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Archive for July, 2010

Join Us For Support in Brooklyn This Sunday!!!!

By East Coast Fertility

July 30th, 2010 at 8:52 am

On August 1st, at East Coast Fertility’s Brooklyn office,  our psychologist, Dr. Kris Bevilacqua will present "Expectations for Treatment". When I asked Dr. Bevilacqua what she will be talking about at this special gathering, this is what she said:

"When couples marry and women try to conceive, they believe achieving a pregnancy will be easy and natural.  They see other families around them with children and assume it will happen for them not long after they start trying.   For younger couples not conceiving on schedule can be the first test of life not working out like they planned.  For older couples it can be an unexpected challenge that requires medical interventions they never thought they would need.   The idea that the intimate task of making a baby would need help from an expert can cause feelings of shame and inadequacy.  What had started as an act of love can become a job with a monthly success indicator.

Sometimes, fear of failure, belief that the future of a relationship is connected to having children,  and generally looking on the bright side, can cause expectations for success from treatment that may be wishful thinking.   In a natural population of women age 20 to 24 years-old trying to conceive and having sexual relations on regularly, 85% of them will achieve a pregnancy within a year.   Within 2 years, 92% will conceive. This leaves 8 out of every 100 young women not pregnant.  Some will conceive in the future, some will require medical assistance, and a very few will not be able to conceive.   As we age, it becomes harder to become pregnant, even when we don’t feel older.   It can feel downright unfair when nature doesn’t cooperate with our plans to have a family.  Luckily, we live at a time when there is help for many infertility problems.

Seeking medical treatment for help with what was supposed to be a natural process can feel like failure for some couples.  Even for those who are ready to ‘fix’ the problem quickly, infertility treatment can feel like a loss:   a loss of intimacy in the relationship, a loss of identity as a fertile individual, loss of control over one’s life plan, loss of belief about how life is supposed to be, loss of faith after having done everything ‘right.’    These feelings of loss can lead to depressive symptoms, fears, sadness, and anxiety which is why a psychologist is part of the medical team available to help patients get through treatment with emotional support".

So, August 1st, we will talk about all of this – about how it is when we finally decide to seek treatment, the simplest and least invasive treatments are not always the fastest paths to pregnancy.   Sometimes these methods take patience, a good sense of what is possible with each method, and the ability to tolerate cycles that aren’t successful.  We’ll talk about managing expectations, ways to deal with disappointment when a cycle doesn’t succeed, and how to feel emotionally connected to each other when everyone around you is having a baby.

Please join us!!!

When: Sunday August 1, at 12 noon.

Where: East Coast Fertility

1725 East 12th Street Suite 401

Brooklyn, NY 11229

RSVP: While this event is free – Please let us know that you are coming!

Tel  (718) 375-6400

This event is open to all people struggling to build a family. You do not have to be a patient of East Coast Fertility to attend.

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Traditional Chinese Medicine and Infertility (Part Two)

By Mike Berkley, L.ac.

July 29th, 2010 at 9:50 am

Infertility and TCM – Mechanisms of Action
It was shown in a study done at Harvard that stress reduces the hypothalamic-anterior pituitary-ovarian axis function, thus being a factor to be considered in the infertility work-up. Acupuncture releases endorphins which mitigate ones response to stressful stimuli thus enhancing the possibility for conception.

"Historically, infertility, particularly "functional" infertility, was attributed to abnormal psychological functioning on the part of one or both members of the couple. Preliminary works in the 1940s and 1950s considered "psychogenic infertility" as the major cause of failure to conceive in as many as 50% of cases. As recently as the late 1960s, it was commonly believed that reproductive failure was the result of psychological and emotional factors. Psychogenic infertility was supposed to occur because of unconscious anxiety about sexual feelings, ambivalence toward motherhood, unresolved oedipal conflict, or conflicts of gender identity. Fortunately, advances in reproductive endocrinology and medical technology as well as in psychological research have de-emphasized the significance of psychopathology as the basis of infertility, and modern research shows that there is little evidence to support a role for personality factors or conflicts as a cause of infertility. This perspective unburdens the couple by relieving them of the additional guilt of thinking that it is their mental stress that may be responsible for their infertility.

Biologically, since the hypothalamus regulates both stress responses as well as the sex hormones, it’s easy to see how stress could cause infertility in some women. Excessive stress may even lead to complete suppression of the menstrual cycle, and this is often seen in female marathon runners, who develop "runner’s amenorrhea". In less severe cases, it could cause anovulation or irregular menstrual cycles. When activated by stress, the pituitary gland also produces increased amounts of prolactin, and elevated levels of prolactin could cause irregular ovulation. Since the female reproductive tract contains catecholamine receptors catecholamines produced in response to stress may potentially affect fertility, for example, by interfering with the transport of gametes through the Fallopian tube or by altering uterine blood flow. However, more complex mechanisms may be at play, and researchers still don’t completely understand how stress interacts with the reproductive system. This is a story, which is still unfolding, and during the last 20 years, the new field of psychoneuroimmunology has emerged, which focuses on how your mind can affect your body.

Research has shown that the brain produces special molecules called neuropeptides, in response to emotions, and these peptides can interact with every cell of the body, including those of the immune system. In this view, the mind and the body are not only connected, but also inseparable, so that it is hardly surprising that stress can have a negative influence on fertility.

Stress can reduce sperm counts as well. Thus, testicular biopsies obtained from prisoners awaiting execution, who were obviously under extreme stress, revealed complete spermatogenetic arrest in all cases. Researchers have also showed significantly lower semen volume and sperm concentration in a group of chronically stressed marmoset monkey, and these changes were attributed to lower concentrations of LH and testosterone (which were reduced in the stressed group). However, how relevant these research findings are in clinical practice is still to be determined.(i) "

The stress factors that acupuncture addresses stems from both psycho-emotional factors as well as physical etiologies. For example, extremely painful pre-menstruum or mid cycle pain can be debilitating. This type of physical stress, no doubt produces emotional stress as a result of missed work, manifest pain and other life-style factors resulting from such extreme pain; all can mitigate the function of the reproductive system.

The insertion of acupuncture needles has been shown to effectively increase blood circulation. Acupuncture is very effective in treating, for example, Reynaud’s Syndrome. Enhanced microcirculatory patency to the uterine lining does, undoubtedly contribute to a healthier and more growth oriented endometrium, especially when utilizing electrical stimulation on inserted acupuncture needles on points known as zigongxue which reside superior to the ovaries. The points zigongxue are located 3 inches inferior to the umbilicus and three inches bilateral to the anterior midline.

"They reviewed existing evidence regarding the role of acupuncture in the treatment of infertility, and identified a number of studies indicating that acupuncture can be beneficial as an adjunct to other infertility treatments, including IVF. Only one randomized controlled study examined the independent effect of acupuncture on IVF outcomes, but this indicated a positive effect.

The reviewed authors also highlight evidence that shows the effects of acupuncture may be mediated through neuropeptides that influence gonadotropin secretion, which could in turn affect the menstrual cycle. The technique can also reduce stress, which is known to adversely affect fertility, and has been implicated in the regulation of uterine blood flow." (ii)

"Using acupuncture during assisted reproduction may improve pregnancy rates, say researchers. However, they acknowledge that the mechanism behind this effect is unclear, and the team plans to carry out further studies to confirm, and further investigate, their findings.

Noting that acupuncture has been shown to affect the autonomic nervous system, Dr. Wolfgang Paulus (Christian-Lauritzen-Institut, Ulm, Germany) and colleagues postulated that the therapy could increase endometrial receptivity via control of related muscles and glands.

The researchers randomly assigned 160 women receiving assisted reproductive therapy to undergo IVF with or without acupuncture, before and after embryo transfer. In acupuncture subjects, the needles were placed at points believed to influence reproductive factors, for example by improving blood flow to the uterus.
Paulus et al report that the acupuncture group had a higher rate of pregnancy compared with those not given acupuncture (43 percent versus 26 percent). They conclude, therefore, that acupuncture could be "a useful tool" for improving pregnancy rates during certain infertility treatments." (iii)

A Diagnostic Window – East Meets West

One TCM diagnosis which exists and which may be etiologic for male or female infertility is called Liver qi stagnation. One of the key identifiers of an individual with the pattern differentiation of Liver qi stagnation is anger, rage, frustration, depression and anxiety.

"Symptoms of depression, anxiety, and anger may help in determining the nature of infertility experienced by some couples, and identify those who would benefit most from psychological counseling, suggest researchers.

Dr. Secondo Fassino (University School of Medicine, Turin, Italy) and colleagues recorded the personal characteristics of 156 infertile and 80 fertile couples, and measured their degree of psychopathology. When the researchers divided the couples according to the nature of the infertility-organic, functional, or undetermined-they found that the triad of anxiety, depression, and a tendency toward anger suppression successfully predicted the diagnosis of organic or functional infertility in women, with 97 percent accuracy.

For infertile men, anxiety was also an important independent predictor of functional infertility, increasing the likelihood of having this form of infertility five-fold, while depression was more predictive of organic infertility. However, with men – unlike women – anger did not appear to influence infertility in men.

The results suggest the possibility of identifying a subgroup of infertile subjects where, beyond the distress that is consequent to the failure of repeated attempts to conceive a baby, there is also a poorly adaptive psychological functioning, which is likely to play an important role in the onset and course of functional infertility," the team concludes."(iv)

It is becoming more and more prevalent that research conducted by Western scientists and physicians are highlighting the veracity and effectiveness of Traditional Chinese Medicine.

Clearly, further research is needed to fully understand the mechanisms of action of acupuncture and herbal medicine in treating the infertile patient. Nevertheless, it is my opinion that the best-case scenario for most patients is to offer them every reasonable option which may serve to successfully address their presentation. Based upon the empirical evidence of my practice in which I specialize in the treatment of the infertility, the integration of acupuncture and herbal medicine into the treatment protocol from a clinical perspective makes sense.


i Domar, Alice (back)
ii Fertility and Sterility 2002: 78: 1149-53 (back)
iii Fertility and Sterility 2002: 77: 721-724 (back)
iv Human Reproduction 2002; 17: 2986-94 (back)
v Adverse reactions to drugs are very common in everyday medical practice. A French study of 2067 adults aged 20-67 years attending a health centre for a check up reported that 14.7% gave reliable histories of systemic adverse reactions to one or more drugs. In a Swiss study of 5568 hospital inpatients, 17% had adverse reactions to drugs. Fatal drug reactions occur in 0.1% medical inpatients and 0.01% of surgical inpatients. The main drugs implicated are antibiotics and non-steroidal anti-inflammatory drugs. Adverse reactions to drugs occurring during anesthesia (muscle relaxants, general anesthetics, and opiates), although less common (1 in 6000 patients receiving anesthesia), are life threatening, with a mortality of about 6%.
BMJ 1998;316:1511-1514 ( 16 May )(back)

&a

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Traditional Chinese Medicine and Infertility (Part One)

By Written By Mike Berkley, L.ac.,

July 28th, 2010 at 7:21 am

Although health and healing are the common goals of Traditional Chinese Medicine (TCM) and allopathic medicine, their ideas on the etiology of disease, disease itself and the process used to regain health are decidedly different. The allopathic physician learns that disease must be cured by prescribing medicine, which kills bacteria or renders a virus ineffective; at times surgical intervention is a necessity.

Though the goal of TCM is to cure a patient, the practitioner of TCM attempts to do this not by treating the disease but rather by treating the whole person, taking into account the various attributes of an individual which, when combined, account for an individual being sick or healthy. A person, according to the tenets of TCM is more than their pathology. While treating the pathology may yield impressive results, they are commonly temporary.

A person is not, according to TCM, represented solely by his or her illness, but by the accumulation of every human interaction engaged in from the moment of birth, including the values of and the culture from which the individual develops. The emotional experiences, eating habits, work habits, work and living environment, personal habits and the social milieu are factors that contribute to disease and are factors which, when modified appropriately may lead to regained health.

Though the Western scientific community has not, to date, arrived at a methodology to use in research of Chinese medicine, the veracity and efficaciousness of this medical modality is nonetheless proven by its long history of continued success. More than a quarter of the world’s population regularly uses TCM as part of their health care regimen. Chinese medicine is the only form of classical medicine, which is regularly and continuously used outside of its country of origin.

The Four Examinations

The ‘Four Examinations’ is a method of diagnosis which dates back over three thousand years. Observing, Listening and Smelling (Listening and Smelling are counted as one of the Four Examinations), Questioning and Palpating make up the ‘Four Examinations’. This method of diagnosis is far from simplistic, allowing the practitioner to arrive at a differential diagnosis.

Each of the "Four Examinations" can take years to master, and while these diagnostic tools are not replacements for that which Western medicine can provide in analyzing and treating disease, they have the ability to offer information which, when understood in the context of TCM, provides additional opportunities in mapping out patterns of disease and arriving at greater treatment success.
The doctor of TCM must approach a patient with a clear and calm mind, without a preconceived diagnosis and etiology.

This mind-set will enable the practitioner to yield clinical gems which are clues about the individual who sits before us! This is the stuff of TCM.

The subjective, interpretive and objective evidence of an individual obtained via the ‘Four Examinations’ leads to the discovery of the etiology of disease while concomitantly opening a window to the ‘Whole Person", thus revealing where in the individual’s life the pathogenesis started and what initiated it. The practitioner of TCM must utilize his own interpretive skills, which takes into consideration what is verbalized by the patient and what is observed, while considering what the patient does not verbalize as well. Often, that which is not said can be as clinically enlightening as the information which is freely provided. The tone of the voice, the complexion, the condition of the eyes (in TCM, the Shen or spirt of an individual is said to be revealed through their eyes. Who can deny the clinical efficacy of this?

Is there a different expression revealed through the eyes of a clinically depressed individual than from those of a happy, well adjusted one?), the facial expression, the overall demeanor, how one walks, sits, and stands are all observed and utilized by the doctor of Chinese medicine as part of the information required to arrive at a differential diagnosis. The doctor must be able to note and sense inconsistencies in an individual that are expressed by the patient even without the patient being cognizant of the chasms which exist between what they verbally express and what their spiritual presentation divulges. The sensitivity to and awareness of these human idiosyncrasies enables the TCM doctor to develop an understanding of who the patient is even before the ‘main complaint’ is discussed.

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Conceivable Options™

By Mindy Berkson

July 27th, 2010 at 7:59 am

The infertility diagnosis can be devastating and demoralizing. Unable to become pregnant or carry a pregnancy to term, women often feel inadequate, alone and depressed.  Infertility treatment is costly, and invasive. Success rates are not guaranteed and insurance benefits are often limited.  The emotional, physical and financial stressors associated with the infertility process are often challenging and overwhelming. 

There is a dramatic rise in infertility today.  One in every five couples, or 7.3 million Americans struggling with infertility diagnosis– the biological inability to conceive or carry a pregnancy to full term.  Many factors can contribute to this staggering and continually growing statistic.  Most common are delayed child bearing, advanced maternal age, medical conditions, sexually transmitted diseases, obesity and environmental factors.  As women continue to work and delay having children, their needs with regard to infertility treatment, has also continued to grow.

Age matters in many aspects of life and definitely in the creation of life.  Women are most fertile between the ages of 20 to 28 with their fertility decreasing in half by the time they reach 35 years of age.  By age 45, only a 1% chance remains each month of conceiving naturally.  This is a startling fact considering the average age a woman has her first child has risen to a record high of 25.1 years with 20% of women waiting until they are 35 years old to begin their family.

An increasing number of women choose to delay childbearing due to further schooling, career choice, or are waiting to find their perfect partner.  Many individuals are choosing to be single parents.  While those choices are understandable and personal, as women naturally age so do their ovaries; affecting their fertility.  Oocyte cryopreservation, commonly known as egg banking, generally provides women up to the age of 38 a chance to stop their biological clock and effectively plan and preserve their fertility for the future.

Other treatment options to help overcome infertility include egg donation and surrogacy.  Egg donation involves retrieving eggs from a donor between the ages of 21 and 32.  Since success rates are linked to the age of the egg, using an egg donor can greatly impact the success rates for pregnancy after in-vitro fertilization treatments.  It is most common to use an egg donor in an anonymous arrangement. 

Surrogacy is another widely available option to help overcome infertility.  Over the past decade surrogacy has become more acceptable as the laws in certain states have enabled couples and individuals to establish parentage at birth or shortly thereafter.  The most prevalent form of surrogacy today is gestational surrogacy where the surrogate candidate is not biologically related to the offspring.  

Infertility treatment is costly, and unfortunately for most of us is not completely covered by an insurance provider.  If possible, the best course of action is to carefully review all of your benefits and payment options before you begin treatment.  Talk it over with your partner and have a financial plan that you both agree on.  Plan for multiple cycles, for two important reasons: you might have a failed cycle, and you might want to more than one child.  Know what the odds are for your diagnosis and treatment.  Have milestones for yourself about when to change treatment and when to stop.  For additional information about financial planning, a free download eBook is available on my website at www.lotusblossomconsulting.com

The pathway to parenthood is not always linear.  But understanding the available treatment options, planning and preparing the foundation emotionally, physically and financially can help you maximize your chances of success and minimize your financial expenditure.  

Infertility Consultant, Mindy Berkson has more than a decade of experience in the infertility field.  As one of the first infertility consultancies in the United States, Lotus Blossom Consulting, LLC was founded to arm consumers/patients with information and education to make the best medical choices.  Mindy has guided hundreds of intended parents through the stressful demands of the infertility process by providing professional and compassionate assistance in dealing with the emotional, physical, and financial barriers involved with third-party reproduction.   Mindy can be reached at 847-881-2685, mindy@lotusblossomconsulting.com, or on the web at www.lotusblossomconsulting.com and www.theinfertilityconsultant.com

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Irregular Periods? Ask Dr. Eli Rybak

By Dr. Eli Rybak

July 26th, 2010 at 7:59 am

“I don’t get my period regularly – and I am thinking about trying to get pregnant.  Should I be worried about infertility? Is there anything I should do now?"

This is an excellent question – and one that arises frequently in reproductive medicine.

I will address it both with a brief response below, and then with a longer explanation.

The Bottom Line:

Having irregular periods is a common challenge among women of reproductive age.  Thankfully, it is one that can be overcome – via lifestyle modification and/or medication / hormonal therapy.  Occasionally, assisted reproductive technology is warranted – and proves highly successful in inducing ovulation among women with irregular periods.  And, yes – a woman who does not get her period regularly should see her gynecologist even if she is not thinking about pregnancy in the short-term.  If she desires a pregnancy, she should see a reproductive endocrinologist (“fertility specialist”) for a specific diagnosis regarding her irregular periods and for a treatment plan.

The Big Picture:

A normal menstrual cycle should be approximately 25 – 35 days, with ovulation occurring approximately 14 days prior to a woman’s (next) period.  When the hormonal pathways between the brain and ovary are functioning properly, a follicle (usually a single follicle, 1% of the time – 2 follicles, reflecting the 1% incidence of twins in the absence of assisted reproduction) grows during the follicular phase (first-half of the menstrual cycle) and produces increasing amounts of estradiol.  At a certain point, this heightened level of estradiol produces a massive surge of LH (a hormone from the pituitary gland) that triggers ovulation – release of an egg from the grown follicle.  Whether or not the egg is fertilized, the empty follicle – now called a corpus luteum – begins to secrete progesterone, which transforms the uterine lining (thickened already from its exposure to rising estradiol in the first-half of the menstrual cycle) to prepare for a possible pregnancy.  The corpus luteum survives in the absence of pregnancy for 14 days.  During this time (the luteal phase), the pituitary secretes pulses of LH to maintain the corpus luteum, which, in turn, produces progesterone.  By 14 days after ovulation, these LH pulses attenuate, the corpus luteum regresses, progesterone production ceases, and the uterine lining begins to bleed – menses has arrived.  If, however, a fertilized egg (now embryo) implants into the uterine lining and secretes HCG (the “pregnancy hormone” detected in the home urinary pregnancy test or in blood tests) to “rescue” the corpus luteum, then the corpus luteum resumes progesterone production – to support the uterine lining and pregnancy – until about the tenth week of pregnancy, when the placenta takes over this role.

A woman who never has a period should see her physician ASAP.  First, of course, she needs a pregnancy test!  Second, her diagnostic workup will depend upon whether she never had a period in her life (primary amenorrhea) or whether she has had periods in the past, but no longer (secondary amenorrhea).  I mention this, only because some of the conditions that cause irregular periods might, in more severe circumstances, cause amenorrhea – i.e. secondary amenorrhea, or the total cessation of menses.

Back to our scenario, having irregular periods means that a woman is not ovulating regularly.  She is not releasing an egg, nor does her uterine lining experience progesterone from the corpus luteum.  Instead, her uterine lining remains exposed only to estrogen – a dangerous phenomenon if this occurs (i.e. if a woman has no period) for many months at a time.  Why?  Because the uterine lining thickens under estrogen influence, and after a prolonged “unopposed” exposure to estrogen there is the long-term (thus, do NOT panic) increased risk of endometrial cancer.  In the short-term, this “anovulatory” woman will experience irregular bouts of breakthrough bleeding, possibly combined with occasionally ovulatory cycles followed by menses.  The nature of these bleeding episodes may be similar, and the woman will not be able to distinguish whether or not she has ovulated – other than to rely on the rule (not-absolute) that cycles more than 35 days apart are unlikely to be ovulatory.

So, if a woman has irregular periods, she should see her doctor for a work-up.  Irregular periods can result from lifestyle factors.  These might include: stress, eating disorders, or an intensive exercise regimen that affect the brain’s regulation of female reproductive hormones.  Indeed, for normal menses and ovulation to occur, a woman must maintain a body weight within a certain window – thankfully this “window” is lenient.  But should her weight sink too low (anorexia, training for the marathon) or climb too high – and each person has a different threshold – then periods may become irregular.

A physician will also investigate other causes for irregular periods:  Does the patient have excess hair growth or acne suggestive of elevated levels of androgens (“male” hormones)?  Does the patient have galactorrhea (milky secretions from the breasts) occasionally seen with hyperprolactinemia?  Are there symptoms including fatigue or cold intolerance suggestive of hypothyroidism?

Among patients I see, The Polycystic Ovarian Syndrome (PCOS) is the most common cause of irregular periods.  But it is important to remember that PCOS is a diagnosis of exclusion.  Other causes of anovulation / irregular periods must be specifically excluded prior to labeling a person as having “PCOS”.  Specifically, thyroid and prolactin function must be assessed.  Additionally, an appropriate array of blood tests should be ordered to ensure that hyperandrogenism is not caused by an adrenal or ovarian tumor (rare) or by late-onset congenital adrenal hyperplasia (more common in the Hispanic and Ashkenazi Jewish Populations).

Treatment for these endocrine disorders is fairly straightforward.  Hence, I repeat my encouragement to such individuals: Do NOT stress or worry about irregular periods.  Rather, proactively pursue medical intervention.  Prolactin or Thyroid dysfunction may warrant some more tests but, ultimately, the vast majority of such patients can be treated with medication that will treat both the underlying disorder, and promptly restore normal menstrual function.  PCOS patients seeking to conceive will benefit from a variety of ovulation induction agents as needed.  Should imminent fertility not be desired, then a physician could prescribe an oral contraceptive or variation thereof to enable the uterine lining to “experience” both estrogen and progesterone.  This will avoid long-term risks of unopposed estrogen and short-term risks of irregular, breakthrough bleeding episodes. 

Bottom Line: Irregular periods warrant a visit to a gynecologist or reproductive endocrinologist.  If a woman is seeking to conceive, she should not wait 12 months (or less, if she is in her thirties) if she has irregular periods.  The “12-month” rule applies to couples without any known disorders.  Having irregular periods is a disorder, but one that, thankfully, is very amenable to hormonal treatment!

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Are We Feeling Sexy Yet?

By Pamela Madsen

July 23rd, 2010 at 7:54 am

One of the hardest part of trying to conceive is what it can do to your sex life.  I remember being told that I had "Hostile Cervical Mucus"…..now isn’t that hot? "Come on Honey – Don’t you want me and my hostile vagina?!!!" Doesn’t that feel welcoming? Well – it didn’t to me. I felt like my body was saying that it didn’t want to receive my husband and my husband’s potential babies. It rocked my world. For a while I was really shut down sexually. I felt like my body was not warm and welcoming….I felt the opposite of sexy. I didn’t feel fertile and lush. I was everything that was not. Just think of the other diagnoses…"habitual aborter" or "premature ovarian failure"…..I mean this is really sexy stuff.

Then we move into timed sex….and the list goes on. We like to think that sex has nothing to do with our ability to conceive. That a man who has many children is not more virile, i.e. more sexual than a man who has none. But that is simply perception. The man with many children may actually be an awful lover – and the man with none may be a regular Don Juan – but the children is what everyone sees and uses as a measure. The same thing goes for a woman.

So how do we manage to separate our sexuality of our ability to procreate? And it I read one more fluffy piece about taking bubble baths and lighting candles – I will be sick. Come on…if it was that easy all of us would hardly have any skin left from all the constant bathing!!!

We truly have to do more than that. I love that in Fully Fertile - that they talk about learning how to touch each other erotically again.  The suggestion of learning how to give sensual massage to each other is a wonderful option for opening the doors to reconnection that separates our sexuality from reproduction.  There are some wonderful resources  – books and videos out there that can help couples learn to give each other sensual touch. Just google it or go to Amazon – it is all there! We need to learn to let go of our diagnosis’s and the pressure to perform – and go back into our bodies and feel pleasure again in being a couple.

So…it took me a long time for me to get my groove back. My self image was thrown to the ground from infertility. But I recovered. A great place to start is through touch. And if you want to start with the bubble bath and the candle….why not?

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“I Didn’t Know” Said the Woman.

By Amy Demma, Esq.

July 22nd, 2010 at 12:00 am

As professionals involved in the field of fertility, we often hear our clients say, “I just didn’t know”. They didn’t know about the age at which fertility begins to decline, they didn’t know how expensive advanced fertility treatments can cost, they didn’t know how difficult it can be to adopt, they just didn’t know how significant the road blocks might be to family building.

With respect to fertility preservation, based on data presented recently, younger women tells us that they  didn’t know that sexually transmitted diseases can lead to fertility struggles, that riskier lifestyles as young women can lead to challenges with respect to later family building efforts.

But what else about our reproductive selves do we not know? Recently, my oldest girlfriend (we have been friends for more than 30 years, the sort of friendship that blurred the lines and crossed over to “family’ decades ago) was diagnosed with advanced stage fallopian tube cancer. I cannot tell you how many “didn’t knows” have come up since the diagnosis. The most shocking of all, dear friends, was that she was completely asymptomatic until a minor fender-bender coincidentally led to a scan which then led to the diagnosis of a metastasized and pervasive cancer. My friend “didn’t know” that her reproductive organs had developed a malignancy….she just didn’t know.

It was suggested, by her oncologist, that because my friend is of Ashkenazi Jewish descent that there may be a genetic link to her cancer, it was also suggested that because my friend delayed child-bearing, that she was, therefore, at higher risk. Guess what, despite regular gynecological visits and standard screens, my friend did not know that genetically or with respect to lifestyle choices she was more likely to develop this rare cancer, some have suggested to me that likely, even her gynecologist didn’t know.

Given the connection to the nature of my friend’s cancer and the work that I do, I immediately began to reach out to colleagues. Powerful, well-informed and high-profile folks have responded with exclamations of not knowing, as well. “I’ve never even heard of fallopian tube cancer” said one very well-know known IF professional and another said, “my only guess is that it is related to ovarian cancer”. It is true, even within the oncology community that little is known about fallopian tube cancer. Because it is so rare, little funding is made available for research, minimal, if any, efforts are being undertaken for awareness.

I am pondering, this morning, this big picture question about how much we, as women, just do not know about our reproductive risks and wondering what that means for our girlfriends, our sisters, our daughters, ourselves. “I just didn’t know” cannot be acceptable, particularly with matters like fertility and gynecological cancers because not knowing until it is too late is just, well, it seems, too late.

To learn more about Amy Demma, JD,  Founder, Prospective Families 

Please visit: http://www.prospectivefamilies.com

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Need a little support? Join us for a free seminar in Brooklyn!

By Pamela Madsen

July 21st, 2010 at 6:52 am

On August 1st, at East Coast Fertility’s Brooklyn office,  our psychologist, Dr. Kris Bevilacqua will present "Expectations for Treatment". When I asked Dr. Bevilacqua what she will be talking about at this special gathering, this is what she said:

"When couples marry and women try to conceive, they believe achieving a pregnancy will be easy and natural.  They see other families around them with children and assume it will happen for them not long after they start trying.   For younger couples not conceiving on schedule can be the first test of life not working out like they planned.  For older couples it can be an unexpected challenge that requires medical interventions they never thought they would need.   The idea that the intimate task of making a baby would need help from an expert can cause feelings of shame and inadequacy.  What had started as an act of love can become a job with a monthly success indicator.

Sometimes, fear of failure, belief that the future of a relationship is connected to having children,  and generally looking on the bright side, can cause expectations for success from treatment that may be wishful thinking.   In a natural population of women age 20 to 24 years-old trying to conceive and having sexual relations on regularly, 85% of them will achieve a pregnancy within a year.   Within 2 years, 92% will conceive. This leaves 8 out of every 100 young women not pregnant.  Some will conceive in the future, some will require medical assistance, and a very few will not be able to conceive.   As we age, it becomes harder to become pregnant, even when we don’t feel older.   It can feel downright unfair when nature doesn’t cooperate with our plans to have a family.  Luckily, we live at a time when there is help for many infertility problems.

Seeking medical treatment for help with what was supposed to be a natural process can feel like failure for some couples.  Even for those who are ready to ‘fix’ the problem quickly, infertility treatment can feel like a loss:   a loss of intimacy in the relationship, a loss of identity as a fertile individual, loss of control over one’s life plan, loss of belief about how life is supposed to be, loss of faith after having done everything ‘right.’    These feelings of loss can lead to depressive symptoms, fears, sadness, and anxiety which is why a psychologist is part of the medical team available to help patients get through treatment with emotional support".

So, August 1st, we will talk about all of this – about how it is when we finally decide to seek treatment, the simplest and least invasive treatments are not always the fastest paths to pregnancy.   Sometimes these methods take patience, a good sense of what is possible with each method, and the ability to tolerate cycles that aren’t successful.  We’ll talk about managing expectations, ways to deal with disappointment when a cycle doesn’t succeed, and how to feel emotionally connected to each other when everyone around you is having a baby.

Please join us!!!

When: Sunday August 1, at 12 noon.

Where: East Coast Fertility

1725 East 12th Street Suite 401

Brooklyn, NY 11229

RSVP: While this event is free – Please let us know that you are coming!

Tel  (718) 375-6400

This event is open to all people struggling to build a family. You do not have to be a patient of East Coast Fertility to attend.

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Fibroids: One of The Most Common Causes of Infertility

By Dr. David Kreiner

July 20th, 2010 at 7:46 am

Fertility is dependent upon so many things!

We must have healthy gametes (eggs and sperm) capable of fertilizing and implanting in a uterus with a normal endometrial lining unimpeded by any uterine or endometrial pathology. The sperm need be in sufficient number and capable of swimming up through a cervix which is not inflamed and provides a mucous medium that promotes sperm motility. The eggs need to ovulate and be picked up by normal healthy fimbriated ends (finger like projections) of the fallopian tubes. The tubes need to be covered with normal micro hairs called cilia that help transport the egg one third of the way down the tube where one of the sperm will fertilize it.

The united egg and sperm (the “conceptus”) then needs to undergo cell division, growth and development as it traverses the tube and makes its way to the uterine cavity by the embryo’s fifth day of life at which point it is a blastocyst. The blastocyst hatches out of its shell (“zona pellucidum”) and implants into the endometrial lining requiring adequate blood flow.

And you wonder why getting pregnant is so hard?

All too often patients, in some groups as many as 30% of women, are told that they have fibroids that may be contributing to their infertility. Fibroids or leiomyomata are non malignant smooth muscle tumors of the uterus. They can vary in number, size and location in the uterus including; the outside facing the pelvic cavity (subserosal), the inside facing the uterine cavity (submucosal) and in between inside the uterine wall (intramural). Fortunately, most fibroids have minimal or no effect on fertility and may be ignored.

The subserosal myoma will rarely cause fertility issues. If it were distorting the tubo- ovarian anatomy so that eggs could not get picked up by the fimbria then it can cause infertility. Otherwise, the subserosal fibroid does not cause problems conceiving.

Occasionally, an intramural myoma may obstruct adequate blood flow to the endometrial lining. The likelihood of this being significant increases with the number and size of the fibroids. The more space occupied by the fibroids, the greater the likelihood of intruding on blood vessels traveling to the endometrium. Diminished blood flow to the uterine lining can prevent implantation or increase the risk of miscarriage. Surgery may be recommended when it is feared that the number and size of fibroids is great enough to have such an impact.
However, it is the submucosal myoma, inside the uterine cavity, that can irritate the endometrium and have the greatest effect on the implanting embryo.

To determine if your fertility is being hindered by these growths you may have a hydrosonogram. A hydrosonogram is a procedure where your doctor or a radiologist injects water through your cervix while performing a transvaginal ultrasound of your uterus. On the ultrasound, the water shows up as black against a white endometrial border. A defect in the smooth edges of the uterine cavity caused by an endometrial polyp or fibroid may be easily seen.

Submucosal as well as intramural myomata can also cause abnormal vaginal bleeding and occasionally cramping. Intramural myomata will usually cause heavy but regular menses that can create fairly severe anemias. Submucosal myomata can cause bleeding throughout the cycle.

Though these submucosal fibroids are almost always benign they need to be removed to allow implantation. A submucosal myoma may be removed by hysteroscopy through cutting, chopping or vaporizing the tissue. A hysteroscopy is performed vaginally, while a patient is asleep under anesthesia. A scope is placed through the cervix into the uterus in order to look inside the uterine cavity. This procedure can be performed as an outpatient in an ambulatory or office based surgery unit. The risk of bleeding, infection or injury to the uterus or pelvic organs is small.

Resection of the submucosal myoma can be difficult especially when the fibroid is large and can sometimes take longer than is safe to be performed in a single procedure. It is not uncommon that when the fibroid is large, it will take multiple procedures in order to remove the fibroid in its entirety. It will be necessary to repeat the hydrosonogram after the fibroid resection to make sure the cavity is satisfactory for implantation.

The good news is, when no other causes of infertility are found, removal of a submucosal fibroid is often successful in allowing conception to occur naturally or at least with assisted reproduction.

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The Role of the Infertility Consultant

By Mindy Berkson

July 19th, 2010 at 6:53 am

Undergoing third party reproduction is an emotionally and physically draining process.  Then throw the financial expenditures in the mix and it is no wonder that individuals and couples undergoing treatment are overwhelmed, confused and distraught.  Adding insult to injury is the fact that there are no guaranteed results for in-vitro fertilization (IVF) treatment.  Therefore, it is essential that patients truly make informed medical decisions and learn to be their own best advocate through the process. 

In my experience as an Infertility Consultant, the most important element in exploring IVF is building the foundation for treatment.  The three factors that need to be considered prior to embarking on any treatment plan are the financial, physical and emotional tolerances for your given situation.  Also knowing what questions to ask specific to your given circumstance is paramount.  The answers you get are only are only as good as the questions you ask.  A qualified consultant should be able to guide you through the process and help you formulate the necessary considerations enabling you to make informed financial and medical choices. 

Infertility treatment is expensive.  It is imperative to plan and prepare for the end family goal and not just one cycle.  I always recommend that my clients consider the total financial resources after insurance benefits that they are able to put towards fertility treatments.  I also suggest that they set parameters for treatment options that suit them emotionally and physically as well.  For example, how many cycles of IVF can and will they endure before turning to a different treatment option that may yield a higher chance of success.  Balancing hope with caution is essential in maintaining sanity and making non emotional choices. 

Pulling together an unbiased multi disciplinary team of professionals is another important aspect of accomplishing a treatment cycle.  Especially when the treatment cycle involves a third party such as an egg donor, sperm donor and or surrogate.  Members of the team should include: reproductive endocrinologist, embryologist, financial and estate planner, licensed insurance agent, recruiting agency, ideal surrogate, egg donor, sperm donor, attorneys and mental health professional.  A qualified Infertility Consultant should be be able to organize this team with unbiased referrals specific to your individual situation.  In addition, your consultant should be able to help you identify available and qualified egg donor and surrogate candidates, and arm you with relevant questions, concerns and possibly the newly available technologies so that you can effectively address these issues with your physician.  Making informed medical choices is being your own best advocate. 

A qualified Infertility Consultant should have all the resources and information necessary to educate you to be your own best advocate.  Ultimately, being your own best advocate will help you maximize your chances of success and minimize your financial expenditure. 

Mindy Berkson has more than a decade of experience in the infertility field.  As one of the first infertility consultancies in the United States, Lotus Blossom Consulting, LLC was founded to arm consumers/patients with information and education to make the best medical choices.  Mindy has guided hundreds of intended parents through the stressful demands of the infertility process by providing professional and compassionate assistance in dealing with the emotional, physical, and financial barriers involved with third-party reproduction.  Mindy can be reached at 847-881-2685, mindy@lotusblossomconsulting.com or on the web at www.lotusblossomconsulting.com and www.theinfertilityconsultant.com

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