were married, they saw an infertility specialist who agreed that in vitro fertilization would be the best choice for them. They decided to begin treatment right after they were married.

The group facilitator set ground rules before the discussion began. The first rule was that each woman would be allowed to share her feelings without comment or interruption. The second rule was that should someone in the group become pregnant, she would be allowed to attend through the first trimester of her pregnancy.

A list was passed around for telephone numbers for those available to be called or to call for support. A packet was distributed providing information on local infertility services, articles, websites regarding new discoveries, and names and phone numbers of former members who had been successful in achieving pregnancies or had adopted and were willing to share their experiences.

The facilitator explained that her job was not to give advice or solve issues but to provide emotional and informational support for members during the transition and exploration period. Women were invited to attend until they became pregnant, adopted, or felt they had resolved their fertility issues.

This group represents just one style of many support groups available for women who are transitioning through fertility crises in their lives. It can be highly stressful and emotionally disabling for a woman who wants children to discover either that she cannot get pregnant or that she will need medical assistance to do so.

The grief experience is similar to a loss such as the death of a family member or friend. A woman in transition may become angry, depressed, or even try to bargain in her own mind about the cause of her inability to bear a child. She may withdraw from women’s groups and avoid family gatherings. Medication can make her feel unusually emotional or irritable. Mother’s Day can be the hardest day of the year for a woman in fertility treatment. Anniversaries of a miscarriage can be especially painful.

It is common for group members to keep in touch after they have either become pregnant or made other decisions. The women in this group were willing to share their stories of where they are now, five years later:

Sheri decided early in her exploration to change the way she thought about her treatments. She just knew she would be able to conceive with the help of her doctor’s expertise. To her they were fertility treatments not infertility treatments. Although her husband suffered from depression during their time of IUI, or injected uterine inseminations, after the third try Sheri became pregnant. After two years, she had another child with no fertility issues. She is now the mother of two and facing the challenges of raising her daughters.

Even though her marriage was shaky, Carmen borrowed again from her retirement account and endured another in vitro fertilization. After the third try failed, her doctor advised using donor eggs and donor sperm, but her husband decided against further treatments. Within a year, Carmen and her husband separated and then divorced. Carmen recently married a widower who is a grandfather. For Carmen, being a grandmother to his children has been a healing experience, although she said she still grieves over never becoming a mother.

After another year of failed fertility treatments, Sue and her husband decided to travel to China and adopt a child. She could not endure any more of the fertility drugs required and her husband was not comfortable with moving to in vitro fertilization. Although they both still grieve that they could not have a child of their own, they have developed a deep love for their adopted child, now three years old.

After Jocelyn’s fourth miscarriage, she and her husband stopped pursuing having a natural child. Although they married with the idea of having a family, they are not sure they want to disrupt the lifestyle they have created. Grief counseling for their loss was difficult but healing. They have recently signed up for training as foster parents. The most important thing to them is that they are a family, whether they adopt children or stay just as a couple.

Two out of the three IVF treatments that Linda and her husband proceeded with produced beautiful, healthy babies. Linda is now a stay-at-home mom with her two young boys. Paul feels grateful that Linda was willing to be open to try the procedure and that their insurance allowed them to choose doctors who were highly successful in the field of fertility.

If you are reading this article, chances are you may be exploring fertility treatments or are the friend of someone on that journey. Although there are many books and websites available on this topic, it can be highly beneficial to interview staff members and doctors of the fertility clinic you select before starting treatment. If it is your walk, seeking out the help of a support group beyond family and friends may be helpful, although only you have the power to decide what is best for you. It is a transitional process. If you are a friend or support person, just love and stand by your friend and trust her choice, whatever she decides.

Albuquerque Reproductive Issues Support Group - (505) 291-5066
Providing education, information, and support for women facing the challenges of infertility, pregnancy loss/high risk pregnancy, and the decision to adopt.

Connie Thompson is a freelance writer and video producer in Sandoval County.

From my Desk

Transitions
by Jill Duval

Watching my children grow up to be productive, responsible adults fills me with pride and awe of their abilities. When children are born they have many changes and choices ahead. We, as parents, do our best to give them the guidance and the tools they need, but we never know where life’s circumstances and their choices will lead them. We can only share what we’ve learned and hope for the best.

I am blessed with children who are making, or have recently made, transitions using many good choices. My oldest daughter is beginning a second career after her children are mostly grown, having completed college to become a special education teacher.

My second daughter, after many years of studying and then practicing veterinary medicine, decided to have a family. Having recently given birth to her third baby, a preemie, she lives a very busy and rewarding life.

After being a single professional for nearly a decade, my third daughter is soon to take on the responsibility of marriage and is busy planning (millions of choices here!) and preparing for her upcoming wedding, with the promise of children in years to come.

My fourth, though not biological child — I call her the daughter of my heart – is adjusting to the challenging world of single parenthood and returning student, and meeting demands that many of our readers have or are facing.

And lastly, my only son has, this past year, faced and embraced the responsibility of being the sole parent to a teenage son, a situation an increasing number of young men find themselves facing.

Our lives take such twists and turns, often without warning. We face so many changes and have so many choices and so many different paths we can take. Mature adults take the path of productivity and responsibility. The path that helps others and leaves the world a little better place for all.

My children are old enough now that I mostly sit back and watch, providing words of encouragement and only an occasional suggestion or opinion. I see them making transitions, major life changes with grace and maturity. If we, as parents, accomplish no more than this in our lives, it is enough.

According to her older sister, Georgia West Babb, Liz Watrin’s entrepreneurial spirit became evident at an early age.

Liz polished windows in her playhouse until her face gleamed through. She used a toothpick to scrape the dirt wedged in the prisms of an acrylic doorknob. She dusted tables and swept the living room, sprayed the plastic flowers, and hung out a sign reading ‘BY SODA AND CIMON TST HERE.’ Liz Watrin was five years old when she went into business. Today Liz is president of Blue Cross/Blue Shield of New Mexico.

“I’ve always wanted to try a variety of things,” Liz relates. “In the Blue Cross/Blue Shield company, I’ve had the opportunity to experience a range of jobs. Each position taught me something new and exciting. When I learned all I could in one job and pushed the boundaries of that position, I went on to another. This position [president of Blue Cross/Blue Shield] will, I believe, offer years of challenges.”

Liz began working at Blue Cross/Blue Shield right after high school. “I wanted to be a teacher,” says the petite dynamo, “but my life took a different twist when I became a single mother with a child to support. While most of my friends were off to college, I was looking for a job and housing. I landed the job at Blue Cross/Blue Shield of New Mexico and rented a small apartment between the sitter’s home and the office. I was struggling, and it was a difficult time. It was then that I discovered that I would have to work harder to make my way in this world. I needed to make sure that I secured my job by working hard and being dependable.”

Liz entered the Blue Cross/Blue Shield world as a claims processor, ensuring that claims were processed according to plan benefits. She moved up through the ranks of customer service, management, project manager, and further up the corporate ladder.

“I’ve held virtually every position,” she says. She’s the first female president of Blue Cross/Blue Shield of New Mexico. Of over 40 Blue Cross/Blue Shields, there are only five female presidents, and three of them work for Health Care Service Corporation, the parent company of Blue Cross/Blue Shield of New Mexico.

Elizabeth Watrin is proud of her company. “As a federal employee, my father had Blue Cross/Blue Shield coverage. With six kids, one of us was always at the doctor’s office. The ‘blue card’ was all I knew, and it represented security.” Liz has had the same security during her tenure with Blue Cross/Blue Shield.

She says that Blue Cross/Blue Shield has been with her during her life milestones such as marriage, children, etc. It is obvious that Blue Cross/Blue Shield is Liz’s adopted family. Her biological family, according to Watrin, has been and continues to be an inspiration. “My father has a sense of humor. He makes people laugh. Even though he’s been through major illnesses, he is always happy. My Mom, whose family immigrated from Madrid, Spain, didn’t know much English. Yet she conquered the English language, raised six children, and worked as a dental assistant. She set an example for me.” Watrin’s sister says, “As the middle child of six, Liz learned early about bargaining power, negotiating, and striking a deal.”

Her children, now grown, incorporate some of Watrin’s characteristics, too. “My son, like me, enjoys variety and is involved in many activities and ventures. My daughter is attending the University of New Mexico for nursing. So she is also in the health care profession. We have a nursing shortage in New Mexico, and I think she would like to contribute.”

Although her seventh floor office overlooks a beautiful residential setting with a view of rooftops and Southwest colors with the backdrop of mountains and blue skies, Watrin is focused. “I love New Mexico. I moved to Seattle for a while but missed my family, the Southwest, the desert, the sun, and green chile.”

Health care is a topic of much attention and debate. Going out on a limb and, at the same time, taking the initiative to add the human touch is one of Liz’s mantras on the job. “It’s about taking care of people and going the extra step,” she says. “Once a man brought in a shoe box filled with doctors’ and hospital bills from his wife’s open heart surgery. He was distraught. I organized his bills on my own time. I felt good about helping him.”

Watrin explains, “When people become sick, they worry about not only health care but the financial impact the health care has on their lives. I get together with the management staff and read all of the letters sent to Blue Cross/Blue Shield New Mexico each month. Most of the letters say thank you. Thank you for covering this; thank you for helping me to navigate the system. The man I mentioned, with the shoebox full of doctors’ bills, sent us a letter saying thank you for making his wife’s month-long stay in the hospital during open-heart surgery a little better. He thought he was going to have to sell his home to cover the costs.”

Blue Cross/Blue Shield offers training and education and the chance to experience a range of jobs dealing with all aspects of the health industry. She says that opportunities lie in all areas of the insurance industry. Blue Cross/Blue Shield of New Mexico employs 85 to 90 percent women. “It is a family-friendly company and recognizes the challenges that we face as women in balancing career, home, children, etc.”

Blue Cross/Blue Shield operates as a nonprofit health plan and as such has a special responsibility – and an enhanced ability – to help address the health care issues of today. “Health care is on the agenda of all the politicians,” Liz says. “It is a volatile issue.” In her new position, Liz will be involved in the political aspects of health care.

The politics and political stances of health care are myriad. Liz’s focus of late has been a Health Care Cost Campaign. Last year, she and her colleagues conducted a tour through New Mexico focused on rising health care costs and the uninsured.

“Blue Cross/Blue Shield of New Mexico believes the existence of thousands of uninsured in New Mexico presents a serious problem for society and the health care industry as a whole. Blue Cross/Blue Shield of New Mexico believes that the U.S. health care system is one of the finest in the world, providing superior access, and the best way to address the problem of the uninsured is to strengthen and enhance the current system.”

New Mexico has the second highest uninsured rate at 24 percent or almost 400,000 residents of the state. “These uninsured have many different faces. In New Mexico, there are about 106,000 residents who are eligible but not enrolled in government-sponsored health care. Another 120,000 residents make over $50,000 per year and may be able to afford insurance. We have 60,000 residents considered short term (college students or seasonal workers) and approximately 87,000 that are considered long term uninsured. And while there is no single bullet, there are multiple solutions,” Watrin says.

According to Liz Watrin, getting ahead in any industry requires creativity, not accepting the status quo, going an extra step to help people, finding solutions to problems, implementing ideas, creating a good reputation, and most importantly, providing the human touch.

“It’s a combination of being prepared when opportunity knocks on your door. Your life is not always going to turn out the way you planned, so you need to be willing to bloom where you are planted.”

She has the opportunity to hang out a new sign for Blue Cross/Blue Shield of New Mexico. She can try out new ideas and approaches, utilize her creativity with hands-on management, and offer a different, more meaningful, and comprehensive menu of services and processes in the healthcare industry through her own personal style. And Watrin can continue to let other kids sell lemonade while she sells soda and cinnamon toast.

Blue Cross Blue Shield of New Mexico
12800 Indian School Rd. NE
P.O. Box 27630
Albuquerque, New Mexico 87125-7630
(505) 816-4400

Joyce DePow has traveled the Southwest writing brochures for government and nonprofit agencies for the last 12 years. Her education and professional training were in psychology, though how people use plants has become her passion. Contact DePow online at www.joycedepow@badgersongpress.com for more info.

The sunrise in the east affirms the balance and harmony within the universe. As the golden glow of the western sky sets, it shimmers with the promise of hope for tomorrow. The endless facets of nature complement one another; light and dark, cold and warmth, life and death. Having a baby is no different; the integration of mind and body, male and female, must work together to achieve the balance needed. For many couples facing infertility, maintaining this equilibrium seems elusive and out of reach.

In the Southwest, the symmetry of East and West are working in concert to bring options and hope to couples experiencing infertility. In March of 2004, Reproductive Medicine & Fertility Center (RMFC) joined with the University of New Mexico, Department of Obstetrics & Gynecology to form RMFC@UNM™, whose private practice specialization is in vitro fertilization (IVF) treatments. Medical director Paul Magarelli, M.D., Ph.D., a board certified reproductive endocrinologist and infertility specialist, says RMFC@UNM™ seeks to provide New Mexico’s infertile couples with compassionate, exceptional, ad-vanced IVF services.

Nationwide, the Centers for Disease Control and Prevention reports 99,629 procedures were performed in 2000 by in vitro fertilization (IVF) — fertility treatments in which the egg and sperm are handled in the laboratory — resulting in 25,228 live births and 35,025 infants. In New Mexico limited access to fertility specialists has resulted in declining IVF procedures. With the opening of RMFC@UNM™, Magarelli estimates that within two years, 150 to 200 procedures will be performed annually in Albuquerque.

In 2002, in an effort to enhance reproductive services in New Mexico, Magarelli conducted a seminar in Santa Fe. Three people attended. At a subsequent seminar, a few months later, the room was filled. “We have the capability and people want this information. New Mexico as a whole is interested in integrative care.”

RMFC@UNM™ is an outgrowth of Dr. Magarelli’s fertility practice in Colorado Springs and a response to genuine desire for expanded services in New Mexico. Working with local professionals in Albuquerque and Colorado Springs, Magarelli offers comprehensive services to his patients at both centers. He hopes the new center in Albuquerque and his affiliation with the University of New Mexico will enhance the one other program operating in New Mexico.

The Problem
When couples face infertility, they want answers. A desire to understand exactly why they cannot get pregnant is of the utmost importance. Dr. Magarelli has created a simple chart outlining four critical questions all patients should ask their doctors. The answers will determine the appropriate treatment for each couple.

Ask your doctor to check the following: Are there sperm? A semen analysis at an Andrology Lab; Are there eggs? Day 2, 3, or 4 after your menstrual cycle starts have your doctor check your blood for Estradiol, FSH, and LH hormones; Can the sperm and egg meet? Have your MD order an HSG or X-ray dye test on Day 10 of your cycle — this will tell him if your fallopian tubes are open or not; Does the baby have a safe place to grow? The same HSG above will also tell your MD that you can safely carry a child.

A Partnership
For a specific and challenging segment of Magarelli’s practice, “high tech” Western medicine seemed to provide few answers. He looked to a respected colleague and an ancient medical tradition for alternatives.

Diane Cridennda is a doctor of oriental medicine (D.O.M.) practicing in Colorado Springs. Magarelli began referring some of his more challenging patients, those with a limited chance of getting pregnant, to Cridennda for acupuncture treatments.

Two articles have appeared in the scientific literature that thrust acupuncture into the spotlight as a viable complementary modality for the treatment of infertility. The protocols outlined in the articles are widely accepted and used successfully in conjunction with IVF to treat infertility.

Cridennda has been following the protocol for 10 years. “Participating in the acupuncture treatment gives women a sense of control; it’s empowering to be able to contribute and actively participate in their care,” she says. Cridennda adds, “The rewards are heartwarming.”

The protocol includes:

• Eight treatments before egg retrieval, two times per week for four weeks
• One treatment the day before or morning of egg retrieval
• One treatment after the egg transfer.

The acupuncture treatments before and after egg transfer are to bolster the heart energy and connect the heart with the head. The other treatments promote increased blood flow to the uterine arteries, preparing to accept the embryo. The final treatment facilitates closure and enables the woman to hold the embryo and bring the baby to term.

Dr. Cridennda treats prospective fathers as well as mothers. The process for men is a little different. It takes three months of treatments to affect the sperm. The treatments consist of vitamins, antioxidants, and specific herbs.

Because of their collaboration, Doctors Magarelli and Cridennda have given birth to a three-year retrospective study, assessing the efficacy of combining IVF and acupuncture to treat infertility. Their results have not been duplicated.

The Bottom Line
Not only are 16 percent more women getting pregnant, but also more women are having babies. “It’s so neat,” Magarelli beams, “to tie together two areas that are really helping women.” The soon-to-be published study is the first to examine birth rates. “We’ve changed the focus to the baby, not just getting pregnant. We want babies, not just pregnancies.”

Despite the focus on babies, cost is an enormous factor. In the past, IVF treatments were “up front, pay as you go” procedures. In New Mexico and Colorado, things have changed, thanks to an innovative funding program called Shared Risk, implemented by Dr. Magarelli.

Using in vitro, it takes approximately 2.2 attempts to get pregnant. Multiple attempts are costly and may not result in pregnancy. Through the Shared Risk program, patients receive four complete cycles of in vitro for the price of one. By making a deposit and affordable monthly payments, patients and doctors share the financial and fertility risk. This lowers the cost to families, increases the chances for pregnancy, and broadens access to these specialized services. Magarelli maintains, “We want to provide New Mexico women with options.”

For couples facing infertility, having a baby can be an arduous journey. The time and energy spent identifying resources and agonizing over how to pay for it all, coupled with the spiritual and emotional toll, can be daunting. Through it all, couples wrap themselves in hope and persevere.

East and West have converged in the high desert plains of the Southwest with a message of hope, anchored in traditional Chinese medicine and the promise of innovation that characterizes Western medicine. This balanced approach emanates from the very core of human existence and will move into the future helping couples, one baby at a time.Jahaan Martin is a freelance writer living in Albuquerque.