Where Do Babies Come From?

When a man and a woman love each other very much and want to have a baby, they share a special hug that puts a baby into the woman's belly.

We tell children variations on this story, adding levels of scientific complexity and biological grossness as they get old enough to need the details.

For 1 in 8 couples, though, this story isn't true.

Sometimes all the love in the world isn't enough to make a baby, no matter how enthusiastic the special hugging.

Sometimes, a man and a woman love each other very much and want to start a family. They throw away all the protection that they've been using since their parents taught them about the mechanics of sex, and they "try". It's fun and it's exciting and they hold their breaths every month as they check pregnancy tests to see if they made it.

And they wait.

Friends and family ask them when they're going to have kids. Soon, they say, and look at each other with knowing smiles.

They start to wonder why it's taking so long. They do some research. She buys tests to check her urine every day so she can find out when she's ovulating so they can have better timing. She buys a thermometer to take her temperature every morning before getting out of bed, to can keep track of her cycles. She drinks green tea and eats pineapples; someone on the internet said it helps. He takes vitamins and tries to eat healthier. She cuts out caffeine and pushes through the headaches. He avoids hot tubs on vacation. Every month, they wait two weeks after ovulation to see if they'll get a pink line on a pregnancy test.

And they wait.

Friends and family ask them when they're going to have kids. Soon, they say, and squeeze each other's hand for support under the table.

Someone tells her to just relax. Someone asks him if they've tried a different position.

They see doctors. They give medical histories. They have blood drawn. How are their hormone levels? Do they have any STDs? They send blood out to see if they're carriers for genetic diseases. He holds her hand as she lies back and tries not to faint while a tech squeezes thick gel into her uterus and fallopian tubes to see if the paths are clear.

And they wait: for the phone calls, the follow-up visits, the medical bills. They wait for answers.

Friends and family ask them when they're going to have kids. The silence is awkward.

Someone says they should try adopting, because their cousin got pregnant right after she got that girl from the Philippines.

Sometimes the problem is obvious, once the test results come back. Bad sperm, blocked tubes, hormone imbalances blocking ovulation. Sometimes it can be fixed with medication or surgery. But sometimes the doctors shrug and say there's nothing wrong that they can find, but that if pregnancy hasn't happened yet without intervention, it probably won't. They give the couple odds. They're bad. They cry.

There are options, of course, but they're expensive. Many insurance plans have little to no coverage for fertility drugs or procedures. Intrauterine insemination, usually the first step, can cost over $1000, and you're only buying a 15-20% chance at a viable pregnancy for your money. In-vitro fertilization has better odds (40-60%) but is much more invasive and expensive - approximately $10,000 per round. It's a whirlwind of tears and hormones, injections and blood draws, medical bills and invasive ultrasounds, and time taken off work for medical appointments. And it's waiting. Always, always waiting.

Babies come from love. Sometimes they come from science, too. Sometimes they come from donor eggs or sperm or from adoption. And sometimes, they never come.

Last week was National Infertility Awareness Week. Many people are reluctant to talk about infertility. Maybe they're ashamed of their issues, feeling like there's something wrong with them. Maybe they've heard one too many "helpful" comments and are afraid to tell anyone else about what they're living. Maybe it's too hard to talk about without crying.

Please take a moment to read this page from RESOLVE, the National Infertility Association. This is information that everyone needs to know in order to create a better support network for the infertile couples in their lives. Read it. Absorb it. Share it. 1 in 8 couples out there could really use your support.

That's why I'm walking in RESOLVE's 2013 Walk of Hope in Washington DC this June. Funds raised from the Walk support local RESOLVE programming, including support groups and educational events, public awareness initiatives, and advocacy efforts to ensure family building options are available to all. Because they should be.

If you'd like to contribute to the cause, my fundraising page is here. But just the act of you reading this post has helped the cause, too, so thank you.

Blood Donation During a Crisis

A horrible thing happened in Boston this week. As is our human nature when faced with violent acts, people reacted with horror, sympathy, and an aura of nervous energy. Whenever there's a tragic event, whether it's a bomb, a plane crash, or a tornado, most of us feel like we should do something to help those affected. Even if we're far away, even if we're not directly connected to anyone who was hurt, there's this spark of humanity inside us that drives us to action.

It's crucial to note, though, that not all helpful actions are necessary, and not all good actions are immediately helpful.

Many people in my Twitter feed were urging people to go and donate blood. I am an occasional blood donor. I encourage people to be regular - for their own personal definition of "regular" - donors. But this week, when I saw the flood of "go give blood" tweets, I cautioned against rushing to the donor centers. 

Why? People were horribly injured and being rushed to hospitals for surgery. Didn't they need blood?

Yes, many of them likely did. But the hospitals were prepared. Every hospital has a plan in place to help them deal immediately with an "external disaster." They keep a good supply of blood on their shelves, and they have means to get more very quickly.

An organization like the American Red Cross* can move blood products efficiently from one area of the country to another. It happens every day, even in calm and peaceful times, but in an emergency, the wheels turn very quickly to get blood products to where they are needed as fast as possible.

There seems to be an almost-constant "blood shortage" going on, so it does seem confusing when Red Cross officials tell people not to come in right now and donate. What's important to understand is that the key to having enough blood available for a crisis is to have an adequate blood supply at all times. That's why the Red Cross encourages regular donations: the need is constant.

So why isn't more blood better? Why is the Red Cross of Eastern MA asking people to please wait and come in next week if they want to donate blood?

The thing about blood is that if you go to the donor center right now and roll up your sleeve, and have a unit taken from your veins, that blood will not be used immediately. It needs to be tested for HIV, Hepatitis B and C, West Nile Virus, and all sorts of other things. There's a two-day turnaround for blood products. Donating blood during a crisis isn't necessarily going to help the victims of that particular crisis. The Red Cross will do its best to accommodate all the generous donors inspired by the tragedy, but there's a risk involved with a huge rush of donors at one time. Blood is perishable. Units of blood get a 21-to-42-day expiration date. So what happens a month after the crisis, when everyone's just donated but all the blood is about to expire? Nobody wants to see blood wasted.

And that's why I urged people to wait and see whether there was a need before rushing to donate. Replenish the supply by donating a little later, so that there's always blood available for everyone who needs it.

What can you do to help when disaster strikes, then, if you shouldn't give blood?

1. Don't misunderstand me! Do donate blood. Please do. It saves lives and nobody would argue otherwise. But don't rush in after a disaster. Wait. See if the American Red Cross puts out a call for donors. If there is no immediate need, make an appointment a week in the future, or two weeks. Give often. Help keep the supply constant so hospitals can do their thing when they need to.
2. Follow @RedCross on Twitter or like them on Facebook. When something is happening, those accounts are very active and are an excellent source of news and support. There are accounts and pages for local Red Cross areas, as well. They will tell you how you can help.
3. Learn CPR and first aid. If you're ever in a position to give more direct help to someone injured in an accident or attack, you will be more confident and better equipped to act.

*I use the American Red Cross in my examples because I have a familiarity with their processes thanks to my work experience, and because they are a very important blood supplier for much of the United States. I don't claim to speak for them in any official matter.

In My Blood

In most other workplaces, a blood-spattered desk would be cause for a police investigation.

For me, it was just Friday.

Let's just say that if blood or other bodily fluids and excretions bother you, you probably don't want to pursue a career as a medical laboratory scientist.

But maybe you do want to pursue that path. Maybe you love medical science but aren't masochistic enough to put yourself through medical school. Maybe you love helping sick people but don't want to be anywhere near them while you do, because, frankly, they're a little needy. Maybe you love biology and lab work, but don't want to spend a lifetime begging for grant money to keep your cell cultures or graduate students fed. There's hope for you yet! Stay tuned to find out how you too can have a vibrant healthcare career!

I know, I'm a ridiculous infomercial, but I feel like it's my duty to promote my profession, because there are too few of us out there, and we're not well understood or respected. I want that to change. Everyone knows about doctors and nurses, but the third vital side of the healthcare triangle, the medical "techs", live in relative obscurity.

The Board of Certification for medical technologists here in the US changed things up a couple of years ago and tried to give us more respect by changing our title from "Medical Technologist" to "Medical Laboratory Scientist". It was a lovely gesture, but it didn't really help. I mean, I didn't get a raise or a talk show or anything, and I still get a blank stare and polite nod when I tell folks what I do. Although I think people picture a lab coat and some test tubes now, which is a little closer to right.

I write about my work sometimes on this blog, and last year, I wrote a series of posts here for Medical Laboratory Professionals Week. Some of them explain the science and techniques behind laboratory tests, and some of them are about my experiences in the various labs I've worked in. I would very much like to do that again this year as a way to raise awareness about the profession. I never heard about medical laboratory science careers until I was already through university with a Bachelors in Physiology and couldn't find much to do with it. I hope that by writing about it here, I can make the profession just a little more visible, and maybe inspire someone to look into it as a career.

Even if I can't inspire anyone to get into a lab career, maybe I can help people understand what the job is about. Why do you only have to fast sometimes before a blood test? What happens to a blood donation? How does blood tell the doctor how sick someone is? I'd love to make Medical Laboratory Professionals Week into a sort of Q&A session, but for that I will need your help. Does anyone have any Qs that I can A?

What do you think the job is? Have you ever heard of it before? What would you like to know about labs, blood, and medical tests? I'm getting started early this year because I want to collect questions and get to work answering them well. I want to give myself time to draw diagrams and take pictures and maybe even interview folks in different types of lab positions, so I can really do right by my profession and show off my colleagues as the caring, intelligent, dedicated people they are.

So, hit me with your questions, and I'll do my best.

'Tis the Season

Not the Christmas season, of course; it's much too early to be thinking about Santa Claus. Unless you're a major department store, in which case you've had your light-up snowman yard ornaments on display in your seasonal section beside the rakes and lawn bags for two weeks. I know it's true because I saw this guy at Sears last week and would have brought him home to live with me if he wasn't so ridiculously expensive.

But I digress.

What I'm trying to talk about is cold and flu season, which started a week ago for me. Despite my best efforts to wash my hands and stay healthy, I caught a real humdinger of a cold. In hindsight, handling a giggling snotty nephew wasn't the best idea, but I just couldn't help myself. So I got to enjoy blocked sinuses, sniffles, sore throat, fatigue, and a low fever, making me a miserable slug for a week. I'm grateful that everyone has given me permission to take it easy and rest up, and I'm glad that laundry is a fairly low-energy task, because otherwise we'd be out of socks by now.

Don't be like me. Don't get sick. Avoiding small, sniffling children is a good start, but that's only one (very effective) method of germ transmission. So what's to be done?

Wash your hands.

 

Everyone says this, because it's absolutely the best way to keep from getting sick. The CDC has a whole page dedicated to handwashing, with links to videos, factsheets, and podcasts.

How to wash your hands. Image from cdc.gov

Yes, sometimes people will cough or sneeze right at your face (small children, I'm looking in your direction) and you'll be out of luck, but it's far, far more likely that you'll get germs on your hands and deliver them to your face yourself. Someone coughs into their hands and then opens a door, or sneezes on an elevator and pushes the buttons, and then you follow behind them a few minutes later, unaware of the collection of cold viruses waiting for you on those surfaces. You open the door, you push the button for your floor, then you rub your tired eyes or bite your nails. The next day, you'll start feeling off and will probably start distributing those germs yourself.

Cold and flu viruses (and plenty of other nasties) can live on surfaces for up to 48 hours under the right conditions, so unless you want to wear gloves all day and get strange looks, you should make an extra effort to touch only what you need to, wash your hands every chance you get, and keep your hands away from your face. At home, if someone's sick, break out the Lysol now and then to spray doorknobs, toilet handles, and faucets. Encourage everyone to wash their hands after using tissues to blow noses, and to cough and sneeze into their sleeves instead of into their hands.

You don't need to bother with antibacterial soaps. Any soap will do, used with warm water and brought to a good lather. In fact, there's research to suggest that the main antibacterial agent in most of the commercially available hand soaps, Triclosan, is contributing to antibiotic resistance.

It's also a good idea to keep an alcohol-based hand sanitizer with you, for times when you may not have quick access to soap and water. Again, antibacterial agents aren't necessary here - anything that's got an alcohol content of 60% or higher will be effective in destroying most of the bacteria and viruses that are on your hands. You should still look for a sink eventually, though, and wash your hands the old-fashioned way as soon as you get a chance.

With all this handwashing, you're likely to get dry skin, no matter how many emollients the soap and sanitizer manufacturers add to their products. Get yourself a good hand lotion, because chapped and cracked skin is not a good barrier against germs!