On and Off Camera: The Development of the Videos

From the beginning, it was important to capture the experiences of “real people” who used Assisted Reproductive Technology and other infertility treatments to form their families. Also important was to put their stories in perspective, having professionals in the video to provide evidence or insights about important topics.

The resulting video segments focus on people who formed families and their stories about experiences before, during, and after pregnancy. Topics that emerged included how they made decisions, how they prepared for ART services (including the important period before beginning treatment), and what happened after “success.” Clearly each story was different as was each family. We prepared brief backstories on each family, providing a bit more context and information than could be presented in the video.

The Experts—Professionals in Public Health and Medicine

Also appearing in the video are clinicians, scientists, and public health professionals who have worked with consumers seeking to overcome infertility. Again, a series of short “backstories” tells viewers a bit more about their work and the concerns they address in the video.

Maurizio Macaluso, MD, DrPH
Dr. Macaluso is a senior research scientist with CDC's Division of Reproductive Health (DRH). He is specialist in epidemiology with vast experience in reproductive health. With others, he is seeking to establish a national plan for public health to address preventing and managing infertility. He has served as a coauthor of CDC’s ART Report as well as scientific articles on ART and other reproductive health topics. Dr. Macaluso studied outcomes of ART where multiple or single embryos were transferred, finding success rates were the same with Elective Single Embryo Transfers (eSET) and birth outcomes (“a healthy infant born to term”) were also enhanced.

Victoria Clay Wright, MPH
Ms. Clay Wright is a public health advisor who helped author the ART Report for many years. She agreed to be part of this video as she answered many consumer questions about ART reports and ART procedures over the years. She remains concerned that many people don’t consider the many personal decisions to be made as they prepare for ART care and choose a clinic offering appropriate services. As she states in the video, the report is complex, but it must be to provide the evidence needed by so many people. Ms. Clay Wright now works in the CDC program to promote childhood and adult immunization services and programs.

James Goldfarb, MD, MBS
Dr. Goldfarb was asked to appear as he is a practicing clinician and the current president of the Society for Assisted Reproductive Technology (SART) , an organization representing 90% of the nation’s ART clinics. As a clinician, Dr. Goldfarb seeks to uphold the professional practice standards set by SART while providing care to patients at the Cleveland Clinic. He is director of Infertility Services at the Cleveland Clinic Health Systems and professor of surgery at the Lerner College of Medicine of Case Western Reserve University. Prior to becoming president of SART. Dr. Goldfarb served SART in many other positions including a 2-year term as clinical director of the society. Dr. Goldfarb has been a pioneer in the infertility field for more than 27 years. His infertility program was responsible for the first in-vitro fertilization birth in Ohio in 1983 and the world’s first in-vitro fertilization/surrogate birth in 1986. In 2004, Dr. Goldfarb was instrumental in having Cleveland Clinic designated as the nation’s first Fertile Hope Center of Excellence. Fertile Hope is a national, not-for-profit organization dedicated to providing reproductive information, support, and hope to cancer patients and survivors whose medical treatments present the risk of infertility. Dr. Goldfarb is also co-founder and medical consultant for the Partnership for Families Program, a philanthropic program that provides free in-vitro fertilization (IVF) cycles for qualifying infertile couples and also free fertility sparing procedures for qualifying cancer patients.

Juliette Kendrick, MD, FACFP
Dr. Kendrick is a senior scientist with CDC, having contributed to the science of “Safe Motherhood” for more than 15 years. As seen on camera, Dr. Kendrick is concerned that women be in optimal health before pregnancy, and is keenly aware of how this optimal health is important to a woman going through ART care. Dr. Kendrick also offers professional perspectives as a clinician, noting risks can result in unforeseen problems for a woman’s health and the well-being of her family.

William “Bill” Callaghan, MD, FACOG
Dr. Callaghan practiced OB/GYN in an area where he encountered women who were not at optimal health before pregnancy, often threatening their health and that of their offspring. The area is known for its high levels of maternal health problems as well as infant mortality. His scientific work at CDC provided some of the first evidence about the nature of maternal health complications in women older than age 35 (an age group that is increasing as women use ART services); obesity (which may cause fertility problems as well as gestational diabetes during pregnancy); and the effects of chronic diseases on women’s health during pregnancy. His work has contributed to our knowledge of preventable risks related to pregnancy.

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Production

CDC’s ART Research and Evaluation Team provided data and insights for the video and related web materials.

Aetna provided funding to the CDC Foundation which defrayed the costs of producing this series of videos. The CDC Foundation’s staff also worked with this partnership providing several types of assistance to make the project possible.

Dr. Joanne Armstrong, MD, MPH, FACOG, is the senior medical director and head of Women's Health for Aetna and assistant professor of obstetrics and gynecology at Baylor College of Medicine in Houston, Texas. Dr. Armstrong provided many insights from her experience as a practicing obstetrician and gynecologist as well as a medical advisor to many corporations, nonprofit organizations, and medical professional and governmental health agencies. Dr. Armstrong's career focus has been on ways to improve the safety and effectiveness of health care delivery for women and their infants.

A team of CDC Health Communications Specialists produced the videos, developed Web materials, and provided special services with the support of videographers (Dogtown Video, LLC), graphic artists (Isa & Company, Inc.), and CDC Web developers.

Closed captioning was made possible through the services of the National Captioning Institute.

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Family Stories

April and Michael, parents of Julianne and Gwendolyn
This couple discussed the 2 ½ years of attempts to form their family. Their twin daughters were conceived using fresh nondonor eggs.

During the filming, they discussed the difficulties they experienced. April talked of her experience with ovarian tumors and surgeries to remove them. Both April and Michael discussed preparing for pregnancy using IVF, using every option to have the “best chance possible” as they cut out anything that could affect success.

Michael’s successful effort to stop smoking before IVF is noted in the video. This action was beneficial in many ways as smoking is known to affect male fertility, possibly outcomes of IVF and of course, reduced second-hand smoke around a pregnant woman and then a family that includes infants. April told of her use of vitamins and supplements, including some that today are considered complementary to the overall health of women.  She, like other women, included folic acid as part of her preconception care.

One of the poignant parts of their interview is shared in the video—their sharing about the stress of infertility on couples who hope to form families. They also went on to discuss the costs of ART, comparing one treatment to what might be the cost of a college education. Also, they share information about what they learned through this experience. While they transferred three embryos, they stated they would have been more comfortable with two. April also talked of an experience common to women who bear multiples, the potential to have a higher risk of childbirth complications including hemorrhage.

Their story underscores several suggestions for anyone preparing for pregnancy using ART services. First, this is a couple that worked together to achieve optimal health before using ART services. Second, April and Michael were able to cope with the emotional stresses related to infertility. Finally, while happy to form their family, they acknowledge their experience did not come without risks.

Michele, mother of Andrew and William
Filming Michele was a short lesson in the life of being a “mom of multiples.” It took several attempts to get all three members of the family in one shot—for Andrew and William were constantly in action in and off camera.

Michele’s story begins with her marriage at the age of 37, continues through her experience to become pregnant and the premature birth of fraternal twins, ending with how she now copes as a single parent after a divorce. What shines through her story is her candid view of what she has endured to form and “keep” her family. On and off camera, she quips about being a mom of a multiple—laughing about being a “burro” as she carried a briefcase, diaper bags, and other things needed to be a working mother of infants, then toddlers. Then Michele admitted to the serious and troubling aspects of having ART and being a mother of multiples—the stresses of work and perhaps parenting may have lead to her divorce.

The birth of Andrew and William came after Michele used hormonal treatment to conceive, but experienced a pregnancy loss. Her pregnancy with the twins was somewhat like that of other women—but she spoke of trying to cope with morning sickness through the day at her job, the constant need to continue a high level of productivity at work, and the pressures related to having premature multiples. Michele went on to tell about the pain associated with medical treatment to delay labor and delivery.

In the video, you see her as she talks of her children in the neonatal intensive care unit—off camera, she discusses how the limited amount of time for holding her newborns while they were in the hospital. Michelle noted, "…I could hold them for a few minutes during every shift of several hours long, I couldn't move or cuddle them because every miniscule movement made them burn calories, which they desperately needed."

Michelle discussed her “grocery store” experiences but unfortunately, you will miss how she needed and received help from others—even to get a cereal box from a tall shelf. There is another short story about her doctor wanting to transfer five embryos, which she decided was an undesirable choice for her. Finally, she talked of her experience as the mother of preemies, including using a special Born-Too-Soon program for children.

Andrew and William, though not identical twins, do have an amazing level of energy and engaged us as they have others—yes, different eye colors and some lingering effects of prematurity. Yet Michelle’s frank discussions reminded us and others that a successful ART treatment is only the beginning of a journey.

Tina and Efrain, parents of Mia
Their story demonstrates how many couples prepare for ART treatment, including coping with the many decisions to be made before, during, and after a single treatment. Tina and Efrain share in the video that it took six years of calendar time and five attempts to bring Mia into their family. They also reveal the need to use an egg donor, someone called “a special lady” in the video.
 
Beyond what you will view in the video is their story of coping with "the long journey and hardships" of infertility and ART treatment. Efrain discusses his views of the experience noting how difficult it was to give Tina hormone shots and to keep track of the medications and numerous medical procedures. He raises the point that it is difficult for both partners, but in their case, he saw and supported the burden carried by his wife as they went through this journey.
   
Tina mentioned having a chronic condition requiring treatment—one that might have had an effect on her ability to carry a pregnancy to term. Here again, Tina and Efrain  emphasized the need to have frank discussions with each other—and with medical providers—being ready to answer the questions that often begin with “...are you prepared for....” At the same time, Tina talked of “taking care of myself, making sure I could carry to term.” Off camera, they mentioned considering alternative or complementary medical care during the course of their journey.

The video segment does not include other important topics raised by all the “real people” and and others—the constant and special experiences some will find in the journey. Tina and Efrain continued to emphasize their desire to parent could have been achieved through the option of adoption if this last attempt failed.

During the course of filming, they would mention their faith and their support networks helped them cope with the many years and attempts to have a child.  More important, their backstory is woven with how they coped with infertility and pregnancy loss while remaining grateful for each other, their support network, and others who helped them during the six years of seeking to form a family.