Happy Holidays to The Non-Exclusive Club of Kindred Spirits

Virtually all of my patients at the Houston Fertility Center come in feeling alone, at least at the start of their fertility journey. Occasionally I receive "Dear Dr. Kristiansen" emails, mostly from women who live in fear that their situation, their particular cause of infertility, is rare and untreatable. And the holidays is by far the hardest time of year to have an overwhelming feeling of being left out in the cold. But things are a lot better now than in past years, when infertility truly wasn't something anyone talked about beyond clinic hallways.

In this blogpost for Huffington Post, author Leslie Goldman sums up the thoughts that run through so many patients' minds: "Why not me?!" Just as Leslie found out when she dared reveal her struggles with getting pregnant, there is in fact a huge number of people who are going through the same or similar. She finishes up her post with experienced advice for those who are still trying to conceive: "Drink wine. Lots and lots of wine. And enjoy it while you can."

For this holiday season, I encourage you to let things go a bit. If you're in the middle of an IVF cycle or other treatment, follow doctors' orders, of course, but also take advantage of every single opportunity allowed to enjoy yourself. Any questions about whether it's okay to do this or that in mid-cycle? Just ask. If you're not in the middle of treatment, then try your best to shelve the sense of urgency. Breathe as much as you can, both literally and figuratively. After the holidays, you can get right back on the path (if you want) or start thinking about new roads to travel.

But for now, I wish you all peace.

~ Dr. Sonja Kristiansen M.D.

Why I'm Grateful For My Own Lab: Twins from Stolen Sperm

In the United States, we're relieved to be free of a strong government hand in private affairs like choosing to use reproductive medicine. Occasionally, though, my inbox is filled with rather frantic "Did you see this, Dr. Kristiansen?!" emails bearing news stories that remind us of why some regulations are necessary.

One such story -- about accusations of stolen sperm and unwanted fatherhood -- is coming out of Houston right now.

A young man is taking a Houston area fertility center to court, saying they never actually had his consent to use his semen for IVF that eventually impregnated a former girlfriend. This news video on Click2Houston.com has interviews of both the man -- now the father of twins -- and a representative of the fertility center.

Stories like this are fortunately rare, but they still play on the fears of fertility patients. It's understandable -- not all fertility specialists use their own labs. In fact, Houston Fertility Center's own in-house, state-of-the-art laboratory has provided embryology and related services for physicians from other clinics for years. Being able to rely on my own lab provides me and my staff with an extra layer of confidence in the fertility services we provide to patients.

While things in general are far more easy-going in the U.S. than in other countries, reputable fertility centers honor both the requirements and recommendations of existing regulatory bodies. This young man's experience clearly demonstrates one reason -- no one should be cornered into parenthood.

Rules about patient consent and the use of tissue (which includes sperm and eggs) can add a layer of cumbersome bureacracy to the IVF process. Now and then, a patient will complain, "But Dr. Kristiansen, some of these requirements seem over the top and unnecessary!" My response? I am grateful to have my own laboratory serving Houston Fertility Center, and for staff who are vigilant in maintaining compliance with regulations for the benefit and well-being of everyone involved.

Things You May Not Want to Hear When You're Trying to Get Pregnant: Stop Drinking Alcohol

"Anything but THAT, Dr. Kristiansen!" I've heard those very words uttered by patients in my office at Houston Fertility Center a few times. There a number of recommendations I might make for optimizing attempts at getting pregnant -- some of those requests are not welcomed by patients!

Here's one: Stop drinking alcohol.

Now, that's a pretty stringent version of what I actually recommend. That blogpost, "TTC with IVF? Skip the Alcohol Tonight" was published on New Year's Eve 2009. Nothing about the information in the links therein has changed: subsequent research bears out the conclusion that alcohol doesn't do you a bit of good if you're using IVF to conceive. In fact -- and there are plenty of theories but no certain, understandable reason yet -- drinking alcohol might be the thing that tips the conception scales against you.

Most recently, clinical researchers published in Obstetrics & Gynecology, the American College of Obstetricians and Gynecologists' journal, that enjoying as few as 4 drinks per week reduces your chances of IVF success. Interestingly, that holds true for couples as well as women who were surveyed prior to going through their first IVF cycle.

As I said, some Houston Fertility Center patients bristle when I suggest they stop drinking alcohol while trying to conceive. I'm sure the same is true in other fertility specialists' offices. But taking charge of your reproductive health means holding yourself accountable -- a little firm but positive self-talk might be in order. If it feels easier to ponder cutting back instead of quitting altogether, try that instead and use the less-than-four-drinks per week as a gauge. Or tell yourself that you're training for parenthood, a time when the idea of drinking more might seem appealing but is really at cross purposes with your goals -- just like during an IVF cycle.

In the end, you'll want to look back on your trying times and be able to say you did everything you could to have that baby.

~ Dr. Sonja Kristiansen M.D.

IVF Myths: You'll Never Be Able to Afford It

My take on another IVF myth, written about by Dr. Kathy D. in a blogpost on Pure Natural Mom:

Myth #3. "IVF is expensive and not covered by insurance"

Money is of tremendous concern to everyone today. One of the first questions I'm asked in a patient's initial consultation is, "Dr. Kristiansen, how much will this cost?"

IVF can certainly be one of the costliest services most people will ever pay for, but when you look at where your household spends its money -- often without much second-guessing -- you can start seeing the expense of fertility treatment as one of the greatest investments of your whole life.

And the truth is that not only will many insurance plans cover some, if not all, parts of the IVF process, many employees have better coverage than they think. There are two different decision-makers in the insurance benefits arena: the insurance company itself and the employer who chooses from among available plans for their workers. Besides contacting the insurance company to inquire about your coverage specifics, talk to the staff responsible for managing your employer's insurance plans. I have specialized staff at Houston Fertility Center who can help you work with whatever insurance plan your employer has chosen.

When you consider how much you'll pay for a car, real estate, travel -- none of which can be compared to getting pregnant and having a baby -- the typical price of a single IVF cycle doesn't seem quite as significant. Some clinics like Houston Fertility Center are able to offer price variations throughout the year. For example, right now, we're offering IVF cycles for $9,250, a considerable discount off our usual rate, through November 30th, 2011. As a way of thanking public servants, I also offer discounted services to teachers, police officers, and fire fighters during different times of the year (like summers, so teachers can benefit during their vacation season.)

The important thing -- which Dr. Kathy D. alludes to in her blogpost -- is to not stop short of getting all the facts. You wouldn't base all of your hopes and dreams for your home and lifestyle on a few personal stories heard on the Internet. Find out for yourself if IVF is out of reach. And if it is, we'll help you find options to make it affordable.

~ Dr. Sonja Kristiansen M.D.

Get Your OB On Board: Regular Menstruation Does NOT Equal Fertility

"Getting your period" is a big event for girls. And many a parent or counselor has tried to console young women's related worries by offering comments that equate menstruation with motherhood. It's understandable that so many of my patients at Houston Fertility Center grew up with the message that if you're menstruating, you can get pregnant.

Your OB/Gyn may even tell you something similar. After all, it's basically true for the average woman with average fertility. But if you're one of the many women who has regular menstrual periods but can't seem to get pregnant, you might be feeling dismissed by your primary care doctor's casually hopeful remarks.

Once you have reason to understand more than the average woman about menstruation, you'll find that the connection between periods and fertility is a bit more complicated. Your OB/Gyn might do a great job of providing you with that in-depth education about the reproductive details of menstruation -- but you'll probably first have to request more explanation. And never hesitate to ask! You definitely won't be the first patient in my office to say with great frustration, "But, Dr. Kristiansen, I have a period every month!"

Your body's menstrual and ovulatory cycles are absolutely linked, but they are also separate. Both cycles are the result of communication between several organs and glands which emit different levels of various hormones, producing a cascade effect that's supposed to be ongoing. There are so many different points along the path where something can go wrong. A small, seemingly insignificant glitch in one spot -- whether it's a gland that produces too much or too little of a hormone, or an organ that isn't responding to its cues -- winds up disrupting the whole fertility process.

Simply put, and as many Houston Fertility Center patients will attest, women can have regular periods and still be infertile, for many reasons -- some structural (as in blocked fallopian tubes), some hormonal (sometimes resulting in anovulatory bleeding, in which no eggs are being released).

It's pretty complicated. And if your OB/Gyn is more OB than Gyn (they're really not all the same!), then their focus in both training and, more importantly, experience may be on helping women manage their pregnancies and deliver their babies -- not on the many things that can go wrong when you're trying to get pregnant.

So if you've heard "If you're having a period, you have nothing to worry about" from your doctor, he or she may not be putting you off or ignoring your worries. It might just not be their area of expertise.

This is the 3rd post in a series called Is Your OB On Board With Baby-Making?
Also see: Get Your OB On Board: Time Is (Almost) Everything

~ Dr. Sonja Kristiansen M.D.

Fertility Treatment & Wellness Go Hand in Hand

A recent article on Fertility Authority reminds fertility patients to get their flu shots (and be sure you get the shot, not the nasal spray!) The article reminded me about all the preventive health measures that might get back-burnered by patients.

Many new patients at Houston Fertility Center enter fertility treatment territory in great physical shape and feeling emotionally hopeful. Some arrive at their first consultation already dragged out, physically and mentally, by their months or even years of trying to conceive. Naturally, their first question is, "Dr. Kristiansen, what can we do to finally get pregnant?" My first recommendation for all of them is to optimize their fertility at baseline by getting or staying healthy, whatever that means for them.

Once you enter fertility treatment, you could find your calendar newly crowded by the required exams and office consults, by scheduled at-home injections and tests, even by scheduled intimate time with your partner. It's easy to lose track of all the good things you've learned to make a regular part of your day-to-day experience to keep yourself feeling fit and well.

Fertility treatment and preventive health measures are different yet interactive. Many facets of your fertility in general can change, for better or worse, as your overall health changes. So you could say your efforts at maintaining wellness -- balanced, healthy diet, moderate and regular exercise, relaxation activities, managing exposure to toxins -- are even more important during this point in your life.

So do remember your flu shot and all the other good things you do to stay healthy. And if you haven't yet instituted preventive health activities into your life, now's the time. It's an investment not only in your wellness, but your fertility, too.

~ Dr. Sonja Kristiansen M.D.

IVF Myths: You'll Wind Up With a Football Team

More debunking of myths about IVF, referring to a recent blogpost I found by Dr. Kathy D.


Myth #2. “IVF produces twins, triplets and more”


Bearing in mind that this is a quick blogpost and not a full-on journal article on the subject, Dr. Kathy D. is right about the age of a woman's eggs. But I want to interject that there are many more facets to consider when trying to institute how many embryos should be transferred in an IVF cycle. So in fact, the decision to use single embryo transfer (or SET) is not as clear cut as it sounds.

Age of the hopeful mother is a huge factor, as is her overall health. Possibly the even greater factor we take into account is the grade of the embryo.

Embryos are graded by observing several parameters. For a detailed but patient-friendly description of the embryo grading process, check out this Healthline article.

At this week's annual gathering of the American Society for Reproductive Medicine, the question of how many embryos to transfer was addressed again. It is, indeed, still an unanswered question -- but we're getting closer!

One poster presentation, titled simply "Optimum Number of Embryos to Transfer on Day 3 to Achieve High Pregnancy Rates and Low Multiples Rates Based on Patient Age and Embryo Quality," looked at 717 ART cycles at one IVF center with Day 3 (post-fertilization) transfers and their outcomes. Their conclusions:

Patients < 35 yrs; transfer of 1 Top quality embryo is recommended. Addition of a second embryo for transfer increases twin rate without significantly increasing pregnancy rate. Patients 35-37 yrs; transfer of 2 embryos is recommended to achieve desired pregnancy rate, however, risk of multiples needs to be addressed particularly if Top quality embryos are transferred. (L. Hill, S. LaBrie, P. St. Marie, K. Lynch, E. Tougias, M. Arny Baystate Reproductive Medicine, Baystate Health, Springfield, MA)

Researchers are continually trying to determine the best culture medium, the best time period, the best tools for helping fertilized eggs grow into the healthiest possible embryos, but there are many things out of even the best embryologist's control. Still, conscientious fertility specialists, like the staff of Houston Fertility Center, stay on top of the latest findings and apply them in their labs and clinics.

Whether your specialist is in Houston or New York or any other location, we're all interested in how to make pregnancy a reality for our patients. So success -- a healthy singleton baby -- becomes more quickly achievable all the time.

IVF Myths: It's "Last-Ditch" Fertility Treatment

When it comes to fertility treatment, IVF (in vitro fertilization) is indeed the most costly and invasive technique available. But it's also very successful -- in many cases, the only thing that works -- for helping men and women who might otherwise not have a chance at having biologically related children.

I recently ran across this blogpost that nicely sums up a few of the myths about IVF. The author, a physiologist and reproductive endocrinology researcher, also has personal experience with using IVF to build her family.

I'm going to write my own responses to Dr. Kathy D's debunking of the myths she calls "most common" through the next few posts.

Myth #1. IVF is a last-ditch effort to become pregnant

She's correct in her responses to this myth! But I'll add that for many patients, IVF is definitely "a last-ditch effort."

For some infertile patients, like those described by Dr. Kathy D., IVF is the only way conception is going to happen. In those cases, heading straight for IVF first is sensible. But for most fertility patients, making the choice to use IVF instead of, say, intrauterine insemination (IUI) is definitely a step that feels like the "final straw" in a series of attempts. In fact, this patient page on "Preparing for IVF: Emotional Considerations" puts it succinctly, saying that for most people, IVF is "the last, best option for having a child."

No experienced, qualified fertility specialist will tell you that IVF (or any other treatment) will definitely result in pregnancy. But it is true that IVF, in particular, helps us get around the greatest number of obstacles and barriers of the most severe nature. So it's no wonder everyone thinks of it as "last-ditch"!

When to recommend IVF for a fertility patient is part of the art (and I don't mean Assisted Reproductive Technology here) of medicine. Some of my colleagues will recommend IVF a little too soon in a patient's fertility treatment journey, while others might wait until it's only going to work with a third-party involved (most often, an egg donor). It takes years of experience on top of specialized training, plus an excellent laboratory team (like the staff I'm grateful to have with me at Houston Fertility Center) to know when a patient's family-building needs will be best served by IVF versus other techniques.

So this myth is actually reality for some patients. And while your attitude and feelings toward whatever medical treatment you choose is important, and timing is a crucial factor in fertility treatment success, in the end, whether it's "last-ditch" or not -- IVF works.

If You're Trying to Conceive, Skip the Triathlon. Try Yoga.

Along the same lines as there being no magic to getting pregnant, whether with IVF or without treatment, there's also no perfect exercise that will lead to conception.


But... yoga comes close.


Conception (and pregnancy) have much to do with balance. Not too much of this, and just the right amount of that. Your fitness factors, including your weight and body mass index, flexibility and strength, all play roles in keeping your endocrine system humming along.


Choice of exercise is a very personal thing. You should take several things into consideration when choosing the type, level, and frequency of physical exertion you engage in, whether you're trying to conceive or not. For example, running isn't the safest idea for everyone, but for some, it's perfect. Swimming is great, but not everyone has regular, easy access to a pool. The same could be said of biking.


As this article in The Windsor Star describes, yoga is about more than stretching and posing. If done well, yoga can both strengthen and relax your body, which is a state of being that facilitates hormone health.


You may want to avoid the most rigorous forms of yoga (there are many different versions), including the forms that are taught in studios heated above 90 degrees. And if you can find a yoga instructor who knows specific poses that are good for your reproductive organs, that's a bonus. (Here at Houston Fertility Center, we'll help you find one...)


Remember, you're looking for balance through activity.
Put your dreams of being a triathlete on hold until after the baby comes, but don't shelve your body's need to move and breathe.


~Dr. Sonja Kristiansen MD

Building a Family In Tough Times

The country's economy is struggling so much that women are quite possibly having fewer children as a result. A report published last month by the Centers for Disease Control likens the trend to the Great Depression's fertility rates.

My patients feel the pain. If getting pregnant the old fashioned way is harder now, imagine what it's like to need special fertility treatment in order to have a baby.

In that light, I'm currently offering a big discount on IVF: $7995 through November 30th.

Because Houston Fertility Center has its own state-of-the-art laboratory, I'm able to provide the highest quality reproductive medicine services at more affordable prices. And since this is the time of year when people living in the Houston area are caught between high electric bills (for air conditioning!) and impending holiday season expenses -- it seems like the best time of year to make family-building a reality for so many.

Hang in there!

~Dr. Sonja Kristiansen MD

When Egg & Sperm Don't Hook Up

It's pretty amazing what is still being learned about the most basic points along the conception trail. The big news recently is about a molecule that helps sperm cells bind to egg cells.

Researchers are calling it SLeX, short for sialyl-LewisX. Their study found SLeX on 70% of the 195 unfertilised eggs tested. If your egg cells don't have SLeX, sperm cells won't connect to it for the mating game. The best news: the authors of the study, who came from Britain, Taiwan, and the U.S., believe this discovery might lead to related infertility treatments in only about two years.

But what about in the meantime? While clinical diagnosis of this condition may be a couple of years away, the treatment for women with missing SLex is already available.

Intractytoplasmic sperm injection, or ICSI, is available for patients whose infertility is caused by lack of SLeX, as well as other causes. ICSI is one of assisted reproduction's most fascinating treatments -- a single sperm cell actually being injected into an egg cell. And while it may sound like science fiction, ICSI is no longer experimental. In fact, ICSI's been around for decades now and used with great success in conjunction with IVF. In 2008, staff of Houston Fertility Center had a related poster presentation accepted for that year's meeting of the American Society for Reproductive Medicine. Our study concluded that patients using ICSI had higher implantation rates.

One of the most incredible uses of ICSI is to treat even the most severe forms of male factor infertility. Since IVF with ICSI requires only one good sperm cell, the treatment has made biological dads out of men who previously had nearly no chance of having offspring.

Developments from our greater understanding of how SLeX can make or break conception attempts might lead to quicker, more direct diagnosis for couples with unexplained infertility. Every little detail makes a difference.

~Dr. Sonja Kristiansen, MD

Cancer & Infertility: The Good Part of the Bad News

We've known for a long time now that cancer treatment can save lives but also render survivors infertile, even completely sterile. Young people who were surviving cancer more often found their new lives had a huge gap: little to no chance of being a parent in the future.

Spurred by organizations like Fertile Hope and the Young Survivors Coalition, researchers began focusing on fertility preservation techniques and their usefulness for this population. We've come a long way with what we can offer both men and women who want a chance at family-building after they're cancer-free. (At Houston Fertility Center, we offer a number of these techniques and even have a site devoted just to deferring conception by way of preserving fertility.)

Now, it appears as though the numbers of women with infertility resulting from cancer treatment is bigger than we thought. A large survey study by the University of California, San Francisco (UCSF) has concluded that our previous understanding may have given women "unrealistically low assessments of their risks" for infertility.

Some of the salient points of this study:

*Acute ovarian failure (no longer having a menstrual period after chemotherapy) increases significantly with age at cancer diagnosis.

*For women who did not experience loss of menses, incidence of infertility increased significantly with age.

*The younger the woman was when diagnosed with cancer, the higher her chances of early menopause.

Learning that the impact of chemotherapy on fertility is greater than we assumed -- that's the bad news.

The good news? That we now have that knowledge and can let women and their oncologists know that the need for fertility preservation is more prevalent than we used to think.

Putting the Risks of IVF in Patients' Hands

Australia is home to some renowned fertility specialists. They've also developed a reputation for research on the offspring of IVF, and the most recent information is now being provided in brochure form to patients in Victoria. The brochure is produced by the Victorian Assisted Reproductive Treatment Authority, an Australian institute that helps regulate the use of A.R.T. in that country.

The news about how "The Children of ART" are doing is important to the patients I see at Houston Fertility Center (Here's a link to a related newsletter, now archived on CallDrK.com.) IVF has been helping people conceive babies for more than 30 years now, so current patients can benefit from long-term studies on their development.

So far, the news is overwhelmingly positive, as this brief, related news piece from the Herald Sun explains. One of the biggest hurdles to health for both baby and mom is multiple pregnancy (often a precursor to preterm and premature births), and the fine-tuning of IVF techniques has resulted in far fewer of those. The article also mentions parenting anxiety as being more prevalent in IVF mothers, but I'd wager there are some cultural differences there. Seems to me that in this day and age, most savvy moms have a lot on their plate to worry about, so some anxiety comes with the territory -- no matter how your baby came to be.

The data on a topic as broad as "development of children born from IVF" will always be changing and sometimes debatable. The important thing is that it's out there, that researchers are continuing to explore with long-term studies, and the information is in the patients' hands.

~Dr. Sonja Kristiansen

Get Your OB On Board: Time Is (Almost) Everything

Being in the right place at the right time can make a difference in your life. It's true for getting pregnant, too. And your OB/Gyn knows how key timing is to pregnancy and delivery.

Does your OB also know how time impacts your ability to get pregnant? If he or she doesn't, you should.

At Houston Fertility Center, I've heard from many new patients their personal reports of months, and sometimes years, full of worry that something is wrong -- all the while being told by their primary care physicians that the best thing to do is de-stress and have patience. Nothing's wrong. Relax and you'll be pregnant in time.

It's true that stress can be a fertility factor, since it wreaks havoc on your hormones, which can result in lessened fertility. But many patients have health conditions that might easily be diagnosed and treated so that conception and pregnancy can occur -- stress or no stress. (And if stress really is your primary fertility problem, there are plenty of recommended steps you can take to change that.)

There's one factor in the fertility equation that treatment can't do much, if anything, about: time and your age. And there's nothing that has a greater impact on your chances for pregnancy.

While we have incredible medical technology that can help women get pregnant all the way into their 40's, the natural fact is that women's fertility levels decline significantly as they get older. That means the older you are when you're trying to conceive, the more effort it may take. It also means your chances of conception get smaller.

Age and time are so important to fertility, experts recommend you consult a reproductive specialist if:

you haven't become pregnant after a year of trying and you're a woman who's younger than 35 years

or

you haven't become pregnant after 6 months if you're 35 to 39 years old.

And women who are 39 years or older should seriously consider talking to a specialist as soon as getting pregnant is a goal.

The American Society for Reproductive Medicine explains details of the age-fertility connection in their related booklet.

Besides the reproductive change that every female body goes through (and that actually begins long before most of us are aware of), many infertility-causing conditions are silent -- no symptoms to cause you concern, all the while the condition becomes a growing barrier to your body conceiving a pregnancy. If you have one of these barriers, which includes structural conditions, trauma, or infections, your own baseline fertility will quite possibly become worse over time.

If you've heard "Everything's fine," a little too often from your OB/Gyn, there's no harm in seeking a second opinion. You might benefit from some easy, inexpensive blood testing or semen analysis, or like some patients learn, it may only take a thorough medical history and brief educational tips on optimizing your trying-to-conceive efforts.

More of my thoughts about timing and conception:

Trying to Get Pregnant After 30 - Time to Panic? - a blogpost about how moving along with your plans is good, but stressing out about it defeats your purpose

Timing Is Everything: When You Want a Baby Later - a newsletter article on using ART to delay conception

a quick intro to Fertility & The Mind-Body Connection

~ Dr. Sonja Kristiansen MD

Is Your OB On Board With Baby-Making?

When questions about getting pregnant arise, most women first turn to their OB/Gyn. You probably even rely on your OB/Gyn as your primary care physician, especially if you have health insurance. Patients typically count on their OB/Gyns to alert them when it's time to see a fertility specialist.

Unfortunately, though, a lot of woman also find that their OB's may not act very quickly when the patient expresses more than just fleeting thoughts but worries about getting pregnant.

That's why I and many of my colleagues spend at least some of our time educating other physicians about the differences in fertility levels and about how those differences may show up in their otherwise healthy patients.

If you're not yet a fertility patient (and you may never have to be!), here are a few related basic points to look into and discuss with your OB/Gyn if your goal is conception:

How long have you been trying to conceive?

Do you know when your most fertile times are each month, based on your cycle?

Do you have any family members who had trouble getting pregnant?

And if you're in your mid-30's or older and are still thinking "maybe someday"... it's time to discuss plans now with your physician, even if you don't plan on putting it into action immediately.

Knowing when to seek care from a fertility specialist can really make the difference between having a baby or not. If your OB/Gyn doesn't know what to look for or doesn't ask you the above questions, start the ball rolling yourself.

How Do Fertility Patients Feel About Donor Anonymity?

I work in a medical field that is ripe with controversy at times. There's nothing casual about helping people try to create life. But I try to avoid bringing a sense of alarm to my patients, even when the news headlines are worrisome. I do think there's a place for staying updated, though, when the news is about laws that may find their way into how I practice reproductive endocrinology and how my patients' treatments will be impacted.

The most recent such item is a state law that's about to bump up against the way things are often done for patients who need third-party reproductive treatment. Later this month, the state of Washington will enact a law that chips away at the anonymity of egg and sperm donors.

Now, most fertility specialists and their patients have been sharing medical history from their egg and sperm donors. It makes good common sense in light of what we know about genetic transmission of many things. If you have a baby using an anonymous donor's sperm or eggs, you likely at least want to know if there are potential medical conditions that may show up in your child. But the sharing of identifying information about donors has long been handled case-by-case, depending on the needs and comfort level of the donors and the fertility patients.

The Washington state law requires that anyone who donates eggs or sperm must provide both medical history and identifying information. Also, children born from third-party reproductive techniques will now be allowed to obtain the donor's information from the fertility clinic once the child becomes 18 years old. However, donors can file a disclosure veto with the clinic that prevents the identifying info from being revealed to the offspring; only the medical history is mandated to be disclosed on request.

This is a first in the United States, but it's not a surprise. Adult donor offspring over the past few years have been gathering to make their needs known. In some countries, donor anonymity is already a thing of the past. America has been slow to legislate these unique and intimate relationships. Those of us impacted by such laws -- fertility specialists, patients, and their families -- will be watching with interest to see if Washington state encounters some of the challenges that have resulted in other nations, most notably a serious decline in the number of available sperm and egg donors. In the meantime, I will continue serving my patients' best interests by providing access to the highest quality fertility care available, including third-party reproductive technology.

~ Dr. Sonja Kristiansen MD

Here's what Huffington Post blogger Naomi Cahn had to say about the new law and its potential repercussions: The Biological Clock -- for Donor-Conceived Offspring?

Disney and I Both Hope You Won't Need My Services

The other day I saw a headline that really pulled me in -- "Disney/ABC Television Group Sponsors The American Fertility Association's Infertility Prevention Program".

The combined images of Disney and infertility were curious, indeed. When was the last time you thought about Mickey Mouse and fertility problems at the same time? But that odd juxtaposition is actually the result of positive progress in terms of fertility education.

Truth is, as a mother and physician, I hope you don't need the services of a fertility specialist, now or later. But another truth is explained in this recent blogpost on EmpowHer, "STDs and Infertility", where the author, Stacy Lloyd, explains how some young women are destined for infertility down the road. And it's those facts that make me smile when I read about Disney/ABC TV granting funds to the American Fertility Association (AFA).

The AFA works hard to not just support men and women who are struggling with infertility, but also to educate everyone about the realities of normal fertility. When young people arrive at the point in their lives when having a baby feels like the right thing to do, some are shocked to find that, all along and without their knowledge, their bodies have built up roadblocks against conception. Programs like the AFA's "Infertility Prevention Handbook" and their outreach gatherings at a broad variety of venues (even manicure salons!) can spread the message that steps can be taken before infertility is a fact in someone's life.

Since Disney definitely brings to mind "family", I think it's fitting that the corporation supports efforts at keeping couples from having to consult fertility specialists in the future.

You can find out more about the AFA at their website.

IVF Works for Hispanic Women, Too

Many of my patients may be relieved to hear this piece of research news from a colleague in San Antonio: Hispanic women are just as successful with IVF as are non-Hispanic anglo women.

There's no particular reason to believe otherwise, but a previous nationwide study that compared IVF success rates among women of multiple ethnicities showed that Hispanics were 13 percent less likely to have a baby following the procedure. They were, however, just as likely to get pregnant via IVF as anglo women.

The newer study is smaller and included only patients at one clinic. Also, nearly all the Hispanic study subjects were Mexican-American, unlike the larger, national study. It also showed that while getting pregnant is comparable in terms of percentages, Hispanic women were more likely to miscarry, although the researcher, Dr. Robert Brzyski, says that's likely a chance occurrence.

Of particular interest is the clear difference in cause of infertility between whites and Hispanics. White women had more endometriosis and Hispanic women were more often diagnosed with tubal factor infertility.

Tubal blockages and resulting infertility were the original reason for IVF being invented. As long as other factors aren't impacting a woman's chances for pregnancy success, using IVF to work around tubal factor infertility is very effective.

Like Dr. Brzyski's practice, Houston Fertility Center is in the middle of a richly diverse metropolitan area. With Spanish-speaking staff and educational efforts within the Hispanic community, we provide every opportunity possible to bring home the message to women that infertility is treatable. I'm happy to be able to add this piece of good news to our message.

~Sonja Kristiansen, M.D.

There's Something Special About Fathers-To-Be

I've worked for many years to help couples finally achieve their dreams of parenthood. As Father's Day approaches this year, I'd like to tell you what I think about the men who come into Houston Fertility Center. They arrive, nearly always with the other half of their team (wives or other partners), sometimes with great anticipation, but more often hesitantly.

I just can't say enough about how important it is that they are there, in my consultation office, sometimes in the exam room (depending on the couple's circumstances), learning how to give injections to their loved ones, sticking their own arms out for blood draws, enduring rather embarassing semen analysis, and just being a part of the team in general.

Hopefully by now everyone knows that infertility isn't "a woman's problem," that it's a situation resulting from many different conditions, statistically dispersed equally between men and women. There's virtually no good reason for a woman to go through infertility testing alone.

And no matter how forward-thinking and sophisticated and educated we are, it's still more difficult for men to discuss infertility -- especially with someone other than their partner -- than it is for women.

So here's to you, guys. Thanks for being part of the process and an active team player. We truly couldn't do what we do for the women you love without you.

If you're into social media, here's a treat for you guys: On Friday, June 17th at 2pm ET, RESOLVE is hosting a special Twitterview (sort of like a Q&A session by tweet) with Alec Ross, blogger at I Want To Be a Daddy.

Here's where you can get all the details on the Father's FriDay Twitterview -- http://www.mydestinationfamily.org/fathers-day-twitterview/

Happy Father's To Be Day,
~Sonja Kristiansen M.D.

Celebrate Fertility Freedom

The Memorial Day weekend brings to mind time off from work and fun in the sun. It's also a time to remember those who sacrificed so we could enjoy that freedom. If infertility's a part of your life, it might be tough to conjure up this feeling of freedom -- but if you look closer, you'll see it.

Did you know that in some countries, egg and sperm donors are required to reveal their identity throughout the process? Since anonymity is what many prefer, the result of such laws is far fewer donors and fertility patients who must travel internationally just to get pregnant.

Even tighter restrictions exist in other nations where donor eggs are simply not allowed to be used for fertility treatment. Just imagine -- the only options available for these women is adoption, unless they travel to access IVF.

Just as incredible: freezing excess embryos is of questionable legality in some places. Imagine being lucky enough to create many embryos in an IVF cycle, but the law requires you transfer them all, increasing your already upped chances for multiples to dangerous proportions.

The United States continues to demonstrate leadership in the championing of individual rights, and this includes the health care arena. Fertility treatment is a highly personal choice and, so far, it's still very much up to the patient and her physician to decide which treatments to use and when. You can find out about the services we're free to offer at Houston Fertility Center's website, http://CallDrK.com.

Have a great weekend, knowing you're free to choose fertility treatment and make other decisions that are right for your life.

~Sonja Kristiansen, M.D.

15 Is Magic Number?

Last February, I wrote that there's no magic to getting pregnant. That post was specific to "miraculous" fertility supplements. Well, now the news is full of "magic" again. This time, it's a Magic Number.

It's 15.

What kind of magic does the number 15 do for infertile couples?

A study that looked at 17 years worth of data concluded that 15 eggs retrieved in one IVF cycle renders the best chance of a live birth. Retrieving more eggs than that was linked to higher incidence of ovarian hyperstimulation syndrome.

The study authors failed to clarify that they were looking at conventional IVF cycles, not at cycles using very minimal or no ovulation stimulation medication. They did, however, tease out and present their findings related to the different ages within the study subjects. Specifically, the number 15 (eggs) did not make the live birth chances for women over 40 much better than otherwise. But as this article in the Globe and Mail suggests, a chance of live birth boosted by 4 percent might be inspiring to fertility patients older than 40.

I would remind patients that this is statistics, although well done. I worry about patients hearing these sorts of numbers and feeling stressed because theirs haven't "hit". As with so many aspects to treating infertility, your mileage may vary. We do everything possible to make each cycle safe *and* effective, and always, the outcome -- a healthy baby -- is our focus.

Tis the Season For Donor Eggs: Fresh or Frozen Work

In our minds, the concepts of fertility and eggs go hand-in-hand -- especially this time of year. Now, there's some very good news for those who want to either preserve their fertility for the future or otherwise have a Plan B in the freezer for subsequent treatment cycles.

Research performed in the nation of Cyprus has concluded that frozen donor eggs are just as likely as fresh to have a pregnant outcome.

Freezing sperm for later use is almost fool-proof, it's been done for so many years. Likewise, freezing embryos has become a far smoother process that ends in success more often than not. Freezing eggs, on the other hand, has been a challenge.

I've spoken often about the use of egg cryopreservation technology -- the tricky nature of the egg cell that makes the freeze-thaw processes so tenuous, and the hope that comes with improvements on the technique. In 2008, I was interviewed by Houston Business Journal about the intersection of related advanced reproductive technology and society. The ASRM has long been pleased to hear of frozen eggs being used for women prior to cancer treatment, but they've been slow to agree on the technique's use for women who aren't preserving fertility in the face of life-threatening illness.

Now, a new subset of patients are given hope by frozen eggs -- women who must use a donor's eggs to conceive a child.

Arriving at "Honey, I think we need to use donor egg to get pregnant" comes only after some serious thought about very tough topics. Women who've gone through menopause prematurely in life -- a huge psychological burden itself -- and older women who've deferred pregnancy find themselves giving thought to what most people don't have to: "I can either have a child who isn't genetically related to me, or not at all."

Using donor egg to get pregnant also adds to the financial burden of these patients, since they are required to meet the donor's compensation needs.

Among other benefits, documentation of frozen donor egg success increases the possibility of egg banks, similar to long-standing sperm banks, which might then make the entire process cost less. More directly for patients, knowing that subsequent cycles using their donor's frozen eggs can be just as likely to help them get pregnant as that first fresh cycle -- that's a huge load of stress taken from the patients' shoulders.


Any bit of hope we can offer to donor egg recipients is a good thing in my book. The news that frozen donor eggs can be just as successful in rendering a pregnancy is very good.

Personal Desires Still Strong During World Crises. And That's Okay.

As I write this blogpost, I recognize that there are many people in the world trying to survive dire circumstances. And I suspect that many readers who are infertility patients might be experiencing twinges of related discomfort.

For example, the other day I read a Facebook post from someone expressing a sense of guilt over how good her life is compared to people in places like Japan and Libya. She revealed her true feelings: that she was having a hard time enjoying the excitement of an upcoming, hard-earned trip to Disney with her family, because she was so acutely aware of the world's distress.

As you might imagine, her friends responded with comments supportive of her desire to be happy. As one posted, "Nobody in Japan wants you to be unhappy!"

With infertility, the pain you feel is most often hidden from the world. You don't want to be the one who brings sadness into a baby shower. You'd rather friends not see the hurt on your face while they chat about their little one's latest antics. The very fact that you keep grief a secret can compound your sense of isolation, which makes a little pain feel overwhelming.

On the other hand, just as we realize how much worse things can be for others -- as in the case of so much recent news from abroad -- you don't begrudge your friends' pleasure at being new parents.

The bottom line is that we are all human, and we all have drives, the strongest of which is to have a baby. We cannot all feel direct empathy for everyone, but we can strive to understand and be sensitive toward each other. In truth, we really do want everyone else to be safe, happy, and have their hearts' desires.

As many of you are, I am praying for people around the world, for peace and restoration in their lives and communities. I also continue on my personal path toward making life better for myself and for those directly around me, including my patients, because that's where it all begins.

How Many IVF's Is Enough?

Yesterday I wrote about the importance of perseverance in fertility treatment. And in light of research that says "more IVF attempts equals greater chances of success" plus my concurring with Dr. Rosen's comment that likelihood of success per cycle decreases... here's my explanation of what sounds like conflicting stances:

There are so many facets that add up to IVF success or failure, we potentially learn something each time we use this technique for a patient. I use every tool I have -- the latest research findings, my years of experience in treating infertility, state-of-the-art equipment, highly skilled staff -- and still must approach each patient as a unique situation. Every body is different.

So any treatment cycle is an opportunity for us to find out more about how this body responds to various components of the IVF journey. When subsequent treatments are required, I take what we've learned, adjust the plan accordingly, and continue to observe the results carefully. Try again.

Decreasing success per cycle may not be related to the failure of the IVF technique itself, but to an organic sort of patient-screening dynamic.

For example, a patient chooses to undergo IVF. Her diagnostic workup reveals a potential reason for her infertility thus far, and we believe IVF can help resolve this issue. Her first IVF attempt does not result in a pregnancy, yet through that experience we learn something else about this patient's fertility factors. We decide on parts of the IVF process to change -- we may tweak the medication protocol, or use some additional technique or tool -- and we all try again. If we continue in this manner, the IVF process may wind up revealing even more causes of this patient's infertility with each treatment cycle. In most cases, after paying careful attention to a patient's IVF responses and adjusting the next cycle accordingly, success -- a healthy pregnancy -- is the outcome. For some, the result is coming to terms with the need to move forward, either with a different treatment technique or to adoption or to living child-free.

So in some situations, each procedure adjustment we make whittles away at the possible infertility causes until finally, we determine that IVF either is or is indeed not the answer for this patient. But there may have been no way to determine that fact if IVF had not been tried.

Of course, passing time is one of the biggest factors for decreasing success rates per cycle. Especially for women who are already in their 30's when they start fertility treatment, the natural biology of the female results in fewer chances for pregnancy as her body ages.

To some extent, medical treatment -- not just for infertility, but other conditions as well -- involves taking risks. My fellow practitioners and I always first balance the risk of harm to a patient versus the potential success of treatment. Each patient is different, not only in their body's responses to treatment, but in attitude and ability to move forward. Some are naturally more at ease taking risks, while others are more comfortable risking little. Helping patients make those choices is part of my job.

~ Sonja Kristiansen M.D.

Try, Try Again

"If at first you don't succeed, try, try again."
I can nearly hear your sighs. One of the hardest parts about infertility and its treatment is the need for perseverance. Many of my patients who are now parents will tell you that even more than peaceful patience, going through infertility treatment and keeping your sanity requires maintaining a heavy dose of "hang in there".

Recently, Australian researchers concluded that the likelihood of IVF success increases with each cycle. This is especially true for mothers-to-be who are older than 35, but even for younger women, going through an average of three IVF cycles boosts success rates up to 58 percent.

Granted, this makes common sense in a way -- the more you try something, the greater the odds you'll succeed eventually. But this isn't the first bit of research that hints at something more: the treatment learning curve and the artful practice of medicine.

of course, as Dr. Rosen points out at the end of the article in BioNews, the likelihood of success per cycle decreases, and eventually an end to treatment attempts may need to be considered for some patients. I'll discuss that seemingly paradoxical point in a future blogpost.

For now, I'll leave you to consider the reality that, yes, for many fertility patients who choose IVF, it takes more than one treatment cycle to get pregnant. As I mentioned in my last blogpost, coming to grips with treatment realities is a kind of loss. Perseverance is a good trait to muster. And when you run out of your own, borrow some from a loved one or friend. Keep trying.

More to come...
~ Sonja Kristiansen

Infertility's Grief: Unwelcome, Yet Present

We typically think of grief as related to traumatic events in our lives, and mostly, in terms of death. It's not a word that anyone wants to apply to their present or future, and even thinking about grieving in the past is tough.

But grief is often a big part of infertility for most patients.

Even for patients who are quite pro-active and forward-thinking about treatment, where infertility is, so is loss. And with loss, necessarily comes grieving.

The first loss that comes hand-in-hand with infertility is the dream of how you thought getting pregnant and having a baby would be. That's a loss that virtually every infertility patient must grieve. From there, variations in grieving depend on many things, including how individuals cope with whatever life throws their way.

I've had patients come to me and say, "Dr. Kristiansen, I'm finding it hard to stay positive about our fertility treatment."

To make it through the losses and grief of infertility, the first important step to take is simply acknowledging they are there. Doing so -- looking loss and sadness matter-of-factly -- does not mean you're being pessimistic. Optimistic thinking based on unreality is not helpful for anyone. Optimism that starts from a solid foothold of understanding where you are is the kind of thinking that allows you to put one foot in front of the other toward resolution.

No need to wallow in it, but if you find yourself doing so, be forgiving. Seek help. It's here.

The staff of Houston Fertility Center can refer you to resources that can support you through your grief.

Here are a couple of related items online:

Writer Ryan Jacobson succinctly described the grief of infertility from a personal perspective in this article, "Infertility: I Wish Someone Would Have Told Me"
He also gives very direct advice to friends and loved ones of those struggling through infertility.

While "how-to's" can sometimes oversimplify complex emotional processes, they can also be helpful for breaking down tough stuff into do-able chunks. This is one filled with meaningful steps:
How to Grieve Infertility Losses
By FaithAllen on eHow


Wherever you are in your journey, I and my staff are prepared to meet you.

~Sonja Kristiansen

There Really Is No Magic to Getting Pregnant

I'd really like to be able to give my patients an easy how-to for getting around their fertility issues. And people who are desperate to finally get pregnant and become parents are easy prey to reputed quick fixes. Fortunately, long gone are the old days of the tonic seller with ridiculous promises. But today's marketing techniques, finely-tuned with psychological research data, can be pretty convincing even to educated fertility consumers.

Take the idea of fertility supplements.

Granted, research studies linking nutrition and fertility have boomed in the last few years. What you eat is indeed a key factor in how you feel and how your body functions, even when it comes to fertility. Every qualified dietitian will tell you that the best source of health-promoting nutrients is food. Supplements are considered a back-up plan, and in some cases, their effectiveness is unproven.

In a Los Angeles Times article, Chris Woolston, aka The Healthy Skeptic, discusses two popular supplements: FertilAid for Men and FertilityBlend for Men. Both are promoted as providing nutritional enhancement for male fertility, specifically, sperm motility and count.

It's a good article that balances the claims of the supplements' makers with commentary by male fertility specialists. The important take-away message that eager-to-be-dads need to hear: supplements can be good for your health, but they aren't miracle cures.

And by the way -- the very same can be said for women, supplements, and fertility.

There's More to Healthy Babies Than Good Eggs

We tend to focus on the very key component of viable egg cells in assisted reproductive technology. There's no doubt that "good eggs" are needed to make conception and pregnancy happen. A piece of the pregnancy puzzle that doesn't usually get as much attention is the impact of uterine health.

It makes sense, of course, that once an egg is fertilized, the resulting embryo needs a healthy place to implant and grow. The lining of the uterus, known as the endometrium, is that place. In cases of women with average to good fertility levels, the endometrium is primed for implantation by a variety of hormones relaying through her body. It's all part of the menstrual cycle. [Here's an explanation of how the endometrium works.] Timing is crucial -- both in natural and assisted conception -- because the lining is re-created and either used or sloughed off through menstruation on a cyclical basis, approximately every 28 days. If a woman's hormones are imbalanced, the result is sometimes an endometrium that's not ready to receive and nourish a conceived embryo. This can be a type of infertility.

We administer endometrium-enhancing medications -- such as progesterone supplementation -- to some patients, regardless of the assisted reproductive technique they're using to conceive. Ultrasound monitoring is used to view and gauge the health of the uterine lining, just as we use ultrasound to see how well a woman's ovaries are ovulating. Still, there's more to solving the pregnancy puzzle, and researchers have recently unveiled a new potential key.

A study of mice has resulted in the newly discovered connection between a protein called Hand2 and the control of the uterine lining's proliferation. The researchers' findings could eventually lead to more ways for fertility experts to help patients who have endometriosis or previously unexplained infertility.

Answering the question, "Why can't we get pregnant?" requires attention to many variables within each patient's situation. The responsive functioning of a woman's uterus is increasingly becoming the focal point of research. After all, there's a lot more to having a baby then simply creating an embryo.

~ Sonja Kristiansen

Does Race Really Impact Fertility Treatment Success?

When a single research study looks at tens of thousands of ART procedures, the conclusions can be quite meaningful. Such a study received attention by Reuters this week with the headline "Weight, race tied to fertility treatment success".

Besides bolstering what we already know about weight and fertility, the study published in Fertility and Sterility determined that both failure to achieve a pregnancy and failure to achieve live birth are significantly more likely among non-white ethnicities. This finding was in light of adjusting for body mass index (BMI).

Unfortunately, since limited data was available to the researchers, their final conclusion about the difference in treatment success between white women (the reference group, having accounted for nearly 25,000 of the total 31,672 transfers researched) and black, Hispanic, or Asian women is that more studies are needed to discern reasons: "Future research should focus on clarifying the underlying causes of these disparities."

Having provided fertility care for over a decade now in a very ethnically diverse metropolitan area, here are my thoughts on possible connections between race and fertility treatment success numbers:

First, we know from past research that people from certain communities are not accessing fertility care as often as other groups. Financial reasons may seem to top the list, but the truth is that for some groups, there exist tremendous taboos against infertility treatment. Another related reason -- especially for Hispanic or Asian couples -- is language barrier.

That's one of the reasons Houston Fertility Center is hosting free Spanish-language educational opportunities -- to remove the language barrier as an obstacle to seeking fertility care. We hope, too, that our culturally diverse staff will be able to help curious couples feel comfortable enough to ask questions and find out about their family-building options.

Trying to determine what affects success rates based on ethnicity is not as simple as it may seem on the surface. For example, if the study did not include a breakdown based on how many patients used donor egg or not, we might see their results as skewed. That's because donor egg use is highly likely in older, white mothers-to-be and has an impact on success rate numbers.

I applaud researchers who undertake large-scale studies, and I look forward to future findings that can assist medical professionals like myself in our mission to truly make the finest fertility care accessible. In the meantime, the Houston Fertility Center staff and I will continue to reach out beyond our clinic doors to extend family-building services to all.

Los tratamientos de fertilidad: No hay ninguna razón que el idioma sea una barrera

Desde la fundación, de Houston de 1836, el ambiente y cultura ha sido enriquecido una variedad de etnias y nacionalidades.

He estado al servicio de los tratamientos de fertilidad necesidades de otros países por muchos años. Ahora, el personal del Centro de Fertilidad de Houston se enorgullece de ofrecer jornadas de puertas abiertas para la gente que quisiera hablar sobre las opciones de creación de la familia en español.

Hemos estado conceintes que huestros pacientes que solo hablan y entienden espanol experiementantan una mayor sensación de aislamiento cuando se trata de la búsqueda de atención médica especializada. HFC siempre ha mantenido personal bilingüe para que nuestros pacientes de la fertilidad puedan ser plenamente informados a los participantes e interactivo en su tratamiento.

A partir de febrero, el Centro de Fertilidad de Houston tendra jornadas de puertas abiertas en nuestra ubicación 9055 Katy Freeway. Individuos y las parejas pueden hablar con nuestro personal sobre los problemas de fertilidad común, ¿cómo se hacen diagnósticos y opciones de tratamiento. Nota que no Habra una evaluacion especifica para cada paciente. Sino que contestaremos preguntas de una manera general. Con el fin de preservar un ambiente cómodo, cada jornada de puertas habiertas sera limitado a sao cinco parejas, de modo RSVP son necesarias. Se servirán refrescos.

Por favor llame al 713-862-6181 para más información y para confirmar su asistencia. La siguiente jornada de puertas habiertas sera el 15 de Febrero, a la 1:30 a 2:30 de la tarde.

No hay ninguna razón que el idioma sea una barrera en obtener atención de alta calidad de la fertilidad. Espero la oportunidad de continuar serviendo los habitantes de Houston en sus tratamientos de fertilidad.

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Fertility treatment: There is no reason for language to be a barrier

Since its founding in 1836, Houston's culture and ambience has been richly flavored by an incredible variety of ethnicities and nationalities.

I've been serving the fertility treatment needs of families from other countries for many years. Now, the staff of Houston Fertility Center is proud to offer regularly held open houses for people who'd like to talk about family-building options in Spanish.

We've known for a long time that our Spanish-speaking patients can experience a greater sense of isolation when it comes to seeking specialized medical care. HFC has always maintained bilingual staff so that our fertility patients can be fully informed, interactive participants in their treatment.

Beginning in February, Houston Fertility Center will host free open houses at our 9055 Katy Freeway location. Indiviuals and couples can talk with our staff about common fertility problems, how diagnoses are made, and treatment options. We should note that evaluations of patients' specific cases will not be discussed at the open house, but we'll be happy to answer questions in a general manner. In order to preserve a comfortable setting, we'll be limiting each open house to only five couples, so RSVP's are necessary. Refreshments will be served.

The next Spanish-language open house will be on Tuesday, February 15, from 1:30 to 2:30 PM. Please call 713-862-6181 for more information and to RSVP.

There is no reason for language to be a barrier to accessing high quality fertility care. I look forward to continuing opportunities to serving the fertility treatment needs of all Houstonians.

Some Folks Will Do Anything to Get Pregnant

You've probably caught yourself saying things like "I'd stand on my head if it would help me have a baby!" A recently published study from Israel of 219 women going through IVF found that bringing in the clowns can help.

It sounds pretty funny, but this was bona fide research published in Fertility & Sterility, the journal of my esteemed colleagues, the American Society for Reproductive Medicine.

The clinic employed the services of a "medical clown" who performed a standardized routine for each patient on some days. Women who attended clinic on a "non-clown" day were less likely to get pregnant, even taking into consideration factors like age, infertility cause, and the number of embryos transferred.

Like the lead researcher, Dr. Shevach Friedler, says, it's "one of the least hazardous interventions" for IVF patients.

While I'm sorry to say that we don't have a clown on staff here at Houston Fertility Center (yet), we do take pretty seriously the growing body of research that points to connections between stress and treatment success. Besides offering a soothing environment at our clinics with staff members who are sensitive to your worries, we refer patients to massage, acupuncture, and counseling professionals, all of whom specialize in the needs of fertility patients. I'm a believer in the value of learning personal stress management and the positive impact on infertility and treatment.

You never know what people will try next. So the next time you're at our place for an appointment, don't be surprised if you hear laughter. After all, helping people make their dreams come true can be pretty fun!

Is Putting Off Pregnancy The Best Idea?

An article in the Los Angeles Times recently touted the benefits of the economic recession in terms of women delaying pregnancy.

While I believe that there are certainly advantages (as described by the author) to later-aged motherhood, I think we need to tread carefully when discussing the impact of age on fertility in general.

The majority of women (and men) have no idea what their body's fertility status is until they try to conceive. Unfortunately for some, the news is not only alarming but comes too late for them to take advantage of treatment in an optimal way.

Of the many causes for infertility, many (perhaps most) are not age-related, it's true. But that rosy perspective can work in reverse -- if a woman's not ovulating or if her tubes are blocked, it doesn't matter how old she is: she won't get pregnant without assistance.

While we're looking for silver linings to the recession's dark cloud, let's not throw the baby out with the bathwater.

Your Environment & Your Fertility

A small-scale study, recently published in Fertility & Sterility, adds to what we know about a woman's environment and the quality of her eggs.

In "Serum unconjugated bisphenol A concentrations in women may adversely influence oocyte quality during in vitro fertilization," the study authors conclude that, during IVF cycles, as levels of bisphenol A (BPA) rose, the number of fertilized eggs fell.

There is no simple test for BPA that can be administered in clinics. So, as with many things that may impact fertility, the best advice I can give patients is to try and reduce your exposure to BPA.

This Mayo Clinic article - What is BPA, and what are the concerns about BPA? - offers a quick list of things anyone can do to avoid BPA.


For more on this study:
BPA can affect egg quality, study claims