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.

Save It For Halloween

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So let’s say you’ve been trying to get pregnant for a while. Maybe you’re starting to think about the possibility of going for fertility treatments. Maybe you’ve already started gathering information about fertility doctors in your area. Maybe you’ve even taken that first step into the fertility clinic. Now you start to tell people about your infertility experience.

Caution!! Danger ahead!!!

Save the Fertility Horror Stories for Halloween

(First published on The Fertility Authority.)

You will hear some strange things from people. You’ll hear some horror stories. This is not a camping trip. This is not Halloween. Don’t let them scare you. Just keep an open mind … and at least one ear closed. Most importantly, make sure you keep your little voice of reason in the back of your head in perfect working order:

  • “You’re not doing those fertility drugs are you? My neighbor’s sister’s daughter did them and had six babies!” (This is probably a lie. Or at least an exaggeration. There’s very little chance that this woman knows much of anything about her neighbor’s sister’s daughter. If her neighbor even has a sister. If this woman even has a neighbor.
  •  “Oh my gosh. Those shots are so painful! I hate needles. Every night I had to wait for the nurse down the block to come home from work to give me my shots. And I still passed out twice!” (I don’t have a problem with needles. This lady is a whack job. She freaks out about everything. She has a panic attack when her morning newspaper lands on the grass instead of the driveway. Why would I assume she picked this moment to finally be rational? And I doubt she really passed out. She just thought it would make her melodrama sound more melodramatic.”)

You have enough going on in your life. If you can’t dismiss these horror stories altogether, at least push them to the back of your head until Halloween. Then get a flashlight, go onto the front lawn, yell “Story Time!” and scare the daylights out of the trick-or-treaters.

 

A Company's Role In Reproduction

You’ve heard the news this month about the two Silicon Valley giants, Apple and Facebook, offering to pay for female employees to freeze their eggs. This recent announcement has brought up some differing opinions on a companies role in reproduction. Read the article below from Fast Company on two women’s perspectives on the case for and against.

The Case For and Against Freezing Eggs, From Women Who’ve Made The Choice

Does the company benefit of freezing one’s eggs give a woman more control, or is it just sidestepping a bigger issue?
(Published on Fast Company by Sarah Elizabeth Richards)

News that tech giants Facebook and Apple would cover the cost of egg freezing for female employees has generated a tsunami of commentary on whether the perk genuinely helps women or is simply a distraction from making real family-friendly changes in the workplace (it should be noted that both companies already have some of the most generous leave polices in tech with Facebook providing four months of paid paternity and maternity and Apple allowing expectant mothers four weeks of paid leave prior to giving birth, and up to 14 weeks of paid leave after the baby arrives).

But the polemical has ignored the fact that freezing one’s eggs is a complicated personal decision in which work is often a small factor.

In one study of nearly 200 women who froze their eggs at New York University Langone Medical Center, 88 said they were delaying motherhood because they didn’t have a partner; only 19% said they might have had children when they were younger if their workplaces had been more flexible.

Yet as other companies surely follow Facebook and Apple’s lead, it’s unknown if more women will take advantage of the chance to stash away some frozen eggs in the hopes of having biological children in their late 30s and beyond. The government doesn’t publish statistics on how many women have undergone the fertility preservation procedure since it became available in the U.S. a decade ago, but several fertility clinics report their caseloads have doubled in the past few years.

What role will work play when women consider freezing their eggs?
Here are two women’s perspectives on the case for and against:

The Case For
Anita S., 40, emergency room physician, Philadelphia

“I’m lucky I was able to freeze my eggs when I did. If I’d had a partner in my 20s, I’m not sure I would have used work as an excuse to wait to start my family. But years of medical school and training definitely played a role in why I’m single.

I’d always hoped to meet someone during my residency, and it was really hard to find time to make dating a priority–never mind moving around the country. I had several relationships in my 30s, but none lasted more than a year. Even now I have to work late nights and weekends, and it’s a struggle getting guys to be patient with my crazy schedule.

But I still hope to fall in love and create a strong marriage and family. I want my children to have a father and don’t like the idea of having a baby on my own. That’s why I did two rounds of egg freezing at ages 37 and 38 and banked 23 eggs. I was fortunate because the science was available, and I could afford it. I didn’t ever want to have regrets.

We all know we should have our kids young, if we can. But if you’re 30 and think that you’re going to spend the next few years building your career and won’t have a lot of time to date, then you should consider freezing. A lot of women hold off because they don’t have the money, but it’s a no-brainer if your company will pay for it. Seriously, why wouldn’t you give yourself every opportunity for a healthy baby in the future? Hopefully, your life will work out the way you want, and you’ll never have to use them.”

The Case Against
Meredith M., 32, editorial director, Los Angeles

“I’m in a serious relationship and hope to start my family within a few years. But even if I wasn’t, I don’t think I’d ever freeze my eggs because I feel compelled to adopt, regardless of my fertility. I would never go to such extreme lengths to preserve the option of having theoretical children when there are living people on this earth that need homes.

I also think we’re doing a disservice to women by glossing over what egg freezing does to your body. You’re taking massive amounts of hormones to grow eggs that your body couldn’t do on its own. You can’t drink or exercise during the process, and you risk over-stimulating your ovaries and causing hellish mood swings. You have to undergo surgery. We don’t know the long-term risks, either.

This is a serious medical procedure. It definitely doesn’t belong in the debate on work-life balance. Even if I got offered my dream job around the time I wanted to start my family, I don’t think I would put off having kids. I grew up in a culture in which my mom and my friends’ moms were able to have careers that mattered to them. But they had to juggle a lot. Our generation has a responsibility to hold companies responsible for making space for families.

I don’t think egg freezing levels the playing field for women. In some ways, it puts more pressure on us. If you have the chance to freeze and instead decide to have a baby, and don’t, will you get passed over for a promotion? This is a good example of companies getting it wrong and expecting women to be grateful. We still have to fight for serious changes so women don’t ever have to choose.”

(Sarah Elizabeth Richards is the author of Motherhood, Rescheduled: The New Frontier of Egg Freezing and the Women Who Tried It).

PGD on 60 Minutes

60 Minutes aired a feature story yesterday on PGD (preimplantation genetic diagnosis) — a medical testing option that can be used during IVF procedures to test embryos for genetic disorders. PGD makes it possible for couples or individuals with serious inherited disorders to significantly decrease the risk of having a child who is affected by the same disorder.

At The Center, we offer PGD as part of our commitment to staying at the forefront of evolving cutting edge technologies. We combine our expert technology and IVF experience with access to advanced genetic testing and counseling – and the result is a program – the first and among the only ones offered in the state of Connecticut – which holds the promise of reducing the incidence of genetic disease. You can read more about PGD here.

If you missed the 60 Minutes episode, see the video below.

Fertility Preservation Options for Men

Fertility preservation, when done prior to certain cancer treatments, is an important but sometimes over-looked part of the cancer patient’s experience. Last week we posted information on the fertility preservation options for women. Today we are focusing on the options for men. See the article below for more information on  or watch the video here.

What are the main options for a pre-treatment adult male?

The options for men are sperm banking which is the most common, testicular sperm extraction which is little bit more in depth and can be done before or after treatment, and testicular tissue freezing which is very experimental and not commonly done in a lot of different places and you‘d have to work with urologist that’s comfortable doing that.

Sperm banking is the most common option for men. It’s readily available. There’s not a large time frame that needs to happen. Generally, men are referred to the urologist and able to be seen rather quickly. The urologist is able to do a quick exam and then able to have them produce a sample. So there’s not a lot of time that’s involved and men can do several samples before their actual treatment starts.

Say a man has a week before treatment starts, he might be able to do two or three samples before that. Even if he’s not able to do several samples, he’s generally able to, at least, do one sample before treatment starts and there’s not a lot of time that’s involved with that. They’re able to bank whatever is available. With advances like ICSI through in vitro fertilization, men don’t need several samples in order to achieve a pregnancy later on. They just really need a few good sperm.

Testicular sperm extraction is an outpatient procedure that an urologist would do where they actually go in and look through the testicular tissue to see if they can find any sperm and to try to extract those sperm in order to use it for ICSI to achieve a pregnancy. And then testicular tissue freezing is actually where they would go in and remove tissue and freeze it, hopefully prior to treatment, but it is very experimental.

Vegetarian Diet & Fertility

This week, the media is highlighting a new study that claims that being vegetarian or vegan could lead to lower fertility among men. So, what are the facts? Read the article below.

Does Being Vegetarian Really Lower Your Fertility?
(Published in Care2 by Steve Williams)

3117942.largePresented at the American Society for Reproductive Medicine’s annual conference this month, the research by Loma Linda University Medical School in southern California reportedly compares results from sperm analyses that were carried out during 2009-2013. The research involved 443 meat-eaters, 26 vegetarians and five vegans and was looking at sperm motility, concentration and overall health.

The researchers say they found that vegetarians had an average sperm count at the 50 million/milliliter mark. The five vegans had a similar level. This  is in comparison to meat eaters, who reportedly had a figure closer to 70 million/milliliters. The researchers also say that vegetarians and vegans had a lower sperm motility than meat eaters, 33 percent compared to 58 percent.

The researchers note that the lower results from vegetarians and vegans do not put those members of the sample into the infertile range. They would fall within the “normal” bracket, but at the lower end of the scale.

Researcher Dr. Eliza Orzylowska told the Telegraph: “We found that diet does significantly affect sperm quality. Vegetarian and vegan diets were associated with much lower sperm counts than omnivorous diets. Although these people are not infertile, in is likely to play a factor in conception, particularly for couples who are trying to conceive naturally, the old fashioned way.”

“The theory that we have come up with is that vegetarians are replacing meat with soy, which contains phytooestrogens and could be affecting fertility,” adds Dr. Orzylowska. “For children who have grown up with those kind of diets, it may have impacted on sperm quality from puberty.”

Dr. Orzylowska also reportedly suggested that another reason for the difference in sperm count and motility might be due to a B12 deficiency in vegetarian and vegan people.

As the research is being presented at a conference and does not yet seem to have been published, we are forced to react only to the comments and reports on that research as we know them.

By any stretch of the imagination, the sample size comparing vegetarians and vegans to meat eaters is low, and while this was a systematic analysis of over four years worth of data, it is incredibly limited in its scope and gives us nothing of itself that is convincing about vegetarian, vegan or even meat-eating diets. That’s not to say it isn’t interesting, but as the researchers themselves will admit, this is a starting point and not a definitive answer surrounding soy and male fertility. To try to find a more concrete insight of this subject, we have to look at the existing body of research and why soy has been suggested as a factor in lower fertility among men.

It is true that when in the body, phytoestrogen (essentially plant-derived estrogen) mimics the female sex hormone estrogen and under certain circumstances and when consumed in very high quantities — one study identified a man as consuming three quarts of soy milk a day for six months, which far exceeds most consumption by vegans and vegetarians — can have the potential to affect our sex hormone balance. For instance, some studies have shown that it can lead to a decrease in libido and even erectile dysfunction in men, though there’s no concrete evidence of more pronounced changes like men developing breast tissue.

When it comes to fertility, a study in 2008 of 99 men who attended a fertility clinic in America found a similar pattern as the above: the more soy that a man tended to eat, the greater the reduction in sperm quantity and motility. However, the researchers in that case stressed that the reduced fertility tended to overlap with the men in the sample being overweight, which is a known factor for a drop in fertility in both men and women. At the time it was acknowledged that, given the fact that soy is a staple across Asia, if soy were to reduce fertility indiscriminately, researchers would expect a more pronounced pattern of fertility reduction, but there isn’t one.

Indeed, soy consumption has not been proved to have a big impact on sex hormones in most healthy men or even primates and for the vast majority of men, consuming normal to moderately high levels of soy appears safe. In fact, it might carry some benefits, such as possibly reducing the risk of prostate cancer and cardiovascular disease.

So the current body of evidence that we do have does not support the stated hypothesis, but unfortunately it is one that the media has focused on and is repeating without proper context or balance.

While it may ultimately be that phytoestrogens do play a part in reducing fertility for some men (though again, not to the point of making them infertile), and probably when combined with an underlying health condition like obesity or, for instance, diabetes, it remains the consensus that for the vast majority of people soy is an acceptable, even potentially healthier, food choice.

The Moment I Knew

What was the moment of recognition when you knew you were fertility challenged? Kristen Darcy, author and fertility coach, is inviting you to join in the conversation and share your story about “the moment I knew.” Read her article below.

The Moment I Knew About My Fertility Challenges
(by )

October is upon us and so are the creepy, ghoulish, dark Halloween decorations displayed everywhere. I’ve read that Halloween sales totaled 6.9 billion dollars in 2013 or $75 per capita. Halloween spending even beat out the Easter bunny. I am so curious why we have embraced this eerie event. Maybe it’s because we can pretend for an evening to be someone else?

So here’s another statistic that’s scary when you first hear it:
Twenty-five percent of infertile couples have more than one factor that contributes to their infertility. That means a quarter of all couples experiencing fertility challenges will have more than one issue. YIKES, EEK!

Let’s share and scream this month by joining in the conversation about “the moment I knew.”

What was the moment of recognition when you knew you were fertility challenged? Where were you? Were you alone? In a doctor’s office? On the phone? What did you do? That moment of knowing is a demarcation line in your life. In a way, your innocence was taken and life as you dreamed was forever changed…

Share with all of us through the hashtag #TheMomentIKnew and then call into Tell All Tuesday this month to gain comfort, support and understanding. You’re not alone.

Tell All Tuesday
October 28th at 7pm
Spooky! Thoughts that Go Bump in the Night! How to practice re-wiring your thoughts by observing your emotional triggers!

#TheMomentIKnew was during the post-coital exam when I learned there were two lonely sperm swimming in a circle. The floor feel out of the room. I wanted to run out naked from the waist down because all I wanted to do was cry! The doctor wasn’t an RE, but an OBGYN and it wasn’t handled well at all. And as the saying goes, it was all down hill from that moment on. I was part of the 25% referred to above.

With Halloween coming, let’s share and release the hellishness of the diagnosis of our fertility challenges.

RSVSP at Kristen@kristendarcy.com

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.