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The American Fertility Association’s Monthly Newsletter

May 30, 2008

Dr. Robert Greene

Laurie Tarkan

WHAT YOUR HORMONES TELL YOU ABOUT FERTILITY
(Part 1)
A Q&A with Dr. Robert Greene, reproductive endocrinologist and author, and his co-author, New York Times health writer, Laurie Tarkan.

Dr Robert Greene’s just-published Perfect Hormone Balance for Fertility: The Ultimate Guide to Getting Pregnant, is a book for anyone trying to have a baby, whether they’re just starting out or having trouble getting pregnant. Dr Greene has seen through his research and his practice that fertility can be compromised by hormonal imbalances caused by lifestyle factors, like being overweight, overstressed or overtired. He and his wife, Morgan, did use Assisted Reproductive Technology to have a child as well, so he speaks empathetically from his own personal conception trials.

Laurie Tarkan: Why did you write the book, and why now?

Dr Robert Greene: For two reasons. First, we are seeing a profound shift in the age that women are having children. The incidence of births went up 45% in women between 35 - 39 in the past 15 years, and it went up 63% in women 40 - 44 years old. Since the chance of a successful pregnancy diminishes as women reach their later reproductive years, it becomes more important for couples to plan their pregnancies. They need to get healthy before they get pregnant, and they need the most rapid route to pregnancy, especially if they want to have more than one child. And second, reproductive medicine is a very high tech and competitive field and there’s a tendency for fertility centers to offer what makes economical sense to them, and sometimes it’s over-treatment for patients and sometimes its under-treatment, but it’s not always the appropriate treatment. For example, a center might not offer intrauterine insemination, so patients who go there will only be offered the more invasive and expensive IVF. This became very apparent to me when Morgan and I became fertility patients ourselves. We wanted to do a 5-day embryo transfer and the center initially agreed, but once we were well into our IVF cycle, they said they could only do a 3-day transfer. We got the bait-and-switch. I feel that now, more than ever, it’s important for patients of reproductive services to be informed consumers. I wrote the book to put the evidence out there so people can shop around, ask intelligent questions, and really understand the answers given to them and avoid being over- treated or under-treated.

LT: How do you define Perfect Balance? What does this really mean?

Dr G: I came up with the term Perfect Balance to represent the delicate balance of hormones. Every hormone influences every other hormone, so that a rise in one type of hormone, like stress hormones, can have a negative impact on other groups, including your reproductive hormones. Or if you’re overweight and have too much of certain metabolic hormones, it can also lower your ability to conceive. I like to think of hormones as a mobile. When you’re in perfect balance, your hormones make subtle shifts up and down and other hormones compensate to keep the mobile balanced. You feel well, you maintain a healthy weight, you have good energy and you’re also fertile. But if one hormone is so high or so low that the other hormones can no longer compensate, that delicate balance is thrown off-kilter . You may experience various symptoms like weight gain or fatigue, and it may make you infertile. What we know is that sometimes by relieving the stress, for example, it can restore the balance. Thinking of fertility this way, provides a more holistic approach to considering how all your diet and lifestyle factors ties into reproduction.

LT: Couples with infertility can already feel like they’re somehow to blame. Doesn’t focusing on lifestyle factors just add to that feeling that it’s their fault?

Dr G: Quite the opposite. The reason there is blame and self-doubt is because people don’t understand what’s going on and they don’t feel they have control of the situation. By educating people about what can affect their fertility, it helps them understand what things they can change in their lives, and clarifies for them what things are not in their control. Even more importantly, this approach empowers them to make positive changes to take back the control of their reproductive health.

LT: Yes, but since you’re saying that being overweight may cause a person’s infertility, that can make someone feel like it’s all her fault?

Dr G: This ties into my “symptoms matter” approach. A lot of people don’t realize that symptoms they experience, like excessive weight gain, are a clue to what’s going on hormonally. Being overweight might not be because someone doesn’t have the will power to refrain from eating. Instead, being overweight may be the result of an imbalance of metabolic hormones that’s causing someone to gain weight. Or it may be that they can’t exercise, because they have too much fatigue because their body’s not able to generate the energy. My approach takes being overweight out of the realm of a character weakness and gives someone the tools, both through diet and lifestyle, as well as through modern medicine, to correct that hormonal imbalance and take control — and that actually alleviates the guilt.

LT: You recommend diet, exercise and stress reducing changes. These are not easy to achieve. Can you give some simple steps that make a big difference in hormone balance, and can improve their fertility?

Dr G: People don’t have to dramatically change their lives overnight. It begins with one step and that leads to another and another. As you start to feel better, you get the snowball effect. Also, my book contains a number of questionnaires that people can take to help them see where their imbalances are, so they can pick and choose what changes they need to make. Having said that, there are a few important steps I recommend. I think beginning to buy organic food and cutting back on your meat consumption can lower your exposure to hormone-disrupting chemicals and help restore balance. Also, for both men and women who are overweight, losing just 5% of their body weight can improve their fertility. I’d recommend doing the things that are easiest for you to do, and build on your successes.

LT: It seems like your book is written for two groups of people, those who may be just starting to get pregnant and may or may not be having trouble, and those who are seeking fertility treatment or are already in the midst of it. How is the advice different for these two groups?

Dr G: For those just starting out, it’s important to make the basic diet, exercise and stress reduction modifications that can enhance your fertility, and when you do get pregnant, optimize your baby’s development and health. It’s also important to make sure you’re up to date on your physical examinations, including dental checkups, and you’re up to date on your vaccinations.

For those who are already experiencing trouble, you need to begin to look more closely at what your symptoms are, as clues to what may be contributing to your infertility — we have great questionnaires that can help people pinpoint their issues — and then you have to make specific changes that target those symptoms. Also, the book provides a great deal of information about understanding your fertility factors and what the best treatment is, depending on these factors. I even provide a diagram that shows a couple what level of treatment they might want to start with (basic or advanced) based on their factors.

LT: For some people, these steps may not result in a pregnancy. How can your book help people who decide they want to get fertility treatment?

Dr G: One of the most common errors fertility centers make is focusing too much on the most obvious problem, whether it‘s a low sperm count or a problem with a fallopian tube. I believe that’s why we still have a ceiling on the success rate. Typically, there’s more than one problem affecting fertility. Every step a couple can take to improve their fertility will have a measurable impact on their overall success. So trying to lose a few pounds if you’re overweight, or choosing more organic foods, or improving your sleep can all help balance your hormones and give you a better shot at success. Very few of my colleagues address these other issues. The book empowers patients to ask for a specific referral to a yoga specialist or an acupuncturist or a nutritionist. I noticed that a lot of centers offer these services now, but it’s more of a marketing tool, rather than being integrated into their treatment. The center that Morgan and I went to boasted a multifaceted approach, but nobody ever offered us one of these services.

Part 2 of “What Your Hormones Tell You…” will appear in next month’s issue of Connections.

Robert Greene, MD, is the medical director of the Sher Institute for Reproductive Medicine in Northern California.

Laurie Tarkan is a health writer for the New York Times.

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Carolyn Berger, LCSW

Transracial Adoption: It Will Change Your Family Forever
By Carolyn Berger, LCSW

As a white person, my understanding of what it took to bring a black, Latino, or Asian child into my family was straightforward. You either adopted a black or biracial child domestically or you traveled to Guatemala, Columbia, Ethiopia or somewhere in Asia to bring a child of color home. You made sure that your child had role models within her race and you incorporated the holidays and traditions of your child’s family of origin, into the life of your family. You joined a support group for people with families like yours so that your child could make friends with others of her race and you could share advice and support.

My early thoughts about transracial adoption barely scratched the surface. Since we live in a country that is racist — Condoleeza Rice aptly called racism our nation’s “birthmark” — the process is far more complex. People considering this option should become very familiar with the terrain before proceeding. I will focus on whites adopting children of color in this article-the first in a series on transracial adoption.

Many white pre-adoptive parents believe that they are ready to adopt transracially because they are at ease with people of color. But we must look at life through the childrens’ eyes. They will be living in a society that is neither comfortable with race, nor color blind. People who are black, Latino, or Asian already know this — it’s in the air we all breathe, although the whites among us are often unaware.

Peggy McIntosh, in her article “White Privilege: Unpacking the Invisible Knapsack,” says that whites are taught not to recognize their power and privilege. She says, “I have come to see white privilege as an invisible weightless knapsack of special provisions, maps, passports, codebooks, visas, clothes, tools and blank checks.” Her article, written in 1989, still resonates today. If you are white, you need to recognize that your child of color will not come equipped with this knapsack of privilege.

When we talk about transracial adoption by whites, we are talking about a significant number of adopted children. In 2004 there were 1.6 million adopted children under the age of 18: 16% were black, 7% were Asian and 2% were American Indian. Of these children 17% were of a different race than their adoptive parents (U.S. Census Bureau). And transracial adoption through foster care is on the rise. In 2004, 26% of black children were adopted transracially, almost always by whites, compared to 14% in 1998 (Clemetson and Nixon, NY Times, 2006).

There are many children of color here in the US and abroad who are in need of families, and many white couples and individuals who want to provide them. The question is not whether we should adopt transracially. Rather, it is how we can do a better job of it. And this can mean turning ourselves and our lifestyles inside out.

John Raible, EdD, a black man raised by white parents and an authority on transracial adoption, points to one way we can do this. He uses the term “transracialization” to describe the change people can undergo when they take part in close, long-term relationships with people of other races. Transracialization emerges when people develop a “deep and sophisticated understanding of race and racism.” Adoptive parents can begin this process before they bring a child of another race home, by immersing themselves in their child’s culture.

Probably the first and most important step is to make friends among members of your child’s race. Sounds a bit contrived? Maybe so, but don’t you do this when you are entering some other new phase of your life? Like a new job? Or when you marry someone and put forth your best effort to get acquainted with your spouse’s family? Begin to read books about race and by members of your child’s race. Open yourself to discussions about race. You might be startled to discover that you’ve never had such discussions, since the subject is taboo: How often have Barack Obama and Hillary Clinton skirted comments about race in their quests to become the Democratic Nominee for the upcoming presidential contest?

The transracialization of your family will be an ongoing, endless, rewarding, frustrating and exciting experience that will reverberate through future generations. Complete transracialization is not always achieved by white adoptive families—perhaps it never can be - but we need to strive for it if we want our children to develop healthy identities.

In the ideal scenario, a child from a transracialized family will feel connected to, and supported by, his adoptive family and deeply connected to some people of his own race, as well. He will live in a city or town that is diverse and where he can find successful role models. White adoptive parents need to have friends who have navigated the shoals of racism in ways they have never had to, and who are willing to guide their child through.

In their book Inside Transracial Adoption (2000)— a must-read for people who plan to adopt transracially - Gail Steinberg and Beth Hall tell us, “When you choose to become a family that is different from most, you must be prepared to confront your own biases in both overt and subtle ways… You can expect to find that you carry within yourself both negative and positive internalized attitudes about adoption and race.”

Hold on to those positive attitudes. Confront the negative ones before you adopt! Why? Because these are the same attitudes your child will be brushing up against on a regular basis. How can you help a child cope with something you have not acknowledged to exist?

Your adopted child will need to grow up in a family where issues of race are discussed and where his experiences of racism are confronted and dealt with, rather than ignored or glossed over. If you are a white person adopting a male black child, for example, you need to think about how he will fare in the schoolyard and on the street. You will need to teach him to stand up for himself when he hears a racist remark or feels the effects of racism in his everyday life. You will have to teach him how to sidestep racial profiling as he grows into adulthood — or he may never reach adulthood.

Or, let’s say you have adopted a daughter from China. Get ready for the possibility of her coming home from school one day to say she hates her eyes, and that the kids on the playground are teasing her by pulling their own eyes back in a clumsy imitation of what they call “Chink eyes.” You and other Chinese people in her life will be charged with the task of teaching her to appreciate her looks in a culture that already makes it difficult for girls to develop positive self-images.

If you are beginning to wonder whether you are up for the challenges of transracial adoption, this is a good sign — for it means that you are thinking critically about the impact of racism on adoption. And if you can think critically about it, you are already a giant step ahead of most people. Besides loving your child and giving her the family every child deserves, there are many things you can do to stack the deck in her favor.

Live in a diverse community where there are many people of your child’s race. This is one of the most important things you can do!

Send your child to a racially diverse school.

Educate your extended family about your child’s race and culture.

Find same-race role models and mentors for your child.

Learn to speak your child’s language of origin.

Choose vacation spots and camps where your child's race is well represented.

Go to social events attended by adults and children of your child’s race.

Fight racism. Let your child know that you will not tolerate racism whether it’s subtle or overt.

Incorporate the music, food, and holiday traditions of your child’s race into your family life.

Your overarching goal can be found in “A Transracially Adopted Child’s Bill of Rights,” adapted by Liza Steinberg Triggs* from “A Bill of Rights for Mixed Folks,” by Marilyn Drame:

Every child is entitled to find his multiculturalism to be an asset and to conclude, “I’ve got the best of both worlds.”

Carolyn Berger, LCSW, is AFA’s Adoption Coordinator and the parent of two teenage sons, one who came to her family through adoption. She keeps “A Transracially Adopted Child’s Bill of Rights” taped to her refrigerator.

*Find this in its entirety on the website of Pact, An Adoption Alliance: www.pactadopt.org/press/articles/transracial.html

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The American Fertility Association, 305 Madison Avenue Suite 449, New York NY 10165.
Support Line: 888-917-3777. Fax: 718-601-7722. www.theafa.org