Archive for August, 2010
By East Coast Fertility
August 31st, 2010 at 9:46 am
We are happy to announce that our consult, monitoring and administrative offices are moving to a new facility. Our 1074 Old Country Road office will be closed Friday September 3rd for monitoring.
All OR procedures will be performed as scheduled on September 3rd.
Please review with our front desk staff which of our Mt. Sinai, West Islip, and East Patchogue offices will be most convenient for you to monitor in on September 3rd. All monitoring for Plainview will commence in our new location on September 4th at:
245 Newtown Road Suite 300, Plainview, New York
We are sorry for any inconvenience this may have caused you and look forward to seeing you at our new office!
By Pamela Madsen
August 30th, 2010 at 7:43 am
Just in case you missed the news – Dr. David Kreiner the Founder and Medical Director of East Coast Fertility has just published his first book – Journey To The Crib which is now being featured at The Huntington Revue.
Journey To The Crib is not just another fertility book – there are plenty of those on the market. Instead – Journey To The Crib is an inside look at the field of reproductive medicine through the eyes of Dr. Kreiner who has been there almost from the very beginning. Journey To The Crib is a personal book – full of insights into the field of reproductive medicine that are not always politically correct – but always honest and in the best interest of the patient.
Journey To The Crib also gives patients a wonderful travel guide of programs that are not often talked about – and might just be the answer to their family building dreams. In over 20 years of patient advocacy – Journey To The Crib is a refreshing first for me in the world of fertility books. You won’t regret the read!
By Pamela Madsen
August 27th, 2010 at 7:31 am
I am a girlie girl., I like doing things like getting my nails polished (bright red) and my hair done which includes getting my hair colored (cause I am getting a little gray around the edges!). And every time I do this kind of "girl stuff" – I always think about to this environmental conference that I attended….
You see – several years ago, I spoke as the representative patient voice at an environmental conference for fertility at San Francisco University. I remember looking out into the audience – a group of doctors, scientists and researchers that studied the environmental effects of the world around us on our health. I remember being stunned by the gray hair – the lack of nail polish and make up! These folks did not use many of the every day products that most of use without thinking – because they knew the health effects of those products - and they didn’t want them!
Yet very little is still written about the environmental effect of the every day products that we use on our fertility. Many of us use all kinds of lotions, cremes and expose ourselves to countless concoctions every day which contain an incredible of synthetic chemicals. We do this often without a thought about how these chemicals could be adversely affecting our overall health and our fertility. The fact is that most of us would be horrified to learn that many of the products that we apply directly to our skin are made from the same harsh chemicals used in industry, and are known hormone disruptor’s for both men and women.
For example, I recently learned that a product called propylene glycol is a solvent used in hair care products, make up and deodorants. It is also the main ingredient in antifreeze and certain types of brake fluid!! Now, if that does not get your attention – I don’t know what will!
How could this be? Well, in our current state of affairs, only new chemicals by law have to be assessed for their effect on our health, which amounts to no more than 3% of those in everyday use. There are activists here in the United States and around the world that are working to change the laws – but that means going up against industry and lobbyists – so it may take a good long time before all the chemicals in the products that we use on a daily basis will be completed evaluated for use on human bodies!
And the fact is that daily exposures to harmful chemicals add up! And it is this daily tank up on harmful chemicals that could really be impacting us. Like most things – only doing something once in a while won’t impact our health. But it is the constant used of these products that come to us in so many different every day forms, that can accumulate in the body and ultimately effect our over all health, including our fertility and the pre conception health of our children.
No one can under estimate the importance of pre conception health. Whether it is our body weight, our diet, our habits such as smoking and drug use. And for those people who are in the fertility trenches trying to conceive – this constant vigilance can feel so painfully extended. I get that – I really do. But pre conception health is something that you can do something about and it is something that you can be in control of! So use your pre conception time wisely! Consider undertaking a detox program to assist your body in getting rid of our everyday accumulated toxins. Studies have shown that detoxing can help our bodies regain our natural hormonal balance – and for men who have been adversely effected by industrial toxins and see an improvement in sperm levels.
So, how do you do this? Some of this is common sense. Check out the basic products that you put in your mouth and on your skin on a daily basis. Think about such common items as tooth paste, mouth wash, soap, deodorant, body lotions, make up, nail polish and hair products. Have you ever read the ingredients? Can you understand them?
So I have been reading around – and here are a few of the tidbits that I have found when it comes to the kind of chemicals that are we exposing ourselves to, that can especially effect our fertility and the health of our unborn children.
In 1989 the Australian Occupational Safety and Health Administration analysed nearly 3,000 chemicals used in personal care products. 884 of the ingredients were found to be toxic with 218 of these products found to cause reproductive problems and 314 found to have some effect birth defects in humans!
It is amazing that more information is not out there in Reproductive Endocrinologist’s waiting rooms about this! But who would fund it? Is not a wonder that more people don’t know about this?
Here is a list that I found of the most common offenders – check out the products that you use on a daily basis. If they contain these chemicals – I would ditch them. I did.
Parabens are mostly likely found in body care products. Parabens have been found hanging out in human breast tissue and evidence suggests they can act as oestrogen making them a hormone disrupting chemical in both men and woman. Propyl parabenhas been shown to adversely affect male reproductive functions. At the daily intake level currently acceptable by our govenment it was found to decrease sperm production.
Phthalates are hormone disruptors and apparently they do not have to be listed on labels. They are most often found in perfumes, musks and fragrances. Phthalates have been shown to have a relationship with low sperm counts and some studies have shown that they can also cause sexual abnormalities and deformities. According to a survey by the CDC, women with the highest levels of Phthalates were also women of reproductive age. Phthalates can also be found in hair spray, make up, nail polish, shampoo and soap! In high levels they are linked to reproductive and fertility problems in women.
Triclosan is another endocrine disruptor which can be found in soaps, toothpastes, body washes and those instant antibacterial hand washes. You may be clean…..
Talc is found which is found in baby, face and body powders as well as the dusting on condoms! Which means that it can put directly applied to women’s reproductive organs! Talc is a known carcinogen, and has been link with ovarian cancer when used in the genital area. So why is it still found on condoms?
This is still a partial list. If you are interested in learning more – please check out Our Stolen Future.
Remember, that environmental toxins such as manicures, hair dye, and what we can find in certain brands of toothpaste – can truly impact our over all health and our reproductive potential. There are replacement products available! We just have to learn how to be educated consumers – we have to get the information so that we can make informed choices. We live in an age where there is natural body care products available almost every where!
Many couples are diagnosed every day with unexplained infertility. Yet we know that stress, diet, lifestyle and environmental toxins can have an effect on fertility. Who knows if changes in these areas in a couple’s life can be the difference between infertility and fertility?
By Joanne Verkuilen | Founder, Co-ceo
August 26th, 2010 at 6:51 am
Good news! We are one giant step closer to understanding more about our female bodies.
Three years ago when I had my “a-ha” moment, standing in my kitchen holding a cup of coffee, with the idea of Circle+Bloom banging me on the top of the head, the stress-fertility connection was only a theory. Over and over we heard friends who “gave up trying” and either adopted or decided to go childless, and they ended up naturally pregnant.
Even my own experience seemed to show the connection: our first baby came with us “trying but not trying,” – we weren’t using birth control, nor were we expecting anything to happen. Our second child was a completely different story. With my biological clock ticking like Big Ben, our work to get pregnant a second time was just that: work. Four years of work.
Now, we have 284 women to thank for shedding light on the subject. With the study published in the Journal of Fertility and Sterility, we can now conclusively say that there is a most definite connection between the length of trying to get pregnant and levels of stress.
Of course there are a multitude of other factors that may be impeding your fertility: PCOS, endometriosis, premature ovarian failure, cysts, etc., etc. This doesn’t mean, however, that you should ignore the stress component if you do have a diagnosed condition. Working through your stress issues will give you peace of mind and having a better feeling of control over your fertility and may give you the strength to carry on.
So let’s celebrate this new-found knowledge! Use it to our advantage! Say NO to stress!
I can hear you yelling at me right now though. Is this easier said than done? This raises questions for ourselves such as how much stress do we really experience in our lives? How can I really reduce stress and relax? How do I know if it is working?
Here are five tips to begin to think differently about your life, your stress and your ability to become pregnant:
1. View the stress-infertility link with a sense of optimism and take control of your fertility. Knowledge is power, and this study brings us closer to making our pregnancy dreams a reality. Think about this as a way to restart your fertility journey.
2. Assess what brings you peace, joy and fulfillment. Every single day, find the simple things in life and find gratitude for them. For me, it could be the sun light filtering through the curtains that makes me stop and enjoy the moment. What else brings you happiness throughout your day? Try to become more aware of your inner state of being, and really make a commitment to yourself to manifest more of the good stuff in your life.
3. Deep breathe every single day. The wonderful book by Meir Schneider who taught his eyes to see after being born completely blind convinced me of the value of deep breathing exercises. The fact that most of the time we take in only enough oxygen for our lungs when the entire body needs oxygen convinces me that we need to take time to restore all parts of our body with deep breathing exercises. Not only will you feel more awake and alive after deep breathing, but the process of focusing on your breathing is step one in any kind of meditation or relaxation work. Focusing only on your breath allows you to become centered and more fully present.
4. Wherever you go, there you are. The wonderful books by both Jon Kabat-Zinn and Ekhart Tolle have been so life-changing for me on a personal level. For most of my life, my thoughts have always been on the next thing in my life, the future, and the “what-ifs” that could either help or hurt me. I was known in my family as the “klutz” and I truly believe I have accidents when I am not focusing on what it is I am doing in the present moment. What these books have taught me is that all we have is right now. All that truly exists is right now. By focusing on the “now,” I begin to see the true value of my existence. (Note – I still have klutzy moments as my sisters will surely point out – but I realize it immediately where my thoughts were and therefore feel more in control.)
5. Integrate relaxation techniques into your schedule. Just like you exercise for health, just like you take vitamins and eat healthy foods, you should also take time to consciously reduce your heart rate in relaxation and focused attention. Slowing your brain chatter, becoming more aware of your thoughts each and every day – and scheduling something in your daily schedule like meditation, using our Circle+Bloom programs, yoga, journaling, or simply taking a long slow walk to savor the day.
For more information on Circle + Bloom:
By Mike Berkley, L.ac.
August 25th, 2010 at 12:00 am
15% of Americans are afflicted with infertility. Certainly this is a disorder that can be effectively treated with Chinese medicine. But our success can be greater with a shift in attitude.
As practitioners of Chinese medicine we must be able to understand not only pathological factors but etiologies too. For example, a pathology leading to male factor infertility is low sperm count. Many TCM practitioners will automatically render treatment based upon the TCM diagnosis arrived at through the four examinations. This is all well and good and appropriate according the context of our training. There is, however, an inherent problem with this type of diagnosis.
Let’s use a case history for illustrative purposes: A forty-five year old male presents with the main complaint of low sperm count. His constellation of signs and symptoms include mild erectile dysfunction, dribbling urination status-post voiding, he craves salty foods and has tinnitus and low back pain and has a chronic sore knee secondary to unresolved childhood Osgood-Schlatter disease. We may conclude perhaps that there is a dual vacuity of kidney qi and essence, and treat accordingly.
Many practitioners of Chinese medicine would be happy to diagnose this case as I have illustrated above yet their treatments would not yield the desired outcome. Why? Because the etiology of this pathology is manifest as a result of a varicocele of long standing. As a result of this varicocele, qi has stagnated, blood has become static and heat has become trapped in the liver channel locally at the level of the affected testicle.
It is important to note that there are no signs or symptoms in this patient of blood stasis or heat. Not in the tongue and not in the pulse and not in other presenting signs and/or symptoms. This type of presentation is not uncommon. I refer to it as a ‘hidden pathology’.
It is a standard method of operation that one must arrive at a differential diagnosis not matter how confusing the case may be and treat accordingly and if the treatment is ineffective, dig deeper, look more closely, reanalyze and alter the diagnosis and try another approach. This is a clumsy approach and with greater knowledge our system of diagnosis can become more economic and more accurate.
In China, one hundred or five hundred or three thousand years ago, the doctors did not have the distinct advantage that we, as modern day practitioners have. That is, Western medical science. If for example, the modern day TCM doctor did his or her full intake on the above patient and then simply inquired “have you been evaluated by a urologist?” the answer to the riddle would have been instantly revealed if the patient had and come back to your office with a Western diagnosis of vericocele. Thus, as a result of a urological examination we are able to state with certainty that the TCM diagnosis is stagnation and binding of liver qi and stasis of liver blood transforming heat; not kidney vacuity! If the patient had not been worked-up by a urologist we would be treating uselessly. Greater knowledge affords greater treatment options. As the Spanish saying goes: “Saber es poder” or knowledge is power!
What we have at our finger tips today that Chinese practitioners of even fifty years ago were deprived of is the availability of a knowledge-base that can positively affect our diagnoses and our treatment outcomes.
I am not suggesting that there is a direct clinical analogue from a Western medical diagnosis to a TCM pattern differentiation in every case, but frequently, in internal medicine there is.
Let’s say that we have a patient whose main complain is azoospermia. Once again, we treat according to the probable diagnosis of jing-essence vacuity. But if the patient was diagnosed as having Klinefelter’s syndrome one could say with confidence that the diagnosis is pre heaven jing-essence vacuity and detriment which, in my opinion, in this case, is untreatable as the pathomechanism is chromosomally derived. So, now we have treated this patient with herbs and acupuncture for six months to no avail. If you treated him for six years, results would not differ. We have taken his money, raised his hopes and proceeded in a way which could negatively impact the reputation of Chinese medicine.
Here is another all too familiar classic story: A thirty-three year old female patient presents at the clinic with the main complaint of primary infertility. She is afraid of Western doctors and really believes in alternative medicine and has heard wonderful things about your skills. In fact, you helped a good friend of hers to become pregnant. So, you treat the patient; and treat her, and treat her some more.
You use many point protocols and many herbal formulas. You supplement the kidneys and boost the spleen. You sooth the liver and nourish the blood. You fail. Why? Because this patient has severe bilateral adhesions on the salpinges secondary to pelvic inflammatory disease. You cannot help this patient to conceive naturally, and your advice at the first interview should have been to visit a Reproductive Endocrinologist and have a full work-up.
Dan Inosanto who was one of Bruce Lee’s martial arts teachers wrote: “Absorb what is useful and discard the rest” I highly recommend that we, as healthcare providers absorb the useful diagnostic data which is presently available to us from Western medical science. Until we do, we will not truly be practitioners of integrated medicine.
Having an understanding of Western medical science will improve our analytic and diagnostic skills and as a result will improve the results of our treatments and as important, help us determine who is treatable and who isn’t.
By Michael Zinger, Md
August 24th, 2010 at 12:00 am
There are two main reasons that women who are attempting conception should consider the use of ovulation detection methods. First, the presence of ovulation is an important box in the normal-fertility checklist, useful to help exclude the need for early medical intervention. Second, the accurate timing for introduction of sperm, close to ovulation, will optimize the chances of success.
Regular, monthly menstrual cycles are suggestive of normal ovulation. However, monthly episodes of bleeding can occur even in women who are not ovulating. Episodes of bleeding without ovulation are usually related to thickening of the uterine lining, such that it becomes unstable and bleeds for several days. This is different from bleeding that occurs after ovulation; normal ovulatory bleeding occurs in response to a loss of the stabilization effects of progesterone. Progesterone is a hormone that is produced in the ovary only after an egg is released during ovulation. This progesterone production should normally last two weeks, creating the normal four-week interval between menses. The four week total comes from two weeks for an egg to mature and ovulate plus two further weeks until progesterone declines. The decline of progesterone is what triggers normal, ovulatory menses
The most accurate approach for verification of ovulation is by measurement of progesterone in the blood. This should be timed one week after expected ovulation; in a normal 28-day cycle, this would be three weeks after the start of the period. The test looks for the presence of progesterone. Progesterone production peaks one week after ovulation and then disappears after one more week. Thus, the presence of progesterone in a significant concentration is an almost certain sign that ovulation has recently occurred.
Progesterone causes a slight increase in basal body temperature, providing clues to the presence of ovulation without the need for medical intervention. The measurement of basal body temperature is performed each morning upon first waking. A result that verifies ovulation demonstrates an increase in temperature that matches the rise and fall of progesterone as described above (starting soon after ovulation, lasting for close to two weeks, and ending at the beginning of the next menses).
There are some significant disadvantages of basal body temperature charting. The progesterone-related increase in body temperature is so subtle that it can easily get lost within normal variations, significantly limiting the accuracy of this approach. Furthermore, the tedious morning chore of checking daily temperatures throughout the cycle serves as an unwanted, stressful, daily reminder of the ongoing struggle to conceive. Also, because the unrelated background variations can be quite erratic, it can take many months before one can verify whether or not a consistent ovulatory pattern exists. This loss of time can be frustrating and could delay useful treatment. It is important to note that basal body temperature charting cannot be used to time the introduction of sperm during the current cycle since ovulation would have already occurred by the time the temperature rise occurs.
Luteinizing hormone (LH) serves as the body’s signal for triggering ovulation. Although initially released into the blood, it accumulates in the urine and can be typically detected by over-the-counter urine testing kits without the need for physician consult. Because the kit measures the trigger for ovulation (LH) rather then something that results from it (progesterone and the resulting increase in temperature), it provides an indication early enough to allow properly-timed introduction of sperm. The positive signal is typically detected on the day prior to ovulation. However, it is important to note that the kits are not accurate for everyone. Hormonal imbalances, such as PCOS, can elevate the LH level to such a degree that, in some women, the kit will read positive every day. Thus, it is best to note a negative reading when first testing and see it then become positive on a subsequent day.
To improve the precision of this approach, a fertility center can provide ultrasound monitoring. Through ultrasound visualization, the fluid around the egg can be seen to increase, creating an expanding pocket of fluid, known as a follicle. The size of the follicle provides an estimate of how many days may remain before ovulation. Then, after ovulation, the follicle usually appears collapsed. This ultrasound approach is often combined with LH measurement to provide adequate warning when ovulation is approaching.
The most accurate way to know when ovulation is occurring is to provide a substitute trigger, through an injection. Physicians time the injection by to be done once the follicle appears large enough on ultrasound. In this way we know that the egg, which is in the follicle, is ready for ovulation. By preempting the body’s own trigger, physicians can schedule a specific time for ovulation to happen. Specifically, we know that ovulation occurs about 36 hours after the injection. In contrast, measuring LH by urine test kits can only tell us which day the trigger begins, not the exact time.
By Dr. David Kreiner
August 23rd, 2010 at 12:00 am
I have received an enormous amount of email from patients over the years asking for information about how they should get started with their infertility workup. Apparently, they are women, men and couples who have experienced difficulty conceiving and now want some direction about how they should proceed. Building a family was something they had imagined their entire lives to be a natural progression–from student to career, getting married then having a family–and they’re frustrated that their difficulty conceiving has affected their lives. For many—some of whom have never experienced a health problem– it prevents them from appreciating or even doing anything else.
See an RE for a Fertility Workup
My response to these emails has been to tell the patients to seek assistance from a reproductive endocrinologist, whose specialty and experience is in helping infertility patients conceive. A reproductive endocrinologist, who has two to three years of additional specialty fellowship training in infertility after completing an OB/GYN residency.
The RE will conduct a history and physical examination during your initial consultation. This exam typically includes a pelvic ultrasound of a woman’s ovaries and uterus. He/she can tell if there are any uterine abnormalities that may affect implantation or pregnancy as well as assess ovarian activity and rule out cases of moderate or severe endometriosis.
Pelvic Inflammatory Disease
If he elicits a history of previous abdominal or pelvic surgery, a physician may suspect that scarring may have developed that typically interferes with fallopian tube transport of the egg to the sperm and the conceptus to the uterus. An infection that develops after a pregnancy may lead to pelvic adhesions affecting the tubes as well as scarring within the uterine cavity itself which can prevent implantation. Pelvic inflammatory disease, PID, can lead to tubal disease and may be associated with other sexually transmitted diseases including HPV, Herpes and especially Chlamydia.
The semen analysis is the simplest test to perform and will reveal a male factor in 50% of cases. A post coital test performed midcycle around the time of ovulation when the cervical mucus should be optimal can detect a male factor or cervical factor when few motile sperm are detected within hours of intercourse.
A hysterosalpingogram, HSG, is a radiograph x-ray of the uterus and fallopian tubes after radio opaque contrast is injected vaginally through the cervix directly into the uterus. It can detect uterine abnormalities that can affect implantation and pregnancy as well as tubal patency. Unfortunately, this exam may be painful and in some patients with PID can result in serious infection. Some physicians will administer antibiotics prophylactically for this reason.
A hydrosonogram is an ultrasound of the uterine cavity performed after injecting water vaginally through the cervix directly into the uterus. It can also detect uterine abnormalities and shares some of the risks seen with HSG but to a lesser extent and usually with less associated discomfort.
A hysteroscopy is a surgical procedure in which a telescope is placed vaginally through the cervix directly into the uterus. The physician can visually inspect the cavity to detect uterine abnormalities. The risks of pain and infection are also seen with hysteroscopy.
Blood tests may be run to identify if a patient is ovulating with adequate progesterone stimulation of the uterine lining. Day 3 E2, FSH and LH levels can give information regarding ovarian activity and ovulatory dysfunction. AntiMullerian Hormone (AMH) levels correlate with ovarian reserve. That is the number of eggs remaining in the ovaries. Hormones that can affect fertility such as thyroid and prolactin are also assessed to ensure that extraneous endocrine problems are not the cause of the infertility.
Laparoscopy is a surgical procedure in which a telescope is placed abdominally through the navel thereby allowing a physician to inspect the pelvic organs. He/she can identify endometriosis, cysts, adhesions, infection, fibroids etc. that may be causing the infertility. Unfortunately, only about 25% of cases in women who have a laparoscopy performed will conceive because of treatment performed at the time of the laparoscopy.
Workup Results and Treatment
Treatment can be directed at the cause such as surgery to correct adhesions or remove endometriosis, uterine polyps or fibroids. Treatment can also be independent of the cause but improve fertility nonetheless. Ovulation induction increases the number of eggs and therefore the likelihood that an egg will fertilize. Gonadotropin injections stimulate many more eggs to develop in a cycle than clomid fertility pills. IVF with minimal or full stimulation is the most successful treatment for any cause of infertility. The decision as to what treatment to undertake will depend on numerous factors including your age, duration of infertility, cause of infertility, cost of treatment and success of treatment as well as your insurance coverage for the treatment and your motivation to conceive and willingness to accept the risks associated with the treatment. Today, there is a highly successful treatment available for nearly all women.
By Dr. David Kreiner
August 20th, 2010 at 12:00 am
You have that dreaded infertility diagnosis, “Over 40 With High FSH Levels.” And there’s no cure or magic herb that will turn back the hands of time. You’re desperate so you are willing to try it all anyway, including acupuncture and some internet recommendations such as DHEA (dehydroepiendosterone).
You hear that you can lower your FSH with DHEA or estrogen. The fact is, however, elevated FSH levels do not cause a problem with conceiving. They are merely a marker of diminishing ovarian reserve, a depletion of ovarian follicles and eggs that, combined with increasing age, means you have very few genetically normal eggs available in your ovaries to achieve a healthy child.
Reproductive endocrinologists typically counsel “Over 40 With High FSH Levels” patients that their chance of successfully achieving a live birth using their own eggs is small and that by using a donated egg from a young, fertile woman they can increase their odds of giving birth to greater than 70 percent per donation. Unfortunately, this comes as a shocking disappointment to most women. It’s often a reason for them to drop out of a doctor’s practice or even quit trying to conceive.
So what do you do when faced with this situation? Your answer needs to be individualized, based on your emotional and financial resources, your motivation and your comfort with using a donated egg.
At our clinic, we try to come up with a strategy with our patients that includes counseling to begin the discussion about donor eggs, as opposed to trying with less chance for successful outcome using a patient’s own eggs, or stopping therapy completely and adopting or living child-free.
Perhaps you will choose a low tech option such as insemination with or without hormonal therapy. Sometimes, the plan will be to blast ahead with the big guns using IVF with full stimulation or with less medication and cost using MicroIVF or Minimal Stimulation IVF. Some patients respond better to different stimulations such as sensitizing with estrace or even DHEA prior to stimulation, using a lupron flare or even using clomid in combination with gonadotropins. Unfortunately, it is hard to predict what will be the optimal stimulation for you until we give it a shot.
The bottom line? There’s no right or wrong choice for you. Remember, a family can look many different ways and still be a healthy, loving unit. Your physician, nurses and counselors are available to assist you and support you with whatever decision you make.
By Pamela Madsen
August 19th, 2010 at 12:00 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 if 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!!! I wanted real advice about how to feel sexy again.
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 erotic 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. 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?
By Richard Vaughn, Esq.
August 18th, 2010 at 12:00 am
Intended parents forming a family through surrogacy face many medical, legal, and family law issues that go beyond the basic surrogacy agreement and the initial family formation, such as:
· Who will act as the legal guardian of your child(ren) in the event you are unable to act due to death, or temporary or permanent disability, prior to the time a parental order is obtained?
· Who is authorized to make medical decisions with respect to your child(ren) in the event of your disability or death?
· Who is authorized to make vital medical decisions for you if you are unable to make those decisions for yourself?
· Who is authorized to make decisions with respect to your other legal and financial matters in the event you become temporarily or permanently disabled, including decisions relevant to the surrogacy and birth process?
Family Planning Documents are drafted to clarify your intentions as to who has authority to make these important decisions regarding your and your child(ren)’s health, medical care, and guardianship in the event of your death or incapacity.
Recognizing that our clients find themselves in multiple states both during the course of, and subsequent to, their family creation process NFLC’s Family Planning Documents cover these family-medical-legal issues in a multi-jurisdictional manner drafted with the intent that they be effective in as many states as possible.
These documents include:
Guardianship Designation, Power of Attorney and Consent Signed by Your Surrogate
Your Surrogacy Agreement is an important legal document; however its main purpose is with respect to your arrangement with the surrogate and the parties’ intentions. We strongly recommend protecting your parental rights through more formal guardianship documents; ideally executed at the same time as your surrogacy contract so that they are in place long before the final court order(s) of parentage are issued.
As an intended parent your parental rights are established with a judgment that becomes effective immediately upon the birth of your child(ren). A surrogate Guardianship Designation will protect your parental rights even before the birth of your child(ren), thus ensuring that you are the one who is legally authorized to make all medical decisions regarding your unborn child(ren).
Your Formal Guardianship Designation
Many parents often consider who will be responsible for taking care of their child(ren) if they were to die or become incapacitated. Unfortunately, many parents do not find the time to ensure that this decision is made legally binding. This document will officially name your choice of alternate/backup guardian(s) of the child(ren), while in utero and once born, in the event that you are unable to be there to care for your child(ren). This document is particularly important for families where only one intended parent will be listed on the birth certificate.
Advance Healthcare Directives/Proxies
Advanced healthcare directives establish your rights to have a particular person make healthcare decisions for you if you are unable to do so for yourself.
General Durable Powers of Attorney
Power of Attorney documents establish the right of your designated person to administer your assets and make legal and financial decisions on your behalf (including with respect to the surrogacy) in the event you are unable to do so for yourself.
Your Family Planning Documents can also:
· Supplement your will or living trust and insure that appropriate legal appointments and expressions of intent are in place prior to the execution of a will or living trust (which are more complex and often require substantial time to develop in conjunction with an overall estate plan);
- Save you time and money, since many of the Family Planning Documents would ordinarily be part of the suite of documents that you would prepare in connection with a will or living trust.
NFLC’s Family Planning Documents are applicable to all Intended Parents, whether single, married, or in a domestic partnership or civil union. For more information, please call NFLC at 800-558-4009 and ask for Richard Vaughn, or email him at Rich@NFLC.net.