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Dr. Jones: Your period is late and you got the test and you're pretty sure it says that it's positive, but this pregnancy wasn't planned. What are you thinking about and how do you feel?

Well, it turns out that in the United States and around the world, about half of pregnancies are unplanned. Unplanned meaning you weren't thinking about having a baby next month, it wasn't exactly on time, but unplanned usually means that you weren't planning on having a baby any time in the immediate future.

In the unplanned category, of these 50% of pregnancies that are unplanned, about half of them are mistimed. You might say that. A woman would say that she was planning on having a baby sometime, but just not right now.

And about half of those unplanned pregnancies are unwanted, meaning the woman when asked in interviews . . . And these interviews are done nationally about every five to six years through the National Survey of Family Growth and many other organizations who try to get a better understanding of this issue. In that spectrum of unplanned pregnancies comes a spectrum of different emotions.

In the virtual Scope studio today is Jamie Hales. And Jamie is a clinical manager at the Huntsman Mental Health Institute. She's here as a social worker to help us kind of think about what are the emotional responses to an unplanned pregnancy. So thank you for being in the studio, the virtual studio with us, Jamie.

Jamie: Thank you. I appreciate you having me.

Dr. Jones: So I'll give you a little bit of my background. I'm a reproductive endocrinologist and an infertility specialist. So, clearly, the unplanned pregnancy among my infertility patients is one that's met with often surprise and joy. But I'm also a family planning specialist and I've been an abortion provider for pregnancy termination.

And the spectrum of emotions is huge in terms of people who come and are faced with a pregnancy that they either didn't want now or didn't want ever. Can you tell me a little bit about your experience and what you've seen?

Jamie: I would completely echo that experience. What I most often see in my practice is more when somebody has had an unexpected pregnancy, it's a happy thing. They're excited about it. But I 100% see people where that is the exact opposite experience.

Sometimes our society, the idea is that, as a woman, you're supposed to be extremely excited about this new journey and chapter in your life. It isn't always that way for everybody, and that's not a bad thing.

And I think something that's really important when you're working with people who are childbearing age is to be as open-minded as possible about this because not everybody's pregnancy journey is the same. There is variation all over the place, and I think it can be hard sometimes for people to admit that, "Yeah, this is something that I'm really struggling with."

Dr. Jones: We go down this pathway of healthy baby, healthy mommy, and we don't spend a little time and say, "Why don't you tell me how you're feeling about this?"

Quite frankly, I'm a mother and a grandmother, and I planned my pregnancy down to the minute, but I was ambivalent. Even though it was highly planned, I was ambivalent thinking, "My life will never be the same." And there was a little bit of worry and grieving about that, even in a very planned pregnancy.

I think it's a matter of recognizing that it's an emotional rollercoaster. First of all, your hormones are different. You are now in a potentially new social domain going forward. You will now be a new person, if you choose to continue the pregnancy, called a mother. And then there's your own emotional makeup and you don't want to do that.

Listen with an open heart. I don't know how to put that in any other way. It's rare to have someone who's so neutral that they've got nothing going on. I worry if I see that.

Jamie: That's a very good point. I think being completely neutral about your pregnancy probably is more of a red flag than having some strong feelings about it either direction.

And those feelings can change, right? One day you may be feeling absolutely fantastic about it, and then there may be other days where that is not the case. And ultimately, it isn't up to the people around you to decide what the normal range of emotion is. That's up to you.

It can be a very fraught topic, but it's also one that I think is very important for us to discuss because this is another one of those situations where you might be out there experiencing some of these thoughts and feelings and think, "Wow, I'm the only one that's dealing with this right now," or, "I don't want to say anything because nobody is going to understand." And it is much more common than I think people realize. 

Dr. Jones: So how do we begin to help women negotiate how they're feeling and what they're planning on doing, figure out what are the resources available to them?

Jamie: Resource-wise, there are a couple of groups that are done online through Postpartum Support International. They have a virtual group for medical termination and also one for post-termination support, even if it wasn't for medical reasons.

So there are really good resources out there, and I think it's important to speak up if it's something that you're struggling with.

Ultimately, at the end of the day, we're not the ones that have to make really tough choices around this. And what the person wants and how they're feeling about it absolutely comes ahead of what any of the rest of us may or may not think about that pregnancy.

If you're going to therapy, that's a really great safe space, I think, a lot of the time to bring up complicated feelings about stuff because it's confidential.

And not everybody in your life may agree one way or the other with your choice whether to continue, not continue, the fact that it happened in the first place.

There are a lot of factors that go into unplanned pregnancies. There's a change in identity. Everyone, I think, comes at it with a different background, a different degree of support and resources.

Dr. Jones: Right. And most women struggle in the sense that they are making a decision thoughtfully, and when they finally make their decision, they're usually pretty sure. But on the way, it's giving them the information that they need so that they can feel that the next 60 years of their life one way or the other is written in a way that they can feel comfortable and move ahead.

I want to thank you so much for joining us. And for everyone who's been listening, thank you for joining us on the "7 Domains."

Interviewer: When it comes to issues of infertility, it's important that both members of the couple are involved in the diagnosis and treatment of the issue.

To find out why that is, we're joined by Dr. Kelli Gross, a men's health specialist and assistant professor in urology at University of Utah Health.

Now, Dr. Gross, why is it so important that both partners are involved when we're trying to, say, diagnose why a couple can't get pregnant?

Dr. Gross: It's incredibly common that men come to see me and they've never been considered at all in their fertility workup. We find that up to about 40% of the time, there is what we call male-factor infertility or an abnormality in fertility in the male partner. So it can be greatly underdiagnosed.

With all of the technology that we have in fertility, things like in vitro fertilization can make it so that optimizing the male partner is not as essential as it once was. But it can be a lot more expensive and have its own set of downsides.

Interviewer: So when you say that it's 40% of the time, does that mean that it is often misdiagnosed, or do we often deal with the female issues more often?

Dr. Gross: It wouldn't necessarily be that it's misdiagnosed, more that it's ignored. With couples, they may be experiencing infertility without having any major health issues or causes. It can be both sides things are a little bit abnormal. So having things that are less than optimal in one partner can still lead to issues, but sometimes we just get around these by other sorts of things.

Interviewer: And what kind of things are those?

Dr. Gross: So it would be things like intrauterine insemination or in vitro fertilization. So what that is, for intrauterine insemination, is we put the sperm directly into the uterus. So it bypasses some abnormalities if there are low counts in the sperm or if there are issues on the female side.

We can also do things like in vitro fertilization, which is where the egg and the sperm are joined outside of the body. And that can, likewise, overcome a lot of issues on both sides, such as having very low sperm counts or issues from a female partner side.

Interviewer: So if a couple is trying to identify what is causing their infertility, why is it more economical to have both partners involved from the start?

Dr. Gross: So there are things that we can improve from a male side that can make it easier to get pregnant either naturally or with help. So, for example, there are certain procedures that we do that can improve sperm counts in certain men.

So if we have somebody who has very low sperm counts, then doing something like that where they previously would not be a candidate for something like intrauterine insemination, which takes a certain amount of sperm, by raising those counts, we then make them a candidate for that, or they are able to get pregnant naturally because the sperm counts are higher. So they can save a lot of money from the cost of, for example, in vitro fertilization.

Interviewer: We spoke about why it's so important to have both partners involved in diagnosing and treating infertility. How long should a couple be trying before they technically are dealing with infertility issues, or when should they start to see a specialist?

Dr. Gross: So we usually define infertility as trying for one year. And that's kind of just because 90% of couples will get pregnant within one year.

It's kind of arbitrary. So, for example, if you've been in a long-distance relationship and you haven't been having intercourse, of course, a year may not mean that there's anything wrong biologically. And at the same time, if there's any sort of history or medical concerns that make you seek treatment earlier, there's nothing wrong with that at all. We don't say, "Keep trying," necessarily. We would typically evaluate to see if there was anything that we can improve, no matter what time it is.

One question I get a lot is, "What formula should I give my baby?" There are so many choices out there, regular or sensitive, one for spit-ups, one for soft stools, brand or generic. My answer always is there is no one formula I recommend. Some babies do just fine on milk-based. Some need a sensitive version or one that is more for babies with reflux. Only very few needs soy based or special formulas for premature babies, or babies who truly are allergic to milk protein. For many babies, generic formulas are just as good as brand name formulas. It may take some trial and error, but the one your baby takes best and seems to not upset their stomach is the one to stick with.

Speaking of infant formulas, some parents worry that their baby will be bored with formula. Babies really don't get bored of having the same thing over and over like we do. Also, formula and breast milk have the best nutrition that your baby needs when they are brand new. A baby's digestive system isn't set up for a lot of variety at birth, or even at two or three months old. Currently, the guidelines are for starting fruits and vegetables and grains at about four months old if your baby's ready. A baby will need to continue to have breast milk or formula until 12 months of age.

What about toddler formula? In most cases, once your child turns one, they can have whole milk and they don't need special formulas. For toddlers who are very limited in their diets, talk to your child's pediatrician to see if they would benefit from one of the toddler formulas.

Next, I get asked a lot, what sippy cup should I give my child? Whichever one they will drink out of. It took seven different sippy cups until we found one that my older son liked that didn't spill all over the place.

Finally, what do I do if my child really only wants to eat candy and cookies and soda and junk food? Two things. One, your child doesn't do the grocery shopping. If you buy those things, of course, your child will want to eat them and not the things that are more healthy. Your child should know that those are special foods for treats and not a main course item. Second, if you eat healthy, your children are more likely to eat healthy. Kids from little on wan to do everything their parents do. So show them by example. Unless we're having something really unusual, my husband and I aren't short-order cooks for our boys. Whatever we made, that's what we serve them. And now they eat, or at least will try, a huge variety of foods. They like fruits, vegetables, foods from other countries. And yes, they still get cookies and candy and soda. But those foods are not the mainstay of their diets and those are treats.

If you have feeding concerns about your child, go ahead and ask your pediatrician. Chances are we've heard your concern before and are able to help.

You are pregnant and trying to do the right thing to keep yourself healthy and provide a safe place for your growing pregnancy. Is it time to get a COVID vaccine?

I have tragic memory of being part of a team that cared for a wonderful young woman who was pregnant and got influenza. Influenza isn't usually lethal to healthy young people, but it's dangerous in pregnancy. We knew this young woman. She worked in our unit, and she and her baby died of influenza. This was before my hospital required all employees to be vaccinated for the flu each year. Now we have over a decade of information about the influenza vaccine in pregnancy and safety, and we encourage every one of our patients to get the flu vaccine. It saves lives.

Now we have this other virus, COVID-19. COVID isn't new to us as humans. We've seen several other COVID viruses that were quite deadly in the past 20 years, but they didn't go that far and we see coronaviruses, the COVID family, make up some of the virus that caused the common cold. But COVID-19 is very contagious and causes severe illnesses and death all too frequently and lingering illnesses in many of those who weren't even really sick.

So when we first offered the COVID-19 vaccine, we had little information about COVID vaccine in pregnancy, but we had almost nine months of data on the COVID-19 virus infection and how it affected pregnant women. Here at the University of Utah, Dr. Torri Metz, a specialist in high-risk pregnancy, helped lead a national team to collect information about pregnant women who were infected with COVID-19. We talked with her, and she said it was sobering to see that young, healthy women who were pregnant had much more serious courses of the infection than women of the same age who weren't pregnant. They were more likely to get hospitalized, they were more likely to be admitted to the intensive care unit, they were more likely to be put on a ventilator, and if their oxygen levels became too low, they were more likely to lose their babies and sometimes they lost their lives.

But it took us another nine months to collect information about women who were pregnant and were vaccinated and compare outcomes to women who were pregnant and were not vaccinated. And the news is good and compelling about the safety of the COVID-19 vaccine in pregnancy.

So what is true? One, the Moderna and Pfizer vaccines had no adverse effects on fertility, pregnancy, and offspring in lab animals. Two, in 35,000 women who were pregnant and received the COVID-19 vaccine, headache, muscle aches, chills, and fever were less frequent in pregnant women than in non-pregnant patients. Three, injection site pain, where you got the shot, was more frequent in pregnant women, but it wasn't really all that bad. Four, the safety data following 4,000 pregnancies in women who were vaccinated showed no higher rates of miscarriage, no higher rates of preterm birth, no higher rate of newborn birth defects, or deaths compared to what we normally experience in pregnancy. I'm going to say that again. There were no higher rates of miscarriage, preterm births, or birth defects in women who were vaccinated compared to women who aren't vaccinated. Number five, women who are infected with COVID-19 have an increased risk of harmful abnormalities in the placenta. Women who are vaccinated don't have these harmful changes. Six, women who are vaccinated are five times less likely to get COVID-19 compared to pregnant women who are not vaccinated, one-fifth the rate of getting COVID compared to non-vaccinated pregnant women. Seven, women who are vaccinated give good antibodies to COVID-19 to their newborn babies. So there are seven true things.

What's not true? One, the COVID-19 vaccine causes infertility. It doesn't. Two, the Moderna and Pfizer vaccines have DNA in them and will alter the DNA of the fetus. Nope. These vaccines have mRNA in them, and these molecules are very short-lived and act mostly in the muscle around the shot. They don't change the DNA of the fetus or the mom. Three, the COVID vaccine has a microchip in it to track you. Really? I don't know where that ever came from, but it's one of the silliest of the vaccine myths.

Women who are pregnant are at high risk if they become infected with COVID-19. Pregnancy may lower women's immune responses, but the vaccine is still very protective against women developing complications from COVID-19.

With the information about the risks of COVID-19 infection to the pregnant mother and now the efficacy data from the vaccine outcome data collection and the safety information from more than thousands of women who were vaccinated while pregnant, the Centers for Disease Control and Prevention, the American College of Obstetrics and Gynecology, and the Society of Maternal-Fetal Medicine have strongly recommended that women who are considering pregnancy, trying to get pregnant, who are pregnant, or who are breastfeeding get vaccinated with the COVID-19 vaccine.

I think back to the day when I saw a young woman die of influenza and how much the flu vaccine is part of our counseling to pregnant women during flu season. So if it's flu season and you're pregnant or breastfeeding, don't forget to get your flu vaccine. And no matter what season it is, if you are pregnant, trying to get pregnant, or breastfeeding, please talk to your clinician and get vaccinated against COVID-19. And because no vaccine is perfect, please wear a mask that covers your nose and mouth when you're indoors in groups of people and practice social distancing if you're with people who aren't vaccinated.

And thanks for doing what you can to protect yourself, your baby, and those around you. And thanks for joining us on The Scope.

You have done all the right things in planning your family and now you're ready to have a baby. How long after stopping birth control before you try to get pregnant? How long does it take to be fertile again? And how long is too long?

Start from the top. How do you stop your method of contraception? Well, that seems like an easy question, but sometimes it isn't. You can stop using your condom or diaphragm or contraceptive foam right now and you can take off your patch, take out your ring or stop your pills today.

Taking out your implant or your IUD takes a medical appointment with your clinician or your family planning clinic. Really now, we don't recommend that you or a friend try to take out these medical devices on your own, so getting an appointment may take a few weeks.

Now, how long does it take after stopping birth control before you're fertile? Well, it sort of depends. If you're using barrier methods, such as condoms or diaphragms or foams or jellies, you could get pregnant the next time you have sex without your protection. Of course, you have to ovulate, and that will be on your regular schedule, but barrier methods don't change that.

If you're on birth control pills or patches or rings, the hormones in these methods are gone from your body within a week. And in the case of the progestin-only mini-pill, it may just be a couple of days then your body will get back to ovulating, so it may be a month or two before you ovulate.

Now, if you don't have regular periods or have a period on your own in three to four months, you should see your doctor. Maybe you weren't regular before you started hormonal contraception or maybe something in your body has changed, but it's not due to your method that you were using.

If you use an implant, the hormones from the implant will be gone in a couple of days, and then your body will get back to ovulation in a month or so, or sometimes in a week. If you're using a copper IUD, you'll be fertile the first time you have sex after it's removed if you're ovulating that day, but you probably won't be fertile on exactly the day that you have it removed, but maybe the next day.

If you're using a hormonal IUD, the hormones will be gone from your body in the week after it's removed, and you should be back to ovulating either next day or next week with a normal uterine lining within a month or so. Of course, there are very rare cases in which the IUD or the implant didn't come out all the way or you thought it was out and it wasn't. And in those situations, there may be a delay in fertility until the implant or the IUD is completely removed, but this is very rare.

If you're using the Depo-Provera shot, the hormone in the shot is in your muscle for months, and it may take as many as 10 months from the last shot before you ovulate again. Of course, as the shot is designed to be given every three months, you may be fertile in as little as four months after the last shot. Because return to fertility is delayed and a little compared to other methods, we usually counsel women who are hoping to get pregnant in the next year but don't want to get pregnant right now to use a method other than Depo-Provera.

Now, when can you try to get pregnant? Do you have to wait a while? We used to think that women were less fertile or more likely to have a miscarriage if they got pregnant immediately after discontinuing a hormonal contraceptive method. We have clinical data that says now it's not so. So you can start to try to get pregnant right away, even though it might be a couple of weeks before you ovulate.

Now, how long is too long? If it's been a year since you stopped your birth control and you aren't pregnant, you should see your OB-GYN. For women over 35 who have lower fertility related to getting older, maybe you should seek some help in evaluation if it's been six months. Is it your birth control that's contributing to not getting pregnant? The answer is no. Using birth control in the past doesn't contribute to fertility problems, but you did get older while you were using birth control so you naturally would be less fertile when you stopped.

How can we be so sure that birth control doesn't cause fertility problems? We don't have a randomized controlled trial of women using different kinds of birth control compared to women who are abstaining from sex, and then seeing which group of women got pregnant first, but that would be an amazing study to do. However, 22 studies that enrolled a total of 15,000 women who discontinued contraception were looked at, and the rate of pregnancy was 83% within the first 12 months of contraceptive discontinuation.

Now that's not significantly different for hormonal methods and IUD users, and it's not significantly different than women who weren't using birth control before they started to try to get pregnant. The study also showed that how long a woman used contraception did not significantly affect the time to fertility when you take into account the age of the woman.

The amount of time it takes to get pregnant is a function of a lot of things. It's your age, your weight, conditions in your pelvis, such as infections or endometriosis, how regularly you ovulate, how often you have sex, and of course the fertility of your partner.

So make decisions about when to start your family or increase your family based on conditions that matter to you and your family, and not because you're afraid that your longer use of birth control will make a difference. Longer use of hormonal contraception may actually decrease the risk of your having problems because it lowers your risk of conditions in the pelvis, such as endometriosis, and some types of ovarian cysts. And here's hopes for the family of your dreams and thanks for joining us on The Scope.

Interviewer: We're with Dr. Stephen Fenton. He is the founder and director of the Utah Fetal Center at Primary Children's Hospital. And it is for women who have high-risk pregnancies due to a congenital anomaly with the child. There is kind of a way things used to be done. And now there's a way things are done at the Utah Fetal Center, Primary Children's Hospital, which is a much better way. Dr. Fenton, first of all, you're the founder and the director. You came in and you said, "I want to start this center."Why did you say that?

Dr. Fenton: I don't want anyone to ever think or believe that what was happening before wasn't being done to the best of its ability because it certainly was. All of these conditions were being cared for before. But the reality is it was kind of done in what I would term a physician-centered approach. So oftentimes that would require multiple clinic visits because they were separate clinics in each of the physician's clinics. And you can imagine how frustrating and how hard that must have been for that mom to kind of shoulder that burden all on her own.

Interviewer: It was a very stressful time.

Dr. Fenton: Very stressful time.

Interviewer: Just to coordinate her care kind of.

Dr. Fenton: I mean, and during all that time, of course, worried about her unborn child. And so what we've done is we've kind of shifted it from this physician-centered care to what I term patient-centered care with a multidisciplinary approach. So we, over the last five years, have put together a multidisciplinary team of all of these specialists that care for the child and for the anomaly. In addition, we've added adult specialists, so maternal fetal medicine or high-risk OBs that care for the mom, all in one place. We didn't have adult providers at the Children's Hospital. Now we have these adult MFM providers who help care for these moms. We also added a coordinator. We've added nurse coordinators that actually help the mom wade through all of this, and ancillary staff, such as a social worker, who can also help with the non-clinical aspects. We are now all in the same place. Instead of being in our individual silos, if you will, we're all located together where we can look at the images together, where we can talk about it, and where we can come up with a care plan not only for the mom until baby is delivered, but also for the child after delivery.

Interviewer: What is the objective of the center?

Dr. Fenton: We want to make sure mom and baby first have the right diagnosis. It's much easier to help the parent learn what the condition is and start understanding what the treatment, if any, will entail before the child is born. Now that's one aspect. The other aspect is some of these kids need intervention before they're born. And in order to do that, it's very specialized. It requires a team and it requires being able to take the mom to proper diagnosis and from diagnosis to intervention, and then from intervention to delivery safely. And you can't do that without proper infrastructure, and the Utah Fetal Center is that infrastructure.

Interviewer: Can you give me an example of a couple of the common conditions that you would require that would require this multidisciplinary team?

Dr. Fenton: Congenital diaphragmatic hernia is one that comes to mind, myelomeningocele, that's another word for spinal bifida, CPAM or congenital pulmonary airway malformation also known as congenital lung lesion, atresias, intestinal atresias, omphalocele, gastroschisis. These are all things that are surgical too. We oftentimes see kids that don't necessarily require surgery. So some of the genetic disorders like trisomy 21. We also see kids that have neurologic issues, so brain malformations that won't necessarily require intervention, but will require a coordinated care with multiple providers.

Interviewer: What does that initial consultation entail when they come to you? What does that look like?

Dr. Fenton: In the morning, they oftentimes will undergo an ultrasound and consultation with one of the maternal-fetal medicine physicians that work at the Utah Fetal Center. Dependent on what the original diagnosis is, and oftentimes we have already received outside imaging from the referring providers and reviewed it, they might also undergo a fetal MRI, and that fetal MRI will give us even more detail, especially when we can compare it to the ultrasound that happens on that same day. It's read by the fetal radiologists that work in the center. And then usually we give them a little bit of a break. They go to lunch, etc., and then come back in the afternoon or early afternoon, and there, they will see the specialist, the sub-specialist that will ultimately care for their child.

Interviewer: If a patient wasn't referred and they believe that the Utah Fetal Center is the place that they would like to go, are they able to call?

Dr. Fenton: Absolutely. They can go to our website, utahfetalcenter.org and self-refer. We really want to help these parents get through this very, very difficult time. We understand that there are a lot of providers out there that are doing a portion of this, and we certainly appreciate all that they are doing. We are not looking to just assume all care of these moms because we know that a lot of their care can be delivered close to home, but we do feel like it's very, very beneficial to start that coordination of care early so that we can help the parents understand what is happening, obtain expectations on the treatment plan, as well as understand the treatments involved and then initiate that plan early, and in the long run we know that doing so with the help of the many providers, not only here at the University of Utah and Primary Children's Hospital, but across the state will allow us to do that.

Dr. Jones: If you have heartburn when you're pregnant, it means that your baby will have a lot of hair when it's born. Really? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is The Scope of Some Myths About Pregnancy, on The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Pregnancy is mysterious, and what is going on in there is mostly unseen and to my biologic eye, magical. There are outcomes that are good and some less than good, and we cannot explain all of them based on scientifically proven cause and effect. So we turn to myths and old wives' tales. Some of these exist back to before there were well-defined scientific methods, and some are new. Let's look at a few.

One, the shape of your pregnant belly can tell you whether you're carrying a boy or a girl. If you carry your baby bulge low, it's a boy. If you carry it high, it's a girl. There is no fact to that. What is a fact that the first pregnancy, before the abdominal wall is stretched out, tend to be visually higher. As the abdominal wall gets stretched out with each new pregnancy, the uterus appears to be carried lower, but it's not the sex of the baby.

Number two, your baby's heart rate can determine the sex of your baby. Higher heart rates are a boy, lower is a girl. That's a no. There is no evidence that the heart rate is determined by the baby's sex.

Number three, spicy foods can cause your baby to be born blind. That's a no. However, because pregnancy hormones and the pushing of the uterus as it gets higher can cause reflux, spicy foods can be less well tolerated, but they won't make your baby blind.

Four, cocoa butter prevents stretch marks. That one is a no. But it does smell good and it makes your skin feel soft, so go for it if you like it. But it makes your sheets greasy.

Number five, looking at the sun during an eclipse will give your baby a cleft palate. That one would be hard to prove because there are few pregnant women who would be so careless as to look at the sun when they're pregnant during an eclipse, and there are a few eclipses and I don't really recommend a randomized controlled trial to test that one out.

Number six, you should eat for two when you're pregnant. I don't know where that one came from except that it's usually a rationalization about how much you might want to eat. You can get enough energy to make a baby in about 300 calories extra a day, about 3 little cookies with no redeeming nutritional value, 3 tablespoons of peanut butter, notice that's not a rounded tablespoon but a flat one, ladies, or 3 glasses of reduced-fat milk, a good nutritional source of calcium and protein. So you should eat for about 1.16 persons or about 1 and a 6th.

Number seven, you cannot color your hair when you're pregnant because it will harm the baby. That's a no. If it were true, there would be some serious fashion problems. It probably isn't good to introduce any new chemicals that you aren't sure about in your first trimester, but after that the amount that might be absorbed by your skin, if you do it a couple of times during your pregnancy, is unlikely to be a problem.

Number eight, drinking dark beer will help your milk come in. That's a no. Really? That's my family's favorite myth. It was given to my mother in Germany by the nuns at the hospital when she delivered me. It was given to my sister and to me, and it sure seemed to bring it on. Well, actually, it doesn't make the milk be produced. However, relaxing a new mom just out of the hospital, who's worried about everything, can help the milk come down. The let-down reflex of releasing the milk stored in the ducts so the baby can nurse can be inhibited by anxiety and stress and maybe the alcohol and dark beer can work for that.

Number nine, if you have heartburn, you'll have a baby with lots of hair. No. Well, a study from Johns Hopkins, published in 2006 in the journal "Birth," asked 64 pregnant women about their degree of heartburn during pregnancy, and an independent observer graded the amount of hair in the newborns, and there was a simple linear association between the degree of heartburn and the amount of hair. The more heartburn, the more hair, and the association was highly statistically significant. Now, I can see that there might be some racial differences in how hormones affect pregnancy and then affect the sphincter or the tight place between the stomach and the esophagus that prevents reflux and heartburn, and some racial groups have babies with more hair and some with less. However, 90% of the women in this study identified as Caucasian. So there isn't really a good reason for this amazing statistical outcome. The author said, "Much to our surprise and somewhat to our chagrin, our application of straightforward but standard scientific methods to investigate the validity of this ubiquitous pregnancy 'myth'" -- they put quotations around the word "myth" -- "resulted in its partial confirmation." Who knew? Pregnancy is still mystifying.

If you have questions about what you've been told by your mom or your auntie, talk to your clinician and make them do their homework and look it up, and thanks for joining us on The Scope.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Jones: Early miscarriage is common, the most common complication in pregnancy. How do we think about our options to manage this?

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: About one million American women experience early pregnancy failure each year. This is the loss of a pregnancy in the first 12 weeks. Before the common use of early pregnancy tests and ultrasounds, women often didn't even know they were pregnant for several months. Now, women know that they're pregnant if they want to within two weeks after fertilization, and an ultrasound of five to six weeks from the last menstrual period, four weeks after fertilization can show early fetal development and whether the pregnancy is developing as it should.

As many as 60% of eggs that are fertilized don't lead to live births. Most of those aren't even recognized as a pregnancy. But for women who've had a positive pregnancy test, 15% to 25% of those pregnancies will not proceed past the first trimester, the first 12 weeks. Early pregnancy loss is common, and it may be that recognized as cramping and bleeding early in pregnancy, signs of the pregnancy is probably going to end in a spontaneous abortion without any medical intervention.

All over the world women miscarry early, and most do not get or need medical intervention. However, with the use of early ultrasound at six weeks from the last menstrual period, we can see if the pregnancy is going to fail. If there's a sac without a heartbeat or a fetus, or if there's a tiny area that might have been an early fetus that doesn't have a heartbeat, that pregnancy will probably miscarry. However, it may take weeks to months for that to happen on its own.

Some women are willing to wait for nature to take its course -- have their miscarriage, pass their tissue, or may just be heavy bleeding. They won't really see a fetus because one hasn't developed. But some women want to get on with their reproductive lives, end this pregnancy so they can start again if they want to.

In the U.S. in past years, women who had access to early pregnancy care and found that they didn't have a heartbeat were recommended to have a D&C. This is a procedure in the operating room with anesthesia. The cervix is stretched open with a dilator, and a tube is passed into the uterus to aspirate the sac and the early placenta. This is expensive -- it can cost thousands of dollars -- and time consuming.

Techniques that have evolved over the last 20 years include using a syringe with a suction device and a little tube to remove the failed pregnancy, and this can be done in about five minutes in the office under local anesthesia. Many physicians are familiar and comfortable with this option, and they counsel this option for the patient. But many are not and are most likely to counsel going to the operating room.

Over the past 15 years, medications have been studied that can cause the uterus to cramp and push out the pregnancy. One of these medications, Misoprostol is widely available and has been used especially in women who've already started to cramp and bleed as they begin to miscarry early. One large study found that this oral medication is as successful in women experiencing early pregnancy failure as a surgical procedure if they've already started cramping and bleeding. The risk of heavy bleeding and infection were not any different in the surgical procedure than the medical one.

If women have an early pregnancy that isn't growing, doesn't have a heartbeat or an ultrasound, but they haven't started cramping and bleeding yet, taking this medication is less successful than if women have already started the process. A recent study published in "The New England Journal of Medicine" compared women who took the cramping medicine called a uterotonic Misoprostol with women who were given the same combination of drugs as women use when they are choosing a medical abortion. This combination has been used safely by millions of women around the world for the past 20 years, and it combines a medication called Mifepristone followed by Misoprostol.

This randomized trial showed that women who were given just the cramping medicine when they had a failed early pregnancy demonstrated by ultrasound, they were successful in completing a miscarriage at home within 4 days and about 67% of the time. Women who were given the two medications were successful in ending the failed pregnancy, but in 4 days 84% at the time. Women who hadn't completed a miscarriage in four days were offered another dose of medication. Some women who didn't complete their miscarriage had a suction procedure to finish the miscarriage.

Most women were satisfied with the process and said that they would recommend it to a friend and they would choose this way of ending an early pregnancy loss if it happened to them again. Now, not all physicians are familiar with these medications and not all pharmacies carry them. But these options can become an important choice for some women.

So how do you use this information? Early pregnancy failure can be devastating to women who've been hoping for a baby. Once the ultrasound findings that there's no growing fetus are explained, a woman may choose to wait until nature takes its course, knowing that this might take days to weeks. Some women want it all over with as soon as possible and are comfortable with the surgical procedure and are not comfortable with what can be significant cramping and bleeding that can come with a spontaneous abortion or with the medication.

Some women want the timeliness of taking the medication rather than waiting, but want the privacy of being at home, knowing that they can call their physician if they're having any difficulties. However you and your clinician come to manage this problem, it's often an emotional roller coaster, a big loss, as well as a physical loss. Make the choices that work the best for you and get the information that will help you move forward. And thanks for joining us on The Scope.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Jones: What if you didn't have to go to the doctor's office to get your birth control prescription renewed? What if low-income women, that includes moms and students, had access to the most effective means of contraception? This is Dr. Kirtly Jones from Obstetrics and Gynecology at the University of Utah Health, and this is The Seven Domains of Women's Health on The Scope.

Announcer: Covering all aspects of women's health. This is The Seven Domains of Women Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: What would the world look like if every child was wanted and planned for with a mother in her very best physical, emotional, and financial health? We know that the health status of the mom and the early environment for the infant have long-lasting positive and negative effects on children and the adults that they will become. So planning your children to support their success is a good idea, huh?

It turns out that governments, state and federal, have a heavy hand in determining who gets birth control, what kind they get, and where they get it, and how much they pay for it. The states with the least access to family planning have the highest rates of unplanned pregnancies and the highest rates of maternal deaths. On the other hand, the states that offer women and families the greatest access to family planning do better.

This year, the state of Utah took a step in the direction of making contraception easier to get and more affordable for some women. Firstly, Utah now joins a few other states, including California, Oregon, and Colorado, in allowing women to get their birth control prescription renewed and refilled by a pharmacist. One factor in women having gaps in their contraceptive coverage is when their prescription runs out. They may have to go back and see the doctor or the nurse practitioner. This can be time-consuming, taking time off work or child care, and can be expensive.

Now, for women who've had a prescription by a licensed provider and the prescriptions can be renewed and refilled by a pharmacist, this makes it more convenient for women to continue on their birth control pills, patches, or rings. Just a few years ago, this idea would not have found favor in the Utah legislature, but the reality that unwanted and unplanned pregnancies are expensive for the state in the case of Medicare, covering the pregnancies and deliveries, and that the knowledge that women who get pregnant who aren't healthy have more expensive pregnancies, as well as more complications for their babies that are born, this got the legislators' attention this time.

The new law, which unanimously, I will say that again, unanimously passed the Utah legislature takes effect May 8th, 2018. Women will need to fill out a form at the pharmacy to assess their risks, and they'll need to check with a clinician every two years instead of every year.

At the same time, the governor also signed a bill to increase coverage for the most effective and expensive forms of reversible contraception. The most effective forms of contraception are long-lasting IUDs and implants. They may last for 3 to 12 years depending on the type, but can be removed at any time and fertility resumes very quickly.

The methods aren't so expensive on a month-to-month basis, but because all of the costs have to be paid upfront, many low-income women can't access these methods. Utah now joins many states and by including a Medicaid waiver to allow low-income women to have access to these methods on their Medicaid. Utah was only one of seven states that didn't have this waiver, and now it joins most of the states in the U.S. Of course, these methods require a trained health professional to place them, and many doctors don't know how. So the next job is to make sure that the many clinicians around the state have the knowledge to counsel women and the skills to provide them.

So Utah is in the forefront with the few, mostly blue states in the first bill that allows pharmacists to renew, for a year, a birth control prescription, and that is great. The state is catching up with most states with the second bill about Medicaid waiver. A great part of this news is that the legislators who wrote these bills that were passed were informed by young professionals at the University of Utah. The first bill was suggested by a pharmacy grad student at the University of Utah, and the second bill was proposed by a legislator who spent a lot of time listening to the rationale and ideas of a group of young clinicians and educators at the U. How great is that?

Wouldn't it be great if every baby born in our pretty, great state could be wanted and planned for by a mother in her best physical, psychological, and financial health at the top of her game in all of her seven domains of health? Did I say that already? It would be really great. And I've said great at least seven times in this broadcast, so I'm really excited.

Ladies, at the end of the day, it's really up to you. But now, it just got a little easier. And thanks for joining us on The Scope.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Jones: Most women who were trying to become pregnant and had a miscarriage are eager to try to get pregnant again. What have we learned about how women might prepare for the next try? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is "The Seven Domains of Women's Health" on The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Early pregnancy loss, miscarriage, is pretty common. Rates vary from 15% to 30% depending on the age of the woman and how early a pregnancy is detected. Certainly, we know that some things are associated with higher rates of early miscarriage, such as age of the mom, especially after 40, and poorly controlled diabetes, for example. However, for young women who had one or two miscarriages, are there any new clues about causes or things women can do to increase the chance that the next pregnancy would be healthy and go to term?

Now, early miscarriage has been the focus of a lot of research in the past 15 years as well as the focus of a lot of cultural myths for thousands of years. We hear from our mothers, sisters, and aunties that we should eat this, don't eat that, do this, don't do that. One recommendation that had been around for about 15 years is that low-dose aspirin, a baby aspirin of 81 milligrams, would increase the chances of pregnancy and decrease the risk of miscarriage.

Several years ago, a large randomized trial done here at the University of Utah and in three other centers around the country looked at over 1,000 young women under 40 who are healthy and had a history of 1 or 2 early miscarriages. These women are randomized with baby aspirin and folic acid, or just folic acid, and their next pregnancies were studied very carefully. Overall, they found that the majority of women had successful pregnancies, about 58%, with the next try whether they took the aspirin or not, and aspirin didn't decrease the chance of miscarriage.

Now, this work was reported in 2014, but there have been some other interesting findings from this study and one that was reported recently. Women in this study were mostly white, often overweight, and the average was 29. The average blood pressure was 111/72. Now, that's a nice average blood pressure for young women. But here's what's new.

For every 10 points increase in the diastolic blood pressure, that's the lower number, there was an increase of 18% in the risk of miscarriage. This means that young women with slightly elevated blood pressure but not a diagnosis of hypertension were increased risk of miscarriage. The study in the journal "Hypertension" found no association of blood pressure with the ability to get pregnant or the rate to get pregnant. They controlled for smoking, body mass index, marital status, education, and other factors that are known to be independently related to miscarriage. And that means that the blood pressure alone or with other factors that they couldn't measure is associated with an increased risk of miscarriage.

Now, we know that hypertension before pregnancy is associated with a number of various very serious problems in pregnancy including still birth, pre-eclampsia, pre-term birth, and placental abruption where the placenta prematurely separates from the uterus before the birth of the baby. This finding that even what we might call pre-hypertension, just a medium elevation of blood pressure in young women, is associated with miscarriage is important. So what's the takeaway from this?

First of all, all pregnancy should be started with women in their best emotional, physical, social, and financial health. If you're thinking about getting pregnant, stopping smoking and maintaining a healthy weight are important because both of these conditions are associated with miscarriage, smoking, and being overweight. And if you can get your blood pressure checked before you get pregnant and if the lower number is between 70 and 80, you might consider increasing your exercise, being mindful to manage your stress, and consider a diet lower in salt and higher in vegetables and healthy fats, kind of that Mediterranean diet thing that we've talked a lot on The Scope a lot.

No matter what happens in your pregnancy, these changes are good for your current and long-term health. Of course, if you are hypertensive, with the lower number over 80, you should get your blood pressure under control before pregnancy with diet and exercise, or with medication. This is really important not just for you, but for the new person you hope to grow. And thanks for joining us on The Scope.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Jones: Finding a comfortable position in bed when you're pregnant can be hard. There's just so much of you. But can some sleeping positions be harmful for you and your baby? This is Dr. Kirtly Jones, from Obstetrics and Gynecology at the University of Utah Health, and this is The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: A recent British study suggested that women who sleep on their back in their third trimester of pregnancy are at increased risk of stillbirth. This shouldn't be complicated, but it is. And here in the studio to help us understand the strengths and weaknesses of this study are not one, but three specialists in high-risk pregnancy from the University of Utah, Dr. Martha Monson, Dr. Lauren Theilen, and Dr. Karen Gibbins are here in the studio. Thanks for coming, all three of you. Does that mean you disagree?

Dr. Monson: No, actually.

Dr. Theilen: No. Absolutely not.

Dr. Gibbins: This is a rare circumstance.

Dr. Jones: Well, this is good news. So you all agree that there's some problems here about either sleeping on your back or this study. So let's talk a little bit about that. I actually understand that the entire division, some 15 specialists in high-risk obstetrics have said, "Wait a minute, there's a problem with this study." Let's talk about it. What is stillbirth?

Dr. Theilen: This is Lauren Theilen, and we define stillbirth as the death of a fetus within the womb that happens at or after 20 weeks of pregnancy.

Dr. Jones: Okay. And how often does it happen?

Dr. Gibbins: In the United States, we currently estimate that stillbirth happens in about 1 of every 160 pregnancies. So that comes out to about 26,000 stillbirths in a year.

Dr. Jones: Well, then, what are the causes? I mean, are they all the same cause, or what's going on here?

Dr. Monson: This is Martha Monson here, and there are multiple causes. We can go over that. So problems such as preterm labor and multiple gestations, so this would be like twins or a triplet pregnancy, and placental abruption, so that's when the placenta starts to separate from the uterus prematurely, are thought to cause about one in three stillbirths, especially those that occur before 24 weeks.

Other causes such as placental insufficiency, and this is when there's placental failure that leads to poor baby growth, is thought to be the cause in about one in four stillbirths, especially those that occur after 24 weeks. Of course, there are birth defects or are genetic syndromes, and these are thought to cause about 1 in 10 stillbirths. Infections of the baby, the placenta, or a mother are thought to cause about 1 in 10 stillbirths.

Dr. Jones: So that means about . . . for the unexplained, because if we're talking about the position you're in, it maybe in the unexplained group, that's maybe one in four, one, about a quarter?

Dr. Monson: Yeah, about that, about a quarter of stillbirths.

Dr. Gibbins: One in four or fewer.

Dr. Jones: Or fewer. Okay, so well, then, but the problem if any, if pregnant women sleeping on their back, how many people are we talking about who are sleeping on their back and how did they get this number?

Dr. Gibbins: So that's one of the problems with the way the study was conducted. The best way to find out what is happening during a pregnancy is to collect it when it is happening. However, that's very difficult. So stillbirth is a very rare occurrence, thankfully. And so the way that these researchers collected this data is they asked women to recall how they were sleeping during their pregnancies. And sometimes they asked women to recall this multiple weeks after the stillbirth and the delivery had occurred. So that would be like asking you a month and a half ago, "How did you go to bed that night?"

And so at this point and time, women who've experienced stillbirth, A, they've forgotten, B, they've been searching the internet and any resource they can find for why this horrible thing happened to them, and they have may have seen that some people have a suspicion that sleeping on your back may have caused their stillbirth. Because of being exposed to those ideas out there, they're more likely to report when a researcher asks them, "You know what? I bet I did sleep on my back. I am blaming myself, I'm feeling guilty, I'm wishing I had done something differently, and so I'm going to say I slept on my back."

Dr. Jones: So it's the way the study is conducted and maybe the way the questions that are answered that might affect this statistic of this twice the increased risk. But even if the chance is 1 in 1000 of people who might have been on their back, that's still a tiny number.

Dr. Gibbins: It is still a very tiny number. And when we're talking about making a broad recommendation for all pregnant women, and we're talking about more than 4 million women a year in this country. And just like you are saying, if we're talking about a small percentage of the 26,000 stillbirths in this country, you get down into a few thousand overall that even could be affected by this.

Dr. Jones: Well, I would have to say, if you'd ask me now, now if this was 100 years ago when I was pregnant, I couldn't have told you where I was sleeping. And in the third trimester, you're all over the bed as best your big belly can do. When I made noises, I'm not using the word snoring because it's so unladylike, but if I did make noises when I was pregnant my husband, who's the sleep doctor, would nudge me and then I'd roll into another position. So you're all kind of over the bed. In any given night I might have spent . . . I don't know. So women have heard about the back to sleep business and with their babies . . .

Dr. Gibbins: Correct.

Dr. Jones: . . . and they might be sensitized to their own sleep.

Dr. Monson: And I think that's . . . The Back to Sleep campaign, you know, what Dr. Jones is referring to is the idea that sudden infant death syndrome could be prevented by putting your newborn on their back when they're sleeping as opposed to putting them on their side or their front. And that has been a public health measure with great success. It is very clear that putting your baby to sleep on their back is the right thing to do and will prevent suffocation deaths for these babies. And I think that is exactly why this concept is so appealing. If we had something . . .

Dr. Theilen: Modifiable.

Dr. Monson: . . . modifiable, as "simple" as that sort of behavioral change, that would be wonderful.

Dr. Jones: Right.

Dr. Monson: However, I think it's a reach in this situation.

Dr. Jones: I want to talk a little bit about the biological plausibility. Meaning, somebody did this big study because somebody thought it there might be some biology. And we know that women in their third trimester tend to snore or make noises. And snoring might lead to obstructive sleep, apnea, meaning they're not getting as much oxygen to the baby or themselves. Or, you know, they're sleeping on their big blood supply. So there is a little biological plausibility.

Dr. Theilen: Yeah, absolutely.

Dr. Jones: So we need a study that will actually do a better job. Are we doing that study?

Dr. Gibbins: So yes and no. There is a large multicenter trial that has been completed in the United States looking at approximately 10,000 women during their first pregnancies. And in that study, a subset of those women had very intensive sleep assessments during their pregnancy. And that data has not been fully analyzed and released yet. I'm hopeful that that will shed some light on this issue. Because that data was collected during the pregnancy when women didn't know what outcome they were going to have. So it's more likely to be accurate and predictive.

Dr. Jones: Right. Well, and I'm going to give a shout out to our very own department which helped really lead this sleep assessment with these many, many women. So what's the takeaway for our listeners, pregnant or not pregnant, and bed partners of pregnant women? What should we be telling them?

Dr. Gibbins: I want women to not feel guilty. That's my biggest takeaway. We do not have enough data to say that sleeping on your back leads to stillbirth. At best, I think it may be linked to sleep apnea. And then the sleep apnea, exactly like you were saying, is the cause, not the sleeping on your back. It is hard enough to get pregnant and to sleep well. The stress caused by trying to sleep in a position that is unnatural to you is more likely detrimental in my mind than the act of sleeping on your back.

Dr. Jones: And we all, we've talked about stress in pregnancy and how that's not good for your baby.

Dr. Gibbins: That's not good for your baby.

Dr. Jones: So get a good night's sleep and grow your baby as best you can. And good luck and thank you for joining us on The Scope.

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Dr. Jones: What do you call a human egg five days after fertilization that's in the freezer? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is The Scope.

Announcer: Covering all aspects of women's health, this is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: This week in the news was a report of a live birth, of a baby resulting from an embryo, a zygote, preimplantation embryo that has maybe from 8 to 100 cells that was frozen 24 years ago. Reportedly, this is the longest time between freezing and live birth, at least that we know of, at least in the U.S. In reality, this record is going to be broken regularly as the technology which allowed us to freeze early preimplantation embryos became regularly used over 20 years ago. So more and more babies from embryos in long-term storage will be used. We'll be hearing about babies 30 years, 40 years, 50 years from conception and on and on.

Now, for just a little moment, let's step aside into comparative reproductive biology and talk about bears. Bears in winter. Bears and some 100 other animals do something called embryonic diapause. Cool name, huh? Well, I think it's cool. This is a natural process wherein a bear egg gets fertilized by a wandering bear sperm and progresses a few days and then stops growing, pauses through mechanisms we don't understand very well, for months. It just hangs out in the fallopian tube until a bear goes into hibernation, and then the preimplantation embryo implants and grows while a bear is hibernating. The goal is to postpone the birth until the appropriate environmental or metabolic conditions for the animal, in this case, the bear. The bear cubs aren't born until near spring when there will be an abundance of food. These pre-embryos in suspended animation are not frozen. They're in the mother but not growing until later.

By the way, to the best of our knowledge, humans can't really do embryonic diapause in the mother's body, but we can put our embryos in the freezer, probably indefinitely. In the in vitro fertilization world, usually a number of eggs are produced either by the biological mother or by an egg donor and then fertilized. In the U.S., we're trying to decrease the rate of risky twin, triplet, and quad births by putting back only one or two pre-embryos. In the U.S., we offer the chance to freeze the rest of preimplantation embryos, which for the sake of easier, we're just going to call embryos, but they only have about 8 to 100 cells.

Now, these aren't frozen in an ice cube tray in a regular fridge, but are very carefully frozen so as to not make ice crystals in the embryos and kept in liquid nitrogen. There are probably millions of cryo preserved embryos in the world with regulations about what can be done with them differing from country to country. For instance, currently, embryos cannot be frozen in Italy. In the U.S., there aren't really any rules and regulations except that IVF embryo labs must be certified. Being able to freeze unused embryos from an IVF cycle allows couples to have another chance of becoming pregnant or have another baby, or have a lot more babies if they want. But what happens if they don't want, couples who have the family size they want, who get divorced, or who get too old?

In the U.S., we offer couples three options. They can donate the embryos for research. They can thaw the embryos without transferring them to a uterus and the embryos will die, or they can be donated to an embryo bank that allows for embryo adoption. The case of the baby recently born from an embryo created 24 years ago arose from a couple that received the embryo from an anonymous donation to an embryo bank that specializes in embryo donation, the National Embryo Donation Center. This child born to an infertile couple who desperately wanted children is possibly the best outcome for unwanted embryos.

There are issues, however. The genetic parents are anonymous, so it'll be hard for the new parents and baby to know their genetic heritage. Of course, with more and more people choosing to search out their ancestry with genetic testing, children and adults from donor sperm, donor eggs, and donor embryos are finding genetically linked persons and figuring it out on their own. In Great Britain and Australia, there are laws which prohibit anonymous donation of eggs, sperms, and embryos, and the genetic parents must be on file for the child to know about when they turn 18.

In the U.S., advanced reproductive technology is less regulated than in Europe, so the origins of the frozen embryos, the so-called snow babies, can be anonymous. But between the donation of extra embryos from the couple 24 years ago and the so-called adoption of the embryos a year ago, when the embryos were in the bank, who owned them? Who was responsible for them? What was their legal status? Should they even have a legal status? If there are egg banks and sperm banks, what do we think about commercial enterprises that create embryos, you pick the color, ethnic background, whatever, of the genetic egg and sperm donors, and they will make embryos for you for sale? There's a little bit, actually a lot, of the yuck factor going on there for me.

In the end, it's probably a good thing that couples who have excess frozen embryos don't have to destroy them if they don't want to. And it's a good thing that they don't have to use them if they already have the family that they want and want no more children. That means there's a place for an embryo adoption center. It also means that couples who cannot make their own embryos for some reason but want to experience pregnancy and having a baby from birth can do so, but we're still left with some sticky issues like who's responsible for the embryos for quarter of a century, or half a century, or a century who have no legal parents, and what right does the grown person have to know who they are? So in this season of snow and miracle babies, thanks for joining us and the snow babies on The Scope.

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