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Archive for May, 2011

The Nominee for Best Supporting Role is…

By Tracey Minella and David Kreiner MD

May 31st, 2011 at 12:00 am

Well, it’s Father’s Day this month, so it’s time to honor our men out there with a post just for them. Life is what you make it…and so is IVF, guys. You can be as involved or detached as you choose. So choose involved. Not just because it’s the right thing, but because if you choke at the big moment, you may just be forgiven.

Dr. Kreiner has seen it all. Read on for his perspective:

Many husbands complain that they feel left out of the whole IVF

process as all the attention and care is apparently directed towards

the woman. If anything they may feel that at best they can show up

for the retrieval at which time they are expected to donate their sperm

on demand. If you should fail at this then all the money, time, hope

and efforts were wasted all because you choked when you could not

even perform this one “simple” step. I have not witnessed the terror

and horrors of war but I have seen the devastation resulting from an

IVF cycle failed as a result of a husband’s inability to collect a specimen.

Relationships often do not survive in the wake of such a disappointment.

Talk about performing under pressure, there is more at stake in

the collection room than pitching in the World Series. Husbands and male partners

view IVF from a different perspective than their wives. They are not the ones

being injected with hormones; commuting to the physician’s office

frequently over a two week span for blood tests and vaginal ultrasounds

and undergoing a transvaginal needle aspiration procedure. At least women are

involved in the entire process, speak with and see the IVF staff regularly

and understand what they are doing and are deeply invested emotionally

and physically in this experience. So what is a husband to do?

 

Get Involved

 

Those couples that appear to deal best with the stress of IVF are ones

that do it together. Many husbands learn to give their wives the injections.

It helps involve them in the efforts and give them some degree of

control over the process. They can relate better to what their wives are

doing and take pride that they are contributing towards the common

goal of achieving the baby. When possible, husbands should accompany

their wives to the doctor visits. They can interact with the staff, get questions

answered and obtain a better understanding of what is going on.

This not only makes women feel like their husbands are supportive but

is helpful in getting accurate information and directions. Both of these

things are so important that in a husband’s absence I would recommend

that a surrogate such as a friend, sister, or mother  be there if he cannot be.

Support from him and others help diminish the level of stress and especially

if it comes from the husband helps to solidify their relationship.

Husbands should accompany their wives to the embryo transfer.

This can be a highly emotional procedure. Your embryo/s is being placed

in the womb and at least in that moment many women feel as if they

are pregnant. Life may be starting here and it is wonderful for a husband

to share this moment with his wife. Perhaps he may keep the Petri dish

as a keepsake as the “baby’s first crib”.  It is an experience a couple is not

likely to forget as their first time together as a family.

 

With regards to the pressure of performing to provide the specimen

at the time of the retrieval, I would recommend that a husband freeze a

specimen collected on a previous day when he does not have the intense

pressure of having to produce at that moment or else. Having the insurance

of a back up frozen specimen takes much of the pressure off at the

time of retrieval making it that much easier to produce a fresh specimen.

There are strategies that can be planned for special circumstances

including arranging for assistance from your wife and using collection

condoms so that the specimen can be collected during intercourse.

Depending on the program these alternatives may be available.

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Do you agree that the man should be more involved or would you prefer not to be? Why or why not?

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Don’t Forget to Remember Today

By Tracey Minella

May 30th, 2011 at 12:00 am

Seems to me that any time there’s a party or celebration going on…and you’re infertile…it can be a tough time. This weekend is no exception.

First off. Let’s not lose sight of the real reason for Memorial Day…to remember our fallen heros. The men and women who have made the ultimate sacrifice so we could live in the world’s best country. The generations of soldiers who’ve protected our borders and solidified our status as a superpower…as a nation where we can enjoy many freedoms, and where most can access the best medical care available through cutting edge technologies, like IVF.

So, remember to be thankful for that. In fact, why not attend a parade in their honor? Or visit a military cemetery and take in the magnitude of their sacrifice by viewing the perfectly aligned, seemingly endless rows of headstones adorned with American flags. It’ll take your breath away, give you some perspective, and get you away from that barbeque you’re dreading for a bit.

The other reason for the day is the inescapable celebration kicking off the start of the summer. It’s pretty much un-American not to host or attend some form of outdoor party or barbeque this weekend. That means mingling with often insensitive family and friends and sometimes strangers. Add some beer or umbrella drinks. Now that can be a recipe for disaster…

Give yourself permission not to go if it’s too difficult for you or to leave after a short time. Unlike major celebrations, it’s just Memorial Day. Your absence won’t be glaring. Besides, hotdogs and beer are not exactly on the fertile foods list. A picnic and walk on the beach with your partner can be just what you need to regenerate your “couple’s energy” and connect again in a stress-free environment. Can you hear the waves now?

If you’re in the mood to party, think of it as the start of a new season…the best one of all. Or at least the least stressful. Go to…or host…the type of gathering that works best for your needs.

If you host, you control the food and drink, so you can make healthy choices and need not feel deprived. Better yet, you control the guest list. I always thought that was well worth the cost of hosting. If you’re a guest, ask the host politely in advance who will be there and what they’ll be having. No one wants to be surprised with a menu they can’t eat or a guest they can’t stand. Then decide if you’ll go and what to bring.

The stress of infertility and TTC makes every day stressful and any holiday…even Memorial Day… brings the potential for added stress. I hope you all find a way to get some stress-free time over this three day weekend.

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What did you do this Memorial Day weekend? Was it stressful or stress-free?

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IVF and Cloning

By Tracey Minella and David Kreiner MD

May 27th, 2011 at 12:57 am

We’ve all joked at one time or other how we’d love to clone ourselves, so we could accomplish more things in less time. But as progress in technology continues to advance, we find ourselves on the brink of a potentially dark place. Cloning technology is no longer science fiction. It is here. It is controversial. Now what?

Dr. Kreiner of East Coast Fertility takes a look at the possible implications of cloning on the field of ART:

First Octomom. Then a fertility doctor is denounced for claims of human cloning*. I get the impression there are fertility specialists out to ruin the reputation of IVF for the rest of us.

In the case of Octomom, there is some question as to how the patient was counseled. We focus on high success with least risk as possible. It is unfortunate that a few others aspire to something other than their patient’s best interests. It is very difficulty for a fertility specialist to deal with patients who insist on using up all their embryos in one attempt. We share with the patient a desire not to discard embryos but retain responsibility for not allowing for potentially dangerous outcomes.

Cloning is an ethical dilemma yet to be solved by society. Until then we do not participate in cloning since we are unsure whether to do so is ethically sound. Benefits of modified forms of cloning have been proposed. Multiplying high quality embryos in patients would theoretically increase their success rates. Women who had poor quality eggs (cytoplasm) could have their nuclei transplanted into the egg of a healthy young woman. Again, theoretically, this can improve success rates. Another proposed clinical use is to produce tissue for transplantation say in a child with cancer who requires chemotherapy.

The form of cloning that usually comes to mind however, is the creation of an identical being whether it be to replace a loved lost child or in our common vernacular a “mini-me”. It is this possible use of the technology that causes almost universal disdain in our society. We have yet to figure out whether there is a place for any of the aforementioned forms of cloning that is potentially more palatable.

IVF is a clinically useful form of technology that is allowing for greater than 40,000 more babies to be born each year who may otherwise never have been given life. But, as with all technology there are risks and potential downsides that need to be considered. Today, cloning as well as high ordered multiple embryo transfers moves the IVF technology beyond our comfort zone with our assessment of the potential risks and downsides. Let us not distort the relative benefit vs. risk of IVF technology by wrongfully applying it to cloning or high order multiple embryo transfer.

Source: www.ivf.net

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Do you think cloning should be available, and if so, in what circumstances?

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IVF and American Idol

By admin

May 26th, 2011 at 12:28 am

By the time you read this, a new American Idol will have been crowned.

One will have realized their dream, secured a bright future, seen their hard work and sacrifice pay off, and will have more money than most people will see in a lifetime.

The other, though amazingly talented and equally qualified and deserving to win all of the things that come with the Idol crown…comes in second. Which is a nice way of saying they are the loser. Hopes and dreams and hard work and sacrifice dashed in a moment of breathless anticipation. No second chance. Done.

Each played an active part in their destiny, yet the ultimate decision on whether their dreams would be realized was not in their control. It was in the hands of others.

This makes me think about IVF cycles.

Someone gets pregnant. They realize their dream. They envision their future with a baby. They get the pay off for spending all or part of their life savings, for going through the injections and procedures, for paying their dues. It worked. That happy phone call from the doctor changes their life from misery and emptiness to ecstasy beyond their wildest imagination.

But someone else does not get pregnant. Their dream is denied. They don’t get the pay off, and now don’t have their life savings. They suffered for nothing. And now they will suffer some more. It failed. They were just as qualified to be a great mother. Their hopes and dreams were dashed in a moment of breathless anticipation. The somber words on the phone are apologetic and they don’t really even register at first. Done. Either for now, or forever.

When I did IVF, I wasn’t antisocial, but I also wasn’t particularly chatty with the other ladies in the waiting room. I did notice and exchange knowing smiles with those having retrievals and transfers on the same day as me. If I didn’t see them at the transfer, I wondered if they didn’t have fertilization. Then I’d see some of them for the big day blood work.

When I’d get my results…whether positive or negative… my mind would at some point shift and I’d wonder which of those women were home crying and which were jumping for joy. Some of us feeling like winners; others like losers. Of course, we aren’t losers, but that’s how it feels because we did lose something.

Guess there’s some small consolation that the results of whether our dream has come true are not announced to a television audience of millions. We’re not put on the spot to pretend we are happy for the winner. We don’t have to hold in our tears and disappointment.

Then again, the loser can sell that new Ford and pay for an IVF cycle or two…

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Oprah Finale: No Big Loss to Infertile Women

By Tracey A. Minella

May 25th, 2011 at 12:00 am

Relax Oprah lovers. I’m not saying this larger than life woman did not leave a major imprint (and footprint) on society over the last 25 years. She’s been arguably the most influential and successful American woman on the planet. Her incredible generosity has helped people the world over.

But she hasn’t championed the cause of infertile women during the last quarter century… and she could have. There was so much power and influence and charitable dollars at hand, but the consensus seems to be that the pain of the infertile woman was not high on her agenda.

First, she covered the topic pretty infrequently on her national show over the course of twenty five years. And when she did, I think she often disappointed the infertile women in her audience. What a shame that she squandered the opportunity to spotlight infertility in a productive way to huge audiences of women who would likely have done anything Oprah asked of them…from writing legislators, to considering being egg donors, surrogates or gestational carriers, to well…reading a book on how to be a supportive and sensitive friend to infertile couples.

She’s been called insensitive for glossing over Jenna’s post-IVF miscarriage in “Thirty Something in America”.  And simply naming an episode “Wombs for Rent” shows a lack of respect to surrogates and gestational carriers. It’s cold. 

People remember in a mostly negative way the show about surrogates/ gestational carriers in India, and how Martha Stewart was financing her daughter’s IVF attempts to the tune of $28,000/month. Wow, who couldn’t relate to that? I mean, don’t we all have parents footing our IVF mega bills? Really, Oprah? You probably had every infertile woman in America tuning in for words of wisdom and support, and valuable information on infertility. Who do you think benefited from that segment?

A show on sperm donation failed to include representatives from sperm banks or attorneys representing anonymous donors’ rights. Instead, it presented a one-sided position which heavily favored the right of the offspring to know the donor’s identity over the rights of the donor and recipient for donor anonymity in accordance with the agreement under which the specimen was obtained. The interests of all parties…offspring, donor and recipient…should have been fully examined and given equal importance. But that doesn’t always make for good ratings. I guess its okay to frighten off potential donors by worrying them that the anonymity under which they donate may disappear. Wonder how low the sperm bank supplies plunged after that show?

And I thought her show with Suzy Orman and the Octomom was more like Jerry or Montel. People on internet forums openly and harshly criticized Oprah for what’s been described as bullying a woman of questionable mental capacity. Those who missed it can only imagine how bad it was if the woman most of America thought was vile came out as sympathetic! Some viewers claimed they’d never watch her again after that show. Not that Oprah would miss them.

Maybe Oprah couldn’t help letting down the infertile women. She’s chosen to live child-free, which is fine, of course. She just doesn’t “get” us and our selfless, burning maternal needs. Which is too bad for us, because if she’d been so inclined, she could have really made a difference.

Imagine if she did a show with top REs from all over America, and every audience member was an infertile woman. And then imagine at the end, when they reached under their seats, there’d be a gift certificate for a free IVF cycle. Maybe I missed that episode?

What a difference a free IVF cycle would make in a woman’s life. Better than cars and trips to the Outback, that’s for sure. East Coast Fertility is holding a series of contests right now, in which one woman will win the grand prize of a free Micro-IVF cycle. Imagine doing this on an Oprah-sized scale?

Oprah, if you’re listening, it’s not too late to change the lives of infertile women. You can make this right. We can help.

With your financial support, we’d be happy to set up a scholarship, grant program, or other such fund to benefit infertile women. Just have your people call our people…if we had people.

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How do you think Oprah’s show influenced the interests of infertile women? Did she help them or hurt them or have no effect? Maybe I missed something really great that she did for the infertile population and someone can tell me and I’ll reconsider my opinion of her as a great and charitable woman who fell short in a key area?

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Bobby’d be the Best Big Brother!

By Jessica Upham

May 24th, 2011 at 12:00 am

A few months ago I ran into an old childhood friend while grocery shopping with my little miracle. We reminisced about how much fun we would have playing together with all of our dolls. She mentioned a specific day when she got angry with me for “always wanting to be the mommy”. I could remember that day clearly…she asked “why do YOU always get all the dolls? Why are YOU always the mommy?” My reply was simple, “Well, because I really want to be the mommy & I think I’ll be really good at it”. Boy, some things never change!

Even then I knew I wanted children, although I never knew just how badly I wanted to be a mother until I met my amazing husband. Everything came so naturally with us. In a way, each day was new, yet, at the same time I felt like he had been part of me for my whole life. We had a short courtship…wedding planning was a cinch…the honeymoon was bliss…the first year was a fairy tale. We did everything right…we followed the rules – first comes LOVE (o.k. check), then comes MARRIAGE (o.k. got it)… now where the heck is that baby carriage already?

We made the decision on a plane, returning home from our 1 year anniversary trip (where on the third day we knew that yet another month has passed without the news we were hoping for), to make an appointment with my GYN. After a year of trying the “good old fashioned way” we knew we might need a little help. It was an easy decision to make…but it was a hard decision to accept. Easy because I already knew I would do anything for my children (even if they don’t exist yet). Hard because I had grown accustomed to the “breeziness” of our relationship. How would this affect our love?

It seemed like every other day I was asked, “So when are you gonna have a baby?” For the first year I’d laugh it off and say “Oh trust me, we’re trying – OH BOY are we trying.”, then give a little wink- wink, nudge- nudge…laugh on the outside, cry on the inside (and in the parking lot, and in the car, and in my husband’s arms). It’s a natural question, but for someone who is having trouble trying to conceive, it can be very intrusive. It also gets harder as the months would pass to think of new “clever ways” to change the subject.

After a few procedures (2 HSGs and one laparoscopic surgery) to determine what we were really up against, we picked a specialist that we stayed with for 1 full year. We did quite a number of I.U.I.’s without success. I thought that all the negative pregnancy tests were hard before – but it did not compare to getting the same old results after all of that work and all of those injections. After a year we began to loose hope and decided it was time for a break. But I couldn’t sit still for long.

Armed with my laptop I began to research all of the specialists in our area. Almost instantly I found East Coast Fertility…and for some reason through all of my searching, I just kept going back to them. Reading more, learning more, gaining more confidence…something told me that THEY would be the ones to help us begin our family. I spoke with my husband and we set up our consultation. It did not take long for us to make our decision. It was time to move on to IVF and we were going forward with East Coast Fertility.

From our initial orientation at ECF, and all of the wonderful staff, we knew this was where we needed to be…but it still didn’t ease our nerves the day that BIG BOX arrived.

I remember walking slowly to the door and taking a deep breath as I signed the driver’s electronic tablet to accept this “special delivery”. I laid everything out on the kitchen table and had what can only be described as “momentary stress amnesia”. OH MY GOODNESS…how much of this do I inject? OH NO, where are my Menopur Q caps? What needs to be refrigerated? I forgot EVERYTHING! One phone call and I was back on track and ready to go.

On Friday, May 1st 2009, we had our eggs retrieved. I laughed with my husband as he snapped pictures of me in my gown and hat before going in to the operating room (thanks babe!). I love him so much for being so strong… I think sometimes people lose sight of the fact that just because it’s the woman that’s getting the injections, this is just as hard for the amazing men in our lives as well. We got the call the following day that we had 5 fertilized eggs. “Our babies are there waiting for us” I told him.

Monday, May 4th 2009 was our transfer day…this time I wasn’t the only one in a gown and hat…he held my hand so tightly the entire time. I didn’t turn away from his eyes for the whole procedure. We just smiled and kept telling each other how lucky we were and how much we loved each other. They implanted 3 embryos and before we left I got a picture of all three. They also let me go home with our dish…or as I like to call it “his first apartment”. We started a new tradition that day. Every morning before my husband left for work from then until today I get 4 kisses 1 for me and 1 for each embryo. Earlier I mentioned having questioned how IVF would affect our love…well it only makes the strong – STRONGER.

Friday, May 15th 2009 – We tried to start the day as if it were any other day – as if either one of us could forget that later today we’d find out we might be pregnant. I was at work when I got a voicemail from Dr. Pena. I could tell by the tone of his voice that he had the news we were hoping for. Still, when I dialed him back I held my breath for what seemed like forever. Our entire long hard journey flashed before my eyes. When he said I was pregnant, our future immediately wiped away all of the past. Now flashing before my eyes, like a big bright neon light was the word FAMILY…FAMILY…FAMILY! We did it! We are going to be a family! I have my husband’s reaction to the news on video. We watch it every now and then and relive that life changing moment.

Every day since then has been amazing! I LOVED being pregnant! Boy, was I ever proud of that belly of mine! We found out we were having one healthy boy; there was no question that we would carry on the family name.

January 9th 2010 we gave birth to Robert Ellis Upham III (his friends call him Bobby!). At 12:21 AM I first looked into the eyes of my son. I kissed his little “gooey” head and introduced myself – but he already knew me (we go way back). Before they took him from my chest to clean him up I whispered in his ear, “Baby, I am so proud of you. Welcome to the world. We waited so long to meet you. I promise I will love you forever and ever, and I promise I will NEVER skip pages when I read to you”.

He is now almost 16 months old. He has mommy’s eyes and daddy’s chin. He has the most infectious laugh. He loves to dance and he has 11 teeth. I can’t get enough of him. He has a great sense of humor and knows just how to make me smile. I need him just as much as he needs me. I can’t think of what my life would be like without him. I still marvel at just how amazing it is to be his mommy- I still can’t believe he came out of me!

I am so grateful for what I already have. I thank my lucky stars every day! Infertility hurts, be it your 1st attempt or be it secondary infertility – pain is pain, heartbreak is heartbreak. The desire to be a mother doesn’t always end after you’ve had your 1st, often…it becomes stronger.

Winning a free Micro IVF would mean so much to my family. Thinking about the possibility of expanding our love, giving Bobby a sibling, carrying and loving another child who is SO VERY wanted, is overwhelming! As I look into my son’s eyes, tears come to mine….he would be the best big brother any kid could ever ask for!

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This essay on secondary infertility was one of our five winners from our recent contest and was reprinted with the author Jessica’s permission.

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The Sun’ll Come Out Tomorrow

By Tracey Minella

May 23rd, 2011 at 12:00 am

Well, it was not the end of the world. Here we all are…still alive. Survivors of the latest doomsday prediction.

Even pumped with hormone medications, most of us adults are reasonable enough not to take such apocalypse claims to heart. We all bet our bottom dollar that tomorrow, there’d be sun. Still it gets you wondering. Maybe worrying, too.

For many TTC, the nagging fear wasn’t so much the end itself, but the question…

Will the world end before I have a baby?

I know there are days when you feel so low that a part of you might welcome the end of the world. And end to the depression of living with the pain and stress of infertility. I worry about what such predictions do to the fragile psyche of those already “out on the ledge” emotionally…like those TTC. It’s scary stuff, especially if you let it suck you in.

So…don’t. The world as you know it is still here, with you and your partner…and your fertility doctor…in it.

And here’s my own prediction…it’ll be here long after your infertility journey ends. It’ll be here long after your kid’s infertility journey ends. And by the time your grandkids grow up, there won’t be any more infertility. Or there’ll be a cheap, easy fix available. And the world will still be here.

None of us are guaranteed tomorrow, but the odds are that the sun’ll come out. So if we got anything out of this weekend’s failed doomsday prediction, it should serve as a reaffirmation of life and a reminder not to delay in pursuing our dreams…at least to the extent the pursuit is in our control.

That famous ginger of an orphan girl…though too perky for my taste… was on to something when she crooned: “When I’m stuck with a day that’s gray and lonely, I just stick out my chin and grin and say Ooooooo the sun’ll come out tomorrow, so you gotta hang on til tomorrow, come what may. Tomorrow, tomorrow, I love ya, tomorrow, you’re only a day away.”

And now I’ll leave you with that annoying tune stuck in your head for the day.

In about an hour, you’ll be wishing that prediction came true!

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How were you affected by the doomsday prediction? Did you do something special or different “just in case”?

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Infertility, Puppies, and Karma

By Tracey Minella

May 20th, 2011 at 9:34 am

Can loving a puppy help you conceive?

I was empty inside. Years into my journey with no baby yet. I had just lost my mom suddenly. Left my job in the city and sunk into a deep depression. I literally wallowed in my grief all day long…over my mom who never became a grandma and over the baby that seemed beyond reach.

One evening, my husband forced me to accompany him to a Chamber of Commerce meeting which was being held at the Guide Dog Foundation for the Blind. He said I needed to get off the couch and be around people again. Had it really been four months?

Begrudgingly, I conceded.

So here I am… taking the tour with a bunch of networking strangers and thinking how this was the last place I wanted to be. Then came the puppies.

Just so happens, they had little Labrador puppies. I got to hold one. A fat little black one with long floppy ears.

That was it.

I couldn’t hold it close enough. It snuggled into my neck. I could feel its heart beating against me. The businessmen were scattered about a multi-leveled Japanese garden, so no one saw me bury my head in the puppy and dissolve into tears.

It was a turning point in my infertility journey.

I told my husband that night that we were going to raise one of those puppies for the Foundation. He said I was nuts. Every one of my friends agreed with him.

I had the puppy home two days later.

It’d be a one year commitment, I reasoned. All vet expenses paid. Free boarding at the Foundation whenever we needed, so we wouldn’t be tied down when we had procedures. Just had to feed it and raise it to have certain good habits which it would need as a working dog.

This was right on so many levels for us. I had a purpose again. I was doing a wonderful thing for a blind person. I had something little…well at least for a short time…to love and that loved me back unconditionally. I had a delicious little diversion. And I needed that for my mental health. It took away some of the stress.

Actually I had five diversions. My husband (the guy who said I was nuts) turned into Ralph Kramden of the Honeymooners. Remember him with the 3 shelter dogs claiming “they were over their limit”?

We had one or two dogs at a time for about 3 years. Coco, a petite little black Lab… who overlapped with each of the other dogs at some point… was with us the longest prior to being placed, having been abused by her prior puppy walker.

Yes, it was heartbreaking to give them back, but we always took a new puppy home the same day. And we got to meet each blind person who “our” dogs graduated with, and they were always so grateful to us. Everyone should experience a connection like that. It’s humbling.

These dogs were there to help me through failed IVFs, a miscarriage, and, finally to celebrate the happy phone call. I don’t think I could have gotten through such a long IVF journey without them to love while I waited for a baby. My husband feels the same.

We stopped puppy walking when I got pregnant, figuring it’d be too hard to put a young child through the heartbreak. Our last puppy, Pavarotti, went in for training that summer. But we missed the dogs. Maybe, once we got settled as new parents, we’d get a Lab of our own.

We hung the ornaments we’d gathered with our puppies’ pictures on them and prepared to celebrate our last Christmas alone before our baby’s January arrival. There was a knock on the door. Sitting there, with a jingle bell around her neck was Coco. The trainer was mumbling something about Coco not being happy in her work. All I knew was she was ours to keep!

Our daughter was born less than two weeks later. After giving back, we now received. Karma is a beautiful thing.

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How does your pet help you through the tough times along your journey? If you don’t have a pet, does this post make you want one?

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Is Your Biological Clock Running Out?

By Tracey Minella and David Kreiner MD

May 19th, 2011 at 9:02 am

I’ve always hated this term.

It used to nag at me in the back of my mind as I pursued my education and got settled in my career…especially since I married young. And when it wasn’t in the back of my mind, it was being shoved smack in my face by the rude comments of nosy jerks, collectively known as the "masses of asses".

If you’re wondering whether your biological clock is really running out, this post by Dr. David Kreiner of East Coast Fertility may be enlightening:

Tears start to course down the cheeks of my patient, her immediate response to the message I just conveyed to her. Minutes before, with great angst anticipating the depressing effect my words will have on her, I proceeded to explain how her FSH was slightly elevated and her antral follicle count was a disappointing 3-6 follicles. I was careful to say that though this is a screen that correlates with a woman’s fertility, sometimes a woman may be more fertile than suspected based on the hormone tests and ovarian ultrasound. I also said that even when the tests accurately show diminishing ovarian reserve (follicle number), we are often successful in achieving a pregnancy and obtaining a baby through in vitro fertilization especially when age is not a significant factor.

These encounters I have with patients are more frequent than they should be. Unfortunately, many women delay seeking help in their efforts to conceive until their age has become significant both because they have fewer healthy genetically normal eggs and because their ability to respond to fertility drugs with numerous mature eggs is depressed. Women often do not realize that fertility drops as they age starting in their 20s but at an increasing rate in their 30s and to a point that may often be barely treatable in their 40s.

A common reason women delay seeking help is the trend in society to have children at an older age. In the 1960’s it was much less common that women would go to college and seek a career as is typical of women today. The delayed childbearing increases the exposure of women to more sexual partners and a consequent increased risk of developing pelvic inflammatory disease with resulting fallopian tube adhesions. When patients have endometriosis, delaying pregnancy allows the endometriosis to develop further and cause damage to a woman’s ovaries and fallopian tubes. They are more likely to develop diminished ovarian reserve at a younger age due to the destruction of normal ovarian tissue by the endometriosis. Even more important is that aging results in natural depletion of the number of follicles and eggs with an increase in the percentage of these residual eggs that are unhealthy and/or genetically abnormal.

Diminished ovarian reserve is associated with decreased inhibin levels which decreases the negative feedback on the pituitary gland. FSH produced by the pituitary is elevated in response to the diminished ovarian reserve and inhibin levels unless a woman has a cyst producing high estradiol levels which also lowers FSH. This is why we assess estradiol levels at the same time as FSH. Anti-Mullerian Hormone (AMH) can be tested throughout a woman’s menstrual cycle and levels correlate with ovarian reserve. Early follicular ultrasound can be performed to evaluate a woman’s antral follicle count. The antral follicle count also correlates with ovarian reserve.

By screening women annually with hormone tests and ultrasounds a physician may assess whether a woman is at high risk of developing diminished ovarian reserve in the subsequent year. Alerting a woman to her individual fertility status would allow women to adjust their family planning to fit their individual needs.

Aggressive fertility therapy may be the best option when it appears that one is running out of time. Ovulation induction with intrauterine insemination, MicroIVF and IVF are all considerations that speed up the process and allow a patient to take advantage of her residual fertility.

With fertility screening of day 3 estradiol and FSH, AMH and early follicular ultrasound antral follicle counts, the biological clock may still be ticking but at least one may keep an eye on it and know what time it is and act accordingly.

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Infertility Patients: Are You Faking It?

By Tracey Minella

May 18th, 2011 at 12:00 am

I don’t mean faking it like Meg Ryan in the famous diner scene of When Harry Met Sally.

I mean faking it when it comes to understanding your IVF doctor and participating in your care.

Do you experience selective deafness when he starts talking technical stuff? You know, glaze over and go off to some far away place. Do you have one of those out of body experiences while she rattles off her treatment plan to you? Then, snap back to reality just in time to give the fake nod of understanding.

And don’t even ask you how many follicles were how big on which side! Once the lights go out, the hearing dims, too. It’s like a touch of the sono wand magically takes away your ability to hear and absorb any details.

Do you have a million questions, but go blank when it’s time to ask them? If you write them down, do you still chicken out and go home without asking them? Why?

My in-laws are in their 80’s and were raised to respect and not question their doctors. It’s a wonder they are still alive. And that’s not a knock on doctors. (Some of my best friends are doctors.) This kind of thinking is outdated, ladies. It’s time to get with the program, tune in, and speak up.

Doctors are human. They are overworked and see many patients. They don’t always have all the answers and they haven’t always thought of every possible thing that can be done.

It is your job to help your doctor help you.

Stop faking it.

If you have something to ask or to add, do it. No one is going to laugh at you or bite your head off. Your questions and their answers just might inspire a revelation on a treatment plan the doctor hadn’t considered yet. Become an active partner in your medical care.

And before you know it, you may spy a pregnant woman in the diner and be able to say “I’ll have what she’s having!”

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