The AFA Blog

Twins are everywhere!

by Jamie Schenk DeWitt

Next time you are walking down the street or jogging in the park, notice how many double or even triple strollers there are.  I was at the park yesterday with my 21-month-old twin daughters and saw three pairs of twin strollers and one set of triplets!  

Based on figures from the American Society for Reproductive Medicine, approximately 30% of couples that undergo ART (Assisted Reproductive Therapy) will give birth to twins versus 1-2 % of spontaneous pregnancies.  

Below are two of the reasons why:

1.  Fertility drugs that are prescribed to patients encourage the ovaries to release more than one egg during ovulation.  

 2. During the embryo transfer of an IVF (In vitro fertilization) cycle, doctors often implant more than one embryo in the womb.  (Ever since the infamous Octomom debacle fertility doctors have been under fire for implanting more than one embryo, but -- needless to say -- depending on the woman’s age,  infertility diagnosis and doctor’s medical evaluation, sometimes it may make sense to implant more than one embryo).  

The first consultation that my husband and I had with our fertility doctor he asked us,   “How do you feel about having twins?”  Spontaneously I responded, “Great!  I would love it.” Our physician went on to inform us that there was a greater chance of having multiples when using assisted reproductive methods.  Because I was so distraught over not being able to get pregnant naturally it seemed like a blessing to get pregnant with one baby, let alone twins.

8 months after our initial visit with our fertility doctor, I was pregnant with twins.  It was one of the most joyous days in my life.  After all of the failed treatments, it felt like a miracle that I was pregnant.  And since being pregnant with twins put me in the high-risk pregnancy category, I was consumed with staying healthy, and the reality of what it meant both physically and financially to take care of twins after they were born did not faze me right away.  Yes, we bought two cribs, two car seats and a double Snap-n-Go stroller (an essential item) in preparation for their arrival.   Yet, the notion that we would have to do two of everything at the same time, -- two diapers, two feedings, and two baths – did not hit me until the morning they were born. Literally, my life changed in an instant. 

The challenges of their first three months, from trying to figure out how to simultaneously breastfeed two babies, to consoling two hysterically crying infants, to learning how to synchronize their schedules, so I could get some sleep at night were tremendous.  I can still remember the first night that I was alone with both of them.  The baby nurse and my mom had left to go back to their respective cities and my husband was working late.  I had successfully positioned both girls on each breast in the football position for their evening feeding.  However, when it came time to give them each a bottle (I had to supplement with formula since I didn’t produce enough milk for two babies) all hell broke out.  They were both crying.   I couldn’t figure out how to hold both of their heads up at the same time to give them their bottles. It was a disaster.  By the time my husband came home, I was bawling.  

Needless to say, I ended up figuring out how to manage that situation, but in the process I felt awful.  It would take several months of trial and error for me to feel like a “mother of twins.” Taking care of my daughters was the most difficult job that I had ever encountered, but with each new challenge that I conquered, I found my voice as a mother.  I learned how to trust myself, rely on the advice of other parents of twins, and use parenting experts in my community.  I also drew incredible strength from observing my spectacular girls grow and develop.  I was proud of who we were becoming as a family and with this newfound confidence, I never shied away from taking them to the park, classes, play dates or the grocery store by myself, which believe me, felt like quite an accomplishment at the time. 

Over the course of the first year I can still clearly remember the comments and looks that I got from other parents or strangers when they would see me out with my twin daughters.  

 “Wow twins!  You’ve got your hands full.”

“Are they twins?  So adorable!”

“Twins!  Two for the price of one.” (If they only knew how much IVF cost)

“A boy and a girl?”

“Are they identical?  Wow, they sure look identical don’t they?”

“You sure have a lot of energy for having two babies.” 

“They must keep you on your toes.”

“Agh twins.” (Insert look of desire) “I wanted twins, but I didn’t get so lucky.  I only have one baby.”

“Agh twins. How’s that going for you?” (Insert look of terror)

“Two babies.  Bet you’re busy.”

“I can’t believe you have twins!”

 Dead silence.  (Insert look at the babies, then look at me. Enough said.)

“Are you enjoying both of them?”

“So precious!”

“Do you have help?”

“Oh my God – Twins!  I could never imagine.”

“She looks so much like you.” (Pointing to the daughter who looks exactly like her father)

“They are so adorable.  You must get sick of hearing that?  They sure must keep you busy?  Okay I’ll leave you alone.”

“A boy and girl?  No.  Two boys.” (One is dressed in purple and the other in hot pink.)

 “You are so lucky and blessed.”

“That’s a lot of work.”

“Do twins run in your family?”

So whether you are taking care of one baby, two or three babies, motherhood is a journey and not a destination. Enjoy the ride because it all goes by so fast!   And just realize that if you need fertility treatments, know if you are willing to have a multiple birth, and know all the facts, both medical, emotional, and practically speaking. 

 Even though we did not plan on having twins when we began our fertility treatments I have learned from my own experience, as well as that of other mother’s of twins that the question of whether or not it is safe to have multiples is one to be taken very seriously. There are tremendous risks to both mother and babies when someone attempts to have a multiple pregnancy and you should make sure that you discuss this in depth with your doctor prior to conception being attempted.. 

 According to the Society for Assisted Reproductive Technology (SART).  the objective of infertility treatment should be the birth of a single, healthy child.  Multiple gestations, meaning twins or greater, can pose significant health concerns.  These include but are not limited to:

• Increased Rates of Miscarriage
• Increased Rates of Fetal Death, Even After Birth
• Cerebral Palsy:
• Increased Levels of Nausea, Heartburn and Vomiting during Pregnancy
• Pre-eclampsia (High Blood Pressure)
• Gestational Diabetes:
• Placenta Previa
• Heart Problems, Including Heart Attack for the Expectant Mother:
• Increased Need for Partial or Complete Bedrest, and Limited Physical Activity:
• Emotional Issues, including the possible need for Mutifetal Reduction
• Increased Rates of Caesarian Section Delivery
• Complications after Birth such as Development Delays or Autism

A sobering, and partial list.  It is important to note that not all twin pregnancies are problematic, many like mine, only posed temporary challenges that we as a family were able to overcome.  The American Fertility Association will be publishing several significant commentaries on this issue during 2011, as well as a fact sheet and video on elective Single Embryo Transfer, later on this month.  In depth information on all aspects of mutliple birth will be covered.

Compassion and The Human Family

by Ken Mosesian

A few days ago, David Kato, a gay rights activist in Uganda was beaten to death with a hammer in his home. The Pastor at his funeral used the opportunity to rail against LGBT persons, and the cemetery workers refused to bury his coffin, leaving his family and friends to dig his grave. 

I first read about it on Facebook. The next post was from friends of ours whose baby just turned one month old. My mind flashed to what David must have been like as a little baby. I can't wrap my mind around what happened. Maybe it was the juxtaposition of my friend's baby and David's horrific murder. Maybe it's because every day I work with the staff and board of The AFA to help people realize their dreams of creating a family. Maybe it's because of the recent terrorist act in Tucson, AZ, and the death of Christina Taylor Green, the little nine-year old girl that resulted from it. I don't know. But those two images - the little baby, and David's coffin - continue to haunt me. 

We're all part of one human family, and yet there is so much hatred that we express based on our differences: gender, orientation, nationality, ethnicity, religion, and virtually any other category that you can think of. 

Mahatma Gandhi taught us to "Be the change you want to see in the world."

What can each of us do to help create a world worthy of the children we hope to bring into it, and the children who are already here? What action, big or small, will each of us take today to be the change? 

Ken Mosesian

Executive Director

 

AP Photos

 

 

 

Villain or victim? An analysis of the Pettway kidnapping case.

by Andrea Mechanick Braverman, Ph.D.

When Ann Pettway kidnapped Carlina White only three weeks after her birth, she began a family based on loss and deception.  Carlina’s biological parents suffered untold anguish at the loss of their daughter, compounded by the uncertainty of her fate.  Was the kidnapping of baby Carlina an act of desperation by a woman who suffered multiple pregnancy losses and feared that she would never be a mother? Or was the kidnapping one of villainous self-interest and cold calculating entitlement?  Is Ann Pettway someone who deserves our pity and understanding or does she deserve our condemnation and scorn?

 We cannot help but have a preconceived judgment about Ann Pettway.  Even if a woman has been through multiple miscarriages, it is the rare woman who steals a baby from another.  How do we begin to understand the tidal wave of emotions that could ever allow a woman to consider such a heinous act?

 There are an estimated 72.4 million infertile women globally and, of that number, many have experienced miscarriage.  Women (and men) typically develop coping strategies, seek out medical help, and get support to get through these terrible losses The fear that infertility will always place the individual on the sidelines watching friends and family experience the fulfillment of raising a child leads to moments of utter despair:  that a pregnancy will never happen; that the dream of a long wanted biological child will be forever unmet; that the most important life goal will never be reached.

 So the nerve Ann Pettway touched was the one similar to the moments of desperation individuals and couples experience on the infertility pathway.  Many infertile women and men have observed that they have indulged in the fantasy of just taking a baby, but, quite obviously, they would never think of actually acting on that wish.  Just as the frustrations of caring for a newborn 24 hours a day can lead parents to fantasize about shaking the baby, such feelings would serve only as a marker of a need for more sleep or help.   Similarly, someone who has been through multiple miscarriages or infertility will recognize that the fantasy of taking a child is perhaps an indicator of a willingness to consider raising a non-biological or non-genetic child through adoption or gamete donation.

 By processing the feelings encountered through loss or infertility, these couples then often seek resolution through adoption or egg, sperm or embryo donation.  They have the appropriate empathy to understand that taking another’s child would leave its parent empty and grieving.  As a result, they build their family in a positive way and not on one based on loss and deception.  Because, as Carlina White proved when she sought out the truth, families built upon lies simply don’t work.  Ann Pettway clearly had something else operating in her beyond what a typical woman experiences when having multiple losses and that “something” allowed her to close down the normal processing of right and wrong; her empathy evaporated.

Most everyone knows someone personally who has experienced a miscarriage.  For some, it was a single loss and may not have had a long lasting impact. as another pregnancy was achieved and emotion and energy was focused on the successful pregnancy.  But for others, multiple miscarriages involve one devastating loss after another without the infrastructure we usually rely upon for such losses.  If public discourse would turn from the sensational aspects of the Carlina White story to one of understanding that many women experience emotional trauma after a pregnancy loss or the experience of infertility – the accompanying grief and fear – then Carlina’s story has a positive ending that extends beyond even her remarkable reunion with her parents.

 We need to support our family and friends who experience pregnancy loss and infertility.  We need to make it safe for those who are grieving to share this grief and the  typical ways we support the bereaved  assist them through their difficult journey.  We must not trivialize any loss with hard words like “it wasn’t meant to be” or “there was probably something wrong with the baby so it’s better it was never born” or “you were only a few weeks pregnant”; no one ever feels it is better to lose a child.  These words seek to paper over the pregnancy and loss when in fact many parents seek to honor the memory of that lost baby.  When a pregnancy begins, so begin the dreams and hopes and love for that unborn child.  So whether a pregnancy lasts a few days or weeks or months, or if the child is lost full-term, we need to let the bereaved hopeful parent know that their grief is real and legitimate and respected. 

 As Ann Pettway faces the (inevitably) very public courtroom proceedings, let us hope that we can step out of the court of public opinion and step into one of public education and better understanding of those 72.4 million infertile women as well as the infertile men who must endure the journey of fear, hope and uncertainty about becoming a parent.  Let Carlina White’s legacy not be one of simple loss and reunion, but rather also one of enlightenment and education.

Dr. Braverman is a health psychologist specialist in medical health management, infertility counseling, third party reproduction issues and diabetes care.

 

How-To; Getting Sperm from the Testis

by Craig Niederberger, M.D., F.A.C.S.

This blog post was inspired by several patients who asked after I explained surgical sperm retrieval, if there was somewhere they could go for more information.  I realized that I hadn’t written about such a common issue.

Just as a carpenter has many ways to make a cabinet, a surgeon can tackle a problem in a number of ways.  And just as two cabinets may differ, different surgical problems demand different approaches.  Such is the case in retrieving sperm from the testis.

Most of the time, taking sperm directly from the testis is necessary when a man has azoospermia, where no sperm is found in the ejaculate.  Azoospermia takes two basic forms, obstructive and non-obstructive.  As the name implies, obstructive azoospermia is due to a blockage in the tubes and structures that convey sperm from the testis to the outside world.  In the best case, a surgeon can fix the errant anatomy, allowing a couple to conceive children without further ado.  But because the tubes are so tiny, sometimes the tubes can’t be reconnected with surgery, and the alternative is to take sperm from the testis for it to be used in in-vitro fertilization.

The other form of azoospermia, non-obstructive, arises when the factory making sperm in the testis isn’t working quite right.  Sometimes, the cells starting sperm are missing entirely, a condition known as “Sertoli cell only syndrome”.  Occasionally, sperm may be rolling along their assembly line, a process that takes two to three months to complete, and stop mid-production.  When that happens, it’s called “maturation arrest”.  But frequently, sperm can be found in small amounts in the testis and can be retrieved using surgery.

Because it isn’t mature, sperm from the testis can only be used with in-vitro fertilization and intra-cytoplasmic sperm injection.

How can a surgeon remove sperm?  He or she can take it from the testis itself, or the epididymis, the tiny coiled tube lying on the back of the testis where sperm mature.  The surgeon can insert a needle into the testis or epididymis, he or she may make one or several small incisions into the testis or use microsurgery to retrieve sperm from either the testis or epididymis.  In the case of obstructive azoospermia, it doesn’t seem to matter which technique is used.  There’s plenty of sperm wherever it’s sought, and any method will do to retrieve it.  When a man has obstructive azoospermia, I usually recommend taking a small piece from the testis, as the sperm may be frozen and is good for a number of in-vitro fertilization cycles so that the man doesn’t need to go through a procedure for every cycle, and can be there for his wife during her procedures.

We’ve found that frozen sperm is just as good as fresh.  in fact, the chances for fertilization are the same for fresh and frozen sperm, and the chance for pregnancy may even be a little better for frozen sperm than for fresh.

Frozen sperm should literally last forever.  It’s in liquid nitrogen, which is so cold that the building blocks making sperm don’t decay.  Freezing sperm gives a couple time to plan when in-vitro fertilization is done.

When he has non-obstructive azoospermia, a man’s options are more limited.  A surgeon can use the operating microscope to comb through the testis looking for areas that may contain sperm, a procedure known as “microsurgical testis sperm extraction“.  Other techniques include making several small incisions in the testis or piercing the testis with a needle in a dozen or so different spots.  When a man has non-obstructive azoospermia, I usually recommend microsurgical testis sperm extraction.  More areas of the testis can be examined, and I can see the places that most likely contain sperm.

We’ve observed that prescribing a man with non-obstructive azoospermia clomiphene citrate for a few months before surgical retrieval seems to increase the chance to retrieve sperm.  In many men, sperm appears in the ejaculate and surgery isn’t needed.  If a couple has a few months, taking clomiphene before surgical sperm retrieval might be a good idea.

In short, a surgeon has many ways to retrieve sperm when necessary.  The choice depends on the preference of the surgeon and the couple, and what’s going on inside the testis.  I’ve listed the surgical techniques available, and my typical recommendations.

Bacon Cheeseburgers and Other Health Foods

By Harry Fisch, MD

Okay, I’m not totally serious. I’m not recommending bacon cheeseburgers on a daily basis.  I’m using this icon of fatty food to make a point: foods high in fat are not the enemy.  

The past decade has seen a remarkable sea change in the medical and scientific consensus about the alleged dangers of fat in our diet.  In part, this is from a re-evaluation of old research, such as that done in the '60s in Africa. Vanderbilt University scientist George Mann, MD, found that Masai tribesman in Kenya and Tanzania who lived primarily on red meat and whole milk were also very lean, had extremely low cholesterol levels, and were virtually free of heart disease.

In addition, a newly critical light has been shed on some research that seemed to support the hypothesis that eating lots of saturated fat raises your risk for cancer and heart disease. In 1953, physiologist Ancel Keys published an influential paper titled "Atherosclerosis, a Problem in Newer Public Health." He compared fat intake and the rate of heart disease in 6 countries: the United States, Canada, Australia, England, Italy and Japan. He found a correlation: nations with high levels of fat intake also had high levels of heart disease.  

Turns out, however, that Keys pulled a fast one. First of all, he “cherry-picked” his data. Statistics about fat intake and heart disease were actually available for 22 countries.  If you analyze all 22, the apparent link between fat consumption and heart disease disappeared. For example, the death rate from heart disease in Finland was 24 times that of Mexico, even though fat-consumption rates in the two nations were similar.

The other problem with Keys’ study is one that frequently bedevils researchers: correlation is not causation. In other words, maybe fat had little to do with the high rates of heart disease in the US, which had the highest level of fat intake of all.  Maybe it was the fact that US citizens didn’t exercise very much, or smoked a lot, or ate a lot of something else that was bad for the heart.

That “something else” is now generally agreed to be refined carbohydrates such as white sugar, white flour and high-fructose corn syrup.   This has led to a number of smart approach low carb diets such as that espoused by the late Robert Atkins, MD.  Recent research suggests that if you want to lose weight, you’re better off on a low-carb diet than a low-fat diet. When people on low-carb diets have been compared head-to-head with those on low-fat diets, the low-carb dieters typically scored significantly better on markers of heart disease, including both LDL and HDL cholesterol and triglycerides.

 The key idea in all of this is that your body makes fat from carbohydrates. It works like this: when you eat carbs (particularly starches and sugar), your blood sugar level rises. This triggers the release of insulin, which, in turn, signals the liver to start converting excess blood sugar to triglycerides, or fat.

So what’s the bottom line?  If you’re trying to lose weight, then I think a low-carb approach makes sense, combined, of course, with exercise.  If you’re already at a good weight and are otherwise healthy, then stay away from processed foods and unnecessary carbs, but relax and eat what you want with moderation. I like the advice of writer Michael Pollen:  "Eat food. Not too much. Mostly vegetables." His point is to eat normal food, the kind your grandmother was likely to cook — not stuff that’s full of added sugars and other ingredients.

I also think Julia Child had the right idea. She suggested that we all have an imaginary shelf labeled “Indulgences” which contained things like “the best butter, jumbo-sized eggs, heavy cream, marbled steaks, sausages, and gooey chocolate cakes.”  These are not “everyday” foods, she once wrote, but for special occasions, and “when that occasion comes, we can enjoy every mouthful.” Amen. And bon appétit!

Photo: Bricck

The Lone Ranger and Me: How I Met my Fertility Doctor

 

by Iris Waichler, MSW, LCSW

One of the most important decisions you make as you begin your infertility treatment is selecting the right doctor.  I was fortunate. I was working at a hospital that had an infertility clinic and a friend was the head nurse there.  She helped me decide which doctor was the best fit for me.                                                                                                       When I realized we were going to need help conceiving a baby, I knew my husband must be comfortable with our doctor.  I set up an appointment and we prepared some questions.  I decided to sit back and let the two of them get acquainted. The doctor had my husband’s immediate approval because of his buffalo belt buckle, and his story of traveling to Montana via motorcycle every summer to stop in small towns and meet the locals. I instantly liked him because he spent over an hour offering us his undivided attention, answering all our questions, and reassuring us that his experience and success with egg donor patients my age helped improve our chances of becoming parents.

            If like me, you need more than “how I spent my summer vacation” as a criteria to select a fertility doctor, or reproductive endocrinologist, there are many places to go.

 

• The AFA Physician Network can be accessed here: http://theafa.org/resources/physician_network/all

This site also features a therapist referral network, as well as one that is focused primarily on LGBT friendly providers.

 

• The Centers for Disease Control site can be accessed here:  http://www.cdc.gov/art/ART2007/PDF/COMPLETE_2007_ART.pdf  

It offers a compilation of fertility treatment success rates from doctors and clinics all around the country. It takes 3 years to collate the data so the most recent report is 2007.  The information is broken down by states, cities, patient age, and diagnosis. 

 

• You can also check the Society for Assisted Reproductive Technologies site at http://www.sart.org/frame/detail.aspx?id=3893 .  It offers similar information you can use to compare.

 

            Unexpected things happen. Our clinic underwent internal staff upheaval and our doctor, along with others, was forbidden to see or contact patients.  It was at a key time for us as we were undergoing our first embryo implantation.  We were frustrated and angry. The clinic referred me to another doctor that would not take phone calls. We refused to work with that doctor because he wouldn’t speak with us to address our questions. People feel especially vulnerable during infertility treatment, but I strongly support self advocating if necessary.  We ultimately worked with a physician that we interviewed over the phone, since timing was key in my treatment.  We nicknamed him “the Lone Ranger” because he had his mask on when he did my implantation.  We never did see his face, but the surgery was a success! 

            Spend time figuring out what is important to you when choosing your physician.  Bedside manner, geographical proximity, years of experience with women of your age category and/or diagnosis, number of cycles performed annually, success rates in your age range, support staff, availability, and treatment philosophy are some key categories.  Add some of your own.  Do the research! It can make all the difference when you embark on your infertility treatment.

How do I support my infertile sister-in-law?

by Shari Degraff Stewart and Julia Fichtner Krahm

"My sister-in-law and her husband have been struggling with infertility for some time now. They have been married 11 years and have been very private about their struggle.

I have two children and the other families each have 4 children, so there have been many pregnancies and babies over the last 11 years, which I can see is very painful for her each time another pregnancy in announced.

Now we (my husband and I) are talking about adopting an older child from an orphanage in Haiti, and I can see that even that is hard for her to hear. I want so badly to care for her in her struggle, but I also don't want to withhold information about our lives if it is not necessary.  Sometimes I just don't know what is ok to talk about, especially at these holiday gatherings when everyone is asking what is going on in your lives.

Any advice you can give would be really helpful".

—Tammy

Your compassion is evident in your question.  While you cannot alleviate the core of her grief, you can offer your support in gentle ways that let her know the door is open, you can run interference for her in family gatherings, you can offer a relationship with you, when loss of relationship is the primary cause of her pain.

You and your family have naturally been cautious in approaching this subject with your sister-in-law out of respect for her privacy.  You have likely been waiting for her to indicate whether she wants to discuss her infertility or not.  In the grief and pain she is experiencing, it is difficult for her to take that first step.  As hard as it may be, I encourage the friends and family members of an infertile woman to see that taking initiative to bring up the topic is one of the greatest acts of support and kindness you can offer.  You will still allow her to choose how much to respond, but your gentle offerings or questions will open the door enough if she does want to talk. Your words will be a simple acknowledgment of her pain followed by questions that invite conversation if she chooses or offers of help or support.  You will want to be careful to avoid giving advice or trying to change what she feels.  Here are some simple statements you could use:

 I imagine this is painful for you and I’m so sorry.

 I’m so sorry for how hard this must be.

 I often wonder if you are struggling. I care about that and I want you to know that your pain does not go unnoticed.

I don’t know where you are and I don’t want to be intrusive, but I want you to know that I care and if there is anything I can do that is supportive of you and your pain, I would like to.

What do you need? 

I would love to be supportive of you and want to know what is helpful and what is not helpful.  What do you need? 

Regarding your possibly adopting a child, offer her a brief description of your plans about the adoption then let her know that, in general, you are not going to bring up the topic, but will wait and let her choose if she wants news or information.  Something like this:

You know that Dave and I are considering adopting a child from Haiti.  I’m not sure if this news is hard for you to hear.  I just want to let you know that I will talk about it anytime you want, but I will wait for you to bring up the subject.

Likely, at some point in the future, she will take you up on your offer.  When she feels like she has the strength, she will ask you a question or two.  Be aware that her initiating the conversation does not mean she has endless capacity to talk about this new child.  Create natural breaks in the conversation that allow her to move on to another topic.  If she wants to continue to hear about your child, she will let you know.  It might look something like this:

Her:  So, tell me what is going on with the adoption.

You:  Oh we’ve just found out that ….  And then we’re going to….  So we’re thinking we might….  Anyway, you were going to tell me about the trip you are planning.

She will either move into this new conversation or will slow you down with another question about the adoption.  What I want you to notice is that you will create ways for her to manage the length of the conversation.  Depending upon your relationship, you can ask her, “How is it for you to talk about this?   The lovely thing about questions is that she can respond to your invitation to talk more if she wants, or she can politely say something simple, like “fine,” and you will know she doesn’t want to open up more about he r feelings at this time.

In family gatherings when it is natural for loved ones to talk about all of the children a nd especially your possible new child, you can do several things. 

• At the gathering, if much of the conversation remains on the adoption, you turn the conversation with a simple phrase, “Oh I’ll fill you in on all of that later, when are we going to play cards?”  In a follow-up conversation, you may say to one of the family members:  “I didn’t me an to cut you short, I just thought it might be painful to talk about the adoption too much with the whole family present.” Your words offer gentle education to this family member about your sister-in-laws needs.

• You can also offer her a break from the conversation by asking her to help you make some coffee in another room.  You might ask her in the kitchen, “Are you okay?”  Your open-ended question allows her to choose what and how much she discloses.

• If you’re hosting the gathering, encourage this couple to choose when and how much they attend:  “We’re thinking of eating around 6:00 and then maybe play some cards.  Do you want to come for all or part of the evening?”

Offer and make available girl-only or couple-only times when she can just be a person, a friend, or sister-in-law and doesn’t feel like she is always wearing a capital “I” for Infertile on her chest.  Dinner with you and your husband and no kids or an afternoon with you shopping or indulging in a manicure will offer the healing that comes from relationship.

Children encapsulate every relationship and feeling in our life.  She grieves not just being a mother.  She longs to re-experience her own childhood in a daughter, or see a glimpse of her husband’s boyhood in a son.  She knows she would touch the life of her mother and grandmother in holding her child in her arms.  She even recalls the thrill of falling in love with her husband as she instantly falls in love with her child.  It is all of these losses that she grieves.  Your friendship doesn’t fill this loss.  It does offer some respite from it and it offers some healing.

Reprinted with permission from the Stewart Institute for Infertility

Just dance.

by Corey Whelan

There are some weeks when my days begin like bubbling cauldrons.  Too much work (a good thing, seriously).  Too little time.  A book to illustrate.  A teenager to placate.  A life to live.  That makes me one of the lucky ones, btw.

One day last week I popped on my headphones and turned on my computer and found, well, nirvana.  The AFA's dear friends and allies at Associacao Portuguesa de Fertilidade, had posted a Michael Buble video on their Facebook wall with the simple affirmation "Music Break".  Ok, that I can do! Because music, and movement, shifts reality in only positive ways.  But of course, you already know that.

My dear sisters.  For those of you who are currently TTC and gritting your teeth.  For those of you who are pregnant after TTC and freaked out.  For those of you who are finally mommies and haven't brushed your hair in three days.  Breathe, girlfriends. 

Oh, and by the way?  For you brave and amazing men who just "don't know what she wants, how the hell can I be there for her anymore?" I have a simple directive for all of you.

Just dance.

Hey people.  It's Monday morning.  What could be more important than this?

Just dance.

 

 

The right to say goodbye. A legislative update.

  
 
by Corey Whelan

One of the most well read and vastly circulated blogs that The AFA has ever published appeared on this page last April, entitled "Old Gay Bones".  This piece relayed a tragic situation experienced by all too many LGBT families, that of not being allowed to visit, or comfort, a relative in a hospital.  No matter if that relative is a mom or a dad, or a grand dad, or a loving partner.  No matter if that relative is merely sick or silently dying, the spouses, children, loved ones of these individuals were often kept away from the bedsides of those who needed them most.  Who sometimes, needed them for the very last time.  

I must say, kudos to President Obama for being able to push this one through.  As of this week, patients at hospitals nationwide will now be allowed to decide who can visit them, and who is authorized to make decisions on their behalf.  New federal regulations that were put into effect this past Tuesday have made sexual orientation, gender identity or family makeup superfluous to the more significant issues at hand in these situations - those most human of issues.  Who do we need?  Who do we love? Who do we want to be with us, when we die?

Hospitals must now inform patients and their attending friends and families of their rights to visitors of their choosing.

For more on this story, click here.

 

 

January is thyroid awareness month. If you can't get pregnant, should you care?

by Corey Whelan

Your thyroid, that little gland at the base of your neck, is the master glad of your metabolism, and plays a significant role in many areas of a woman's reproductive life, from conception through to delivery.  59 million Americans, mostly women, currently have thyroid abnormalities in the U.S.  A significant percentage of these women are currently trying to conceive a baby.  Could you be one of them?

Thyroid problems fall along two specific lines, 1) hyperthyroidism, where the thyroid gland is overactive and producing an overabundance of thyroid hormone and 2) hypothyroidism, where the thyroid gland is underactive and not producing enough. 

Ironically, both extremes can present problems for women who are trying to get and stay pregnant.  Women with hypothyroidism may produce too much prolactin, which is the hormone that helps to create and maintain breast milk.  Too much prolactin can adversely affect fertility by inhibiting ovulation and therefore, conception. 

Women with undiagnosed hyperthyroidism may be at greater risk of miscarriage or premature birth, making it hard or impossible to maintain a healthy pregnancy.

It should be a no brainer that your thyroid is tested when you are first experiencing difficulties conceiving but unfortunately that is not often the case.  The reason is simple. The symptoms of both underactive and overactive thyroid are often vague and attributable to a wide variety of other disorders.  Symptoms  include sleeplessness, weight loss or gain, constipation, memory loss, or hair loss.  

A good rule of thumb is simply this.  If you are having trouble getting or staying pregnant, ask for a full battery of thyroid tests.  These tests include the TSH (Thyroid Stimulating Hormone) Test, the T4 test, the Free T3 test, and the Autoimmune Antibodies Test.  In addition, make sure that your physician is a reproductive endocrinologist or other specialist who can accurately  analyze the results of these blood tests and integrate them into your care, by evaluating your symptoms, taking your medical history and performing a clinical exam.  Proper diagnosis, and follow up treatment is key, particularly if you are placed in medication as your dosage will need to be carefully evaluated over time.

 That little butterfly shaped gland called the thyroid affects virtually every system in your body.  If you are trying to get pregnant, particularly if you are over the age of 35, make sure that a full battery of thyroid tests are part of your initial infertility workup.

For more information on this story, check out these important links:

http://www.thyroidawarenessmonth.com/ebook.htm

http://www.thyroid-info.com/pregnancyguide.htm

http://www.thyroid-info.com/articles/fertilitythy.htm

http://thyroid.about.com/cs/basics_starthere/a/couldyou_2.htm

http://www.examiner.com/x-14154-Raleigh-Infertility--Miscarriage-Examiner~y2009m11d23-Hypothyroidism-and-infertility?cid=examiner-email

http://thyroidawarenessmonth.com/

http://thyroidawarenessmonth.com/allyson-averell-facepainting.htm

Reprinted with permission from www.examiner.com

Photo: Allyson Averell