Path to Fertility Questions and Comments
I have a problem that is driving me to distraction. Without a doubt, it is less of a problem than infertility was and that’s good to remember. That’s actually a yardstick that I use on a consistent basis. Is this as important or have the essential and significant consequences that fertility treatment cycles not working has? No? Ok, good to know and take it down a notch or two. Or eight.
Still, I am upset about this problem. I write these blogs, for you. About you. To you. With you in mind. You get the idea. It’s not all about me, at all. It’s actually all about you.
And so many of you wonderful readers respond. Often with thoughtful, honest and open hearts. With comments that are helpful and kind and educational even.
So here’s my problem, at least for right now. Because we are doing everything behind the scenes to correct this problem.
My problem is that I cannot respond on the blog itself to you, as I used to be able to do. In the past, you would write a comment, I would respond to the comment, you would see the comment. Right now, I cannot respond to you via PathtoFertility comments. Did I mention that we are working on this?
Here’s why it’s a problem. I love hearing from you. And I believe that it’s very discouraging to not see your comments post or to see them post and not see my response to you. It cuts into and stops the dialogue rather than continuing it.
It’s closing the door on a conversation instead of inviting someone into it.
Not my style at all.
So for the time being, I’ve decided on this. I will post your comments and respond to you all privately. That I can do. I can also post your thoughtful comments into a blog itself, which is also what I will do.
I have a great team who is continuing to find a way to have this work more smoothly. I have faith that will happen.
And so the conversation continues. I have a question.
What closes a conversation for you? What feels like an open door to more interchange?
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Insensitive Questions for the Infertile
You want a baby. It’s not happening quickly or easily. You realize that you may be infertile. You may need fertility treatment. You are getting asked questions that make you uncomfortable.
There are questions that should be asked and answered. And there are questions that should not be asked and should be answered, but maybe not in the way that you might think.
Here’s a list of questions that I believe an Obstetrician/Gynecologist should ask you:
- Are you planning or hoping to have children?
- Do you realize that it could be more difficult past the age of 35?
- Would you like to have your AMH (Anti-Mullerian Hormone) levels tested to see a baseline of what your fertility potential might be?
- Is there anything I can answer about you having a baby?
Please note. Those four questions were prefaced with, “questions an Obstetrician/Gynecologist (Ob/Gyn) should ask you". If you do not see an Ob/Gyn, then a primary care physician should ask you these questions.
Why are you asking or how is it any of your business?
Here’s a short list of people who should not be asking you these questions and to whom, I would hope, you would not feel even remotely obligated to answer.
- The person standing behind you on the supermarket line
- Your second cousin, once removed, who you see every other year
- A work colleague with whom you have no relationship
Here’s a list of people who may ask you the question and to whom you can answer the question if you feel like continuing a conversation with them regarding your family building.
- Your parents or other family members
- Your friends
- Close work colleagues
If you think that having children is something you might like in your life, these are important questions. They are questions designed to make you more educated and therefore empowered to make choices that you will not have to second guess or have regrets about.
Here is a list of questions that could easily come under the category, “None of your business” or even, “why would you possibly ask me such a personal question?” or possibly “you’ve got a lot of nerve to ask me a question like that”. These are questions that no one has the right or the need to ask you or know. Keep in mind, this is a very abbreviated list; there are so many more questions that you may be asked that do not appear here.
Conversation Openers or Closers? Consider the Source
If however, they are being asked by someone you are close to, maybe these are conversation openers, not closers. Consider the source. Decide whether the person who is asking may have something to contribute to the struggle you are going through.
- When are you having children?
- Why haven’t you had children yet?
- What are you waiting for?
- Don’t you want to have children?
- Don’t you think it’s selfish not to have a brother/sister for your child? (Secondary infertility)
- You do realize at your age it will be very difficult to have children, don’t you?
- If you had wanted children, you should have started a lot earlier. (Variations, “you should have put children ahead of your career,” “you should have stayed married,” “you should have settled down sooner”.)
- When should we expect your good news?
- Don’t you want to have babies while you’re young enough to enjoy them?
- Could you have your babies soon enough so that I can enjoy them? (From older family members.)
Not every question needs to be answered. Not every question should be asked but often is anyway.
Good responses? What do you think?
What are questions that you have been asked that you are thrown by? What is the best and the worst question you have been asked?
Responses most welcome! I will compile a list and publish it next week. No names will be used.
Thanks in advance for your help!
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What would I have done differently if I had known that infertility was going be such a long, drawn out struggle in my life? Would I have been more serious in my studies in college? Would I have gotten married sooner? Would I have chosen and married someone other than who I did?
Would I have eaten differently? Enjoyed things differently? Gone into therapy sooner?
Would I have traveled more? Gotten settled into a home more quickly? Never ever have tried a recreational drug? Drank less? Exercised more?
Would I have chosen not to have wanted children to avoid the pain of infertility?
Would I have wanted to know this was coming?
Do I allow my infertility experience, even now, to color everything that came before? When I look back, are there piles of regrets lying around getting larger and larger?
How do I begin to weave infertility into being part of my life and not all of my life? Is it possible to do that if there is no pregnancy, no children?
Is infertility a failure that one can recover from? How do I look at childfree living? When do I look at it?
If I had done things differently, would it have mattered? Changed things? Made my path to fertility, to my children, to my family, possible?
How do I begin to answer these questions and heal? How do I forgive my partner? How do I forgive myself?
How do I start to live again?
I think Friday's my day for musing out loud. Today is about connecting dots and seeing how many heads the pony has. You know the game. In a coloring book, an illustrator designs a picture that you can't see; until you connect dot one to dot two to dot three and so on. By the time you've finished connecting the dots you have a picture of a pony. Or an elephant. Or a flower. Sometimes when you connect the dots though, you get a three headed pony. How come? Either the artist designed it that way, the artist made a mistake or you connected the dots in a very, shall we say, creative way.
And sometimes it just needs to be a three headed pony. Sometimes when you connect the dots, the answer doesn't make sense. Ok, so I had no idea where I was going with this, but in the back of my mind, I've been thinking about "failed cycles". I am going to take this opportunity and say that I do not like that phrase. In fact, I can't stand it. Maybe it's just semantics, calling a spade a spade and I'm over reacting. For me though, infertility is all ready tainted with "failure" and it adds insult to injury to call a cycle that you have poured all your hopes into a failure. I'll just go with the cycle didn't work, seems a little less emotionally charged than "failed".
Be that as it may, even when we connect all the dots; cut out caffeine and liquor, administer all the medications properly, show up for all the ultrasound monitoring, even when we do every single thing our doctors tell us, our cycles still fail. Follicles don't show up in the numbers we are hoping for or needing, they don't grow and develop, blood levels don't rise, eggs don't fertilize, embryos don't develop or thaw properly. All these things contribute to our cycles "failing". Connect the dots and get a pony, seems simple enough. Except when it isn't.
Even when you do everything right, the cycle doesn't always work, one doesn't become pregnant. The chances that you will feel lousy when this happens are very high. The chances that you will want answers from the doctor, the nurse, the embryologist and anyone else who can offer one, are also very high. Chances are you will second guess yourself. Maybe you didn't administer all the medication properly. Maybe you shouldn't have worked out in the gym quite so hard. Maybe you didn't eat as well as you should have. Maybe your stress levels were too high.
Mother Nature has about a %25 success rate of pregnancy for a woman who is timing intercourse properly and has no fertility problems. That leaves a %75 rate of "failure". Most good fertility clinics have a much higher success rate than %25, depending on your diagnosis. We improve on Mother Nature. And yet it still doesn't work.
Maybe you didn't get pregnant and there aren't any answers or reasons. We connect the dots and don't come out with a recognizable pony. There just aren't any answers. There aren't any reasons. The cycle just didn't work.
Sometimes there are no answers.
Fertility Specialists Answer Most Common Infertility Questions
Norwalk, CT (March 30, 2010) - The fertility doctors of Reproductive Medicine Associates of Connecticut (RMACT) - Fairfield county's largest fertility clinic - have compiled the most common questions they receive about fertility, as well as answers.
"Infertility can be confusing, and people frequently ask questions because they want to know if they should seek help from a fertility specialist," says Dr. Mark Leondires, Medical Director. "The questions and answers below are intended to give some basic knowledge. Many couples put off seeing a fertility specialist when they are having trouble getting pregnant, but they are typically reassured after being diagnosed and starting a treatment plan."
What is infertility?
Infertility is a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has been unable to carry a pregnancy that results in a live birth.
Is infertility a "women's problem"?
Infertility is a medical problem. Approximately 35% of infertility is due to a female factor and 35% is due to a male factor. In the balance of cases, infertility results from problems in both partners or the cause of the infertility cannot be explained.
How long should we try before we see a doctor?
In general, if you are less than 35 years old and have been trying for more than one year you should schedule an appointment with a fertility specialist. If you are greater than 35 years old we would like to see you after at least six months of timed, unprotected intercourse. However, if you have a reason to suspect you may have a problem getting pregnant such as a history of pelvic inflammatory disease, painful periods, miscarriage, irregular menstrual cycles, or if your partner has a low sperm count, you should seek help sooner. Many couples have a hard time admitting that there may be an infertility problem, but be reassured there are often many things we can do to help.
What is a Fertility Specialist?
A fertility specialist, or Reproductive Endocrinologist, is a medical doctor who has been specially trained in the complex issues that can contribute to infertility. In addition to being trained as an Obstetrician/Gynecologist which requires a four-year residency a fertility specialist must complete an additional two to three year fellowship in reproductive endocrinology. This fellowship training is highly specialized to focus on the diagnosis and treatment of infertility and female endocrinology.. A physician can become Board Certified in Reproductive Endocrinology by successfully completing the fellowship as well as written and oral examinations.
Currently in the Unites States, there are only about 1,000 Board Certified Reproductive Endocrinologists. Specifically for infertility related to males, Urologists with a sub-specialty in Andrology are the most qualified experts as they have often completed two-year fellowships and passed exams to become Board Certified in Andrology.
At what time of the month is a woman fertile?
The most fertile time of a woman's cycle is just before or the of day ovulation. Ovulation usually occurs two weeks before a period starts, so it is necessary to count backwards from the anticipated start of the next period in order to find the most fertile time. Take the number of days in the usual cycle (from the beginning of one period to the beginning of the next) and subtract 14. For example, a woman with a 32-day period would likely ovulate around day 18 (32-14=18), while a woman with a 28-day cycle would ovulate around day 14 (28-14=14). We recommend every other day intercourse around the day of ovulation. That would mean days 12, 14 and 16 for women with 28 days cycles.
It is best to have intercourse before ovulation rather than afterwards, so a woman who ovulates on day 14 would have a good chance of conceiving if she has intercourse on either day 13 or 14. For women with irregular cycles you can extend the period of having sexual relations to every other day from day 11 to 18 ( 11-13-15-17). In order to better understand what day you ovulate take your average menstrual cycle length (for example 32 days) and subtract 14 and that will give you that day you ovulate around (that would be about day 18). Therefore you would have relations days 15-17&19 to cover all your bases.
Alternatively, women with irregular cycles may want to use an ovulation predictor kit, which can be purchased over the counter at most local pharmacies. This involves testing your urine around the time of ovulation using a detector stick, which give you a visual reading. Additionally, there are electronic monitors which detect ovulation by tracking two hormones (estrogen and luteinizing hormone) starting with urine testing on day one of your menstrual cycle. The methods that utilize urine predictor sticks or urine ovulation detector machines are usually highly sensitive, accurate, and reliable.
How can a woman tell if she ovulates?
The simple, inexpensive way of finding out the approximate time of your ovulation is to take your basal temperature (that is, your body temperature at rest) every morning and record it on a chart. You can buy a Basal Body Thermometer at your local drug store. Save all your charts so you can review them with your doctor. Three or four months of charting should be adequate. If your temperature goes up after the middle of your menstrual month you likely do ovulate. In general you ovulate about two days prior to the temperature rise.
How often should we have intercourse?
It is a good idea to have intercourse every other day around the time you ovulate. Remember, every woman is different, and may not ovulate exactly on "Day 14." And, just because you ovulated on "Day 14" this month, doesn't mean you will next month. It is preferable to have intercourse every other day rather than every day so that sufficient sperm will be available. To increase your chances of the egg becoming fertilized, do not douche or use lubricants immediately before having intercourse.
What fertility testing should our fertility doctor perform?
Your doctor will likely do the following:
- Blood tests to check reproductive hormone levels in the woman; estradiol (E2), progesterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid hormone, prolactin, and possibly male hormone levels.
- Complete semen analysis on the male partner
- Hysterosalpingogram (HSG), an x-ray exam to evaluate if the woman's fallopian tubes are open
- Ultrasound to confirm the normal appearance of your uterus and ovaries in the woman
What about smoking and drinking alcohol and caffeine?
There is evidence linking reproductive impairment with exposure to alcohol, tobacco, and caffeine.
Alcohol and tobacco use have been demonstrated to affect the reproductive capacities of both men and women, and tobacco is an especially potent reproductive toxin that negatively effects female fertility by damaging eggs. In men there is a direct effect on sperm quantity, quality, and reproductive function. In general we ask that women consume less than 150 mg of caffeine per day which is equivalent to two small 8 oz cups per day. Remember sodas and tea also contain caffeine. In addition, it is wise to be in the best physical shape possible while you attempt to conceive and, of course, to ensure a healthy pregnancy and baby.
Are hot tubs really bad for a man?
Yes. High temperatures can damage sperm. That is why the scrotum is located outside the body - to act as a kind of "refrigerator" to keep the sperm cool. So, it is a good idea to avoid hot tubs, saunas, and steam rooms when men are trying to help in the pregnancy pathway.
What else can we do?
Learn as much as you can about infertility.
- Get and read good, reliable information (not just from popular magazines) from your doctor, library, or trusted friends or family.
- RESOLVE (http://www.resolve.org/) and the American Fertility Association (AFA - www.theafa.org) has over 60 fact sheets on different topics related to infertility, and support groups in many areas.
- Also visit the ASRM (http://www.asrm.com/), SART (http://www.sart.org/), ACOG (www.acog.org) and CDC (http://www.cdc.gov/) web sites for more information.
Reproductive Medicine Associates of Connecticut (RMACT) specializes in the treatment of infertility. With Connecticut fertility clinics and egg donation offices in Norwalk, Danbury and Greenwich, and affiliate New York fertility clinics serving Westchester, Putnam and Dutchess counties, our team of Board-Certified Reproductive Endocrinologists offer a wide range of infertility treatments from ovulation induction and intrauterine insemination (IUI) to the most advanced assisted reproductive technologies including in-vitro fertilization (IVF), egg donation and preimplantation genetic diagnosis (PGD). The RMACT team of fertility doctors includes Drs. Mark P. Leondires, Spencer S. Richlin, Joshua M. Hurwitz and Cynthia M. Murdock. All physicians are members of the American Society for Reproductive Medicine (ASRM), the Society for Assisted Reproductive Technology (SART) and the Fairfield County and Connecticut Medical Societies. RMACT's IVF laboratory is accredited by the College of American Pathologists (CAP), and CLIA; other accreditations include the Accreditation Association for Ambulatory Health Care (AAAHC) and the American Institute for Ultrasound in Medicine (AIUM). RMACT offers individualized infertility treatment plans in a patient-focused and supportive environment. Support services, such as, infertility treatment financing, psychological counseling, acupuncture and yoga are also available. For more information visit, http://http://www.rmact.com/.
Below is a list similar to what my best friend and I formulated 20 years ago, 17 years ago, 10 years ago, 2 years ago. I remember copying the list and handing it to family members, whether in the words below or in a slightly different form. I wish I had a translator right now to translate this part of the blog today into Spanish, but truthfully what is below stands on it's own.
The Five Most Helpful Things to Say- from a family member or friend- Las cinco cosas más útil que decir-de un familiar o amigo
- 1. I am here to listen, I won't judge or suggest or offer help. Estoy aquí para escuchar, no voy a juzgar o sugerir u ofrecer ayuda. I'll just listen. Voy a escuchar.
- 2. Whatever you choose to share with me will be kept in the strictest confidence. Lo que usted decide compartir conmigo se mantendrá en la más estricta confidencialidad.
- 3. I'm here for you no matter what. Estoy aquí para ustedes, no importa qué.
- 4. I will not pry or ask too many questions. No voy a curiosear o hacer demasiadas preguntas.
- 5. If you would like some company at the doctor, I will be there for you/ Si desea alguna compañía en el Dr. estaré allí para usted /
Ten Things Never to Say - Diez cosas que nunca decir
- 1. Things happen for a reason. Las cosas suceden por una razón.
- 2. Maybe God doesn't mean for you to have children. Tal vez Dios no significa para usted tener hijos.
- 3. Relax and take a vacation, you'll get pregnant! Relajarse y tomar unas vacaciones, usted quedar embarazada!
- 4. Adopt a baby, and then you'll have your own baby! Adoptar un bebé, y entonces tendrá su propio bebé!
- 5. You're lucky, you won't have to get huge or be up in the middle of the night. Tienes suerte, usted no tendrá que conseguir enormes, o estar en medio de la noche.
- 6. Not everyone is meant to have children. No todo el mundo tiene la intención de tener hijos.
- 7. Be grateful for what you do have. Sea agradecido por lo que tienen.
- 8. I'll give you one of mine! Te daré uno de los míos!
- 9. Have puppies, they're easier. Los cachorros tienen, son más fáciles.
- 10. Have you tried this-treatment-this-doctor-this-herb, I heard it worked for so and so. ¿Has probado este tratamiento-esta-médico-esta hierba, he oído que trabajó para esto y lo otro.
Ten Things I Wish I Could Say. Diez Cosas que me gustaría poder decir que
- 1. I wish I could be fat and pregnant. Ojalá pudiera ser gorda y embarazada
- 2. I wish I could be exhausted from nursing and being up all night. Me gustaría poder estar agotada a partir de la enfermería y está toda la noche
- 3. I wish I could celebrate Mothers day as a Mother. Me gustaría poder celebrar el Día de las Madres como una Madre
- 4. I wish that I could have a child the old fashioned way Ojalá que yo pudiera tener un hijo a la manera antigua
- 5. I wish that I could attend my best friends' baby showers and their children's birthday parties without crying. Ojalá que yo pudiera asistir duchas de mis mejores amigos 'bebé y los partidos de cumpleaños de sus hijos sin llorar
- 6. I wish everyone could understand how incredibly sad I feel. Ojalá todo el mundo podía entender cómo me siento increíblemente triste
- 7. I wish I could do the things that I know make me feel better. Me gustaría poder hacer las cosas que sé que me sienta mejor
- 8. I wish I didn't have to miss work/social engagements/family functions because I need to be at the doctors. Me gustaría no tener que faltar al trabajo / compromisos sociales / funciones de la familia, porque tengo que estar en el de los médicos
- 9. I wish I didn't have to have to experience another birthday or New Year without a child. Me gustaría no tener a la experiencia de otro cumpleaños o Año Nuevo sin un niño.
- 10. I wish my nurse would call and tell me that I'm finally pregnant. Me gustaría que mi enfermera llamada y me dicen que por fin estoy embarazada.
Thank you to Carrie Van Steen for revising this list and getting it translated. Carrie is also THE person responsible for putting together our Ladies-Night-Out evenings in Danbury. I love our dedicated staff!
What would you like to add? What did we leave out? Come on, you must have a suggestion!
When I speak to my Fertile Yoga students, (many of whom are patients in our practice) I am reminded again of how perspective is skewed by the observer. The old tale of "seeing" an elephant by touching his tail, foot, trunk or belly. Each of those body parts will give a vastly different idea of what the elephant truly is, physically.
Here's what happens in doctor's offices across the world. Yes, world. I will stick to the infertility arena since that's the one I know. A doctor gives a comprehensive explanation during a consultation about (infertility treatment, IVF, IUI, pregnancy success rates, third party reproduction, diagnosis, fertility test results, etc.) and feels satisfied that he/she has covered the information in an understandable way. They have taken the time to explain in a non-patronizing, well measured way.
Here's what the patient has heard. Blah, blah, blah...
If you are a patient in infertility treatment, you know what I mean. Your doctor tells you something that you perceive as bad news. Might not even be bad news, but it doesn't sound good. Even infertility words are scary- IVF failure, hostile mucous, diminishing ovarian reserve, poor or low responder. We hear these words and we shut down. Our physician has gone on to explain what they mean and we are stuck hearing the words reverberate in our head. We feel anxious and upset and can't even explain why. We heard something that sounded like bad news and were unable to follow the rest of the conversation. We may look like we are, we may ask questions as if we are hearing the information, but often, very often, we aren't.
How do we avoid this disconnect? Our doctors are doing just what they should. They need to be able to give us information and use the language of infertility, it makes things understandable. How do we hear past that possible bad news?
A few suggestions. Take a pad with you, write down the questions you have before your appointment. Leave space after the questions. Write down the answers while you're in the appointment. Ask your doctor to slow down or repeat something if you need to. While you're at it, take someone with you to your appointment. Someone who can either write down the answers or just be a second set of ears to guide you through a replay when you leave the office. During the appointment, write down questions as you have them. Write down the answers. After the appointment, write down questions that you may have missed. Email or call and get the answers.
Make sure that you understand what you are being told. Make sure that you ask the questions that you need to make things more clear if you do not understand. Keep in mind that this is what your doctor and nurse want for you. They want you to understand.
You see, I also get to speak to the doctors, the nurses and the patient coordinators at RMACT. They do want you to understand, it upsets them if they think they are being unclear. They care that you understand your fertility treatment, diagnosis and prognosis.
So whether you are touching the elephants' tail, trunk, leg or belly, there is still one whole elephant when you open your eyes. It helps to see even more when you walk around the elephant and put it all in perspective. So ask your questions, find your answers. Make sure that you are seeing the whole elephant.