Posted by Lisa Rosenthal on Thu, Jul 29, 2010 @ 06:19 AM
Some of us are lucky enough to live in states with mandates concerning infertility and treatment. Some of us are lucky enough to have insurance that covers infertility treatment, regardless of a state mandate.
Some of us are lucky enough to have health insurance at all.
Many people in this country do not have health insurance and you might be surprised at who they are. They are new college graduates, they are people who make minimum wage, they are people with pre-existing health problems, they are people who have lost their jobs.
Paying for infertility treatment, whether through a state mandate, health insurance or out of pocket is something that not all people can afford. This probably reads as though I am stating the incredibly, perfectly, unbelievable obvious. Not everyone can afford infertility treatment.
What if you couldn't? What if I couldn't? What if it were completely out of reach to afford infertility treatment? No state mandate, no health insurance, no credit card to max out, no parents or family members to borrow from, no bank loans?
Infertility makes us feel so desperate in so many ways. When help is out of reach because of lack of financial resources or lack of insurance coverage, it's a whole different level of desperation and sense of failure.
If you are one of those people, please respond to this blog. If you don't want your comments posted, just let me know and I will not post them.
If you are one of those people who has coverage, health insurance or some other financial means to pay for infertility treatment, you have reason to feel some sense of gratitude, even in the midst of the struggles with infertility.
Does this turn infertility treatment into a possibility only for some people? Only for people with enough money or a certain type of job? Should affordable infertility treatment be available to everyone? Should it be up to an employer whether they offer infertility coverage?
These are questions that are being asked every day and will continue to be asked as health reform moves forward.
Ultimately, the question also becomes whether affordable infertility treatment is elitist.
What do you think?
Posted by Greg Zola on Wed, Jul 28, 2010 @ 06:02 AM
Straight from our FAQ's (frequently asked questions)
At what time of the month is a woman fertile?
The most fertile time of the month is just before or the 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 every other day sexual relations.
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.
Some literature recommends following your basal body temperature. One important fact to note is that if a woman is using a basal body temperature chart, that the temperature will rise after ovulation, and therefore after the most fertile period. The couple should therefore not wait until the temperature has risen to start to have intercourse, as they will have missed the most fertile time. Therefore this is useful in the first few months of trying to confirm ovulation and time it before the temperature rises.
Posted by Greg Zola on Tue, Jul 27, 2010 @ 05:40 AM
We all know people who try to warn us away from having children, especially when infertility rears its ugly head. We all know that they really do not understand. They don’t understand how, what is a powerful urge in the beginning, it then becomes so all consuming. They don’t understand how, faced with not having children and a family, your choices feel so limited and narrow. They don’t understand the pain and loss of this particular dream, which is so different than other dreams, so much more basic and primal. They don’t understand, if they have not experienced, not having a choice about having their children.
The cover article in the New York Magazine is not telling us not to have children. It is speaking to how many parents feel about parenting. Scary it is. Definitely upsetting and scary. Especially for those of us spending so many precious resources to have our children. We’d like to feel that we would be exempt from what is being reported, how these other parents feel, since we’ve tried so hard to bring our families into being. Funny thing is (funny, odd, not funny, ha ha) that once you become a parent, you are a parent. You are not in a special category because it took an IUI or IVF cycle or 3 years to get there. You are not exempt from the frustration, confusion and despair that parents feel as they raise their children.
Here’s what the author (Jennifer Senior) says early on in the article:
Yet a wide variety of academic research shows that parents are not happier than their childless peers, and in many cases are less so. This finding is surprisingly consistent, showing up across a range of disciplines.
And here’s a quote from the first page:
The economist Andrew Oswald, who’s compared tens of thousands of Britons with children to those without, is at least inclined to view his data in a more positive light: “The broad message is not that children make you less happy; it’s just that children don’t make you more happy.” That is, he tells me, unless you have more than one. “Then the studies show a more negative impact.”
The article goes on…
It wouldn’t be a particularly bold inference to say that the longer we put off having kids, the greater our expectations. “There’s all this buildup—as soon as I get this done, I’m going to have a baby, and it’s going to be a great reward!” says Ada Calhoun, the author of Instinctive Parenting and founding editor-in-chief of Babble, the online parenting site. “And then you’re like, ‘Wait, this is my reward? This nineteen-year grind?’ ”
And more…
Annette Lareau, the sociologist who coined the term “concerted cultivation” to describe the aggressive nurturing of economically advantaged children, puts it this way: “Middle-class parents spend much more time talking to children, answering questions with questions, and treating each child’s thought as a special contribution. And this is very tiring work.” Yet its work few parents feel that they can in good conscience neglect, says Lareau, “lest they put their children at risk by not giving them every advantage.” 
What does all this mean? Probably different things to each person who reads it. Some of you may be annoyed by my even blogging about it today. I do know that our focus can become more and more narrow when we are trying to conceive, that other choices feel almost impossible. And while we do not appreciate being told how tough it is to have children by our friends, maybe reading this article and seeing the research can allow you to consider things that you have not been able to otherwise.
I am not advising you to give up your quest to have children. I am encouraging you to take a good, hard look at what your motivation is, what you think the payback will be. Each step of this path is challenging. Conceiving and giving birth to our children is still only the first step, however long it takes, however much work it is. Then we have these children and evidently, according to this article, many of us may not be the happier for it.
Posted by Greg Zola on Fri, Jul 23, 2010 @ 08:13 AM
In the midst of infertility treatment, I refused to tell people my age. I was young, very young. A fact that every reproductive endocrinologist I ever saw was always happy to tell me. I know that my age made my fertility doctors hopeful for a few reasons.
It made my chances of becoming pregnant higher as maternal age is a predictor of success and I had age on my side.
There was time to work with; the doctors didn’t feel as much pressure as they would if I had been older, with my ovarian reserve diminishing each month.
And I felt old at 26. Old, incapable, insufficient, blighted. Old, old, old.
When I would meet someone, I would not mention my age. When it came up in conversation casually, I would not tell people my age. When I was asked pointedly, I refused to tell people my age. I would smile and say that it wasn’t something I talked about. I had one friend who truly was driven crazy by my refusal to tell her and I admit to a fairly medium size dose of satisfaction out of torturing her about it. After all, I was feeling my age in ways that she never suspected. Anyone who wanted to know my age that badly was not going to be someone I wanted to share my infertility pain with. No way.
Infertility ruined every birthday for six years. I hated my birthday, more even than New Year’s Eve, which was also an official marking of time. Every birthday confirmed my feeling of how old I was. Old, not young. Because it was clear, quickly with infertility treatment, that age was my enemy. I was beautiful at 26, lovely unlined skin, graceful and strong body. The pictures I have of myself of that age do not tell you the whole truth. Think Dorian Grey. Think of how that portrait aged and became scarred and ugly. That was how I felt. At 26, I felt old and ugly.
Therapy helped. Yoga helped. Friends who were able to listen and not advise helped. My best friend in the throes of her own infertility helped. My family helped tremendously. My mother helped. For my 30th birthday, my present was her Grandmother’s diamond wedding band. Having my mom pass down an heirloom to me at that time was critical. It wasn’t being saved for my sister who one day might be able to give her grandchildren. It was being given to me, with love and affection for who I was, right there, in the middle of being old and ugly. Boy, did that help. Thanks Mom!
Fighting for how I felt helped too. That is was ok to feel how I felt. That I didn’t have to judge how I felt on top of feeling how I felt. In yoga, we observe our breath, not to change it or judge it, but to notice and even appreciate it, just as it is.
And that’s where I got. I started to have moments of appreciating my strength, beauty and yes, youth. Moments when I was 27, more moments at 28. And I remember feeling quite lovely, beautiful and young at 31. Much younger than when I was 26.
Tomorrow I am 49. I understand that it’s a significant age. Multiples of 7, prime numbers, cycles of 7. All I know? Is that I feel beautiful. And young.
Posted by Lisa Rosenthal on Thu, Jul 22, 2010 @ 06:22 AM
Fertility is about conceiving. Whether it's an idea, painting, business plan or a child. The definition from Webster's Dictionary is "1. To become pregnant with a child, 2. To take into one's mind; to devise, form a conception of, or imagine. 3. To apprehend by reason or imagination; to understand, 4. To think; suppose
We all reach those places in our lives where it's apparent there is a choice that must be made. The path divides. There are apparent paths, clean, well cleared. There are obviously untrodden paths that one has to look carefully to find and which are rather grown over.
And there are the pathless paths, the ones that don't exist until you clear the way.
When we come to that part of our life, or perhaps the many times that paths diverge and a choice needs to be made, how do we make the choice? What leads us down one path and not another? Is it a decision, an intuition, a well thought out previously 
conceived plan, a message from a past life, a message from a past lover, is it closing your eyes; spinning around and walking blindly forward? How we make the choice can be vastly different each time we need to decide.
So we get to these points, pivotal, life changing, and we stand there, or we blunder ahead. Do we "take into one's mind, form a conception of, imagine, understand, think or suppose"? How we spend our time, our lives, our energy, our heart, those are the biggest decisions we make in our lives.
Sitting quietly is an option.
Posted by Greg Zola on Wed, Jul 21, 2010 @ 08:10 AM
Medical Day!! Consider this a preview for a comprehensive series on Preimplantation Genetic Diagnosis (PGD) that our own Dr. Spencer Richlin is putting together. Dr. Richlin is passionate on the subject and determined to have patients understand the big picture as well as all the intricacies that this very sophisticated technique uses.
Preimplantation Genetic Diagnosis (PGD)
Preimplantation genetic diagnosis (PGD) is an advanced laboratory procedure in which embryos are screened for genetic diseases or chromosomal problems prior to placing them in the uterus. Introduced in the 1990s, its initial purpose was to help patients avoid passing genetic diseases, such as cystic fibrosis or Tay-Sachs, to their child. It has been shown to be very effective for this purpose, and more recently, its indications have expanded. For example, it has also become a screening test for aneuploidy, which is an error in cell division resulting in an embryo with an incorrect number of chromosomes, either too many or too little. 
Chromosomal abnormalities are the most common cause for miscarriage in the human population and are often a reflection of reproductive aging (otherwise known as the female "biological clock"). Couples utilizing preimplantation genetic diagnosis would have their embryos evaluated prior to embryo transfer and only the most genetically normal embryo(s) would be selected. It is a relatively complex procedure that involves manipulation of the embryo, so it is offered judiciously to patients in situations where the benefits outweigh the risks.
PGD Testing
Patients who believe they are candidates for PGD should schedule a consultation with a physician separate from their new patient consultation. At that consultation, detailed information (including risks and benefits) will be reviewed and their treatment strategy will be individualized based on their situation. Considering this procedure involves an embryo biopsy, which is equivalent to surgery on the embryo on a microscopic level, there is approximately 1-3% chance that the embryo will be harmed. Having an experienced embryologist perform the biopsy minimizes this risk.
PGD has also been recently used as a tool to prescreen embryos in patients over 35 for chromosomal abnormalities in order to help the embryologist and physician choose the best embryo(s) to place into the uterus. Utilizing PGD in this context is somewhat arguable and should only be performed after extensive counseling.
So,coming soon, all the different pieces of PGD; how it's used, what it can tell us, how it's performed and when. Dr. Richlin is working on it, he wants you to understand all the different pieces.
Posted by Lisa Rosenthal on Tue, Jul 20, 2010 @ 10:17 AM
Every single day there are hundreds of articles reporting on different aspects of infertility, treatment and things associated with the two. Here are a few articles that I felt were timely, and I hope, of interest to you, with short comments from me.
Infertility treatment for the future? Removing a two year old’s
ovary in the hope that twenty years or so from now that she will be able to have children, why not? This child is going to undergo medical treatment that may render her infertile. Why not give her a chance for the future, especially with technology that has been used successfully in other situations? FoxNews reports on Monday, July 19...
“The plucky, 2-year old Brooklyn girl is set to become the youngest person ever to undergo a fertility procedure when a New York doctor removes one of her ovaries Tuesday and freezes it while she undergoes treatment for a serious immune disease."
Moving onto a more personal piece-
A beautiful, touching tribute from a mother 
with a fourteen year year old daughter, to the woman who donated the egg. How feelings can evolve is poignantly expressed here. How precious is that gift, fourteen years later. From the Huffington Post...
"What began as my ambivalence about having another woman's baby has alchemized into a purity of love for both Olivia and Angel Cate, and I realize the longer I love Olivia, the more indebted to Angel Cate I become.”
In the courts in Wisconsin, a decision is overturned-
A triumph for gestational surrogates in Wisconsin, where why and how you got pregnant determined whether you could receive health care. The Supreme Court in that state has overruled lower court rulings against this bias. Let’s hope that influences any other state with similar rulings.
“Wisconsin Insurance Commissioner Sean Dilweg said the ruling supports his department's view that insurance companies can't discriminate against women based on the reasons they got pregnant.”
And research about the success of IVF from the west coast-
New research that could predict IVF success in the future, for you specifically. Interesting to see the research that is being done on the west coast, regarding IVF success for individual prognosis. Here is a quote from the article published in Science Mag on July 19:
"In an attempt to bring hard numbers into IVF forecasting, Yao and colleagues collected data on over 50 variables that influence the success of the treatment. 
These included figures known before the start of IVF, such as age, number of previous pregnancies, and sperm count, and figures known after the completion of the first round of IVF, such as whether there was fertilization, endometrial thickness, and average number of cells per embryo. In all, the researchers fed data on over 1600 first-round IVF procedures from patients treated at Stanford University Hospital and Clinics."
I opted out on writing about any screaming headlines and chose what appears to be responsible journalism. Interesting to see how much there is out there, often hard to sift through what's pertinent and relevant.
What do I know for sure? As long as there are people trying to create families, we'll get to read about it in the news.
Posted by Lisa Rosenthal on Mon, Jul 19, 2010 @ 10:19 AM
When I shared the PathforFertility blog on facebook last week, the two week wait elicited the following thread and responses from two of my facebook friends:
Lisa Rosenthal: My Fertile Yoga students just last Saturday were talking about the two week wait. So much worse than the injections, mixing the meds, the scans, the retrievals, the transfers. Who wants to sit and wait??!!!! How is it possible to enjoy the downtime? Any thoughts you want to share with my students and blog readers????
Of course! For me, it was all about preparation. Before the two week wait,
I set up a series of projects and tasks that could occupy my time and mind (coloring books, movies I wanted to see, etc.), I scheduled phone calls with several friends I wanted to catch up with and I had several sessions with my therapist. I also think you have to commit to maintaining the attitude of not getting too hopeful and not getting too negative. For me, certain key phrases and reminders helped with that... like “I can’t control the outcome so why stress over it.”
TheTwoWeekWait Blog
Hi, I think a couple should fill that time up with activities they did when they were dating before the wedding, setting up house, settling into marriage and finally TTC. I strongly believe that couples should rejoice and celebrate the love that brought them to this point in their lives! Laugh, play tootsies in bed, go out,
and be spontaneous. If success is achieved you will be so glad and if that positive outcome is not delivered to you then the couple would have just renewed the love they share and the places, activities, and people who brought them together. I wish well for all those going through this fertility journey and hope your lives will be changed forever. Best Wishes, Deana
Deana Hall DeGroot
President of Loving Donation
I think that's genius Deana! I think women get too focused on thinking about what they are waiting for but honestly, it's just not productive, relaxing or helpful in the least. I SERIOUSLY have to write about all this in the coming week... TwoWeekWait
I'm glad you liked my comments! I have a couple more things to share: 1) Visualize every night before the transfer and after the following: "My uterus is a warm, happy, and inviting nest for a baby to grow.” 2) TAKE each step with cautious optimism!!! Deana Hall DeGroot
I love all of this. Would you please consider sharing this over on my blog? Or can I just quote you and attribute it to you, how? This conversation is exactly what we all need.
What suggestions would you like to add? Here are a few of mine from a few weeks ago, just in case you missed them
- cotton sheets
- good books
- leisurely walks
- fresh fruit
- egg white omlettes
- sappy movies
- crossword puzzles
- yoga classes
- friends who didn't ask questions but listened well
- sleeping late on the weekends
- gardening in the shade
- waterfalls
- fireworks
- clean floors
- grilled cheese sandwiches
- college Lacrosse games
- well vacuumed rugs
- hammocks
- picking blueberries
Keep the list growing. What are your suggestions to get through the two week wait?
Posted by Lisa Rosenthal on Fri, Jul 16, 2010 @ 09:19 AM
What’s going on at Reproductive Medicine Associates of Connecticut these days? Exciting goings on, so I figured I would do a little update for you.
We are so pleased to announce FertilityAuthority.com, a trusted source for fertility information, awarded "Nurse of the Month" to our nurse practitioner Monica Moore.
As a nurse practitioner (NP), Ms. Moore received advanced nursing education in addition to being a registered nurse. She is fully licensed and is a registered nurse n the state of Connecticut and by the national certification board of the American Academy of Nurse Practitioners. Ms. Moore's nursing work experience spans nearly two decades in the field of fertility treatment. Prior to joining RMACT, Monica was the donor nurse coordinator at the Atlanta Center for Reproductive Medicine. Monica's first job in reproductive endocrinology was at Cornell Center for Reproductive Medicine and Infertility over 10 years ago. “Taking care of the whole patient is where my passion lies,” says Monica Moore, M.S.N, R.N.C., a nurse practitioner and a nurse manager at RMA of Connecticut. During our conversation, Moore talks about the importance of integrating comprehensive care – including yoga, acupuncture, massage therapy and nutrition care – with fertility treatment. “It’s a natural extension,” she says. Body mass index (BMI), the mind-body connection and stress release are important parts of the fertility equation. As is nutrition.
Monica's research interests include: improving the efficiency of donor oocyte programs, advancing education for nurse managers, and developing patient teaching techniques. Monica enjoys any opportunity for teaching nurses or other staff members. Monica has published abstracts, online articles and a book chapter. She chaired the ASRM Nursing course in 2007 and was a recipient of the IVP Care's Professional Patient Education Grant in 2004. She is one of the founding members of the Advanced Nursing Network, a committee of the nursing practice group (NPG), whose purpose is to establish a national network of nurses in managerial or midlevel positions.
Monica received her undergraduate and graduate degrees from the University of Pennsylvania, where she was a member of Sigma Theta Tau, the nursing honor society.
Fertility Authority is a web portal dedicated to providing the best information available to assist those who need to make informed decisions about their fertility.
Our Danbury office is missing the presence of two of our favorite nurses these days. We are fortunate enough to have wonderful, professional and experienced coverage from our other RMACT nurses (Christina, Jocelyn, and Brigette), so there will be not be any changes in the way that you, our patients, are being treated and no change in how quickly your questions are answered. For those of you used to working with Kathleen and Anne, we miss them too, and will be welcoming them back sometime in the fall. You can request speaking with or working with one particular nurse if that feels more consistent and comfortable for you. Please let us know if you have any questions, we’re always happy to answer them.
Fertile Yoga this weekend in both Norwalk and Brookfield. As always, free of charge. A wonderful way to enhance treatment and the possibility of conceiving. On Saturdays, class meets from 9:30 until 11:00 in Norwalk, (20 Glover Avenue, Norwalk, CT); 4:15 until 5:30 in Brookfield (777 Federal Road, Brookfield, CT.)
The classes are very gentle, in the style of restorative yoga. There is absolutely no creating pretzel like poses, or balancing on one hand while the other three limbs are up in the air. One of my students describes the class as a mini-vacation that she treats herself to each week; a way to take a formal break from the rest of her routine. Classes focus on very gentle movement (often not getting off the mat at all), guided meditation, focused breath and relaxation.
My intention is to teach different mechanisms of releasing stress that we learn in class to take and use out of class. Each class is different, with a focus on new tools.
Preconception Considerations:
Getting Ready for Pregnancy
Health and lifestyle changes made prior to pregnancy help to reduce complications in pregnancy and delivery, in addition to helping improve the health of the baby. Prenatal nutrition, environmental concerns and the health of both partners will be discussed. This seminar will be led by Carolyn Gundell, MS and Diana D’Amelio, RPA-C.
Wed | July 21 in our Norwalk location 6:00 PM - 7:30 PM
Please note, you do NOT have to be a patient of RMACT to attend any of these seminars, nor will you be given any kind of push to switch to our practice. RMACT brought Carolyn on so that our practice would be better able to offer patients the nutrition help that they need. The seminar series was added so that the reach would be broader and more help could be offered outside of our smaller community. The same is true of Fertile Yoga. All are welcome, RMACT saw that there was a need in the larger community and is trying to help fill it.
Posted by Lisa Rosenthal on Thu, Jul 15, 2010 @ 06:21 AM
Very happy to be home. Wonderful vacation, lovely wedding. Still, very happy to be home. Interesting that even on vacation, thoughts of infertility pop up. Even at a wedding. Or especially at a wedding.
Watching two twenty three year old people get married, it did occur to me that perhaps that should be illegal. Too young, too soon, too early. But of course, it's not. And what other thoughts come up at a wedding? You know. When are they going to start a family, have a baby. The beautiful couple that I watched exchanging vows weren't married for more than ten minutes before that question was being discussed.
The assumption of course, is that life will go just as planned. They met, grew to love each other, decided to marry. Natural next step, babies.
I didn't say much about it all. But when it came time to toast the happy couple, that was my wish for them. There were plenty of calls for happy and healthy lives. Plenty of calls for other sweet things in their new life together. My wish for them was fertility.
My husband thought I was being a bit of a cynic, assuming that they would have a problem. Being married as long as we have been, he was certainly not going to suggest that I was wishing it on them by thinking about it. I felt a kinship to the witch in Sleeping Beauty, not the wicked one, but the who got in the last wish.
After the wish was made that the princess die from pricking her finger, there was one more fairy who had a wish...
At this very instant the young fairy came out from behind the hangings, and spake these words aloud: "Assure yourselves, O King and Queen, that your daughter shall not die of this disaster. It is true, I have no power to undo entirely what my elder has done. The princess shall indeed pierce her hand with a spindle; but, instead of dying, she shall only fall into a profound sleep, which shall last a hundred years, at the expiration of which a king's son shall come and awake her."
My wish for this young, healthy, hopeful, beautiful married couple is that infertility not enter their lives. I want that to be the last wish made, the last blessing said over their heads.
For those of you already struggling with infertility, this is the fairy I want to be for you, the one who can help undo or mitigate or transform. "I have no power to undo entirely...." I will settle for offering help, support, advice while you're on this fertility journey.