Welcome to your April issue of Connections, The American Fertility Association’s monthly e-newsletter. In this issue, you’ll find:

1. Message from the Executive Director
2. Save the Date! Sunday, May 7, 2006 - Family Matters Annual Conference
3. TTC: Trying to Conceive?
4. Fertility Dream races and walks
5. Adoption, Egg Donation: Is Either – or Both – Right for You?
6. Advocacy Alert
7. Illuminations in Los Angeles
8. Free Teleconference Coaching Groups:
   — Stress Management during the Infertility Process
   — Considering Adoption
   — Confident Decision Making: Navigating the Fertility Maze
   — When Enough is Enough
9. Connections Online Educational Sessions

A Message from the Executive Director

Pamela Madsen

Dear Friend, If you’re trying to have a child, if you’re facing fertility challenges, or if you’d like to adopt, you believe – as The American Fertility Association does – that family matters. Please join us on Sunday, May 7 at the Grand Hyatt New York Hotel, on Park Avenue and 42nd Street in New York City. Click here for more details and to register. At our Family Matters conference, you’ll find a welcoming and supportive setting, where you can attend 40 lectures and workshops and speak one-on-one with top doctors and other healthcare professionals, who will answer your questions and offer insights and perspectives on range of topics, such as in vitro fertilization (IVF), female and male factor infertility, PCOS, ovum donation, PGD, blastocyst transfer, complementary/ alternative therapies, international and domestic adoption, and so much more. The AFA will also host an exhibit hall featuring fertility clinics, egg donor and surrogacy programs, urologists, alternative therapy programs, pharmacies and pharmaceutical companies, adoption agencies, and attorneys. You will have the opportunity to meet these professionals face to face, ask them your questions, and learn about their services. I look forward to seeing you on Sunday, May 7. For more information or to register, 24 hours a day, 7 days a week, call 888-917-4777 or click here. Warm Regards, Pamela

Save the Date!

Sunday, May 7, 2006, 7:00 am - 5:45 pm, The New York Grand Hyatt Hotel

Family Matters is largest annual U.S. fertility and adoption educational event, featuring over 45 workshops, 90 world-renowned speakers and over 60 exhibitors. Please click here to for more information or register.

Register now for Family Matters, The American Fertility Association's National Fertility and Adoption Conference, on May 7th at the Grand Hyatt Hotel in New York City. Meet leading physicians as well as top-notch heath care, legal and adoption professionals; attend workshops and get support. Click here to register.

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TTC: Trying to Conceive?
The insiders guide to conception including: Misconceptions, myths, legends and some practical advice.

By Serena H. Chen, MD
Director, Reproductive Medicine, Saint Barnabas Medical Center
Director, Ovum Donation at Institute for Reproductive Medicine and Science

It is estimated that of the millions of people attempting to conceive in the United States, only about 50% of those who feel that they are having trouble conceiving will seek help or advice. We know that the stresses of infertility are of a similar magnitude to the stress that people experience with the death of a family member. However, even in our modern, no-holds-barred society, infertility sometimes seems to carry a greater stigma than death. Rates of anxiety, depression and marital problems are significantly higher in the infertile population than they are in the fertile population. Even once a couple conceives, people who have experienced infertility will still have higher rates of anxiety, depression and less confidence in their parenting skills than parents who have not experienced infertility. In my experience as a reproductive endocrinologist who has treated thousands of infertile people, information and advice about the process of trying to conceive can go a long way towards relieving some of the stress and anxiety.

The title of this article is the popular internet message board abbreviation: TTC or Trying to Conceive. The fact that so many people today turn to the internet for advice, information and comfort about such an intimate and potentially devastating problem is a reflection of the simultaneous hunger for communication and a strong need for privacy. Although the internet is a powerful generator of information, it can also be a forceful perpetrator of misinformation. Despite the fact that people attempting to conceive today have access to more information than ever, many people still feel very much in the dark about how to make a baby. The problem with much of this information is that it generates needless anxiety and does not improve a person’s chance to conceive. Misinformation, combined with lack of success lead to feelings of loss of control, increased anxiety and then depression. This article will attempt to address some of the more common misconceptions about conception, set the record straight and relieve a little bit of the anxiety of TTC.

BOXERS or BRIEFS?
While physicians who specialize in infertility frown upon soaking the testicles in hot water, this does not mean that everything that might generate some heat is a bad thing. This is typical of many myths – an exaggeration of truth. The testicles hang away from the body in the scrotum to allow them to remain at a temperature a couple of degrees below normal core body temperature. For some reason, this seems to be more optimal for sperm production. Submersion of the testicles in a hot Jacuzzi can rapidly increase their temperature and can have adverse effects upon sperm production, but does this mean that tight underwear is bad and loose underwear is good? In the Journal of Urology in 1988, two researchers – R. Munkelwitz and B.R. Gilbert studied scrotal, core and skin temperatures of 97 males complaining of infertility. Males were divided into two groups – those who wore briefs and those who wore boxers – and semen analyses were performed on all. No differences were noted between the two groups in prevalence of abnormal semen analyses and no differences were noted between the two groups in scrotal temperature. So, gentlemen, you can wear what you want, but please stay out of the hot tub while you are trying to conceive.

REALLY TRYING
“ Trying to conceive” means that you stop using contraception. Stop the birth control pills, stop the condoms, stop the spermicidal gel, don’t use the diaphragm, don’t withdraw prior to ejaculation, have sex when you feel like it – not just when it is “safe”. Trying to conceive should be easier than trying NOT to conceive, but for many couples, just the opposite is true: morning after morning taking the temperature; using the fertility monitor; peeing on a stick; having sex at times when you do not feel like it; more often than you feel like it and not having sex even if you do feel like it; using particular sexual positions because you were told they are associated with a higher chance of pregnancy; lying still with your hips in the air for prolonged periods of time after sex to keep the sperm in, checking your cervical mucus, worrying about your cervical mucus, etc. Trying to do the right thing, the best thing, the thing that helped your friend or your friend’s friend conceive can drive you crazy. People who are trying to conceive spend hours each week worrying about these details and yet, all they are doing is driving themselves and their partner crazy. There is no data that any of this is helpful. The fertile period in a typical 28 day cycle is cycle day 10 to 16. If you have intercourse twice during that period of time, that will result in the same pregnancy rate as if you have intercourse 10 times during that period of time. When researchers looked at how often and when couples have intercourse, they found that couples have intercourse more often when they are more fertile and less often when they are less fertile. In other words, external signals about when and how often to have sex are no better than just having sex when you feel like it. Temperature charts and fertility monitors do not improve your chances of conception, are disruptive, time consuming and therefore increase stress. Twenty percent of normally ovulating women, do not show a “normal” biphasic temperature chart. Throw out the thermometer.

SEX: WHO’S ON TOP?
The position of intercourse should not really matter as long as the male ejaculates into the vagina. The good sperm move very quickly into the cervix and the liquid that leaks out of the vagina after intercourse is mostly liquid, and some dead or immotile sperm. Holding onto this liquid for prolonged periods of time will not increase your chances of pregnancy. So if you feel like lying down after sex, then do it. If not, don’t. You will not affect your chances of conception either way.

CERVICAL MUCUS
Cervical mucus is often a source of stress for infertile couples. Is there enough? Is it the right time? What is the right way to check the mucus? Should I take cough syrup or do other things to make my cervical mucus better? The bottom line is that cervical mucus can be abnormal in fertile women and normal in infertile women. It is not a good predictor of fertility and is not a reliable method of timing intercourse for couples attempting to conceive. Again, have intercourse when you feel like it. If you never feel like having sex, seek help. But do not drive yourself crazy at home worrying about cervical mucus because this will not help you to conceive.

FOOD
There are no magic bullets when it comes to food. All women who are trying to conceive should make sure that they are getting 100% of the RDA (recommended daily allowance) for folic acid or folate. This B vitamin can lower the risk for some serious birth defects known as Neural Tube Defects, or Spina Bifida. 100% of the RDA is 400 micrograms of folic acid or 0.4 milligrams. Most multivitamins contain this amount of folate. Do not take extra vitamins as some common vitamin supplements, such as vitamin A and beta carotene can actually cause birth defects if taken in amounts greater than the RDA. If you have questions, discuss the details with your gynecologist.

AIM FOR A HEALTHY WEIGHT
Overweight and obesity are extremely common in this country. Unfortunately this can lead to significantly higher rates of infertility, miscarriage and birth defects. Underweight is less common but can also have adverse effects upon fertility. Do not suffer in silence. Talk with your doctor. See a professional nutritionist. Get some help! Losing weight is not easy and being overweight is truly a medical problem. If you had cancer, you would not try to battle it on your own.

JUST RELAX?
You have probably heard these two words many, many times. There is no scientific evidence to support this advice. You cannot make yourself infertile by being stressed out and you cannot solve your problem by “just relaxing”. While the people who tell you to “just relax” are trying to be helpful, this advice can often become destructive rather than constructive. People who are having trouble conceiving often blame themselves for their problem. By telling someone who is infertile to “just relax”, you are, in some way, blaming them for their own problem.

On the other hand, while stress does not cause infertility, the opposite is true: infertility does cause stress. Stress management is often a good idea and especially for those having trouble conceiving. Studies have demonstrated that couples that undergo proactive stress management may have higher rates of conception than couples that only seek help on an emergent basis. What is meant by stress management? This has to be individualized. Formal individual, couples or group psychotherapy is one method. Acupuncture (no herbs), massage therapy, yoga, meditation, may all help one manage stress. Unloading your plate a little while you are trying to conceive can sometimes be beneficial. On the other hand, putting your life on hold while trying to conceive may lead to more stress. Each person must figure out what works for them. The important thing is to realize that infertility can cause enormous amounts of stress and to be proactive about attempting to reduce stress.

PRECONCEPTION HEALTH AND LIFESYLE: What to do, what not to do
Just say no to cigarettes, drugs and alcohol. Cigarette smoke is so toxic to sperm and eggs that even regular exposure to second hand smoke can lead to significantly higher rates of male and female infertility, miscarriages and birth defects. Drugs and alcohol can interfere with normal hormonal function and can increase the rates of serious birth defects.

In general, discuss the medications that you are on with your gynecologist and with the doctor who prescribed the drugs. People trying to conceive should still be able to take medication, if it is needed, but some alternatives may be better than others. In general, herbal remedies should be avoided. Many people take herbal remedies on a regular basis. Agents such as Echinacea, Ginkgo Biloba, St John’s Wort, Ginseng and DHA may have some beneficial health effects but some studies have demonstrated negative effects upon sperm and eggs. In addition, since these types of agents are not regulated by the FDA, the consumer cannot be certain of the accuracy of the labeling.

Some agents used to enhance athletic performance contain anabolic or other types of steroids. These can have significant adverse effects upon the heart and liver and can cause the testicles to completely stop producing sperm. In theory, once the agents are stopped, sperm production should resume, but some men never recover normal function.

Aspirin and related compounds such as Advil, Alleve, Ibuprofen, Motrin can interfere with release of the egg if taken near the middle of the cycle. Tylenol, if taken as directed, does not have this effect and usually can be taken safely.

Women who are trying to conceive should limit caffeine intake to about 50 milligrams a day. This is about 6 ounces of brewed coffee or 2 cups of tea or 2 sodas. High levels of caffeine intake have been associated with infertility, miscarriage and pregnancy complications.

Men with high blood pressure should be aware that a particular group of anti-hypertensive medications – calcium channel blockers – can cause infertility. These agents block the calcium channels located in the head of the sperm and can prevent the sperm from fertilizing the egg. If your doctor feels that there is a reasonable alternative to calcium channel blockers, then it may be worthwhile to consider a change. For men who must use a calcium channel blocker, IVF with ICSI (in vitro fertilization with IntraCytoplasmic Sperm Injection) can be used with great success.

There may be other issues associated with other drugs. In general, anyone with a chronic health condition may have to make adjustments in their medications once they decide to conceive. In addition, the condition may worsen with pregnancy, or the pregnancy may be at risk due to the condition. Speak with your doctor and your gynecologist about planning for a healthy pregnancy in light of your condition or your partner’s condition.

INFERTILITY 9-1-1
How do you know when it is time to seek professional help? Timing is very important. The older a person is, the more likely they are to have a problem conceiving a healthy pregnancy. This is especially true for women. If a woman is under 35 and has had unprotected intercourse for 1 year or more, she should have a full infertility evaluation by her gynecologist or a reproductive endocrinologist. If a woman is over 35, the evaluation should be performed after 6 months of unprotected intercourse. After age 40, infertility is extremely common and an evaluation with a specialist should be considered immediately.

Other people should consider evaluation sooner rather than later. Anyone, male or female, with a chronic medical condition should speak with their doctor before attempting to conceive. Women who do not have a period every month are probably not ovulating and will need medical help in order to conceive. If you have a family or personal history of endometriosis, you should seek evaluation early. Women who have had major abdominal or pelvic surgery in the past, men with a history of groin or reproductive tract surgery are at increased risk for infertility.

Do not be afraid to let your doctor know that you are trying to conceive. She or he may have some helpful advice and reassurance for you. If you have concerns that your doctor does not take seriously, it is not unreasonable to see advice from a specialist – a board-certified reproductive endocrinologist.

CONCLUSION
Trying to conceive should not be an excessively stressful process. If it is, it may be time to seek some expert help and advice. Hopefully some of the myth-busting in this article will relieve some of the stress. If not, please do not suffer in silence. Seek some professional help. Visit our message board, open 24-7 at www.sbivf.com. Contact the folks at the AFA – www.theafa.org. Call your doctor. Very best wishes and best of luck,

Serena H. Chen, MD
Director, Reproductive Medicine, Saint Barnabas Medical Center
Director, Ovum Donation at Institute for Reproductive Medicine and Science
94 Old Short Hills Road
Suite 403 East
Livingston, NJ 07039
www.serenachen.yourmd.com
www.sbivf.com
serenac@sbivf.com
973 322 2682

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Fertility Dream

Join the American Fertility Association at the Fertility Dream races/walks in your area.

The Fertility Dream is breaking new ground, promoting health and a sense of community within the fertility community and our supporters nationwide. Our 2006 goal is to build fertility awareness and raise research and advocacy funds. Remember, "Together we can do what we can't do alone.”

Anyone can participate in the Fertility Dream races and walks, no matter you age or fitness level: fitness enthusiast elite runners, and even those who have never participated in a race before. The AFA can help find a pace that is right for you. Click here for more information and to register.

Support the Fertility Dream 2006 races/walks near you:

Anyone raising $5,000 or more in pledges will receive an all-expense paid trip to a Fertility Dream race: round-trip airfare, two nights lodging, meals and race entry. Please visit the American Fertility Association web site for details or call 888 917-3777 to register or donate.

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“Why don’t you just adopt?”    “Why don’t you just use donor eggs?”

As a family building counselor, I see many couples plagued by these questions. Family members tend to say, “JUST adopt.” Physicians often lean toward “JUST” using donor eggs. Either way, that little four letter word—JUST—is painful. It minimizes the enormity of the decision individuals and couples face as they prepare to move beyond fertility treatments to an alternative path to parenthood--in this instance, to adoption or pregnancy through donated gametes.

If you find yourself at – or nearing – the end of a long journey through IUI and IVF, you may be feeling overwhelmed. In addition to the sadness and disappointment you feel, there are the questions that lie ahead: “Which, if any other parenting option, might work for us?” “How do we know how to proceed?” “What do we do once we have made a decision?" These are complex questions that I spend hours exploring with couples. However, here are some of the “basics” you might want to consider as you look ahead.

Let’s look at the options, beginning with Adoption. On the positive side, adoption will work. It will place a child in your home in a reasonable and sometimes, predictable, period of time (usually about a year). In addition, the Federal Tax Credit of $10,400 and wide ranging Adoption Employee benefits (usually about $5000) makes adoption affordable for many. With adoption, you pay for a “sure thing,” while with egg donation; you pay for a “chance.”

Another reason to choose adoption is that it offers you the ability to begin with a healthy child, something that no pregnancy can guarantee. Adoption is also well regarded in our society, viewed as socially, morally and politically correct and for some people, an alternative “first choice” path to parenthood. No one dreams of one day growing up to become a mom or dad through egg donation, but many fantasize about adoption—especially from overseas. There have been some ethical questions associated with adoption practice in some countries, but most of them have been addressed through The Hague Convention (international laws on adoption) and other policy making groups. Egg donation, by contrast, is a new frontier, with complex ethical questions yet to be addressed.

Adoption sounds pretty positive, doesn’t it? Indeed, it offers you a lot. Why then, do people consider egg donation? When we flip things over, you will see that for many couples, there are compelling reasons to attempt pregnancy with donated eggs.

Egg donation offers you the opportunity to share a pregnancy. Couples can experience all the joy of watching the expectant mom grow large with child, they can feel the baby kick together and can make decisions about prenatal and obstetrical care. Concerns about what a child is exposed to in-utero in terms of nutrition, alcohol and drugs and negative emotions all abate when would-be parents are able to gestate their babies. Egg donation also offers couples the opportunity to have a child that is genetically and genealogically rooted in the dad’s family and for those women with a sister who offers to donate, a child connected to both families. Unlike adoption, egg donation does not involve the transfer of a child from one family to another and the attendant losses. Rather, it offers people the chance to be “present at the creation”—the only two people who ever intended to parent the child.

“ How do we decide?” You ask. “What if we don’t agree with each other?” Again, these are complex questions and ones best dealt with in conversation with a trusted counselor. However, here are some things you should think about:

1. What are our emotional, financial and physical reserves? Undoubtedly you have been through a lot. Although there are some people who, either because of age or a cancer diagnosis or surgery are catapulted into the worlds of egg donation and adoption, many arrive in this strange new terrain after a long journey. That journey usually costs a great deal in terms of time, money and emotional and physical resources. As you contemplate moving forward, it may help you to do an inventory—look at what it will cost you. For example, if you and your partner are 45 years old and concerned about being older parents, Chinese adoption, which takes about a year and offers you a year old baby, stops the clock now. By contrast, egg donation may lead to further disappointment, including a miscarriage or even a late loss. Can you afford to postpone parenthood another two years or so? And what will it all cost financially? Have you depleted your savings while pursuing IVF? How much remains for other options?

2. How do we feel about pregnancy? For some people, pregnancy is an essential ingredient in parenthood. As one man put it, “I always assumed we would have a ‘countdown’ to parenthood.” Others discover when they examine their feelings, that pregnancy is not so important to them. Some say, “Pregnancy lasts nine months and we seek an experience that lasts a lifetime.”

3. Your child’s story. Your child will enter your family with a “story” different from most. Perhaps he will be adopted domestically and you will have met his birthparents. Or she may come from another country and culture and most likely, you will have scanty information about her birthparents. Perhaps your twins will be born through donated eggs, either from a sister or perhaps, from someone you meet through an egg donor program. Regardless of which path you choose, what is most important is that you feel happy, proud and confident in the path you take. If there is some part of the story that you can’t live with (e.g. a child from China who was abandoned or a child conceived from donated eggs from a “serial donor”), you should not pursue this path to parenthood. Remember that you will want to be able to joyfully tell your child or children the wonderful story about how all of you became a family.

Ellen S. Glazer, LICSW is a family building counselor and consultant in Newton, Massachusetts and the co-author of Having Your Baby through Egg Donation (with Evelina Sterling) and Choosing Assisted Reproduction (with Susan Cooper) and the author of Experiencing Infertility: Stories to Inform and Inspire and The Long Awaited Stork: A Guide to Parenting after Infertility. Ellen can be reached at EllenGlazer@verizon.net.

Online Education Session Schedule—April – May 2006