The AFA Blog

Please exercise

by Fred Licciardi, M.D.

Please exercise.

In the preceding centuries, tremendous physical activity was required for human survival, and yet, reproduction carried on. Imagine the exhaustion and stress if we had to spend one week hunting or farming with few tools or resources. Yet probably, under these conditions, most women would be able to get pregnant.

Excessive extreme exercise causing weight loss will cause ovulation to stop because the body figures that there are not enough nutrients stored for both the woman and a fetus. If she can just barely feed herself, she can’t feed the growing baby. The same is true for an anorectic. But here we are talking about extreme extreme. Moderate exercise is fine.

Surprising to me, I did come across a paper from Harvard showing that women who underwent moderate levels of exercise had lower pregnancy rates that those who did not. Like we always say, it’s just one paper. I do not really believe it. The Harvard doctors that I know do not restrict moderate exercise.

Exercise is bad if you are taking fertility drugs because the medications make the ovaries grow. Normally the ovaries are about the size of a walnut, and the drugs increase the number of follicles, therefore the ovarian size increases. Sometimes the ovaries can get to the size of plums or even oranges. They hang inside the pelvis. As they become heavier, they become more likely to twist, and this is called torsion. Here the twisting cuts off the blood supply and causes the ovary to choke. This really hurts, and is treated by laparoscopy. Exercise will increase the odds of this twisting. So in this case, exercise is not good.

Exercise increases blood flow to all areas of the body. The uterus and ovaries are organs that would love to get as much blood flow as they could.

Exercise clears your head. Yes, endorphins are released with strenuous activity, and these can help us fell better, but I think it’s more than that. My theory is that it’s not just about increasing the good chemicals; it’s about getting rid of the bad. Increased blood flow flushes away the old stale thought chemicals that are just hanging around causing trouble. Get rid of them.

Even better, do exercise that requires tremendous concentration. This really clears you head. Any sport will do: sailing, golf, soccer, basketball, biking, you name it. Some are more strenuous than others, but they all work. Same thing; flood your brain with fresh blood and new thoughts, lose the waste products.

Exercise builds muscle mass. This is also good. It just makes you feel better if you have a little tone. Even if you think you are fat, the tone goes a long way. It’s healthier to have some tone and muscle. It helps with balance and lowers you chances of getting injured during an accident (falling, for example).

And people with a little tone just age better.

Not to mention all of the obvious benefits of upping your cardio-vascular reserve.

I am not an expert in Yoga, although I have happily done it a few times. It's very good alternative.

So you don’t have time for exercise? Yes you do, make time. If you are tired, go to gym tired, it works just as well. You will sleep better.

If you do decide to take my advice (and the advice of others), go all out. A little exercise once a week is better than nothing, but more is better. You need at least 2 sessions per week of vigorous activity to really make a difference. Don’t start on any aggressive workout without checking with our doctor first, and consider a trainer at least initially.

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.     

Leading experts bring infertility prevention awareness to University of Colorado

DENVER, Feb. 21, 2011 /PRNewswire/ -- The American Fertility Association (The AFA), a national family-building non-profit organization, is heading to college campuses around the country to educate young men and women about infertility - a disease affecting one out of 6 couples in the U.S. The 2011 College Tour Series kicks off on March 4th at the University of Colorado in Boulder with a presentation entitled "Why Mother Nature Wants You To Get Laid Right Now". Students will learn about preventing infertility by avoiding certain environmental toxins, STI (Sexually Transmitted Infection) prevention, and about the realities of the biological clock. Brenda Strong, The AFA's national spokesperson, board member, and Desperate Housewives actress, will be on hand to talk about the benefits of yoga to help alleviate stress, which can affect fertility. She will also lead a yoga demonstration for the students. Though The AFA's goal is to prevent infertility whenever possible, sometimes infertility can't be avoided. Dr. Mark Bush, a reproductive endocrinologist with Conceptions Reproductive Associates in Denver, will speak at the event so students are aware of savvy treatment options.  Executive Director Ken Mosesian and Program Director Corey Whelan will discuss infertility prevention for men and women, environmental toxin avoidance, and STI (sexually transmitted infection) avoidance.

Later that night, The AFA will honor Dr. Mark Bush with the Joyce M. Vargyas, MD, Visionary Award at the Illuminations Denver cocktail party. Dr. Bush has extensive experience in all aspects of reproductive endocrinology, infertility, and assisted reproductive technologies. He has published numerous scientific and clinical papers in the field of women's health. Recently, Dr. Bush has taken a serious interest in elective single embryo transfer in order to avoid multiple births. The AFA strongly supports the use of single embryo transfer when possible for the safety of the patient and the child.

This year's Illuminations Denver will focus on The AFA's work, empowering young men and women to take control of their fertility. Illuminations Denver will be held at Palazzo Verdi at Fiddler's Green, and special guests will include Brenda Strong, Dr. Kevin Fitzgerald from Comedy Central and Animal Planet and pianist Joseph Eisele with the prestigious Young Musicians Foundation of Colorado. The event is designed to raise much-needed funds to support the educational outreach work of The American Fertility Association.

The media is welcome, and encouraged, to attend both events. The AFA would like to thank all of our sponsors who are helping to make both of these events a huge success, including our Platinum Event Sponsors, Ferring Pharmaceuticals and Conceptions Reproductive Associates, and our Gold Event Sponsor EMD Serono. Special thanks to Disney / ABC Television Group for their support as the Charter Sponsor of our 2011 College Tour. If you're interested in sponsoring Illuminations Denver or purchasing tickets, please contact Corey Whelan at 718-853-1411.

Press Contact: Merry Armentrout Director of Communications, The AFA 205-470-9406 [email protected]

The American Fertility Association, a 501(c)(3) national non-profit organization, is a resource for infertility prevention, reproductive health and family-building. AFA services and materials are provided free of charge and without reservation. These services include an extensive online library, resource directory, hosted message boards, daily fertility news and a toll-free support line. http://www.theafa.org or 888.917.3777

This press release was issued through eReleases(R). For more information, visit eReleases Press Release Distribution at http://www.ereleases.com.

SOURCE American Fertility Association

Read more: Preventing Infertility and the Future of Fertility Treatments - The Denver Post http://www.denverpost.com/coloradocorporatestatements/ci_17442679#ixzz1EdBw9Rec
Read The Denver Post's Terms of Use of its content: http://www.denverpost.com/termsofuse

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.

 

 

Anger and infertility

by Shari DeGraff Stewart

A woman wrote to me, expressing embarrassment about the extent of the anger she was feeling over her infertility experience.

Infertility is a fight, and how can you fight without anger?

 

Anger is an important and normal emotion indicating, “something is not right.”  Anger is a signal for change and action.  Every infertile woman describes this experience as a “fight” and anger is a powerful emotion that gives us strength for fighting. 

The women I see who most successfully navigate through infertility are those who can express both their grief and their anger.  Crying will give you some relief and can leave you feeling calmer.  Anger will give you energy.  Both are helpful.

Appreciate the rightness and necessity of anger and allow it to propel you forward past barriers and pain. The best use of anger is to bring about changes within yourself:  what you will do, what you will choose, what you will walk away from.  Be angry.  Be kind and respectful in your words or actions to others.

Adapted from an article with permission at http://www.stewartinstitute.com/qa.asp?qaid=9

Laughter is the Best Medicine

by Merry Armentrout

"Kids, when Lily and Marshall started trying to have a baby, they went a little crazy."

That was the opening line for last night's episode of How I Met Your Mother. 

It's the truth, isn't it.  Infertility can make you go crazy. It's stressful, physically grueling and emotionally draining. Infertility isn't a laughing matter.There's nothing funny about it.  That being said, there are times when laughter can be the best medicine.

 Each month you try to conceive, there are a mix of emotions that accompany the process. Constant feelings of rising hopelessness and sinking despair can certainly take an emotional toll on you and your partner.  You might not feel like laughing, but letting out a good laugh can help lighten the mood surrounding infertility.

My colleague, Corey Whelan, recently published an Examiner article on different ways other women have dealt with infertility through laughter. It seems the idea is catching on judging by last night's episode of How I Met Your Mother.

The episode follows married couple Marshall and Lily as they make a trip to a fertility clinic after failing to get pregnant. The first scene shows the couple talking with their OBGYN about their fear of being infertile. The doctor asks how long they've been trying to get pregnant...the answer is 6 days.  It then flashed forward to a few months later, and Lily and Marshall think something must be wrong because they're "doing it" a lot.  And in various locations (including the doctor's waiting room), and different positions. Lily declines Marshall's plan to continue to have as much sex as possible, and insists on seeing a Reproductive Endocrinologist.

They both undergo infertility testing.  You can imagine the fun the shows writers must have had when creating the sperm collection scene.  Marshall walks into the room as another man is walking out, and gets way too freaked out by the thought of another person collecting semen that he is unable to perform the task. I can imagine how intimidating and embarrassing  it would be to collect a sperm sample in a fertility clinic's office, but I would suggest watching this episode- it might lighten the mood.

Lily checks out ok, and instantly Marshall is scared he's too blame. Since male infertility is to blame 40% of the time, it's certainly a possibility, but he checks ok as well.  During this time, Marshall doesn't want to tell his father of the chance he might not be able to give him a grandchild.  He says he's used to telling his family happy news, and is embarrassed to tell them about their struggle to conceive.

It's a tough question- should I tell anyone, and if so, whom?  Ellen Speyer, a Member of The AFA's Mental Health Advisory Council wrote a wonderful article on this very subject- the pros and cons of telling people about infertility.  It's a personal decision, but loved ones are there for you during the good and the bad. 

If you're dealing with infertility I would suggest you watch this episode, and get a good laugh at infertility.  Laughter is the best medicine.

   

 

Your infertility arsenal for 2011

by Corey Whelan

A new year, a new you. 

Easier said than felt, particularly for women who have spent the last year (or longer) trying to get pregnant, without success.

Let's face it, we often experience Infertility as a powerful enemy.. And one of this most hated enemy's weapons is it's ability to diminish the feeling of control that we so covet, even require, in our own lives. 

While it's true that you may not be able to eradicate infertility at will from your own life, you can absolutely opt to disable this element of the experience and to achieve more balance, and control, than you currently may be experiencing.  And you have the right to do that.  Believe it or not, you have an arsenal at your finger tips.  You simply need to call it up, and now is a good time to practice doing that.  While every woman's arsenal will vary somewhat, there are a few handy dandy items you should always tote around in yours.

Laugh. Ever hear the expression "fake it till you make it"?  There's nothing wrong with having fun, and joy in your life. It's not fattening and it won't stop you from getting pregnant.  Funny movies and television shows are more than just a diversion. They are often a life saver.  Pick your pleasure, and pick it often.

Talk. It's no secret that infertility puts a strain on the hardiest of relationships. You may be feeling this in your romantic life, your family life and your friendships.  But always remember, you are loved, even if you may not be feeling an avalanche of the kind of support you need coming at you from friends and family right now.  Something that might help is this.  Enlist the shoulder of the person that you feel is best armed to support you through this piece of your life, and request of him or her an oasis of time, just for you, on a daily basis to simply talk.  This is your opportunity to dump, to scream, to cry, to blurt out everything you are feeling without judgement or even that person's opinions or comments (unless you request them).  If you need to enlist more than one person, that's ok.  And if no one comes to mind but this sounds like something you could use, well, that's what therapists are for.

Choose.  Not everyone will be able to hang in there with you through this time.  It doesn't mean they don't care about you or you about them.  But you have the right to choose who you spend time with and who you don't.  If you can't handle that annual family get together or party, then don't go.  Baby showers?  Up to you.  And, if you get a nagging feeling that a friend is not able, or willing to support you through this right now, gently put a hiatus on the friendship. You're in control, remember?  Exercise that control.

Move.  Movement displaces anxiety.  Take a walk, take a run, take a yoga class, but take your body to a transformative place by giving it time to breathe, and heal, through movement.  Your body, despite it's current trying to conceive and not getting there state, is still an instrument of joy, and pleasure.  Let it be that for you.

Touch. You have the right to enjoy your sex life.  Baby making sex is not the only kind of sex there is, remember?  Find creative ways to get back in touch with that, and then, find some more.

Thank. Think about what you have in your life to be grateful for and give thanks for that.  You are still you, and there is more to you than this experience.  Try giving thanks for what you currently have.  If this feels too difficult for you right now, let it go for a day, or two. Consider it a goal for tomorrow.  But hold onto this one, it's a goal worth acheiving. 

Remember. Yesterday is gone, and tomorrow is a new day.  Your life will not always feel like this.  Remember to be kind to yourself and to hold on to all of the tomorrows, and all of the dreams, that are still ahead of you.

Happy New Year to all of the women who so want to be mommies but who are not there yet. I hope that 2011 will be your year.     

Reprinted with permission from examiner.com

Photo: 123RF

New Year's Resolutions

by Merry Armentrout

I've noticed a pattern in my New Year's Resolutions- they're always the same. Eat healthier, lose weight and exercise.  I'm already justifying my bad eating habits over the holidays with the promise for a new year, new you attitude.  I've made a decision. This year will be different. I mean it!

It started this morning over breakfast.  Instead of using the holdiays as an excuse to eat unending calories, I chose egg whites, wheat toast and fruit instead of the french toast with real Vermont maple syrup and whip cream...not an easy thing to do.  Don't get me wrong, I've had my fair share of rich and delicious food choices over the holiday, but enough is enough.

There are a number of articles citing the importance of health and fertility. The female body is most likely to conceive when it is within 15% the ideal weight. So if you're looking to get pregnant, losing weight shouldn't be just a New Year's Resolution- it should be something to strive for year round.  

As 2011 approaches, end 2010 on a positive note. Don't use the last few days as a pig fest, use it as a way kick-start your body and health.  During infertility, so many things are out of your control.  That's why it's important to control the things you can- your health, mindset and mood.  It's important to make sure you're getting adequate vitamins, including folic acid- for your health, and your future baby's health as well. Folic acid supplementation is particularly important since studies have shown that adequate stores of folic acid can greatly reduce the risk of neural tube defects in the fetus.  It's best to get vitamins through food- focusing on lots of fruits, vegetables, grains and lean protein can help you get the nutrients you need.  A vitamin supplement is always a good back-up plan.

If you're a smoker, than a perfect New Year's Resolution is to quit!  The Attain IVF website has a great article on the 5 Facts About Smoking and Infertility.  Bottom line, it's bad for you, your fertility and a baby.  Smoking also effects infertility treatments- such as IVF, and smokers have an increase risk for miscarriage. 

The New Year is a great time to focus on a new you.  This year I'm forgoing a resolution.  I don't have to wait until December 31st to eat healthy- I will start now.  Here's to a Healthy and Happy 2011!

 

Timing Sex

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

If you’re trying to get pregnant, something useful to know is how often to have sex.  Sperm counts peak at two to three days after ejaculation, meaning, after you have sex (or masturbate,) the swimmers will be most abundant two to three days later.  Sperm live for about 48 hours in the female reproductive tract, so the optimum timing is sex every other day.

However, don’t freak out if you have an especially romantic weekend with a little extra frequent activity, or get caught up and miss a few days.  Stressing out about sex is counter productive, as stress itself can result in poorer sperm quality.

I’m often asked when during the month (or cycle) a couple should try to conceive.  Studies show that conception usually happens up to six days before, and ending on, ovulation.  The big problem is that most tests for ovulation show the event after it happens.  So a good plan is start having sex every other day after menstruation ends, and keep going until the next menstruation.

So, soldier on.  Have sex every other day.  Doctor's orders.

Craig Niederberger, M.D., F.A.C.S. is a highly published author and editor, and head of the Department of Urology, University of Illinois at Chicago. His blog, Male Health, and other writings will be syndicated on this page for The American Fertility Association's readership