Archive for June, 2010
By Michelle Sobel
June 24th, 2010 at 6:00 pm
Every year on June 27, National HIV Testing Day is honored with the goal of reminding people of the importance of HIV testing. And while days like these are helping to eliminate barriers to testing, undiagnosed HIV is still a serious problem in the U.S.
Consider these statistics from the CDC: more than one million people are estimated to be living with HIV in the United States. Of those, 200,000 people don’t know that they are HIV positive. Plus, about 40% of the people who become infected with HIV every year will not find out about their status until they’ve developed AIDS. This means that thousands of people are living with – and possibly spreading – the virus for years without knowing it.
With statistics that alarming, HIV testing needs to be part of an annual health routine. Early diagnosis leads to a better prognosis. With early detection, there are fewer hospitalizations and better quality of life. Plus, early diagnosis helps prevent spreading the disease to others.
In honor of National HIV Testing Day, there are clinics and testing centers throughout the country offering special events and testing. If you are in an area that does not have any events offered, you can get a free test online through STDtestExpress as well.
While you’re getting your HIV test, you might consider getting tested for other STDs that often go undiagnosed. The effects of undiagnosed chlamydia and gonorrhea tend to be discounted, but can be very serious. And perhaps most critically, there isn’t a “National Syphilis Day,” an infection that can be fatal if left untreated, but is completely curable.
Unfortunately, routine STD testing is not yet part of the American medical culture, but days like National HIV Testing Day will help spread awareness and remind people of the importance of getting tested. Take control of your health, help prevent the spread of HIV and other STDs, and get tested!
Postscript from Pamela Madsen – The Fertility Advocate
STD’s is one of the leading causes of infertility. Let’s help raise awareness!
By Dr. David Kreiner
June 23rd, 2010 at 6:00 pm
I grew up on baseball in the 1960’s with the likes of Mickey Mantle and Roger Maris. A few years later Tom Seaver and the Miracle Mets held my fancy. Over the years I have been intrigued by many baseball spectaculars such as Mark McGwire and his run to break Roger Maris’s homerun record and Barry Bonds’s overcoming Mark McGwire’s record. Roger Clemens winning his 300th game and pitching his 3000th strikeout was unforgettable. I was enchanted with these baseball heroes when they achieved their record breaking accomplishments.
Then the story about how modern day athletes were using steroids became public and the glory of those heroes from the past 20 years disappeared. Many of us lost our youthful innocence with the discovery that steroids had intruded into the daily routines of professional baseball. But as my bubby (my Russian grandma) used to say; c’est la vie. At least that was the French translation.
This week someone’s little boy who was pitching in the big leagues for the first year had a perfect game, meaning no batter reached first base the entire game with only one out to go. This is a rarity in baseball having previously occurred only 20 times in major league history. The final out was weakly hit, a ground ball to the infield, the pitcher covering first base beat the batter, and the throw was caught before the batter reached the bag. Replays documented the batter was out but unfortunately, the umpire mistakenly shot his arms out signifying a safe sign thus preventing the last out which would have made this a rare perfect game.
So why should I blog about a botched call ruining a perfect game? This arbitrary wrong turn of events which prevented a perfect game crushed me emotionally the same day my patient who I wanted so much to have her baby, miscarried after 3 years of trying to conceive. She, like the rookie, Galarraga, deserved to have their day, the perfect game, the perfect baby. Randomly, both were denied. How is an individual who has such hopes, dreams and aspirations focused on the denied event to deal with this catastrophic disappointment?
As an observer of both, I was feeling distraught, angry, pushing me to cry out for justice for some supernatural power to make things right again.
Forty five minutes after the game after umpire, Jim Joyce, had the opportunity to review the play he went to the dugout to speak with pitcher, Armando Galarraga. He apologized to the pitcher for spoiling his slice of fame. … There were few words, just a deep apology, as tears welled in Joyce’s eyes. "He feels really bad, probably worse than me," said Galaragga, who began the season in the minors in Toledo. "I give a lot of credit to that guy, to say he’s sorry. I gave him a hug. His body English said more than the words. Nobody’s perfect, everybody’s human."
We, in the field of infertility face disappointments as regularly and the menstrual cycle. When a pregnancy is conceived, in our minds, the “perfect baby” is essentially created. Miscarriage, the loss of one’s “perfect baby” seems to be a life crushing blow. Perhaps, we can gain strength from the story about these two men, Armando Galarraga and Jim Joyce, who were able to reconcile this catastrophic schism in their path to obtaining their “perfect” goal and move forward to the next game.
Thank you, Armando and Jim for helping us to see the way. After all, if you can get this close once only to miss because of a random mistake, then why can’t we expect that we have a good shot that it will work next time?
In the mean time, again as my Bubby would say, “Play ball”.
By Pamela Madsen
June 22nd, 2010 at 6:00 pm
I have been speaking to women who are struggling with infertility for what feels like a life time. From my time as the President and then Executive Director of RESOLVE NYC to my time as the founder and first Executive Director of The American Fertility Association.
Now, I am hearing again from woman through this blog. The stories are all different and they are all the same. It is the regret that always gets me – that rips my heart. The level of self punishment that many of the women are putting themselves through because they blame themselves, even while they tell me that nobody ever offered them education about their fertility. And the pain that vibrates through the phone or an email is palpable. Often the woman makes apologies for the life that she had lived. There might have been an abortion. There was waiting too long to start trying once she was married….If only she had been better…if only she had been "a good girl”.
What I want to say here – is that the system has failed so many women. They have not failed themselves. Where were they supposed to get this information? From the air? When I was in school – I was taught about sex, STDs’ and birth control. That was it. Sex Education was about pregnancy prevention. That was it. Woman need to be given all the facts about reproduction starting from a young age. We need the complete story and that does include safer safe, information about STD’s, birth control and information about our reproductive potential as women.
These days – I spend about as much time directly with gynecologists as I do patients. I drop in – and chat with them about fertility – and also the importance of talking to women about the getting a fertility evaluation.
Recently, I met with a young female GYN – and in the beginning the gynecologists agreed with us that the woman that they see have no idea of their biological clock – and they understood why giving them this information is important. And then, as it sometimes happens – this lovely female gynecologist got nervous about getting her patients nervous about their biological clocks. I told her that I really get nervous going for my mammograms and my pap smears – but that I go – because the information obtained from those tests can change my life.
I talked to her about the importance of women getting this information so that they could plan their own reproductive lives and perhaps stay out of reproductive endocrinologist’s offices. It is all about the possibilities that women now have – that if they learn that they are in a borderline place when it comes to their fertility – and they are not ready to start their families that they can freeze their eggs.
By the time that I left that office – I knew that I had created change. I had brought this office more than bagels and coffee – I had brought them information and a point of view that this office had not heard before – and it was a big office. By making these house calls of GYN’s, perhaps I had changed the course of the reproductive lives of some women. I know that this sounds dramatic – but it is dramatic. This one practice with several gynecologists literally sees hundreds of women. By enrolling these doctors into our quest for better education for women around their fertility. I feel like we are building an army of educators one office at a time. We even talked about ways to introduce this information. And before the coffee and bagels were finished – they got it.
When I got home there was a letter from a woman waiting for me. She was full of regret. She was sure that how she had lived her life was the reason for her struggles to conceive. I wrote to her and I told her about all of the possibilities that still awaited her…for there were still many possibilities…the world still had much to offer up. That this was not about some notion that she had not lived a good life. That the infertility that she was now struggling with was not some kind of punishment. Why do we always go there? Why do we as women always blame ourselves? I wish that she had gotten information earlier – but that was my only regret for her – but that was it. And then I sent her this poem by Mary Oliver – perhaps this poem will touch you too…perhaps it is for all of us…no matter where you are in your life….
by Mary Oliver
You do not have to be good.
You do not have to walk on your knees
for a hundred miles through the desert repenting.
You only have to let the soft animal of your body
love what it loves.
Tell me about despair, yours, and I will tell you mine.
Meanwhile the world goes on.
Meanwhile the sun and the clear pebbles of the rain
are moving across the landscapes,
over the prairies and the deep trees,
the mountains and the rivers.
Meanwhile the wild geese, high in the clean blue air,
are heading home again.
Whoever you are, no matter how lonely,
the world offers itself to your imagination,
calls to you like the wild geese, harsh and exciting –
over and over announcing your place
in the family of things
By Dr. David Kreiner
June 21st, 2010 at 6:00 pm
Dear The Fertility Doc,
I am 39 years old, single and I am very involved with my career. I want to continue to work but I always dreamed I would have children. I don’t have a partner with whom to get pregnant. What should I do?
At My Reproductive Crossroads
I hear this question frequently in my practice. As women age they are forced to consider whether to have their children now rather than delay while they may still be able to use their own eggs versus those of an egg donor, or adopting.
This patient needed to consider the ramifications of taking time off from her career, as well as creating a child with donor sperm. She wanted to know if she were to meet Mr. Right, how would he respond to this child? Were there tests that I could perform to help her make a decision?
Screen Your Fertility
First of all, it’s imperative in cases like this to do a full fertility screen so that we understand from a fertility perspective how much time a woman has left and how urgently she needs to make a decision. To assess fertility, I do a Day 3 serum Estradiol and FSH, an AntiMullerian Hormone and a sonographic antral follicle count. The FSH is regulated by negative feedback from serum Estradiol and inhibin, both of which are produced by the granulosa cells of the ovarian follicles. With diminishing ovarian activity, there are fewer follicles, less estradiol and inhibin, so with less feedback, the FSH level is high.
Occasionally, in patients with low ovarian activity (often called low ovarian reserve), a patient may have an ovarian cyst that produces estradiol. This will lower the FSH level to otherwise normal activity levels even when there is minimal ovarian activity and inhibin. One would misinterpret the low normal FSH in the presence of higher estradiol which is why this must be measured concurrent with FSH.
AntiMullerian Hormone is also produced by the granulosa cells and low levels therefore indicate depleted ovaries. Likewise, few antral follicles seen on ultrasound typically performed during the early follicular phase of the cycle will indicate low ovarian reserve.
Making a Decision
Once we know a patient’s relative fertility through this screen, we need to decide whether she is prepared to delay her career for pregnancy and motherhood or whether she should undergo IVF and freeze her embryos, thereby freezing her fertility potential at its current state.
Since she is single without a participating partner, we would be using the sperm from an anonymous donor. Sperm specimens are obtained from sperm banks that are certified by New York State by virtue of their screening and testing for infectious and hereditary diseases. Patients may review what is available from the sperm banks, reading on the internet the sperm donor’s demographic information, physical attributes, educational and occupational histories, etc.
If a woman does not have any infertility issues, I would attempt donor insemination. However, due to her advanced age, I would progress to more aggressive therapies if we were not successful after a few cycles.
A common concern for women in this circumstance is that they may meet their soul mate in the future and he may not be comfortable with a child produced with someone else’s sperm. This is an issue that is very individual and I can only offer to support my patients as they decide what is best for them.
As a woman prolongs the decision, her fertility is diminishing, and she thereby risks not being able to have a child using her own eggs. If conceiving with her own eggs is crucial, then she must weigh the downside of conceiving a child from an anonymous donor and, if she does so, the potential problems associated with finding a man in the future with whom she may want to have a family.
It’s enormously stressful making these decisions at these reproductive crossroads. I discuss them with my patients and help them arrive at the decision that is right for them. Everyone who has ever supported a woman making such a difficult decision knows that it can have a heavy toll on a woman’s psyche.
By Joseph Peña, Md, Facog
June 20th, 2010 at 6:00 pm
So how does the HSG feel and what to expect?
- The procedure should only cause minor discomfort.
- With insertion of the vaginal speculum, most experience slight or minimal discomfort similar as to what one experiences in the gynecologist’s during a pap smear exam. Increased discomfort may be expected with increasing difficulty of visualizing the cervix with the speculum, which may occur due to certain individual body types and differences in anatomy. The best indicator for this portion of the procedure is one’s experience having a pap smear at her gynecologist’s office.
- When the contrast material is injected, there may be slight discomfort or cramping, possibly due to distention of the uterine cavity. This may be somewhat similar to menstrual cramps during menstrual bleeding.
- For a few days after the HSG, one can expect vaginal spotting/light vaginal bleeding as well as a sticky vaginal discharge as the dye is expelled from the uterus.
- Notify physician or seek medical evaluation if one has:
- Severe abdominal/pelvic pain
- Heavy vaginal bleeding (soaking more than one pad/hour)
- It is important to note that a great majority of women do not experience major problems with the HSG. While it is true that a very small minority do have a negative HSG experience, they are few and far between. Keep this in mind when surfing the internet as many infertility patients do, as there may be a reporting bias when it comes to HSG experiences. Someone who has had a negative experience is much more likely to write, blog, post, and/or tweet about her negative experience with HSG (or anything for that matter) than someone who didn’t. Many of the women who had an uneventful HSG are less likely to write, blog, post, and/or tweet about her routine HSG experience and are more likely to focus on another aspect of her infertility experience. Certainly any concerns you have should be addressed with your doctor.
What are the risks/benefits of HSG?
- There is a small chance (1-3%) of a pelvic infection, infection of the uterus and/or fallopian tubes after the HSG. The chance is increased with history of previous pelvic infection. Your doctor may prescribe antibiotics to prevent or treat suspected pelvic infection.
- There is a small chance of having an allergic reaction to the iodine contrast dye.
- The effective radiation dose with HSG is very low, similar to the background radiation one is exposed to in four months. Thus, the risk of cancer is very slight and the benefit of an accurate diagnosis far outweighs the risk.
- HSG is a minimally invasive procedure with rare complications. An alternative option to assess and confirm tubal patency and a normal uterine cavity involves surgery (diagnostic laparoscopy with direct visualization of flushing of the tubes with colored dye; diagnostic hysteroscopy with direct visualization of the uterine cavity) with its associated anesthetic and surgical risks.
- HSG can identify abnormalities of the uterus and/or fallopian tubes that may be contributing to infertility or pregnancy loss. The HSG findings can directly affect management and treatment options. A couple of examples may illustrate this.
- If tubal patency is confirmed, then intrauterine insemination may be one fertility treatment option to consider pending other diagnostic infertility testing (e.g. normal sperm). However, if both tubes are found to be blocked, insemination is unlikely to work and either in vitro fertilization or surgery should be considered.
- If a uterine septum is noted in one with a history of recurrent miscarriages, serious consideration for surgical excision of the septum prior to subsequent pregnancy is warranted to decrease the chance of miscarriage.
- No radiation remains in the patient after the procedure and x-rays usually have no side effects for a diagnostic procedure like this.
- Although HSG is a diagnostic procedure and not a therapeutic one, anecdotally a number of women have become pregnant soon after the HSG without further treatment. Forcing dye through the tube may occasionally dislodge debris such as mucus plugs or break through thin scar tissue to unblock a fallopian tube.
What are the limitations of HSG?
- HSG only yields information about the inside of the uterus and fallopian tubes. Other diagnostic tests are needed to evaluate abnormalities of the ovaries, the uterine body, and the pelvis.
- There are other causes for infertility (low sperm count/motility, irregular ovulation) and recurrent pregnancy loss (e.g. abnormal chromosomes, antiphospholipid syndrome) that a normal HSG doesn’t preclude one from having reproductive difficulties. It is simply one part of a battery of diagnostic tests that may be needed.
References: – WebMD: Infertility & Reproduction Guide – Radio
By Joseph Peña, Md, Facog
June 17th, 2010 at 6:00 pm
The best way to answer this question is to break down the HSG into the basics…
What is hysterosalpingography or hysterosalpingogram (HSG)?
HSG is a radiology procedure usually done in the radiology department of a hospital or an outpatient radiology facility. HSG is an x-ray examination of the inside of the uterus and fallopian tubes that uses fluoroscopy and a contrast material. Fluoroscopy is a special x-ray that makes it possible to see internal organs in motion. A water-soluble contrast dye is infused through the cervical canal with a catheter or cannula and is used in conjunction with fluoroscopy to fill the uterine cavity and fallopian tubes and appears bright white on the x-ray film.
What are indications for obtaining an HSG?
- Infertility: this diagnostic imaging study is often obtained for a woman who has trouble conceiving for a prolonged period of time (greater than one year, or 6 months if greater than 35 years old). An HSG may be recommended if one has had a previous child or pregnancy and/or if one had a previous HSG in the past. Health conditions may change with time. If an HSG was done prior a cesarean-section delivery and now there are difficulties conceiving again, another HSG should be seriously considered. It is not uncommon for abdominal and pelvic surgery (such as a cesarean section) to result in pelvic scarring that may distort and/or block the fallopian tubes. Thus, it is important to consider tubal patency in the evaluation of one’s fertility, and the HSG is currently the most commonly used diagnostic study to accomplish this.
- If tubal blockage is found, a natural pregnancy may be difficult if not impossible. Fallopian tubes can result in blockage due to pelvic scarring from a previous pelvic infection (may be subclinical-unknown to woman), previous abdominal/pelvic surgery, or endometriosis. Tubal blockage on HSG is suggested when the contrast dye is not able to fill the fallopian tube and/or spill into the pelvic cavity.
- Irregularities in the uterine cavity such as endometrial polyps, submucous fibroids (benign muscle tumors), or scar tissue, may contribute to infertility as well, possibly by having a negative impact on implantation. These pathological conditions may be noted on HSG as uterine cavity filling defects.
- Recurrent pregnancy loss: this diagnostic imaging study is also used to investigate repeated miscarriages by focusing on the intrauterine cavity portion of the test.
- A uterine septum, which is one form of congenital malformation of the uterus, is not an uncommon form of correctible cause for recurrent pregnancy loss. Endometrial polyps, submucous fibroids (benign muscle tumors), or scar tissue may also contribute to early miscarriage in those with a history of recurrent pregnancy loss.
How to prepare for the HSG?
- Schedule HSG for after menstruation and prior to ovulation. This turns out to be usually between cycle days 7-10 for most women, but may vary depending on a woman’s menstrual cycles. The study should be deferred if you might be pregnant to avoid radiation exposure during early pregnancy.
- HSG should not be performed if one has a chronic pelvic infection or untreated sexually transmitted disease currently. After appropriate treatment, HSG may then be considered after resolution of the infection. Inform your physician if you suspect you have either condition.
- You should inform your physician and the radiologist if you have any allergies, especially barium or iodinated contrast materials.
- You should inform your physician if you have a history of kidney problems or if you are taking glucophage (Metformin). Since the dye can potentially have a negative effect on kidney function, your physician may wish to assess your kidney function and/or withhold the glucophage prior to the HSG.
- About 30 minutes prior to the procedure, you may take ibuprofen (e.g. Advil, Motrin, Aleve) if you are not allergic to help relax the uterus and decrease uterine cramping and/or discomfort during the procedure.
- Depending upon your diagnosis, your physician may prescribe antibiotics (e.g. doxycycline) for prophylaxis against possible infection.
How is HSG performed?
- HSG is usually done on an outpatient basis, either in a radiology facility or in the hospital.
- Patient is positioned on her back on the exam table, with knees bent and feet in stirrups. A speculum, similar to one used at a gynecologist office, is inserted into the vagina to visualize the cervix, which is then cleansed usually with betadine.
- A catheter (flexible tube) or cannula (stiff tube) is inserted through the cervix and the contrast dye is infused to fill the uterine cavity and fallopian tubes. Patient may be asked to shift and change position at some point during the procedure to obtain different views.
- X-ray pictures are taken just before the contrast dye is infused, during the infusion, and after the infusion. Still images are stored on either film copy or electronically as a digital file.
- After the test, the catheter or cannula is removed, followed by the speculum. Patient is then allowed to get up and get dressed.
- HSG procedure usually takes 15-30 minutes to complete.
By Anita Mccullough, Ma
June 17th, 2010 at 7:35 am
I had a talk with God the other day.
Why did you make me this way?
God answered "What do you mean? You are perfect in my eyes. Don’t you see?"
But I am not perfect. Something happened to me. The inside of my body doesn’t work. What can it be?
God said nothing is wrong. You just don’t believe. I will give you my angels – Dr. Kreiner, Dr. Pena, Dr. Styne and Dr. Zapantis.
These angels God what can they do?
Are they miracle workers? Can they help me too?
God answered Yes my miracle workers can. They were put on this earth to help women and man.
For with love and patience they will strive.
To give you what you need
a healthy strong baby born alive.
With tears in my eyes, I said "Thank you God. I do believe that with help and love
life will be with me.
By Dr. David Kreiner
June 16th, 2010 at 8:42 am
The other day, I asked Dr. David Kreiner a few questions about his own personal take on the changes in reproductive medicine. Here is our conversation.
"What do you think is the biggest change in reproductive medicine since you started?"
"When I decided to specialize in reproductive endocrinology and infertility (REI) I was looking forward to being on the frontier of fertility medicine. The details of Reproductive physiology were being unraveled in real time and IVF had just reported its first successful pregnancies. In those days, microsurgery of the fallopian tubes was commonly performed by REIs as well as endometriosis and fibroid surgery.
During my fellowship, surgery was a huge part of my training. I travelled to Nashville to train with one of the world’s experts in laser laparoscopy. I practiced my tubal microsurgery skills weekly on anesthetized rats in a plastic surgical lab. I assisted on reproductive surgery several cases every week throughout my fellowship.
Myself and other fellows performed research on basic reproductive physiology questions that had yet to be worked out. Personally, my interest was polycystic ovarian disease and its relationship to weight gain. I studied male hormone production in the ovary and the adrenal gland before and after significant weight loss. I discovered that there was an inverse relationship between weight loss and male hormone production and that this was mediated through insulin. These were exciting times.
Today, discoveries in reproductive physiology are much more esoteric than it was when I was a fellow. Reproductive surgery, in particular tubal microsurgery and laser laparoscopy for endometriosis and adhesions is usually replaced with in vitro fertilization (IVF) which has become so much more successful, less invasive and therefore a preferable option. Most causes of infertility, if they are not successfully treated with ovulation induction and intrauterine insemination (IUI) can be overcome with IVF.
Today, we get excited about advances in preembryo genetic screening and diagnosis and contemplate the current and future potential of eliminating hereditary medical disorders".
"What are you the most proud of?"
"In the 1980’s when I was a fellow, IVF was grossly inefficient and we had to transfer multiple embryos to achieve a pregnancy. Consequently, triplets and quadruplets were not rare occurrences. In many programs, they constituted over 10% of all pregnancies. Today, we can often transfer one embryo at a time minimizing the risk of multiple pregnancies. We can freeze excess embryos so many patients need go through only one stimulation and retrieval and still have multiple transfers providing them with an excellent chance of conceiving a baby from their efforts.
What would you change about the field of reproductive medicine today if you had a magic wand?
I wish that REI was not a competitive business but purely a medical service".
By Pamela Madsen
June 14th, 2010 at 6:00 pm
I have spent the better part of 22 years waiting for babies.
I have hoped for, waited for and welcomed my sister’s son, (conceived through IVF), my two boys (GIFT and IVF), my sister-in-laws two sons after five years of repeated miscarriages and, through the years, countless others who have entered the families of those I care about. I have listened to the myriad stories of the obstacles overcome and the fears challenged that did not stop so many in their pursuit of all the various means of family building that were available to them.
Infertility has permeated the lives of my family, my closest friends and my neighbors. Since I began my work as a patient advocate, my family of friends who are infertile has expanded, and the waiting for babies has continued. I was recently in a book store where I saw an “advent” type calendar for a typical waiting period for a child. It was only nine months long! If only that was true for all of us! The waiting, for the infertile, can be an endless circle beginning with hope, turning to disappointment, and then back to hope again. And this is how we wait.
I have waited with two very good friends for their babies. One of them is my oldest friend who I have loved since I was small. We have gotten into trouble together, we have double-dated together, she was a bridesmaid at my wedding. Infertility is something we never planned to do together, but it became yet another tie that bound us together. We shared doctors, did IVF cycles together, compared estrodials, and said “I know” to each other a lot. And mostly we waited to be mommies together. My children arrived first, and we waited together for her pain to end. I have a beautiful picture of her holding my son Spencer at his bris, her eyes shining, holding the secret, still unknown, of her pregnancy.
My other friend was at the time, my newest; the special kind that finds you when you aren’t looking. We met through volunteering on a infertility related committee together. She was looking for a birth mother. I listened and learned about the world of private adoption: advertising, resumes, portable adoption phones that ring in movie theaters, and birth mothers who can change their mind. I heard her voice the same insecurities we all feel when we want something so much and fear that somehow we are doing something wrong that will prevent what we want most from entering our lives. And we waited together for her pain to end. On a beautiful morning, the phone rang, my friend said to me, “Pam, you would never believe what has happened!” And she welcomed her baby home.
I have waited for many babies. I am waiting now. The pain can end, the beginnings can happen. I am waiting with you.
By Pamela Madsen
June 13th, 2010 at 6:00 pm
What makes The Fertility Daily so special is that it is a chorus of voices and information from holistic and medical information to personal stories of the challenges and victories over infertility. We would love to hear your story and publish it here. Are you going through infertility right now? How is it touching your life? Have you had an experience with a care giver that you would like to write about? Or a moment that meant so much to you – that you want to share it with all of us? Success stories are welcome too.
If you are interested in blogging for The Fertility Daily – please call me – Pamela Madsen at 917 703 3785 or email me at PMadsen@thefertilityadvocate.com. And we can talk about your idea – and get you published!
I am looking forward to hearing from you soon!