The AFA Blog

A world on fire.

  by Corey Whelan

It feels like the whole world is on fire right now.  Civil unrest and natural disasters have been nudging the stressometer up notch by notch in our collective unconsciousness for awhile now, I think.  I remember reading newspaper articles years ago about the Cold War and how constant anxiety about the bomb was increasing the daily stress that Americans (and I'm sure Russians too) lived with, like a sort of  low level whirring sound in the brain that you forget is there, but that never really recedes.  

Headlines this weekend about that fool, that monster, that idiot in Florida and the violence that has ensued since he burned the Koran pumped up the jam just enough to flip me out completely.  It just feels like open season now, not just on Americans world wide, but on the whole species Human Being.  As it has always been, I guess.

I thought about all this while I was running this morning.  Three miles in and I started to think about stocking up on bottled water.  Five miles in and I started to think about the talk I need to have with my children about all this and how I don't want to.  Seven miles in and I remembered the reason why I started running in the first place.

Many of you who haven't known me for forever find it hard to believe that once upon a time I weighed around 50 pounds more than I do now.  Pregnancy with multiples, and a marriage that was shredding itself to bits turned into a lust for bagels, maple syrup and low fat dulce la leche frozen yogurt that I deluded myself into thinking was ok for me to eat on a daily basis.  And then 9/11 happened.

My babies were small then.  I remember thinking, if I have to run out of a burning building with one kid under each arm, would I be able to do it?

And the answer was no.  I was too overweight and out of shape to run and get my babies and myself to safety if I ever needed to.

So I went for a walk.  A very long walk.  And a few days later I went for a run.  A very short run.  And I threw out the bagels and all the high carb crap I had let my PCOS insulin resistant body get addicted to and I slowly became my old, healthy-weight self again.  Strong, thin, and robust.  My own personal best for my own physical self.

People, look.  I don't know what's coming next, none of us do.  But I do know that no matter what comes, and also no matter what doesn't come, the species human being, all of us, deserve the right to be our own personal best.  For me it's being a runner who weighs 115 lbs.  For you it may mean being a walker or a tennis player who weighs 135 lbs.  But whatever your own personal health best is, I urge you to acheive it.  It is better for your fertility.  It will be better for your pregnancy and your baby, God willing.  It will be better for you no matter what life brings.  Really.  

Think about maybe joining in and doing what The AFA staff will be doing for NIAW.  Think about doing a Fertility Bootcamp, if that feels like a fit for you.  Think about doing something.  And then just do it.  

I don't know what's coming next.     

International adoption alert: China is resuming adoption applications from single women.

The following information was supplied via our friends at the Ametz Adoption Program:  The China Center for Adoption Affairs is opening the program to aid in finding good families for their Special Focus Children. Children with a Special Focus designation are those who have been waiting on the shared list for more than two months; they are generally older (pre-school- and school-aged) or any age (infant through school-aged) who have an identified special need. The following is the notice released by the CCAA: Government departments and adoption agencies in receiving countries, In order to promote special needs child adoption and guarantee the basic interests of the orphaned and disabled children, CCAA decided to accept the adoption applications from female single applicants to adopt according to the requirements listed in this notice, starting from March 15, 2011: Female single applicants are allowed to adopt special focus children listed on the special Needs System of CCAA. One applicant can only adopt one special focus child at a time, with an interval of at least one year between two adoptions. The applicant shall have reached the age of 30 years and are under 50. For applicants over 50, the age difference between the child to be adopted and the applicant shall be no more than 45 years. The applicant shall provide her civil status certificate. Unmarried applicants shall provide certification for being single and non-homosexual; divorced applicants shall provide the divorce certificate of the last marriage; and widowed applicants shall provide the death certificate of their ex-spouse. The reason of being single and attitude towards marriage. Applicants shall have clear indication of willingness to appoint male figures as role models for the adopted child, and welcome male friends to join family gatherings. Applicants shall have received inter-country adoption training and training specifically for special needs child adoption so as to understand fully the physical and psychological needs of special needs children. Detailed nurturing and rehabilitation plan. Applicants shall be qualified personally and socially for caring special needs children and have wide social and family supporting network which can provide assistance any time. Guardians appointed by the applicants shall provide written statement as consent to act as the guardian of the adopted child. X. If the applicant has a stable relationship and lives with a male partner, t he requirements of couple applicants shall be applied. Applicants shall be healthy both physically and mentally according to the requirements by CCAA for prospective adoptive couples. Applicants shall be law abiding with no criminal records, and have good moral quality and conduct. The family annual income shall reach $10,000 per family member, including the prospective adoptee and the family net assets value should reach $100,000. The applicant shall have good medical insurance which can cover the medical expense of the adopted child. Applicants shall be experienced in child caring or be occupied in child-related fields, such as doctor, nurse, teacher, child psychological counselor, etc. It's best that the applicants have already had successful experience in caring for special needs children. The number of children in the applicant's family under the age of 18 years shall be no more than two, and the youngest one should have reached the age of 6 years old. Applicants shall be fully prepared for adopting a special focus child. Social workers shall provide the following information fully and timely in the home study reports besides family visit interviews: Adoption motive. The decision to adopt a special focus child shall be well-considered. Applicants shall be capable of caring for a special need child and be responsible for the well-being of the child. For information about Ametz's upcoming adoption conference please click here. Photo: Hongqi Zhang

A London Fertility Charity, Chana, Provides a Lifeline to the Orthodox Jewish Community

by Lisa Marsh, The AFA's London Correspondent

I recently attended the 1^st International Medical Conference in London, hosted by Chana, a not-for-profit organization serving the Jewish community.  In this ground-breaking event, Chana brought together specialists in fertility medicine, Rabbis from the UK and Europe, local GPs, midwives and counsellors, Kallah teachers (Jewish pre-marital instruction) and members of the community.

I attended the conference, titled "Facing the Fertility Challenge Together," to learn about the part that Jewish (Halachic) law and culture play in a couple's decision-making process about fertility treatment.  While Jews represent only about 2% of the population in London, and only .5 % of the total UK population, the greatest concentration of Jewish people are in the areas of Hertsmere and Barnet in North London, comprising 11% and 14% of those communities, respectively.  The majority belong to one of the Orthodox Jewish sects, ranging from the Modern Orthodox to the Ultra-Orthodox.  I think it’s fair to say that within those communities, both religious and cultural traditions govern the way that individuals conduct their personal lives.  Their Judaism is inseparable from the rest of their personal identity.  The Orthodox community favours early marriage, some still arranged by parents to ensure appropriate matches, and large families.  On the one hand, I wondered how individuals within that community cope when faced with infertility and pregnancy loss.  On the other hand, I wondered how religious leaders within the Orthodox community respond to some of the ethical dilemmas posed by ever-changing technology in fertility medicine.

Chana sprung from the need for mutual support of a few infertile, Orthodox Jewish women fifteen years ago.  It has developed into a large, charitable organization dedicated to informing and supporting infertile people across the entire Jewish community.  According to Carolyn Cohen, Principal Social Worker at Chana, they hold many fertility-related, educational programmes in the London area and have provided support through its Helpline to callers from as far away as South Africa.  Callers are not asked any questions about their religious affiliation or beliefs.  However, it must be emphasized that Chana takes a sensitive and respectful stance on the place that rabbinical guidance plays in family matters within the Orthodox community.  In the Conference guide, it is noted that “Rabbonim (Rabbis) advise members of the public to seek professional Rabbinical guidance before embarking on fertility treatment.”  

As you may expect, in practice, even among Orthodox Jewish fertility patients, some will involve their rabbis in the enquiry, discussion and decision-making process, and many others will not; afraid perhaps of what their judgment will be.  One might suspect that Orthodox Rabbis are restrictive, operating under very old-fashioned values and uninformed about matters of fertility, medically-assisted conception, the use of third party donors and new technologies.  I discovered that, far from shying away from the very progressive area of reproductive medicine, the Orthodox community is using its strong links within the medical field to educate itself about the causes of infertility and miscarriage, the emotional impact they cause upon the couple involved, the availability of treatment and its accessibility. There were 90 Orthodox Rabbis present among the 400 people attending the Conference.  Dr Simon Fishel, Managing Director of Care Fertility Group and a member of Chana’s Medical Advisory Panel, told me that Orthodox fertility patients sometimes bring their Rabbi with them to consultations in an effort to reconcile their family-building goal, their diagnosis and the medical treatment available with their religious beliefs.  According to both Dr Fishel and Carolyn Cohen, there is no one rule which governs a Rabbi’s judgment about any aspect of fertility treatment; they take each couple’s situation on a case-by-case basis. The overriding intention is to help the couple achieve parenthood if at all possible.

As in other cultures that promote large families, there is enormous pressure on Orthodox Jewish couples to conceive early and often.  An infertile couple in that situation may feel particularly embarrassed, ashamed, judged, isolated and/or excluded.  Added to that, the extreme privacy with which matters of intimacy are regarded, it can be difficult for them to seek advice and support.  Chana successfully negotiated the interests and needs of the various members of the community by providing separate, single-sex meetings for men and women, and entirely separate seminars for
Rabbis, Groom and Bride Teachers attending.  This enabled members of the packed seminars to listen to matters of marital intimacy, such as the consummation of marriage, and ask questions after each presentation without the potential embarrassment of a mixed audience.   

Some of the lectures were all about the current status in a given area of fertility medicine, such as the one on recurrent miscarriage by Prof Lesley Regan, of St Mary’s Hospital, Paddington (London).  Prof Regan carefully explained the research in which her team is involved, why miscarriage occurs and the restrictions upon investigation and treatment under the National Health System. None of the facts or figures was specific to the Jewish community.  What made this lecture and the others unique was the context in which they were made.  Care was taken by speakers to respect the particular sensitivities of the largely Orthodox Jewish, female audience, how they communicate and the level of privacy they cherish. Their cultural norms also present characteristics that form a part of the patient's history to be taken by a fertility specialist. For example:

1.       Sexual history - Patients may be very reticent about matters of sexual function and intimacy, which are generally not discussed in mixed company.  Without a full and frank discussion of their sexual relationship, her menstrual cycle and fertility health issues such as sperm production, it could be very easy to mistake very early miscarriages for a failure to conceive or vice-versa, complicating potential treatment. Understanding of the sensitivities involved, as well as religious proscriptions against consummation of the sexual relationship prior to marriage, would be essential for a good doctor-patient relationship;

2.       Genetic History - there are certain genetic mutations which affect Jewish people, which would be exacerbated by inter-marriage within the relatively small Orthodox community. One in 27 Ashkenazi Jews are carriers of the gene mutation that causes Tay - Sachs disease, while only 1 in 250 Sephardi Jews are carriers. Therefore, genetic testing may be an earlier focal point in couples who are both Ashkenazi Jews. Additionally, the usage and source of donor eggs and sperm is of particular interest, so that any potential incestuous relationships among  future generations are absolutely avoided;

3.       Emotional aspects of the patient's infertility -  Because having children is such an integral part of an Orthodox Jewish's woman's life purpose and her marriage, those who fail to conceive could feel particularly pressured, leading to feelings of anxiety, failure and low self-worth.

Chana does not limit its support to the Orthodox community; however that is largely where its users are from. Perhaps it is because Jews from other sects do not feel as strong a connection between their Judaism and the medical decisions they need to make.  However observant they may be, it may simply never occur to members of the Reform or Liberal Jewish movements to consult their Rabbi about an inability to conceive, a need for assisted conception or a decision to stop trying when IVF fails.  It is likely that they believe their needs for emotional support are adequately met by other people who are trained in talking therapies and/or infertility. While I didn’t glean any definitive information about how fertility treatment is viewed in relation to Halachic Law, I did come away with the feeling that Rabbis seek, where possible, to permit medical assistance for infertility rather than preclude a couple from having a family of their own. 

If there was one element missing from the conference, it was the absence of any personal examples of how infertility affected members of the community and how they have resolved or might be able to resolve them. I didn’t hear anyone speak publicly of their personal experience with infertility, or with their need for medical assistance and emotional support.  Questions for the speakers were carefully phrased very generally or technically, changing the nature of the intended “workshops” to more of a lecture or presentation.  It was not until I had a chance to read the very personal, albeit anonymous, stories, poetry and letters in the remarkable Chana Magazine, that I understood the unique social repercussions of infertility in the Orthodox Jewish community and how Chana’s services are a lifeline for those affected. The message was clear: no one in the community needs to bear the pain of infertility or pregnancy loss on their own. Isolation is unhelpful; reaching out is worthwhile; help is available.

Update on Haitian Adoption

Dr. Diane B. Kunz, Esq.

Responding to   “After Haiti Quake, the Chaos of U.S. Adoptions, ” by Ginger Thompson, the New York Times, August 4, 2010.

This article unfairly maligns the dedicated government officials who worked tirelessly, hand in hand with the Haitian government, to serve the needs of all Haiti citizens in the aftermath of the January 12 earthquake.

Consider the context. Unicef, along with many NGO’s, has been operating in Haiti for years, funding, and therefore tacitly approving a system, that allowed an estimated 380,000 children to languish in orphanages. Many of these children had biological parents, but parents who were unable or unwilling to care for them. Another 200,000 were used as restaveks (child slaves), often by family members, and in plain sight of those who are supposed to be protecting them.

The earthquake threw this already fragile system into complete disarray.  Unicef led the charge to keep children in the country. When all you have are tents, a tent city seems like the right response. Others attempted to count children; when you don’t have a family, or food or water, an id bracelet can seem like the right response. Never mind that there was no way to verify the information used to register the children. Organizations experienced in providing group homes weighed in-arguing for their “family-based” care options. Never mind that there is nothing family about it-it is small scale institutional care. Meanwhile, citizens from many countries, including the U.S. begged to help. Potential adoptive parents asked for an accelerated process, many others proposed large scale “Peter Pan” airlifts to bring children to safety.

It is the largely thankless task of Department of State and Homeland Security officials to weigh all of these proposals, and decide how to act. Secretary of State Hillary Clinton appointed Michele Bond, Deputy Assistant Secretary of State, to the position of interagency coordinator for this unprecedented effort.    She and her colleagues knew that despite ideological pressures for all children to remain in country and “enjoy their cultural heritage”, congregate care exposes children to risk of exploitation, and is never a safe or appropriate placement.

In Haiti, we can be proud that our officials acted swiftly and with the best interests of children at heart. With imperfect information, and respect for a partner government that suffered enormous personnel and structural damage, the U.S. government offered a haven to children who had suffered a devastating loss. The Haitian children brought to the United States through this program will have the opportunity to embrace their Haitian past as well or better than if they were left in a tent city. With the benefit of health care and an education previously unknown to him or her, these children will be free to explore their future from the arms of  parents who have made a lifelong commitment, secure in the knowledge that their lives were valuable to the country which granted them refuge.

Diane B. Kunz is an American author, historia and lawyer, and executive director of the Center for Adoption Policy.  She is the author of Butter and Guns, an overview of America's Cold War economic policy.

The Exaggerated Scandal of Aborted IVF Babies and How it Could Set Back Public Opinion of IVF and Abortion

 

by Lisa Marsh, AFA London Correspondent

How my heart stopped and my mouth went dry when I initially saw the reports online of approximately 80 women a year in the UK aborting babies conceived through IVF.  It was reported, unfortunately, as a step taken in response to  “losing in love.” One woman was reported to have never really wanted a baby, but had just gone ahead for her husband's sake.  She aborted her IVF baby without her husband's knowledge.  This is not normal behaviour.  I believe that, for most of the women concerned, it was probably a heart-rending decision.             

This news flash, combining eye-catching key words, #scandal, #aborted and #IVF, made an appearance  on the front page of The Sunday Times yesterday. It was suggested that the abortions were for "social" reasons.  It's not at all surprising that it’s been picked up  on Twitter and re-Tweeted  around the globe, supporting the idea that medical procedures, the creation of a life and a hard-won pregnancy were being tossed around thoughtlessly by patients and doctors alike. 

Professor Bill Ledger, a member of the Human Fertilisation and Embryology Authority (HFEA) in the UK, expressed shock at the number in The Sunday Times article, and called each one a tragedy.

While I am both pro-IVF and pro-choice, I agree that it is tragic, not only for the actual ending of each pregnancy, but also for the inevitable fallout it will create in public opinion of IVF.

Having been through IVF myself, I can hardly imagine that anyone would let themselves in for that rigorous, physical and emotional experience unless they really wanted to be pregnant.  An IVF cycle is planned months in advance, requires drug treatment and, while not surgical, is an invasive procedure.  It's expensive, so must be justified whether your insurance company, the National Health Service (UK) or you are paying for it. It inconveniently interferes with your work and social schedule, does a number on your self-image and practically invites the opinion of third parties.  It’s stressful, requiring the voluntary suspension of control over many aspects of your life, including intimacy.

How does a much-wanted pregnancy turn into a self-imposed tragedy?  I don't believe that these abortions are carried out on a whim.  Having an abortion at the end of a relationship is not considered at the same level as the old song from the film South Pacific: "I'm gonna wash that man right out of my hair." Pro-life activists assert that all abortion is unconscionable and those carrying it out are thoughtless, selfish and sinful; using abortion as a method of birth control.

According to an article in The Telegraph, approximately 190,047 abortions were carried out in the UK in 2009, 1,000 of which were performed on children under the age of fifteen.  Fear that the under-15s are using abortion as birth control may be justified, as the UK is reputed to have one of the highest levels of teen pregnancy in Europe.  Casting that aside, an older woman who becomes pregnant accidentally, may face a decision that impacts upon her chances of having another child in the future;  it’s not one made lightly.

An IVF procedure is voluntarily sought and undergone, not forced, therefore a pregnancy resulting from IVF will always be purposeful.  At each step forward, a woman is assessed by her general practitioners, gynaecologists, reproductive endocrinologists and hopefully, by counsellors or coaches, to determine whether IVF is absolutely necessary and appropriate for her to conceive. It requires conviction and commitment; the lack of either almost certainly showing up before she has gone through the IVF procedure.  Statistics show that of 36,861 women who had IVF treatment in 2007, only 11,091 of them had successful births, resulting in 13,672 babies or a 30% success rate.  There being alternative means of family-building, for a woman to pursue IVF to the stage of conception and become part of that minority who succeed, it's unlikely that she will merely change her mind. The circumstances would have to be dire. One woman cited her need to break all ties with her soon-to-be ex-husband.

My personal reaction to the news reports about aborted IVF babies ranges from dismay to distress.  As a fertility advocate, I educate people about infertility and treatments like IVF, in the hope that any residual stigma will eventually disappear.  I know that this news item could negatively affect public opinion about infertility, fertility treatment and those who need it, particularly in a country that provides such treatment through tax-supported, public  funds.

In a scathing comment to Lois Roger's article in The Times, a person calling himself Forrester Christopher said: "This is just obscene. The problem with IVF is the consumerist attitude it denotes. Some are not intended by nature for genetic reasons to conceive.  IVF is a form of pet ownership...just odd... adopt a child and get real!"

Another reader took a financial stance, saying that all people who wanted IVF should pay for it themselves instead  of it being provided by the NHS.  In the U.S., an equivalent argument would be a person who believes that his insurance premium is inflated in order to pay out to women who claim for fertility treatment.  These kidns of comments are uninformed, insensitive and boorish, making sweeping judgments of all people who can conceive a child only with the help of medial science.  That's the forest.  There there are the trees; the thousands of women who, one by one, may now reverse the tide and decide to hide their efforts to conceive through assisted reproductive techniques, fearing renewed scrutiny and judgment.

There is also a troublesome dichotomy: whether aborting a single IVF baby is any different to aborting "extra" foetuses if it appears that there will be multiple births. It has long been a practice of fertility doctors to implant several embryos during IVF to give a woman the best chance of conceiving.  Many doctors then recommend aborting (Is "thinning out" a more acceptable term?) one or more for the health of the surviving babies, the best chance of a healthy childbirth and ultimately, the lifestyle of the prospective parents. Some might think this is only common sense, but from the moral standpoint of the pro-life community, these procedures would be classed as murder.  Yet, it seems to have slipped under the radar and even to be considered a second, but preferred, choice to another woman becoming Octomom, which was a scandal in itself.

There's an uncomfortable, unresolved question hanging in the air over the difference, if any. The far more neat solution would be to limit implantation to one embryo, which is the choice that is advocated by the UK charity Oneatatime. Their mission statement is: "The aim of all fertility treatment should be the birth of a healthy, singleton child." It merits discussion, perhaps in an article of its own, but I'd bet that on a gut level it doesn't have the same impact upon the public as does the "scandal of aborted IVF babies."

On a personal level, I shudder to think how this negative media attention could affect the dozens of infertile women whose blogs I read.  Many have blogged for years under anonymous  usernames to protect themselves from the perceived disapproval and/or hurtful comments of others.  Some of them have let down their defences after becoming familiar with each other on Twitter and infertility forums.  They consider themselves part of a sisterhood and rejoice with each other at every positive test result and feel each other's pain at every negative result, whether it be a number on a chart, a failed cycle or a miscarriage. It's a fantastic support network when you find like-minded individuals who click in a cyber-friendship and even better, when the friendship survives in "real-time."

Unfortunately, one common theme among members of the infertile community is resentment toward women who can conceive easily, who announce their pregnancy with great fanfare on social networks like Facebook, and blissful, pregnant women or new mothers out and about.  It isn't their most shining quality, however, its source is  deep inside the emotional well: the deep sadness, sense of insecurity, lack of self-worth and envy.  What I do know is that even those IF sisters who sound almost militant and separatist are in truth, still vulnerable. To think of another woman, who had already achieved with IVF what they want so much for themselves, throwing away that achievement would be the ultimate slap in the face.

I felt a little current of electric shock myself when I first saw the news report about the “scandalous” abortions of IVF babies.  However, we haven't been made aware of a breakdown of the 80 or so women included in the HFEA statistics, if one has even been done. We don’t know their ages, mental health, cultures, health risks, relationships, change in employment or financial situation, or indeed, any possible anomalies in the foetus.  According to the UK National Statistics Office, there were 690,013 births and 198,500 abortions performed in the UK in 2007.  Compare the number (about 80) of IVF babies aborted, with no accompanying breakdown as to the reasons why they were performed, relative to the statistics mentioned above.  It is obvious that this is not a wide-scale trend even remotely applicable to most IVF pregnancies and births. 

I hope that anyone reading articles mentioned and Tweets about this finding by the HFEA will understand that, while it’s shocking to realize that post IVF abortions are occurring at all, these headlines are just hype.  I hope they will not use it as a weapon to negate the status of infertility as a medical condition deserving of treatment, funding and research. I hope that the infertile community does not crawl back into the shell from which it only recently emerged.  I hope that I can cast off the gloomy thought that any of these 80 women may have used abortion of an IVF baby with no other reason than a change of mind about being a mother.

Lisa Marsh is an American fertility coach who lives and works out of London, U.K. and London correspondent for The American Fertility Association's blog page.  You can find more information about Lisa’s work at http;//yourgreatlife.typepad.com  or follow her fertility and miscarriage-related Tweets on Twitter @yourgreatlife.