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The American Fertility Association Blog

Green Birth Control?? What About Green Hamburgers?

July 29, 2009 - Wednesday
Posted by admin

By Jennifer Rogers

Created Jul 28 2009 - 7:00am

Green seems to be the color on everyone’s mind, and lately that has come to include birth control [1]. A green contraceptive is something we should work toward but it won’t prevent the growing number of gender bending fish in our waterways.

Synthetic estrogen used in oral contraceptives contributes only 1% to the total amount of estrogens excreted by humans [2].  Additionally, almost half of this synthetic estrogen is filtered out during our wastewater treatment processes. Of all the estrogen sent into our water supply through human biology, only a very minute fraction is synthetic. Clearly, there are other sources contributing to gender confusion in fish [3].

If we really care about our environment and our water supply, I’d like to suggest an alternative culprit: hamburgers. It turns out cows, chickens and pigs contribute an estimated 90% of estrogens to the environment. Yes, 90%. So if we really want to green our water supply, we need to start by greening our dinner. How? Well, first we’d stop pumping our livestock full of hormones or, at the very least, we would treat agriculture manure. Studies have shown that hormones from animal manure reach both surface and ground water and that livestock pumped full of hormones increase their excretion of these hormones up to six fold.[1]

If we are going to be concerned about synthetic human estrogen in our water, we also need to pay attention to other likely culprits, and both industrial and agricultural sources need to be considered.

I find it troubling that we have dramatized the contribution of estrogens in our environment to women on the pill. I’m not suggesting we should ignore the impact of estrogens in our environment. In fact, quite the opposite. Clearly, the types and sources of estrogens in the environment are diverse and cumulative. Natural estrogens (agriculture and natural human excretion) as well as synthetic estrogens and estrogen-mimicking compounds (other pharmaceutical uses, industrial chemicals, pesticides, plastics, etc) are present in our waterways and cannot be discounted as sources of the observed phenomena in fish, even at trace levels. What I am suggesting is that we stop the knee-jerk response that reducing estrogens is as simple as reducing women’s use of birth control pills. It is estimated that unregulated agricultural run off annually contributes 13 tons of hormones to our water sources. Clearly, we need to broaden the conversation.

What else can we do? First, we need to reform our chemical policy in the United States so that harmful estrogen-mimicking compounds found in our everyday products stay off the shelves. The burden cannot and should not be on individuals and communities to protect the health of their families. Instead, we need reform that requires pre-market safety testing of all our consumer goods and personal care products. Second, as the 50th anniversary of the pill is on the horizon, I’d like to ask my friends and allies to take some time to appreciate and even celebrate contraception. Modern contraception enables women to choose the number and timing of their children, which is central to our health and economic well-being. And, where all women have access to affordable contraception, birthrates decline and population growth slows. Slower population growth is not a panacea for today’s environmental problems, but it can ease pressure on natural systems that are reeling from stress. So, contraception is good for women—and for the planet.

In the meantime, we might think about forgoing that next hormone-riddled bacon cheeseburger. 

References: Callantine MR, et al. “Fecal elimination of estrogens by cattle treated with diethylstilbestrol and hexestrol.” Am J Vet Res. (1961) 22:462-465.


Jennifer Rogers is the Programs and Policy Director for the Reproductive Health Technologies Project (http://www.rhtp.org) where she is responsible for developing and leading key reproductive health projects and advocacy initiatives for the organization. Prior to joining RHTP, Jenn was the Director of Programs at the American College of Preventive Medicine, where she developed and oversaw ACPM’s adolescent and environmental health initiatives. She received her Masters in Public Health with a concentration in Maternal and Child Health from Boston University where she also served as a reproductive health advocate for the Massachusetts Emergency Contraception Network.

Categories
Fertility and the Environment • Reproductive Health

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Minimal Stimulation

July 28, 2009 - Tuesday
Posted by admin

By:  Dr. Fred Licciardi

I have been practicing infertility at NYU for 16 years. Basic infertility, reproductive surgery, ovulation induction, IVF, and egg donation are all areas of my expertise. Most of my patients are from New York , but people come to see me from other states and other countries.

Reprinted From Monday, January 21, 2008

Does taking a lower dose of fertility drugs improve your chances of becoming pregnant with IVF? I think not, but I can tell you of some exceptions. Mostly I have had some very good experiences with patients confirming that lower is not better.

How do I know?

Well, as it turns out over the past few years I have been seeing more patients from Europe. There are a few things that have contributed to this. One is the blog. It’s been fun getting e-mails and seeing patients from around the world. The second is the exchange rate: for some, New York is now a “reproductive tourism” destination. The third has to do with laws in Italy, Germany and other countries that restrict IVF and donor egg.

Anyway, the European doctors give their patients a much lower dose of drug that we do in the US. Part of this is due to the fact that they may not be allowed to fertilize more than a few eggs, so they don’t bother trying to get more. Another reason may just be due to a general philosophy that less drug is better.

So the typical European woman that sees me has done IVF many times, usually making just a few eggs on a lower dose of drug. Unless she has had a fantastic response, I increase the dose for her IVF cycle with me. In most cases, the egg yield is much higher (still in a safe range) and the pregnancy rate in these women is very high. So the point is that in these women, a higher dose is better because it increases the number of eggs, and therefore there are more embryos available for selection.

Do some women make more eggs with a lower dose? I have seen a few cases of this. This is typically the woman who was given a lower dose for IUI and develops more follicles than she did with her higher dose IVF cycle. Should we go back to the lower dose for the next IVF cycle? It’s a gamble and it takes a little courage. It is really hard emotionally to go into an “experimental” IVF cycle.

Many patients considering this have had many attempts and may not be ready to give up a couple months for a “let’s see” cycle. If you and your doctor can stomach it, you can give it a try. I can tell you I have one woman, who had been through many cycles, who wanted to give it a go, and she did better with less. Was that her month to make more, regardless of drug dose? Who knows, but let’s give her the credit.

But I do think starting on a minimal dose, just because your doctor thinks it’s more homeopathic and will result in better quality embryos, is not correct. To return to our common theme, if one of the self proclaimed experts in minimal stimulation wants to take 100 women and give them minimal stimulation, and take another 100 and give them regular stimulation, and then show us that minimal is better, great. But until this happens we have to say that it’s not better, and may be worse for most people. I know some of you can tell me that you did minimal and got pregnant. I just feel that my experience has shown that overall, regular may be better.

Categories
Donor Egg • Egg Donation • Fertility • Fertility Drugs • IUI • IVF • Pregnancy

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Looka!  Looka!

July 27, 2009 - Monday
Posted by admin

Tonight I am going to Coney Island with my kids to see the fireworks.  We will ride the Cyclone first (at least they will, you can’t get me on a roller coaster to save my life) and then Nathan’s, and after that we’ll hang out on the board walk until the display starts a little after sundown.  I love Coney Island, I’ve been going there since I was a kid.  My dad used to take me to the chick hatchery and put me smack in the middle of the fluffy little yellow things until I had my fill of patting their soft downy coats.  I used to love that, and I cried bitter tears when it closed.

But there was a place my dad didn’t take me, a place I didn’t even know existed until this week, my friend Barbara saw a TV show on PBS about it. 

Ironically, had my own kids been born in 1945 instead of 1995, I would have known about this place all too well.

The most popular attraction at the Coney Island Freak Show, next to the midgets, bearded ladies, and other assorted poor souls that we as a society could not find in our hearts to accept in those days, were the incubators.

For human infants, born too soon.

Like mine.  Connor and Caitlin were born on the first day of my third trimester.  I never made it to a LaMaze class and didn’t have time to paint the nursery.  My babies were 2 lbs. 3 oz (Caitlin) and 2 lbs. 6 (Connor) and lived in state of the art incubators for over two months.  The incubators that helped to save my babies lives cost $4,000 a day each and were not covered by my health insurance. (Did I mention that I’m divorced?)

But from 1903- 1945 there was only one place premature babies could be cared for and that was in a side show, not in a hospital.  Doctors from around the country rushed premature infants to Coney Island for treatment. There was no other option available for these most fragile of souls. 

File this under Where There’s A Will, There’s A Way.  He was a visionary, he was a failure.  He was a showman, he was a man of medicine.  He was a savior, he was a public joke.  Sometimes revered, sometimes ridiculed, but he didn’t stop.  Dr. Martin Couney was determined to save premature babies, when the world assumed they did not have a chance, when infant mortality rates were so high that these tiniest of the tiny were not even an afterthought.  Even, unbelievably so, for their parents, who often abandoned them at birth.  Dr. Couney continued to experiment and refine the incubator system in the only place he could, among the barkers and cotton candy sellers.  6,500 out of 8,000 babies lived, because of The Incubator Baby Exhibit in Luna Park.  The development and application of an important, ground breaking technology was paid for with each sticky handed admission, ten cents at a time.  There was no other way for him to fund his work. 

Eventually hospitals caught up to Coney Island, with Cornell being the first, and of course the rest of the world followed.
So tonight when I’m oohing and aahing at the fireworks I’ll be hearing the barkers yelling “Looka Looka!  See the Babies no Bigger than Chickens!” and remembering a time when my own babies looked like a two pack of Cornish hens.  I’ll say a silent thank you to Dr. Couney, and remember to never give up.

Corey Whelan
Program Director

Please visit these links for more information:

http://www.americanheritage.com/articles/magazine/it/1994/2/1994_2_24.shtml
http://www.neonatology.org/pdf/NYT_BeardedLady.pdf
http://www.coneyislandhistory.org/collection/index.php?g=detail&object_id=602

 

Categories
Family Building

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My Life in France

July 23, 2009 - Thursday
Posted by Ken

On our recent vacation to Paris, my spouse and I picked up a couple copies of Julia Child’s “My Life in France” forming the world’s smallest book club. As we began reading, we would share passages with each other that held special meaning to us. When we got about a third of the way in, we both were struck with the following:

        “I, too, had tummy troubles. Ever since our trip to Italy with Philapop, my stomach was no longer a brass-bound, iron-lined, eat-and-drink-any-amount-of-anything-anywhere-anytime machine that it had been. I had suffered bouts of feeling quite queer the entire time we’d been in France. “It must be something in the water,” I’d say to myself. But when I continued to feel suddenly sick and gaseous, I declared: “Aha, pregnant at last!”

        We had tried. But for some reason our efforts didn’t take. It was sad, but we didn’t spend too much time thinking about it and never considered adoption. It was just one of those things. We were living very full lives. I was cooking all the time and making plans for a career in gastronomy. Paul—after all his years as a tutor and schoolteacher—said that he’d already spent enough time with adolescents to last him a lifetime. So it was.”

It was just one of those things.

There was an acceptance of the fate that she and her husband had been dealt that I found really powerful. Clearly this was not a choice for Julia and Paul, but, as with everything in life, she took it in stride, and kept moving forward.

As a couple that has chosen childfree living, this passage resonated with us. She spoke of living “very full lives” and we thought; well we’re living very full lives, too. All will be well. At the end of the book, Julia discusses a time in life when friends and family began to die:

        “Then came a period when our intimate friends and family began to slip off into the Great Blue Yonder. Charlie and Freddie died of heart attacks. Jim Beard died in 1985, at age eighty-one. Jean Fischbacher died the following year, at age seventy-nine. Simca, living alone in Le Mas Vieux, refused to put herself into a retirement home or to ire a nurse. I worried about ma belle soeur, but, as always, she was determined to do things her own way.

        “I do often think of we childless ones, with no offspring to lean on,” I wrote Simca. “Avis, for instance, who evidently has only a year or so to live with her internal cancer, has her grandchildren to take her shopping, etc. Eh bien, we shall take care of ourselves . . . which we do very well. But I realize at our time of life the great difference between ourselves and those who have produced!” There were melancholy moments when I wished I had a daughter of my own to share things with.

        But we cooks are a hard lot: Escoffier survived to be eighty-nine, after all, and my old chef Max Bugnard lived to be ninety-six. Perhaps Simca and I would make it to eighty-five, or even ninety.”

Memories of both our moms at the end of their lives came flooding back to me. I remembered vividly how, when they were dying of cancer, they had their sons and daughters to care for them. The thought “what about me” crossed my mind at the time, but I quickly dismissed it. “I’ll be fine – we’ll be fine.” And we very well may be. God knows I’ve seen parents abandoned by their children in their times of need all too often, so having children is certainly no guarantee of being cared for when one is sick or dying. Nor is a desire to have nursing care that you don’t have to pay for the reason that people should have a family.

But now the issue has resurfaced and I can’t get it out of my head. What will happen if we require long-term care?

And why we are so obsessed as a society with a baby, and not equally obsessed with the quality of life at the end of life? How much money is spent by the medical industry to help people conceive, relative to what is spent to provide our grandparents – once considered wise and treasured resources – the best care we can give them? Why will insurance pay to institutionalize a person, sometimes relegating them to substandard care and abusive treatment in so-called rest homes, but won’t pay for at-home care, which is far less expensive and much more humane?

Where does the breakdown happen along the continuum of life and why don’t we provide a seamless standard of care from pre-conception through death? With the debate raging on health care, this is the perfect time to be asking these questions.

Quotes from “My Life in France” by Julia Child with Alex Prud’homme, Anchor Books, © 2006, pp 101; 329-330.

Ken Mosesian
Executive Director

Categories
Child Free Living

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Justice Sotomayor – How Will Her Confirmation Affect Those Suffering from Infertility?

July 22, 2009 - Wednesday
Posted by Lisa

By:  Theresa Erickson, Esq.

While watching the confirmation hearings last week (yes, I am one of those dorky lawyers), I was listening for any cues regarding how she may address a case that involved fertility treatments, fertility coverage, pregnancy discrimination (including pre-pregnancy for IVF treatments) and, of course, a woman’s right to chose, including the right to privacy involving medical treatments.  Now, mind you, I understand regulation may be needed in some areas of this industry, but I also do not want to see the government restricting our ability to create a family, regardless of marital status, age, or sexual orientation.  Again, these are issues that must be determined between a physician and their patient when he or she is accessing the health risks for the woman carrying the children, as well as any harm that may come to the future children in terms of prenatal health. 

I did discover, despite her attempts otherwise, that she appeared to hold a liberal point of view in many ways, which despite my own leanings, is important when it comes to autonomy for those patients and those involved in this industry.  However, regardless of her political stance, what is important is that she applies the law neutrally with a perspective of her life experience.  I know that many do not agree with that statement, but we all must agree that it is not humanly possible to take one’s own life experiences out of the picture when making decisions.  What we do want is for judges to use that experience, while simultaneously utilizing an objective vision when making decisions that will affect us all, as well as future generations.

Of course, much of what we do and what our clients/patients deal with is family law.  Judge Sotomayor has little experience in that area due to her previous posts as a federal judge, as most Supreme Court judges.  Even the Supreme Court itself has little experience in that area.  The most notable family law case is the case of Troxel v. Granville in which the Supreme Court did strike down a trial court judge’s decision to allow grandparent visitation involving a completely fit mother.  They were concerned that the judge had used his personal experience in making the decision since he stated he truly enjoyed his time with his grandparents as a child.  But, as I stated above, personal experiences do shape our lives and how we shape our decisions; however, in this case, the Court did not state that the judge did anything wrong in doing so, it was merely that it was a case with a backdrop of a fit mother.  Different set of facts could have created a different ruling. 

Now, with that in mind, Justice Sotomayor is a woman – she has no children, and she has been battling diabetes since the age of 8.  Does that make her more sympathetic to our plight or not?  I am not certain, as we do not know why she does not have children or if it was a path she chose.  But, we do know that she knows what it is like to battle a disease that controls your life, which should be good for those of us in the community. 

Remarkably, after reviewing her previous decisions, I was unable to locate much information on how she would rule if any such case comes before her.  In fact, she has not dealt with stem cell research regulation of Assisted Reproductive Technologies, healthcare choices, or on-point abortion cases; however, there are a few notable cases that she has dealt with as a judge:

1.  Saks v. Franklin Covey Co (316 F.3d 337 (2d Cir. 2003)) – This is a bioethical issues case in which she joined a Second Circuit opinion rejecting a claim that exclusion from coverage of surgical impregnation procedures, including in vitro fertilization, violated Title VII and the “Pregnancy Discrimination” Act.  Note that this does not assume that she is against IVF, only that she did not judge that that particular case was within the parameters of the Pregnancy Discrimination Act, which is her duty as a judge – to interpret law, not make laws.  For changes like this to be made, we need to address our Congress to have them amend these laws as they currently stand. 

      2.  Center for Reproductive Law and Policy v. Bush (304 F.3d 183 (2d Cir. 2002)) – Judge Sotomayor found that a “reproductive rights” group had standing to challenge the Mexico City Policy.  She concluded that the group had “competitive advocate standing,” on the grounds that the government’s allocation of a benefit “creates an unequal playing field” for organizations advocating their views in the public arena.  She agreed that the government had a rational basis for favoring “the anti-abortion position over the pro-choice position” with public funds.  Again, as the above case, since this case is not on point, we truly do not know how she would rule regarding the right to life, the right to abortion, status of embryos, etc.

Ultimately, based on her performance at the hearings and her record, and despite a few bumps in the road involving the case of the firefighters, it does appear that she will be confirmed prior to the start of the next Supreme Court session.  And, of course, I am truly excited, as a woman, as a lawyer, and as a member of the US Supreme Court Bar, that there is another woman on the bench.  Call me sexist, call me whatever you want, but we need diversity on the bench so that those who have never “walked in our shoes” can see the perspective, albeit objectively, when our cases come before them. 

 

 

Categories
Fertility • Infertility • IVF • Pregnancy • Reproductive Freedom

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