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Friday, August 21, 2015

How Infertility Stress Ruins Your Sex Drive

Your to-do list could fill an entire legal pad. Even if you could add an eighth day to the week, you still wouldn’t get everything done. With day-to-day stress sapping your energy, it’s no wonder that your libido is sinking as well.

If you’re also struggling with a medical condition—like infertility—the stress amplifies. Between the stress of the treatments themselves and your own natural feelings of worry, sadness or insecurity, there’s little respite.

“The stress of infertility can absolutely ruin one’s sex drive,” confirms Puneet Masson, MD, director of the Male Fertility Program at Penn Fertility Care.

When you’re under chronic stress, your body releases cortisol, a hormone that sparks your fight or flight response. High cortisol levels equal low sexual arousal.

Now sex—once a fun and pleasurable activity—feels like yet one more thing on your to-do list. And if you’re struggling with infertility, it can be a constant reminder of your challenges with conceiving.

When intimacy becomes drudgery—in the midst of an already stressful experience—it’s tough to get back to normal.

Here’s what you can you do to decrease stress, so that sex is something you want to do—not just something you have to do to conceive.

Make Sex Enjoyable Again

When you’re not trying to have a baby, sex can be exciting, spontaneous and romantic. Sex on a schedule, multiple times a week, with the constant pressure to have a baby? Less exciting, less spontaneous and definitely less romantic.

And if you think only women struggle with this, you’re wrong. Men have difficulty as well.

“Many men tell me they’re worried they have erectile dysfunction. A lot of these guys don’t have erectile dysfunction. They have situational erectile dysfunction because they come home from work, their wife’s ovulating, and they have to have sex right now. And that’s a lot of pressure," says Dr. Masson.

When men can have normal erections at any time other than when there’s an on-demand need to perform, they struggle because the process is not natural.

“It’s not healthy for the relationship, either,” Dr. Masson adds.

To stop sex from becoming little more than a dreaded appointment, don’t make it all about the baby. Have sex for the sake of it. That could mean spending a little more time getting in the mood—date nights, lingerie, soft music, candles… whatever does the trick.

Make Time for Exercise

Yes, it’s one more thing to do, but heart-pumping exercise can lower your stress level.

It can also boost your sex drive, explains Laurie Mintz, PhD, author of "A Tired Woman’s Guide To Passionate Sex", in an August 2010 article in Psychology Today. Exercise helps you sleep better, reduces anxiety and boosts your body image.

The National Infertility Association says breathing exercises can help stave off stress by boosting the hormones that lead you to feel relaxed.

If you’re more relaxed, it’ll be a lot easier to stop thinking about your fertility for a while and enjoy some quality time with your partner.

Dealing with a diagnosis of infertility can be a heavy weight to bear emotionally. When you’ve always planned on having a family, it can bring on feelings of guilt, self blame, failure and inadequacy.

Some couples seek counselling, individually or together, to deal with the psychological problems that accompany the stress of infertility.

Dr. Masson also recommends sex therapy for his patients.

“Sex therapy is not at all psychiatry. It’s a very active behavioral and cognitive process for couples to reintegrate some intimacy back into their lives as they’re going through this,” he explains.

Take a Break

If you’ve tried everything and you feel like you’re still stuck, Dr. Masson suggests going on a babymaking hiatus.

“It might be worthwhile to take a month off if it’s ruining your sex life, ruining your relationship, or affecting your intimacy with each other,” he says. “Just forget about this and really try to focus on your health together as a couple.”

Infertility treatments can be mentally and physically taxing, so don’t blame yourselves if your sex life becomes a casualty as a result.

“Take a step back,” Dr. Masson advises. “Remember, sex has more than a functional purpose. It should still be intimate, fun and romantic, regardless of the goals you’re trying to reach.”

For more help on getting pregnant, schedule a consultation with Dr. Masson or another fertility specialist today.

Thursday, August 6, 2015

Four Questions to Ask Other Couples Who Are Going Through Fertility Treatments

“Fertility is not a male or a female issue; it’s really a couple’s issue.” — Dr. Puneet Masson

Puneet Masson, MD, assistant professor of Urology and director of the Male Fertility Program at Penn Fertility Care, knows the importance of finding social support when you and your partner are struggling with fertility issues.

“Support groups are out there to help with coping. They can meet other people who are struggling with the same issues and don’t know how to begin a conversation about this,” he says.

Sometimes just talking to one other couple going through a similar situation can be an enormous source of comfort and advice. That’s because they know firsthand what you're going through.

Additionally, we know that there is a tremendous amount of stress when patients are struggling with fertility concerns.

At Penn, we have a multidisciplinary Fertility Wellness Program, where patients or couples undergoing fertility evaluations can have access to psychological support and group counseling, acupuncture and yoga.

Led by Suleena Kalra, MD, MSCE, assistant professor of Clinical Obstetrics and Gynecology at Penn Medicine, in collaboration with the Healing Arts Center of Philadelphia, this program is a way to help couples “fill their tank” during their fertility journey and also reinforce that they are not alone.

What Not To Say To Those Struggling With Fertility

People who don't understand what you're going through may say some insensitive things, like:
  1. “If you just stop worrying about it, you’ll get pregnant. It’s all in your head.”
  2. "Getting pregnant just takes time. Be patient.”
  3. “You and your partner are probably just doing something wrong.”
  4. “Maybe this is a sign that you aren’t meant to be parents.”
  5. “The world is overpopulated anyway, so why stress about getting pregnant?”
Source: The National Infertility Association

You won't hear those kind of comments from other couples who are going through fertility treatments. To get the peace of mind and support you need, consider speaking with another couple who struggled to get pregnant and asking them these questions:

1. How do you cope with the emotional ups and downs of fertility treatments?

Source: American Society for Reproductive Medicine
One thing is certain about fertility issues: So much uncertainty surrounds the causes.

“One-fourth of couples have idiopathic infertility, where it’s not a clear-cut male issue or a clear-cut female issue,” Dr. Masson explains.

But even when the underlying cause can be identified, the process of going through fertility treatments can be its own emotional rollercoaster.

“There are a ton of emotions. Sometimes in the course of a clinic visit, we’ll see emotions ranging from anger, to depression, to fear, to guilt, to a sense of failure,” says Dr. Masson.

Talking to other couples about how they deal with these intense feelings can help you and your partner figure out coping strategies of your own.

2. What did you tell your family and friends about fertility treatments?

“I think the biggest sources of support for a lot of our patients are their spouses or partners,” says Dr. Masson.

However, he adds that, “We need to recognize that infertility is like any other medical condition. It has physical manifestations that affect people and also tremendous emotional manifestations. We need to be more comfortable with this as a society.”

But telling family and friends about fertility struggles can be a challenge. Talking to another couple in a similar situation can help you figure out:
  • How much information you want to share
  • How to explain what is going on
  • How the treatment process is affecting you emotionally
  • What kind of support you need from loved ones
These are all important issues to consider before discussing fertility issues with people who may not understand what you’re going through, says the National Infertility Association.

3. What side effects can I expect from fertility treatments?

The American Pregnancy Association explains that women undergoing follicle stimulating hormone injections in preparation for in vitro fertilization may experience a number of physical side effects, including:
  • Breast tenderness
  • Mood swings
  • Depression
  • Abdominal pain
You should always talk to your doctor about any side effects you may experience from fertility medications or procedures.

It can also help to talk to someone undergoing similar treatments. She may have creative suggestions for coping with these symptoms—such as taking a warm bath or practicing meditation.

4. When is the right time to consider other options for starting a family?

The answer to this question will vary widely from couple to couple. Age plays a role, as does a couple’s financial situation.

Other options for starting a family may include surrogacy, donor eggs or sperm, or adoption. Which one is right for you as a couple depends a lot on your specific circumstances.

“Everyone has a different timeline with regard to their future family planning,” says Dr. Masson.

But hearing from other people who are going through a similar situation can help you and your partner come up with an “enough is enough” point that is right for you.

Thursday, July 23, 2015

Why Getting Pregnant As You Age Can Become a Challenge

The irony of reproductive biology and parenthood is not lost on Suleena Kansal Kalra, MD, MSCE at Penn Fertility Care.

“Most couples spend so much time trying not to become pregnant,” says Dr. Kalra. “Then when they want to achieve pregnancy, they think it’s just going to happen. There’s this myth out there that it’s easy to become pregnant, and it’s not.”

She explains, “A lot of women don’t realize the impact of reproductive aging on fertility.”

The Impact of Reproductive Aging on Fertility

“There’s a pretty slow decline in a woman’s reproductive potential in her late teens and early twenties, and then the decline steepens,” says Dr. Kalra. “Some women are not aware of that.”

It’s not as drastic as it sounds, she adds: “You don’t fall off a cliff at 35. Picture a line that’s gently sloping downward. Then picture the slope steepening after 35. It’s not an abrupt drop.”

Fertility 101: Why Getting Pregnant Gets Harder

“A female has the greatest number of pre-eggs that she’ll ever have in her entire lifetime when she’s still in her mother’s uterus,” explains Dr. Kalra. “At five month’s gestation—around 20 weeks—there’s seven million. At birth, there’s two million. At puberty, there’s about 500,000.”

But not all of those eggs are bound to be released from your ovaries for a chance at fertilization, she says. “Throughout the course of our reproductive lifetime, the majority of these pre-eggs are lost. We only develop around 300 to 500 to become eggs.”

In contrast, men hit the reproductive lottery and are lucky enough to produce sperm throughout their lifetime.

Dr. Kalra says the challenge as women get older and approach 40 and beyond is two-fold. The first issue is that the quantity of eggs has declined.

The second issue relates to quality. “Those remaining eggs have been sitting there for however many years. There’s an increased chance of chromosomal abnormalities.”

As she explains, “What happens when an egg and sperm meet is that the egg has to divide in half to make room for half of the genetic material from the sperm. As eggs age, they get less adept at cleaving in half and they take over an extra set of chromosomes, increasing the chance of chromosomal abnormalities in the embryo. This also increases the rate of miscarriage.”

Why Getting Help Is Important

Dr. Kalra admires her patients’ bravery. For some women, just coming to the office is a huge step.

“If you’re having difficulties getting pregnant, it takes a lot of courage to say, ‘I need help. I don’t know what’s going on.’"

That’s why the Department of Health and Human Services’ Office on Women’s Health recommends that you see a doctor if you’re over 35 and have been trying to get pregnant for more than six months.

“The important thing to keep in mind is that the majority of people do still get pregnant on their own. Your age is not depressing. It’s just something you have to be aware of,” says Dr. Kalra.

Read about couples struggling to get pregnant or make an appointment with Penn Fertility Care.

Thursday, July 9, 2015

The Truth About Testosterone and Male Fertility

When you think of testosterone, traditionally masculine images and words may come to mind: facial and body hair, toned muscles, virility.

Dr. Puneet Masson
If the idea of testosterone stirs up all things male, then what are the implications of low or no testosterone? Many might assume that less testosterone makes you less manly. Now add pregnancy to the mix. With low or no testosterone, conception would be tricky.

You might believe the most natural fix would be to take testosterone. It makes sense that added testosterone will surely boost your manliness, including your fertility, right? Well, not exactly.

Doing so can lead to problems, according to Puneet Masson, MD, assistant professor of Urology and director of the Male Fertility Program at Penn Fertility Care.

What Low Testosterone Really Means

“Hypogonadism—or low testosterone—can lead to issues with sexual desire,” Dr. Masson says. “It can alter a man’s libido. It could affect sexual functioning—namely, erections. It can also affect the development of sperm.”

In other words: “Low testosterone can definitely affect a man who’s having difficulty achieving a pregnancy,” he says.

A man’s testosterone levels fluctuate throughout the day. They’re usually highest in the morning and lowest at night; however, there are a few things that can lower testosterone levels:

Why Taking Testosterone Supplements for Fertility Is a Bad Idea

“Many times people feel that, ‘Oh, I have low testosterone—it affects fertility—I should take a testosterone supplement,’” Dr. Masson says. “That’s actually something we do not want them to do. If a man is taking any extra testosterone, it can basically shut off his body’s ability to make its own testosterone—and the body’s ability to make its own sperm.”

The number of men taking testosterone supplements has noticeably increased in the last decade. This growth is even among men who don’t need to because their testosterone levels are normal, according to a March 2014 study in the Journal of Endocrinology and Metabolism.

“There’s a lot of misuse of these supplements and treatments,” Dr. Masson adds. “People take them as a sort of anti-aging treatment when they have normal testosterone. Testosterone replacement therapy should be given to someone who has low testosterone and is symptomatic from it.”

Potential causes of low testosterone include:
  • Chronic diseases, such as liver or kidney disease, obesity or Type 2 diabetes
  • Underactive pituitary gland
  • Injury or disease of the hypothalamus (the part of the brain responsible for hormone production)
  • Injury or disease of the testicles
  • Non-cancerous tumor in the pituitary cells
  • Genetic conditions, such as Klinefelter syndrome
  • Certain medications, such as opiate painkillers
  • Radiation or chemotherapy
Sources: Penn Medicine Health Encyclopedia, Hormone Health Network

Low Testosterone Treatment When Trying to Get Pregnant

“When men come in with low testosterone, they may have already gone to another provider who put them on a testosterone supplement,” Dr. Masson says.

He explains, “Many times I’m taking these guys off of supplements or medications and putting them on something to get their body to make its own testosterone.”

Dr. Masson does this because the goal is “to stir up testicular testosterone production in a man with low testosterone who is interested in fatherhood,” he says.

Additionally, taking exogenous—or external testosterone— shuts off other hormones essential for sperm development. “Many times, these potential fathers have no idea that they are actually undermining their fertility by taking these medications,” adds Dr. Masson.

Tuesday, June 30, 2015

Five Facts You Should Know Before Having a Vasectomy

If you and your partner are looking for a permanent birth control method, you may be considering a vasectomy.

“A vasectomy is permanent male sterilization,” explains Puneet Masson, MD, Assistant Professor of Urology and Director of the Male Fertility Program at Penn Fertility Care. “That being said, life changes—it’s a very dynamic process.”

Before you have a vasectomy, here's what you should know:

1. Both you and your partner should decide if a vasectomy is the right choice

The decision to have a vasectomy is not one that should be taken lightly. You and your partner should take time to really think about whether it is the right choice for you.

A vasectomy may be right for you if:
  • You are certain that you desire no more or any children
  • Your partner should not get pregnant for the sake of her own health
  • You and/or your partner are carriers for genetic disorders that you do not want your children to have
On the other hand, a vasectomy may not be right for you if:
  • You and/or your partner are still unsure about whether you should have children
  • You are interested in temporary birth control

2. A vasectomy is generally safe and effective

A vasectomy can be done either under local anesthesia or conscious sedation (aka “twilight anesthesia”). If performed under local anesthesia, pain medicine will be administered directly to your scrotum to numb the area. You will be awake for the procedure. With conscious sedation, you will receive medications to sedate you and relieve any anxiety during the procedure in addition to receiving local anesthesia directly to your scrotum.

Regardless of the anesthesia, the procedure is the same. The physician will disconnect the vas deferens—the tubes that transport sperm from the testicles. After the surgery, sperm will not be able to leave the testicles.

Not Down For Long

You may be wondering what the vasectomy recovery period is like. After a vasectomy most men can:
  • Return to work in two to three days
  • Resume normal exercise in seven days
  • Start having sex again in seven days
Bruising and swelling should be gone within two weeks.

3. Having a vasectomy will not affect your sexual functioning

A vasectomy should not decrease your sex drive, nor should it negatively impact your ability to have an erection or orgasm. Only five to 10 percent of the ejaculate comes from the testicle. The remainder comes from upstream structures such as your prostate and seminal vesicles. Thus, ejaculation will still look and feel the same. Just microscopically, there will be no sperm in the semen.

If you experience any changes in your sexual drive or functioning after the procedure, contact your physician.

4. Sterilization does not happen right away after a vasectomy

After the surgery, the sperm count in your ejaculate will begin to decrease gradually.

You will need to continue to use other birth control methods until your semen sample comes back completely sperm-free and you get the okay from your physician. This usually takes about two months or 20 ejaculations.

5. A vasectomy can be reversed, but...

“Patients might desire children in the future. They may have a second marriage. Different sorts of things come up, and we have to respect that life is so dynamic,” says Dr. Masson.

There are a few options for achieving a pregnancy after vasectomy. “We can do a vasectomy reversal or a surgical sperm extraction,” explains Dr. Masson. “There’s a lot of counseling that goes on with this decision process as well.”

Whereas a vasectomy takes 20 minutes, a vasectomy reversal can take four to six hours. It's a much more complicated, delicate procedure. And there is no guarantee that it will lead to pregnancy.

If you and your partner decide that you would like to have children after you have had a vasectomy, there are other ways to obtain your sperm than a vasectomy reversal.

“We can do a surgical sperm extraction in combination with in vitro fertilization,” says Dr. Masson.

These procedures, known as testicular sperm extraction (TESE) and percutaneous epididymal sperm aspiration (PESA) have a high success rate of about 98 percent.

Both procedures involve extracting sperm through a small incision in either the testes (TESE) or epididymis (PESA), the Urology Care Foundation explains.

Friday, June 12, 2015

Improving Health for the LGBT Community

Lesbian, gay, bisexual and transgender (LGBT) people experience multiple health disparities due to harassment, discrimination and stigma. Because of these disparities, and the barriers to high quality patient-centered care members of the LGBT community face, the Penn Medicine Program for LGBT Health was created.

Dr. Baligh Yehia
“Barriers such as decreased access to healthcare, lack of awareness and/or insensitivity to their unique health needs, and inequitable health system policies and practices put members of the LGBT community at greater risk for diseases and conditions that affect their physical and mental health,” says Baligh Yehia, MD, MPP, MSHP, director of Penn Medicine’s Program for LGBT Health. “Greater public awareness of these health issues allow us to address these health disparities and advance the health and well-being of all lesbian and bisexual women.”

Recent studies by the National Institute of Health, Gay and Lesbian Medical Association, the Institute of Medicine, and the Center for American Progress have identified numerous health disparities and issues that need to be addressed including higher rates of smoking, obesity, psychological distress, partner violence, cancer risks as well as reduced access to care.

“We are working to improve the health of lesbian women, bisexual women and all individuals within the LGBT community,” says Dr. Yehia. “Our program is unique because we are interdisciplinary, and have access to resources through Penn Medicine, the University of Pennsylvania and affiliated health systems such as the Children's Hospital of Philadelphia and the Philadelphia Veteran's Affairs Medical Center. As a local and national leader in LGBT patient care, education, research and advocacy, we can advance the well-being of the LGBT community.”

The program’s focus areas include:
  • Institutional Climate and Visibility: Nurture and support LGBT diversity and inclusion in the workplace, classroom, and healthcare settings
  • Health Education: Enhance education of faculty, students, and staff in LGBT health and health disparities.
  • Research: Foster research on the optimal ways to improve the care for LGBT patients and their families.
  • Patient Care: Provide patient and family-centered care to the LGBT community.
  • Outreach: Increase collaboration between Penn, affiliated health systems, and the Philadelphia LGBT community.

Friday, April 24, 2015

When Should You See a Doctor for Irregular Periods?

Maybe you’re in your mid-to-late 20s and and suddenly—after having regular periods for more than a decade—your cycle suddenly stops behaving like clockwork. You’re not pregnant, and you’re nowhere near menopause, so what’s the deal?

Here’s what you should know about how to identify irregular periods, what causes them and when to see a doctor.

What Are Irregular Periods, Anyway?

During a normal menstrual cycle, an egg is released from one of your ovaries during ovulation. If the egg is not fertilized by a sperm, then changing hormone levels signal for your body to shed the blood and tissues that line your uterus, says the Office on Women’s Health (OWH).

This bleeding typically lasts about five days. Then, the monthly cycle repeats itself.

But some women have what is called abnormal uterine bleeding—another term for irregular periods, the OWH explains.

What is abnormal uterine bleeding?
  • Bleeding or spotting between periods
  • Bleeding after sexual intercourse
  • Heavy bleeding during your period
  • Menstrual bleeding that lasts longer than normal
  • Bleeding after you’ve reached menopause
According to the American Academy of Family Physicians (AAFP), between nine and 14 percent of women who have already gotten their first period but haven’t yet reached menopause have irregular periods.

What Causes Irregular Periods?

There are a number of reasons why a woman has irregular periods, says the National Institute of Child Health and Human Development (NICHD). 

When a girl first starts menstruating, it may take some time time before her periods become regular. And periods may stop becoming regular up to eight years before menopause.

Common causes of irregular periods include:

Uncontrolled diabetes—Women with unmanaged diabetes may have irregular periods because the interaction between blood sugar levels and hormones can disrupt a woman’s menstrual cycle, says the American Diabetes Association.

Eating disorders—Women with conditions like anorexia or bulimia may have irregular or missed periods because their bodies are not producing and circulating enough hormones to control the menstrual cycle, according to the Hormone Health Network.

Hyperprolactinemia—Women who have too much of a protein hormone called prolactin in their blood can have irregular periods.

Certain medications, including anti-epileptics and antipsychotics—can cause irregular periods.

Polycystic ovary syndrome—PCOS is caused by imbalanced sex hormones, which can disrupt regular menstruation.

Premature ovarian failure—The ovaries of women with POF stop working before the age of 40, says the National Institutes of Health. Some women with this condition continue to have periods occasionally, however.

When Should You See A Doctor For Irregular Periods?

It may be time to talk to your doctor if:
  • You haven’t had a period for 90 days
  • Your period suddenly becomes irregular
  • You have a period more often than every 21 days
  • You have a period less often than every 35 days
  • Your period lasts for more than a week
  • Your period becomes unusually heavy
  • You bleed between periods
  • Your periods are extremely painful
Source: Office on Women’s Health

A gynecologist will be able to determine the cause of your irregular periods and help you figure out a treatment course. This may include oral contraceptives to regulate your cycle.

Friday, March 27, 2015

Is Egg Freezing Right for You?

In recent news and media coverage, you may have heard about the increasing number of women who choose egg freezing as a way to delay childbearing without the risk of their most fertile years passing them by. That’s because the popularity of this process is on the rise.
Dr. Kaldra

“I’m seeing a lot more patients coming in for egg freezing,” says Suleena Kansal Kalra, MD, MSCE at Penn Fertility Care.

“Women come in and say, ‘You know what? I’m traveling a lot; I’m building my career; I’m 37 years old. I haven’t met Mr. Right, and I’m really not sure I’m going to in the next year or so, and I want to do something to take charge of my fertility.’”

Here’s what you should know about how egg freezing works and if it’s the right option for you.

What Is the Egg-Freezing Process?

During a normal menstrual cycle, “there’s a signal from your brain each month to release one egg,” Dr. Kalra explains. “But we want 10 or more for egg freezing.”

Egg freezing is done in three steps:

1. Hormone injections stimulate your ovaries to produce many eggs.

2. A physician monitors your eggs and hormone levels.

3. The eggs are retrieved, using a transvaginal ultrasound to guide the process, and are immediately frozen.

“Women take about 10 to 12 days of shots on average, and they come in for bloodwork and monitoring,” says Dr. Kalra. “Then we do the egg retrieval, generally within about two weeks of starting the medication. The eggs are flash frozen in a process called vitrification.”

Does Egg Freezing Work?

As with any fertility treatment, “It’s not a guarantee, but it’s certainly an option,” Dr. Kalra explains.

There have been more than 1,000 children born worldwide as a result of egg freezing. And conceiving using frozen eggs does not increase the risk of pregnancy complications or birth defects.

In fact, the rates of live births for fresh versus frozen eggs are about equal, found a December 2014 study in the medical journal Fertility and Sterility.

Is Egg Freezing the Right Option?

You may want to consider egg freezing if you know you want to have children, but you aren’t at the point in your life where you’re ready to become a parent.

Cancer patients may also want to consider egg freezing as a means of fertility preservation before having chemotherapy.

“Ideally, the best time to do it is before 35. The idea is to do it before your egg supply is starting to decline more rapidly,” Dr. Kalra says. “You can come back when you’re 40 and think that you’re at the point where you’re ready to start your family.”

As for how long eggs can stay frozen, “There’s no expiration date,” Dr. Kalra says. “But the ideal time to come back for your eggs is when you’re healthy and in good shape.”

Ultimately, the decision to freeze your eggs is one you must make carefully. If you’re considering egg freezing, a Penn Fertility Care specialist can talk to you about your options.

Friday, March 13, 2015

Penn Fertility Care Celebrates 50 Years: Pioneers in IVF, Reproductive Services and Preservation

This year, Penn Fertility Care celebrates its 50th anniversary. Penn Fertility Care was the first fertility practice in the Greater Philadelphia area and established the fourth in vitro fertilization (IVF) program in the country. Propelled by expert visionaries and compassionate care, it has helped couples create and grow their families for decades.

Dr. Coutifaris
“When the Penn Fertility Care practice was first created, Penn had a vision to develop a practice that included three cornerstones that are still relevant today. They include: innovation and research of technologies to help couples conceive, education and training of the next generation of fertility specialists, and excellence in providing patient care,” says Christos Coutifaris, MD, PhD, chief of Reproductive Endocrinology and Infertility.

To commemorate the anniversary, we thought we'd give you a look at our past breakthroughs in reproductive medicine and patient care, our current focuses in the field of fertility, and our vision for the future.

The Beginning

Dr. Mastroianni
In 1964, Luigi Mastroianni Jr., MD, joined Penn Medicine as the chair of the department of Obstetrics and Gynecology. He, together with his long-time colleague, Celso Ramon Garcia, MD, were committed to establishing a world-class academic program that would develop and provide state-of-the-art care for infertile couples.

They recognized that it was critical to have a robust research program focused on reproductive biology and a clinical program focusing on human reproduction. To accomplish this, they established the division of reproductive biology, which eventually evolved into the Center for Research on Reproduction and Women's Health, one of the best research programs in women’s health.

“The tools were very limited in the 60s,” says Clarisa Gracia, MD, MSCE, director of Fertility Preservation at Penn. “There were a few medications to induce ovulation, but treatments didn't address male factor infertility or blocked Fallopian tubes, then treated solely with surgical procedures pioneered here at Penn.”

“Patient care has evolved over the past five decades. In the 1950s and 1960s, IVF had not been applied to clinical practice. Today, it's the preferred and most common infertility treatment used when the Fallopian tubes are severely damaged or absent and for unexplained or male factor infertility. In fact, due to its high success rate, IVF is being used more frequently in recent years as a first line of therapy for practically all causes of infertility,” says Dr. Coutifaris.

Dr. Mastroianni’s vision and leadership are acknowledged by many to have shaped obstetrics and gynecology into an academic and clinical specialty. Beyond his scientific expertise and his skill in training physician-scientists, Dr. Mastroianni was an eloquent advocate for reproductive biology and women’s reproductive rights.

Penn Fertility Care Today

Dr. Gracia
To this day, Penn Fertility Care continues to be among the top National Institutes of Health (NIH)-funded programs in the nation, providing a range of comprehensive reproductive and infertility services for both men and women.

“In the past, because IVF was still so new, we were very focused on its success,” says Dr. Gracia. “Now that IVF success rates have improved, our expectations have grown. We continually strive for excellence and try to make patients happier and feel good about the process.”

At Penn Fertility Care, we provide consultation and evaluations, diagnostic imaging and testing, medical and surgical treatment options, and IVF. We also offer the following specialty programs:
  • Penn Polycystic Ovary Syndrome (PCOS) Center: Under the leadership of Anuja Dokras, this program takes a multi-disciplinary approach to treating women with PCOS. It provides treatment options to address their menstrual problems, fertility concerns, weight management, emotional and psychological issues and cardiovascular health.
  • Fertility Preservation Program: Directed by Dr. Gracia, Penn Fertility Care pioneered approaches for the care of patients facing fertility threatening cancer therapies. The Fertility Prevention Program offers a variety of options for both females and males to preserve embryos, eggs, sperm or ovarian tissue. 
  • Male Fertility Program: Puneet Masson, MD, director of Male Fertility at Penn, established a program that provides evaluation, testing, consultations and specialized treatment options for men with fertility concerns. Penn Fertility Care is the only clinic with a full-time reproductive urologist on site to care for couples with male factor infertility. 
“Penn Fertility Care brings together a well-rounded, diverse group of experienced fertility specialists, nurses and dedicated staff into one practice” says Dr. Coutifaris. “Our physicians are all leaders in their field with national and international reputations, and are dedicated to our specialty programs for both women and men trying to conceive.”
The Penn Fertility Care Team

The Future of Fertility Care at Penn

Our clinicians and researchers are constantly working towards improving success rates for IVF and using more sophisticated approaches to achieve better outcomes.

As the only program in the country that has received continuous funding from the NIH for clinical research, we believe we'll remain on the forefront of reproductive medicine. We're able to offer clinical trials to fertility patients and give patients access to the latest treatment options before they are widely available elsewhere in the region. 

Working with the Abramson Cancer Center and Children’s Hospital of Philadelphia, it's become routine for us to bank eggs or ovarian tissue for women who are undergoing cancer therapy. 

“There have been so many advances in cryopreservation for women’s eggs,” says Dr. Gracia. “Because we can offer this service with confidence to women, they can focus on their cancer care.”

Genetic testing of embryos is also getting more sophisticated.

“We can biopsy embryos prior to transferring the embryo after IVF and test the embryo for a number of genetic conditions,” says Dr. Dokras, director of the Preimplantation Genetic Diagnosis Program. “This level of care and diagnosis can help improve success rates, decrease the chance of pregnancy loss or avoid other genetic problems."

Looking at how much has been accomplished in the past 50 years, we're excited to see what's next for us. One thing we know for sure: We'll continue coming up with new options for people to build the family that they dream of.

“Penn continues to propel innovation, education and patient care to new levels,” says Dr. Coutifaris. “We are proud of the accomplishments that Penn Fertility Care has made over the years, but also look forward to what is ahead for the program in the years to come.”

Wednesday, December 3, 2014

Pick Your Battles: How to Handle Insensitive Comments About Fertility

If you are working through fertility issues, you've probably learned that you can’t share your experience with everyone. No doubt, someone will say something that dismisses your feelings or outright offends you.

To be on the receiving end of those comments is tough—and it’s tempting to reply with an equally dismissive or rude comment. Many people simply don’t understand what it’s like to go through challenges trying to have a baby.

The key is to resist the urge to fire back. You don’t need added stress of trying to navigate insensitive comments.  Dealing with negativity gracefully—or not at all—can help you skip the fuming phase and get back to your day.

Here are five of the most common insensitive comments and positive suggestions for how to deal with them: 

1. "Maybe it's not meant to be."

This comment is painful on multiple levels. First of all, it assumes defeat, like you will never conceive. It also removes all of the power from your hands—at a time when you may already feel like you are not in control.

The first thing to remember is that the person who is saying this isn't thinking about the deeper implications. She probably has no idea what to say. And instead of just keeping quiet, people grasp at clich├ęs—not helpful. Some women have even heard this from their own doctors.

The best way to respond is not to. Just give her a blank stare, even if it means there’s an awkward pause while she’s waiting for you to say something. It’s amazing how weird silence can send the message that the comment was inappropriate. Then, make a note to yourself that you should avoid the topic with this person going forward.

2. "Fertility issues? I could just look at my husband and get pregnant."

This kind of “it’s easy for me” comment is annoying and belittling. How you respond depends on how close you are to the person.

If this is a random person you decided to vent to at the coffee shop, then feel free to just laugh, since she’s clearly trying to make a joke. If this is your grandmother, who’s so old she just says whatever she wants, let it slide—especially if she really did have 10 kids.

But if this is someone close to you, like a sister or best friend, you may want to address it more directly. Calmly explain that you’d rather her try to understand your experience, rather than compare it to her own.

3. "Whose fault is it?" or "What's wrong with you?"

Let’s assume that this person is genuinely asking about the cause of the fertility issues, not acting like you have a contagious virus. These are deeply personal—not to mention poorly phrased—questions, whether or not the person asking knows it.

If you even know the cause, you have to be cautious about what you share. Answering this question honestly may mean revealing more than you or your partner is comfortable with.

If you don’t want to go into detail, then say something like, “The reasons are personal, but we’re working through them.”

4. "How are you paying for all that?"

No one would ask how you managed to pay for a new car or your new home. And if you disclose too much about the out-of-pocket costs of fertility treatment, you may open yourself up to judgment, depending on who’s asking.

If it’s coming from someone else dealing with fertility issues, you may feel more comfortable sharing your advice. Or if it’s coming from someone who wants to make sure you’re okay financially, that may be fine too. Also, if it’s coming from someone to whom you owe money, you might want to explain.

But if it’s someone just being nosy or wondering if you've got a hidden stash, feel free to brush this comment off: “We’re handling the costs just fine.” Next subject.

5. "Why don't you just adopt? There are a lot of kids out there."

(Sigh.) The underlying social commentary here can be really hard to take.

While the person may be trying to offer a solution—or really thinks you never thought of adoption—this comment implies that something’s wrong with wanting to experience pregnancy and give birth to your own child. (Or that adopting an infant will somehow be easier.)

It also implies that you should give up trying to conceive. This might be the hardest comment to respond to because just about anything you say could continue the conversation.

If you choose to address this question, here’s the truth: You and your partner owe it to yourselves to try until you feel at peace about moving on to the next possibility. That may mean adoption. It may mean trying another fertility treatment.

The best way to address this comment but end the conversation is to be direct: “We know that adoption is an alternative, but we’re not ready to give up trying to conceive.”

Wednesday, November 12, 2014

Trying to Conceive When Everyone Else Is Getting Pregnant

You’re sitting at your desk fiddling around on Facebook when a friend messages you via chat. She has big news: She’s pregnant.

On one hand, you’re happy for her and excited about this new phase in her life—and you want her to know that. But, on the other hand, your stomach drops. You can’t wait to be the one sharing the baby news. Until then, each birth announcement makes you want to either stand up and shout or break down and cry.

So how do you show your support while protecting your emotions? Here are five suggestions:

1. Predict announcements

Prepare yourself for pregnancy announcements before they happen. Get in the habit of predicting who you might hear from next.

  • Which of your friends has recently gotten married?
  • Has your sister been talking about starting a family?
  • Have you noticed your former college roommate recently gave up wine and sushi?

Practice your response so you won’t be totally blindsided. If these friends and family members know you’re going through fertility treatments, you can also give them a heads up of what reaction to expect from you when they do share the news, such as “Hey sis, I know you are trying to get pregnant. If I act a little weird when it does happen, here’s why...”

2. Take social media breaks

Social media has turned into a giant, scrolling news feed—a strange mix of international stories, cat videos and friends’ updates. Often, those updates include baby announcements.

If you’re sick of seeing a new ultrasound photo pop up every other day, sign off. It doesn’t have to be forever, but taking a hiatus from Facebook, Twitter and Instagram can give you a chance to turn inward and focus on you.

Besides, the people closest to you will probably share these announcements with a phone call.

3. Vent somewhere

Did you (just barely) make it through your cousin’s baby shower? Now, your neighbors have told you their good news?

Online support groups like Resolve, part of the National Infertility Association, can be the perfect place for you to unleash some of your frustrations. And because they’re online, you’re still able to maintain your anonymity.

Tell the group what’s getting to you at the moment, and let them share their own experiences, reactions and coping mechanisms. You can learn from and help each other at the same time.

If some of the people in the group want to arrange for a meeting in person, don’t be afraid to join them. You also can confide in someone in your life who you know has struggled with fertility. She will likely have unique, honest insight to help you through.

Facebook has private groups that may fit your needs. Even if you’re not ready to open up about your situation, scroll through the feed to see if anyone is experiencing similar issues to yours.

4. Write it out

Writing in a journal can help you process your feelings without worrying about judgment from others. It’s a one-way conversation that can easily prompt self-realizations. At the same time, it can ease the weight of all those emotions you carry around with you.

You may have tried journaling at different points in your life to varying degrees of success. But this time, make a point of finding a system that works with you. Then, stick with it. A blank page or blank screen is one of the few spaces where you can pour out your raw feelings without wondering how it will be received.

Keep a Word or Google Drive doc opened on your computer at all times, so you can access it easily when the mood strikes you. You could also carry a small notebook in your purse and write down your thoughts whenever you find a free moment.

5. Take it to the mat

Whether you choose yoga, Pilates, weight lifting or jogging, exercise can help you work out some sources of frustration while at the same time bettering your health. Typically, your mood will feel better within five minutes of moderate exercise, according to the American Psychological Association.

Researchers also hypothesize that regular exercise can help the body adjust to anxious situations—which often include similar physiological reactions, such as sweating and increased heart rate.

So the next time someone tells you they’re pregnant, your body may know better than to go into fight-or-flight mode. You can extend the congratulations that your logical mind knows you want to give.

And remember that deep down inside, you know you’ll melt the second you meet that new baby.

Thursday, October 9, 2014

Five Myths About PCOS

Some medical conditions have the potential to change your life and the decisions you make about your life. If you’re diagnosed with one of those conditions, you’ll want to learn as much about it as you can—that is, once you get over the shock of it.

Polycystic ovary syndrome (PCOS) is a perfect example of this. Yet, while wading through the piles of information, you’ll want to sort out the facts from the fiction.

Here are five myths about PCOS:

1. You did something to cause it.

While the exact cause of PCOS is still unclear, one thing is certain: You are not to blame.

There is a relationship between certain hormone levels and PCOS. Changes in the amount of these hormones can make it more difficult to have regular menstrual cycles and release eggs that are fully mature.

The hormones in question—androgens—are male hormones, but women’s bodies produce them as well. Women with PCOS generally have higher levels of androgen. Some scientists think that another hormone—insulin—may play a role in the body’s increased androgen production.

There may also be a genetic component as well, explains the Office on Women's Health. Mothers and sisters of women who have PCOS are more likely to be affected by this condition, too.

2. If you lose weight, you can get rid of PCOS.

Unfortunately, there is no cure for PCOS. But overweight or obese women can help balance their hormone levels by losing weight. Otherwise, treatment is aimed at managing symptoms.

A wide range of treatment options can help prevent any potential problems.

Lifestyle changes, such as eating healthy and regular exercise, improve the way your body uses insulin and, therefore, regulate your hormone levels better.

Birth control pills are a good treatment option for women who aren’t interested in getting pregnant any time soon, because they can regulate menstrual cycles and reduce androgen levels.

Fertility medications can help women who want to get pregnant by stimulating ovulation. In some cases, that may be enough to spur the process for women with a lack of ovulation—the main reason women with PCOS struggle with fertility.

A surgical procedure known as ovarian drilling can also increase your chances of successful ovulation. While the operation can temporarily lower your androgen levels, the operation does have a risk of creating scar tissue.

3. PCOS is a rare condition.

Scientists estimate that anywhere between four percent and 18 percent of women have PCOS. On the high end, that’s nearly one in five women.

But, according to the PCOS Foundation, less than half of all women with PCOS are actually diagnosed correctly, meaning that millions of women are unaware of their condition.

The PCOS Foundation estimates that this condition is the cause of fertility issues in women who have trouble with ovulation around 70 percent of the time.

4. You can’t get pregnant if you have PCOS.

Not true—at least, not for everyone. Give your body a chance by talking with your doctor about fertility treatment. A number of medications can stimulate ovulation, which, according to the Office on Women's Health, is the main issue that women with PCOS face.

Other fertility treatments for women with PCOS include insemination and IVF.

5. PCOS only affects overweight women.

It is true that many women who have PCOS are overweight or obese. And it’s also true that obesity can make PCOS symptoms worse. However, PCOS does not discriminate and can affect women of all shapes and sizes.

The relationship between weight and PCOS has to do with the body’s inability to use insulin properly, which can lead to weight gain, says the Obesity Action Coalition.

That’s why getting into the habit of eating healthy and exercising regularly is recommended as part of most women’s treatment plan.

If you think PCOS may be behind your fertility struggles, contact Penn’s Polycystic Ovary Syndrome Center to get a treatment plan tailored to your symptoms.

Tuesday, September 30, 2014

A Couple’s Story of Perseverance Through Fertility Treatment (Part 2)

This is the second installment of a two-part series. Read the first half of the the couple’s fertility journey or check out more stories about couples struggling with fertility.

For an entire month, being good, compliant people became the focus of Valerie and Jason’s lives. But even that didn’t guarantee that their fertility doctor, Suleena Kansal Kalra, MD, MSCE, would give them the green light to remove Valerie’s eggs at the end of the month.

Naturally, women give off one egg each month—the dominant follicle. Once that one is released, the others that were growing disintegrate. But in Valerie’s case, all of the medications she was using caused many follicles to take off, not just the dominant one.

The result: “Your ovaries are on steroids,” Valerie says. “That’s the whole point, but you feel unusually bloated. You have bruises on your buttocks from  the injections. You’re sore, swollen and high on hormones that can throw you for an emotional loop.”

At the check ups, the doctor was monitoring the number and size of what they hoped would become Valerie’s harvested eggs—ideally 10 to 15 per side. She was also making sure that hormone levels were right, signaling that Valerie’s uterus would be a welcome environment when it came time to implant the fertilized egg.

High Hopes

When the time came in Valerie’s monthly cycle, Dr. Kalra approved Valerie for retrieval. The results were solid: about 15 eggs, which technicians mixed in a dish with Jason’s sperm. They were hoping for a call within the next 24 hours to find out if the sperm fertilized any eggs, and then another call about five days after that to hear if the process was continuing successfully.

“You’re just waiting for that phone call,” Valerie says.

On their second wedding anniversary, Valerie and Jason got the call from Dr. Kalra. Valerie could tell immediately that something was wrong. She felt sick and broke into tears.

None of the eggs had fertilized. And the doctor didn’t know why. The sperm hadn’t penetrated properly, and when they did, too many got in to each egg.

“We didn’t even get to the starting line. I got off the phone and had to tell Jason. It was a horrendous anniversary,” Valerie says.

Second Chances

Still, the couple wasn’t ready to give up. They had enough financial aid left to cover one more round of IVF. Valerie started on a different protocol of drugs.

This time, Valerie produced more than 20 eggs. All of them looked better than the first round. Yet, instead of giving them the chance to fertilize naturally in-vitro, the doctor suggested intracytoplasmic sperm injection (ICSI). With this procedure, the doctor wouldn’t leave it to the sperm to break into the eggs, but instead specifically implant one sperm into each egg.

Valerie and Jason approved the idea, but with so many eggs, they wanted to give some the chance to fertilize naturally. The doctor agreed to do half that way and half through ICSI.

Then, it was time to wait...again. Just like the first time, they anticipated Dr. Kalra’s call.

And that second phone call was very different from the first.

Surprise Ultrasound

Good news: 14 eggs had fertilized. But again, the ones that went naturally “acted goofy,” Valerie says. “We don’t know why, and we never will. We have to move on from that.”

They waited five days, with technicians watching the cells divide under a microscope. Some fizzled out, and others grew stronger. They wanted to pick the very best embryo for implantation. The couple ultimately had to decide how many eggs they wanted to implant in Valerie’s uterus, knowing that more eggs led to a greater risk of multiple births.

In the end, Jason wanted to protect their odds and try for two eggs. Valerie agreed. Guided by an ultrasound, the doctor implanted the eggs in Valerie’s uterus. It was late 2013.

“We have an ultrasound image of that,” Valerie says. “It’s in the very first page of our twins’ baby book.”

Moving to Motherhood

The next two weeks, waiting to see if the embryos continued to grow, may have been the toughest part of the whole process. All Valerie and Jason had to do was wait. There were no more phone calls, blood tests or check ups. Just the silent waiting.

“I felt like I was going to lose it. I was so nervous about getting a period,” Valerie says.

On November 21, they went in for the scheduled check up—the “big reveal.” It was Valerie’s 33rd birthday.

The ultrasound showed two embryos, growing strong side by side.

A month later, Valerie mainstreamed to a standard obstetrician. Eight months after that, on June 28, 2014, she gave vaginal birth to two babies, a boy and a girl—Blake and Paloma.

After the challenge of infertility, Valerie says, “I was lucky to experience a wonderfully ‘normal’ pregnancy, labor and then delivery. And much like any new mother probably feels when she holds her new babies for the first time, it was utterly surreal. Any hesitation or stereotypes I may have fostered towards IVF were washed away with a gush of pure adrenaline and joy.”

Looking back, she says she hopes that everybody who experiences fertility challenges has a supportive partner: “I can’t imagine if my husband wasn’t all on board. It takes two.”

She also says she wishes she would have known in the beginning how hard it would be to have kids. “You want this end game, to be holding these babies. So you have to take it one step at a time,” she says.

And whatever happens, honor your own struggles and dedication. Valerie still keeps a syringe in her fridge as a reminder of all she went through. Find a way to acknowledge your strength.

Thursday, September 18, 2014

A Candid Story of One Couple’s Challenges with Fertility Treatment (Part 1)

This is the first installment of a two-part series about a couple's challenges getting pregnant and their fertility treatment journey. If you too are having trouble conceiving, find out about the many fertility treatment options available. Don't stop hoping and working towards having a family.

There’s a single, unused syringe in the refrigerator at Valerie’s house. It serves as a reminder of the struggle she and her husband went through to get where they are today: happy parents of two-month old twins, a boy and a girl. The babies were born in June 2014.

“There were many layers to that struggle, different challenges at different times,” says Valerie, a resident of Philadelphia.

At 33 years old, Valerie, a surgical nurse at Penn Medicine, had never had so much as an abnormal period. Yet, doctors couldn’t decipher exactly what was causing her and her husband’s miscarriages and difficulties conceiving.

Valerie and Jason had gotten pregnant within two months of trying initially. But, then they miscarried. Over the next six months, they struggled to conceive again.

Diagnosing a Mystery

Their doctor was encouraged that they’d gotten pregnant naturally and said the couple had time to keep trying. Valerie was still two years shy of the pressure point in fertility—age 35 for women. Jason, also a nurse, was 38, and they wanted to be parents while they still had the energy to chase after a child.

“Initially, the challenge was not knowing. There was this lack of understanding, this mystery. We thought we should start investigating.” Valerie says.

Between 1 in 10 and 1 in 20 women has polycystic ovarian syndrome, or PCOS, according to the U.S. Office on Women’s Health. That means as many as five million women don’t produce an egg every month, which lessens their chance of conceiving.

Valerie didn’t fall under that diagnosis, though. She and Jason appeared healthy—no physical obstructions or fibroids. They had lab tests to check hormone levels. Those came back normal, too.

Except for one.

One of the tests showed that Valerie had a slightly elevated level of follicle stimulating hormone. This signaled that she may have poor quality or quantity of eggs. But nothing was certain.

“That was the first challenge.” Valerie says, “The insecurity, as a female, of feeling as though I was unable to get pregnant. I took it on my shoulders, even though it’s not an exact science, and there are many pieces to it.”

Learning the Language of Fertility

She and Jason were still in the beginnings of the process. They talked openly about it. Valerie worked to keep her ego in check and not take things personally. They focused on learning this new language —the terminology of fertility—and navigating this new system, even though they were both in the medical field.

“I can’t imagine not being a nurse and going through this,” Valerie says.

The couple decided to start on a method called intrauterine insemination, or IUI. In this process, doctors collect the husband’s sperm and wash it out to make it as potent as possible. They then monitor the wife’s cycle. When her ovaries release an egg, they insert the sperm and let nature take its course.

“Every step of the way has its own challenges. You look at your partner, you look at yourself, and you say, ‘What are you willing to do? How far are you willing to take this?’” Valerie says.

Despite multiple attempts over three months, the IUI wasn’t producing any results. In-vitro fertilization (IVF) was on the table. This process involves doctors fertilizing an egg outside of the body, and then inserting it into the woman’s uterus.

Constantly Questioning

Valerie hesitated at first. Financially, IVF is expensive, with no guarantee that it will work. The average cost per cycle in the U.S. is $12,400, according to the American Society of Reproductive Medicine.

“I thought I would never do IVF, that I would never go there. There’s this stereotype leading into it that people who do IVF are utterly baby crazy,” Valerie says. “It seemed like an extreme use of science. I didn’t know what to make of that.”

Yet, she was committed. A trained swimmer, Valerie knows that once you dive in, there’s no looking back. But doctors still couldn’t explain the couple’s fertility challenges, outside of that one slightly abnormal test.

“It’s probably a frustrating place to be as a clinician, to say you don’t know why,” Valerie says.

Physical Pains

In order to be within the Penn Medicine network, the couple switched doctors to Suleena Kansal Kalra, MD, MSCE. This enabled them to use financial aid that Penn reserves for employee fertility treatments. They sat with their new doctor and explained their recent decision—to try IVF.

“Her confidence made me nervous,” Valerie confesses. “I work with surgeons in an intensive care unit. I see confidence given to families all the time. They want to give people hope, but hope is a double-edged sword.”

Then the physical challenges began. Valerie started on a host of hormones for a month to prepare her body for IVF. A nurse explained the different medications Valerie would be administering to herself, some orally and some via needles.

“This part would be incredibly overwhelming as a non-nurse. I found it nerve-wracking as a nurse,” she says. “Who uses needles in everyday life if you’re a lawyer or an art teacher?”

Financial Stresses

The couple had to order five medications through the mail. Each one is so tailored to the individual taking them, that pharmacies and clinics don’t have the demand to keep them on-site. Here too, the financial challenges presented themselves. A single vial of medicine could cost thousands of dollars.

“I’m on the phone with some pharmacy or the insurance company saying, ‘Damn it. I’m trying to get pregnant.’ I felt like I was inventing the wheel to get things that I knew other people had gotten,” Valerie says.

“All the time, I’m thinking, ‘This is just because I want to be pregnant,’” she adds. “Emotionally, I was really high strung and hurt by this.” The struggle was making her question her resolve to get pregnant.

And financially, it wasn’t just about the price of the medications. Valerie had to miss work to wait for the deliveries, which could arrive anytime between 8 a.m. and 8 p.m. “And they would show up at 8:05 p.m.”

Every other day, she had to go back to the doctor for blood work and ultrasounds to monitor hormone levels and follicle growth.

“It was very stressful because I had to work with managers and get people to cover for me,” she says. “You’re handcuffed every single day for the length of your menstrual cycle. Don’t even think about going on a plane to your cousin’s wedding. This takes over. It’s all-invasive.”

Find out how the story ends in part two of Valerie’s fertility quest.

Thursday, September 11, 2014

Considering a Surrogate?

For some couples struggling with fertility, it’s simply not possible for the two partners to carry a pregnancy to term. But, keep in mind, it’s pregnancy that’s not possible. Parenthood—the ultimate goal—is still very much a possibility.

That’s where considering a surrogate or gestational carrier comes in:

Surrogate versus Gestational Carrier: What’s the Difference?

Surrogacy may be a good option if you are not able to produce enough healthy eggs or if you have a medical condition that will not allow you to carry a pregnancy to term.

With a surrogate, a woman will pair one of her eggs with your husband’s sperm and carry the child throughout the pregnancy, the US Office on Women’s Health explains.

The baby will be biologically related to your husband and the surrogate, but you can declare parentage before the baby is born or adopt the baby afterwards, depending on the laws in your state.

With a gestational carrier, your egg and your husband’s sperm are joined together to create an embryo. But another woman carries that embryo in her uterus and delivers the baby at birth. You and your husband are biologically related to the child. The gestational carrier is not.

The decision to go down this particular treatment path may not be easy for a number of reasons—biological, emotional, financial and legal. As with any fertility treatment option, it’s important to do your research and really take time to consider what is best for you and your partner.

Here are six questions to help guide the decision-making process for you, your partner and your medical team:

1. Do you want to go with a known surrogate or gestational carrier, such as a family member, or do you want to go with person to whom you have no personal ties?

There are pros and cons to both options. You and your partner will need to decide which of these options you feel most comfortable with.

If you decide to go with a stranger contracted through an agency, be sure to ask for references you can contact first, suggests the National Infertility Association.

Regardless of which one you choose, the American Society of Reproductive Medicine recommends that both the surrogate and the parents have separate representation by lawyers with experience in this area.

2. Do you want your surrogate or gestational carrier to undergo genetic testing? What if a test comes back abnormal?

If you go with an unknown surrogate or gestational carrier, you may want to make sure that her medical history does not include conditions that could be passed on and potentially threaten the baby’s health.

You also want to be sure that if your child does develop a medical condition that you and your partner are emotionally and financially prepared for it.

3. What type of relationship do you and your partner want to have with the surrogate or gestational carrier during the pregnancy and throughout the child’s life?

There are all kinds of horror stories out there about surrogates popping up and suing for parental rights or child support. Whether they are true or not, this is something that you and your partner should determine with your surrogate or gestational carrier and your respective legal teams beforehand.

During the pregnancy you may want updates and ultrasound pics from your surrogate or gestational carrier—but is she okay with that? If the surrogate or gestational carrier wants updates on the baby after birth, are you okay with that or would it disrupt your family bond?

4. If you choose a surrogate, how will you respond if the child eventually wants to know her biological identity?

First, this involves deciding if you’ll even tell the child how he was conceived. This is especially important if you do not plan to continue a personal relationship with the surrogate after the pregnancy.

After all, the surrogate is biologically related to the child. And the child may grow up wanting to know who his or her biological mother is.

5. How do you plan to tell others about taking this step toward building your family, if you want to tell them at all?

It could be awkward if you and your partner show up to the next family reunion with a baby. Be ready for the questions, the confusion and maybe even the judgement.

That’s why it’s important to decide who in your personal circle you’ll inform about this decision and how much information you’ll share. Because they will ask.

6. How much will the medical and legal costs come to?

As much as you may want to focus only on the emotional anticipation of becoming a parent, it’s important to spend time calculating the financial aspect of bringing your child into the world via surrogate or gestational carrier.

The ASRM suggests you agree upon the compensation for your surrogate or gestational carrier ahead of time.

Some of the costs to your and your partner may include:
  • A general fee for the surrogate or the gestational carrier
  • The agency fee if you choose one
  • Medical screenings for pre-existing conditions
  • Prenatal care after the surrogate or gestational carrier becomes pregnant and gives birth
  • Compensation for the surrogate or gestational carrier’s time off work, particularly for bed rest and recovery from delivery
  • Living expenses for the pregnancy, such as extra food, maternity clothes, travel to and from doctor’s appointments, prenatal vitamins, etc.
  • Legal costs for the surrogate or gestational carrier to have her own legal representation
All expected costs should be outlined in writing before any fertility procedures begin, advises the ASRM.

The process of choosing whether you want to go with a gestational carrier or surrogate can be difficult. Penn Medicine’s fertility experts can share additional questions to consider on your journey to parenthood.

Thursday, August 7, 2014

Recurrent Pregnancy Loss: How to Cope

For some women, the struggle with fertility happens after the pregnancy test comes back positive.

Imagine this: You’ve finally gotten past the loss of your pregnancy through miscarriage and now you’re pregnant again. You want to believe that this time is it—that you’ll really become a mom.

Then, you miscarry again.

When your doctor says you have recurring pregnancy loss, at first you feel devastated. But you soon discover that the emotional effects of this condition run the gamut from grief to fear.

Here’s what you need to know about recurrent pregnancy loss—what it is, what causes it, the emotional effects and how to cope.

What Is Recurrent Pregnancy Loss and What Causes It?

Recurrent pregnancy loss is a disease. It is not the same as infertility, says the American Society for Reproductive Medicine.

Infertility is an inability to get pregnant, whereas recurrent pregnancy loss means you can get pregnant but have had two or more miscarriages after the 10-week mark, the National Infertility Association explains.

If You've Experienced Recurrent Pregnancy Loss, You Probably Feel:


Couples who live with recurrent pregnancy loss may find themselves asking, “Why me?” At the root of this anger is likely disappointment. You saw this part of your life going one way, yet it’s going in a different direction. There is likely no reason why you are having challenges carrying your pregnancies to term while others don’t.


There’s a reason it’s called “loss” and not “failure.” You have in fact lost something, much like families who face grief when an infant or older child passes away. Avoid trying to talk yourself out of how you’re feeling or letting anyone else do it. It’s perfectly okay to let yourself go through the grieving process.


Feelings of guilt may stem from a sense that, as a woman, you are letting your spouse down. But it is important to remember that recurrent pregnancy loss is not something you’re choosing. And it’s likely not anything you’re doing to cause it.


But when you have just suffered from a miscarriage caused by recurrent pregnancy loss, it can be hard to stay encouraged that you’ll eventually carry to term. Feelings of helplessness are common.

You may feel as if you have no control over your body, and you’re waiting on some stroke of luck to make this happen for you. Remember that by seeking the right medical care, you are in fact taking control. It’s about being patient and open to your options.


How often do you find yourself asking “what if” and then filling in the rest of the question with the worst-case scenario. You may feel as if you will never be among that 65 percent who eventually become moms.

Fear that you will continue to face recurrent pregnancy loss over and over is understandable. But it is critical to your well being to not let this feeling become all-consuming. Otherwise, you risk being tempted to give up before you’re ready.

What are Some Coping Strategies for Dealing with Recurrent Pregnancy Loss?

Your best bet for dealing with the tumultuous emotions of consecutive miscarriages is to talk to someone. Open up to someone who will listen to you and encourage you.

Support groups

You may want to consider joining a support group if you are having a difficult time coping with the emotional effects of recurrent pregnancy loss. A support group can help you deal with feelings of loss, isolation and loneliness, says the National Infertility Association.

Support groups are especially beneficial if you feel as if you have no one to talk to about your experiences with recurrent pregnancy loss because no one you are close with has dealt with this condition.


Sometimes it helps just to have someone listen to your struggles without judging. If sharing in a group setting isn’t your thing, you could try individual or couples therapy. Look for a therapist who specializes in fertility related issues.

If you have recurrent pregnancy loss, you might consider seeing a fertility specialist for an evaluation. This is especially true if, in addition to miscarriages, you have a family history of repeated pregnancy loss or an autoimmune disorder. A fertility specialist can help you decide what the next step in fertility treatment should be.