Diet Plan With Hormone Has Fans and Skeptics

Every morning, Kay Brown engages in a ritual similar to a heroin addict’s, or a diabetic’s: she sticks herself with a syringe. Only hers contains hCG, a pregnancy hormone.

Ms. Brown, 35, is not taking hCG to help her bear a child. She believes that by combining the hormone injections with a 500-calorie-a-day diet, she will achieve a kind of weight-loss nirvana: losing fat in all the right places without feeling tired or hungry. “I had a friend who did it before her wedding,” Ms. Brown said. “She looks great.”

Women like Ms. Brown are streaming into doctors’ offices and weight-loss clinics all over the country, paying upward of $1,000 a month for a consultation, a supply of the hormone and the syringes needed to deliver it. More than 50 years after a doctor at a Roman clinic began promoting hCG as a dieting aid, it is as popular as ever, even though there is scant evidence that it makes any difference.

The regimen combines daily injections with a near-starvation diet, and patients, mostly women, are often enticed by promises that they can lose about a pound a day without feeling hungry. Perhaps even more seductively, they are frequently told that the hCG will prompt their bodies to carry away and metabolize fat that has been stored where they least want it — in their upper arms, bellies and thighs.

In response to inquiries stirred up by the diet’s popularity, the Food and Drug Administration warned in January that “homeopathic” forms of hCG, like lozenges and sprays, sold over the Internet and in some health food stores, are fraudulent and illegal if they claim weight-loss powers.

The injectable, prescription form of hCG, human chorionic gonadotropin, is approved as a treatment for infertility and other uses, and it is legal for doctors to prescribe it “off-label” for weight loss.

But the F.D.A. has also reiterated a warning, first issued in the mid-1970s, that is required on hCG packaging: It has not been shown to increase weight loss, to cause a more “attractive” distribution of fat or to “decrease hunger and discomfort” from low-calorie diets.

The F.D.A. recently received a report of a patient on the hCG diet who had a pulmonary embolism, said Christopher Kelly, a spokesman for the agency. He said the hormone carried risks of blood clots, depression, headaches and breast tenderness or enlargement.

Dr. Pieter Cohen, an assistant professor at Harvard medical school who researches weight-loss supplements, said that aside from the issue of side effects, the use of hCG as a diet tool was “manipulating people to give them the sense that they’re receiving something that’s powerful and potent and effective, and in fact they’re receiving something that’s nothing better than a placebo.”

But unlike other popular diet supplements, hCG, which is derived from the urine of pregnant women, has acquired an aura of respectability because the injections are available only by prescription.

Ms. Brown’s physician, Lionel Bissoon, a well-known society doctor with an office off Central Park West, charges $1,150 for his hCG program, which covers an examination, injection training, a month’s supply of the hormone and syringes, and blood work to monitor for possible trouble.

“From an anecdotal point of view,” Dr. Bissoon said, “physicians all around the country have seen people losing a tremendous amount of weight with this stuff, and you cannot afford to ignore that.”

Another New York doctor, Scott M. Blyer, offers the hCG diet as an adjunct to his cosmetic surgery practice, working with Jacqueline Fulop-Goodling, an orthodontist, out of her office in Midtown. Dr. Fulop-Goodling does not prescribe hCG, but she counsels patients. They charge $800 for a 40-day course of therapy, half-price for repeat rounds; they also require an EKG to make sure the patient has no heart trouble.

One of Dr. Blyer’s patients, a 30-year-old business consultant named May, who asked that her last name not be used because she was embarrassed to be considering the diet, described herself as an “emotional eater.” She is 5-foot-3 and 130 pounds, but said she hoped to shed 20 pounds in time to be a bridesmaid at an April wedding. “So I have just six weeks,” she said.

Dr. Blyer looked uneasy. “Your legs are thin, your face is thin,” he told her. “You’re a very attractive woman.” But he reassured her that she would lose weight where she wanted to, in her stomach. The hCG, Dr. Blyer said, “tricks your body into a state of pregnancy; it burns off fat so the fetus can get enough calories, but it protects muscle.”

May eventually decided that she did not need to lose much weight and did not go through with the diet.

Dr. Blyer’s explanation of how the hCG diet works resembles a theory first popularized in the 1950s by A. T. W. Simeons, a doctor in Rome who said he had used it on more than 500 patients, and published a paper about it in The Lancet, the British medical journal, in 1954.

In 1995, a Dutch study in The British Journal of Clinical Pharmacology tried to resolve the question of whether the hCG diet really worked by analyzing 14 randomized clinical trials of the diet. Only two, including one co-written by an advocate of the diet, found that people on hCG lost more weight, felt less hunger and had an improved body shape, compared with people on the same 500-calorie diet who received a placebo, like saline injections.

But several studies concluded that the ritual of the daily injection and the instant gratification of quick weight loss helped motivate people to stay on the diet.

However arcane the theory, some doctors say it is theoretically plausible that hCG would create a more toned body, because it can induce the production of male hormones and increase muscle mass.

“There’s a reason Manny Ramirez took it,” said Dr. Martin Keltz, director of the division of reproductive endocrinology and infertility at St. Lukes-Roosevelt Hospital Center in Manhattan. Mr. Ramirez, the baseball star, was suspended for 50 games in 2009 after evidence surfaced that he had used hCG, which is banned by Major League Baseball.

Dr. Keltz said he thought it was possible to redistribute fat with hCG, but, he added, “there are risks, like cardiovascular risks.”

“I would shy away from them,” he continued.

Then there are the nutritional concerns about a diet that some say mimics anorexia. “The average person is going to eat 1,800 to 3,000 calories,” said Kristen Smith, a bariatric surgery dietitian at Montefiore Medical Center.

“I don’t think it promotes healthy long-term eating habits,” she added.

Doctors who prescribe hCG for dieting say that experience is in their favor, even if the research is not. They point to women like Guldal Caba, a 53-year-old psychologist from Toledo, Ohio, who traveled to New York for treatment from Dr. Bissoon. “It was the fat that needed to go — you know behind my bra, that back fat, my belly,” Dr. Caba said.

Ms. Brown, a theater administrator who is 5-foot-8, said she was thrilled to lose six pounds in seven days, and hopeful about reaching her goal of losing 30, which would bring her close to her ideal weight of 135. She said she did not feel hungry and did not obsess about food as she had years ago, when suffering from anorexia.

“A lot of people have a lot of opinions,” Ms. Brown said, “but I don’t want to be a person who feels like my weight is not under my control.”

By ANEMONA HARTOCOLLIS
Published: March 7, 2011
The New York Times

Multisource political news, world news, and entertainment news analysis by Newsy.com

S'pore MD gives up 5-figure salary to be Mister Mum

This couple believe that a maid can never be a substitute for parents.

Especially when their offspring are twins conceived by in-vitro fertilisation (IVF) treatment.

It was a painful process and a difficult pregnancy for Madam Rachel Foo who was 33 when she gave birth to a pair of non-identical twins on June 29, 2005.

The couple, who married in 2001, named their boy, Aston, and their girl, Chelsea.

But when it came to the crunch on whether it would be Madam Foo, 39, or her husband, Mr Peter Chua, 56, who should stay home to look after their precious twins, the decision wasn't easy.

He was older. And he had a successful career.

Mr Chua was the managing director (Asia Pacific) of a US company in the cruise and resort industry, earning more than $10,000 a month.

On the other hand, the wife, who was then working as an executive assistant to the manager in a finance company, was earning about $4,000 a month.

But Madam Foo felt that she was not as patient as her husband and she did not like to stay at home.

The couple then decided that Mr Chua would stay home in their four-room HDB flat in Punggol, to look after the children while the wife would be responsible for bringing home the bacon.

Mr Chua said: "Rachel has a career to build. I think I have done enough in my career. To stop working and stay home to look after the children is just sacrificing my income.

"Our children are our primary concern..."

Open-minded

"To me, I want to spend more time with my children."

Madam Foo agreed, saying: "I told my husband that maids can never substitute us as parents.

"Peter is very open-minded and he didn't mind. He really looks after the kids very well. And I respect him for his sacrifices."

The first few years were tough as the couple struggled a little to make ends meet. They had to plan for everything that they were going to spend on. It also meant shorter holidays to places like Hong Kong and Macau and eating out less.

Madam Foo said: "It helped that we were staying with my mother while waiting for our new flat in Punggol."

But six years on and the couple are still very happy with the arrangement. Their twins are now six years old and attending pre-school.

Madam Foo has since joined a fund investment firm as a business manager and earns more than $5,000 a month.

She pays for her children's school fees and household expenses such as utility bills and groceries. When Aston and Chelsea were born, they spent three and five weeks respectively in the intensive care unit in the hospital.

"They were so tiny and it was not easy to care for them," Mr Chua recalled.

The couple had to hire a maid to do the household chores so that Mr Chua could fully concentrate on looking after the twins.

With the role reversal, Mr Chua was the one who woke up in the middle of the night to feed the twins and changed their diapers.

Now that the twins are in pre-school, Mr Chua begins his day by waking up at 6.30am to get them ready. He drops them off before taking his wife to the MRT station where she takes the train to work.

Before picking up his kids at 11am, Mr Chua goes grocery shopping or dabbles in stock trading activities.

After fetching the twins home, he ensures that Aston and Chelsea have a good bath and lunch before supervising them in their homework.

"After they have finished their homework, I play with them or read to them," Mr Chua said.

In the past six years as a house husband, Mr Chua has learned to be careful with his grocery spending as he would have to fork out the extra money whenever he exceeded the budget, he added jokingly.

"I did not have any training before, but I learned to bathe them, feed them and take care of them when they are sick.

"I call it a parent's instinct. Be it the dad or the mum, it is the parents' instinct to look after their children. I had learned to identify their cries, whether it was a cry that they had wet their diapers or a cry for milk," Mr Chua said.

As the twins grew older, Mr Chua attended toddler classes with them. It was inevitable that he received curious stares from other toddlers' mothers. But Mr Chua took the stares in his stride. He said: "I was the only man in my kids' class. And unlike them, I didn't just look after one kid, but two. I took the initiative to interact with them and even gave them some parenting tips that I had learnt."

Mr Chua said his family and friends supported his decision to care for the children, much to his surprise.

He said: "They told me that I have made the right decision and they actually envy me for being able to do it.

"There are always sacrifices in life. Sometimes money can create a lot of family problems, but I am glad that it has never been our problem.

"When Rachel and I decided on this arrangement, we knew what we were getting into. We had our little struggles and we don't envy others who are able to take their children on holiday during every school holiday. We need to strike a good balance."

On her part, his wife has never doubted his ability to take care of the children.

She said: "In my previous job, I would get very stressed out with the office politics and I would ask Peter if we could switch back our roles. But I also knew that I wouldn't last more than two months at home."

Madam Foo admits that her husband has done a better job than she ever could.

When Madam Foo returns home in the evenings, Mr Chua would patiently wait for her to settle down and have her dinner before lending her a listening ear.

He said: "I would listen to her talk about her work in the office and sometimes give her my advice. That's what a husband is for."

It is something his wife greatly appreciates.

Madam Foo said: "Sometimes I can get very carried away with my work and Peter is always there to remind me that our family is equally important."


Role reversal

With this reversal of roles, Mr Chua admitted he can now appreciate the role of a housewife better.

He said: "In our relationship, there is no one party who is superior to the other.

"Few men would like to do what I do. For it to work, you must believe in what you are doing and there needs to be trust between the spouses.

"If right now, I tell my wife that I would like to rejoin the workforce, she will support me in my decision.

"But now that I have grown so close to my children, it would be a huge sacrifice for me to go back to work and not be able to care for them.

"Unless the work is very challenging, I value my time with my children more than earning an income."

Wives: No respect lost for house hubbies

IF ONE party has to give up the job to look after the children, who should it be? Should it be dad or mum?

The New Paper on Sunday spoke to five couples who said that they have no issue with the man staying home to look after the children.

Most of them were more concerned with the loss of income of the party who needs to stay home, given the high cost of living in Singapore.

Typically, they felt that the person with the lower income should be the one to stay home.

Madam Jennifer Tan, 35, a sales executive, who gave birth to a son last week, said: "If the woman is earning $10,000 a month and the man is earning only $5,000 a month, then it makes more sense for the woman to keep her job to support the family."

Madam Tan's husband, Dr Andy Lee, 37, an entrepreneur, was asked if his wife would lose respect for him for if he stayed home to look after their baby.

Dr Lee replied: "I don't think so. If she wants me to be a stay-home dad, she can't say that I am worth nothing. I would have contributed by looking after our son."

Madam Tan said: "Why would I lose my respect for him? I feel it's a big sacrifice for the man to be able to do this. It just shows that he loves the family a lot."

Psychologist and family counsellor Richard Lim said there is a big jump in the number of wives who now earn the same, if not higher, salaries than their husbands. Often, this leads to unhappy situations at home.

Dr Lim said: "Regardless of what the initial arrangement was, it's hard for the man not to feel insecure. When the power shifts, it'll take for both the man and woman to adjust.

"Pride, which is an emotion, is not something that can be controlled."

Lawyer Steven Lam of JTJB has handled a few cases of wives divorcing their house husbands.

He said: "We're still an Asian society and the man is still regarded as the breadwinner. I have came across some cases where the woman had loved the man because of his status. And problems popped up when he became a house husband and she did not see him as capable as he used to be."

Lesbian mothers: My two mums

A recent study found that children raised by lesbian couples were often brighter, happier and more confident than kids brought up in more traditional family units. Here, four women-only households describe their experiences of parenthood – and why tolerance and honesty are the key.

Do lesbian mums make the best parents? According to research released earlier this year, children raised by two mothers do better academically, have higher self-esteem and are less likely to have behavioural problems than peers who have been brought up in a family with two heterosexual parents.

The 25-year study, published by the American journal Pediatrics, followed 78 couples who conceived using donor sperm. The mothers were interviewed during pregnancy and the children were tested and interviewed at ages 2, 5, 10 and 17, along with their parents. The study found that children raised by lesbian mothers scored similarly to children raised by heterosexual parents on measures of development and social behaviour. However, children raised in lesbian homes scored higher than kids in straight families on psychological measures of self-esteem and confidence, and did better at school. And while 26% of American teens report physical abuse by a parent, not a single case was found among the children in their study.

What do the results mean: that lesbian women are more committed parents? Or, perhaps, that early teaching about diversity, sexuality and tolerance is the key to raising emotionally intelligent, confident kids?

We met four different families living in the UK, to talk about both the benefits and the challenges of raising children with two mums. In each case, it was noticeable that both mothers were equally involved in all aspects of their children's lives; and that they consider open communication with their children to be crucial. They shared with us their style of parenting, how they explain the difference of their situation to their children – and whether attitudes towards gay families have really changed.

ASHLING PHILLIPS AND NATALIE DREW

Ashling, 32, and Natalie, 35, have been together for nine years and live in Birmingham. They have two children, Giana, five, and Kai, two

NATALIE: My family didn't take my coming out very well. They were so homophobic that I moved out at 17. It was only after Ashling and I got together that there was some level of acceptance. Having our children has brought the whole family closer together. They've accepted us and realise that times have changed.

ASHLING: Natalie and I had been friends for 17 years. We both went off to university, and when I moved back to Birmingham nine years ago, we got together.

NATALIE: I'd always wanted kids and a few of my gay male friends had offered to donate sperm. We thought it would cause complications, so we researched agencies online and found they were charging huge amounts. We didn't trust the process. How do you know it's what you ordered?

ASHLING: We decided to find a private donor and do it ourselves. We found Ben on a sperm-donor website and arranged to meet. We got along well, and after we'd all had a health check, he fathered our two kids. He's in their lives and sees them two or three times a year. They know him as Daddy Ben, and we've tried to keep everything as open and honest as possible.

NATALIE: You'd be surprised how many men want to help women in our situation. After our experience, we decided to set up gayfamilyweb.co.uk, offering to connect gay families with donors and other gay families. It was difficult for us to meet other gay women with children in our area – although we had the support of our straight friends, we felt isolated as we had no one to talk to in the same situation.

ASHLING: It's been difficult at times because I think people in our town weren't exposed to gay families before. Overall we've been accepted by our community, but every now and then there's a little reminder that people don't know how to deal with gay families. The week before Father's Day this year, Giana's class made cards, and because her school wasn't sure what to do with her, they got her to make a card for her little brother instead. She's young and didn't understand why she was asked to make a card for her brother while all the other children made cards for their dads. The school knows that Natalie and I are together – they just didn't know how to deal with the dad issue.

NATALIE: The children are still a bit too young to really be aware that our family isn't the traditional set-up. They know Ash and I love one another and that Daddy Ben helped us make them.

ASHLING: The one issue people tend to bring up is the concept of the absent father figure and the effect that will have on the children, especially Kai. We've made a conscious decision to ensure there are strong male role models around.

NATALIE: Ash and I are both secondary-school teachers, so we do see neglected children or those who have absent fathers. We're very aware of what we shouldn't be doing.

ASHLING: We've talked about how we're going to deal with any issues that come up as they get older, and we believe that we have to be as honest as possible with them. I think having two women in the household means the children get more attention. It's very homely, and there are two people with a motherly instinct.


DAKSHA SINGH AND SEEMA KHAN

Daksha, 39, and Seema, 45, have been together for 10 years. They had a traditional Indian civil wedding in 2006 and have a 15-month-old daughter, Lia. They live in east London

DAKSHA: I've been out to my family since I was 17. It didn't go down great at the time, as I come from a close-knit Asian Hindu community in Birmingham. My parents didn't know what being a lesbian meant and were fearful of what people would say. My siblings, cousins and people of my age within the community were fabulous. Once my parents came to terms with it, everybody else just followed suit.

SEEMA: I grew up in a Muslim Asian family in Blackburn. I came out to my siblings when I was 16 and they were fine with it, but I didn't come out to my parents for a long time. My dad implied he knew when I was in my late teens, and he encouraged me to move to London to university – he was supportive in his own way.

DAKSHA: Seema and I met through work and it was quite instant for me. I hadn't dated an Asian woman before, but it felt so right.

SEEMA: We decided we were going to have our civil partnership in 2006. My mother adores Daksha, so she was pleased initially, but when she realised we were having a registration ceremony and a big Asian wedding, like a straight couple would, she was anxious about what people would say. My siblings, my parents and close family know about Daksha and me, but the wider community in Blackburn doesn't – it's easier that way.

DAKSHA: I always wanted a child. We asked friends to ask their friends if they'd be a donor, and when one said yes it turned out we knew him already. It was important to us that he was Asian, as we figured Lia would have enough to contend with without having to deal with issues about her nationality, too. We inseminated at home and it took us almost a year to get pregnant. It was difficult and stressful, but we got there in the end. We see Lia's biological father every couple of months.

SEEMA: Her biological father is very much what we wanted. When Lia asks who her dad is and we tell her, she will already have a relationship with him. As far as I'm concerned she is our daughter, and although the law allowing me to appear on the birth certificate changed after Lia was born, I have legal parental responsibility with Daksha.

DAKSHA: We've talked about homophobia and bullying, and we've come to the conclusion that kids get bullied for all sorts of reasons – it's not a massive concern. We're part of a tight-knit group of friends and neighbours and we have family close by, so we are lucky.

SEEMA: It's complex, we're aware of that, but what families aren't complicated? We love each other, we're committed to our daughter, and we have an amazing support network. Nothing is secret, nothing is hidden, and we'll talk about everything – that will give any child confidence and a good start in life, regardless of whether their parents are gay or straight.


LARA FARNHAM AND RUTH OVERTON

Lara, 41, and Ruth, 45, have been together for 10 years. They have seven-year-old twins, Bell and Isaac, and Ross, who is three and a half, and they live in north London

LARA: We both wanted the experience of carrying a child, but as Ruth's a little older we decided she would go first. It was important for us to have known donors, as opposed to an anonymous donor. We found the right man, who we spent time building a relationship with before Ruth got pregnant. It wasn't something that we treated lightly. He wasn't able to donate to us when I wanted to get pregnant, but luckily a close friend of ours offered to help.

RUTH: We wanted the children to know who these men are. We don't call them a dad – they are a donor – although the word doesn't quite match or fit the role they play in the children's lives. We see them once every couple of months and the relationships have developed over time. The whole process was quite intense, but we're aware that these fantastic men have helped us out in the most enormous way.

LARA: A tremendous amount of trust, love and respect has built up between us and the donors. Aside from the fact they helped create them, it's great for the children to have male input, along with their grandfathers, uncles and friends. It's important to have that male energy around them so that there's a balance.

RUTH: My firm belief is that a child's well-being is down to the quality of parenting. Academic results are a little bit about a child's ability and 95% about support from parents to achieve. Lesbian couples have to work so hard to have their families – I suppose for that reason there's a possibility that you make more of an effort. What children need most is unconditional support and love. I don't think it has anything to do with having two mothers.

LARA: We are doing everything we can to equip our children with the right language and attitude to deal with peer pressure – and the main thing is for them to feel like they can talk to us. Whatever we do, our kids are at the centre of it.

RUTH: You'll always come across people who are prejudiced. What's amazed us is that we're going through it as adults, and it's easy to forget what it's like for a child. Just recently Lara and I have tried to look at prejudiced behaviour from a seven-year-old's point of view and teach them skills to deal with what may come.

LARA: The desire to be as involved as possible in our children's lives is part of the reason Ruth is a governor at the school. We want to be right in there and know what's happening. Having a close-knit community has been pivotal for us – both at the school, in our local neighbourhood, and with our friends and family.

RUTH: There's this idea that because we stand out from the norm, we have to be better than it – like super-parents – and there is a pressure to justify the fact that we're lesbian parents, but we're doing the best we can. It's a constant learning process for us.


LAURA MARAKOWITS AND NATALIE BUSCHMAN

Laura, 43, and Natalie, 35, have been together for seven years and were married in Belgium in 2006. They have two children, Sanne, three, and Quinten, seven months, and live in south London

NATALIE: We met while on holiday in South Africa. I'm from Belgium but had been living in London for some time, and Laura is American. We were introduced by mutual friends and neither of us saw it coming, not least because until I met Laura I had only been in heterosexual relationships. It was quite the whirlwind romance.

LAURA: It was a reach for both our families initially. Natalie had never dated a woman before, much less announced she was going to marry one. She's from a small village in Belgium and gay marriage is recognised over there [as opposed to civil partnership]. I'm from a conservative town in Virginia, so when we told my family we were getting married it took a while for my dad to agree to come – he was expecting protesters waving banners, which wasn't the case at all. I guess there was a natural element of fear there for us, but they're totally fine with it now, especially since the children arrived – how could you not love your grandchildren?

NATALIE: I definitely wanted children all along. The relationship wasn't going any further if Laura didn't want them – it was a deal breaker for us.

LAURA: For me it wasn't a must, but I was open to the idea if I met the right partner, because I knew I was never going to be the one that had the children. It felt like a natural progression in our relationship and I thought Natalie would be an amazing mother.

NATALIE: We planned and researched our options thoroughly beforehand, and of course we had to decide what method we wanted to take. It was about finding the process that we felt most comfortable with. We'd initially considered a friend based in the US, who was happy to help us, but we felt it could over-complicate matters. We decided to go for an anonymous donor instead.

LAURA: It's enough work trying to get two parents to agree on how to raise a child without adding a third parent to the mix. That's why the anonymous-donor option was the best for us. The donor is only anonymous until the children turn 18. As far as we're aware, they only get a name and a last known address, upon request.

NATALIE: We got pregnant via artificial insemination – with Sanne it happened straightaway, but it was harder with Quinten. After three attempts we were both stressed – and it's expensive – so we had to sit down and decide where to go from there. IVF was at the bottom of our list of options because of the cost and the drugs involved, but we didn't have any other option. It turns out there was a scheme whereby if I donated eggs myself, I would get a cycle of IVF in return, which luckily worked for us on the first go.

LAURA: I think we plan a lot more than a straight couple would. Natalie and I were discussing how we'd pay for the children's education before she got pregnant. It's all to do with having to make such an effort to try and have children – you're constantly reminding yourself what you went through to have them and that it was a more conscious decision than if you were to accidentally fall pregnant.

NATALIE: For us, our focus is to be honest about our sexuality and open to any questions we're asked by our children as they get older. We probably emphasise how special they are and how special our family is a lot more than straight families. Sanne is only three and a half, but she's already being asked questions at nursery about where her daddy is and why she's drawing two mums – we just make sure she feels secure enough in our family to answer.

LAURA: Of course we're concerned that our children will be bullied, but being a child – regardless of the parents' sexuality– is stressful. The average 10-year-old gets harassed by their peers about everything. I'd like to think that they won't be teased just because their parents are gay.

NATALIE: We've heard of lesbian mums who have told their child that if they feel uncomfortable telling the truth, they can lie and say that their other mummy is just a friend or an aunt, but Laura and I hope that Sanne and Quinten won't feel like they have to do that.

LAURA: We've had a wholly positive experience so far – people's attitudes have moved on so much in such a short space of time. We can make our own choices and not feel marginalised. It feels as though the wider society realises we're just a normal, boring family – we don't spent our days swinging from chandeliers.

Shahesta Shaitly (Shahesta Shaitly is editorial assistant of the Observer Magazine)
The Observer, Sunday 12 December 2010

Lesbian couple show off quintuplets in Australia

A lesbian couple are beaming with happiness after becoming parents to quintuplets in a world first.
Melissa Keevers, 27, and Rosemary Nolan, 22, have entered the record books after their five babies, conceived with a U.S. sperm donor, came into the world in Australia.
The chances of a woman becoming pregnant with quints from a sperm donor without the aid of IVF are estimated at 60million to one.
The two boys and three girls join an IVF child already in the family - 18-month-old Lily - born to Miss Keevers.
Miss Keevers has become mother again to the five newcomers, Charlie, Noah, Eireann, Evie and Abby but the multiple births have not come as a surprise - the couple told the world about their expected quints last October.
Now Miss Keevers has told Australia's Woman's Day magazine that in the days leading up to the births she spent three days in the birthing suite - 'they wouldn't let me leave in case it happened'.
Irish-born partner Miss Nolan, who met Miss Keevers after arriving in Australia from Waterford in 2008, said that at the time 'I was running around like a headless chicken!
'I was in shock thinking it was actually going to happen.'
The women, who live in Brisbane, admit that they are going to need a team of volunteers to help them raise the children in the first few months and years.'
They have realised this in the weeks following the births in January - and even during the births Miss Keevers had to be attended by a team of 25 hospital staff.
'We couldn't hold them, as they were so small,' said Miss Nolan. 'We wanted to cuddle them but we knew the biggest thing was to make sure they're all right.'
As the babies grew stronger the two mothers were allowed to have what they described as 'kangaroo cuddles', where the baby is placed down the front of their shirt so they can have skin contact.
Miss Keevers recalled for the magazine that when she was pregnant with Lily she knew it was her who who moving.
'With the quins, I just knew the one on the bottom right was moving.
There were movements all over. I couldn't pinpoint who it was.' At first it was feared that Eireann would need an operation to correct a murmer in her heart, but she has improved and doctors hope they won't need to operate after all.
The women are now looking forward to taking the babies home to live with Lily.
'We're not sure she understand they're all going to come home,' said Miss Nolan. 'But she likes going to visit them at the hospital and kissing them through their crib.'
The quints' father is a 27-year-old dark-haired law student with good teeth and eyesight and a high IQ. He waived all rights to meet the children.
Under Queensland law, Miss Nolan will not be legally recognised as a parent of the children.
Only the birth mother will be known as the parent and Miss Nolan will also not be allowed to adopt the children.

IVF may raise risk of diabetes, hypertension and cancer

People conceived through in vitro fertilisation treatment should be monitored for the early onset of high blood pressure, diabetes and certain cancers before the age of 50, according to a fertility specialist.

While IVF is generally considered to produce healthy babies, doctors have identified subtle genetic changes that may raise the risk of particular medical conditions in later life.

Since the birth of the first test tube baby, Louise Brown, on 25 July 1978, more than three million babies have been born through fertility treatment around the world. The vast majority are still under the age of 30.

The extent to which IVF babies develop more hypertension, diabetes and cancer will begin to emerge over the next two decades as they enter middle age, doctors said.

"By and large these children are just fine, it's not like they have extra arms or extra heads, but they have a small risk of undesirable outcomes. What's going to happen to them down the line? Bear in mind none is older than 31-years-old," said Carmen Sapienza, professor of pathology at Temple University School of Medicine in Philadelphia.

"They have a much higher frequency of being low birthweight and this results in a higher tendency to be obese, a higher risk of type 2 diabetes and hypertension when you reach 50 years old," Sapienza told the annual meeting of the American Association for the Advancement of Science in San Diego on Monday.

In 2006, the Department of Health warned that Britain was facing a new wave of cancer on the back of increasing obesity in the population.

Obesity plays a role in 4% of cancers, including breast and womb cancer, and has also been linked to the disease in the bowel and kidney. In most cases, hormones released from fat are to blame.

"It makes sense for IVF children to watch out for hypertension, obesity and related diabetes and cancers as they reach their fifties," Sapienza said. "It will be interesting to monitor these children."

Embryo swap mother of all mix-ups

Carolyn and Sean Savage were on their fourth round of IVF when they discovered she was pregnant - with another couple's child. Emma Brockes talks to them about what happened next.

In some US states, Carolyn Savage would be called the ''natural mother''. In others she is known as the ''birth mother''. The fertility industry generally refers to her as a ''gestational carrier'', a term she finds abhorrent. It's a complicated situation. In February 2009, while undergoing IVF, Savage was mistakenly implanted with the fertilised egg of another couple. She carried the baby to term and, after giving birth, handed him over to his ''genetic parents''. If she doesn't know exactly what she is to 18-month-old Logan, she does know this: ''I took him from 12 cells to a living, breathing human being.'' The 41-year-old pauses. ''That's a big deal.''

Since news of their situation got out, Sean and Carolyn Savage have been caught in a publicity whirlwind. They come from Sylvania, Ohio, where Sean works for a financial services firm and Carolyn was headteacher of a primary school. At the time of starting what they thought would be their last try at IVF, she had already undergone 20 ovarian stimulation cycles, three rounds of IVF, and had four miscarriages. So the first shock, on reading the book they have co-written, comes on page two, when the couple asserts that if treatment didn't work this time, ''We would thank God for our three beautiful, healthy children and move forward.''

The Savages were, by most standards, a complete family: they had two teenage boys, naturally conceived, and a one-year-old daughter conceived by IVF. Even to want four children in this age of dwindling birth rates is considered eccentric, and to pursue that aim across years of cost and turmoil has incurred rapid judgment, and the suggestion that, despite the uniquely dreadful circumstances in which they found themselves, they are less deserving of sympathy than they seem.

Today, in a Manhattan hotel room, they are braced for the onslaught. As a couple, Carolyn says, ''Sean's a type A and I'm like a B+. So we're swell together'' - though she is by far the more assertive in conversation.

Sean, a young-looking 40, was at work when he received a call from the couple's fertility doctor. That morning, Carolyn had gone into the clinic for a pregnancy test. Now, the doctor said: ''I have bad news, but not the type of bad news you'd expect. Carolyn is pregnant with another couple's genetic child.'' Sean drove home immediately to break the news to his wife. ''You are joking,'' she said. What else could she say? They both collapsed into tears.

So began nine months of unimaginable heartache, including, as they saw it, the thoughtlessness of the baby's genetic parents, the inadequacy of the clinic's response and the condemnation of the Catholic church, to which they belonged, for their use of IVF. Meanwhile, Carolyn struggled to figure out what it meant to carry another woman's child.

It would take a long investigation to discover exactly how the error occurred; the other woman, Shannon Morell, had registered for IVF under her maiden name, Savage. The two women's files were next to each other in the clinic and were mixed up, so when it came to locating Carolyn's fertilised eggs in cryopreservation, the wrong information was used. The mistake came to light only because of a small, unrelated error - Carolyn's birth year was wrong on her hospital wristband - which sent a technician back to the paperwork, where the bigger anomaly was discovered. By then it was too late; the eggs had already been transferred.

Technically, when the mistake was revealed, there was a decision to make, but the Savages say they had already made it. They had chosen their fertility doctor in part because he didn't believe in abortion. To their amazement, he urged them to consider a termination. They couldn't. They would have the child, they said, and after the birth, return it to its rightful parents. This decision was all the more extraordinary given Carolyn's pregnancy history: she had nearly died giving birth to their second son, Ryan, after suffering a rare form of pre-eclampsia, and Mary Kate had been born prematurely and spent a month in a neonatal unit.

The second question was: who were the other couple and how much interaction should they have with them? Sean urged caution. They might sell the story to the tabloids, he thought, or lobby for termination. A letter was sent through the Savages' lawyer, confirming that they would proceed with the pregnancy and keep the Morells informed but that, at this stage, they didn't wish to be in direct contact. The lawyer concluded: ''My clients do request that your clients understand how devastated they are by this situation.''

There is nothing like other people's child-bearing decisions to bring out any free-floating prejudices. Sean, the second youngest of nine children, and Carolyn, one of three, always wanted a large family. ''Yeah!'' says Carolyn, brightly. ''Well, I'm a teacher. I love kids. Sean was from a huge family. The idea just appealed to us. So we pursued that.''

''It's a personal choice,'' Sean says. ''We've seen some things out there [about us] - you know, why try to have four? It's tough to pass judgment on people. It's like looking at someone without a child and saying, why? But that's a personal choice.''

After the mistake was discovered, the first thing Sean did was start a giant filing system to deal with the paperwork. They had to find lawyers, a therapist - above all, a new physician. Their fertility doctor, utterly horrified by what had happened, made what they considered a bizarre suggestion: that they ''reverse surrogacy'', ie, transfer their embryos into the other woman and swap babies when they were born. As they write in the book, ''The idea sounded like it belonged in the circus.''

The next task was to tell friends and family. After reassuring everyone that no one had died and they weren't getting divorced, they called a meeting at the church hall - and warned those present that they detested the religious platitude that put their misfortune down to God's will. ''Ugh,'' Carolyn says. ''It got said a lot of times - 'It's God's plan' - and I thought, really? You think God did this to me? I don't believe in God's plan. I believe in God, but I think sometimes bad stuff happens.''

Early on, she had to decide how to consider the child she was carrying. Was it in any way hers? Could she possibly detach from it as it grew, so that come the handover, she was any less devastated?

No, she says. Even if she'd wanted to, her body wouldn't let her. ''I tried. I tried. In the first couple of days, I heard the term 'gestational carrier' thrown at me. And I just kept thinking, I'm not, I'm a mother. I tried to detach, but I couldn't.'' And it was, in some ways, her child. ''Obviously we kept our promise to return him to his genetic parents, but we made a decision to bring him into this world and I'll always feel responsibility towards him. It's just we don't get to raise him.''

Into the equation came the Morells, who'd been together for seven years and had twins conceived by IVF. Given the Savages' religious principles, would their decision not to fight for custody have been different if the Other Family had turned out, say, to be a divorced woman, having a child alone?

Carolyn says: ''We knew whoever was coming through that door was going to get this child. We knew that. So it didn't matter who they were. It was nice it was a family and a married couple. But we had already prepared ourselves for anything.''

What they didn't know was just how difficult interaction with the Morells would be. The most compelling part of the book is the terrible dance that takes place between the two families. When an introductory email from Shannon Morell arrived, the Savages' lawyer forwarded it with the warning: ''Think carefully before reading this, Carolyn.''

The letter had an incendiary effect. In it, Shannon complained about how she'd lose her privacy, how hard it would be to explain things to her co-workers and, in the line that inflamed Carolyn most, said, ''God for some reason decided another woman would carry this baby for me.''

Carolyn said to Sean: ''It's heartless.''

It was the beginning of a series of exchanges with the Morells, culminating in a very difficult meeting, which the Savages felt was characterised by the other family's insensitivity to their feelings; their failure to recognise the scale of what was being done for them. In that meeting, in the presence of lawyers, Carolyn was so distressed she couldn't look Shannon in the face, fixing instead on her necklace.

Shannon's husband Paul was, Sean thought, ''unbelievably uncomfortable''. Shannon is portrayed as flippant, pointing out the overlap between her maiden name and Sean's surname, and joking, ''Do you think you and I are related?'' She did express gratitude to the Savages for continuing with the pregnancy, but in a later phone call complained to Carolyn that her doctor had questioned her ultimate right to keep the child.

Carolyn says: ''It had never even occurred to her she might not be entitled to this child. I remember hearing that and thinking, OK, I feel a little bit vindicated because someone actually understands I am making a contribution. I didn't want to be looked at as an oven, or an incubator for this child.''

The Savages say they are on friendly enough terms with the Morells now, not least because they want to stay involved in Logan's life - something the Morells say they would also like. They have yet to see the book. Carolyn says: ''I offered to sit down with Shannon and go through some of the tougher moments, and she declined. That's their prerogative. We're not sugar-coating it; we experienced feelings we're not proud of and that aren't flattering to us. We all have those moments, right? We have weak moments and lose our patience; there's bitterness, resentment, anger, frustration. On the flip side, we're trying to show people if you keep focused, you can push that to the side and get to where you need to be. That's why we included those moments. We don't anticipate any...'' She hesitates. ''I hope they understand. Time will tell.''

All the Savages had left, after the birth, was the moral high ground, and you can hardly blame them if an air of condescension creeps into their references to the Morells. Their youngest son, Ryan, when told about the baby, asked of the Other Family: ''Do they smoke? What do they do for a living? Where do they live?''

The pregnancy continued and Sean and Carolyn talked about what they would do after it. Astonishingly, they decided to pursue having another child. Given Carolyn's age, they felt more IVF might not be ideal. So, as the birth approached, they found a surrogate. She was implanted with their remaining fertilised eggs and became pregnant.

There is a sense, in the book at least, that Carolyn is the driving force behind this relentless push to have more children. Earlier on in their marriage, Sean had said, ''Drew and Ryan are beautiful and healthy. Why can't this be our family?''

Carolyn replied, ''Sean, you don't understand. Our family is supposed to be bigger than this.''

To which her husband said, ''I am not opposed to more children. But at what cost?''

The cost was, of course, huge. There comes a point in the story when each scene seems more cruel than the last. Having invited Shannon along to an ultrasound, Carolyn is desperately upset when the technician directs all her comments to Shannon, handing her the scans at the end. And when, finally, she goes into labour, she is grief-stricken. ''I wasn't ready for this child to be born. I wasn't ready to say goodbye.'' She had suggested having the Morells in the delivery room, but Sean put his foot down. ''It will be like a birth and a death in the same room at the same time,'' he said.

They negotiated with the other family to have some private time with the baby after he was born. They introduced him to their other children, then, as a couple, spent a few moments with the baby they could not be sure they would ever see again. Sean took him from Carolyn to where the Morells were waiting and handed him over, in tears. The other couple shrieked and clapped. Sean said, ''Congratulations, you have a healthy baby boy. Five pounds, three ounces.'' They said they were calling him Logan, which means ''lucky'', and that his middle name would be Savage.

The hospital asked the Savages if they'd like a ''bereavement box'', given to families who lose a child at or after birth, containing, among other things, a photo and a footprint in clay. Carolyn said she would. A week after the birth, the surrogate mother pregnant with their own baby miscarried.

The couple have said their ability to withstand these experiences has come down in part to their faith. Yet the Catholic church called their use of IVF ''morally unacceptable''. It's hard to imagine how they dealt with such an unforgiving attitude.

Sean says, ''Our view is our church is a man-made institution, founded on the principles of an incredible God. But man-made institutions are flawed and they're going to make mistakes.''

They continue to seek fertility treatment of one kind or another, in the hopes of having a fourth child. (On the issue of adoption, Sean says, ''We have significant respect for people who adopt. We considered it. It's a very personal choice as well.'')

Isn't there a danger it has become an obsession?

''Oh, sure,'' says Carolyn. ''I can see that. I don't think it has, for us. We're in a pretty peaceful place right now. That said, we're not willing to slam the door on anything.''

If it hadn't been for the slip-up with her birth date in hospital, the mistake would never have been discovered. Do they ever wish that was the case?

''Oh, yes,'' says Carolyn. She laughs. ''Of course. Yeah. Sean and I are stronger and better people for what we've been through, OK? But I don't know how you wouldn't consider that... Logan - we would've never known. We just wouldn't have.''

Sean looks alarmed. ''In no way are we saying we wish the mistake wasn't discovered,'' he says. His wife turns to him as if he's taken leave of his senses. He continues, ''I don't think that's a fair -''
''Well, whatever,'' snaps Carolyn. ''OK. I would say it's fair to say there are moments when we wonder, hmmm. So.''

After the birth, the Morells sent out a card announcing Logan's arrival, with a photo of the family in which he was wearing an outfit given to them by the Savages. When he was three months old, the Morells brought him for a visit. Shannon let Carolyn change his nappy; while she was doing so, she murmured to him, ''Mamma loves you.''

''I said that to him all the time in utero - to all my babies. That's not saying I'm his mum. I'm saying when he was with me, he had my love, like he was my child; now - we had a great afternoon [with Shannon] - I've seen his mother loves him.''

It had a double meaning? ''It did.''

Sean says, ''I think you have to celebrate that. We have unconditional love for him. I don't know if there's a greater love.'' That they decided to ''embrace the gift'' by loving the baby is, says Sean, ''probably the way we survived it''.

They came to a settlement with the hospital, the size of which can't be disclosed. Some of it, along with proceeds from the book, will be tithed to a charitable foundation set up in their name.

They hope when Logan grows up and reads the story of his birth, he'll want to be part of their lives. But they know they will always be in a strange no man's land where he is concerned. ''We have three children. Or do we have four?'' they ask. During the pregnancy, Carolyn had an amniocentesis, to make absolutely sure the baby wasn't hers. A small part of her still hoped that, despite all evidence to the contrary, the error was in itself an error. The results came back: there was a zero per cent chance the baby was her genetic child. ''I thought, surely, a little bit of my soul had crept into him. But I guess the DNA test couldn't measure my contribution.''

Inconceivable by Carolyn and Sean Savage is published by HarperOne.

IVF odds of success are decent - study

IVF treatment continues to be a popular choice for making babies.

The treatment, known formally as in vitro fertilisation, is successful in producing a live birth in 41.4 per cent of treatment cycles for women under age 35, according to information released Monday by the Society for Assisted Reproductive Technology.

Data for 2009, the most recent year analysed, showed the rate of live births per cycle with fresh embryos did not change much from 2008, when it was 41.3 per cent for women under 35. However, that's an improvement from 2003, when the rate was 37.5 per cent.

Success rates fall off quickly for older women, however. In 2009, the percentage of cycles with fresh embryos resulting in live births was 31.7 per cent for women aged 35 to 37, 22.3 per cent for women aged 38-40 and 12.6 per cent for those aged 41-42.

The more embryos transferred, the higher the risk of multiple births. Several years ago, the Society for Assisted Reproductive Technology called on doctors and patients to limit embryo transfers to one in healthy, younger women who have a good chance of pregnancy.

But it appears as if SART's goal of reducing the number of embryos transferred isn't enthusiastically embraced. Only 7.2 per cent of women under age 35 opted for a single-embryo transfer in 2009, up from 5.2 per cent in 2008. In 2003, the rate was 0.7 per cent.

Overall, the average number of fresh embryos transferred was 2.0 for all age groups in 2009 compared with 2.6 in 2003.

The rate of live births with twins for women under age 35 was 32.9 per cent, a trend that hasn't changed much since 2003. The rate of triplet births in that age group, however, was 1.6 per cent in 2009 compared with 6.4 per cent in 2003.

The leading, single cause of infertility continues to be the male factor, which accounts for 17 per cent of cases in which people seek IVF treatment. A diminished number of eggs, which occurs most often in women age 35 and older, accounted for 15 per cent of cases, and in 12 per cent of cases the cause of infertility cannot be explained.

The rate of patients who elect to have preimplantation genetic diagnosis, in which a cell from the embryo is screened for evidence of genetic disorders, was 4 per cent in 2009.

The reports on specific clinics' success rates can be found on the SART website at www.sart.org. The society announced plans to enhance its website for consumers later this year to make it easier to find data.