National Eating Disorder Week is almost upon us. It officially runs from February 26th through March 3rd.  In recognition of NED Awareness, I would like to share with you a link to a recent interview that I did with “Getting Over ED (Eating Disorders) Summit”, about my own personal experience with eating disorders.  You can jack into the audio interview for free here.

I think talking about eating disorders and their relationship to trying to conceive and our sexuality is incredibly important. I have heard from many of my fertility coaching clients that they are often asked by their fertility doctors to adjust their body weight. Whether it is to gain weight or lose weight – the request can set people over the edge.  It can be the one thing that perhaps we can control, and feel the most out of control of.

The one thing we can do during National Eating Disorders Week is talk about it. And if it is time – come out.

“He won’t go and have it tested” she whispered.  “He is too embarrassed.”

“So, you have no idea if his sperm count is normal or not and you are taking fertility drugs?”, I try not to explode.

The telephone line goes silent as she tries to muffle tears.

I wish I could say this was a new conversation for me, but during my years as president and the first Executive Director of RESOLVE NYC, and then as founder and first Executive Director of The American Fertility Association, and now as a private fertility coach – I have had this conversation more times than I care to count. The conversation has not changed much in over 20 years.

Countless women are still going it alone in fertility treatment. Many gynecologists do not require the men to have their sperm count checked if they are resistant to the idea, and are willing to prescribe fertility drugs to women even while knowing that half of infertility has a male factor component.

I understand the discomfort. Going into the doctor’s office to produce a specimen is not fun, especially when you are in the beginning stages of trying to have a baby. And many men just won’t go.

“What if he could test his own sperm in the privacy of your home? Do you think he would do it?”

The answer was “Yes”, and I recommended that she go and pick up a brand new FDA approved over the counter kit that has been proven to be 98% accurate – called SpermCheck^® Fertility. (Facebook SpermCheck^® Fertility)

It’s a first step kit. Knowing that my client’s husband’s sperm count is normal would make her feel so much better about taking the fertility medication – and would quiet so many fears. And if the sperm count came back low, she would know to stop taking the medication, and that it was time for a new conversation with her husband and doctor.

Having the privacy to do this at home made all the difference to my client’s husband, and he was willing to finally check his sperm. The good news is that his sperm count is very healthy, and now my client is looking into other options for conception.

I am now recommending SpermCheck^® Fertility to take some of the guesswork out of conception. There is no reason now, when couples are waiting longer to start a family, why they can’t check out their own fertility facts right in the very beginning of their baby making journey. It’s common for women to pick up ovulation predictor kits to make sure that they are ovulating! Now the guys can check their sperm too!

Countless months of frustrating baby making sex can now be erased by these early-bird warning systems using diagnostic tests that can be done privately and inexpensively in the home. Now, I call that a breakthrough.

I am so excited about this that I have agreed to participate in a special sweepstakes to get the word out about SpermCheck^® Fertility. Now through Feb. 29th, enter the  ”Committed to Conception” Sweepstakes and one grand prize winner will win a private fertility coaching session with me  (by phone or online) and four runners-up will win a copy of my Shameless Baby Making CD and a $50 retail gift card to either Walgreens or CVS! Enter here!

You can learn more by joining SpermCheck^® Fertility on Facebook at www.facebook.com/SpermCheck

If my friend was someone that I was sharing my infertility journey with, I was losing someone to cry with. And she was now in the place that I longed for. These are difficult feelings to express. They feel selfish, and small – and I often felt selfish and small when I was feeling them. Sure, I wanted to be thrilled for my friend – but mostly I died a little inside. Let’s face it – my friend’s life was about to radically change with the birth of a baby – and I was still doing cycles of IVF.  But my friend’s were precious to me, and I had to figure out how to cope. Eventually I figured out a few tips to survive the ups and downs of lives going in different directions.

Each year in the U.S. approximately 12,000 women are diagnosed with cervical cancer, and more than 4,000 lives are lost as a result. This doesn’t take into account the many thousands of women who have cervical abnormalities and abnormal Pap tests for reasons other than cancer, but who still undergo expensive and inconvenient follow-up exams and treatments.
Cervical cancer is caused by specific types of the Human Papillomavirus (HPV), a common infection that almost everyone who is sexually active will have at some point. There are vaccines that block the types of HPV most often found with cervical diseases, and screening tests (such as Pap tests and HPV tests) that can identify women most at risk. We can prevent cervical cancer!

Vaccinate early (females and males ages 9-26 are eligible)
Pap test regularly (beginning at age 21)
HPV test when recommended

What else can you do?

Talk with your friends about cervical health! Decide to make friends with your cervix.

Read articles, like this one on checking your cervical position, by Rachel Gurevich

Check out the documentary “At Your Cervix”.

Jack into the Beautiful Cervix Project!

It’s that time of year when so many of us are dealing with that extra ten pounds that was gained during the holidays. For the first time, in a really long time that is not my story, but for years, and years it was and I often thought about gathering my friends and trying to get a group rate!

I ate my way through my years of infertility, sometimes wishing that someone would just tie my hands up behind my back! I ate out of sadness, comfort, and hunger for a baby.  I don’t know about you – but I can find this time of year almost as difficult as the holidays themselves when it comes to my food environment and staying sober with my eating.

Perhaps it is the darkness and the cold Perhaps it is the all of the New Year Resolutions. Perhaps it is because this time of year really brings out all of our emotional hungers.

Staying sober with food is a really good concept for people with emotional hunger.  For me, eating can be like a drug or a band aid that I put on my emotional hungers.  That is why I have become very conscious of how I use food. What am I feeding? Am I eating because I am truly hungry? Or am I eating because of something else – and trust me you don’t want to read the list of Pamela’s reasons to eat.  Infertility used to be a great reason.  Now there are other reasons to abuse food….it’s funny how some things change and other things stay the same.

Disordered eating and it’s twin sister, Disordered Body Image plagues millions of women and men and when you add in another life crisis such as infertility – the use of food through restriction (to feel control in an uncontrollable time in our lives) or through over eating to numb our feelings can reach crisis proportions.

It is not just the over or under eating that plagues us – it is also how we see and feel our own bodies.  Or don’t feel our own bodies.

Our bodies and how we feel about our physical selves is a loaded subject all by itself. But it’s all connected – and if you are going through infertility your body may feel like it no longer belongs to you.  In so many ways – you may feel like you have handed over your body to doctors, medications, and procedures. You may be completely furious with your physical self for not giving you what you need your body to give you – whether it is as simple as a positive response to treatment, ovarian reserve or a baby. You may feel completely disembodied from your physical self – and this can impact every part of your life from your self esteem,  increased depression, heightened feelings of anxiety, and your sex life. Never mind how you may also feel trying on a new outfit and trying to feel attractive in the skin you are in.

And it’s not just folks struggling with infertility – it can even simply be aging and mid life that can separate our minds from our bodies.  The list of ways that people can become disconnected to the very skin that they are in is quite endless. But the solution as far as I am concern keeps coming back to helping people connect in a very physical way to their bodies in order to find reconnection and healing to self.

There is help – and I am not going to be talking here about a therapist’s couch, Jenny Craig, or getting on the “Biggest Loser”.  And I am going to talk from experience – and there are studies that have told me that my experience is not simply mine alone.

I am going to write this week on how therapeutic touch (massage therapy)  can be absolutely transformational in helping to heal eating disorders, ease depression, anxiety, self image issues, and help us get back to feeling our bodies.

When I talk about disordered eating,  I am not just talking about anorexia and bulimia – but all kinds of disordered eating and body dimorphism.  The healing and transformational power of all kinds of massage/touch therapy is something that I deeply believe in  on all levels.  I believe in the studies that show that women who receive massage therapy not only have reduced rates of depression and anxiety – but also change the way women felt about and interact with their bodies.

Now, as I said earlier,  I have known this for a while. I am such a good guinea pig. As a woman who has struggled with almost every type of disordered eating and body imagine issue under the sun,  I found my own personal healing quite accidentally,  not through a pill but through time spent on a Swedish massage table receiving touch.

It was through my eyes being closed,  not thinking about how I looked, lying naked on the table,  that my body slowly began to shift from being the enemy to this healthy and special container that was no longer my opponent, but a giver of pleasure. I began to see myself perhaps for the first time as beautiful and worthy of being touched and loved on the deepest of levels.  It was after I noticed the changes in my behavior that I began to do the research – and it is out there – just under reported.

Now why isn’t the connection between healing and touch out there more in the media?  Why isn’t that making it onto the evening news?  There are links everywhere that lead back to the importance of touch. It’s all connected in some way, and unlike the medicine that comes with a prescription and a list of side effects -  touch therapy doesn’t have any down side that I know about. Perhaps it’s because there isn’t a huge pharmaceutical gold mine in touch – or  perhaps it’s about us as a culture that seems to be conflicted about the role of touch in our lives.  Or it is the paradox that something healing can also give us pleasure that is confusing for us.

I recently talked to Don Shewey, an incredible hands on therapist in NYC and this is what he had to say “A lot of people automatically/unconsciously associate touch with sex, and if they don’t want sex they don’t want touch”.

Don is right – this is perhaps a tremendous stumbling block for people who need touch in their lives.  Getting a massage and receiving touch does not mean that you are requesting sex. Non sexual touch may feel sensual but does not need to lead to sex.   You may need to practice this at home with your partner. Set up at time to exchange touch – but be explicit that this sharing of massage and touch will not end in sex.  Set up the boundaries a head of time – so that you don’t feel pressured to go further and can simply relax into receiving one way touch and feeling the pleasure of that. And sometimes it helps to work with a professional practitioner. I did.

Sometimes we have to jump start our bodies to begin to feel again.  Don’t look to a bottle – look to a set of trained practitioners hands.  Often it is the most uncomplicated things that are overlooked such as a simple willingness to receive safe non sexual touch.  Once we can allow that – and combine it with loving thoughts and intentions about our bodies – we will all become people who need to use food and other addictive behaviors less in order to feel calm, alive and embodied again.

This advocate’s advice? If you are struggling this dark season with the pain of infertility, you may just find some comfort in touch instead of the cupcake. Skip the bakery and make an appointment with a the massage table.

Those on the female side of the equation of  “Baby Making Sex” have little sympathy for the guys. After all, it is often the ladies who are the ones taking the medications, getting their blood drawn, having the pelvic exams, and experiencing mood swings.  When it comes to the high tech stuff, you can add in egg retrievals and transfers.  When it comes to the guys, and their piece of baby making sex or conception sex – it can seem like a breeze. All they have to do is have an orgasm! Right?

In fact, the pressure on the guys to perform on command is something that wives and physicians often push aside as the least of the worries. But what is it like for the men? And what does ejaculation on demand do to a marriage bed? Let me give it to you straight – it’s not pretty.  For most men, producing sperm, requires arousal, orgasm and ejaculation.  For many women have baby making sex,

a conception friendly lube can take care of most of her needs. Some women simply forget about their arousal and orgasm. They just want the sperm to get to the right place at the right time.  Baby making sex has nothing to do with their sexuality. But the guys can’t fake it. And often they find themselves alone in the sexual act, whether it is meeting their woman in a place of arousal, or along in a room in a doctor’s office – producing sperm on command. It is lonely, and some men find it upsetting – but feel like they can’t express that because their wives are going through so much.

But I am beginning to hear something different from the men. It start was a rumble, and how it is a great big grumble! They are started to speak out about “being a sperm factory”.  Some have started to request their wives to come in with them at the doctors office to produce the sample. It can take guts to tell the nurse that you are going in together to produce the sample. But why not? He is with you during an insemination, retrieval or a transfer. Perhaps it is a return show of support and unity to help him produce the sample?

How about making some time in bed just for holding and loving. Letting go of baby making and welcoming in intimacy. Sexuality during infertility can be an incredible rough road. But if you don’t work together on facing the difficulties, it can be something that your marriage does not recover from.

Baby making can be all consuming. It can consume your sex life. But it is different for the men. Women are receivers of sperm. It is perhaps the only part of infertility baby making that woman can be passive about!  The sperm for baby making can be delivered to us via test tubes or non responsive sex void of desire. But for the men, they actually have to have some kind of sexual experience.

It’s time for us to really look at this. It is one of the keys for having our sexuality survive infertility – and it can start with acknowledgement, a conversation – and a commitment to showing up for the sperm in the same way that we want the sperm to show up for the egg!

It can be something as simple and complicated as a woman’s mother choosing to pass a set of family heirloom china to the daughter WITH children because in her mind – the child with no children has “no one to pass the china down to”.  The childless daughter feels hurt and left out. And the mother thinks she is doing the right thing. This pattern can play out over and over again, as children or family members with no children see money, gifts, and support offered to siblings or family members with children versus  themselves. The reason always stated or implied is that of course the siblings with children would get more because they have kids.

Now – perhaps this does make sense on many levels. But it can be a painful experience for the childless siblings seeing “all the good stuff” going to the siblings with children.

I don’t have easy answers around this. I am writing this entry for those of you who are going through this – to know that you are not alone. That other people who are childless have been left out of inheritances or didn’t get things that they may have wanted such as the family china because they didn’t have kids. It can feel like a double punishment and a constant reminder that you don’t have children.

To the family members and friends of people who are childless – please be mindful of this possible pattern of behavior and try to think about how you would feel if you were told that Aunt Sarah’s candle sticks that you really loved were not going to you simply because you had no one to pass it down to.

My conversation with “Jennifer” was not unusual.  What she thought she knew about her biological clock, and what the facts are. 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. My client Jennifer is not alone.

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??

It’s very likely that even your doctor will give you a blank stare at the mention of a Fertility Evaluation.  That’s because it’s a relatively new concept. 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 fertility 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 recent breakthroughs in egg freezing gives young women the opportunity to put the best of their oocytes into a safe deep freeze until they’re ready to use them. .

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.

People experience involuntary childlessness for lots of different reasons such as infertility, the desire to be partnered or married to have a child, illness or even a lack of agreement in a couple as to whether or not to have a child.

So if you decide no matter what your life circumstance – that you are not going to build a family through birth or adoption and live your life without having a child – are you “Child Free” or “Child Less”?

I have also gone with the term “Child Free” as I always feel like it comes down to a decision even if you feel like the decision is forced upon you.  Everyone always has a choice – even if the choice is one that is filled with sadness, regret and pain. But not everyone buys that.

Some feel that since the choice to have a child easily through birth was taken away – that they are child less.

What do you think? I would love to hear your perspective on this.