The AFA Blog

Tick, Tick, Boom!

by Merry Armentrout

I found my first gray hair this morning.  One loan gray hair hiding amongst my brunette curls had me screaming bloody murder before my husband had a chance to drink his coffee.  After my tears subsided I made an emergency call to hairdresser, and she assured me a stray gray hair is normal in your 30's.  I miss being 29.

I wrote a blog a few months ago about my struggle with turning 30.  In today's world, women are fighting tooth and nail to stay younger, thinner, firmer, sexier.  It's working.  There's a TV show dedicated to the term "Cougar".  Celebrities are dating younger men.  Jennifer Aniston looks better at 41 then she did at 29. It's amazing what a personal trainer, expensive facial moisturizers, hair color and in some cases, surgery can do for you.  Unfortunately, all the money in the world can't buy Mother Nature.  A new report shows a ticking biological clock increases libido in women in their 30's and 40's as they enter the end of the child-bearing years.

Researchers from the University of Texas published a study showing a heightened sex drive in relation to declining fertility.  827 women filled out an on-line questionnaire about sexual attitudes and behaviors.  Researchers divided the women into 3 groups: high fertility (ages 18-26), low fertility (ages 27-45) and menopausal.  More women in the high fertility group reported an increase in sexual fantasies, active sex life and willingness to engage in casual sex.

An article in The New York Daily News says this study compares an increase in libido is in direct response to declining fertility- as if the biological clock starts ticking faster as it nears the end.  The results of this survey could indicate more and more women are waiting until they're late 30's and 40's to conceive, and their sex hormones are in overdrive because they subconsciously know their chances of getting pregnant is decreasing.

Just like there are things you can do to look younger, or gain "cougar" status, there are things you can do to help preserve your fertility.  Things such as, a healthy diet, maintaining a normal BMI, STD awareness and staying away from certain environmental toxins helps increase your chances for becoming pregnant. Research continues to show the biological clock is real for both male and females, so knowing the facts can help you stay informed for your family's future. 

Merry Armentrout is Communications Director for The American Fertility Association. Merry has a degree in journalism and is a former Fertility Consultant for Ferring Pharmaceuticals. 

Photo courtesy of Amy-Rose King.

Sperm Morphology: New Guidelines Announced: 4% is Normal

by Fred Licciardi, M.D.

Wow, what a relief to know that what we have been saying for years is now finally officially stated. Any sperm morphology over 3% is considered normal.

How did this change come about? The World Health Organization (WHO) determines the normal parameters for semen including volume, count, motility, forward progression and morphology. The WHO published their guidelines in 1987, with updates in 1992 and 1999. The original “normal” cutoffs were based on estimates from old data, some of it dating back to the 1950’s. There were inconsistencies in the way data was collected, ie the sperm studied was collected and analyzed in many centers, but there was little regulation of how the tests were being performed. Plus there was not clear data on the history of the men.

This time the semen tests were performed using similar protocols in all of the testing centers. Plus, some history was obtained from the men, mostly related to fertility status.

4500 men in 14 countries on 4 continents were tested. Australia, China, Denmark, Germany, Chile, Singapore, France, the UK, and the USA were some of the countries included.

Men were placed into one of 4 groups.
Fertile men. All men in this group had initiated a pregnancy sometime in the 12 months preceding testing. This was the most important group because the researchers could establish normal values based on men know to have fertile sperm.
There were 3 other groups evaluated. To save a little confusion, I’ll summarize and say 2 groups were a little more random in nature and the fertility status of the men was mostly unknown. The 4th group was also fertile, but the time since last pregnancy was unknown and may have been longer than 12 months.

The results.
The normal fertile men’s sperm had the following results.
Volume: The median (midway between the lowest and highest results) was 3.7 cc, but anything over 1.5 cc was considered normal
Concentration: the median was 73 million but anything over 15 million was considered normal
Motility: the median was 61%, anything over 40% being normal
Morphology: the median was 15%, anything over 3% was deemed normal.

Some important points.
You may have noticed that morphology is not the only parameter with a new normal value. Volume was at 2.0 cc, now it is at 1.5cc. A normal count was 20 million, this changed to 15 million. Motility was 50%, now it’s 40%. The normal morphology had the biggest change, as it went from 15% to 4%.

Keep in mind that in this group, all of these men were fertile, so even men with levels lower than the new definition of normal had working sperm. The normal values were established mathematically. If you were in the upper 95% of the fertile people you were deemed normal. The bottom 5% of the fertile people was deemed abnormal. This 95%/5% cutoff is the system used to define cut offs for other tests such as TSH, Prolactin and many others.

When comparing the different groups of men there were very slight differences in volume, count, etc, but hardly worth mentioning. Fertile men did have slightly higher volume and counts then men whose fertility status was unknown. Morphology was mostly similar in the different groups. Remember, there was no group of men who had established infertility, so in this study there is no way to compare normal fertile men to known infertile men.

And even though we have no details on the women, knowing that they became pregnant in the past year is probably all the information we need.

So now you know. Any morphology over 3% is considered normal. If your doctor tells you otherwise, ask him if he has seen the new WHO guidelines.

To take it one step farther, can there really be difference between 4% and 2%? I doubt that there is a difference between having 96% abnormally shaped sperm and 98% abnormally shaped sperm. So as I have said before, morphology is not considered with much respect, except in some rare cases where the sperm is unusually abnormal.

I hope this helps.

For those of you who want more details, here is the link.

www.who.int/reproductivehealth/topics/infertility/cooper_et_al_hru.pdf

Dr. Fred Licciardi is a reproductive endocrinologist practicing at NYU Fertility Center in New York City and a frequent contributor to The AFA's blog page.

New Gallup poll reveals overall gay-positive trend in the US

by Kelvin Lynch

While public attitudes haven't moved consistently in gays' and lesbians' favor every year, the general trend is clearly in that direction, according to Gallup's latest annual Values and Beliefs survey, conducted each May.

There is a gradual cultural shift under way in Americans' views towards gay individuals and gay rights.  For the first time in American history, a record 52% of Americans perceive gay and lesbian relationships as morally acceptable, while the percentage of poll respondents calling these relations "morally wrong" dropped to 43%, the lowest in a decade.

Interestingly, the biggest change was seen almost exclusively among men, particularly men younger than 50.  The biggest change (20%) was found among men aged 18 to 49.

Gallup found greater movement toward acceptance among Independents (11%) and Democrats (9%) than among Republicans (9%), and a big jump in acceptance among moderates (14%). Liberals were already widely accepting of gay relations in 2006, and have remained that way , while conservatives' acceptance continues to run low,

Most notably, there has been a significant jump in acceptance among Catholics (16%), nearly three times the increase seen among Protestants (6%). Acceptance among Americans with no religious identity has expanded as well (11%).

Gay marriage has gained more acceptance among Americans as well.  Last year, 57% were opposed to gay marriage while 40% approved, but this year 53% opposed gay marriage while 44% approved.  Compare that to when Gallup first polled Americans about the legality of gay marriage in a 1996, and 68% were opposed while only 27% were in favor.

By geographical region, a majority of Eastern and Western residents favored of gay marriage, and roughly 6 in 10 Midwestern and Southern residents opposed it. 

Kelvin Lynch is a writer, gay activist, political watchdog, pop culture enthusiast, and small business consultant who lives in San Francisco.

Reprinted with permission from Examiner.com

Ordinary, or Extraordinary?

by Sean Perry

 

When my sister Merry, who works for The American Fertility Association, called yesterday asking me to write a blog to recognize Gay Pride Month, I had no idea what I would say.  Being gay is just ordinary in my world.  It almost goes unnoticed.  Probably not really worth writing about.  I mean, the neighborhood I live in is a very hip one where everyone just does their thing.  Live & let live.  I own a home and a business with my partner in East Nashville, which is like a small town within a big one.  We have most everything we need within the neighborhood, so we almost never leave it.  Here gay people and straight people are happily inseparable.  So what's the big deal?

But after thinking more about Merry's request, I quickly remembered that East Nashville is East Nashville...and unlike many places in the South.  Here, we are sheltered from bigotry and hatred.

As we all know, in many Southern towns, actually in cities and towns throughout the world, there is anti-gay sentiment.  We are perceived as being very different from what is wholesome and right.  Hated.  These are the cities & towns that support bans on gay marriage.  Because gay couples are abnormal.

I met my first love when I was 21.  We lived together and prospered for 16 years until he died.  Luckily he was cared for at Vanderbilt Cancer Center...another place where gay and straight are happy together.  I was by Chipper's side at every doctor's appointment, every chemo.  I slept in his hospital room.  I was working at the time at Gaylord Opryland, another place where sexual orientation is a non-issue.  My family, bosses and co-workers supported me through his illness every step of the way.  To them, my spouse was dying.

As cancer goes, it was all pretty normal.

Five years later I have found new love, bought a historic home and fixed it up.  Took in 2 rescue kitties. Opened a burrito joint.  Gained a few pounds (5).  Volunteered in the Nashville Flood relief effort. Unfortunately for The AFA's blog, my story is just very ordinary.  The love I felt for Chipper and feel for Tom is as normal as it gets, but at the same time all love is extraordinary.  

 

When gay couples decide to settle down & have kids, send them to college and then grow old together...just normal.  So I just can't think of anything to write about.  Sorry, Merry!  :-(   I love you.  Keep up the great work!

Sean Perry is the uncontested burrito maven of East Nashville, Tennessee and brother to Merry Armentrout, The AFA's Communications Director.

Unforeseen Victims of the Law: Children of Same Sex Marriage

by Julie Tavoso, Esq.

I can’t imagine how it would feel to fear dying alone.  I can’t imagine the thought of not being with loved ones because of legal restrictions based on a definition of marriage or parentage.  I take for granted the protections that marriage provides because my marriage is ‘traditional.’  Even if something terrible happened, such as an accident where I’m on life support in an ICU somewhere – I know my kids would be allowed to be by my side.  I don’t have to worry whether my kids will be recognized as my legal children under the laws of any state.  Most states, however, leave ‘unconventional’ families unprotected by refusing to recognize the relationships or offering legal status to the family members.  

We don’t all have the ability to take such basic principles for granted.  Societal views of same-sex marriage results in prejudice and obstacles for those seeking to protect their own families.  The regular presumptions of family – who is a parent or spouse – are not available. These legal presumptions have profound consequences when evaluating spousal privilege or next of kin presumptions, and can lead to a devastating outcome in a tragic emergency.

States that don’t recognize same-sex marriage or grant parentage to same-sex parents not only deny equal rights to a ‘non-traditional’ parent, but also to the children resulting from those arrangements who simply wish to support and love the only parents they’ve ever known.  Each of us likely knows those who decry the boundaries of a state institution such as marriage, but there are several others that wish desperately for the benefits such a state institution can offer.    

Despite some changes in public opinion, a vast number of Americans continue to oppose same-sex marriage, if polls and statistics are to be believed.  Perhaps this is based on religious ideals, or misperception (misconception?) and stereotypes regarding ‘alternative lifestyles.’  But even if that were the reason, how could that justify depriving any individual or couple of the same rights another couple has by virtue of their gender or ‘natural’ heterosexual orientation?  And worse, what about the children in these families?  Don’t all children deserve the legal protections the law is intended to provide?

Much of the literature I read espouses the theory that marriage should only apply to male-female relationships because its fundamental purpose is for procreation.  As reproductive technologies advance and families are established in such a variety of ways (donor egg, donor sperm, surrogacy, etc.) regardless of the marital status or gender of the intended parents, how can a procreation argument still carry any weight?  It would imply that only heterosexual couples who are able to achieve a pregnancy naturally, without any reproductive assistance whatsoever, should be entitled to the protections of marriage if its fundamental intent is to procreate. 

The antiquated perspectives and stereotypes need to catch up to the technologies that allow new frontiers to become achievements.  The facts of life at this point are that families are created in a myriad of ways, not only through reproductive technologies, but also through divorce and re-marriage or adoption, and they happen regardless of the legal institutions that recognize (or fail to recognize) the relationships themselves.  Even if those opposed to same-sex marriage can find a rational basis to argue their perspective, what reasonable person can argue that children born into ‘alternative’ families should also suffer the inequities that the bias against same-sex marriage carries along with it?  Why do the children need to suffer and be left to battle the courts and hospitals to recognize the legal protections afforded to most families, to access to their parents during times of need?  What if the ‘legal parent’ under the law dies and the state won’t grant custody of a minor to the surviving parent?  What if a family member challenges a will or power of attorney, or attempts to exclude a survivor from a funeral, or to challenge custody? 

As I reflect on the gratitude I feel for my family, my heart goes out to those that have to worry about the ‘what-if’ scenarios that can cause such grief and frustration during a time of great need.  And while I recognize the importance of legal documents appointing designated healthcare agents and naming individuals to perform certain functions, too many individuals and families need to rely on the natural presumptions of the law in the absence of these documents.  It seems only right to extend the same protections to all families, regardless of their legal status.

 Julie Tavoso is an attorney at the Law Offices of Julie M. Tavoso, LLC based in Chicago, Illinois.  Her practice is dedicated to the law of collaborative reproduction and reproductive technologies, focusing primarily on gestational surrogacy arrangements and egg donation in Illinois and Colorado. 

What Kind of Mother Am I?

by Jamie Schenk DeWitt

My husband and I were sitting in our fertility doctor’s office for the first time.  My doctor had just finished discussing my medical history and the protocol for my treatment when he asked, “Are you okay with the possibility of having multiples? “

Without hesitating I said, “YES!  I would love to have twins.” My husband was silent.  He looked at me and then at my doctor who looked at him and smiled.  A minute later, my husband spoke. ”We never really discussed the reality of having twins, but (he looks over at me) it looks like we are okay with it.”  My doctor responded, “I always ask couples because you know there is a 20- 40 percent chance that it can happen when using assisted reproductive methods.”

I wanted to have a baby more than anything else in the world and if that meant having more than one baby at a time, then great.  At the time, I didn’t think about what kind of mother I would be to a baby or babies.  I just knew like all of us who have gone through fertility treatments that I wanted to be a mother.  Who would put themselves through all the poking, prodding and exposure of their most “private parts’ if they didn’t want to be a mother?

 

Eight months after that meeting with our fertility doctor and after numerous attempts and heartaches, I was pregnant and elated.  During my six-week ultrasound, my husband and I saw and heard the baby’s heartbeat.  We were mesmerized.  We couldn't take our eyes off the screen.  Our doctor then said, “Well, do you want to go fishing for some more?”  We laughed.  Oh, did we laugh and then with a slight move to the right of the ultrasound wand there was another baby’s heartbeat thump, thump, thumping away.  I was one of those 20-40 percent and I WAS PREGNANT WITH TWINS!  I laughed and cried while my husband smiled and fell back against the wall, and said, “There aren’t anymore are there?’  My doctor laughed and said, “No.” 

 

For the next eight months through the nausea and leg cramps, I was the happiest pregnant woman on the planet.  After having traveled to the depths of despair fearing that I couldn’t have children, being pregnant with twins brought me more joy than I had ever experienced in my life.  And thankfully I had a very healthy and easy pregnancy with no complications.

 

At around nine months, just a few weeks before I was going to deliver, the reality of what was happening to me hit with full force.  I was about to be a mother of two babies.  In a few weeks, I would be coming home with two babies who needed the same care at the same time.  This created within me an overwhelming sense of concern.  Could I manage?  Would I be a good mother?   Unable to answer any of these questions, I refocused my energy on believing in myself in the same way that I did when I was going through fertility treatments.  It takes an incredible amount of inner strength to preserver trying to get pregnant and so I tapped back into that will and belief and didn’t let my fear take over.

On April 8, 2009 after thirty-eight and half weeks of being pregnant, Olivia and Charlotte came into the world.  They were two healthy and beautiful little girls.  Olivia weighed 4 pounds 13 ounces and Charlotte weighed 5 pounds 4 ounces.  I immediately started breastfeeding them and thankfully they both latched on quickly and easily.  I listened to the advice of the lactation consultants at the hospital who recommended that since I was feeding two babies and had had a breast reduction that it would be a good idea to breastfeed and supplement with a little formula.  All babies after they are born lose half of their birth weight, so it was very important to my husband and I to keep the girls from losing too much weight.  We agreed that it was okay to supplement with formula as long as we were also breastfeeding.  

 

By day two in the hospital, we were getting into a routine with Olivia and Charlotte and I slowly understood the intricacies of breastfeeding.  Both of the girls were eating well and I felt more confident about my ability to feed them. As a new mother, this was one of my main concerns.  I just wanted them to get what they needed.  

 

By the last feeding of that second night, Charlotte had breastfed and drank her ounce of formula but Olivia only wanted to breastfeed.  I tried and tried to give her the formula, but she didn’t want it.  After several failed attempts, I realized that she was full and when she was hungry, she would eat again.   Sadly, the nurse on call that night felt differently.  When she came into the room and saw that Olivia had not drank the formula, she accused me of trying not to give it to her.  When I explained what had happened, she got very forceful and indignant.  She said, “Well if you aren’t going to give it to her, then I will. “ She actually tried to lean over and take Olivia from me.  My husband quickly stepped in and said, “We would like for you to leave the room please. Now.”  

 

Fifteen minutes after the nurse left our room there was a knock on our door and in walked the pediatrician on call.  He introduced himself and said, “Your nurse just called me and was concerned that…”  I cut him off before he could finish his thought. I said,  "She was concerned that we weren’t feeding our baby.  That we were starving her?”  The doctor continued. “Well, yes.  You know there are those types of women who breastfeed and can be so adamant about…”  Again, I cut him off. I didn’t want to hear his generalizations about women who breastfeed as being radical or dangerous and that they would rather starve their infants than give them formula.  I said, “These are IVF babies.  Do you really think that after what we went through to have these two beautiful babies I would seriously put their lives at risk?  Do you really think that as their mother I would do that?”  

 

In a matter of seconds I was transformed into this lioness protecting and defending her babies. The doctor, realizing my fury with his line of questioning said,  “Oh, no, no.  I didn’t know you had them using IVF.  I totally understand.”  My husband and I just looked at him.  The doctor continued, “I am so sorry.”

 

After the doctor left the room, I sensed that this interaction with him and the nurse was a defining moment in my development as a mother.  For at this vulnerable time, I could have felt bullied into believing that I had no idea how to feed my child.  Instead, I trusted my instincts and found the inner strength to believe that I knew how to take care of her.  From the bottom of my heart, I knew that after everything that my husband and I had experienced to have these babies that we would never jeopardize their health.  The notion was unfathomable.  I would do whatever it took to properly care for them.  That night, I had my daughter’s best interest at heart.  I wasn’t being foolish or selfish.  She wasn’t hungry even though I had tried to give her more. When I stopped trying, it was because I was meeting her needs.  I knew it as her mother.  

For more information on breastfeeding multiples after infertility, click here

Sex and the City 2. Part Deux. AFA Style.

by Corey Whelan

My girl Merry was right!  Two and a half hours is just not enough.  No, I'm talking about Sex and the City 2.  Man, how I missed those girls!  That TV show got me through some rough Friday nights and especially, one really rotten eventually to be divorced New Year's Eve.  The Computer Guru to the Stars wouldn't go with me, he said we could rent both movies back to back and watch them all day.  That's ok.  Bob went to the midnight show without Ken and told him the theatre was filled with women and gay men. I guess Arizona and New York have one thing in common.

So look.  If you are thinking about seeing this movie and you're not sure you want to buck the crowds?  Here's the deal.

If you're thinking about surrogacy?  Go see this movie.

Grappling with the concept of child free living?  Go.

In a marriage that feels, well, not so much?  Please go.

My dear girlfriends.  If you struggled to get pregnant for years and now can't stand to hear the baby crying?  And crying...And still crying.  I beg you to go.  Now.  Take a sip, then a gulp, and go.

Did you think motherhood would be enough?  And maybe it is and maybe it isn't?  Go.

Dealing with menopause?  Grab a tweezer and go.

Do you like watching really hunky men splashing around in pools? (sigh). Please do go. Immediately.  Then meet me for a martini. 

Don't know what to wear to a gay wedding?  Don't know if it's PC to say gay wedding?  If you go you will know.

Did you think she should have married Aidan?  You must go.

Did you cry when she married Big?  And yes, his real name is John.  Guess what you should do.

Do you love New York?  (If you don't, please unsubscribe from this blog and thank you.)

Any Liza Minnelli fans? You get the picture.

Look, it's Memorial Day weekend.  The AFA will get back to serious on Tuesday.  I promise.  

But for now?

Hear me roar.

_____________

AFP Photo

Umbilical Cord Blood Banking

by Wendy Spry, LVN and Certified Perinatal Support Specialist

Pregnancy and the promise of a new life bring much excitement and presents many options as well as decisions to be made.  One of the important decisions facing expectant parents is cord blood banking. 

Why Bank Cord Blood?

Cord blood banking involves saving the blood that remains in the placenta and umbilical cord after the birth of your baby.  This blood is rich in hematopoietic stem cells which are pristine, newly born cells that can replicate into healthy tissue of many sorts and hold remarkable potential to treat and cure nearly 80 diseases today.  However, even more remarkable, are the future applications for these perfect stem cells.  According to researchers, the possibility of curing type 1 diabetes, cerebral palsy, lupus, multiple sclerosis, spinal cord injuries,  hearing loss, blindness,  Parkinson’s, Alzheimer’s, cancers, heart and lung disease, and scores of other life threatening conditions is just around the corner.  The potential uses of these cord blood stem cells are truly unlimited!  This area of science is called Regenerative Medicine and involves taking your own stem cells, reintroducing them into the body when needed and allowing the body to heal itself with its own cells.  While it all sounds a bit like science fiction, the research is promising and very exciting!

With the future of medicine taking a cellular approach, all expectant families should strongly consider banking their baby’s cord blood.  However, families who experience infertility and who are adopting should give even greater consideration to cord blood banking.  When choosing to store your child’s stem cells you will know that you have a 100% perfect genetic match for your child, and a 25% match for your childs siblings banked at the ready should you ever need them.  If you experienced infertility, the likelihood of conceiving another child as a match is unknown and puts an even greater importance on insuring the genetic match for your child.  With adoption, a complete family medical history may be unknown in addition to the decreased likelihood of having a sibling match.  By banking your baby’s cord blood, should your child require a stem cell transplant, these cells will not be rejected by his body since the cells will be recognized as his own tissue.

Collecting Cord Blood

The process of collecting your baby’s cord blood is a simple and painless one.  Once you have chosen and contracted with a cord blood bank, the bank will provide you with a kit that is to go to the delivery location with you.  All the necessary collection supplies are included in the kit, and most care providers are well versed in the collection process.  After the birth and transition of your baby, the care provider collects the blood that remains in the placenta and umbilical cord…a simple process that takes about five minutes.  Once complete, the collection kit is returned to you.  You will notify your cord blood bank that your baby has arrived and the cord blood will be picked up and transferred to the bank for processing and long term storage.  It is a very easy process that can reap wonderful and life-saving results for your baby!   

Banking your newborn's umbilical cord blood can be one of the smartest, farthest-reaching decisions you can make when it comes to the health and wellness of your newborn, and to your own peace of mind. Knowing you've taken steps to safely store these incredible, life-affirming cells - and that they're just a phone call away - can put any parent's mind at ease.

Umbilical Cord Blood and Regenerative Medicine:  http://www.crscm.org/USOBGyn2008Willert.pdf

 

When is the Right Time for hCG?

by Fred Licciardi, M.D.

The time between the hCG and retrieval

For an FSH injection cycle leading to insemination, it’s ok if the ovulation naturally occurs a little early (via a premature LH surge) because we can just do the insemination early. Rarely it’s too early, before the follicle is big enough, and we cancel the cycle. However, for an IVF cycle we have to cancel the cycle if there is an early natural LH surge, even if it’s only a little early, because the timing of the retrieval is very dependent on when the surge starts. The retrieval needs to be about 34-36 hours past the start of the surge (which would also be the time if the hCG shot).

Because we are not taking blood every hour, if the blood test shows a rise in the LH level, we don’t really know when the rise started so we don’t know the right time for retrieval. Lupron, Antagon and Cetrotide prevent the natural rise of the LH, so the premature surge usually cannot occur. However, these drugs do not interfere with the effects of an hCG injection. So there is no natural surge, but there is an artificial surge which starts the moment the hCG goes in.

Final Maturation
There is a second very important job of the LH Surge/hCG injection:
it causes the egg to mature. As the days of stimulation progress the eggs are slowly maturing, but more is needed for the final maturation. Necessary last minute changes occur inside the egg from the LH/ hCG.

Why is this important? An immature egg will not fertilize. If the retrieval is before about 33 hours after the hCG, the result will be immature eggs. Sometimes they are all immature, or just some.

If the retrieval is 38-39 hours after the hCG, the eggs will be mature but they will already have ovulated. We would retrieve none; they would be floating in the pelvis around the ovaries waiting to get picked up by the tubes. So we need to grab the eggs just after they mature but just before they ovulate, which is at about 34-37 hours after the hCG injection.

What day should you get your hCG?
hCG can only mature eggs that have been growing for enough time for the follicle to become large. The sizes of all of the follicles need to be taken into consideration before giving hCG in IVF cycle.

Not all of the follicles grow at the same rate. For example, if there are 10 follicles, and the biggest is 18mm, they will not all be 18 mm. Some will be mid-sized and some will be much smaller. Each follicle does not need to be 18 mm to produce an egg that is mature. As long as the biggest (the lead follicle) is 17-18mm, the mid-sized (13-16) should also have mature eggs. The small follicles (10-12) may or not be mature. But if the lead follicle is 14 mm, none of the eggs have yet reached maturity. Giving hCG would not be enough to achieve maturity.

How Important are Estrogen Levels?
Not very. When you are monitored for your IVF cycle, the follicle size is much more important that the estrogen (estradiol) levels. We need the estrogen to rise, but if midway through your cycle we see 10 follicles, with the biggest being 13 mm, we don’t really care if the estrogen level is 500 or 900. Estrogen is more important when we are monitoring someone who may be on track for hyperstimulation.

Therefore, we use mostly the size of the follicles, with not much emphasis on the estradiol levels, to determine when to give the hCG. At NYU we feel the best time to get the hCG is when the lead follicle reaches 18 mm. Now because there are many variations from cycle to cycle and from patient to patient, it’s not easy to say that 18 mm is the rule.

For example, let’s say there is one follicle 18 mm, three that are 15 mm and others that are smaller. Here we may worry that some of the small ones may be too immature, so we may wait another day before giving the hCG. Let’s say there are 20 follicles, with the biggest 17mm and an estrogen level of 2900. Here we are aware that the smaller follicles may be immature, but we also are concerned about the estradiol getting much higher because the woman would be increasing her risk of hyperstimulation. So we give the hCG at 17 mm, which may yield some immature eggs, but should give us enough mature eggs to work with.

And there are many more variations. Some women have gotten their hCG a little on the early side and have all mature eggs. Some women in their first cycle get the hCG at 18 mm with lots of good size follicles, and have ½ their eggs be immature. So next cycle we wait till the follicles are 20-22 mm before giving hCG. This sometimes gets more mature eggs but sometimes no matter what we do, that woman’s ovaries make more immature eggs than expected.

So why not wait and give hCG later? Because eggs can get over-mature. This over-maturity can lead to lower embryo quality and lower pregnancy rates.

When we see the records of women who have failed IVF elsewhere, many times we see that he hCG was given with large sized follicles. The first and easiest “fix” we can do is to give the hCG earlier in her next cycle, more inline with our standard procedures.

Why do some doctors wait longer to give the hCG?
Some may feel that the higher the estradiol level the better, so by waiting estrogen levels will go up. This is probably not important. Others may feel that it is necessary to wait so there will be no immature eggs. Well this sounds good, but it may not be worth sacrificing the quality of the eggs form larger follicles, which are probably the best eggs anyway.

And back to the original question.
What if instead of the average 11-12 days it takes to grow the follicles, they are of the right size after only 6 days or 8 days?
If the size is good, but it seems early, we usually go at least one more day that we normally would, maybe 2. If it’s day 9 and the follicles are 19-20 mm, it really sounds ok to give hCG. If it’s day 7 (so 5-6 days of FSH injections), and the follicles are 17-18 mm, more time would probably be a good idea.

How Hollywood Loses the Baby Weight

by Merry Armentrout

People magazine is my guilty pleasure. I love browsing through pictures of movie stars while I enjoy a cup of coffee, but this morning a picture of Bethenny Frankel left me baffled.  The reality star had a baby two weeks ago, and was photographed on Tuesday looking fabulous and fit. I stared at her non-existent belly wondering how this was possible. My only conclusion is she has to be sporting some heavy duty Spanx.

This isn't the first time a movie star flaunted her post-baby figure just weeks after giving birth. Gisele Bundchen did a photo shoot six weeks after having baby Benjamin, and model Adriana Lima claims losing the baby weight was "easy". Yes, losing weight is "easy" when you have a personal trainer every day, and a food service delivering low-calorie, portion controlled meals to your doorstep. I don't know about you, but my budget doesn't include such luxuries. And, thankfully being photographed in my bikini isn't in my job description, or else I would have reconsidered the huge plate of pasta I thoroughly enjoyed last night.

Losing baby weight, or any weight for that matter, isn't easy, but definitely is doable. Parents magazine published an article with expert weight loss tips for "real mothers".  The tips include the obvious, such as exercise and choosing healthy snacks, but also reminds you to be patient. Losing two pounds per week is considered reasonable, but nursing mothers should only lose one pound per week. The article says losing weight too quickly can interfere with your milk production.

I hear so many new mom's complain they hardly have time for a shower, let alone a run. I'm not a mother, and might one day find this to be very true, but I do strongly believe anyone can make time in their day for exercise.  Staying active will not only help you lose weight, but studies show exercise helps new mothers sleep better at night and helps with postpartum depression. You can ask your family or friends to baby-sit while you go to the gym, or get a workout in when your husband's home to help with the baby. Workout DVDs can be found everywhere, and will have you sweating without having to leave your house, or your baby. Many websites offer examples of exercises for both mom and baby, so you're able to bond with your little one while keeping yourself healthy.

For all of those women who aren't pregnant, but one day hope to be, being healthy now will pay off during, and after your pregnancy. The National Institute for Health says women need to think about a healthy pregnancy before they even try to get pregnant. Studies show women who are obese before pregnancy are more likely to have babies with congenital heart defects compared to women at a normal weight. It's also easier to lose baby weight if you maintained a healthy weight before you're pregnant.

You don't need grueling personal training sessions or a fancy food delivery service to lose baby weight (it would be nice though). Be healthy, be patient and be thankful your baby doesn't care if you fit into your skinny jeans. All they want is your love. And a clean diaper.