Conference turris::womannotes-v1

    Well, I'm not incensed, but I'm getting there.  Please let's stick
    to the topic at hand, and not let this tangent before it even gets
    started.  I am having troubles with infertility, too, and would
    very much like to see some responses to the base note from men and
    women who have been there.
    
                 Carol

    to .1 movaghar
    
    Not having had a serious fertility problem and having adopted
    kids maybe I can say something to your note....
    
    You obviously meant well - but your note would be a very
    painful one to an infertile woman.
    
    The only thing I can compare it to would be like telling
    a young woman whose husband had just died that she was
    young and pretty and would marry again soon,
    
    or, to tell the parent of an adopted child that had died
    that it was not the same as if it had been their own child.

	back to .0:
	>I don't want to be reminded of it constantly and
    	>have to act civil to these people.  This is a *very* private matter
    	>and I am not about to tell them *why* I'm not pregnant.   So I have to
	>smile, while I feel frustrated and I sometimes want to cry. 

	It's none of their business!!  

	You could actually cry or explain, which should sufficiently embarrass 
	these clods to cause them to shut up, but I can understand that you 
	don't want to discuss it.  

	Do you read Miss Manners?  She's very good at suggesting perfectly
	civil, reasonable, and uninformative answers (aka put-downs) to 
	impertinent questions.  

	Another option might be to turn the question back on the person.
	If they're so wild about kids, when are they going to have THEIR next
	one?  

	or just smile and say "well, not for the next nine months" and 
	change the subject.

	Good luck.  I was somewhat luckier, but recall and sympathize
	with your frustrations.

		Helen

    .0
    I'm glad you said what you said.  Occasionally I have run into
    ex-co-workers whose main topic of conversation (while we were
    co-workers) was Trying To Get Pregnant.  Because it was discussed
    so openly, when running into some of those people after a job change,
    I asked how it was going.  I got the feeling I had committed a major
    faux pas, and now I understand better why that is so.  I'll think
    twice next time, and have some measure of understanding.
                             
    

    re .7
    It looks like another case of awkward pharasing here - I think people
    reacted to your first note on the assumption that you had not had
    infertility problems (I know I did). This is a subject where the
    emotions lie very close to the surface and it is easy to misunderstand
    what another person is or is not saying.
    Bonnie

    re: .7
    
    thank you for clarifying.
    
                Carol

    	Well, I suppose I'd better put on my asbestos suit because I'm
    sure I'll get flamed for this.
    
    	I don't think whether .1 has/had an infertility problem has
    anything to with whether or not she should have been flamed for
    her well-intentioned note.  Perhaps it wasn't the right thing to
    say, but how to you teach someone to be considerate/understand the
    "other side", by being intolerant and flaming judgementally at her?
    
    	You have to realize that there are indeed all different types
    in this world.  Perhaps I was wrong, but I thought that one of the
    purposes of this notefile was "valuing differences".  
    
    	Well, one of those differences is rearing it's ugly (?) head 
    now.  I happen to believe that if/when I ever decide to have a child, 
    it won't make any difference to me as to whether it is a child of
    my body or an adopted child.  This does not mean that I do not
    sympathize with .0.  It is indeed a very difficult thing to come
    to terms with the fact that something you very dearly want to happen
    looks like it may not.  What it does mean is that from my point
    of view, .1 had a valid suggestion, phrased rather delicately as
    a matter of fact, in my opinion. 
    
    	re:.0  While I am not in your situation, I am in a related one.
    My husband and I do not wish to have children.  Gary's more vehement
    about than I am, and yet the main pressure to have children is on
    me.  While the questions about "when are you going to have a kid",
    don't bring me the pain they do you, they are uncomfortable to put
    it mildly.  It is especially difficult when you realize that my
    husband is an only child and his mother dearly wishes to have
    grandchildren.  I get extremely tired of being pressured and having
    people make me try feel "less than a woman" for not wanting children.
    
    	I wish I had an answer for you.  ( I wish I had an answer for
    me ;-)) 

    tlh
    

    As with TLH, .10, we decided not to have children.  We got the same
    questions.  The thing that seems ridiculous to me is that it is
    always assumed that its the *woman* who is infertile.  I guess if
    the man were infertile, he would be less of a man in the eyes of
    many.  (Hogwash, I know)  We were both fertile, but just try to
    tell someone that.  We've been called selfish, stupid, self-centered,
    and accused of depriving a life.  Lots of people would try to convince
    us that we would be happy with our own child and the conversations
    almost always ended up with us finding that they weren't happy with
    their own children.
    
    Just tell them that you're thinking about it.
    
    spence

    I've been hassled, too, about having kids. the ribbing and the
    questions started several years before i even met my husband,
    intensified at the wedding, and haven't really let up yet. everyone
    wants me to have children for THEIR pleasure; few of these people
    have bothered to figure out how WE feel about it. and right now,
    i'm not interested. my in-laws ASSUME we're going to have kids 
    (and they've asked us to hurry up so that they can enjoy the tots 
    while they (the in-laws) are still healthy). the in-laws are also 
    planning to take things away from other family members so that the 
    grandchildren can get them.  I imagine that the pain of having to
    deal with these intrusions would be greatly increased if I DID want
    kids but was unable to have them.
    
    liz

    My daughter has an answer for people who ask "her" (while I am
    standing there) "when's your mommy going to give you a little brother
    or sister?? 
    
    She opens her eyes real wide, innocence personified and says...
    She's spaded.
    
    So thanks to her, when people ask me if I am going to have anymore
    children, I give her PJs answer.
    
    vivian

    I've been mostly fortunate in that my family has not ever even asked
    if we plan to have children.  My folks had an incredibly difficult
    time having children since my father had a low sperm count, and
    my mother had some kind of problem.  My Mom told me they will never
    ask us about our plans for kids because it hurt so much when they
    were trying and failing and people kept on asking.  It took them
    2 years before my mother conceived my brother, and it was another
    15 years before they got me.
    
    Now, my in-laws are an entirely different story.  My mother-in-law
    stayed in our apartment while we were on our honeymoon.  When we
    returned, we found all sorts of Planned Parenthood pamphlets on
    having children and how to be good parents.  I immediately called
    her and told her that those hints were not appreciated, and that
    we would let her know about children when the time came.  She has
    not asked since.
    
    My husband's aunts and grandmother have been pushing for us to have
    children lately, so I told them in no uncertain terms that it was
    none of their business.  They also have not asked again.  I have
    found that if you answer such questions firmly and in a very cold
    manner that it is no one's business but your own, people will get
    the message.
    
    Also, on a more positive note, I have a cousin who is in his
    mid-forties.  He and his wife had tried for years to have children,
    and had tried just about everything imaginable.  I think they had
    pretty much given up, but after 18 years of marriage, they finally
    had a beautiful baby girl, so anything is possible, and don't give
    up hope!
    
    Good luck.
    
    Cathy

	I don't have children either and people ask me when too.  Sometimes,
	though it's not a direct question.  It's more a matter of discussing
	someone's birthing (there seems to be a lot of people having children
	lately), and when they mention problems (like 3 days in labor, 
	c-sections, etc) they look at me and say:  "but it's worth it".  I
	usually give them a sceptical look and don't comment.  I'd like
	a good comeback too, but somehow saying it's none of their business
	doesn't seem appropriate in that situation.  I actually find
	relatives much more discrete than acquaintances.

	I don't know much about the problems of infertility, but I think
	(from the number of women who've mentioned it to me) that it must
	be much more common than people believe.  Maybe that's why so many
	are insensitive when they ask about having children.

	..Karen

    I have a Fundamentalist Christian aunt who (prior to my marriage)
    asked at a family gathering, "When are you going to get married
    and give your grandparents some greatgrandchildren?"
    
    Well, I looked her in the eye, put on my most serious expression
    and tone of voice, and said, "Well, I really don't want children,
    but my sweetie and I practice quite alot, just in case."
    
    You know, she never asked me that again.
    
    A little shock goes a long way.
    
    Rita
    

    not on the topic of fertility, but doing this made me feel good
    even though it was snotty--
    
    (I was a teenager, and  about 40 lbs. overweight when this happened.) 
                                                                        
    At my grandmother's funeral one of my older aunts walked up to me 
    and said, "Holly, you're so fat!  You really should do something 
    about yourself!".
    
    I looked her straight in the eye and said "You look like you're pushing a
    size 44 yourself."                                             
    
    She was horrified, but that was the last *I* heard of it.  It's
    too bad that it takes sheer rudeness to get some people off one's
    case.

    re: .0
    
    I can really understand how you feel.  When my husband and I decided
    to try to have children we had a tough time of it.  After a year
    of trying on our own I went to a doctor.  He have me the same chart
    and thermometer for 6 months.  But he didn't really see a problem
    and wanted me to go fo another 6 months of the same telling me I
    was still young and had plenty of time to think about and try having
    children.  I asked him what types of tests he would recommend my
    having at the end of the additional 6 months and he told me.  I
    then told him I didn't want to wait another 6 months for the tests,
    but he seemed rather firm about it.  Additionnally, my husband had
    already gone through testing as well, and we were pretty sure that
    the problem wasn't on his end.  I remember the hurt feeling I had
    thinking about what I considered another wasted 6 months of time
    and his STUPID remark on my being young enough not to have to worry
    about it so much.  So, what did I do...I told him that I DID NOT
    want to wait the 6 months and I wanted the tests done NOW.  If he
    wouldn't do them, then I would find another specialist who would.
    I also told him what I thought about his remark regarding my age,
    then 23.  Well, he agreed to do the tests and low and behold, the
    problem was discovered.  It seemed that I was producing a type of
    acid that would, as soon as an egg was released, kill it.  Prescribed
    treatment was take birth control pills for 6 months, stay off them
    for additional 3 months to get them out of my system again, and
    then try.  The results...A baby girl born 9 months after treatment.
    And, my second child born last may.
    
    I think what hurt most is people's casual attitude about having
    children...like it wasn't such a difficult thing to do.  I remember
    people asking me when we were going to have children during the
    first year we were trying on our own.  All I said was.."You'll be
    the third to know.  
    
    Just never give up for what you know you want so badly, and keep
    those doctors on their toes.   What may seem like plenty of time
    for your to have children to them, it NOT how it seems to you.
    
    Best hopes and strength to you....
    
    Lois  

    .18 reminded me of something...
    
    A very close friend of mine was trying to have kids. I would have
    asked her about it relatively often, because I knew it was something
    she cared about very much. *However*, she also made it clear to
    me that it was a painful subject, so, I always let her (or her hubby)
    bring it up. 
    
    So, if someone tells me that they're trying, and that they'll tell
    me when the pregnancy occurs, I'm not always sharp enough to realize
    they don't want to be asked about it. I have to be told.
    
    Hers is a happy ending (after two miscarriages).
    	Mez

    Well, this seems like a good time to share my news.  The doctor
    found a cyst which was preventing me from becoming pregnant.
    It worked.  I am now pregnant and the baby is due around late February.
    I have two friends who are still going through tests to find out
    if their infertility can be helped.  I pray that they will be as
    lucky as I am.
                               Carol  (Hooray!!!)

    Congradulations Carol. Just think, the way things change so fast
    nowdays you can tell your kid stores about the old days when you
    had to use keyboards instead of just telling the computer what to
    do. :*) liesl
    

    The following response is from the author of the basenote.
    
    						=maggie
    =========================================================================
    
    RE: adoption 

    I was talking to my specialist a while back about what problems
    could be found during a laparoscopy.  Without getting into much
    detail; he mentioned that some things he could fix using a lazer at
    the same time as the laparoscopy, and that others would require
    coming in for more complicated surgery.  And then there were things
    that could not be fixed.  He said that if he saw something that
    required further surgery, that we would discuss it then and we would
    have to decide whether we wanted to go through with it.  He then
    made a comment about how he wasn't very sympathetic to couples who
    have "fixable problems" but decide to try for adoption.  He didn't
    like to write recomendations for them.  He said he knows of so many
    people who just can't have children and that there are few enough
    adoptable children to go around. 

    I don't want to go into a tangent on how many adoptable children
    there are and from where.  What struck me was that it encouraged me
    to go on.  To find out why we weren't getting pregnant and to try to
    resolve it.  Maybe just as I look with envy at pregnant couples,
    maybe "unfixable" infertile couples look with envy at me if we have
    something that could be "fixed". 

    Of course, I have to add that infertility is one of those grey areas
    in science.  There's never any "fixable" problems.  It's more like
    unfixable and we don't know. 

    Anyways the above seems to ramble a bit.  Maybe you'll know what I
    mean.  I'm still in the looking process, I've finished my "basic"
    workup and have to work with the Doctor on what's next. Sometime
    when I have the time, I'll make a list of what the basic workup is
    for those who might have to go through it. 

    .0 

    re .22
    
    I would appreciate more info on your basic workup and the follow-up
    as I have just started to go through this procedure.  My doctor
    has said there are 4 things that she wants to do to determine if
    there is a problem, then I guess we will discuss the alternatives
    if she finds something wrong.  The things that are being done are:
    	1) Temperature chart (I've got enough done already so that she
    could determine that the cycle is normal)
    	2) Semen Analysis.  (My husband came through with flying colors
    and lots of complaining, so we know that if there is a problem,
    it's not with him.)
    	3) Blood work to check my hormone levels. (That was done at
    the time of the consultation)
   	4) Post coital exam. (This is the last part of the workup, and
    will be done shortly.)
    
    I hope to have some answers on what's going on after the postcoital
    is done.  I would be very interested in knowing more about what
    kinds of problems can be found, and what my alternatives may be,
    if you have that kind of information.  Fortunately, I have received
    no pushback from my regular doctor or the fertility specialist.
     When I told my regular doctor that we've been trying for 9 months
    with no success, she immediately gave me the referral to the fertility
    specialist, and I was able to see the fertility specialist 2 days
    later.  She (I like having female doctors) ordered the workup right
    away, and I expect my results next week.  This whole process has
    been going on for 2 weeks, and I definitely feel like we are making
    progress.  I was expecting to get the same story you did about "try
    for another 6 months", and I had already decided that I was not
    going to accept that as an answer.  It sure had helped to have read
    this note for some encouragement.  
    
    Good luck to you on the rest of your testing, and if you get a chance,
    please let me know what to expect.  I'd appreciate it.
    
    Thanks,
    Cathy

    The following response is from the author of the basenote.
    
    						=maggie
    
    ================================================================

    Basic workup for infertility (order may vary):
    
    1. History 
    2. Complete Physical Exam 
    3. Pelvic Exam (with pap smear and cultures) 
    4. Basal Temperature Chart 
           Each morning when you awake, you take your temperature, and mark
           it on the chart.  You also mark when you have intercourse and
           other items.  Your temperature is low after menstruation and
           rises right after ovulation.  This helps you time intercourse. 
        
    5. Blood and urine tests 
           This checks for hormones in the woman. 
        
    6. Semen Analysis 
           How many, how active are they? 
        
    7. Post-Coital Test 
           This test is performed just before the expected day of
           ovulation. You and your partner have normal intercourse (without
           lubricants) the day before.  The doctor will take a small amount
           of mucus from your cervix to be studied for the number of live
           active sperm. They also check the quality of your mucus.  This
           is performed in the doctor's office and is similar to a pap
           smear. 
        
    8. Ultrasound 
           Here the doctor is looking at your follicles to see if you're
           ovulating properly and help determine what day you ovulate. It
           is also used in conjunction with treatments to get the exact
           time of ovulation. You have to go in a few days in a row, and
           the doctor measures the size of the follicle.  The doctor can
           see when it bursts which indicates you have ovulated.  For this
           test you must have a *full* bladder.  (I thought mine was full,
           and they made me go drink a few more glasses of water).  The
           doctor moves the ultrasound over your bladder and ovary area, so
           it's kind of uncomfortable.  However, you can watch it on the
           screen, so it's the most fun of the tests. (I like the
           examination rooms that have bathrooms in them). 
        
    9.  Endometrial Biopsy
           This test determines if you are ovulating, and examines the
           quality of the uterine lining in preparation for implantation of
           the fertilized egg.  You might want to use a barrier
           contraceptive to avoid pregnancy during the cycle preceding
           this.  If you were to get pregnant it might abort it.  This
           procedure is done in the office 2 days prior to your menstrual
           period, ideally on day 12 of the temperature rise. The doctor
           gives you a local anesthetic in your cervix before scraping the
           uterine lining.  You might feel some cramping.  Sometimes you
           have some spotting  (bleeding) after this test is done. (My
           first doctor forgot to tell me, and I was afraid she might have
           injured me). A small instrument is inserted into your uterus and
           a portion of uterine tissue is obtained. (My regular
           gynecologist didn't have a small enough instrument, so couldn't
           perform the test, that's when I went to the specialist.  I think
           specialists are also better at it). You need to call the office
           when your period starts so they know exactly how many days
           before the test was done.  The lab usually needs 2 weeks to get
           the results. 
     
    10. Hysterosalpingogram     
           This test is done on an outpatient basis in the Radiology
           Department and involves injecting a dye into your uterus that
           shows up on x-ray. The dye outlines the inside of the uterus and
           tubes. If the fallopian tubes are open, the dye passes in the
           surrounding pelvic cavity and is reabsorbed by your body.  This
           test may or may not be associated with mild cramping.  This test
           is done after you have stopped menstruating but before ovulation
           generally between days 6 to 10. Generally, you will be told the
           result of this test when it is completed.  (I didn't have this
           test done.  It's usually done near the beginning of the tests,
           and then they ask you to try for awhile again. Since we have
           been infertile for over 2 years, my doctor decided to move on to
           the laparoscopy.  You can find out the same information as well
           as other stuff during that.) 
        
    11. Semen antibodies test 
           This is another semen analysis to check for antibodies. I think
           that if antibodies exist, then this is a serious problem. 
        
    12. The hamster test 
           Another semen analysis.  In this one they take the sperm and see
           if it can penetrate a hamster egg, and how many of them can. 
        
    13. Laparoscopy-Hysteroscopy 
           This test is done in Day Surgery in the hospital.  You are put
           to sleep and a laparoscope (like a telescope) is placed through
           a small incision in the navel.  The uterus, tubes, and ovaries
           are viewed directly.  At the same time another laparoscope is
           placed through the opening in the cervix-womb to view the inside
           of the uterus. You will usually go home a few hours after
           surgery and feel well enough to return to work in 3-5 days. (see
           related topic for what this is like) 

    This is pretty much all I know about.  I'll tell you about more tests
    as I learn about them.  Of course these will probably be directed
    towards the area where we have our problem.  Oh, here's a list of
    organizations that might help: 

    American Fertility Society
    1608 Thirteenth Avenue South
    Birmingham, Alabama 35205
                                   
    The Barren Foundation
    6 East Monroe Street
    Chicago, Illinois 60603

    Planned Parenthood of New York City, Inc.
    Family Planning and Information Service
    300 Park Avenue South
    New York, New York  10019

    Resolve, Inc.
    P.O. Box 474
    Belmont, Massachusetts 02178

    United Infertility Organization
    P.O. Box 23
    Scarsdale, New York 10583

    .0

    re: .24
    You are good!  What detailed explanations!
    
    I have had many of the procedures you talk about, but most of them
    were performed during my laproscopy.  There are so many things that
    could be wrong when a woman is infertile, and I didn't want to spend
    forever trying to find out; I wanted to get it over with.  My doctor
    told me basically the same as yours: that it could be easily fixable
    (at the same time), fixable for later surgery, non-fixable, or they
    might still be stumped.  Luckily for me, they found a cyst on one
    of my ovaries, drained and biopsied it, and I got pregnant the next
    month.  If I had chosen one test each month (or so) then I would have had
    to wait forever before we got to something that would have found
    the cyst, and I still would have had to have the surgery.  I consider
    myself lucky.
    
    It was no fun going through the heartache of trying month after
    month, charting the temperature, taking the ovulation tests, and
    feeling like a failure (even though I knew that it wasn't my "fault",
    or anyone's "fault" that I wasn't pregnant).  Every month was a
    frustration.  I knew other people going through it also, and I really
    did feel jealousy and hurt when a friend saw us having trouble and
    decided just to go off the birth control for a month and "see what
    happened" and then she immediately became pregnant.  I was so happy
    for her, but deep down I also felt some resentment.  She had been
    scared to tell me, because she was afraid of a reaction like that.
    I tried to show only happiness for her.
    
    For those people who are going through this, I can only offer my
    understanding and my experiences.  There is no guarantee that I
    will not have troubles in any future attempts to become pregnant,
    but at least I don't feel so hopeless now.  The worst "help" I got
    while trying to become pregnant was from an infertile friend who
    told us not to get too excited or rush out to buy baby things yet,
    since we might not be able to get pregnant.  She was almost gloating
    when we were having troubles.  The important thing to remember is
    that most infertility troubles are fixable, and to hang in there.
    It may take a year, or even much longer, but the chances are that
    you WILL be able to have a baby.
    
                     Carol

    
    Feeling resentment is normal when a person is unable
    to conceive or carry a child.  At one point in time I
    would get physically sick to my stomach when I saw a
    happy pregnant woman.  This to me seemed a bit overboard
    but I paid a shrink $75.00 an hour to tell me that I wasn't
    going off the deep end.  Whew! That was close! :*)
    
                                  - Sue

    The new issue of U.S. News & World Report has a 6-page cover story
    on this subject. Oct 6 issue, I think. Included is a list of
    helpful groups, books, and adoption agencies, for any wishing to
    pursue that alternative. 
    
    Dana

    I just read a book called "How To Get Pregnant" by Sherman J. Silber,
    MD (ISBN 0-684-16508-2) which was recommended by my doctor.  I found
    it to be highly informative and easy to read.  Everything is written
    in layman's terms and things are repeated where applicable so that
    you don't spend lots of time with "see section xxx" and forget what
    you were reading to start with.  I learned a lot about the process
    to locate the problem and about infertility in general. 
    
    One interesting point that was brought up several times is that
    even if the problem is with the man, they treat the woman to get
    her to maximum fertility.  I guess it is next to impossible to treat
    the man and have any good results, so they treat the woman who has
    a much better chance of responding to treatment leading to conception.
    
    
    Another book which my doctor recommended is "Infertility:  A Guide
    for the Childless Couple" by Barbara Menning, Prentice Hall Publishers
    (ISBN 0-13-464438-7).  This book was written by the founder of Resolve,
    and I have sent for a copy.  I'll post a quick review of it after
    I have read it for anyone else who may be interested.
    
    Cathy

    The response below is from the basenote author (I think)
    
    						=maggie
    
    ===================================================================
    
    I just received a letter from RESOLVE about the Infertility Benefits
    Bill. Massachusetts residents, please write a letter supporting the
    regulations. 

    In case you don't know, IVF [In Vitro Fertilization] costs $5000. each
    month you try it.  It involves taking a fertility drug to increase the
    number of eggs ripened in a cycle.  Ultrasound is used to monitor the
    egg growth (lots of Dr. visits), and a laparoscopy (oh no, day surgery
    again!) or an ultrasound-guided aspiration is performed to harvest the
    eggs.  The sperm cells from the father are mixed with the harvested
    eggs (this is why they're called test tube babies) and if the resulting
    embryos are developing normally, the embryos are placed in the uterus.
    This is done with a tube or catheter inserted into the vagina through
    the cervix and into the uterus. 

    Now some statistics:
    Recovery rate for harvesting ripened eggs:	90-100%
    Fertilization success: very high
    Birth rate: 14-20%

    


    From Resolve:                   
    
    "Most of you know by now that the Infertility Benefits Bill passed last
    October; Chapter 394 of the Acts of 1987 took effect January 6, 1988. 

    The same day, the Massachusetts Division of Insurance issued emergency
    regulations intended to explain what compliance with the new law means.
    The Division reversed the usual procedure by publishing the Regulations
    before holding public hearings.  A hearing will, however, take place on 

	Tuesday, February 9, 1988 at 10:00 a.m.
	Massachusetts Division of Insurance
	100 Cambridge Street, Boston MA, 18th floor.

    *Public Hearing.*  Since permanent regulations will not be published
    until after the public hearing, it is extremely important that
    supporters of the bill express positive support for the emergency
    regulations in order to offset what the Insurance Division expects will
    be unified opposition from the insurance companies, who clearly found
    less to their liking in the regulations than we did. 

    If you can, please plan to attend the hearing on February 9.  And in
    any event, *write to the Division* to explain how important the bill
    and the Regulations are to you or others close to you.  Be
    specific--our personal stories are our most powerful ammunition-- and
    write as soon as you can to: 

	Roger M. Singer
	Commissioner, Division of Insurance
	100 Cambridge Street
	Boston, Massachusetts 02202. 

    *The Regulations.* ... The regulations require insurers to cover all
    "non-experimental" infertility procedures, specifically including IVF
    and AI [Artificial Insemination]. (GIFT unfortunately is not covered,
    because it is still considered to be experimental.  But the
    commissioner can--and, we believe, will--require coverage of GIFT and
    other new technologies as soon as the American Fertility Society (AFS)
    or American College of Obstetrics and Gynecology (ACOG), or other
    fertility experts recognized by the Commissioner determine that they
    are no longer experimental.)  Certain other procedures, such as
    reversal of voluntary sterilization, are also not required to be
    covered. 

    Insurers are prohibited from imposing waiting periods or other
    restrictions on infertility coverage that are different from those they
    apply to other non-fertility-related conditions or procedures, and
    insurers may not exclude coverage on the basis of a pre-existing
    condition.  Insurers are, however, permitted to establish reasonable
    medical eligibility requirements for covered procedures, and reasonable
    medical standards governing IVF clinics and other providers of covered
    procedures.  These must be written, and must be provided to any insured
    who asks for them.  The insurers say they are now in the process of
    preparing schedules of charges for IVF and other covered procedures,
    and these and any eligibility and provider standards they adopt will be
    subject to review by the Division for reasonableness. 

    ...

    The coming months will be important for the future of infertility
    benefits in the Commonwealth, as permanent regulations are adopted by
    the Division of Insurance and insurers gradually (and finally!) adapt
    to the arrival of the 20th century.  Pass the good news around--make
    sure your doctor gets a copy of the Regulations, for example--and
    insist on your rights. For the first time, infertility patients seem to
    have the Division of Insurance as an advocate, and with Chapter 394 and
    the Regulations in place, a strong hand to play.  Congratulations! " 
                                                                         

    Does the birth rate of 14-20% mean that 20% of the fertilized eggs
    will be born as babies, or does it mean that 20% of the time a woman
    goes through this procedure that she will give birth to a living
    child?
    
                Carol