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The American Fertility Association Blog

A Typical Monday at the Computer, or, I Couldn’t Get Away From Articles About Being Fat Today

August 4, 2009 - Tuesday
Posted by Corey

I am currently in the process of editing the articles that will appear in The AFA’s 2010 edition of the National Fertility and Adoption Directory.  This year’s book will have around 23 articles.  I received three of them for editing today, and it struck me that all three (written by Mike Berkley, L.AC; Daniel Shapiro, M.D.; and Stacey Roberts, PT, MH. Ph.C) discussed obesity and its detrimental effects on fertility and overall health.

Then, being a creature of habit, I checked out The AFA’s homepage newsfeed, which changes several times a day and picks up relevant news stories from around the world, and two stories right on our homepage were about?  You guessed it.  Being overweight.  One article focused on that newest catch phrase, brown fat, and the other one focused on body image and weight.

Recently I learned that Forever 21, my daughter’s (and mine) favorite clothing store, is creating a line of cool clothes for larger teenage girls called Faith 21.  And Lane Bryant is launching a teenage girl’s line this September as well.  You can certainly say that this is great news, and it is.  Everyone deserves to wear beautiful clothing.  But obviously, overweight teenagers represent a fairly large market and big profits, and that is the motivator here.  And no. This was not a play on words.

Personally?  I’ve been fat, and I’ve been thin.  Once upon a time, I even had the photos to prove it.  And I need to be honest.  At least for me?  Thin is better.  No, I didn’t say mega skinny.  I said thin.  Healthy thinness is better.  For overall health, certainly.  But also, for fertility. 

And here’s the at least for me part.  I feel prettier now than I did when I was fat.  Was that my reason for losing 78 lbs.?  No.  My motivator was a routine trip to the doctor, and finding out that my blood pressure was at potentially catastrophic numbers.  With two babies at home relying on me to, you know.  Live. 

I was sure that diabetes was in my near future if I didn’t straighten up and fly right, so I did.  I chose to be healthy and live. 

Fourteen years later, I have a teenage daughter who is thin and I am grateful, for a number of reasons, none of which have to do with her looks.  She would be beautiful in my eyes no matter what she weighed.  But when Caitlin contracted swine flu this past spring, I would have had to worry much more about it’s effect on her health if she had been 25 lbs. heavier.  If my girl was a typically overweight American teen, I would be concerned about her potential for diabetes, heart disease, and a whole litany of weight related health issues.

And of course, given my own pcos, I would be concerned about her future fertility.

We all know that everyone has the right to feel, and to be, beautiful.  I think that healthy weight exists on a spectrum and that we in this culture are not very tolerant of the spectrum.  Five pounds up or down and you’re Too Fat!!!  Or, Too Thin!!!  But.  If you go too far in either direction, I truly think you look unattractive (yes, I went there) for a reason.  And the reason is that being too skinny, or too fat, is simply not healthy.  And we as human beings find these ends of the spectrum unattractive as a way of preserving our species.  Being grossly overweight, or grossly underweight, will inhibit fertility potential as well as overall health. 

I know it’s hard.  There is no magic bullet for weight loss.  But if you are currently ttc, and feel in your heart that you are overweight, or underweight, talk to your doctor, make changes that make sense for you, and if overweight is the issue, exercise!  Magic bullet for weight loss?  There isn’t any.  Cliches aside, if I can do it, you can too.

For more information on weight and fertility check out these, and many other stories:
http://www.integramed.com/inmdweb/content/cons/conceptions/optimalweight.jsp
http://www.consumerreports.org/health/conditions-and-treatments/fertility-problems/what-works/fertility-treatments-and-your-weight.htm
http://www.dailymail.co.uk/health/article-1203036/Calorie-burning-healthy-fat-latest-weapon-battle-obesity.html?ITO=1490
http://www.di-ve.com/Default.aspx?ID=72&Action=1&NewsId=62850

Corey Whelan
Program Director
The American Fertility Association
http://www.theafa.org

Categories
Fertility • Infertility • Reproductive Health

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Infertility: where religion and science meet

August 3, 2009 - Monday
Posted by Ken

In a recent article titled Reconciling Religion and Infertility, the author thoughtfully outlines the beliefs and teachings of Judaism, Islam, and Christianity and how those beliefs affect each tradition’s teachings about infertility treatment. The article was written from the perspective of helping the 10 percent of the 10 million people worldwide that will be diagnosed with cancer this year and who may require fertility treatment. The term “oncofertility” has been coined for the field that assists patients in looking at fertility preservation options.

From my perspective, there are three key points raised in the article. First, those diagnosed with cancer have not been routinely offered fertility preservation options. Second, there is a real desire for dialogue with religious leaders on this issue, so that health care teams can better deal with people of faith who are faced with cancer and who desire to preserve their fertility. And third, that there are great variations between and within faith traditions on how to approach this issue, and those approaches may change or be nuanced over time as our understanding of technology continues to advance.

But the broader issue that the article points to is the importance of those undergoing or contemplating treatment to have a conversation about it. Have the conversation with your religious leaders. Have it with trusted family and friends. Share what you are going through so that assisted reproductive technology becomes human for others. Finally, share what you are going through so that the conversation becomes normalized in the population at large.

We often talk about the gains The AFA has made in terms of web traffic and media coverage. It’s not because I want The AFA or any member of the staff or board to have attention drawn to them. It’s because I want the conversation about this issue to become part of the mainstream so that the fear and shame, which still surrounds it, can be diminished.

So join the conversation. Health care professionals, patients, those faced with cancer, patient advocates, religious leaders, children born as a result of IVF – everyone’s voices are needed – and so are everyone’s ears; because talking is only half of it.

Ken Mosesian

 

Categories
Cancer & Fertility • Fertility • Fertility Preservation • Infertility • IVF • Reproductive Technologies

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Pee in a Cup

July 31, 2009 - Friday
Posted by admin

That’s all it takes, suggests a recent study on bmj.com, to determine if you have an STD which could stand in the way of you successfully conceiving a child.  Chlamydia is the most common STD in the United States and it can lead to serious long term health complications in women, including infertility.  Guys, you’re not far behind.  Recent studies show it may also cause infertility in men.  When I say recent, I mean yesterday. 

And, as part of The AFA’s male reproductive health program, now underway with several other “A-listers” like the Society for the Study of Male Reproduction (SSMR) - an official branch of the American Urological Association, Men’s Health Network, and the CDC, an extensive amount of research is currently being launched to determine the best ways to educate younger men and the most effective ways to approach them with that education. We have a lot of work to do, without a doubt, but all of us are really excited about making an impact in this area. In addition to STD prevention, we’re going to be looking at the effects of environmental toxins, steroid and other drug use and testicular self-exams as a way to get guys more “in touch” with their own reproductive health.

Five minutes with your doctor and a urine sample are all it takes to “flush out” (sorry, it’s Friday and I’ve been caffeine-free for two weeks) the possibility of carrying an undiagnosed STD.  If you want some incentive to do so, while getting a European vacation out of the deal, head to the UK where you’ll get an iPod just to get tested for STDs. Seriously. This is a real program and you may read about it here. 

Read Article about STD Testing:

Simple Urine Test Could Help Cut Chlamydia in Men

Brian Armentrout
Communications Director
The American Fertility Association

Categories
Family Building • Fertility • Fertility Preservation • Infertility • Male Factor • Reproductive Health • Sexual 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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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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