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Path To Fertility Blogger Lisa Rosenthal  

Lisa Rosenthal has over twenty-five years of experience in the fertility field, including her current roles as Coordinator of Professional and Patient Communications for RMACT and teacher and founder of Fertile Yoga, a class designed to support, comfort and enhance men and women's sense of self. Her experience also includes working with RESOLVE: The National Infertility Association and The American Fertility Association, where she was Educational Coordinator, Conference Director and Assistant Executive Director

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Sperm Bank Mix Up and There's a Beautiful Baby Involved

  
  
  

The Sperm Bank Mix Up

spermI was having a lovely day. Really, I was. Productive, busy, interesting, fun. Great meeting at work with co-workers that I respect and of whom I am fond. Great Fertile Yoga and Prenatal Yoga class. All around good, busy day.

 

Then I started to hear whispers. Something about a sperm bank mix up. Something about a baby being different in a way that they were not prepared for by their parent. Immediately, faces popped into my mind. Patients, especially our single moms to be (SMTB), who are currently making important choices about donor sperm and donor sperm banks. Choices that were hard to settle into, that required a lot of thought and then a small leap of faith. Following closely behind those beautiful women came the faces of our RMACT third party reproduction team. Consternation was likely the emotion felt as the damage control that needs to be done has suddenly increased their already heavy work day. Damage control because of course there are going to be more questions, more levels of questions and a much higher level of anxiety than there was three days ago.

 

I have read very little about this so far. Seen a few pictures. Heard a few fairly hysterical headlines and accusations. I’m sure it’s going to get very ugly, very fast. I’m sure it will be polarizing and that each side will feel and know that the other point of view is just plain wrong.

 

The blame game will be in full force, I suspect, by later today.

 

I have to say, I just hate this. I so very rarely use that word. It feels ugly and harsh in my mouth and it looks the same way when I write it.

 

Still, I hate this.

 

Here’s why.

 

First and foremost, there is a beautiful baby out there, getting lots and lots and lots of attention that she never needed, wanted, or asked for. It’s not the kind of attention that any baby needs. It’s not nurturing or loving or delighted.

 

Please understand I am not blaming the parent or parents here. The second reason that I hate this is because regardless of how they feel about their baby (I hope so much that they love her), they probably feel betrayed. They were promised one thing and they were let down. They put their hopes and dreams into a little basket and handed it over, with a bunch of money, and thought they would receive what they paid for; that’s a reasonable expectation. It really is. It’s a reasonable expectation to have a legal and financial agreement that is upheld responsibly. So, please, let’s not blame the parent and start throwing mud about whether they love their baby or not. That’s not really the point.

 

I’m not blaming the sperm agency. Yet. The horrible fact is that no matter how incredibly good, how protected, how safe any protocol  is, there is rarely 100% success. In other words, mistakes are made in most places of business, even if extraordinarily rarely. Notice the use of words please. Incredibly and extraordinarily. To put this in perspective, we would need to know how many vials of donor sperm are sold and used in the USA. And I looked, very carefully for that information. I tried numerous different searches, including the CDC (Centers for Disease Control and Prevention), ASRM (American Society for Reproductive Medicine) and SART (Society for Assisted Reproductive Technology), and I couldn’t find it. So I can’t actually tell you that this only happens 10% of the time. Or 1% of the time. Or even .00% of the time.

About the Disclosure of Medical Errors

I did find this interesting link, titled “Disclosure of medical errors involving gametes and embryos, which is quite interesting and which is written by the Ethics Committee of the ASRM, (our own Andrea Braverman, PhD, was one of the authors). ASRM’s mission statement is, “ASRM is a multidisciplinary organization dedicated to the advancement of the science and practice of reproductive medicine. The Society accomplishes its mission through the pursuit of excellence in education and research and through advocacy on behalf of patients, physicians, and affiliated health care providers. The Society is committed to facilitating and sponsoring educational activities for the lay public and continuing medical education activities for professionals who are engaged in the practice of and research in reproductive medicine.”

 

At the very least, this paper, among many others helped me simmer down and reminded me that this is a medical field that looks at things very seriously. Reproductive medicine has two major groups that help regulate standards of practice, ASRM and SART. SART’s mission statement, “SART is the primary organization of professionals dedicated to the practice of assisted reproductive technologies (ART) in the United States. ART includes the practice of In Vitro Fertilization (IVF). The mission of our organization is to set up and help maintain the standards for ART in an effort to better serve our members and our patients.”

 

This is an arm of medicine that takes its responsibilities about standard of care very seriously. Thank goodness.

 

Donor Sperm - What Are the Risks?

 

OK, back on track here. No matter how infrequently, how micro-tiny that possibility of donor sperm mix up or other failure is, we don’t want it to happen. We don’t want it to happen to our friends, family, our colleagues, ourselves. We don’t want it to happen, ever.

 

We hate when it happens. It brings up all of our fears that next time? It will happen to us. Of course it brings up those fears. It is a frequently asked question from most people who are looking to become pregnant via sperm donation, even without this issue in the media.  “How do I know that the sperm I am purchasing is what I am being told it is?”

 

Of course this brings up our fear. And our outrage. And out comes the blame game.

 

Blame someone. Anyone. Everyone.

 

That will ensure that it never happens again.

 

Uh. No, it actually won’t. Unfortunately, not.

 

So while you’re reading about all this today and trying not to freak out that this could happen to you, please know how incredibly small the chances are that it would or could. I promise that I will have some actual numbers for you by Monday morning.

 

Meanwhile, to all involved and all those who feel the need to comment, please just have some compassion. Please try to avoid playing the blame game.

 

There is a beautiful baby out there who has no reason to be dragged into that kind of ugliness. If for nothing else, let’s keep the ugliness to a minimum please.

 

 

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SuperSperm, Guilt and Unexplained Infertility

  
  
  

SuperSperm - A New Phrase Coined at Ladies Night In

supersperm drawing by lisa rosenthalA new phrase coined last night at Ladies Night In. Said with a sense of humor. With a sense of irony. With a definite sense of affection.

 

It’s said by the men in some of our lives when they find out their sperm count is just fine. Better than fine. Super even. I wonder if any semen analysis count has ever really said that. Super sperm.

 

How come these normally rather sensitive men, who really love us don’t get it?

 

How come they don’t get when they proudly announce they are in possession of SuperSperm, that we then feel the finger pointing right at us about whose fault it is that we are not conceiving? We know they aren’t necessarily saying that. But if they have SuperSperm, then whose fault is it?

 

It’s not that we’re not happy for them or that we wished that the results were different. It’s just that if they’re ok, then even if a fertility doctor can’t find the problem with us, we still know it’s us. Because it’s not them. They are in possession of SuperSperm.

 

I kind of like it. SuperSperm.

 

Shouldn’t we have an equivalent for our eggs? A few ideas:

 

  1. Wonder eggs
  2. Eggs Supreme
  3. Excellent Egg

 

I don’t really think any of them have the same ring that SuperSperm has, maybe that’s why many men have come up with that phrase independently of one another. They are rightly relieved and even proud to know that their fertility is intact. We’re happy for them. Really, we are.

Unexplained Infertility and Relief from Guilt

We just still don’t want it to be us. And especially with unexplained infertility, we really don’t know what tiny, little piece of ours doesn’t quite fit with some tiny, little, indecipherable piece of theirs. We don’t know who it is exactly when all the testing comes back that everything is fine. SuperSperm and Excellent Egg still sometimes don’t create a pregnancy or a baby that emerges nine months later.

 

Very frustrating. Yes, maybe it seems like there should be relief in knowing that nothing major is wrong. And there is. We don’t want anything to be wrong, yet with no answers as to what’s wrong, there’s a feeling that there’s less that can be done because there’s nothing to fix.

 

Is it comforting that with an IVF cycle so many potential small problems are bypassed? That problems that can’t be detected won’t matter because the cycle is being handled, one step at a time?

 

I don’t know. Maybe all this is comforting in some moments and not in others. Maybe we can be happy when SuperSperm is elated that there’s no detectable problem with him without immediately blaming ourselves.

 

It’s great when there’s one less problem to worry about. No doubt about it.

 

I just wish it didn’t immediately make us point the finger at ourselves.

 

The compassion we would show our partners if SuperSperm turned out to be SubFertileSperm could be the same compassion we could show ourselves if the problem does lie with us.

 

Couldn’t it?

 

If we were half as kind and considerate to ourselves as we are to our partners, friends, colleagues and family members, we would be far better off.

 

Don’t you deserve that? Don’t we all deserve that?

 

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Male Infertility Facts - American Society for Reproductive Medicine

  
  
  

Male Infertility- ASRM Fact Sheet

PATIENT FACT SHEET from ASRM (American Society for Reproductive Medicine)Infertility Specialist Examining Sperm

 

Sperm Shape (Morphology): Does It Affect Fertility?


How do doctors decide if a man might have a fertility
problem?

 

For many years, experts have focused on semen analysis, but research studies show that the number of sperm (count) and the movement of sperm (motility) do not always predict fertility very well by themselves.

 

It may also be useful to look at the shape of the sperm (morphology),
which is also one of the important parts of the semen evaluation.
An updated way of determining sperm shape is called the
Kruger's strict morphology method. Kruger morphology is
a useful system that helps doctors determine if a sperm is
normally shaped or not. It was originally used to predict
the success of in vitro fertilization (IVF), a fertility treatment
in which the sperm are mixed with the woman's egg
in a laboratory.

 

More recently, it has been used to tell if
intracytoplasmic sperm injection (ICSI) is a necessary
treatment. ICSI is a procedure that helps a sperm fertilize
an egg by injecting a single sperm directly into the center
of the egg.

 

Even though it is used for these purposes, not all physicians
and scientists are sure that strict morphology method alone
predicts success with IVF or whether it indicates the need
for ICSI.


Characteristics of normal sperm


A normal sperm has:


• a smooth, oval shaped head that is 5-6 micrometers long
and 2.5-3.5 micrometers around (less than the size of a
needle point)

• a well defined cap (acrosome) that covers 40% to 70% of
the sperm head

• no visible defect of neck, midpiece, or tail

• no fluid droplets in the sperm head that are bigger than
one-half of the sperm head size



Intercourse versus artificial insemination

 


For patients with fertility problems, sperm morphology may have an effect on your ability to achieve a pregnancy. If the strict sperm morphology is more than 4%, there may be little difference in success whether timed intercourse or artificial insemination is utilized.


In vitro fertilization

 

A successful pregnancy using IVF depends on many of
factors: how many eggs are fertilized, whether the fertilized
eggs grow into embryos, and whether the embryo implants
in the woman's uterus. When strict morphology is 4% or
less, eggs may have a better chance of fertilization with the
use of ICSI.

 

Frequently asked questions

 

If an abnormally shaped sperm fertilizes the egg, does
that mean that my child will have genetic abnormalities?

 

There's no scientific link between the shape of a sperm and
its chromosomal content. Once the sperm penetrates the
egg, fertilization has a good chance of taking place.
However, there may be some male offspring who will
inherit the same type of morphology abnormalities.
Whether routine investigation of Y-chromosome abnormalities
should be initiated when low morphology is noted is
controversial.

 

Are there any substances that I can reduce or eliminate
exposure to (e.g., alcohol, tobacco, caffeine) in order to
improve the shape of my sperm?


Studies haven't shown a clear link between abnormal sperm
shape and these factors, but it's a good idea to try to eliminate
use of tobacco and recreational drugs and limit your
consumption of alcohol. These substances reduce sperm
production and function in several ways. They may hurt
sperm DNA (material that carries your genes) quality.
Studies have not shown a clear link between caffeine consumption
and changes in sperm shape.

 


Are there any dietary supplements or vitamins that I
can take to improve morphology?


Dietary supplements or vitamins have not been clearly
shown to improve sperm morphology. Some specialists do
recommend that you take a daily multivitamin to improve a
number of body functions, including reproductive health.

Created 2008
The American Society for Reproductive Medicine grants permission to photocopy this fact sheet and distribute it to patients.

Male Infertility Section on Fertility Authority- Responsibility, Blame and Fault

  
  
  

Male Infertility- Healthy Sperm Described

I was spending some time on the Fertility Authority website earlier and was pleased to find a robust section on male factor fertility. Always appreciate a place where you know you can find solid, reliable information.

 

Seeing a section just for men, made me think about blame and fault and responsibility and the difference between all of those things. I don't know why, it just did.

 

Very often infertility is not simply a problem with the women or the man, but a problem here or there with both of them. I wondered if I were with a different partner whether either of us would have had problems becoming parents.

 

Even with a significant problem on one side or the other, with a different partner, outcomes can be drastically different.

 

That's why infertility, when there's a heterosexual partner involved, is considered a couple's problem. That's why a fertility specialist looks carefully at both partners involved.

 

For men, that starts with a semen analysis. It can explain a lot. How many sperm are present. How healthy they are, in terms of appearance and in terms of movement.

 

Since sperm are produced all the time, sometimes this test needs to be repeated to see if there is an improvement in semen production and quality. Sperm can be affected greatly by environmental factors, including eating, drinking, exercise and sleep.

 

This is vastly different than the state of a woman's eggs. We women are born with all the eggs that we will ever have. In fact, our eggs are created while we are in the womb of our mother. While our general health and reproductive health is greatly affected by the same environmental factors as our men, our egg quality is unlikely to be significantly affected in the same way.

 

Responsibility, blame and fault.

 

I felt guilty about being infertile. We had unexplained infertility. It was not even necessarily more my fault than his.

 

I still felt guilty.

 

Maybe it's just part of the human condition to feel guilty. Or the female condition.

 

I don't think my husband felt guilty. I know that he felt badly, very badly, about our inability to become parents. But he didn't talk about guilt or shame. He did what he had to do. With very little complaining.

 

There were moments when I blamed myself. There were moments when I blamed my husband. There were moments that I blamed the doctor.

 

Mainly though, I blamed myself. Mainly I saw this as my fault, even with very little medical information backing that belief up.

 

Responsibility? Hopefully we are all taking responsibility.

 

Showing up for the doctors appointments. Folllowing through on testing. Taking good care of ourselves even when it means giving certain pleasures up for a while.

 

Yeah, I was glad to see this part of Fertility Authority's website. A place just for men.

 

We all need a place to go to get answers, to ask questions, to feel understood.

 

 

 

Infertility and Sperm at Your Fertility Center

  
  
  

PathtoFertility Blog- Sperm and infertility treatment

Straight from the pages of the Reproductive Medicine Associates of CT website, written by our board certified reproductive endocrinologists and other highly trained medical staff:


For men, fertility pretty much hinges on having healthy sperm, so semen analysis is the most important test for the male half of a couple that is experiencing fertility issues. It is an inexpensive test that should be done early in any infertility evaluation.

 

Usually two or more semen samples, taken at separate intervals, are analyzed because it’s normal for sperm counts to fluctuate. The analysis requires abstinence for two to three days. The specimen is collected directly into a clean container.

 

The semen sample is examined in a laboratory for quantity, color and the presence of infections or blood. Then a detailed sperm analysis is done to determine the number of sperm present and any abnormalities in their size, shape and structure (morphology) and movement (motility).

 

Low sperm count is also called oligospermia. Theoretically, it only takes one sperm to fertilize an egg, but the odds of one sperm reaching the egg are very low. Consequently, a low sperm count reduces a man’s chances of fathering a child. An urologist can suggest medical or surgical treatments to increase those odds, and men are advised to avoid smoking, excessive drinking and illegal drugs, maintain a healthy weight, and stay out of sources of excessive heat (like tubs and saunas) that can temporarily reduce sperm count.

 

Both morphology and motility are factors in male infertility because they impair the sperm’s ability to reach and fertilize an egg. Some causes of abnormal morphology are infections, high fever, congenital testicular abnormalities, varicocele (enlarged veins in the scrotum) and illicit drug use. Again, an urologist can recommend treatments that can improve morphology, including treating an infection, varicocele repair and hormone replacement. Pregnancy may still be possible through intrauterine insemination or in vitro fertilization.

 

If sperm abnormalities are detected, the semen analysis can be repeated in four to six weeks to determine if they are permanent or temporary. If the sperm analysis is normal, your doctor will probably recommend a thorough testing of your female partner before considering additional male infertility tests.

 

While there's much more that we know about sperm, these are the basics. Want to know more? Please let us know and we will answer those questions right here!

Infertility Problems? Gentlemen, Get Your Laptops Off Your Laps!

  
  
  

describe the image
I’m just going to cut to the chase. If you’re having trouble conceiving and you’re a man, often there is little that you can do. Even if it’s male factor infertility (problems in the male reproductive system), often it is still the woman that will need to be stimulated. To get the shots, go for bloodwork, have ultrasounds done, embryo retrieval (if treatment includes IVF- in vitro fertilization) and embryo transfer. Certainly there are men out there who are enduring surgeries and procedures, I don’t mean to suggest otherwise. However there is only so much that needs to go on with the male in the equation; we need to get the sperm, essentially. Even if it’s just one sperm. After that, what goes on is in the woman’s court.

And what do we give up, we women? Caffeine (not always), intense exercise, alcohol, recreational drugs, certain types of fish. And so on. Many of us give up nitrates (hot dogs, other cured meats), sushi, baby showers (too painful), vacations, etc. The list is as long as my arm and just as personal as the woman involved.

Read the article below about male factor infertility. Is it the best research out there? Not sure about that from what I was able to read. Not sure how the well documented the research is or how many men were studied. The research is from a well known infertility program in Argentina and I’m sure with further digging, more information could be found. I will look more.

Meanwhile, here is what’s being reported. I jumped to the conclusions as that was my biggest concern. It’s Monday after all, and I’m into the bottom line this morning!

A vital bit of information on why having your lap top on your lap is not the greatest idea for our men.

The direction of this research was provided by Conrado Avendaño, a biochemist specializing in Andrology. He was accompanied by a team of Ariela Mata, a specialist in Reproductive Biology and Chief of the Laboratory of Embryology, Cesar Sanchez Sarmiento, medical director, Andrew Juarez Villanueva, head of Gynecologic Endoscopy and Valeria Martinez, laboratory specializing in Andrology and Embryology.

Results. There are three factors that were examined to study the sperm quality: if the sperm were alive, if they moved and if the sperm DNA was intact. “The study showed that exposure to these devices did not cause the death of sperm,” said Avendano.

Meanwhile, the analysis of mobility, it was found that in the group exposed to WiFi radiation, there was less sperm that are moving faster and an increase in the amount of stationary sperm.

“This is a sobering if you take into account that the sperm are moving progressively to finally be able to reach the egg and fertilize it, and then form an embryo,” said César Sánchez Sarmiento.

Finally in terms of sperm DNA integrity, was found through a study known as “Tunnel”, which both groups of spermatozoa had a significant difference. “In the fraction exposed to radiation had a significant increase in sperm with fragmented DNA (broken),” said Avendano. Sánchez Sarmiento argues that the importance of this aspect is that reproductive medicine has proven that “one of the causes of changes in fertilization and embryonic development is therefore the break in the DNA molecules of the sperm.”

Ok, I looked further. Here's some information from the University of Stonybrook, echoing what is posted above:

Men and teenage boys should think twice before placing a laptop computer on their laps as they can lower sperm counts and reduce your chances of fathering a child. If you are male, thinking about having a family, or even a decade away from planning a family, you may be better off placing your laptop on a desk.

A concrete, solid suggestion is offered. Gentlemen, get your laptops off your laps and onto a desk.

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