This is your home for learning more about fertility factors--medical, emotional, and physical. Our team of bloggers, from physicians to nurses, financial counselors to patients, are all dedicated to giving you news, information and thoughts relating to the the fertility journey. Please explore and let us know if there other topics of interest to you.

Education & Training of Doctors

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The Center for Advanced Reproductive Services is a vital part of the University of Connecticut School of Medicine. The School of Medicine provides postgraduate training for more than 550 newly graduated M.D.s each year. As part of this program, The Center is home to some of the few postgraduate fellowships for Reproductive Endocrinology and Infertility available in the United States. Due to The Center’s national reputation as a “Center of Excellence,” acceptance to one of our 3 fellowship positions is very competitive.

More about the program here.

Fertility Preservation Options for Women

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In recognition of Breast Cancer Awareness Month, we are continuing with posts to raise awareness of fertility preservation to those facing a cancer diagnosis. Fertility preservation, when done prior to certain cancer treatments, is an important but often over-looked part of the cancer patient’s experience.

See the article below for more information on the fertility preservation options for women or watch the video here.

 

What is a summary of the fertility preservation options for women?

(Ralph Kazer, M.D., Professor, Ob/Gyn, Oncofertility Consortium, Feinberg School of Medicine, Northwestern University)

Patients who are facing treatment for cancer, which may involve either chemotherapy or radiation therapy or both, potentially have a number of options to explore if they are interested in preserving their childbearing potential.

In the first place, patients always have the option of foregoing any particular strategy for fertility preservation if, for example, it’s not thought that their therapy is likely to have a significant impact on their fertility. Or if they don’t want to carry out one of these options for any other reason.

Active strategies for fertility preservation include, in the first place, something called emergency in vitro fertilization, or emergency IVF for short. This is a strategy which exploits a technology which is currently used primarily to treat infertility patients. It involves harvesting eggs or oocytes from the patient before she starts her therapy, fertilizing them, presumably with her husband’s sperm, and freezing or cryopreserving the embryos for future use. This is a mature technology with a fairly high success rate and it is probably the most commonly used option that we offer at Northwestern.

Some patients don’t have a mate; some patients are single and wish to defer the choice of a mate into the future. Those patients have the option of participating in a research protocol, which involves freezing their eggs before they are fertilized. The reason that this is experimental is because, technically, it is significantly more difficult to freeze unfertilized eggs than fertilized eggs.

A third option, which also involves a research protocol, is the retrieval and freezing of ovarian tissue. This particular option is most appropriate for patients who have a very, very short time frame leading up to their treatment. A timbered which would not permit the medical part of the therapy required for harvesting eggs. Or, patients who, for some other reason, are concerned about the potential effect of the drugs that are used in emergency IVF on their cancer. So these patients may enroll in the study, which involves surgically removing one of their ovaries and freezing or cryopreserving the ovarian tissue for later use. The technology for using that kind of tissue for making babies down the road is still very, very much cutting edge. Babies have been born after frozen tissue has been transplanted back into patients after they’ve had their cancer treatment, but the overall picture for this technology is very much in the future.

Facebook & Apple Paying for Egg Freezing

Two Silicon Valley giants now offer women a game-changing perk: Apple and Facebook will pay for employees to freeze their eggs.

141013-egg-freezing-jms-1734_496d108f768d4f3ec4ec46f4e529a309.nbcnews-fp-880-600Perk Up: Facebook and Apple Now Pay for Women to Freeze Eggs
(Published on NBC News by Danielle Friedman)

Facebook recently began covering egg freezing, and Apple will start in January, spokespeople for the companies told NBC News. The firms appear to be the first major employers to offer this coverage for non-medical reasons.

“Having a high-powered career and children is still a very hard thing to do,” said Brigitte Adams, an egg-freezing advocate and founder of the patient forum Eggsurance.com. By offering this benefit, companies are investing in women, she said, and supporting them in carving out the lives they want.

When successful, egg freezing allows women to put their fertility on ice, so to speak, until they’re ready to become parents. But the procedure comes at a steep price: Costs typically add up to at least $10,000 for every round, plus $500 or more annually for storage.

With notoriously male-dominated Silicon Valley firms competing to attract top female talent, the coverage may give Apple and Facebook a leg up among the many women who devote key childbearing years to building careers. Covering egg freezing can be viewed as a type of “payback” for women’s commitment, said Philip Chenette, a fertility specialist in San Francisco.

The companies offer egg-freezing coverage under slightly different terms: Apple covers costs under its fertility benefit, and Facebook under its surrogacy benefit, both up to $20,000. Women at Facebook began taking advantage of the coverage this year.

Why freeze?
While techniques and success rates are improving, there’s no guarantee the procedure will lead to a baby down the road. The American Society for Reproductive Medicine doesn’t keep comprehensive stats on babies born from frozen eggs – in fact, the group cautions against relying on egg freezing to extend fertility – though experts say the earlier a woman freezes her eggs, the greater her chances of success. Doctors often recommend women freeze at least 20 eggs, which can require two costly rounds.

But in the two years since the ASRM lifted the “experimental” label from egg freezing, experts say they’ve seen a surge in women seeking out the procedure. Fertility doctors in New York and San Francisco report that egg-freezing cases have nearly doubled over the past year.

For many women, taking the step to boost their chances of having kids in the future is worth the uncertainty. A majority of patients who froze their eggs reported feeling “empowered” in a 2013 survey published in the journal Fertility and Sterility. Women who know they want kids someday “can go on with their lives and know that they’ve done everything that they can,” said Chenette.

Egg freezing has even been described as a key to “leveling the playing field” between men and women: Without the crushing pressure of a ticking biological clock, women have more freedom in making life choices, say advocates. A Bloomberg Businessweek magazine cover story earlier this year asked: Will freezing your eggs free your career? “Not since the birth control pill has a medical technology had such potential to change family and career planning,” wrote author Emma Rosenblum.

News of the firms’ egg-freezing coverage comes in the midst of what’s been described as a Silicon Valley “perks arms race.” It’s only the latest in a generous list of family and wellness-oriented health benefits from Apple and Facebook (whose COO, of course, is feminist change agent and “Lean In” author Sheryl Sandberg). Both companies offer benefits for fertility treatment and adoption. Facebook famously gives new parents $4,000 in so-called “baby cash” to use however they’d like.

New ground
Silicon Valley firms are hardly alone in offering generous benefits to attract and keep talent, but they appear to be leading the way with egg freezing. Advocates say they’ve heard murmurs of large law, consulting, and finance firms helping to cover the costs, but no companies are broadcasting this support. “It’s very forward-looking,” said Eggsurance’s Adams.

Companies may be concerned about the public relations implications of the benefit – in the most cynical light, egg-freezing coverage could be viewed as a ploy to entice women to sell their souls to their employer, sacrificing childbearing years for the promise of promotion.

“Would potential female associates welcome this option knowing that they can work hard early on and still reproduce, if they so desire, later on?” asked Glenn Cohen, co-director of Harvard Law School’s Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, in a blog post last year. “Or would they take this as a signal that the firm thinks that working there as an associate and pregnancy are incompatible?”

But the more likely explanation for lack of coverage is simply that egg freezing is still new, and conversation around the procedure has only recently gone mainstream. “I think we’ve reached a tipping point,” said Adams. “When I used to say ‘egg freezing,’ people would stare at me with their mouths open.” Now? Most people know someone who’s done or considered it.

Many large companies adopt new benefits in response to employee demand – firms have recently started to offer benefits for transgender employees, for example. As women’s awareness of egg freezing grows, more employers may jump on the band wagon.

“The attitude toward egg freezing is very different,” and more positive, than just a few years ago, said Christy Jones, founder of Extend Fertility, a company that offers and promotes egg freezing across the country. Women are making the proactive decision to freeze their eggs at a younger age, and the choice is “more one of empowerment than ‘this is my last chance.’”

EggBanxx, the first service to help women finance egg freezing, has recently begun to capitalize on this shift by hosting “egg-freezing parties,” where experts educate guests. “Maybe you haven’t found Mr. Right just yet or perhaps you would like more time to focus on your education or career,” the company website says. “Whatever the reasons, freezing your eggs now will allow you to tackle conception later.”

Women generally need about two weeks of flexibility for one cycle of egg freezing. After about ten days of fertility drug injections, patients undergo a relatively short outpatient procedure – and they’re “back to work the next day,” said Lynn Westphal, Associate Professor Obstetrics and Gynecology at Stanford University Medical Center. From there, eggs are frozen and stored until a woman is ready to use them, at which point she’ll begin the process of in vitro fertilization.

Once a woman freezes her eggs, she may never return to use them, fertility doctors report. Some women get pregnant the old-fashioned way, others make different life plans. Westphal compares egg freezing to car insurance: You hope you don’t have to use what you’ve put away, but if you find yourself in a situation where you need to, you’re glad to have the protection.

Will the perk pay off for companies? The benefit will likely encourage women to stay with their employer longer, cutting down on recruiting and hiring costs. And practically speaking, when women freeze their eggs early, firms may save on pregnancy costs in the long run, said Westphal. A woman could avoid paying to use a donor egg down the road, for example, or undergoing more intensive fertility treatments when she’s ready to have a baby.

But the emotional and cultural payoff may be more valuable, said Jones: Offering this benefit “can help women be more productive human beings.”

Dr. DiLuigi on CT Spotlight

CT Spotlight talks to Dr. DiLuigi about the Center’s new location in Farmington. See the video below.

Pediatric Cancer & Fertility Preservation

The possibility of an adolescent male becoming infertile as a result of treatment for cancer should be discussed soon after a diagnosis is made, according to an expert in the field. Unfortunately, these discussions rarely take place, despite recommendations from the American Society of Clinical Oncology.

Read the article below.

Tell Boys With Cancer About Ways to Preserve Fertility
(Published on Medscape Medical News by Fran Lowry)

“Fertility preservation can be a difficult topic to discuss with an adult in the setting of an acute cancer diagnosis, and this issue can be even more challenging to address with a child and their parents,” Robert E. Brannigan, MD, professor of medicine at the Northwestern University Feinberg School of Medicine in Chicago, writes in a comment published in the October issue of the Lancet Oncology.

The comment was prompted by a study published in the same issue by Daniel M. Green, MD, from St. Jude Children’s Research Hospital in Memphis, Tennessee, and colleagues, which showed that cyclophosphamide reduces sperm irreversibly after treatment, rendering patients infertile.

Results of the study were presented earlier this year at the American Society of Clinical Oncology (ASCO) annual meeting, as reported by Medscape Medical News.

“My concern is that, while an excellent, outstanding job is being done with the treatment of pediatric cancer, very often the fertility preservation issue is overlooked,” Dr. Brannigan told Medscape Medical News.

There are a number of reasons for this, including a lack of awareness among pediatric oncologists of the ASCO recommendations on fertility preservation, and the fact that they rarely cross paths with fertility specialists, he said.

“There was a survey done in 2011 of the attitudes and practice patterns of pediatric oncologists toward fertility preservation. Only 44% of respondents reported being familiar with the ASCO fertility preservation recommendations, and only 39% reported routine use of them to guide decision-making for patient care,” Dr. Brannigan reported.

Respondents to that survey also noted barriers to fertility preservation for their male patients. These included the need to start treatment right away because of aggressive disease and discomfort discussing sperm banking, he noted.

Another common obstacle to fertility preservation in the pediatric population is the fact that pediatric healthcare facilities are often located far from reproductive health centers. As a consequence, little or no dialogue takes place between pediatric oncologists and reproductive specialists.

What Can Be Done?
Pediatric oncology patients want to know about preserving their fertility, Dr. Brannigan said.

“We have done some focus groups on this at our institution, and it is very clear that the adult survivors of pediatric cancers feel very strongly that the issue of preserving their fertility should have been raised with them and their parents at the time of their diagnosis and treatment,” he said.

Centers treating children with cancer should identify reproductive specialists who can come and discuss the issue and help provide advice and care, Dr. Brannigan said. It is unreasonable to expect the pediatric oncology provider to have these discussions with their patients. “I think it is unreasonable to expect the pediatric oncology provider to have these discussions with their patients. We need experts in the area to be available to do this. We’ve done it at our institution and it has worked very nicely,” he said

At the moment, there is no effective way to preserve the fertility of a prepubertal boy with cancer. But most adolescent male oncology patients are capable of providing semen of sufficient quality for cryopreservation before initiation of cancer therapy, he said.

“They can preserve their fertility by banking sperm. The doctor treating them must look at this as being something that is worthwhile, has value, is important,” Dr. Brannigan explained. “There are some men who become infertile as a result of their therapy and, while they are incredibly grateful for the excellent care they received and for surviving their cancer, they really wish that someone would have gone the extra step to help avert their infertility.”

Dr. Green and colleagues provide important information, but prospective studies initiated at the time of cancer diagnosis are needed to provide the most meaningful insight into fertility preservation issues, he added.

Longitudinal studies tracking infertility are also needed to shed light on the eventual reproductive outcomes for childhood cancer survivors.

“Collectively, this work will enable clinicians to more effectively stratify the risk of future fertility impairment in the aftermath of a cancer diagnosis and cancer therapy,” Dr. Brannigan said.

Drinking & Male Fertility

New research suggests that moderate alcohol intake every week is linked to poorer sperm quality in otherwise healthy young men. And the higher the weekly tally of drinks, the worse the sperm quality seems to be, the findings indicate, prompting researchers to suggest that young men should be advised to steer clear of habitual drinking. Read the article below.

Moderate Weekly Alcohol Intake Linked to Poorer Sperm Quality in Healthy Young Men
(Published in Science Daily)

They base their findings on 1221 Danish men between the ages of 18 and 28, all of whom underwent a medical examination to assess their fitness for military service, which is compulsory in Denmark, between 2008 and 2012.

As part of their assessment, the military recruits were asked how much alcohol they drank in the week before their medical exam (recent drinking); whether this was typical (habitual); and how often they binge drank, defined as more than 5 units in one sitting, and had been drunk in the preceding month.

They were also invited to provide a semen sample to check on the quality of their sperm, and a blood sample to check on their levels of reproductive hormones.

The average number of units drunk in the preceding week was 11. Almost two thirds (64%) had binge drunk, while around six out of 10 (59%) said they had been drunk more than twice, during the preceding month.

The analysis showed that after taking account of various influential factors, there was no strong link between sperm quality and either recent alcohol consumption or binge drinking in the preceding month.

But drinking alcohol in the preceding week was linked to changes in reproductive hormone levels, with the effects increasingly more noticeable the higher the tally of units.

Testosterone levels rose, while sex hormone binding globulin (SHBG) fell; similar associations were also evident for the number of times an individual had been drunk or had binge drunk in the preceding month.

Almost half (45%, 553) of the men said that the quantity of alcohol they drank in the preceding week was typical of their weekly consumption.

And in this group the higher the tally of weekly units, the lower was the sperm quality, in terms of total sperm count and the proportion of sperm that were of normal size and shape, after taking account of influential factors.

The effects were evident from 5+ units a week upwards, but most apparent among those who drank 25 or more units every week.

And total sperm counts were 33% lower, and the proportion of normal-looking sperm 51% lower, among those knocking back 40 units a week compared with those drinking 1-5.

Habitual drinking was associated with changes in reproductive hormone levels, although not as strongly as recent drinking, while abstinence was also linked to poorer sperm quality.

This is an observational study, so no definitive conclusions can be drawn about cause and effect. And the researchers point out that the findings could be the result of reverse causation — whereby men with poor quality sperm have an unhealthier lifestyle and behaviours to start with.

But animal studies suggest that alcohol may have a direct impact on sperm quality, they say.

“This is, to our knowledge, the first study among healthy young men with detailed information on alcohol intake, and given the fact that young men in the western world [drink a lot], this is of public health concern, and could be a contributing factor to the low sperm count reported among [them],” they suggest.

And they conclude: “It remains to be seen whether semen quality is restored if alcohol intake is reduced, but young men should be advised that high habitual alcohol intake may affect not only their general health, but also their reproductive health.”

The above story is based on materials provided by BMJ-British Medical Journal.

Cancer and Fertility

Every October, we are reminded to celebrate the progress made in the fight against breast cancer and advocate for further advances.

While the success of cancer treatments continues to rise, the side effects of those treatments are still being realized. For women, certain therapies can cause ovarian damage or failure, early menopause, genetic damage to growing eggs and other reproductive problems. For men, cancer treatments can cause damage to the testes and interfere with sperm production.

The Center for Advanced Reproductive Services is a select member of the Oncofertility Consortium — an exclusive nationwide group of researchers who are dedicated to the advancement of technologies that will provide improved fertility preserving options to cancer patients with threatened fertility.

This special membership allows us to participate in and have access to the latest clinical research, expand current knowledge of all issues related to cancer treatments and fertility, and be on the forefront of discovering new technologies and methods that successfully preserve fertility.

This month we will be posting resources from the Oncofertility Consortium that will help you navigate the complex fertility issues facing patients with cancer and other serious diseases.

Invitation: RESOLVE'S Annual Conference

The Center will be at RESOLVE New England’s 21st Annual Fertility Treatment, Donor Choices and Adoption Conference on November 8th and we are excited to extend you a personal invitation to join us. The conference will be held at the Best Western Royal Plaza Hotel 181 Boston Post Road West, Marlborough, MA.

We will have a booth at the conference so come and chat with us! Also, Dr. DiLuigi, from The Center, will be speaking about Navigating a Cycle: What to Expect and How to Manage.

We hope to see you there!

Playing the Odds

“You’ve got to know when to hold ’em. Know when to fold ‘em. Know when to walk away. And know when to run.” Kenny Rogers

My husband and I have never been to Vegas.  In fact, neither of us really likes to gamble. We don’t even know how to play poker. I would rather save my money and energy on a “sure” thing. Maybe that’s why the idea of IVF was so hard for us. You could spend all the money in the world and end up with nothing.  I have met people who re-mortgaged their homes, sold their cars, and took loans out against their life insurance polices. I’ve met couples that would rather not even play the game because the odds are so stacked against them, they don’t dare gamble.

Our first cycle of IVF started off pretty routinely. We did everything we were told to do. I was injected with the correct doses of medicine at the precise time of day (admittedly a bit fearfully!). We went to all our appointments on time, abstained from exercise, and took our multivitamins. We did everything right. We did it better than right…we did it extraordinarily. And still it did not turn out the way we hoped.

I remember it was a Saturday appointment for an ultrasound to check on my progress. The doctor doing the exam mentioned he was concerned that I was not responding to the medicine the way they had hoped. There was a possibility that we may have to cancel the cycle. I was blindsided by his statement. We did everything right. Why was I not responding?  There had to be some mistake. Canceling a cycle had never crossed my mind as a possible outcome.  I was only 31–if anything I thought I would over-respond and produce too many eggs. We were reassured that it was not uncommon, but we’d have to make some tough decisions. And quickly.

I went back to the doctor on Monday, and the scenario was the same. I was not producing as many eggs as they hoped.  Our choices: continue the cycle because I did have a few good eggs, no pun intended. Or, cancel the cycle and hope I would respond better with a different protocol. What do you do?  Do you play the hand you were dealt?  Or do you fold and hope for a better hand?  Dr. Engmann went over the pros and cons, and he reassured us that we needed to listen to our gut. Funny thing was, my gut and my husband’s gut were telling us two different things.  I felt it would be better to go into retrieval with optimal conditions. And right now, this was not optimal.  My husband on the other hand felt this was the hand we were dealt and we should “play.”

I think we spent the next 24 hours looking for a sign: we tossed coins, and even bought a scratch off ticket. In the end it came down to me.  It just didn’t feel right.  It didn’t feel like it was our time.  I wanted “optimal” conditions, and this was not our best.  So we decided to fold.  We decided to walk away, and hope the next time would be our best.  It would be our extraordinary.

Jen is mom to two amazing boys, thanks to the help of the Center for Advanced Reproductive Services. She’s also a middle school teacher and a peer support leader for Resolve. She credits her incredible husband for his support through their journey together.

11 Things to Know Before Going to a Fertility Center

If you’re thinking about making an appointment with a fertility doctor, here is some information that can give you a leg up before you walk in the door. These 11 items can help you understand the “big picture” of infertility and make navigating the process easier. See the article below.

FertilityClinic

 

 

 

 

 

 

 

11 Things to Know Before Walking Into a Fertility Center
(Published in the Huffington Post by )

If you’ve been trying to have a baby without success, you aren’t alone.

Approximately one in eight couples has difficulty conceiving. And contrary to popular belief, it isn’t always because of the woman. In fact, men and women are both equally diagnosed with infertility.

Infertility is defined as being unable to achieve a pregnancy after one year if a woman is under 35 years of age, or for six months if a woman is over 35 years of age.

So if you think you might have a problem with infertility, where do you start? It can all be very overwhelming. There is a wealth of information available, but distinguishing fact from positive rhetoric can be confusing.

If you’re thinking about making an appointment with a fertility doctor, here is some information that can give you a leg up before you walk in the door.

These 11 items can help you understand the “big picture” of infertility and make navigating the process easier.

1. Find a doctor with whom you connect.

As you consider getting started, remember that you need a good partner in crime and someone that gets you. This is an important chapter in your life that connects you to your dream of a family. This doctor and health care team will lead you to achieving that goal, so it is critical that you have a bond of trust and caring.

2. Success rates are confusing.

Success rates are measured by your friends who sing the praises of their own success. They are also measured by your OB doctor’s recommendations; the U.S. government, which reports fertility clinics success in IVF; and the Society for Assisted Reproductive Technology, which provides detailed information on each center. Some centers have high success rates, which may reflect that they only take easier cases. Other centers may have lower success rates but deal with harder diagnoses. Every patient and medical problem is unique, so ask questions that pertain to you. Inquire about your doctor’s experience with your particular problem, as well as their success rates with women of your age. This is a big project and may require that you invest considerable finances, so don’t be afraid to ask hard questions.

3. We can work with your biology, but we cannot change it.

We can change many things, but we cannot change how old we are. We doctors have years of training and experience which allows us to be professional problem solvers and troubleshooters for complex medical issues, but we can’t change basic biology. Biology dictates that ovarian reserve declines with age, as does fertility potential in both men and women. Conditions like endometriosis and PCOS can be tempered, but not eliminated. While these biological facts of life cannot be changed, with a great team behind you there is a better chance of success.

4. Ouch! That is more than I expected.

The average cost of an IVF cycle is $12,000 plus $3,000-5,000 for medication. Across the country, that number will vary. The good news is that there are several avenues to curb the cost of treatment. Centers typically have multiple financial plans to consider. Some options provide a full refund if you do not deliver a baby, while others allow you to finance your treatment. Some centers offer a self-pay discount. Participating in studies may offer free or discounted treatment, while non-profits like the CADE Foundation and BabyQuest Foundation offer grants to those with infertility. Some couples are even crowdfunding their treatment on sites such as GoFundMe.com.

5. There’s no place like home.

Depending on where you live, state law, insurance mandates and even treatment availability can help or hinder your efforts. States with insurance mandates are by law required to provide coverage for fertility treatments. If you’re not sure where your state stands, take a look at the Fertility Scorecard by RESOLVE, The National Infertility Organization. State law concerning third party reproduction such as surrogacy or donor egg can vary greatly — in Illinois surrogacy is legal, while in New York it is illegal to compensate a woman for being a gestational carrier. It is critical to do your legal research prior to treatment to avoid legal battles now or after the baby is born. Lastly, fertility centers are not equally distributed in location. In California there are 142 fertility specialists, while in Wyoming there are zero.

6. “Twins would be awesome!”

Yes, twins would be wonderful, but one baby at a time is safest. How many embryos are transferred during IVF is determined by the doctor and the patient. As doctors we share our recommendations, but the final decision is usually decided by both the patient and the doctor. Our goal as physicians is to deliver one healthy baby. For some patients, transferring more than one embryo may be optimal when taking into account age, diagnosis and finances, but for others, a single embryo may be best. Single embryos can also split and become identical twins. If you are averse to the possibility of twins or triplets, opt for a single embryo transfer.

7. Stop trying to be Superwoman and get support.

Ask anyone who has been through it — infertility treatment is no cake walk. Yet many women and couples avoid talking to a counselor, don’t join a support group and keep their journey private. There are no awards given for suffering alone. Being strong is knowing when you need to take care of yourself. Talk to a fertility counselor who specializes in helping couples and individuals thrive through the unique challenge of infertility. Or find someone to confide in to share some of the emotional parts of this process, which can be priceless. Many fertility centers have their own programs to support patients in treatment.

8. Are you crazy?! I would never use an egg donor!

You may need to consider other options to have a family. After three unsuccessful intrauterine inseminations, the odds of a pregnancy via IUI go down. If you have had several pregnancy losses and/or multiple failed IVF cycles, it may be time to look at other options. For some, third party reproduction options such as surrogacy, donor egg or donor sperm can allow couples and individuals to overcome their infertility struggles. Undergoing genetic testing or screening embryos through preimplantation genetic diagnosis (PGD) prior to embryo transfer may reveal new information. Adoption is also an option to consider. The question is not IF you will have a family, but how you will have a family.

9. Give me a break! Actually, taking a break from treatment can be a good thing.

Feeling exhausted and at the end of your rope? Yes, fertility treatment can do that. Taking a break to re-energize can really help. Stress does not cause infertility, but it does affect your fertility potential. A scientific study found that women whose enzyme alpha-amylase levels, a stress-related substance, were in the highest third had more than double the risk of infertility. If you need a break — even if it is only for a month or two — take it.

10. That is why they call it the “the practice” of medicine. It is ever-evolving.

In the world, there are always advancements and changes presenting new medical options. The practice of medicine could not have advanced to what we have today without trials, studies, and research. Around the globe, there are people hard at work trying to uncover data that can make pregnancy and parenthood a reality, no matter what the infertility issue. As a physician, it is critical to stay up-to-date on new medication and techniques to help patients conceive. When you are talking to a fertility doctor, ask them about the new techniques that the practice has adopted recently.

11. Fertility centers are not all alike, so look around.

Each fertility center is different, and it is important to consider those differences during your research. Practices may have multiple physicians, each with their own specialties and interests. Facilities will also vary greatly. Does the center have an IVF lab in their office or is this outsourced? Do they offer genetic testing/PGD? Do they have a research department? Take into account history, experience, services and staff when selecting a fertility center. It shows breadth and depth of an organization.

Don’t forget to be your own advocate. Ask yourself. Ask Dr. Google. Ask your physician.

You will find your way. Just don’t give up.