Infertility Issues in the Teen Years, Not Just for Girls

As I wrote earlier this year, we're starting to see more awareness of the need for even teens to consider how their current health can impact future fertility. Polycystic ovarian syndrome (PCOS) generally begins in very young women, although most women don't even learn about the hormonal condition until they have problems trying to get pregnant. Now, just as research is showing us that men's lifestyle choices – including diet and exercise – can make a difference in their fertility, we're also learning that teen boys' health might foretell whether they'll have obstacles in becoming fathers later.

A study published in Clinical Endocrinology produced mildly alarming results – a 50 percent reduction in testosterone in teen boys who are obese. According to this related article on the SUNY website, such findings point to an increasing risk of impotency and infertility later in life.

Granted, the sample size is small, so the researchers advise that more studies are needed with greater numbers of subjects to confirm this study's findings. And the research group plans to next look at weight loss and any resulting (hopefully positive) changes in obese teens. But there is already a wealth of strong data pointing a strong connection between obesity and negative reproductive consequences, and now, that data appears to hold up across the lifespan for both genders.

~ Dr. Sonja Kristiansen M.D.

Positive Movement In Veteran's Infertility Legislation

I'm very happy to report that U.S. veterans and their spouses are closer to having much-deserved coverage for fertility treatment. As I mentioned in August, a bill was introduced that would expand fertility coverage by the Veterans Administration. Now I can echo the applause by the American Society for Reproductive Medicine for the Senate's passing of the “Women Veterans and Other Health Care Improvements Act of 2012’’ which

“...would direct the Secretary of the Department of Veterans Affairs to furnish fertility counseling and treatment, including the use of assisted reproductive technology, to severely wounded, ill or injured veterans whose infertility was incurred or aggravated in the line of duty.  Female veterans, the spouses of veterans and surrogates would be eligible.”

The Department of Veteran Affairs has up to 18 months to establish rules of the program, so resulting benefits will not be immediate. But this is a very positive step – next up, to encourage the House of Representatives to pass the bill for Presidential signature – toward facilitating full access to health care services for military personnel who have sacrificed so much for us all.

~ Dr. Sonja Kristiansen M.D.

Image: FreeDigitalPhotos.net

Depression Treatment During Infertility

It's common for women with infertility to also experience depression, even if for many the relationship is like “the chicken and the egg” – was the patient going through undiagnosed depression prior to running up against conception obstacles, or has the infertility journey, itself, triggered clinical depression? Which struggle started first is not the biggest question, though.

As a recent review of studies bears out, there are legitimate concerns about the use of certain types of antidepressants by pregnant women. The review, published last October in the journal Human Reproduction, concluded that there is no evidence of improved pregnancy outcomes with antidepressant usage and, in fact, the opposite is true. This related article on ScienceBlog describes “mounting evidence that SSRIs may decrease pregnancy rates” in women who used fertility treatment, and there's a link between antidepressant use and increased miscarriage rates.

Depression must be taken seriously, and not dismissed as “merely” infertility-related sadness. But the choice of depression treatment by women who are also going through fertility treatment should be handled with caution, on a very individualized basis. Just because a particular drug benefits one woman, that doesn't necessarily mean it will benefit all.

If you have ever been diagnosed with depression, or if you have a strong family history of depression, be sure to let your fertility care providers – as well as your primary care physician – know. An informed team approach is the best way to handle a dual diagnosis of infertility and depression.

~ Dr. Sonja Kristiansen M.D.

Image: FreeDigitalPhotos.net

Are You In the Infertility Closet?

The infertility journey presents most of us with an uncomfortable opportunity: How open should we be about our problems with others?

There's no right or wrong approach to the question. Every individual's circumstance is filled with variables, from family history to religious views to personality traits. For some, it's important to keep their infertility struggle quiet, perhaps telling only a very select few people about being in treatment. Others may find a load of stress lifts from their shoulders when they come right out and tell the world, “We're going through infertility treatment.”

In this piece on Crosscut.com, Seattle writer Cathy Merchant reveals how she and her husband have come to terms with infertility, moving down that all-too-familiar path that starts with “We're going to get pregnant!” to adding “totems and rituals and snake oil” and finally, to the choice of medically-assisted fertility treatment. As of this writing, they're still trying to have a baby, but have arrived at a somewhat resigned resolution that this isn't going the way she'd hoped – but she still has hope.

I'm honored to be in a position at Houston Fertility Center to assist people in their quest to become parents, no matter how private or public the experience.

~ Dr. Sonja Kristiansen M.D.

Image: Free DigitalPhotos.net

Takes a Village to Have a Child

It's remarkable, the things that people will do in order to afford fertility treatment. While it is disheartening that so few people have insurance coverage for the medical techniques that could make them parents, the creativity and resourcefulness of some patients is inspiring. Raising funds through social media is becoming more mainstream, as discussed in this ABC News piece.

Using the Internet to rally your supporters is a new take on the old concept that “it takes a village to raise a child” – now, because of social media's ability to expedite getting in touch with others, fertility patients who need assistance to afford treatment are thinking it takes a village to have a child.

And their Twittering, Facebooking, and website-building are apparently paying off. If you find yourself in the majority who have little to no insurance coverage to help you pay for fertility treatment, the holidays may be the best time of year to put the word out and see what your loved ones think about helping out. And to help out further, nearly every year Houston Fertility Center offers IVF discounts – our current low price is good until the last day of 2012. Take a look at CallDrK.com for more details. We're happy to be part of your family-building village!

~ Dr. Sonja Kristiansen M.D.

Image: FreeDigitalPhotos.net

What Loved Ones Would Tell You, If They Knew What Infertility Feels Like

If you've been through the holidays while struggling with infertility before, you know the drill. As you travel toward gatherings of friends and family, your mind searches for the next best response to the inevitable question: “Are you pregnant yet?”

Fortunately, the Internet is now full of helpful tips for the people around you, advice on what not to say. But this article by Larami Williams on Divine Caroline offers more than that – she lists 7 things that infertile people want to hear from loved ones.

This could one of those links that gets passed around frequently this time of year. And instead of dreading the holiday gatherings, try considering that most loved ones really will say the right thing, once they've been enlightened about how it feels to long for parenthood. I and my staff at Houston Fertility Center wish you the warmest Thanksgiving ever.

~ Dr. Sonja Kristiansen M.D.

Image: FreeDigitalPhotos.net

Stop Smoking, Increase Your Fertility, Live Longer

November 15, 2012 is the date of the37th annual Great American Smokeout. It's a great time to quit smoking, especially if you're a woman who wants to get pregnant. The effects of smoking aren't only bad for babies in utero – it's bad for your fertility.

The ASRM Patient's Fact Sheet on Smoking and Infertility gives you some of the details on how smoking can get in the way of your getting pregnant. And now, there's a study that highlights another angle of why moms-to-be should kick the habit: Women who smoke lose a decade of life.

Many of my patients arrive at Houston Fertility Center having struggled for years to get pregnant before finally deciding to use assisted reproductive techniques. So, as with many fertility practices, I counsel a lot of older moms-to-be, who have a few things to worry about that women in their 20's don't when it comes to infertility. Women in their 30's and 40's often express different concerns about how their bodies will fare through pregnancy, labor and delivery, and they often have more questions about higher risks for their babies. I doubt if a single one of my older patients hasn't done some quick math – with a little trepidation – to figure out how old she'll be when her child is a teenager or heads to college. Longevity is a natural, normal concern.

In this UK study published recently in the medical journal The Lancet, more than 1 million women were surveyed and followed for up to 15 years and asked about their cigarette smoking habits. The impact on their mortality was significant. From the study:

“... smokers lose at least 10 years of lifespan. Although the hazards of smoking until age 40 years and then stopping are substantial, the hazards of continuing are ten times greater. Stopping before age 40 years (and preferably well before age 40 years) avoids more than 90% of the excess mortality caused by continuing smoking; stopping before age 30 years avoids more than 97% of it.”

So, older moms, you have even more reason to stop smoking now – you might want to enjoy being a grandmother longer.

~ Dr. Sonja Kristiansen M.D.

Image: FreeDigitalPhotos.net

One Woman's Egg Freezing Story & Hope for Brighter Futures

As discussed in October, the American Society for Reproductive Medicine no longer considers egg freezing experimental. The topic was big news, covered by everything from national to local media affiliates.

This interview show on NPR offered an opportunity to hear the patient's perspective of oocyte cryopreservation, as told by well-known New York Times blogger, Suleika Jaoaud. She's the young woman who shares her experience with leukemia in “Life, Interrupted”, including her need to confront the possibility of infertility after life-saving chemotherapy. In this interview, Suleika describes how she learned about the option of oocyte cryopreservation on her own, not from her oncology physicians, and what it was like to go through the egg freezing process just prior to her initial treatments.

Also speaking is Dr. Samantha Pfeifer, one of the physicians on the ASRM committee that made the decision which should result in more expedient coordination of treatment for such patients. I and my Houston Fertility Center staff look forward to continuing teamwork with physicians who are helping save lives, so that our patients can have the brightest futures possible.

~ Dr. Sonja Kristiansen M.D.

Image: FreeDigitalPhotos.net

Surviving Infertility & Mental Illness

As more men reveal their experiences with infertility, a picture is unveiling that the male struggle is just as impacting and, sometimes, debilitating as for women. While not all guys are comfortable enough yet to be as open as women tend to be about their fertility problems (as evidenced by the huge number of online infertility support groups, and the relatively sparse number of men participants), the ones who are “coming out” have powerful stories to tell.

I recently came across this interview with Matt Barwick, a young man whose life has already included a great deal of loss, including family tragedy, infertility, and mental illness. But when you listen in on this radio show where he talks about his new memoir, “My Life in Limbo: Surviving depression, infertility and mental illness” (Big Sky Publishing), what you hear isn't depressing at all.

Like some of my patients at Houston Fertility Center have expressed, venturing through the infertility journey is daunting, but also instills of sense of being a “survivor” along the way. Couples usually find that this shared experience both challenges and strengthens their relationship. For anyone, regardless of relationship status, taking such conscious steps to have a child becomes a hallmark period of time in their life, and most often, a time that they look back on with great pride. The same feelings can be felt by individuals who are further challenged in life by mental illness.

Take a few minutes to listen to this young man's story. While the title sounds like it would be a let-down, in fact, it is inspiring and should be shared, especially with the men in your life.

~ Dr. Sonja Kristiansen M.D.

Image: FreeDigitalPhotos.net

Egg Freezing Is No Longer Experimental

I spent part of the past week at the annual meeting of the American Society for Reproductive Medicine. Each year, thousands of individuals from all realms related to fertility come together to share research news and camaraderie. This year, as always, the days were filled with hopeful ideas and grounded conclusions about how best to help men and women with their reproductive medical needs. One of the big announcements this year was not about a brand new technique; rather, an announcement was made about a change in perspective toward techniques that have been in limited use for several years now.

Oocyte cryopreservation, or egg freezing, has been offered by several clinics in the world since the early 2000's. Specialists in Italy, especially, charged ahead with making egg freezing a viable option, because of that country's stringent laws regarding freezing embryos. It took reproductive lab experts a long time to finally “get it right” – specifically, egg cells (the human body's largest cells) were easy to freeze but often did not survive the thaw. When the science began closing in on successful freeze-thaw methods, many fertility specialists started offering the service to women for the deferment of conception.

In 2008, the ASRM published “Ovarian Tissue and Oocyte Cryopreservation” (Fertil Steril 2008;90:S241-6) which stated egg freezing, while not harmful, should still be considered experimental because of the unknown efficacy of the process. In that same year, I published a website called BabyLater introducing Houston Fertility Center's egg freezing services for women who wanted to preserve their fertile potential for later use with IVF. I joined many fertility providers around the country who saw the enormous need for cancer patients (and others who undergo sterility-causing chemotherapy or radiation treatments) to be able to “put their eggs on ice” before undergoing life-saving therapy, in hopes of parenthood later.

At this year's ASRM meeting, the announcement was made that egg freezing is no longer considered experimental. Enough data now exists to demonstrate that the science and clinical techniques behind the process is solid enough to present acceptable success rates. The committee continues to strongly advise that patients interested in egg freezing must be fully informed about the limitations of the technique, which primarily include the age factor: As always, eggs from younger women survive the process and result in pregnancy more often than eggs from older women.

I expect far more fertility providers to start offering egg freezing, and as with any “new” technique, tenure of experience can have an impact in treatment success. I'm happy to respond to related inquiries about how oocyte cryopreservation can be part of a reasonable family-building plan.

You can read the new guidelines from the Practice Committee of the ASRM here.

Image: FreeDigitalPhotos.net

Waiting on Infertility Insurance Reform? That's Risky

The issue of insurance coverage for the diagnosis and treatment of infertility has been a hot topic for many years. Just ask the good folks at RESOLVE and the American Fertility Association, the country's primary organizations that carry the advocacy banner for fertility patients into the halls of legislators. And while there is much discussion about hopeful possibilities for the majority of patients without infertility insurance coverage, there is still far more up in the air than nailed down in reality.

This article in the WashingtonTimes illustrates how hard it has been for states to decide what is an “essential health benefit” in accordance with the 2010 Federal health care law. These decisions must be hard-wired into place – ready for sale through insurance policies – by January 2014.

As of October 10, 2012, the state of Texas has not chosen a benchmark plan If you want to follow along, the Texas Department of Insurance maintains an updated page about thedetermination of Essential HealthBenefits. From that page, you can access a chart that shows the plans being considered, on the “Updated TDI Analysis of Essential HealthBenefits Benchmark PlanOptions”. If you're either a legislative or insurance expert, you might be able to discern from the TDI website whether or not infertility treatment will be covered. If, on the other hand, you're not an expert in those areas, you could be left simply confused and frustrated.

My opinion, after nearly 20 years of helping worried patients resolve their infertility: You can put off getting pregnant for years waiting for insurance coverage to be available. Eventually, some patients find that putting off fertility treatment for years equates to forever. I've never had a patient tell me that postponing treatment, sometimes to the point of making treatment no longer an option in terms of a woman's age, was worth it. I've also never heard a new parent say that they wouldn't do whatever they did to afford treatment all over again.

If you haven't sought help but need to, don't put it off by waiting for the states to figure it out. HoustonFertility Center has financial staff who can guide you, and time is of the essence.

~ Dr. Sonja Kristiansen MD

Image: Freedigitalphotos.net

Can ART Kickstart Your Body's Natural Fertility?

Are the rumors true, that if you get pregnant using assisted reproductive technology, you might also later conceive via the old-fashioned way? An article on the Huffington Postwebsite by reporter Catherine Pearson offers up several women's stories with a conclusion of “Maybe.”


The stories, while excellent accounts of what many infertility patients struggle through to have a baby, amount to what we call “anecdotal evidence,” individual's experiences that don't necessarily hold up statistically for large groups of people. Some of my patients have said to me with hope in their voices, “Dr. Kristiansen, I have a friend who finally adopted a baby – and then got pregnant on her own!”

The reporter cites a couple of studies that build on the rumor:

• a French study published in 2012 in Fertility & Sterility, the American Society for Reproductive Medicine's journal, and

• a German study from 2008 published in Reproductive Biomedicine Online
  

In the French study, 24 percent of women who attempted IVF unsuccessfully went on to conceive spontaneously (that is, without fertility treatment.) The German study looked at patients who had successfully used ICSI with IVF (and so had a child), finding that 20 percent of them later conceived intentionally without fertility treatment, most within two years of their “ART baby's” delivery.


The still-untested theory is that the state of pregnancy, itself, may be healing for some forms of female infertility. Some also say that components of the fertility treatment process may also have a hand in kickstarting a woman's natural fertility levels, beyond the treatment cycle.


Both ideas make a sort of intuitive sense. I and my staff at Houston Fertility Center would love to be able to tell patients that spontaneous conception is something they can look forward down the road, should they want to have another baby. But even the French study's authors, after surveying more than 2,000 couples, call for conservative reason with their conclusion that “it should be remembered that the BSP [spontaneous pregnancy] rates are cumulative rates observed over a long period of time and that these couples have a very low monthly probability of conceiving.”

~ Dr. Sonja Kristiansen MD

Image: FreeDigitalPhotos.net

Infertility All In Your Head?

I stumbled across this recently: a survey of 1,000 women in 10 countries found that nearly half of them believe they're infertile because of “God's will” and half also feel infertility is attributable to “bad luck”.

image: freedigitalphotos.net

The study covered the countries of China, India, Japan, South Korea, Thailand, Vietnam, Singapore, Hong Kong, Taiwan and Malaysia.

Hopefully my readers and Houston Fertility Center patients know by now that what is in your mind – whether it's stressful emotions or negative beliefs – is NOT the cause of your infertility. But the study highlights how self-defeating thoughts can certainly prevent you from taking the steps necessary to resolve your problems, including infertility.

Yes, your beliefs can get in the way of your getting pregnant, but only if you let misinformation prevent you from believing that the conditions causing infertility are physiological and treatable – not “only in your mind”.

~ Dr. Sonja Kristiansen M.D.

One Possible Answer for Recurrent Miscarriage

Being unable to get pregnant when you're ready to have a child is difficult enough. Conceiving and then losing a pregnancy adds to the emotional burden. Going through early miscarriage more than once deserves medical attention. This, too, is the realm of a reproductive endocrinologist.

In fact, some of my patients at Houston Fertility Center don't consider getting pregnant their primary problem. For them, the mystery is “Why can't I carry a pregnancy?”

There are several possibilities, but much of what we know about the causes of recurrent miscarriage (RM) remains theoretical. Patients struggling with RM might take some comfort in the fact that it is a research arena of great interest.

A recently published study may shed some light on yet another possible explanation. Researchers in The Netherlands looked at the human endometrial stromal cells (H-EnSCs) of women with RM and fertile women. Their findings support their theory that, for reasons not yet fully understood, “H-EnSCs of fertile women discriminate between high- and low-quality embryos whereas H-EnSCs of women with RM fail to do so.”

In other words, while women with RM seem to conceive more readily than women without RM (a concept called “super-receptivity”), the lining of their uterus is more often facilitating the implantation of non-viable embryos. These pregnancies are destined to end from the start.

While you might feel callously dismissed by some who offer condolences like “It just wasn't meant to be” and “Don't worry, you'll have a baby the next time” – know that there are healthcare providers out there, like the Houston Fertility Center staff, who take your concerns to heart and offer the best that science has to offer.

~ Dr. Sonja Kristiansen M.D.

image: freedigitalphots.net

Why Would a Woman Be a Surrogate?

image: freedigitalphotos.net

Of the many ways to use assisted reproductive technology for growing your family, perhaps no other produces more raised eyebrows as gestational surrogacy. That's understandable, especially in light of surrogacy's history and resulting legal issues.

Traditional surrogacy – in which the woman who carries the pregnancy is also the egg donor – is so fraught with potential issues that many fertility specialists and third-party matching agencies avoid it altogether. Instead, they and many infertile couples favor using gestational carriers – women who carry a pregnancy created by the IVF union of the couples' own eggs and sperm. Gestational surrogacy removes many of the legal and ethical issues from this infertility solution.

But there's still quite a bit of mystery in this process. The idea of a woman carrying a pregnancy and delivering a baby for another family to raise still makes some people uncomfortable. It's a very private experience, for the most part, so we don't often get to hear voices like Kymberli Barney's, a woman who experienced PCOS-related infertility and went on to become a gestational surrogate.

If you find yourself edging toward the idea that surrogacy might be your best option for finally having a baby, I encourage you to read Kymberli's brief story. And of course, as always, Houston Fertility Center staff will be happy to provide you with assistance in learning more about the incredible choice of surrogacy.

~ Dr. Sonja Kristiansen M.D.

Frozen Sperm Last Long, But Age Still a Factor

This past August, twin girls were born to a woman in Minnesota following IVF using donor sperm. The real news here is that the sperm had been donated and cryopreserved in 1971.

This news article on TwinCities.com offers interesting details about the donor and his journey to “carry on his family's bloodline.” The story is also yet another that points to the resiliency of sperm cells and their viability for fertility treatment by patients who need to use frozen donor specimens to conceive.

The article also importantly points out that even our amazing assisted reproductive technology cannot completely defeat the power of passing time's impact on fertility. All that could be revealed in the media about the donor's age was that he was at least 25 years old when his deposit was made. Presumably, since the donor participated in the selection of a couple in this unusual case, he was not too far from age 25 in 1971.

While men have always been thought to be able to father children later in old age than can women, we are now learning that, in reality, there are greater chances of older men passing on inheritable mutations. Reproductive specialists recommend that young men who will face impaired fertility – such as from cancer treatment or even being in harm's way in terms of military deployment or job-related risks – can take steps to preserve their future fertility by banking their sperm.

~ Dr. Sonja Kristiansen M.D.

Before Infertility Strikes, PCOS Is Common, Treatable, Even for Teens & Young Women

A little bit of facial hair in “the wrong places” can be normal, even if aggravating, for women near and after menopause. But for younger women, hirsutism (hair growth in abnormal patterns) can signal something to be worried about – polycystic ovarian syndrome.

image: freedigitalphotos.net

PCOS is one of the most commonly-presented female disorders in a fertility clinic. Not every woman with polycystic ovarian syndrome has infertility, but many do. In fact, not all PCOS sufferers have the same symptoms, which in addition to hirsutism might include:

• small cysts on the ovaries

• irregular menstrual periods

• weight gain for no apparent reason

• acne beyond the teen years

This article in UK's Daily Mail says that one in 10 British women are affected by PCOS. A fact sheet from the U.S. Department of Health and Human Services Office on Women's Health says similar numbers of affected women are found in the U.S., as many as 5 million of them, and that it can occur in girls as young as 11 years old.

This is a point I want to impress: PCOS is a hormonal condition, not merely a nuisance of facial hair and weight gain, and it begins in most cases during puberty. Unfortunately, most woman don't become knowledgeable about PCOS until it's created a problem for them – most of the time, that problem is infertility.

Most important to know is that infertility is not the only problem to which PCOS can lead. It's also been linked to a number of very serious metabolic disease-related health conditions like diabetes, high blood pressure, high cholesterol, and cardiovascular disease. So treating PCOS is something that should be initiated as soon as it's discovered, and not just for fertility-related reasons.

How can teens and young women know if PCOS is a worry for them?

• Develop an ongoing relationship with either a family practitioner or OB/Gyn.

• Keep close track of your menstrual periods and report on them to your physician annually. If you notice something different (for your body) happening – such as longer or shorter times between periods, more pain than usual, or periods that are heavier or lighter than usual – let your doctor know that you are concerned.

• If you have “male-pattern hair growth,” let your doctor know.

• If you notice extreme weight loss or gain within a brief period of time that cannot be explained by changes in your activity level or eating habits, tell your doctor.

There's more good information about PCOS specifically for young women on this website by the Center for Young Women's Health.

Finally, as a reproductive endocrinologist, I have a great deal of expertise and experience in treating hormonal conditions related to the reproductive system -- and PCOS-related infertility is indeed successfully treatable. If PCOS is your issue, the Houston Fertility Center can help.

~ Dr. Sonja Kristiansen M.D.

Surrogacy Is Special In Many Ways, Including Legally

Some of the hardest choices to make when infertility gets in the way of your family-building is whether or not to involve other people in making your dreams of a baby come true. For many who must turn to third-party reproductive services, the use of a gestational surrogate feels like a final step in the journey. Fortunately, surrogacy is a very successful means of arriving at the destination of a healthy baby! The laws surrounding the use of surrogacy can be tricky to manage, though.

image: freedigitalphotos.net

This article in the Milwaukee-Wisconsin Journal Sentinal describes the confusion that can occur because of the varying laws from state to state. This matters a great deal to patients using a gestational surrogate, because surrogates can live in states different from the intended parents.

In addition to the variances in state laws, it's also good to keep in mind that these laws are changing in many places. While the medical treatment side of infertility has been fine-tuned to result in tremendous success, the legalities involved haven't quite kept up pace. This is especially true regarding third-party ART.

So we naturally insist that patients wishing to use a surrogate do the best thing: Get experienced, qualified legal advice. Texas is actually one of the best (some say THE best) state in terms of laws that pertain to surrogacy. There are many attorneys who specialize in reproductive laws right here in the state, and Houston Fertility Center is happy to connect patients with those experts.

Surrogacy is an incredible way to build a family, for so many reasons. Making sure your arrangements and agreements are bound by law protects everyone involved, including your new child.

~ Dr. Sonja Kristiansen M.D.

VA On The Path to IVF Coverage for Vets

The men and women who have served our country in the Armed Forces are on our minds more than ever lately. The numbers who are returning with medical needs of all kinds are staggering. Fortunately, many established service agencies are thinking ahead and new organizations to meet their needs are popping up all over.

What does this have to do with infertility?

Many of these troops are coming home with fertility issues they never thought they'd encounter. And while the Veteran's Administration has long provided coverage for limited fertility treatment, such as diagnostic tests and IUI, patients needing IVF to conceive have been left out of the VA picture.

Now, there's a bill being considered by the Senate that would specifically allow the VA to cover IVF, among other expansions to fertility treatments covered.

From a recent Associated Press article on FoxNews:

More than 1,830 veterans of the wars in Iraq and Afghanistan have suffered pelvic fractures and genitourinary injuries since 2003 that could affect their abilities to reproduce, according to Pentagon figures provided to Sen. Patty Murray, the bill's sponsor and chairwoman of the Senate Veterans Affairs Committee.

Senator Murray, a Democrat from Washington state, says she hopes the committee will act on the bill after returning from August recess.

I've been honored to help build families for men and women who've served the United States. A few years ago, I performed an egg retrieval and ICSI fertilization for a couple at Houston Fertility Center's central location while the husband looked via live video in Iraq. It was an exciting moment for all of us and a perfect example of how the combination of medical and communication technologies can enrich our lives. Houston Fertility Center has served several other veterans, and we regularly offer discounts to the men and women who are serving our country. Now, the Women Veterans and Other Health Care Improvement Act of 2012 seeks to increase the likelihood that all who need fertility care to build their families can access the types of assisted reproductive technology that are necessary for their situation.

You can hear the related personal story of Staff Sgt Matthew Keil's family as they struggled with barriers to fertility treatment access, as told by Tracy Keil (the sergeant's wife, who has become a leading advocate of the proposed bill) at a Senate hearing earlier this summer. 

Mrs. Keil says it best: "War time changes a family. It shouldn't take away the ability to have one."

How Treating Infertility Can Help A Nation

If you've ever had a nagging feeling that your struggles to have a baby are selfish, now there's news that might make you feel otherwise. The United States' fertility rate has arrived at its lowest point in 25 years.

So you could say that efforts to get pregnant are a way to give back to the community!

Image: FreeDigitalPhotos.net

With all of the news about over-population and its impact on the earth, talk about low fertility rates might sound off-track. But this essay on FoxBusiness explains how, for a nation, the short-term benefits of a fertility rate that's lower than the normal 2.1 replacement rate "are outweighed by the more serious long-term consequences."

In brief, having 2.1 children is a way to replace a population and promote a balanced economy. When a population's overall rate is lower than that, eventually there is a proponderance of older people (who naturally have less earning power and tend to be more dependent on government assistance) and not enough younger ones to balance out the burden.

The good news, as the writer points out, is that this marked decline could likely prompt introduction of very family-friendly policies, like those seen in some other countries. Nations like France and Sweden, among others, offer new parents economic and childcare incentives to make family-building not only less of a burden personally, but also supportive of the community.

So if you hear misinformed comments by individuals demonstrating their lack of understanding or compassion for people who go to great lengths to get pregnant, you might rest assured knowing that, in fact, trying to have a baby is good for the economy!

~ Dr. Sonja Kristiansen MD

Speaking of Fertility Preservation: Frozen Eggs Do Well

In Malta, there's a legislative proposal that might decrease the ability of some citizens to resolve their infertility with IVF. While political and social pundits wrestle with the questions of which patients can access which treatment and even specifics on which treatment protocols can be used, one expert shed some positive light on one option in particular.

Image: FreeDigitalPhotos.net

Dr. Eleonora Porcu is possibly the most experienced reproductive specialist in the world when it comes to the use of frozen eggs with IVF. Because of Italy's highly restrictive assisted reproductive technology laws, Dr. Porcu has been very active in the pursuit of technique advancements that make oocyte cryopreservation a viable option when frozen embryos are not available. She was called on by the Maltese government recently to testify about the success she has seen over the past 15 years.

The Times of Malta published this interview with Dr. Porcu, who reports she and her medical team have produced "some 500 births of children conceived using frozen eggs."

In the United States, we are so fortunate to be free of extreme governmental restrictions mandating which individuals may access ART and which forms of ART they can use to resolve their fertility issues. My Houston Fertility Center staff and I have offered egg freezing to patients for several years now, believing it to be an optimal fertility preservation technique for unmarried women who are about to undergo cancer treatment, as well as others who are without partners and do not want to use donor sperm.

~ Dr. Sonja Kristiansen MD

Not All Infertility News Is Bad News!

I realized the other day that my most recent blogposts were presenting nothing but the "bad news" about trying to get pregnant. Lots of "don't do this" and "here's something else to avoid" can add up in a fertility patient's mind to "Well, what's the use in trying?!"

I was browsing the Internet for topics of interest to my blog readers when I stumbled on this: "Women ditched me because I was infertile" (It sounds like an ad, but it's an article on the Daily Mirror.)
 The young man's story perfectly illustrates so many aspects of why we do what we do at Houston Fertility Center.

Image: FreeDigitalPhotos.net

Not many men feel secure enough to reveal their deepest emotions about their infertility, and particularly in the way that this semi-pro football player in Great Britain did. His loss of a testicle to cancer -- without fertility preservation efforts prior to cancer treatment -- resulted in a distressing mix of relief from being a survivor and embarassment at "losing his manhood". He even felt that his diagnosed inability to father a child kept women from wanting to be his partner.

I won't reveal the whole story to you -- it really is a sweetly romantic tale worthy of a screenplay, and I encourage you to read it on the Daily Mirror's website.

It's important to stay on top of new research findings, as well as all of the fertility basics that are already known to optimize your chances at pregnancy. But now and then, it's also good to just bask in the hope of others' true stories.

~ Dr. Sonja Kristiansen MD

Common Chemicals Not Just Harmful for Baby – Bad for Baby-Making

A recent study of men and women undergoing IVF found that even low levels of some pervasive environmental chemicals are associated with reduced number of pregnancies. In the small sample of IVF patients, researchers adjusted for confounding factors like age, race, and smoking, and found that small increases in blood levels of both mercury and cadmium are associated with reduced rates of clinical and biochemical pregnancies.

[The term “biochemical pregnancy” refers to two positive hCG tests in very early pregnancy, while the term “clinical pregnancy” refers to detection of a gestational sac on ultrasound.]

In the women, slight increases in blood mercury were associated with pregnancy decreases of up to 35 percent, whereas slight increases in blood cadmium were associated with decreases of up to 94 percent. There were no similar effects detected in the men.

So what does this mean for you, if you're trying to get pregnant? Chemicals are all around us, in products, furnishings, and even foods, and you cannot completely avoid every one of them. But there are a few steps that can be taken to lessen your risk of exposure:

• Don't smoke cigarettes or be around second-hand smoke.
  
  
• Avoid certain types of fish that contain high levels of mercury: bluefin and albacore tuna, swordfish, shark, king mackerel.
  
  
• Don't use phosphate-laden fertilizers.
  
  
• Eat only moderate amounts of organ meats, like liver and kidneys.
  
  
• Have your blood tested for toxins. You might also consider testing your soil and, if you have a well, your water supply.

For more details on the study and on the effects of mercury and cadmium, see this Fertility Authority article.

On Women, Bicycles, Sex & Fertility

Here's a topic that you won't hear a lot of reproductive specialists talk about – but maybe they should! A new study in The Journal of Sexual Medicine advises that women bicyclists can lessen their chances for potential sexual dysfunction by changing up a couple of things on their bikes.

How about the seat on your spin cycle?

Women cyclists can experience genital nerve damage if the bicycle seat is higher than the handlebars. This type of nerve damage reduces a woman's ability to detect vibrations, which can then lead to impaired sexual function.

An important point: Sexual dysfunction in and of itself does not equal infertility! But as many of my patients unfortunately know already, trying to get pregnant when there's a fertility problem in the way can be less than pleasurable. So I advise couples to take reasonable steps (and seek related counseling, if necessary) so that enjoyable physical intimacy remains a part of their experience.

Granted, the women studied are competitive cyclists, and most of my Houston Fertility Center patients are not in that category. Bicycling is one of the activities that has been recommended as healthy for women who are trying to conceive, but again, in moderation, since over-activity and extreme weight loss can work against your body's ability to get pregnant.

And if you want to maintain a healthy sexual relationship with your partner through what can be a daunting process, you might also need to adjust your bike seat and handlebars.

IVF? Skip That Last Cup & Croissant

Cut back on the caffeine and saturated fats. It's not new advice. But there's a bit more research now that arrives at the conclusion that too much of these dietary no-no's can get in the way of IVF success.

I know my patients at Houston Fertility Center sometimes feel “up to here!” with the restrictions that they already find infertility and its treatment have put on them. So information like this is not always welcome – but remember, the more data we have on which to base our treatment decisions and techniques, the less likely it is that patients will be required to go through numerous treatment cycles to get pregnant.

In two different presentations, researchers at this year's meeting of the European Society for Human Reproduction and Embryology informed us of these findings:

• Drinking more than 5 cups of coffee per day can reduce your chance of pregnancy from IVF by 50 percent, but the reasons are not clear.
  
  
• The type and amount of dietary fats consumed by a woman seems to impact IVF success. Specifically, chances of IVF pregnancy were lessened in women who had higher intakes of saturated fats because they produced fewer mature egg cells.

The dietary fats study is especially small, and the researchers call for more follow-up. The caffeine-related study, too, should be expanded, but for now, authors of this Danish study of nearly 4,000 IVF patients are suggesting that adverse effects of coffee are comparable to the detrimental effects of smoking on IVF.

The researchers in both of these studies clearly state that there's no need to make drastic changes based only on their findings.

Overall, our patients are admirable in how they heed the warnings of research about lifestyle-based effects on fertility treatment. Whether a woman is experiencing infertility or not, going through a little dietary “clean up” during preconception is a great idea with benefits for mom and baby.