Why is this important?  It is important because egg quality one of the most important determinants of embryo viability.   And, until very recently, distinguishing a healthy embryo from one that is not viable has been an educated guessing game, where most embryos are judged by it’s good looks rather than what is inside.

It’s amazing to me as the founder of The American Fertility Association,  guiding thousands of potential parents on their path to parenthood that I have seen almost every kind of breakthrough there is – except one that helps women with aging eggs or multiple miscarriages, use her own eggs to have a child.

After all, we have been able to take one single sperm and make a baby – but still – we cannot help a woman with eggs that are not healthy become healthy enough to make a baby. That is rather incredible,  isn’t it?

In fact, other than checking ovarian reserve or expensive genetic tests, we have been very limited in our ability to tell if an egg is normal or not. This, coupled with inability to look inside a seemingly normal embryo and know if it is a viable, has  been one of the biggest hold backs in success for many couples.

So while we still can’t fix a broken egg, or can now crack the code on which embryos are healthy, and most likely to result in a baby. Pretty amazing stuff.

This new technology developed at RMANJ, and is also now available to patients at RMA Philadelphia and RMA Central Pennsylvania may be what is the pin in the needle stack for so many.

It’s a unique, rapid and scientific method to improve the embryo selection process, called SelectCCS (comprehensive chromosome screening).

This one-of-a-kind 24-chromosome screening platform identifies whether embryos are euploid (normal number of chromosomes or 46 with 23 obtained from each parent) or aneuploid (abnormal number of chromosomes).

Embryos are complicated, and errors can occur with all 23 pairs of chromosomes.  Patients who opt to use SelectCCS  are able to have their embryos screened at the molecular level which is more effective than previous testing processes that only count a handful of chromosomes. This can be especially helpful to women who have experienced miscarriages or are older as the current data suggests that 50-70% of miscarriages are due to embryos with too few or too many chromosomes.

Taking that extra step and using SelectCCS during the embryo selection process can improve the safety and success of your IVF cycle.

In addition to reducing the anxiety of not knowing if your embryos are healthy, the SelectCCS process allows patients to also take advantage of single embryo transfer (SET), which is a huge advantage as this allows patients the ability to avoid complicated twin pregnancies and deliveries.

It works like this, Select CCS allows the doctor to know if he/she is transferring a healthy embryo which is more likely to result in a healthy pregnancy. Therefore is no reason to transfer more than one embryo at a time. There is no compromising of success rates to avoid multiple birth pregnancies.

So if you are a patient 35 or older, or with multiple unsuccessful in vitro fertilization (IVF) cycles or miscarriages, please check out SelectCCS.  It truly might be the answer that you are looking for.

Same sex-couples also have the wonderful opportunity to examine their basic beliefs about parenting, family, values, and decide in a conscious way about what they want to bring to their children.

It’s also important to all prospective parents, whether they are same-sex or not, to discuss basic beliefs prior to baby making, including religious beliefs, discipline, parenting roles, education, communication, and how they speak about the child’s conception to family and friends.

Prospective parents should also use the time before a child is conceived to talk about expectations of each other – not forgetting to consider the stuff we all bring along to the party (our baggage!). It’s also important to talk with members of your extended families  and friends with whom you and your child will engage.. What will those relationships be like after the birth of your baby?   Are there any conversations that should happen now?

The path to parenthood, is filled with lots of twists and turns for every prospective parent, including LGBTQ individuals and couples. But once that baby is in your arms, you simply become parents, with all the thrills and obligations that everyone else has.  Children are one of life’s greatest pleasures and a lifetime commitment of hard work. The best way to get ready for your greatest life pleasure is to have these important conversations while that bundle of joy is still a twinkle in the sky.

• Infertility is a disease that results in the abnormal function of the reproductive system.
• Infertility prevents people from creating a family – one of the most fundamental and highly valued human activities. A United States Supreme Court decision concluded that reproduction is a major life activity as defined by the Americans with Disabilities Act.

What is the Scope of Infertility?

• Infertility affects people of all ethnic backgrounds and socio-economic levels.
• Infertility is a medical condition, not a sexual problem and not a curse! Infertility does not equate to sexual dysfunction. Infertile people are just as virile and beautiful as everyone else.

Infertility Treatment and It’s Costs:

• Infertility puts a family on hold. It is a life stopping crisis that can affect everything a person does, from job performance to self esteem, to important decisions such as buying a house or home.
• Infertility affects more than one in ten people of reproductive age around the world. It affects both men and women in about equal numbers. The mean age of those seeking infertility treatment is about 32.
• As with other serious diseases such as cancer and heart disease, infertility can lead to depression and anxiety, affecting job performance and productivity, as well as relationships with family and friends.
• Over the last two decades, few areas of medicine that have advanced as rapidly as infertility
• Infertility treatment is provided by reproductive endocrinologists who are specialists in reproductive health. Though most people associate treatment with “high tech” procedures such as in vitro fertilization, approximately only 2% of patients actually need these treatments.
• A majority of infertile couples build families with the assistance of a vast array of increasingly refined medical therapies and treatments, including oocyte and sperm donation.
• Infertility is not solely a women’s problem. In fact, infertility affects men and women equally. People are often surprised to learn that 35% of infertility cases are related to the male, and 35% to the female. Additionally, 20% of infertility cases are due to combined causes between the male and female, and 10% of infertility cases remain undiagnosed. Therefore, it is very important that both partners in a heterosexual couple experiencing infertility receive a full evaluation.
• Unfortunately, many people think they should wait up to 30 months before seeking help. In reality, people should seek treatment for infertility after 12 months of unprotected intercourse. Women older than 35 should not wait longer than 6 months to see a specialist.
• For women under 30, it’s estimated that the chance of becoming pregnant in any one cycle is 20-30%. By age 40, that chance plummets to approximately 5%.
• Female fertility diminishes with age, beginning in the late twenties. The first dip in a woman’s fertility usually comes at around age 27. By age 37, approximately 50% of women will experience infertility.
• Frequently, women who delay first-time parenthood until after age 30 (about one in seven of those in their childbearing years) are stunned and furious when they discover that age compromises fertility.
• Approximately ninety percent of all women will experience infertility at age 42.
• The average 30-year-old couple will require approximately 6 months of active trying to achieve a pregnancy.

Get the facts. Once you know them, you have power and that incredible feeling of knowing that you are not alone. Which fact was new to you? What was the most surprising?

Not that things haven’t improved over the years. They have. The atmosphere has palpably relaxed. The famous and not-so-famous talk about their personal trials with and triumphs over infertility. True, it’s still mostly women doing the talking. But their candor, coupled with the streaming reports about medical and scientific advances, has made it easier for men to acknowledge procreative problems, either their own or as part of an infertile couple.

The proof: There are more men in waiting rooms supporting their spouses through treatments; they are more proactive in seeking information about male factor and pursuing therapies. Sure, we still see women gathering the brochures and educational literature in the waiting rooms and handing them to their husbands. But attend any infertility support group or conference, and there are more men showing up than ever before. The fact is, men aren’t as inhibited about admitting that they want to be dads and in significant numbers, they’re willing to do a lot to achieve fatherhood.

They’re getting better about separating male infertility from their machismo. It’s important that we do everything we can to encourage that trend. For far too many years, the male perspective on infertility wasn’t even a blip on the radar screen of reproductive professionals and patient advocates. Once upon a time, nobody thought that infertility was part of the male agenda. It was a commonly held belief that anything to do with the disease had to begin with the woman. That history has its own inertia. And believe me, men have a point of view on the disease. But there’s a push-pull between the need for privacy and the need for disclosure and support. The fact is, men don’t like to talk about it. Couple that with the general tendency for men to brush off even routine health issues and infertility becomes hard to get at. Men simply don’t take care of themselves the way women do.

And that’s a big problem. They don’t even show up for physicals. So, although it is conventional wisdom that infertility is a couple’s problem and that male factor is the root cause almost half the time, men are often last to be analyzed and diagnosed. That’s why at many of the best  IVF Centers, they are now taking special care to make sure that men are included in the treatment plan, with individual assessment and sensitively.

Infertility still packs the wallop of social stigma. Maybe it’s not as stinging as it was two or three decades ago. Yet the bias is stubborn, hanging on in ways both insidious and blunt. We see and feel it in the off-hand comments of friends and in the sitcom kitsch of family hour TV. It’s there in the political debates over insurance mandates to cover treatment and in pointed religious discourse. In response, infertile women have responded by actively seeking solace in the support of peers and professionals.

Infertile men, on the other hand, still tend to withdraw into lonely funks of self-doubt, crumbling self-esteem and suspicion about their manliness. Women tiptoe around their partners because they worry the men in their lives may be feeling guilty and mortified by their inability to impregnate. Some men confuse virility with fertility. Because my background is in fertility education, one of the main issues I see in men is their willing to compromise health if there’s a chance something – like prostate cancer treatment – may compromise the ability to perform. It’s hard for most men to grasp that sperm count has nothing to do with masculinity or sexual performance.

The truth is, one thing has nothing to do with the other. To survive in a marriage you have to learn to separate baby-making sex from sex and if you don’t, you’re doomed. Men are sometimes so “susceptible” to thinking that the inability to impregnate their partners compromises their sexuality, they begin to feel useless. That worry, if it continues long enough can lead to performance anxiety and loss of desire. As hard as it is – what with sperm sample production, sex-on-demand and the pressures of IVF – try to remember that sex is more than a way to make babies. It is relationship enhancing, it is stress relieving and it’s fun. Perhaps because there are now more treatment options that hold the possibility of overcoming infertility, men are demonstrating a willingness to tackle a problem that usually defies the easy fix.

Let’s hear it for the men!

There have been great  strides in dismantling oppressive folklore as outspoken honesty among patients and advocates takes root. But the global community fighting these misconceptions continues to face enormous obstacles.

When I did work internationally working with patient groups back in the days when I led The American Fertility Association (I am the founder), I had the chance to interview and get to know many international fertility patient advocates.  Here are some examples of these misconceptions (no pun intended).

According to the group Childless Women of Zimbabwe, a wife who does not bear child is often “labeled a witch.. or suspected of being possessed by evil spirits.” Her husband’s family will claim that she “must have been in prostitution.” What’s more, the organizations explains childless women are completely isolated since “even their own parents, sisters and brother cannot accept them. “ Should their husbands die, they become economically disenfranchised and left to fend for themselves.

In the United States, our culture is different, but we still deal with incredible shame when we can’t get pregnant. Even here, as we are working to demolish the old infertility folklore with facts, inevitably new myths,  especially around In Vitro Fertilization, have sprung up!

The ART-intoxicated media pay far less attention to other less spectacular, low-tech treatments. Consequently, there’s a common belief that IVF is the only option available to people trying to conceive a baby. And IVF is often perceived as so mysterious and overwhelming that many people don’t seek help at all.  The truth is that most people with reproductive difficulties can overcome the obstacles to conception with less “elaborate” treatments than IVF.  And IVF is not as “elaborate” as many think at all!

One of my favorite myths have to do with the children of IVF. Guess what? IVF Babies are completely  natural babies! IVF involves the same biological union of egg and sperm that occurs without intervention within the body. The process of conception is assisted, not reinvented!  There is nothing artificial and nothing is “manufactured”.  IVF babies are completely and 100% made of all natural ingredients!

Technology is not a panacea: Since IVF made headlines more than three decades ago, the technology has been refined and pregnancies attributable to the procedure have increased with every passing year. But every couple  contemplating its use should be prepared to repeat an IVF cycle more than once.  They should know up front the probabilities of a positive outcome given their specific underlying diagnosis, maternal and paternal age and health among other factors.

There are countless homegrown explanations for infertility, stress, ancestral spirits, witch craft, and the usual bad karma. But in reality there are always a host of perfectly comprehensible factors that usually have solutions to why we are not conceiving a baby. There is genetics. There are some common behaviors, illnesses (from sexually transmitted diseases and pelvic inflammatory disease to mumps in men and endometriosis in women) and environmental contaminants that are linked to reproductive difficulties.

Put another way, there are simple things men and women are do to proactively preserve fertility and treat infertility when it happens.  I don’t'  believe in bad Karma, only potential parents.

Whoa. That “no hope for you” script is so yesterday. Well, so three decades ago! Mercifully times have changed. And this week, is National Infertility Awareness Week, the perfect week for an update!

For 30 years, ever since Assisted Reproduction Technology (ART) began its astonishing metamorphosis from purely experimental to standard operating procedure, people with almost zero chance of procreating have been making babies. Not everyone, for sure. But tens of thousands of individuals have beaten once insurmountable odds to build families.

That many of us have children – or have a real shot at having them- is a result of that first great leap forward, In Vitro Fertilization.  Originally developed to do an end run around blocked fallopian tubes, IVF opened the sluice gates to treatment for a range of reproductive difficulties. We’re talking about everything from male factor to Polycystic Ovarian Syndrome, low ovarian reserve and unexplained infertility. We’re also talking about sociological obstacles-such as delayed childbearing, single parenting, and same sex partnerships. Indeed, age, marital status and sexual orientation have been reduced to factors in the reproductive equation, not absolute determinants. Year after year, new protocols opened up the dream of sons and daughters to ever-broadening populations.

As the possible became possible, even commonplace, the demand for ART (Assisted Reproductive Technology) surged. Fertility centers proliferated. Instead of one or two facilities serving the whole country, there are now one or two or more within commuting distance for most people. In short time, IVF began to shed its exotic skin. It took on the look of the familiar and reliable.

Let’s be clear. The history of ART is relatively short, but is is complex. IVF remains a flashpoint for heated public and private debate. Infertility treatments continue to mesmerize the media as it has since Louise Brown, the first IVF baby, was conceived in 1978. Each new breakthrough – from Intra-Cytoplasmic Injection (ICSI) or SelectCCS (Comprehensive Chromosome Screening) or even gamete donation (egg, sperm or embryo) can still spark controversy over ethics and efficacy. Patients still fight for insurance to defray the daunting costs of treatment as only a handful of states have mandated coverage.

Nonetheless, ART is entrenched, a fact of life. The field is maturing. Scientists and clinical practitioners are doing the research that’s redefining those once futuristic techniques and treatments.

Patients can be more selective about how they pursue their family building imperatives. They’re better able to evaluate the technologies realistically for themselves and better able to assess when to proceed with another cycle or call it quits. Doctors are more precise in their treatment recommendations, tailoring the options to each individual case. They’re more concerned about their patient’s overall well-being, offering more services under one roof to improve the whole experience, not just increasing the clinic’s pregnancy rate. They’re determined to make sure that ART does what is was always intended to do – help people have healthy children one at a time.

As reported by Reuters:  “Women getting fertility treatments can be reassured that in vitro fertilization (IVF) does not increase their risk of breast and gynecological cancers, according to a U.S. study of Israeli women.

‘The findings were fairly reassuring. Nothing was significantly elevated’ said lead author Louise Brinton, chief of the Hormonal and Reproductive Epidemiology Branch at the National Cancer Institute in Rockville, Maryland.

Since I began my career as a fertility advocate, the concerns about getting cancer from fertility ovulation medications have been a shadow of fear for so many patients, and constant place of inquiry for reporters and the media.  It has been an implied fear for years, never with any good studies linking fertility medications for getting cancer.

The relationship between infertility, infertility treatment, cancer,  and the patient who shows up with infertility in the first place has been difficult to tease apart.  It is hard to know why people get cancer, and some experts have even wondered if being childless is itself a risk for cancer or the fact that the woman is infertile could be an underlying cause.

And in the over 20 years that I have spent as a patient advocate in the field in fertility, there hasn’t been many women who developed cancer after fertility treatment included in studies.

“We all want answers, but it’s a very difficult exposure to study, particularly when we don’t have the numbers we would really like,” Brinton, whose results appeared in the journal Fertility & Sterility, told Reuters Health.

She and her colleagues examined the medical records of 67,608 women who underwent IVF treatments between 1994 and 2011 and 19,795 women who sought treatment but never received IVF.

The researchers linked those files to a national cancer registry and found 1,509 of them had been diagnosed with cancer through mid-2011.

There was no difference in women’s chances of being diagnosed with breast or endometrial cancer based on whether they were treated with IVF. The researchers did find that a woman’s risk of ovarian cancer slightly increased the more rounds of treatment she received, but that finding could have been due to chance.

Brinton said her study was too small conclusively link IVF and ovarian cancer – and that it remained very rare, with 45 cases in the entire study.

A similar association was found in a study headed by Bengt Kallen, director of the Tornblad Institute at Lund University, Sweden, who said that any increased ovarian cancer risk might be due to the dysfunctional ovaries themselves.

“Infertile women have a primary problem with their ovaries and IVF has nothing to do with it,” Kallen told Reuters Health. “It’s a rather difficult thing to disentangle if there is an effect from the hormones or from the IVF procedure.”

Others warned of biases that may make the results of studies like this difficult to interpret, noting that women undergoing IVF are watched very closely, which would likely increase the chance that ovarian cancers are detected.

(Reporting from New York by Trevor Stokes at Reuters Health, Editing by Pamela Madsen)

Here’s the Fertility Lifestyle Tip Sheet:

Don’t smoke. Cutting down won’t cut it. You must stop completely. Smoking alters a woman’s estrogen metabolism, increases the risk of tubal (ectopic) pregnancy, boosts the rate of miscarriage, among other things. Male smokers have significantly lower sperm counts and a high incidence of abnormally shaped sperm than non-smokers.

Forget recreational drugs. Even occasional use of marijuana, cocaine, heroin and all hallucinogens can interfere with ovulation in women and sexual function in men.

Curtail alcohol consumption. A glass of wine is just fine. But even in the short term drinking can lead to abnormal sperm production in men and menstrual disorders in women.

Limit caffeine. Current thinking is that excessive caffeine impairs reproductive function. There is no adequate definition of “excessive”. Play it safe and stick to one cup of coffee or caffeine-laced side per day.

Moderate your exercise regimen. While trying to conceive, women should suspend the heavy duty workouts (think marathon running) that result in irregular menstrual periods. Both men and women should avoid any activity that gets them overheated. And by all means, everyone must stay well hydrated.

Swear off appearance-enhancing drugs. Anabolic steroids build up the body builder, but they’ll also make him impotent. Hair growth formulations such as Rogaine and Propecia may interfere with male reproductive systems. Given that it takes 90 to 108 days to make and release a sperm, these treatments could cost a couple three or more months.

You can also boost your chances with any of the do it yourself, over the counter fertility predictors! Check out your ovulation and sperm count! Get a base line!

And here’s to happy baby making in 2013!

As a fertility advocate, I get a lot of press releases. And sometimes, I really love them. Especially when they actually have more to tell me than why I should I buy a product or see a movie! Did you know that 12% of women of reproductive age experience difficulty having a baby and black women have twice the odds of infertility compared to white women? I didn’t.

Infertility in Black Women

11.5% of black women report infertility compared to 7% of white women, yet studies indicate that black women use infertility services less often. Why?

“In the past, there was a lack of attention toward the problem of infertility in black women, and most marketing campaigns of infertility awareness and treatment were not directed towards us. This resulted in a lack of awareness about infertility as a disease and about avenues for seeking evaluation and treatment,” says Dr. Desiree McCarthy-Keith, of Georgia Reproductive Specialists. “Cost of infertility services can be prohibitive to couples from all ethnic backgrounds and cost may be a factor for some black women as well,” she continues. “I believe lack of access to infertility care and limited awareness about evaluation and treatment options can also be substantial obstacles that keep many women from receiving the care that they need.”

Most of us don’t realize that the leading cause of infertility in black women is uterine fibroids. We don’t know why but black women develop uterine fibroids at a younger age then white women. Even bigger news is that the incidence of fibroids is higher in black women at every age, compared to white women. According to Dr. McCathy-Keith, “By the end of the reproductive years, the incidence of uterine fibroids in black women is 80%. As a result, black women have hysterectomies for treatments of fibroids more often than women from any other ethnic group”.

Dr. McCarthy-Keith, whose medical research focuses on the molecular mechanisms of uterine fibroid regulation, states that “black women are disproportionately affected by uterine fibroids and uterine fibroids are a common diagnosis among black women undergoing infertility treatment.”

Help for Minority Couples’ Infertility

Lack of information holds so many people locked down and isolated. Thank heavens that in the African American community there is now The Broken Brown Egg, a national support group created to support the needs of people of color who are trying to conceive.

Shame and feelings of isolation are often the biggest issues in getting people to come out to get the information that they need. The internet is great for so much. But often, there is nothing like face to face support for getting through the stuff that most people don’t talk about at cocktail parties.

I get it. The hardest thing for me to do in life is wait. And when you are trying to conceive, life can seem like it is full of waiting. The waiting for an appointment, for your period, for the results of blood tests, the waiting room, waiting for the doctor, the list is endless. All capped off with the dreaded two week wait.

Waiting can feel like an active process of doing nothing. Sometimes it can feel like it can take all of our conscious effort and it can be exhausting. 
And yet, there is a part of me that believes that patience is power. That the doing of nothing, the actual process of waiting is not an absence of action; rather it is about perfect timing. It’s about really getting clear on the right time to act, for the right reasons and in a right thinking way. Infertility is an incredible spiritual journey of exploring your relationship to patience, waiting and uncertainty. It can be a self-enforced time of doing nothing. And for me it is like fire burning me to the ground. It consumes me and leaves room for nothing else. There is nothing left to do but be fully in it.

Burning with you.