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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 clichés—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:

Anger

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.

Grief

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.

Guilt

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.

Helplessness

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.

Fear

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.

Therapy

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.

Monday, July 14, 2014

In Vitro Fertilization: A Step-by-Step Process

When you think of common fertility treatments, in vitro fertilization (IVF), probably appears near the top of your list. There’s a reason for that.

IVF has been around for decades and today it accounts for a third of all fertility treatments worldwide, says the European Society for Human Reproduction and Embryology (ESHRE).

IVF is commonly used to treat:
  • Older women with fertility issues
  • Women with damaged or blocked fallopian tubes
  • Women with endometriosis
  • Male infertility caused by low sperm count or blockage
Source: NIH

You most likely already know the basic idea behind IVF: uniting egg and sperm outside the body in a culture. But there’s so much more to IVF that happens before and after that. Here’s a closer look at the IVF process in five steps.

1. Superovulation (Egg Production)

You’ll be given fertility drugs that will begin a process called stimulation—or superovulation, says the National Institutes of Health. In other words, the drugs—which contain Follicle Stimulating Hormone—will tell your body to produce more than just the normal one egg per month.

The more eggs you produce, the more chances you’ll have of a successful fertilization later on in the treatment.

You’ll receive transvaginal ultrasounds and blood tests on a regular basis during this step in the IVF process to check on your ovaries and monitor your hormone levels.

Source: National Institutes of Health and ESHRE

2. Egg Retrieval

A little more than a day before your eggs are scheduled to be retrieved from your body, you’ll receive a hormone injection that will help your eggs mature quickly.

Then, you’ll have a minor surgical procedure—called follicular aspiration—to remove the eggs. This is generally done as an outpatient surgery in your doctor’s office, according to the NIH.

During the procedure, your doctor will use an ultrasound to guide a thin needle into each of your ovaries through your vagina. The needle has a device attached to it that suctions the eggs out one at a time.

If this part sounds painful, don’t worry—you’ll probably be given medication beforehand so that you won’t feel any discomfort. You may experience some cramping afterward, but this usually disappears within a day, the NIH explains.

3. Sperm Collection

While your eggs are being removed, your partner is going to need to provide a sperm sample. The sperm are then put through a high-speed wash and spin cycle in order to find the healthiest ones.

4. Insemination and Fertilization

Now comes the part of IVF that everyone’s most familiar with—combining your partner’s healthiest sperm with your healthiest eggs. This stage is called insemination.

It usually takes a few hours for a sperm to fertilize an egg. Your doctor may also inject the sperm directly into the egg instead.

5. Embryo Culture and Transfer

Once your eggs have been collected, you’ll receive yet another medication. This one is meant to prep the lining of your uterus to receive the embryos that will be transferred back into you.

About three to five days after fertilization, your doctor will place the embryos in your uterus using a catheter. Like Step 3, this part of IVF is performed in your doctor’s office while you are awake.

Multiple embryos are transferred back into you in the hopes that at least one will implant itself in the lining of your uterus and begin to develop. Sometimes more than one embryo ends up implanting, which is why multiples are common in women who use IVF.

The IVF process basically replicates natural reproduction. The next step after the IVF process determines whether the procedure worked: the pregnancy test.

IVF is increasingly becoming one of the most common and successful procedures, helping couples become proud parents. If you think IVF is the next step in your fertility journey, check with one of Penn Medicine’s fertility experts.

Learn more about the IVF process from Director of Assisted Reproductive Technology (ART) and Andrology Laboratory, Matthew D. VerMilyea, PhD.

Tuesday, June 24, 2014

Fertility Specialist or OB/GYN: Which Is Right for You?

When you’re struggling with fertility issues, you might experience a bunch of different emotions, all at the same time:
  • Frustration that your efforts to get pregnant seem to be taking you on a fast train to nowhere;
  • Envy that your friends are decorating their nurseries, but you’re still waiting to see a plus sign on a home pregnancy test yet;
  • Maybe even embarrassment because you’ve finally come to a tough conclusion: It’s time to seek more specialized help.
But there’s one feeling you may need more of: Hope. And seeking medical help for fertility issues can provide you with a sense of hope.

At first, you may not know where to turn for treatment. Do you see your OB/GYN or would you be better off going to a fertility specialist? What’s the difference between them anyway?

Here are a few factors to consider, when deciding between a fertility specialist and an OB/GYN:

1. How Long You’ve Been Trying to Get Pregnant

A visit to an OB/GYN is generally the first stop in the fertility treatment journey.

Your gynecologist can perform a preliminary fertility evaluation, according to the American Society for Reproductive Medicine. A common problem for couples with fertility struggles is how to properly time intercourse with ovulation, says the National Infertility Association.

While an over-the-counter urine test—known as an ovulation predictor test—can sometimes do the trick, your OB/GYN can conduct an evaluation to see if there are other factors affecting your ability to get pregnant, the Association explains.

You should consider having a fertility evaluation if you:
  • Are under 35 years old and have been trying for at least one year
  • Are older than 35 years and have been trying for six months
Source: American College of Obstetricians and Gynecologists

If the evaluation points to an underlying fertility issue—such as pelvic inflammatory disease or uterine fibroids—it may be time to consider seeing a fertility specialist.

2. Your OB/GYN’s Training

Some obstetrician-gynecologists undergo extra training to better treat patients who are struggling with fertility difficulties.

If your doctor is board certified in reproductive endocrinology, then she’s had this extra training.

If she hasn’t, she may only be familiar with a few of the more common fertility treatments.

If that is the case, you might want to consider seeing a fertility specialist instead. This is especially true if other treatment methods have been unsuccessful for you.

A fertility specialist has completed three years of specialized training with an approved reproductive endocrinology fellowship program in addition to an OB/GYN residency.

Source: American Society for Reproductive Medicine

3. Your Medical History

If you have irregular or painful menstrual cycles, or you have a hard time tracking your ovulation, you may want to consider seeing a fertility specialist instead of an OB/GYN.

Other reasons to see a fertility specialist:
  • You’ve had more than one miscarriage
  • You or your partner had or have an STD
  • You or your partner are overweight or underweight
Source: National Infertility Association

4. Your Age

Women over 30 years old, who have a history of pelvic inflammatory disease or problems related to their menstrual cycles, should see a fertility specialist sooner than the recommended one year, according to the Association.

5. Your Partner’s Fertility

Another reason see a specialist, sooner rather than later, is if your partner has a low sperm count, according to the Association. If your partner’s semen analysis comes back abnormal, he might be referred to a urologist who has been trained to handle issues concerning male infertility, the American Society for Reproductive Medicine explains.

Have you or someone you know seen a fertility specialist? Was it more helpful than going to an OB/GYN?



Thursday, June 5, 2014

Four Ways To Handle Feelings of Failure When Dealing with Fertility Issues

Has this thought ever crossed your mind: What’s wrong with me?

Couples who are struggling with fertility issues are bound to struggle with feelings of failure at some point.
So what are you supposed to do when it seems like nothing ever goes right in your fertility journey? Here are four ways to handle feelings of failure when dealing with fertility issues:

1) See Failure for What It Really Is

As women, we’re told that our bodies are designed for pregnancy. But anyone who has faced fertility issues knows that design and function can be very different realities. That’s why it’s so important to re-frame the way you think about your struggles with fertility.

Failure isn't something you’ve done. It’s certainly not a character trait. It’s something that happens.

Internalizing fertility issues as a mark of personal failure implies that you’re the cause or that you’re
consciously doing something wrong.

That’s probably not the case. You are experiencing a challenging chapter in your life story. It’s temporary and that’s it. Recognizing this is an important first step in getting feelings of failure under control.

2) Don’t Let Your Emotions Take Over Your Body

You’re probably well aware that stress can wear you down physically and make you feel tired or sick. The same may be true of internalizing feelings of failure, according to an August 2012 Psychology Today article.

Negative thinking can cause your muscles to tense. Tension buildup leads to inflammation. And inflammation can lead to illness.

Practicing meditation and relaxation techniques are great ways to manage the physical and emotional effects of infertility stress, says the National Infertility Association. Eating well and staying active are good ideas as well.

A vacation or a visit to your favorite shoe store might help, too. Just a thought.

3) Recognize That Not All Setbacks Are Equal

Try to avoid all-or-nothing thinking, such as “Since this physician can’t help, no one can” or “If the treatment didn’t work this time, it won’t ever work.”

Viewing every setback as a complete loss can be detrimental to your well-being. Also, it leads to a false sense of defeat, when determination is probably the better approach.

Yes, sometimes it seems like everything is going wrong, but try putting negative experiences into perspective. Don’t give them more weight than they deserve.

In fact, re-framing minor setbacks as positive experiences can be one of the most effective coping strategies, says a July 2011 study published in Anxiety, Stress & Coping.

For example, if your doctor’s appointment gets pushed back, look at it as an opportunity to have some free time, not another stumbling block.

4) Remember—You Are So Much More than Your Fertility Issues

When getting pregnant is your top priority goal, it can be easy to lose sight of who you are, says the American Fertility Association (AFA).

But your goal to get pregnant is not your identity. Before this, you were an awesome swimmer, a great friend or a really good cook. And guess what—you still are.

If you remember that you are more than your fertility issues, you can prevent feelings of failure from taking over your entire perception of yourself.

Your fertility struggles must be kept separate from your sense of self, says the AFA. You’re still someone’s wife, daughter or best friend. Fertility issues don’t change that.

This may sound a bit self-helpish, but try drawing up a list of the different parts of your identity—your career, relationships, skills, hobbies and passions. Title the list “I am…” Ask your spouse or best friends to weigh in too. They may offer some of the defining characteristics that you overlook.

When you look at yourself and only see fertility issues, this list can remind you of one simple truth: This challenge does not define you. You do.

Read stories from couples struggling with fertility and find out the latest treatment options. 

Tuesday, May 20, 2014

What’s the Link Between Obesity and Infertility?

For couples struggling with fertility, there’s an unlikely tool that could help—the scale.

That’s right. Being overweight or obese can affect a couple’s ability to get pregnant.

In fact, obesity is the cause of fertility struggles in six percent of women who have never been pregnant before, says the American Society for Reproductive Medicine (ASRM).

Obesity affects infertility by changing the way a woman’s body stores sex hormones. Here’s how:
  1. Fat cells convert a male hormone known as androstenedione into a female hormone called estrone.
  2. Estrone affects the metabolism of the part of the brain that regulates ovarian and testicular function.
  3. This can impair reproductive function. 
And it’s not just the woman’s weight that affects fertility. Obese men are more likely to have low or nonexistent sperm counts, according to a March 2012 article in JAMA Internal Medicine. 

This happens for several reasons:
  1. Obesity can elevate body temperatures, especially around the scrotum. 
  2. It can also lead to hormonal imbalances. Obese men are more likely to have higher estrogen levels, combined with lower levels of sperm-producing hormones like inhibin b and androgen. 
  3. This can mess with sperm count, sperm concentration and the sperm’s ability to swim well, according to a March 2010 study in the journal Nature Reviews Urology. 

Making Fertility Issues Worse

Obesity and infertility can have a weird, circular relationship as well. It’s hard to tell which one caused the other. For example, stress—like the kind couples experience during a long fertility journey—can not only cause irregular periods, but some women “stress eat,” meaning they binge on junk food during times of stress. 

Then, there are health conditions like polycystic ovarian syndrome (PCOS), a hormonal disorder that can cause cysts on the ovaries. While the cause of PCOS is unknown, one side effect of PCOS is obesity. The National Infertility Association points out that obesity is common among PCOS patients, affecting 50 to 60 percent of women with this condition. The symptoms may be worse if a woman is obese.

Take Charge of Your Health

Sometimes addressing fertility challenges starts with getting to a healthy weight. Losing weight is a simple concept, but in practice, it’s not always easy. If changing your diet and exercising have not worked, you may want to talk to your doctor about bariatric surgery. It may be worth considering if you:
  • Are more than 100 pounds above your ideal weight
  • Have weight-related health issues, like high blood pressure or Type 2 diabetes 
  • Have tried weight loss programs, but nothing has worked 
  • Don’t have any current challenges with alcohol or drug abuse



Think about it. If obesity is the underlying cause of your fertility challenges, it’s best to address that before starting or continuing fertility treatments. Talk to your doctor about how your body weight may be affecting your fertility.

Friday, May 9, 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.

Have you felt conflicted over friends’ pregnancy announcements while you’re trying to conceive?
How did you react?

Thursday, May 1, 2014

How Couples Struggling with Infertility Can Keep the Spark

There’s a reason diets are difficult. You have to switch from eating for pleasure to eating for a specific goal. That can make food unenjoyable. Cooking, a chore.

For couples struggling with fertility, sex and romance can feel the same way, only more intense.

Sex and romance can feel like an all-consuming, full-time job.

“At least it’s fun trying, right?”

Maybe not. Before, you and your partner probably had sex because you felt like it, because it was Saturday morning and raining.

But now, depending on where you are in the fertility process, you might need to have sex at very specific times to increase your chances of getting pregnant—whether you’re in the mood or not.

Here’s the reality: 

Sex on a schedule isn’t always that sexy.


During the fertility treatment process, sex can become simply a means to a baby—if you let it. You or your partner might be so focused on getting pregnant and the next steps in the fertility treatment process that the rest of your relationship—including romance—takes a backseat.

And that can really strain your relationship.

Keep the Romance Alive During Fertility Treatments

Fertility treatments can be taxing, emotionally and physically. There are days you’ll feel sick, sad, grumpy or just plan unsexy. But remember: Sex isn’t the only way to connect.

Here are four ways to keep the flame from blowing out in your relationship during fertility treatments:

1. Talk About Other Stuff

You probably didn’t talk or stress about babies all day everyday before the fertility process. Perhaps when you first got together, you talked about the crazy people at your job, your next vacation or other things that make you interesting, complex people. Ideally, pick something that will get you both out of the baby conversation and back to seeing each other as complex people with other interests.

Because guess what? You still are those interesting, complex people. Check in with each other on the other aspects of life. And that shouldn’t be pushed aside just because having a baby has become a priority.

2. Remember the Beginning

Remember what connected you in the first place. Try to get back there. Maybe when you and your partner first got together, he made you dinner, and it blew your mind that he was such a great cook—or such a terrible one. What did you and your partner like to do before you started fertility treatments? What was something that made you feel close? What was something your partner did that attracted you in the beginning?

3. Relocate

Save the scheduled sex for a specific location that lends itself to doing what you have to do and getting it done—like an unoccupied guest room. Then, have another spot—like the bedroom—for the real-deal sex, when you’re both feeling romantic and aroused and just want to enjoy it.

This separation can remind both of you that there is a slice of your marriage that you will not allow to be taken over by the fertility process. It’s off limits, and it’s just for you two.

4. Show Your Love

Sometimes, there’s nothing sexier than a genuine compliment. Make an effort to give them and receive them with gusto. If your husband says, “You look really pretty today,” don’t come back with, “Ugh, I feel so gross.” Rub each other’s shoulders; leave each other love notes; plan fun dates. Then, remember to express appreciation for even the smallest romantic gesture.

The positive side is that you and your partner are a team, working toward something together. During the fertility process, make sure to keep your romantic spark a priority, too. Besides, it’s not like romance will get any easier when you become parents.

Wednesday, April 23, 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 clichés—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.”

Which insensitive comments are we missing?
Share how you've handled comments
about your fertility journey.

Tuesday, April 1, 2014

Parenthood After a Vasectomy?

That tattoo you thought was a great idea in college? Maybe not so much now. And that perm you shelled out big bucks for in 1985...probably wouldn't be a discussion with your hairstylist today.

It’s a fact of life – situations change, minds change, decisions change.

For men and couples who make a decision not to have any (or any more) children, they might decide to have a vasectomy. But what if their minds change? Or, in many cases, a relationship ends, a new one begins and all of the sudden you do want to have children?

“A vasectomy is one of the most common urologic procedures and should be considered a permanent form of contraception,” says Puneet Masson, MD, assistant professor of urology in surgery and director of Male Fertility at Penn Medicine. “That being said, approximately five percent of vasectomized men express the desire for future children and one to two percent may seek consultation regarding options for future fatherhood.”

Dr. Masson sees men who are interested in having a vasectomy. However, he advises that they should only have the procedure if they are 100 percent sure they do not want any more children. A man can also cryopreserve sperm if there is any concern that someday he may desire more children.

“Of course, we understand that life is dynamic and unpredictable and that some vasectomized men are highly interested in achieving a genetic pregnancy,” says Dr. Masson. “There are two options for these patients: vasectomy reversal, and sperm extraction. Both pathways are equally effective at achieving future children and the decision depends on the preferences of the patient/couple.”

Reversing a Vasectomy

First, it’s important to understand how sperm is made. Sperm are made in the testicle in extremely small tubules called seminiferous tubules. This process takes approximately 60 days. Afterwards, they are slowly transported to the epididymis and continue to mature over a period of two weeks. Following this, they are ready to be ejaculated and are stored in the section of the vas deferens immediately next to the epididymis and part of the epididymis itself.

During a vasectomy, the vas deferens is cut and each end of the vas is tied, clipped, and/or burned. Thus, the semen of a vasectomized man should not contain any sperm. During a vasectomy reversal, the vas deferens is reconnected so that the man’s ejaculate contains sperm.

A vasectomy reversal typically takes four to six hours and is done under general anesthesia. Afterwards, the patient is able to go home the same day. Following a healing period, the man is “allowed” to resume unprotected sexual relations. Due to swelling in the vas deferens, which occurs as a natural part of healing, it may take up to a year before sperm are visible in the ejaculate. If the more complicated connection is done (vas to epididymis), it may take up to 18 months.

“What all patients should understand is that there is no guarantee that a pregnancy will be conceived through natural means following a vasectomy reversal,” says Dr. Masson. “Though most studies report a ‘natural’ pregnancy rate between 50 and 70 percent, some couples may still choose to participate in assisted reproductive therapy following a vasectomy reversal and do in utero insemination (IUI) and/or in vitro fertilization (IVF).”

Retrieving Sperm

“A sperm extraction procedure is also an excellent option for vasectomized men who desire future children,” says Dr. Masson. A percutaneous epididymal sperm aspiration (PESA), testicular sperm aspiration (TESA), microsurgical epididymal sperm aspiration (MESA), and microsurgical testicular sperm extraction (microTESE) are procedures that directly extract sperm from either the epididymis or testicle. This can be done under local anesthesia, conscious sedation (aka “twilight anesthesia”), or general anesthesia, and can be completed in about an hour.

“What is important to understand is that all sperm extracted must be used in conjunction with IVF, where a woman undergoes an egg retrieval procedure and the sperm must be injected directly inside the egg,” Dr. Masson says. “After a few days, the developing embryo is placed into the woman’s uterus. Excess sperm that was not used for fertilization is usually cryopreserved and stored for future IVF cycles.”

All vasectomized men who are interested in future genetic children should be counseled on both options. A full female evaluation is also recommended, as this may aid couples in making an informed decision. Penn Fertility Care is committed to understanding a couple’s reproductive goals and preferences. Our team includes physicians, nurses, and financial counselors who can discuss all aspects of fatherhood after a vasectomy and individualize a plan for future family planning.

Tuesday, October 1, 2013

Nutrition and Pregnancy Event!

Penn Fertility Care
presents an informational seminar on
Nutrition and Pregnancy
October 9, 2013


Penn Fertility Care presents an informational seminar on Nutrition and Pregnancy

Join Samantha Butts, MD and Celeste Durnwald, MD for an informational seminar about the impact of nutrition on fertility and how the role of weight, diet, vitamins, and exercise during pregnancy plays a direct role in the health and well being of both mother and baby.

Date: October 9, 2013
Time: 6 to 7:30 pm
Place: Biomedical Research Building (BRB) Auditorium
421 Curie Boulevard
Philadelphia, PA 19104

Samantha Butts, MD
Assistant Professor of Obstetrics and Gynecology Dr. Butts
received a medical degree from Harvard University School of Medicine, and completed her residency in obstetrics and gynecology and a fellowship in reproductive endocrinology at the Hospital of the University of Pennsylvania. Her special interests include reproductive aging, nutrition, environmental exposures and reproductive outcomes, and neonatal/perinatal outcomes related to in vitro fertilization.


Celeste Durnwald, MD
Assistant Professor of Obstetrics and Gynecology
Dr. Durnwald received a medical degree
from Northeastern Ohio Universities College of Medicine. She completed a residency in obstetrics and gynecology at Summa Health System in Akron, Ohio and a fellowship in maternal fetal medicine at Case Western Reserve. Dr. Durnwald area of clinical focus is maternal fetal medicine and she specializes in the management of diabetes during pregnancy