Dear AFA Member,

Welcome to your October issue of “Connections.” This fall two special women have joined The AFA’s cause – educating, supporting, and advocating for women and men with reproductive difficulties. Each brings a fresh, new perspective to you, our AFA members, and to all seeking fertility information and support.

• “Desperate Housewives” Actress Brenda Strong to Serve as AFA National Spokesperson
• Welcome aboard Deborah Capone, AFA’s new Educational Coordinator and Publication Editor
• Kokopelli Ball at the Chelsea Piers, November 7, 2005 - New York City
• Featured Article: Complementary and Alternative Medicine & Fertility– a primer By Machelle M. Seibel, M.D.
• Online educational sessions

“Desperate Housewives” Actress Brenda Strong to Serve as AFA National Spokesperson

I’m so excited to announce that “Desperate Housewives” actress Brenda Strong will serve as The AFA’s first national spokesperson!

Brenda Strong

Known to many as Mary-Alice Young, the narrator and dearly-departed Wisteria Lane neighbor on ABC’s hit drama, Brenda has wrestled with infertility and turned to the practice of yoga to manage and alleviate the associated stress brought on by the diagnosis. She will use her spokesperson platform to educate infertile women and men on how they can re-connect with their bodies, reduce stress, and increase self esteem through exercise and complementary medicine.

Brenda's holistic approach to fertility teaches us to treat the whole individual – mind, body, and spirit. We have to balance the elements we can control with those that we cannot: an important message that too often gets relegated to the sidelines.

Too often fertility treatment addresses only a failing body part or an inadequate hormone level. But reproductive difficulties are much more than a bad ovary or low sperm count. Brenda brings a fresh, new perspective and reminds us that there is a soul and an emotional component to reproductive challenges that we should not forget.

This fall, Brenda will begin a high-visibility media campaign to support The AFA and women and men on the journey toward wholeness and acceptance in their reproductive capabilities. To kickoff her role as national spokesperson, she will serve as Master of Ceremony at the American Fertility Association’s Kokopelli Ball at the Chelsea Piers on Monday, November 7, 2005.

She has taught at UCLA’s Mind-Body Institute and produced and starred in “Yoga 4 Fertility,” a video series designed to help infertile couples through yoga therapy (www.yoga4fertility.com). She and her husband designed a system of yoga postures for women and couples experiencing infertility which reduce stress, increase coping mechanisms, deepen awareness, increase relaxation capability, and improve circulation and muscle tone. The yoga practice enhances and supports any protocol treatment suggested by a fertility doctor.

Brenda is a familiar face on the small and big screen. In addition to “Desperate Housewives,” Strong is also recognizable to television audiences as Sue Ellen Mishkie (a.k.a. “The Braless Wonder”) on the award-winning series “Seinfeld.” She has also has recurring roles on such acclaimed series as “Nip/Tuck,” “Everwood,” “Sports Night,” “7th Heaven” and “Party of Five.”

“ It’s difficult to love your body when you feel like it’s failing you. Yoga reduced my stress and bodily tension. It allowed me to bring my body back into balance, to emerge from my fertility struggle with my sense of self esteem and self worth intact, and to forge a stronger bond with my husband.” --Brenda Strong

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Welcome aboard, Deborah Capone, AFA’s new Educational Coordinator and Publication Editor

A very warm welcome to the newest member of our team, Deborah (Deb) Capone, who will serve as The AFA’s Educational Coordinator and Publication Editor. She replaces Lisa Rosenthal, who now serves as the AFA’s Assistant Executive Director. We’re all very excited to have Deb as an active member of our staff and we’re confident she’ll make major contributions.

Warm Regards,
Pamela

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Kokopelli Ball at the Chelsea Piers, November 7, 2005 - New York City The Stars Come Out to Support the American Fertility Association! Brenda Strong Jason Alexander Joan Lunden kokopelli ball 2005 MONDAY, NOVEMBER 7, 2005 PIER SIXTY at CHELSEA PIERS 23rd STREET & the HUDSON RIVER NEW YORK CITY COCKTAIL RECEPTION, DINNER, DANCING AND SILENT AUCTION For tickets, please contact Corey Whelan, Director of Development, at corey@theAFA.org or (718) 853-1411. Master of Ceremony Brenda Strong, actress, “Desperate Housewives” Special Guest Jason Alexander, actor The Howard and Georgeanna Jones Lifetime Achievement Award Richard J. Paulson, MD The Robert Edwards Scientific Award David K. Gardner, PhD Media Award Joan Lunden, TV host and author Family Building Awards Serena H. Chen, MD Mark Evans, MD Ronald F. Feinberg, MD, PhD IntegraMed Isaac Kligman, MD Kathleen Miller, BSTS Gabriel San Roman, MD Kaylen M. Silverberg, MD Platinum Sponsors Cornell Center for Reproductive Medicine and Infertility Organon USA, Inc. Reproductive Medicine Associates Gold Sponsors Apthorp Pharmacy Ferring Pharmaceuticals IntegraMed America Kraupner Pharmacy Metro Drug Stores Reproductive Medicine Associates of New York Reproductive Specialists of New York, LLP Schraft's Pharmacy Serono, Inc. Silver Sponsor The Center for Male Reproductive Medicine and Microsurgery, Weill Medical College of Cornell University The Chen Family Comprehensive Genetics Freedom Drug The Institute for Reproductive Medicine and Science at Saint Barnabas Kings Pharmacy Maternal Fetal Medicine Associates Montefiore's Institute for Reproductive Medicine and Health Old Post Road Group, LLC Reprogenetics Reproductive Associates of Delaware Reproductive Medicine Associates of Connecticut Sher Instituties Texas Fertility Center The Silverberg Family USC Fertility Bronze Sponsor Melissa Brisman, Esq.

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This month's featured article:

Complementary and Alternative Medicine & Fertility– a primer
By Machelle M. Seibel, M.D.

Complementary and alternative medicine (CAM) is huge. Based on a survey of 31,044 interviews of adults, age 18 years and over, the Centers for Disease Control determined that 62% of adults used some form of CAM therapy during the past 12 months when the definition of CAM therapy included prayer specifically for health reasons. (Advanced Data from Vital and Health Statistics, Centers For Disease Control and Prevention, National Center for Health Statistics, Number 343, May 27, 2004).

How much money does that translate into? Between $36 billion and $47 billion in 1997 alone. Of that vast amount of money, between $12.2 billion and $19.6 billion was out-of pocket dollars. CAM is most often used to treat chronic conditions such as back problems, neck pain or neck problems, joint pain or stiffness, and anxiety or depression. It is also used commonly for diseases that traditional medicine has failed to cure such as cancer or HIV. Although exact numbers are not known for CAM use by infertility patients, infertility regrettably may be both chronic and unsuccessful. Therefore it is not surprising that a growing number of infertile couples are seeking CAM therapy. Most use it as a complement to conventional medicine, not as an alternative. (Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997; results of a follow-up national survey. JAMA 280 (18):1569-75. Nov 11, 1998.)

That is why it is called “complementary.” When used alone it is called “alternative” medicine. The wide range of treatments that collectively are known as CAM therapy are shown in Table 1. Although CAM is exceedingly common, many patients have difficulty figuring out who they should go to for treatment. Others are surprised at the cost. This article will focus on finding a CAM practitioner and offer some suggestions about the financial issues surrounding CAM.

SELECTING A CAM PRACTITIONER
The best way to find a good CAM practitioner is to speak with your PCP or Reproductive Endocrinologist. They may have worked well with a CAM provider who has just the skill set you need. If they don’t have a suggestion, ask someone you think is knowledgeable about CAM and see if they have a recommendation. Still no luck? Contact a nearby hospital or medical school and find out if they have a referral list of CAM specialists.

Some of the larger regional medical centers will have CAM practitioners on staff. You can also contact a professional organization for the type of practitioner you are seeking. These organizations can tell you if a practitioner must be licensed or certified in your state. Your state, county, or city health department may also serve as a resource for finding the needed agency or licensing board. Check the Internet or directories in libraries (ask the librarian.) One good resource is the Directory of Information Resources Online (DIRLINE) that was created by the National Library of Medicine (dirline.nlm.nih.gov.)

Once you find the name of several potential CAM providers, find out about each of them – where they trained, if they have licenses or certification, and how much treatment costs. You can call ahead of a first visit and gather some information. Find out if the practitioner will speak with you ahead of time. At that time you can ask how much time they spend with each patient, how often they treat conditions like yours, how successful they are in the treatments, and whether or not there is any scientific evidence to support the therapy they are suggesting. You can also ask practical questions such as the hours appointments are offered, how long is the wait for an appointment, and what involved in the first appointment. This type of interview may or may not be associated with a charge. On your first visit, bring a family member or come as a couple so that you both can hear the discussion. You should be asked all the questions you expect from a traditional doctor such as what illnesses and surgeries you have had and what medicines you take. The Centers for Disease Control suggest asking the following questions at your first visit:

• What benefits can I expect from therapy?
• What are the risks associated with this therapy?
• Do the benefits outweigh the risks for my disease?
• What side effects can be expected?
• How long will I need to undergo treatment?
• How often will my progress or plan of treatments be assessed?
• Could the therapy interact with my conventional treatments?

FINANCIAL ISSUES TO CONSIDER ABOUT CAM
Although your insurance plan may provide some coverage for CAM, it is often limited and varies from state to state. Become familiar with your health insurance plan. Does the plan limit the conditions it will cover? Does it require you to use a specific practitioner? It’s a good idea to check with your insurance company before you start treatment. If you use a CAM practitioner who is not part of your network, will you be covered at all? Are there any additional out-of pocket expenses? Here are some additional questions to ask your insurer:

• Do CAM services have to be preauthorized or pre-approved? If so, be sure to bring it with you on your first visit and keep a copy for your records.
• Do I need a referral from my PCP?
• What services and tests are covered?
• Is there a co-payment?
• Will additional costs such as laboratory tests, dietary supplements, equipment or supplies be covered?

The following are questions the National Center for Complementary and Alternative Medicine suggests you ask your CAM provider or his/her staff:

• Do you accept my health insurance?
• Does the patient or the provider file the claim forms?
• What is the cost for the initial appointment?
• How many treatments will I need?
• How much will each treatment cost?
• Can I receive treatment for a trial period to see if the therapy works for me before committing to a full course?
• Are there any additional costs?
• Is there a payment plan if you cannot pay for full costs each visit?
• Do you offer a sliding-scale fee that adjusts charges for patients with less ability to pay?

You may find that if CAM services are covered by your insurance, it may be either as a higher deductible, meaning you must pay for a larger amount of dollars than is usual before your insurance begins to pay. Alternatively, you may have a policy rider which is an amendment to your insurance policy that say it will cover CAM services in some part only if you purchase at additional cost that specific coverage. Some insurers may also have a contract with a network of CAM providers that offer services to group members at a lower than standard rate. Check with your company’s benefits administrator to find out about what plans are offered and what preferences you might have.

TABLE 1
Complementary and Alternative Therapies

Alternative Medicine Systems
Traditional Chinese Medicine (TCM): Includes herbs, acupuncture, acupressure, and physical exercises such as t’ai chi chuan and qigong. The purpose of treatment is to correct imbalances.

Ayurveda (ayur, meaning longevity and veda, meaning knowledge): Emphasizes the relationship between the inner life (spirituality, consciousness) of the individual and the external world. Treatments include alternate nostril breathing (pranayama), rubbing the skin with oil (abhyanga), herbs and spoken mantras (rasayana), yoga and cleansing therapy (panchakarma).

Naturopathy: Based on the healing power of nature, it emphasizes natural cures, proper bowel habits, and hygiene. Focus on prevention and first do no harm. Attempts to pinpoint the underlying cause of illness, recognize the ability of the body to heal itself, and treat the whole person.

Homeopathy: Based on theory of “like cures like.” Founder Samuel Hahnemann taught that any substance that causes a healthy person to become ill will cure a person who is already ill if infinitesimally small doses are use.

Chiropractic: Founded by Daniel David Palmer in 1895. Based on premise that disease is caused by subluxations (partially dislocated joints) and dysfunctions of the skeletal system. Treatments based on gentle spinal manipulation, usually preceded by soft tissue therapies and message.

Osteopathy: Founded by Andrew Taylor Still in the late 1800’s. Similar to allopathic doctors except their approach is holistic rather than disease specific and they believe musculoskeletal manipulation is essential for patient health.

Environmental Medicine: Evolved in the 1940’s by Theron Randolph, it strives to balance the patient’s physiology with substances in the environment. Treatments include immunotherapy, nutritional supplements, and desensitization.

MIND/BODY APPROACHES
Focus on the mind’s ability to affect pain and disease. Major treatment approaches include hypnosis, biofeedback, and relaxation techniques including autogenic training, progressive muscle relaxation and meditation. Prayer is also included in this category.

BODYWORK
Healing therapies applied by a practitioner who uses their hands to treat the patient, such as massage, postural therapies and therapeutic touch.

DIETARY SUPPLEMENTS
Includes nutritional supplements and vitamins and minerals to ensure that diseases, such as pellagra and scurvy, would not be caused by nutritional deficiencies. Also includes other beneficial supplements such as essential fatty acids, acidophilus, choline, and others. Orthomolecular medicine prescribes mega doses of vitamins for disease treatment, and botanical medicine ranging from St. John’s Wort (Hypericum perforatum) to soy and regulated by the Dietary Supplements Health and Education Act of 1994.

DIET-BASED THERAPIES
Dietary approaches such as Atkins, Ornish, Pritikin and Zone diets, Vegetarian and Macrobiotic diets are all being evaluated as CAM therapies.

CAM TIPS SPECIFICALLY FOR COUPLES WITH DIFFICULTY CONCEIVING:
While most of this article is intended as a primer for couples trying to conceive who might want to know how to include CAM therapies into their treatment options, I wanted to also provide some key points about CAM that patients might find useful:

• Take a prenatal vitamin prior to conceiving (two to three months before you are actually pregnant.) It reduces the risk of having a baby with a neural tube defect such as spina bifida (the spinal chord fails to close.) For most women, diet alone is not enough to ensure getting enough folic acid and other nutrients to prevent this problem. Although 80% of women of childbearing age are aware of folic acid and prenatal vitamin benefits for conception and pregnancy, a recent Gallop poll found that only 30% of them are actually taking a prenatal vitamin. (Dickson A. The Benefits of Nutritional Supplements. Council for Responsible Nutrition. Washington DC. 2002)

• Several large studies have shown that taking a prenatal vitamin with 0.8 mg of folic acid rather than 0.4 mg which is present in many multivitamins starting several months before conception and continuing it for the entire pregnancy had a 5% shorter time to conception, a lower risk of miscarriage, and a lower rate of all major genetic abnormalities diagnosed up to the eighth month of life. In addition, women taking a prenatal vitamin had more regular menstrual cycles.

• Eat fish at least once a week. If you are worried about contaminants, try taking a highly concentrated, high quality fish oil supplement containing omega-3 fatty acids throughout pregnancy. Studies have shown that doing so helps optimize brain development, reduces the risk of postpartum depression, and the babies of mothers who consume omega-3 fatty acids tend to be calmer after birth.

• In one report, infertility patients who had others pray for them during their in vitro fertilization cycle achieved a statistically higher pregnancy rate than those having no one pray for them.

• Avoid herbs during conception and pregnancy unless you specifically talk with your doctor about them (9.1% of pregnant women report using herbal supplements, 13.3% report using CAM.)

• One study raised the question about St. John’s Wort, Echinacea and ginkgo being harmful to sperm.

• Herbs such as St. John’s Wort, gingko, feverfew and ginseng may increase your anesthesia risk during surgery. Discuss any and all with your anesthesiologist.

• Smoking reduces your chances of conception and if you smoke during pregnancy your baby will likely be smaller and more likely to become a smoker.

• If you are overweight, losing as little as 10 pounds may increase your chances of conceiving. It may also lower your blood pressure and lower your risk for diabetes.

Machelle Seibel, M.D. is a reproductive endocrinologist in practice at Caritas Norwood Hospital and a Professor of Clinical Obstetrics and Gynecology at the University of Massachusetts in Worcester, MA.

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