There is a lot out there right now in the traditional and social media about egg freezing. In fact just this past weekend The Boston Globe entered the conversation with a piece called “The Big Thaw”. Actually – it’s really all about the” Big Freeze” right now in fertility preservation technology. That’s the issue. There isn’t a lot of actually thawing going on in real live patients.  And that’s primary because of who needs egg freezing in the first place.  The women who are freezing their eggs – are usually cancer patients who are not ready to build their families (sometimes not for quite some time) and women who are facing the end of their biological potential who are not ready or able to start their families yet.  What that means is a lot of hope on ice.  And let’s be clear that is exactly what it is – hope.

But is that any different than anyone else accessing reproductive technologies ever?  Yes – we know more today about IVF success rates than we ever did – but that has taken time. Back in the day – when I did IVF -all we had was hope. We were being given a chance at hope – at possibility. But we weren’t discouraged from taking that chance – as I think women are in some circles  being discouraged from egg freezing because it is still experimental. I wonder if I would have done IVF when I was a going through infertility – if ASRM had released a statement about it being so unproven when I was a patient.

If I was a patient facing cancer – or a woman nearing the ledge of fertility decline (not yet ready or able to build my family) – and I knew that I wanted children someday – I would absolutely freeze my eggs today.   Yes – women need to be told that this is not an insurance policy – that this is experimental – and they need to be consented. But egg freezing holds real promise – and for those women who are at a place in their lives where it is take a chance or no chance – I would look them straight in the eye and say go for it.

We already know what not trying will give you – so why reach for the chance?

Posted under Egg Freezing, Fertility, Fertility Preservation

As a peri-menopausal woman – the answer is yes. In fact I would like to know in advance that the period I am getting is my last one – so I can celebrate it. But the way things stand now – I won’t know that I am getting my last period until a year passes.  Kind of takes a lot of the ritual possibilities out of it. My girlfriend has a “Goddess Party” for her daughters when each of the got their first period – why shouldn’t we celebrate the last?

Now a new study released during 26th annual meeting of the European Society of Human Reproduction and Embryology in Rome  states that researchers  have developed an  accurate way to predict the age when women will hit the menopause using a simple blood test.

The average difference between the predicted age and the actual age that the women in their study reached the menopause was only a third of a year, and the maximum margin of error was between three and four years.

The  implications of this test for women and their doctors; if the results of the research are supported by larger studies,  means that women will be able to discover early on in their reproductive life what their expected age at menopause will be, so that they can plan when to start a family.

Knowing you fertility life span – is huge for women. That’s why Dr. David Kreiner at East Coast Fertility and I have been trying to get the word out about “Fertility Evaluations”. Right now we can’t predict when a woman will hit menopause but technology does exist right now for women to get a reading on where they are now in their own biological clock.

In this new study – they are taking blood samples from 266 women, aged 20-49, who had been enrolled in the much larger Tehran Lipid and Glucose Study, Dr Ramezani Tehrani and her colleagues were able to measure the concentrations of a hormone that is produced by cells in women’s ovaries – anti-Mullerian Hormone (AMH). AMH controls the development of follicles in the ovaries, from which oocytes (eggs) develop and it has been suggested that AMH could be used for measuring ovarian function. The researchers took two further blood samples at three yearly intervals, and they also collected information on the women’s socioeconomic background and reproductive history. In addition, the women had physical examinations every three years. The Tehran Lipid and Glucose Study is a prospective study that started in 1998 and is still continuing.

Dr Ramezani Tehrani, who is President of the Reproductive Endocrinology Department of the Endocrine Research Centre and a faculty member and Associate Professor of Shahid Beheshti University of Medical Sciences in Tehran, Iran, said: “We developed a statistical model for estimating the age at menopause from a single measurement of AMH concentration in serum from blood samples. Using this model, we estimated mean average ages at menopause for women at different time points in their reproductive life span from varying levels of serum AMH concentration. We were able to show that there was a good level of agreement between ages at menopause estimated by our model and the actual age at menopause for a subgroup of 63 women who reached menopause during the study. The average difference between the predicted age at menopause using our model and the women’s actual age was only a third of a year and the maximum margin of error for our model was only three to four years.

“The results from our study could enable us to make a more realistic assessment of women’s reproductive status many years before they reach menopause. For example, if a 20-year-old woman has a concentration of serum AMH of 2.8 ng/ml [nanograms per millilitre], we estimate that she will become menopausal between 35-38 years old. To the best of our knowledge this is the first prediction of age at menopause that has resulted from a population-based cohort study. We believe that our estimates of ages at menopause based on AMH levels are of sufficient validity to guide medical practitioners in their day-to-day practice, so that they can help women with their family planning.”

Dr Ramezani Tehrani was able to use the statistical model to identify AMH levels at different ages that would predict if women were likely to have an early menopause (before the age of 45). She found that, for instance, AMH levels of 4.1 ng/ml or less predicted early menopause in 20-year-olds, AMH levels of 3.3 ng/ml predicted it in 25-year-olds, and AMH levels of 2.4 ng/ml predicted it in 30-year-olds.

In contrast, AMH levels of at least 4.5 ng/ml at the age of 20, 3.8 ngl/ml at 25 and 2.9 ng/ml at 30 all predicted an age at menopause of over 50 years old. The researchers found that the average age at menopause for the women in their study was approximately 52.

Dr Ramezani Tehrani concluded: “Our findings indicate that AMH is capable of specifying a woman’s reproductive status more realistically than chronological age per se. Considering that this is a small study that has looked at women over a period of time, larger studies starting with women in their twenties and following them for several years are needed to validate the accuracy of serum AMH concentration for the prediction of menopause in young women.”
Who knows – maybe one day we will be able to celebrate our last period – just as some people celebrate the first.

Posted under Biological Clock, East Coast Fertility, Egg Banking, Fertility, Fertility Preservation, Fertility Rites and Symbols, Menopause, Menstrual Health

I have been speaking to women who are struggling with infertility for what feels like a life time. From my time as the President and then Executive Director of RESOLVE NYC to my time as the founder and first Executive Director of The American Fertility Association.

Now, I am hearing again from woman through this blog. The stories are all different and they are all the same. It is the regret that always gets me – that rips my heart. The level of self punishment that many of the women are putting themselves through because they blame themselves, even while they tell me that nobody ever offered them education about their fertility. And the pain that vibrates through the phone or an email is palpable. Often the woman makes apologies for the life that she had lived. There might have been an abortion. There was waiting too long to start trying once she was married….If only she had been better…if only she had been “a good girl”.

What I want to say here – is that the system has failed so many women. They have not failed themselves. Where were they supposed to get this information? From the air? When I was in school – I was taught about sex, STDs’ and birth control. That was it. Sex Education was about pregnancy prevention. That was it. Woman need to be given all the facts about reproduction starting from a young age. We need the complete story and that does include safer safe, information about STD’s, birth control and information about our reproductive potential as women.

These days – I spend about as much time directly with gynecologists as I do patients.  I drop in – and chat with them about fertility – and also the importance of talking to women about the getting a fertility evaluation.

Recently, I met with a young female GYN – and in the beginning the gynecologists agreed with us that the woman that they see have no idea of their biological clock – and they understood why giving them this information is important. And then, as it sometimes happens – this lovely female gynecologist got nervous about getting her patients nervous about their biological clocks. I told her that I really get nervous going for my mammograms and my pap smears – but that I go – because the information obtained from those tests can change my life.

I talked to her about the importance of women getting this information so that they could plan their own reproductive lives and perhaps stay out of reproductive endocrinologist’s offices. It is all about the possibilities that women now have – that if they learn that they are in a borderline place when it comes to their fertility – and they are not ready to start their families that they can freeze their eggs.

By the time that I left that office – I knew that I had created change. I had brought this office more than bagels and coffee – I had brought them information and a point of view that this office had not heard before – and it was a big office. By making these house calls of GYN’s, perhaps I  had changed the course of the reproductive lives of some women. I know that this sounds dramatic – but it is dramatic. This one practice with several gynecologists literally sees hundreds of women. By enrolling these doctors into our quest for better education for women around their fertility. I feel like we are building an army of educators one office at a time. We even talked about ways to introduce this information. And before the coffee and bagels were finished – they got it.

When I got home there was a letter from a woman waiting for me. She was full of regret. She was sure that how she had lived her life was the reason for her struggles to conceive. I wrote to her and I told her about all of the possibilities that still awaited her…for there were still many possibilities…the world still had much to offer up. That this was not about some notion that she had not lived a good life. That the infertility that she was now struggling with was not some kind of punishment. Why do we always go there? Why do we as women always blame ourselves? I wish that she had gotten information earlier – but that was my only regret for her – but that was it. And then I sent her this poem by Mary Oliver – perhaps this poem will touch you too…perhaps it is for all of us…no matter where you are in your life….

Wild Geese
by Mary Oliver

You do not have to be good.
You do not have to walk on your knees
for a hundred miles through the desert repenting.
You only have to let the soft animal of your body
love what it loves.
Tell me about despair, yours, and I will tell you mine.
Meanwhile the world goes on.
Meanwhile the sun and the clear pebbles of the rain
are moving across the landscapes,
over the prairies and the deep trees,
the mountains and the rivers.
Meanwhile the wild geese, high in the clean blue air,
are heading home again.
Whoever you are, no matter how lonely,
the world offers itself to your imagination,
calls to you like the wild geese, harsh and exciting –
over and over announcing your place
in the family of things

Posted under Egg Banking, Egg Freezing, Fertility, Fertility Education, Fertility Preservation, Fertility Support, eggs

Ah Springtime! The time of year when mother nature is showing off her buds! And those of you with lawns and gardens are adding fertilizer to the soil. But what about us? What are some “Fertility Do’s ” for us? Well….I just happen to have some – of course I do!

Fertility Do’s:

1. Do get those annual exams done! If you are thinking about getting pregnant – get your annual exams done first! You know what I am talking about – get your teeth cleaned and any x-rays done.  What about you mammogram and your pap? If you have been trying to conceive for a year – please take a short break and do your annual exam again! We want you to be a healthy parent!

2.  If You Are Under The Age of  of 34 and not planning on getting pregnant right now:  Do Get a Fertility Evaluation.

3. If you are sexually active and you are not in a monogamous relationship or only “fluid bonded” to one person – Do use condoms. Sexual Transmitted Diseases (STD’s) is a leading cause of infertility.

4. Do see a Fertility Specialist if you are 35 years old and have been trying for six months or longer. Too many women waste precious years sitting in their gynecologist’s office cycle after cycle. Or on too many cycles of clomid.

5.  Do make friends with your body. Your relationship to your body does count. Get in touch with yourself. What is your body trying to tell you through physical symptoms? Read “Women’s Bodies, Women’s Wisdom: Creating Physical and Emotional Health and Healing” by Christiane Northrup, MD. Learn about how the effects of nutrition, stress reduction, complimentary medicine, sex and lifestyle can impact on your fertility.

6.  If you use a intimacy lubricant when making love,  Do use a product that is fertility friendly, and organic such as  YES Baby.

7.  If you find yourself going through infertility,  Do build yourself a “Fertility Support Team”.  A Fertility Support team could consist of your everyday friends and family. For some people that is the best – and for others the idea of talking about infertility with close family and friends is really edgy. But there can be lot of components to a “Fertility Support Team”.  For peer support there are lots of great on line opportunities for connection. Check out Fertility-Ties for a great on line 24/7 community of peer support and professional answers, or INCIID has a great network of message boards.  If you prefer meeting face to face check out the in person support groups that are offered by RESOLVE and Parents Via Egg Donation.

8. Do think about hiring a “Fertility Consultant” if you are able to afford one (and some of them are not too pricey at all). It is wonderful to have your own personal guide through the world of reproductive medicine.  Your Fertility Consultant acts as a kind of “Conception Life Coach”  You don’t need to live in the same town or even state as your consultant. Most of the work is usually done on the telephone.  A short resource list would include - “My Fertility Plan”,  and “Lotus Blossom Consulting”.

9. Do get a second opinion if you are working with a doctor and have not achieved a pregnancy in six months to one year.  A great way to get a second opinion is to take advantage of free consultations. To learn more about free consultations and second opinions read this blog entry.

10.  Do read fertility blogs like The Fertility Advocate or The Fertility Doc. There are all kinds of fertility blogs on line and they are wonderful and different.  It is a great way to feel like you are not alone – get daily support and information – and learn about the reproductive medicine community. There are doctor blogs,  reproductive attorney blogs,  patient blogs, and “Tell it like I see it blogs”!

Fertility Authority has a great blog community – but there are lots of independent fertility bloggers out there, (I only linked to a few here) with so many unique stories and points of views. Go investigate community sites like Blogher, and Empowher. You will find just what you are looking for…..

11.  Do explore the websites of the fertility industry’s professional organizations such as The American Society of Reproductive Medicine and The Association of Reproductive Health Professionals. These professional organization often have good patient information on them – and you can get familiar with fertility practice guidelines there. Also the medical information may be more updated then the fact sheets that are on the patient organization’s websites. I was just checking some of those out – and I was shocked to see some fact sheets that were older than ten years old on some of these sites. Check for dates! Don’t just assume that fact sheets are current just because they are there (uh-oh a “Don’t” slipped in here!).

12.  Do Investigate your clinic’s success rates by jacking into The SART Report. And remember when you are reviewing success rates that small differences mean nothing.

Posted under Clomid Therapy, Egg Donation, Fertility, Fertility Authority, Fertility Blogs, Fertility Coach, Fertility Message Boards, Fertility Preservation, IVF, In Vitro Fertilization, Infertility, Infertility Consultants, Micro-IVF, PVED, STDs, Sexually Transmitted Diseases, The Association of Reproductive Health Professionals, The Fertility Advocate, The Fertility Doc, The SART Report, conception tips, eggs, miscarriage, sexual health, sexuality

Did you know that March 8th was International Women’s Day? Did you know that according to Wikipedia that International’s Women’s Day is “s a major day of global celebration of women. In different regions the focus of the celebrations ranges from general celebration of respect, appreciation and love towards women to a celebration for women’s economic, political and social achievements.

Started as a Socialist political event, the holiday blended in the culture of many countries, primarily Eastern Europe, Russia, and the former Soviet bloc. In many regions, the day lost its political flavour, and became simply an occasion for men to express their love for women in a way somewhat similar to a mixture of Mother’s Day and St Valentine’s Day. In other regions, however, the original political and human rights theme designated by the United Nations runs strong, and political and social awareness of the struggles of women worldwide are brought out and examined in a hopeful manner”. Who knew? I didn’t.

But you learn everything in life on Facebook! And that is where i found out that I had indeed missed International Women’s Day.  I kind of felt a little bit better when I realized that I wrote about being a Fearless Woman yesterday.

Being fearless has been kind of a theme for me in the past few weeks ever since the “Fertility Authority” featured my blog and they described me by calling me “Fearless”.  It kind of made me smile because I had never thought of myself as fearless – to me I was perhaps shameless.  But fearless?

What I do know is that, like so many women around the world, I have had an incredible and varied life.  I live full out. I play full court – and I make no excuses for myself.  And for so many women, we live in a time where we can finally integrate our lives.  Now, once upon a time – I didn’t integrate my life. Because women are never actually encouraged to do this. We are expected to be one thing or another….We are either “professional” or “homemakers” – we are either “Madonnas or Whores”.  But what if you were allowed as a woman to have a fully integrated life? What if you could have a professional life, and still have a family? What if being a successful lawyer didn’t mean that you could still also be around to cook for your family if that pleased you? What if you could be wearing sexy lacy panties under  your business suit – and was meeting your lover for some fabulous sexual adventure after work? Could women truly have it all?  Isn’t this what we have been saying with the introduction of egg freezing? That it is okay to freeze your eggs now – and have your children later while you were figuring the rest of your life out? That you didn’t have to choose? That everything could happen in it’s own good time and that women could integrate their lives as they saw fit?

Was this possible? Maybe not everywhere in the world right now perhaps – but I do believe that this possibility does exist right now in many places of the globe.

Think about it. Could we actually be mothers, Madonnas, workers and sexual beings all at the same time? Would society know how to wrap their arms around that?  What is going on with women who are hooked up to machines in a study to look at their sexual response – and their bodies register a response to the visual stimulation but the woman’s mind does not? What is going on? How do we help women connect these dots? There is something incredibly broken in that.

I think that we are getting closer to putting the pieces together. But we will never get there if a woman’s sexuality is still used to punish her.  And even today – it is. But like New Hampshire passing gay marriage – we are a country in transition. And I believe that we are closer than ever to supporting women living fully integrated lives.

Sociologists and sex perts are finally writing about the new integrated woman – and that’s a start. But who are the brave women out there who will do it and speak it?

Can you wear something sexy to work and still be taken seriously? For a good long while – before Katie Couric showed  her legs on The Today Show – the answer was no. But I have been watching those anchor women in the morning – and their sexuality has been starting to bloom – even as they have interviewed Presidents and talked about the issues that their kids were having in school. I love that.  They are all people – and they do not hide their sexuality – their  motherhood or their professional  smarts. They are clear that all of those pieces of themselves is a part of who they are as women.

And I have been as guilty of it as the next person. There was this one pharmacy rep that sent out this really sexy picture of herself in a Christmas outfit last year – and everyone was tearing her apart. How dare she? Who did she think she was? How could she show herself as sexy and playful? She was after all a “Professional”!!!! Oh well. Perhaps we were all a little jealous of her carefree, youthful  and yes – sexy spirit! What is it that gets us all fired up? Is it that we think that we are supposed to be this judgmental? Or were we simply happy to dismiss her as a slut? It was after all so much easier than seeing her as a full person.

I love that Oprah is getting on the band wagon. Several recent shows have explored a woman’s sexuality – and she has even taken sex toys to the stage. Oprah is saying that she cares about women being  integrated beings when she does these kinds of shows. And I love that.

But women are still persecuted today for being sexual beings. Recently one of the Miss America’s made big news when some topless photos showed up of her – you see – she was allowed to look sexy – to tantalize us in her bikini body – but not actually show us her breasts. Kind of interesting huh? In the end – The Donald realized how silly it all was – and the girl has her crown for a little while longer!

I love that we have a first lady who has the right to bare arms and those fabulous legs.  Our first lady – and frankly our President are clearly sexually integrated people. They are alive – and that aliveness permeates everything that they do. Mrs. Obama can be sexy and serious – and be a parent.  She is able to be a full woman – and I love that she is being a role model for other  women in this regard.

I have been talking a lot lately about how confused we are as a nation when it comes to our gender roles, our sexuality, and what is allow able and what is not.  We get glimpses of celebrities who are under the full view finder of the camera being sexual beings – and it freaks us out in the moment. Whether it is Brittany Spears forgetting her panties – or Paris  Hilton’s private sex tape (by the way I recently saw that in the Museum of Sex). But I am hoping that this too shall pass.

Look to France where a nude portrait of French President Nicolas Sarkozy’s wife Carla Bruni will go under the hammer in New York next month, according to auctioneers Christie’s.

The 13 x 10 1/8 inch gelatin silver black and white photograph was taken in 1993, when Bruni was one of the world’s top fashion models, and is being sold by art collector Gert Elfering.

Carla Bruni who is now beloved by all – started her public life as a mistress, actress,  and as a model that sometimes posed nude. Yet she looked quite lovely when she met the Queen of England. Yes – my dearies – we can live in full color and have integrated lives. Nothing is stopping you but a little bit of fear – and concern about whether or not you will be taken seriously if you dare be all of the parts of you.

And it just one day past International Women’s Day!  Take my hand – the water is fine.

Posted under Egg Freezing, Facebook, Female Sexual Desire, Fertility, Fertility Authority, Fertility Preservation, Integrated Woman, International Women's Day, Self Image, Sex, Sex Education, Shameless, inspirational thoughts, sexual health, sexuality

The Fertility Do’s:

1. If You Are Under The Age of  of 34 and Not Planning on Getting Pregnant Right Now: Do Get a Fertility Evaluation.

2. If you are sexually active and you are not in a monogamous relationship or only “fluid bonded” to one person – Do use condoms. Sexual Transmitted Diseases (STD’s) is a leading cause of infertility.

3. Do see a Fertility Specialist if you are 35 years old and have been trying for six months or longer. Too many women waste precious years sitting in their gynecologist’s office cycle after cycle.

4. Do make friends with your body. Your relationship to your body does count. Get in touch with yourself. What is your body trying to tell you through physical symptoms? Read “Women’s Bodies, Women’s Wisdom: Creating Physical and Emotional Health and Healing” by Christiane Northrup, MD. Learn about how the effects of nutrition, stress reduction, complimentary medicine, sex and lifestyle can impact on your fertility.

5. If you find yourself going through infertility,  Do build yourself a “Fertility Support Team”.  A Fertility Support team could consist of your everyday friends and family. For some people that is the best – and for others the idea of talking about infertility with close family and friends is really edgy. But there can be lot of components to a “Fertility Support Team”.  For peer support there are lots of great on line opportunities for connection. Check out Fertility-Ties for a great on line 24/7 community of peer support and professional answers, or INCIID has a great network of message boards.  If you prefer meeting face to face check out the in person support groups that are offered by RESOLVE and The American Fertility Association.

6. Do think about hiring a “Fertility Consultant” if you are able to afford one (and some of them are not too pricey at all). It is wonderful to have your own personal guide through the world of reproductive medicine.  Your Fertility Consultant acts as a kind of “Conception Life Coach”  You don’t need to live in the same town or even state as your consultant. Most of the work is usually done on the telephone.  A short resource list would include - “My Fertility Plan”,  and “Lotus Blossom Consulting”.

7. Do get a second opinion if you are working with a doctor and have not achieved a pregnancy in six months to one year.  A great way to get a second opinion is to take advantage of free consultations. To learn more about free consultations and second opinions read this blog entry.

8.  Do read fertility blogs like The Fertility Advocate! There are all kinds of fertility blogs on line and they are wonderful and different.  It is a great way to feel like you are not alone – get daily support and information – and learn about the reproductive medicine community. There are doctor blogs,  reproductive attorney blogs,  patient blogs, and “Tell it like I see it blogs”!

Fertility Authority has a great blog community – but there are lots of independent fertility bloggers out there, (I only linked to a few here) with so many unique stories and points of views. Go investigate community sites like Blogher, and Empowher. You will find just what you are looking for…..

9.  Do explore the websites of the fertility industry’s professional organizations such as The American Society of Reproductive Medicine and The Association of Reproductive Health Professionals. These professional organization often have good patient information on them – and you can get familiar with fertility practice guidelines there. Also the medical information may be more updated then the fact sheets that are on the patient organization’s websites. I was just checking some of those out – and I was shocked to see some fact sheets that were older than ten years old on some of these sites. Check for dates! Don’t just assume that fact sheets are current just because they are there (uh-oh a “Don’t” slipped in here!).

10. Do Investigate your clinic’s success rates by jacking into The SART Report. And remember when you are reviewing success rates that small differences mean nothing.

The Fertility Don’ts:

1.  If you are trying to conceive, and not having any luck. Don’t forget to get the man tested first! Getting a semen analysis is simple.  Getting pregnant is a fifty-fifty proposition.

2. If you are a man or a woman who is sexually active and not in relationship that is fluid bonded please don’t depend on each other to provide birth control that will protect your from getting Sexually Transmitted Diseases, including HIV and HPV. The best protection is barrier protection and that means a condom for a man or a woman.  The female condom is on the market and is a great product. Check it out. There are no excuses ladies to being safe, sane and responsible for your own body.

3.  If you are a woman, don’t postpone child bearing too long if you want to have children. Female fertility begins to decline at age 27.

4. Don’t believe everything you read or hear about how people have their babies. Your friend or famous celebrity who has twins at age 50 using IVF – DID use donor eggs – no matter what she says.

5. Don’t stop living while trying to conceive! Allow yourself a cup of coffee, a glass of red wine, chocolate and the occasional hot tub! It won’t hurt you! Moderation is the key.

6. If you are seeking medical treatment for infertility don’t think that your doctor is a deity. He or she isn’t. The practice of reproductive medicine is as much an art as it is a science.  If you are not getting pregnant or being treated the way you want to be treated – get a second opinion!

7. Don’t do multiple cycles of Clomid or IUI’s.  Three cycles of Clomid are enough – and if your doctor is recommending IUI – please explore “Micro IVF”.

8. Don’t think that putting back more embryos is better than putting back one or two. It’s not. Learn about Single Embryo Transfers.

9.  Don’t believe everything that you read on infertility patient message boards.

10. Don’t give up hope on having a family.  Families come in so many ways – just keep an open heart. And one day you will realize that you are in the heart of the family that you always dreamed about.

Posted under Biological Clock, Clomid Therapy, Diet and Fertility, Egg Donation, Fertility, Fertility Authority, Fertility Blogs, Fertility Coach, Fertility Consultants, Fertility Medications, Fertility Message Boards, Fertility Preservation, Fertility Support, Fertility Ties, INCIID, In Vitro Fertilization, Infertility Consultants, Micro-IVF, Mini IVF, Sperm, The American Society for Reproductive Medicine, The Association of Reproductive Health Professionals, The SART Report, fertility evaluations, infertiity, male infertility, sexuality

The news about there being a female biological clock is not brand new information. From the infamous tee shirt that read “Oh! I forgot to have children!!!” to our aging eggs finding it’s way into movie scripts and television shows. The information that women and yes, even men have a biological clock is out there.

The problem is, an awful lot of what’s out there about fertility and reproduction is pulp fiction. The blurring of fact, opinion, myth and misunderstanding makes for a treacherous misinformation landscape. The knowledge gap has claimed millions of victims, people who learned about the fundamentals of protecting and preserving fertility too late to help them have genetically linked offspring they always assumed would be theirs.  Armed with essential and accurate information, you don’t have to join their ranks.

What is still not understood across the board is the time line of the biological clock.  And most of us don’t have a clue about our own.

So the big question is – what do you know about your fertility?

Well, if you’re like most people, the answer is not as much as you might believe. Just to give you a little perspective, a spate of recent surveys reveals that the overwhelming majority of U.S. women:

·        Don’t understand the biological clock – the trajectory of reproductive capabilities from its peak in the early-to-mid-20s to the age of inevitable decline beginning, typically, around 27.

·        Mistake overall good health for an indicator of fertility.  However wonderfully youthful and fit a 42-year-old might be, her eggs are operating on an independent and fixed timeline.

·        Believe they can get pregnant easily until their 40s. The stark truth is women at that age are more likely than not to require medical intervention.

·        Are unaware that men, too, carry a ticking reproductive timer.

·        Don’t know that lifestyle factors—sleep, diet, exercise and environment, for instance – can have a profound effect the ability to have a child.

Yet this basic information can make a critical difference in the life of every person who dreams of having a child this year, next, or 10 years down the road. If you know about your body’s reproductive lifecycle, you can take steps to protect and preserve your fertility. That way you can have the children you want– if and when you choose.

Start Where You Are: Get To Know Your Baseline

Statistics and general truths aside, every woman is unique.  Given just how complicated it is to make a baby in the first place, understanding your own body’s reproductive capability and the changes it might undergo from year to year is an invaluable planning tool. Consider an annual fertility evaluation or screening.

A what??

Simply put, the screening involves a few simple blood tests and an ultrasound to get a handle on your ovarian function.  These tests have been around for years, tried and true tools in the diagnosis and treatment of compromised fertility. The piece that’s different is using them in the context of preventative fertility.

Taken together with your individual and your family’s medical histories, the screening helps establish where you are on your personal fertility curve. The first screening establishes your baseline, subsequent annual evaluations will flag changes in key hormone levels and mature egg production that could signal potential trouble. Mind you, any warning flares are just that and may mean nothing. But they could indicate that follow-up with your doctor, gynecologist or a reproductive specialist is warranted. And if there is problem, you’re ahead of the game with the opportunity for early intervention and, where possible, corrective action.

More about the nuts-and-bolts of the screening later. First, let’s talk about why the evaluation is so important.

Marking Time: The Biological Clock and You

Let’s start at the beginning. Each woman’s oocytes (eggs) supply is finite. That means the body doesn’t produce new ones. So the 7 million or so eggs each female is born with is all she’s going to have. Ever.  By the time the average girl hits puberty, only about 250,000-300,000 oocytes remain in her ovaries.  With each menstrual cycle one egg become ripe enough for fertilization and is released. An additional thousand eggs each month are lost through a process called artresia, the natural breakdown of the eggs by the body.  After ovulating an average of 400 times through her life, typically around 50 years of age, the store of oocytes is tapped out. That’s menopause.

Then there’s the matter of oocyte aging. Eggs age along with the rest of the body. The older oocytes are more likely to have chromosomal abnormalities making them unlikely to become viable embryos. It’s important to note that a fertilized egg with abnormal chromosomes is the single most common cause of miscarriage. A woman in her 20s has only a 12%-15% chance (about one in every eight pregnancies) of having a miscarriage each time she becomes pregnant.  On the other hand, a woman in her 40s faces a 50% risk of miscarriage (that’s one in every two).

Despite the amount of ink and airtime that’s been lavished on the biological clock, most women still don’t know about the direct, inverse relationship between age and procreation.  The bottom line is the older we get, the less likely we are to conceive and have a successful pregnancy. What’s harder to grasp is that in this context, women qualify for “older” at 27.  You read it right. Statistically speaking, when a women hits 27, her fertility begins an exorable decline. When she hits 35, it take a sharp downturn.  At 40, fertility falls off the edge of the earth.

Of course, some women in their late 30s and a few in their 40s conceive effortlessly, carry and deliver healthy babies. But the likelihood of that happening without medical intervention becomes more remote with each passing year.  For women under 30, the estimated chance of becoming pregnant in any one cycle is between 20% and 30%.  When women turn 40, that probability plummets to approximately 5%.

OK, So Now That You Know, What Next?

Rest assured, this IS NOT a push of the panic button. It’s not a call to rush into loveless marriage, or drop out of school and give up your career in order to guarantee your bloodline continues.

Rather this is a call to arms. Women deserve to know the full truth about reproduction so they can take the family-planning reins and make informed decisions. The goal is to help you and every woman of childbearing years make the choices that help protect and optimize fertility.

·        The Contraception Contradiction. While all contraceptives prevent pregnancies with greater or lesser efficacy, some actually help preserve fertility. Oral contraceptives decrease the incidence of tubal disease because birth control pills make it more difficult for some infections to grow. They also minimize the growth of the endometrium (the lining of the uterus), reducing the incidence of endometriosis, a condition that can closely linked to infertility. Condoms and, to a lesser extent, diaphragms, protect against sexually transmitted diseases, which contribute to or cause compromised reproductive function and infertility.,

·        Weight of the World. When it comes to baby-making, you absolutely can be too thin. Or too fat.  A woman’s body is at its reproductive best when it’s within 15% of the ideal weight. And by ideal, we don’t mean runway ready. It’s the weight at which your body and its hormonal systems hum like a finely-tuned Ferrari. There are individual variations, but, many women experience problems when they’re less than 95% or more than 124% of that weight.  Using a standardized measure called the Body Mass Index (BMI) you can determine your “ideal” weight.

At less than 95% of the ideal weight, women might stop ovulating, having regular menstrual cycles – or any at all. On the other end of the scale, excess weight is associated with unpredictably long gaps between menstrual periods and superabundance of ovulation-interfering hormones.

·        Feed Your Fertility. Eat all the things you know you should but probably don’t, including fruits, vegetables and low-fat protein. In fact, adequate protein is absolutely essential because without it, estrogen breaks down into inactive byproducts more rapidly and menstrual cycles become longer.

·        The Drink That Refreshes? Sorry but you’ll have to cap your caffeine and alcohol drinks to one cuppa joe (or latte or cappuccino) a day and maybe the occasional glass of wine. Heavy drinking is a fertility wrecker for both women and men.

·        Get Exercised. Regular, moderate workouts are the gift of the fertility gods. They help keep your hormones happy, your weight under control and bring down your stress levels. Heavy exercise, say running 35-40 miles a week, can trigger amenorrhea (no periods), diminish progesterone levels so that an making it difficult for an embryo to implant.

·        Smoke Signals. Tobacco is no friend of fertility.  It increases susceptibility to sexually transmitted diseases in both men and women, increases the likelihood of tubal pregnancies, cervical cancer and pelvic infection.  It’s just plain bad.

·        Drug Drag. It’s not just the obvious culprits like cocaine and marijuana that spell trouble. It’s the pharmaceutical that people routine take to treat common diseases and conditions, such as Crohn’s Disease or ulcers or even psychological disorders, that could be problematic. If you’re contemplating getting pregnant in the near future, consult with your doctor.

Fertility Screening for Your Reproductive Life

Knowing what you know, you can actively in shelter your fertility from harm and even get it to optimal levels. Now there’s an important tool to help you identify where you are on your own fertility curve. Perhaps even more important, the screening can help pinpoint women whose ovarian function is on the wane so they can get timely treatment.

The screening itself is fairly low-tech. Part one consists of four blood tests to check the levels of FSH, estrodial, MIS (mullerian inhibiting substance), inhibin-B, all critical to conception and pregnancy. Ideally this is done on the third day of your period. Each blood factor is an indirect assessment of ovarian reserve. Any one of them is helpful. But the combination of all four allows for much greater precision in identifying potential problems.

Part two is a vaginal ultrasound to count the number of antral follicles in ovaries. Antral follicles are a good indicator of the reserve of eggs remaining in the ovary. In general, fertility specialists like to see at least eight antral follicles per ovary.

What you and your doctor are looking for is a dramatic shift in values from one year to the next.

Although none of these tests is in of and of themselves an absolute predictor of ability to get pregnant, when one or more come back in the abnormal range, it is highly suggestive of ovarian compromise. It deserves further scrutiny.  That’s when it makes sense to have a sit-down with your gynecologist or fertility specialist. Bear in mind, the “normal” range is quite broad. But when an “abnormal” flare goes off, you want to check it out.

It’s important to remember that fertility is more than your ovaries. If you have risk factors for blocked fallopian tubes such as history of previous pelvic infection, or if your partner has potentially abnormal sperm, then other tests are in order. And if, for example you do have blocked tubes, it’s better have the corrected sooner rather than later when the becoming pregnant is an urgent matter.

Precisely because your fertility profile is as singular as your fingerprint, it’s important to get a baseline as early as possible. Currently, specialists recommend that annual screening beginning at 21 years of age would be most helpful in establishing your own benchmark. If you are not 21 – don’t lose sleep.  Remember that these Fertility Evaluations are a new concept. If you are concerned about your ferility at any age – you can go find out the facts by having these simply tests performed.

Fertility Preservation: The Egg Freezing Revolution and The  Biological Clock

As so many women discovered late in life, procreation is a far more delicate and complicated process than most of us ever suspect. After all we spend so much time trying to avoid pregnancy, it never occurs to us that we may not be able to when we want.

So what do you do if you are in the midst of getting your degree or your career is on an upward trend that you don’t want to derail? Until recently, the options were few and unreliable.

But the world of reproductive medicine is on the fast track to breakthroughs in egg freezing which is giving young women the opportunity to put the best of their oocytes into a safe deep freeze until they’re ready to use them.

Some IVF Centers  claim that they are ready to provide state of the art egg freezing right now to women. Others like East Coast Fertility are in the midst of doing studies and offering discounts to patients who want to be a part of the Egg Freezing Studies. If you want to know more about your own reproductive potential, you could take advantage of a free consultation, and find out if participating the egg freezing study is something that is appropriate for you.

With careful attention to fertility protection, a program of annual fertility screening and the egg freezing option, for the first time young women really do have reproductive choice.   Not just the promise but the real thing.

Posted under Biological Clock, East Coast Fertility, Egg Freezing, Fertility, Fertility Preservation, IVF, infertiity

I have been on both sides of the baby making field – from the non profit world of patient organizations to the for profit world of medicine. I sit on a very unique and sometimes difficult perch. I see myself first as a patient advocate – but I now work as a marketing director of an IVF program . In some ways life hasn’t really changed for me. And that in of itself is really interesting to me. It should be for you too.

For instance – right now I am in the midst of running two free patient seminars for East Coast Fertility. I have run hundreds of these for RESOLVE and The American Fertility Association in my various roles as volunteer and paid executive director. This is an educational event that is in many ways no different than any other patient event that I ran when it was for a non profit infertility organization. I have the sponsoring doctor that I wouldn’t be working with if he wasn’t very highly regarded.

I arranged for the venue, the refreshments and the advertising. My physician speaker will be giving a presentation that will look no different than if he was speaking at a non profit sponsored event. We even sent out a press release! I will be there to talk to the patients, and introduce the speaker with a word or two about the infertility experience. The only difference for me is my title.

The intentions for me are really the same – I want to out reach to patients and let them hear a well known and highly respected reproductive endocrinologist speak. I want to give them access to face to face support and information. And I want the doctor to be happy, and that means a good turn out of prospective patients to listen to the talk.

This is absolutely no different than when I was running these events for the non profits. It is the odd mix of good intentions – trying to do the right thing and direct to consumer marketing. Let’s call a spade a spade.

Somehow we like to think that the non profits are doing something different when they have medical professionals speak at their meetings (which they hang their banners over), than marketing infertility services. Somehow it is “better”… more authentic and non partisan if the patient organizations are running the show. And lots of folks are willing to pay for the privilege of that stamp of approval over the banner of their talks.

You see, the non profits call these types of marketing outreaches “education” – but doctors and service providers are often paying for the opportunity to sponsor and speak at these educational events – which is viewed and paid for out of their marketing budgets – or subsidized by the pharmaceutical industry in support of the doctor’s practice.

In return for their sponsorship dollars, time and effort – the doctors, therapists, agencies and adoption experts want to know how many people they will reach if they support a non profit event. It is a business deal for them, and rightly so – many of them want to know what their return on investment is. It doesn’t mean that the providers do not care about their patients, patient education and don’t feel good about channeling their efforts into these events. Of course most of them do. But everyone has a bottom line – even non profits.

Does this make the information inherently bad? Or in some way corrupt?

The answer is a difficult one, with lots of different points of views. And I have heard it all – from the pharmaceutical companies to the physicians. My response to that is “no” it really doesn’t make the information provided to the patients bad – and the non profits have to pay the bills too – but full disclosure around all of this is lacking.

When I speak or write for professional conferences or associations, or even when I supplied my blog to Medpedia, I needed to fill out a disclosure form that is made public which talks about any financial ties that I have to the industry or political influences such as board seats. I think it is a healthy practice.

You see, there is a recognition on the professional level that the presentation of information and education based in part on a sponsorship dollar or board seat does have it’s consequences. And there is the issue that you tend to see the same speakers and writers over and over again based on their ability to pay and based on their relationship and ties to the various organizations. Pay attention – the camps are clearly divided.

None of this is talked about publically – but it is talked about by grumpy smaller name practices and individuals who can’t afford the practice tags to get into the game of patient education – often over martinis.

Some of this may be news to you – but none of this is veiled either. You just have to look – it’s right in front of your nose. I am not telling any secrets of the industry here.

Our patient community is completely vulnerable to all of the different ways that marketing efforts have on some level or another affected patient care and education in this country.

And then there is my free patient seminar tomorrow night, and September 21st on Long Island, where Dr. Kreiner and I will be talking about Micro-IVF, The Single Embryo Transfer Program, Financing Infertility Treatment and the New York State Grant Program. Lots of good stuff – and an opportunity to get support and patient questions answered by two fertility pioneers!

Patient education paid for out of East Coast Fertility’s marketing budget.

Posted under Advocacy, East Coast Fertility, Egg Freezing, Fertility, Fertility Education, Fertility Preservation, Fertility Support, IVF, In Vitro Fertilization, Infertility, RESOLVE, The American Fertility Association, sexuality

I can’t help it. The latest fertility breakthrough has given me a case of the big ickys (and no ‘big ickys’ is not a scientific term).  And I can’t quite get a handle on why. But I never could look at the medical presentations when Dr. Kutluk H. Oktay would demonstrate his ovarian tissue transplants with the transfered ovarian tissue bulging during “ovulation” under the skin of the woman’s forearm or tummy.  I always had to turn away. Look – I am a fertility advocate not a doctor! I admit to occasionally getting squeamish.

I am trying to be all forward thinking about this latest and greatest research just released at this year’s meeting of the European Society of Human Reproduction and Embryology (ESHRE), in Amsterdam.  And it is just not completely working. Perhaps it is about Dr. Silber’s vision for how to apply this latest reproductive technology rather than the breakthrough itself.

The breaking news is in fertility preservation (something that I am, and have been tremendously supportive of) and Dr. Sherman Silber of St Louis is doing some ground breaking work on ovarian freezing – and promoting this as the future for fertility preservation for young woman.

What Dr. Silber is doing is actually removing an entire ovary from a woman and freezing it through vitrification (a newer fast freezing process that is more successful) for later use for reproduction. And he is marketing this as a fertility preservation option for women who wish to delay child bearing. When they are ready to build their family – Dr. Silber just “transplants” the ovary right back in the woman and apparently they just start ticking again! If I understand this properly – the women don’t need fertility drugs to get their ovaries pumping again.

Now, I get egg freezing for younger women for sociological reasons and cancer patients. But I really can’t get my mind around surgically removing a young girls ovaries to freeze them for her future fertility when this is not cancer related. Why do this when we can freeze eggs so well now and just leave a woman’s ovaries in her body where they belong?

This feels – well – so completely radical.  I also understand why cancer patients would do this as they may lose complete ovarian function after radiation or chemotherapy.  Getting egg freezing to these patients is often difficult as the reproductive endocrinologists have to work really fast to time an egg freezing cycle with the patients treatment. But with ovarian transplants – they could just go in – rescue the ovary and worry about getting those eggs later. For cancer patients – ovarian transplants is a incredible break through.

I was chatting with my friend Lisa (who works in fertility) last night – her daughter Rosie just turned 16.  I asked her about ovarian transplants – and how she would feel about this for her daughter as a means of banking her future fertility. Lisa asked me why I was being gross so late at night.  Oh – she got an “ick” too.

I don’t know about the future of ovarian transplants for sociological reasons. But I didn’t get Facebook or Twitter in the beginning either.

Posted under Biological Clock, Egg Banking, Egg Freezing, Fertility, Fertility Preservation, ovarian freezing

So this week we are going to be learning a lot of gender re-assignment and sex change operations in the mass media.  Not only has   – Chastity Bono has come out with his true gender identity – and the name he prefers to use “Chaz”.   But in the same week –  Thomas Beatie  the trangender man (he kept his female reproductive organs) who made the news as the first pregnant man has given birth again – this time to a son.  Yes – it is going to be a big news week for the Trangender Community!

As a fertility advocate –  I see this as an opportunity for people who are thinking about transitioning from one gender to another to possibly get some good information through the media – and perhaps to not feel so alone.  Especially young people who are struggling with their sexual identity often alone, scared, shamed and isolated.

One of the things that I have cared about for years is family building in the LGBT Community.  And somehow – the Trans Community has always been left out of that discussion in any real way. The only time we have heard about transgender people having children has been Thomas Beatie – and perhaps the fact that some transgender people have had children before they came out and were living in their original gender roles.

I wish that there was more information out there for the Trans Community about banking your fertility before beginning hormone treatment and transitioning. But it doesn’t seem to happen very much at all – at least for women who are transitioning.  Sometimes – it is mentioned to men that they could bank their sperm before the transition process – but mostly everyone is so focused on the transition that few health care providers, mental health professionals for family members talk about this part of a gender reassignment.

Life is long and full of choices – we don’t know what will come next.   The LGBT Community has been fighting for the ability to marry across the country – and there are many groups that support LGBT family building.  I wish that fertility preservation conversations was a part of the conversation – so when life marches on – and people’s priorities start to shift and move – the possibility of progeny is there.  

I wonder if anyone has talked to Chaz who is 40 – about trying to bank his eggs before continuing on hormone treatment and surgery? I hope so. The time to do it would be now.

Posted under Chastity Bono, Children of Lesbians and Gays, Egg Banking, Egg Freezing, Fertility, Fertility Preservation, LGBT Family Building, Transgender Family Building