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The American Fertility Association Blog

The Bad News Island:  An Interview With Tour Guide Melissa Ford

June 24, 2009 - Wednesday
Posted by admin

In MY day, when people found out they couldn’t have children, they gave up their power to the men in the white coats. We allowed the men in white coats to poke and prod us without completely understanding the whys. We suffered alone, isolated. And we liked it! We loved it!

Today, modern people confronted with infertility will have a much easier time of it, thanks to the recently released book, Navigating the Land of IF: Understanding Infertility and Exploring Your Options.  The Land of IF is a guidebook for a place just off the mainland, a place where one in six people find themselves marooned. Author Melissa Ford, has explored every nook and cranny of this formerly insular jungle-of-a-place, and she indulged me in a few questions about her journey to parenthood and to authorhood.

***

You decided to become a tour guide for an island where no one wants to go. Huh?
Well, someone had to do it! Actually, there are a lot of really good books out there for infertility, but they were all missing items here and there. I wanted to cover the basics, but also make sure that all of the questions I still had after I put those books down were answered. Such as what happens if you hit a blood vessel during an injection? Or what are the various IVF protocols?

I also wanted one book for everyone: primary, secondary, situational, biological, young, old, single, or married. This doesn’t mean that everyone will love the book because they may hate my writing style, or how inclusive it is, or any other reason. But I wanted the door to be open to everyone who wanted to walk through by using inclusive language, considering a plethora of situations, and including information for everyone in the community.

You call this island the Land of IF. What does IF mean?
IF is the online abbreviation (on bulletin boards and blogs) for infertility, but “if” is also a huge part of infertility. “If” also conveys the uncertainty and leaps of faith one needs to take daily with infertility.


You’ve done a lot of actual travel. What did you look for in a good guide book? And how did you incorporate this into the Land of If?
I looked for consistency between chapters/cities and information I could use. I love Lonely Planet and Let’s Go because they both skip the pictures and essays about the place (well, they contain that in a small amount) and instead use the space to list the important information you need while you’re there, keeping in mind all people and not just a small subsection of the traveling population. They don’t make assumptions about your financial situation or your interests. They just throw it all in there along with a few helpful tips that will help you bypass difficulties while on the road.

Everyone gets off the island eventually, one way or another. What neighborhoods did you hang out in and what was your path off the island?
It’s an interesting question because I had the neighbourhood I lived in (and most of us only own one home), but many neighbourhoods that I visited due to friends or family members living in other spaces. Many of my childhood friends ended up going through infertility with me, and, of course, I met people along the way through Resolve and now blogs.

In addition, I think the way off the island is really an emotional journey. You can have children and still not resolve your infertility or you can stop the family building process and still not resolve your infertility. There is a saying with Resolve that children resolve childlessness, not infertility. And I find that to be very true.

So my path off the island was a lot of self-searching and finding peace with the journey. But my neighbourhoods while on the island (and I’m still living over here because we’re not finished with our family building) were primary infertility and early loss, with our apartment building being the Injectable IUI Cycle Towers.

When did it first strike you to write the Land of If? What was that a-ha moment where you thought, “This must be written?”—was it a sudden or gradual realization?
It actually started out as a very different book—a book for non-infertile men and women to read to understand the infertility experience. I came downstairs one morning and my husband, Josh, was angrily writing a response to an advice columnist. He had followed an intriguing sentence from the “front page” of the online newspaper to read a question about adoption. And her advice was crap. We were talking about it with my parents that night and they said, “well, you can do something about this. You could write something. You’re both writers.”

I started writing that book, but realized after a chapter or two that it wasn’t a good fit. It wasn’t flowing and it didn’t feel comfortable. I switched it to being a book for me, for my community. And that’s when it clicked.

Would this book have come about if not for your blog, Stirrup Queens?
I don’t know. I don’t think so. I guess one thing that makes this book very different from all other infertility books is that it has this living, breathing counterpart—the blog—and the author is completely accessible. I tell you to join a community and vent your frustrations, but then I also participate in said community and make sure you’re welcomed inside by maintaining the blogroll and Lost and Found. I hope people who read the book then step through the fourth wall that sometimes exists between the author and the reader and communicate with me, either through the blog or by emailing or meeting me at a reading.

Why would someone who is NOT experiencing infertility want to pick up this book?
To better understand someone they know who is experiencing infertility. I don’t know how many people who are not experiencing infertility will pick up this book, but that’s okay. The words are there for everyone to use who is experiencing infertility and they can pass them along in conversation with people outside the experience.

How different would your own IF journey have been if you’d had this book?
I probably would have felt less lonely. The exercises in the book I used to make decision and I included one of the real decision webs we made before we started treatments. And I took my sister’s advice to heart a lot and still do in living my life. But I wish I had known about the online community back then. It was small, but still existed. I wish I had known about blogs and read them.

There is a lot of humor in your book. Can you talk about the importance of levity while putzing around on the Isle of If?
If you don’t laugh, you’ll cry. And even as you laugh, you’ll still cry. I think it’s important to note that having a sense of humour doesn’t mean that you’ll laugh your way through every insemination or egg retrieval or meeting with the adoption facilitator. It means that you’ll bring whatever levity you can to every situation while also honouring the enormity of the situation.

One time, when we were at the beginning of a very early loss, we stopped at a rest stop while driving and when I saw the blood in my panties, I instinctively took off my glasses and threw them. In this very dirty gas station bathroom. And after I had cried and cried and cried, I realized that I couldn’t see anything without the glasses—especially in the dim bathroom light—and didn’t know where they were outside the stall and feared that I would step on them in my attempt to find them. So I could cry but still see the amusement in having thrown my glasses—the ridiculousness of it all.

What is your marker of success with this book. I mean, how will you know when you’ve accomplished your goal(s) in writing it?
If someone writes me and says that it helped them breathe. That it made anything easier or shed light on something that had been muddled in their brain prior to reading it. If people feel that it is inclusive and respects everyone in the adoption/loss/infertility (ALI) community. I wish it could also speak to those outside the community and hopefully the book is respectful to other members of the adoption triad, doctors, nurses, surrogates. It is hard to write balancing everyone, but if I did so overall, I will think the book is a success.

What other projects are you working on, books or otherwise?
Right now, I’m finishing up a work of fiction. I needed something lighter and less research driven this winter/spring. As I complete that project and release that, I have three more non-fiction ideas that I’m tossing around. It is interesting because at the same time, I thought up four non-fiction projects that sat well with me and four fiction projects. So I would love to weave back and forth between the two—with the heavier topics being balanced by the lighter ones.

You’ve tweeted that you’ve been writing sm.ut. Is writing sm.ut as much fun as writing about timed intercourse and hormone levels?
Oh, timed intercourse wins out every time. There is nothing more joyous than writing about timed intercourse EXCEPT writing about home inseminations.

Give us the sales pitch. Where can we get your book?
Navigating the Land of If has its own website where I post information such as readings and where to purchase the book. You can get it at any bookstore in the US as well as online from sites such as Amazon, Barnes and Noble, or Borders.

Lori

Weebles Wobblog ... mindful living amid chaos.
All Thumbs Reviews ... get your sass on.

Categories
Infertility • IUI • IVF

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Story of the Three Must-Haves

June 19, 2009 - Friday
Posted by admin

When my partner and I decided to get pregnant, the first step was finding a sperm donor who would help us conceive a child. Over the course of our attempt to get pregnant, we used one known donor and 5 anonymous donors.

We initially focused on finding a known donor because we wanted our child to have the potential to know this person when they were older. We established a few criteria: they must be in a monogamous relationship, should have children, and who was willing to be identified as the donor. We didn’t want him to co-parent, but we did hope he would be open to being in our lives as a friend. We approached a few of our friends, and a couple even approached us.

Not surprisingly, many declined because they didn’t feel they could remain uninvolved, especially those with children. These men are great fathers, and though they wanted to help us, they were afraid of remaining uninvolved with a child that was biologically related to them. A couple times, it was the female partner who offered their male partners’ gametes. These conversations often originated after a few drinks, and both time the men rescinded their partners’ offer. Many times, these conversations were light-hearted and respectful, but didn’t progress beyond the initial inquiry. After a year, we finally found someone who was interested in helping out and he underwent testing. We hired lawyers specializing in family law to draw up the legal contracts which would protect everyone’s rights, but we found out he would still have to sign over his parental rights after a child was born so that Barbara could adopt. We ended the agreement when no pregnancies occurred after a year of trying at home inseminations with fresh semen, and we remain friends with him to this day.

Rather than re-initiate the whole process of finding a known donor, we decided to turn to an anonymous sperm bank to provide the missing gametes. We started the process with a long list of criteria which included a decent sense of humor, not too religious, blue or green eyes, no family cancer history, between 5’9” and 6’2,” European descent, and willing to be known when the child turned 18. Many sperm banks offer a range of information for free and for a small fee. Most even offer a photo matching service where the non-biological parent (male or female) can send a picture and a donor with similar features will be suggested. Sperm banks are pretty similar in policies and information, but there was tremendous diversity in costs, free online information, and availability of donors. In addition to having a wide range of choices, there were clear legal benefits to using an anonymous donor that protected us from a potential parental challenge we could have faced from a known donor.

We used five different donors from two banks before we finally got pregnant via IVF and ICSI. The longer it took to get pregnant, the shorter our criteria list got until we ended up with three “must-haves.” Those must-haves included no family history of cancer, a height range, and someone willing to be known in the future. The earlier list reflected our personal values and physical characteristics, but in the end, our number one goal was to have a baby. We achieved that goal, met the three must-have criteria, and realized that it didn’t really matter if the donor had a sense of humor or a happy childhood. The only things that really mattered were that our son would be loved, nurtured, and cared for by two loving parents thanks to the help of a third person’s generosity. I don’t know if the young man knows the joy he has brought to our life, but I hope we get a chance to meet him some day and thank him in person.


Sierra Hansen

Categories
Donor Sperm • Family Building • IUI • IVF • LGBT • Sperm Donation

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Georgia House Bill 388, The ‘Option for Adoption’ Act.

June 3, 2009 - Wednesday
Posted by admin

By:  Daniel Shapiro, M.D.

Georgia recently enacted Georgia House Bill 388, the ‘option for adoption’ act. The bill provides legal basis for patients using donated embryos to ‘adopt’ them under the Georgia family law code. This bill is the first of its kind to be enacted and represents one of many attempts by right to life groups to establish ‘personhood’ of embryos. By all prior legal standards and in all reproductive medicine clinics practicing embryo donation, embryos are considered property, not people.

The moral standard implied by this bill is likely to be unconstitutional because it violates the 1st amendment’s establishment clause (separation of church and state).  Though reasonable people can certainly argue for the ensoulment of a pro-nuclear embryo, the civil pacts by which we live in this country prevent the supremacy of one religious view over any other or over any irreligious view.  Since the concept of personhood is inherently a religious question, this law violates our nation’s constitution. The law also probably violates the 14th amendment (equal protection under the law) since it establishes a special class of human being with rights that supersede the rights of others in the class. Why should an IVF embryo have the right to be adopted and treated as an ‘individual’ while a naturally conceived embryo has no similar protection?

I had the privilege to testify before the Georgia committee hearing this bill before it passed. First let me say that what was originally written was so egregious and foolish that had the original language passed Georgia’s legislature would have looked plain stupid. An attorney with extensive experience in Georgia family law and third party reproduction rewrote much of the bill and eliminated the expressed intent to make all IVF embryos into full grown people. She also crafted the language in a way that makes the bill superfluous in that it only created the option for an expedited adoption process but does not require it. In effect the law does nothing except answer to the rantings of the religious right.

Because the law is vague as to how it is we are supposed to actually proceed with these cases, we in the REI community in Georgia do not foresee any change in our practice. Our consents and contracts with patients have provided for rescission of parental rights in the case of embryo donation from time immemorial. Unless a recipient patient actually tells outside parties how she achieved pregnancy, all anyone would see is a pregnant woman anticipating delivery.  Since the overwhelming majority of embryo donations are anonymous, the donor would not know if a) her embryos became pregnancies or b) who actually got pregnant. It is hard to imagine a case where a willing embryo donor would come back and sue for parental rights since said donor wouldn’t know if or when a donation took place. Even if she could discern the above from the unavailability of her former property, she would not know if the procedure actually worked. Someone would have to show a compelling reason for us to violate someone else’s right to privacy and reveal their identity and the circumstances of their embryo recipiency. Ain’t gonna happen. I defy anyone who claims to believe in freedom and autonomy (many are in the same party as the religious right) to explain why the state of Georgia has a compelling interest in unmasking HIPPA protected patients.

Dr Shapiro is board certified in Reproductive Endocrinology and is the former medical director of Reproductive Biology Associates (RBA). He is currently the clinical director of RBA’s egg donor program and the RBA egg bank.

In cases where the embryo donor is not anonymous (a rarity) the bill allows for expedited adoption. Though this may afford a greater level of protection for the recipient’s claim to parentage, the physical reality of labor and delivery is probably a good enough standard under which a couple may establish their claim. To the best of my knowledge, there are no cases of willing embryo donors coming back to claim parental rights. It is equally hard to imagine what would happen if they did. For this law to be applicable at all, the donation, gestation and residence of all the parties would probably have to be in Georgia. If any of the parties, especially the recipient lived out of state, the existing property laws and family statutes of the resident state would likely apply.

From a medical perspective, we could limit our donations only to embryos that came from egg donation and then offer them only to out-of state recipients. This is likely to be unnecessary as again the bill only provides for the adoption option. After the law is enacted on July 1st it would be prudent of us to be sure to document that we informed recipients of the adoption option. Beyond that we see no change to medical practice standards under this bill.

Dr Shapiro is board certified in Reproductive Endocrinology and is the former medical director of Reproductive Biology Associates (RBA). He is currently the clinical director of RBA’s egg donor program and the RBA egg bank.

Categories
Adoption • Embryo Donation • Family Building • IVF • Pregnancy

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Pretty Woman

June 1, 2009 - Monday
Posted by admin

By: David Kreiner, M.D.


“We at The AFA have received a large number of emails from women who are confused by Kate Gosselin’s diagnosis of PCOS because, in their eyes, she is simply too pretty to have it.  Many people seem to have the misconception that a woman with PCO is doomed to a lifetime of unattractiveness.  AFA blogger, David Kreiner, M.D., has written about PCOS today in an effort to further educate women about this disorder” – The AFA staff

Polycystic Ovary Syndrome (PCOS) is a condition in which a woman’s hormones are out of balance.  It can cause problems with your periods and make it difficult to get pregnant.  PCOS may affect the way you look and can be associated with a variety of health problems including diabetes, hyperlipidemia and hypertension.

PCOS is the most common hormonal disorder of reproductive age women, occurring in over 7% of women at some point in their lifetime.  It usually develops during the teen years.  Treatment can assist women attempting to conceive, help control the symptoms and prevent long term health problems.

The most common cause of PCOS is glucose intolerance resulting in abnormally high insulin levels.  If a woman does not respond normally to insulin, her blood sugar levels rise triggering the body to produce more insulin.  The insulin stimulates your ovaries to produce male sex hormones called androgens.  Testosterone is a common androgen and is often elevated in women with PCOS.  These androgens block the development and maturation of a woman’s ovarian follicles preventing ovulation resulting in irregular menses and infertility.  Androgens may also trigger development of acne and extra facial and body hair.  It will increase lipids in the blood.  The elevated blood sugar from insulin resistance can develop into diabetes.

Symptoms may vary but the most common are acne, weight gain, extra hair on the face and body, thinning of hair on the scalp, irregular periods and infertility.

Ovaries develop numerous small follicles that look like cysts hence the name polycystic ovary syndrome.  These cysts themselves are not harmful but in response to fertility treatment can result in a condition known as Hyperstimulation syndrome.  Hyperstimulation syndrome involves ovarian swelling, fluid accumulating in the belly and occasionally around the lungs.  A woman with Hyperstimulation syndrome may become dehydrated increasing her risk of developing blood clots.  Becoming pregnant adds to the stimulation and exacerbates the condition leading many specialists to cancel cycles in which a woman is at high risk of developing Hyperstimulation.  They may also prescribe aspirin to prevent clot formation. 

These cysts may lead to many eggs maturing in response to fertility treatment also placing patients at a high risk of developing a high order multiple pregnancy.  Due to this unique risk it may be advantageous to avoid aggressive stimulation of the ovaries unless the eggs are removed as part of an in vitro fertilization procedure.

A diagnosis of PCOS may be made by history and physical examination including an ultrasound of the ovaries.  A glucose tolerance test is most useful to determine the presence of glucose intolerance and diabetes.  Hormone assays will also be helpful in making a differential diagnosis.

Treatment starts with regular exercise and a diet including healthy foods with a controlled carbohydrate intake.  This can help lower blood pressure and cholesterol and reduce the risk of diabetes.  It can also help you lose weight if you need to.

Quitting smoking will help reduce androgen levels and reduce the risk for heart disease.  Birth control pills help regulate periods and reduce excess facial hair and acne.  Laser hair removal has also been used successfully to reduce excess hair.

A diabetes medicine called metformin can help control insulin and blood sugar levels.  This can help lower androgen levels, regulate menstrual cycles and improve fertility.  Fertility medications, in particular clomiphene are often needed in addition to metformin to get a woman to ovulate and will assist many women to conceive.  The use of gonadotropin hormone injections without egg removal as performed as part of an IVF procedure may result in Hyperstimulation syndrome and/or multiple pregnancies and therefore one must be extremely cautious in its use.  In vitro fertilization has been very successful and offers a means for a woman with PCOS to conceive without a significant risk for developing a multiple pregnancy especially when associated with a single embryo transfer.  Since IVF is much more successful than insemination or intercourse with gonadotropin stimulation, IVF will reduce the number of potential exposures a patient must have to Hyperstimulation syndrome before conceiving.

It can be hard to deal with having PCOS.  If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition.  Ask your doctor about support groups and for treatment that can help you with your symptoms.  Remember, PCOS can be annoying, aggravating even depressing but it is fortunately a very treatable disorder.

Sincerely,

David Kreiner, M.D.
Do Live in California?

To learn more about PCOS and how to control it, along with other steps you can take to prevent infertility, be sure to attend The AFA’s FREE Manicures & Martinis Infertility Prevention Series, which is coming to San Francisco and Laguna Niguel.  Enjoy complimentary manicures and martinis and learn about the reality of the biological clock, how STD’s can compromise your fertility, and how certain environmental toxins can jeopardize your ability to conceive a child. 


Manicures & Martinis San Francisco
Nova Nail Spa
811 Mission Street in San Francisco
Tuesday, June 9th, 6:00-7:30 PM
RSVP with Vivian:  vivian@theafa.org or 646-861-3226
More Details


Manicures & Martinis Laguna Niguel
Accent On Nails
28121 Crown Valley Parkway in Laguna Niguel
Tuesday, June 16th, 6:00-7:30 PM
RSVP with Vivian:  vivian@theafa.org or 646-861-3226
More Details

Categories
Fertility Drugs • Infertility • IVF • Ovulation • PCOS • Pregnancy

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Kate Gosselin Has PCOS and It’s None of Your Business

May 28, 2009 - Thursday
Posted by admin

May 27, 2009
11:30 p.m.

I’ve successfully avoided watching Jon & Kate plus 8 since the series started.  Yesterday, I wasn’t so lucky.  My daughter Caitlin came home from school dying to watch the show because her middle school – middle school!  - was all abuzz about the infidelity angle and she wanted to see what the deal was.  So last night, along with about half the population of the United States, I tuned in. 

Oy vey.  Now I get why I avoided it so stringently for so long. 

According to Wikpedia, Kate has pcos, the same diagnosis as me.  I didn’t know that.  Women with pco are very inclined towards hyperstimulation syndrome and multiple births and since Kate did IUI’s, not IVF, she was way more likely to conceive high order multiples, which she did.  Just like me.  I talk a lot about my twins in this blog space but the truth is, Connor and Caitlin are not twins.  They are surviving triplets.  So the high order multiple thing really flips me out.  And that’s why I’ve avoided this particular show for so long.  Anything that glorifies, and therefore misrepresents multiple birth, truly upsets me.

On top of that I am not a fan of reality TV.  I am not a shy person by nature.  But this voyeuristic need to see all, and this self focused need to show all, totally baffles me.  Why does everyone need to know, and see everything? And most importantly, for crying out loud, what about your kids?  No matter what the potential financial gain might be, what you put out there for the world to see, frankly, gets seen by the world!  And children are often the collateral damage of their parent’s need to show and tell their whole lives for all the world to see. 

So this is where it all lands for me.  These very real people, Jon, Kate, and their children, whose names are impossible to find on line, (what does that tell you?) are a family. 

These heartbreakingly adorable children were clearly wanted, and their parents worked very hard to conceive them.  So please. Remember why you had them, and protect them. 

Unfortunately, parents can’t always be trusted to do right by their children.  We all know that. 

Laws must be put in place, now, that eliminate the possibility that children can be exploited through their participation on reality TV shows. 

Life is hard enough.  Having your life plastered on a national stage without your consent is no way to grow up, no matter how you were conceived.

Corey Whelan
Program Director

Do Live in California?

To learn more about PCOS and how to control it, along with other steps you can take to prevent infertility, be sure to attend The AFA’s FREE Manicures & Martinis Infertility Prevention Series, which is coming to San Francisco and Laguna Niguel.  Enjoy complimentary manicures and martinis and learn about the reality of the biological clock, how STD’s can compromise your fertility, and how certain environmental toxins can jeopardize your ability to conceive a child. 


Manicures & Martinis San Francisco
Nova Nail Spa
811 Mission Street in San Francisco
Tuesday, June 9th, 6:00-7:30 PM
RSVP with Vivian:  vivian@theafa.org or 646-861-3226
More Details


Manicures & Martinis Laguna Niguel
Accent On Nails
28121 Crown Valley Parkway in Laguna Niguel
Tuesday, June 16th, 6:00-7:30 PM
RSVP with Vivian:  vivian@theafa.org or 646-861-3226
More Details

Categories
Infertility • IUI • IVF • PCOS

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