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.

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.

For Women with Cancer, the Fertility Preservation Pipeline Is Clogged

Here's a situation that illustrates how fantastic medical advances don't always translate to patients benefiting in the clinic. For that to happen, the science needs to be carried along a pipeline of practitioner communication, all the way to the patient.

Cancer patients' fertility is in the hands
of cooperating physicians. 

More women are surviving cancer. We know that some of the cancer treatments will leave them less fertile or even completely sterile. Fortunately, the assisted reproductive technology exists to help young women preserve their fertility for later use, post-cancer. But a new study in the journal Cancer says very few of these women take the steps to save their eggs or embryos before infertility-causing cancer treatment.

Of the 1,041 women sampled from the California Cancer Registry, ages 18 to 40 at time of diagnosis between the years 1991 and 2007, and who participated in the survey, only 4 percent underwent fertility preservation techniques.

One of the study's authors, Dr. Mitchell Rosen of California, cites a couple of reasons. One is cost. Another is the limited amount of related counseling that oncologists are providing to these frightened patients.

The good news is that more cancer doctors are informing their patients of the connections between cancer treatment and future infertility, partly due to guidelines instituted by the American Society of Clinical Oncology back in 2006. But just what constitutes adequate information is in question.

According to Rosen in this Huffington Post article, an oncologist may refer vaguely to the problem ('The treatment might affect your fertility, but let's figure out how we're going to go ahead and save your life') and "That brief sentence might be considered counseling..."

Another issue this study brings to light: it appears not every woman is equally informed, based on demographics like age, race, and even educational level. The article says:

"Those who had gone to college were 20 percent more likely to be counseled than those who had not.
Women who were childless, younger, white and heterosexual were also more likely to be told about the possible effects of cancer treatments on their ability to conceive."

In 2008, Houston Fertility Center published a website called BabyLater.com to inform the public that we offer a number of techniques for deferring conception by way of preserving fertility. The purpose of our website and my related outreach activities is to educate not only patients, but the abundance of professionals in the cancer care field here in Houston.

This Huffington Post article says a panel of recommendation experts is revising guidelines now, but they won't be made public for another year or more. The article also quotes Dr. Kutluk Oktay, co-chair of that expert panel, commenting on the current state of that crucial information pipeline:  "On the cancer side, there's no official training for this."

Physicians on the front line of cancer treatment are holding the cards in terms of letting women know that they have choices, that they can save their ability to have children in the future. I will continue to do what I can to spread the good news, that not only is there very often life after cancer, but parenthood, too.

~ Dr. Sonja Kristiansen M.D.

“Racial, Socioeconomic, and Demographic Disparities in Access to Fertility Preservation in Young Women Diagnosed With Cancer.” Joseph M. Letourneau, James F. Smith, Erin E. Ebbel, Amaranta Craig, Patricia P. Katz, Marcelle I. Cedars, and Mitchell P. Rosen. CANCER; Published Online: March 26, 2012 (DOI: 10.1002/cncr.26649).

Traveling the Other Direction for Fertility Treatment

Medical tourism is growing, and for United States residents, the promise of less expensive fertility treatment is one of the reasons why. But not everyone who travels for fertility treatment is flying from here to there. Some are coming here, to Houston Fertility Center.

A new report commissioned by UK-based medical tourism site, Treatment Abroad, reveals where people are going and why. Traveling to other countries for fertility treatment has become more popular in the UK because of tight government restrictions on who can access varying types of fertility treatment. Among the more than 1,000 European patients who took part in the study, 4 percent were seeking treatment for infertility. The most popular destinations for those patients were Spain, Cyprus, and the Czech Republic. The biggest reason cited? To avoid waiting lists for treatment in their home countries.

The U.S. gets bonus points for leaving questions about treatment access up to physicians and patients, not government agencies. Still, patients from America are also finding reasons to bundle up their vacation time and fertility treatment cycles, sometimes flying to the other side of the world to try and achieve pregnancy. But as this article in the International Medical Travel Journal reported in 2009, more and more Americans are traveling to... other states in the U.S.

We often have patients from other states and regions of the world, including Mexico, South America, and even Scandinavia. Their reasons? When they combine all the factors -- sophistication of medical care available and all costs involved in fertility treatment -- coming to Houston Fertility Center makes the most sense.

Photo: TracyMorris.com

Houston is a great place to visit, and here's why:

• Two large airports and a central U.S. location make flying here relatively inexpensive.

• Big city culture and amenities -- thriving arts community, world-renowned restaurants and shopping -- yet neighborly friendliness abounds.

• It's just a quick drive to the Gulf Coast for fun on the beach.

• Our weather is usually moderate (maybe not so much in summer, but every place you go has great air conditioning!)

• The cost of living is lower than in nearly every other big city in the States, so visitors find savings in accommodations and travel around town.

When you match all of Houston's benefits with Houston Fertility Center's locations, highly experienced staff, state-of-the-art laboratory, and variety of patient discounts, it makes a lot of sense to come this way for fertility treatment. And you won't even need to learn a new language.

~ Dr. Sonja Kristiansen M.D.

Depression, Even Among Infertile, Should Never Be Shrugged Off

Speaking as a physician who has specialized for years in helping infertile men and women get pregnant, the high rate of depression among fertility patients is understandable. And for some patients, it's a little bit of a chicken-and-egg situation: Which came first, the struggles of infertility or the clinical depression? Whichever the case, something we do know is that treating your depression is crucial.

Image: imagerymajestic / FreeDigitalPhotos.net 

A common question in my office: "Dr. Kristiansen, should I continue taking my depression medication while we're going through fertility treatment?"

My general answer: If it works, keep it up, but there are a few exceptions.

This is a really tough decision for most patients, because they've often done enough of their own research to be confused by the data, even from well-done scientific studies. You can find large-scale, carefully conducted research that says depression, itself, seems to decrease fertility, even with fertility treatment. You'll also see studies that say women who are using depression medication have higher rates of fertility treatment cycles canceled.

Men, too, may have something to worry about if they're trying to become a dad and need to treat their depression. A small 2009 study demonstrated that men using paroxetine (Paxil) had significantly higher rates of sperm DNA fragmentation, which can lower their fertile potential.

Until we know more about links between fertility and depression and depression medication, physicians and patients are instituting choices based on the more established data about impact during pregnancy. Here, fertility treatment provides an advantage over conceiving without fertility assistance. The benefit has to do with timing.

Women using fertility treatment virtually know the moment conception takes place. There are far fewer mysteries when you're inseminated or you've had embryos transferred. And since we know some depression medications when taken during pregnancy are closely linked to congenital defects, essentially scheduling conception allows the woman to make choices in advance. She may choose to stick with her current medication, or she may talk to her prescribing practitioner about using an alternative treatment.

I and my staff at Houston Fertility Center encourage our patients to speak frankly with the health care professional who prescribes their depression treatment. Tell them you are trying to get pregnant, even before you make the choice to use fertility treatment. In no case do I ever recommend that you simply avoid making a choice.

The hormonal fluctuations that every woman undergoes through both fertility treatment and pregnancy can have a tremendous impact on  your emotional well-being. If you already know you experience depression, or if you start to experience mood swings or emotional dullness that are worrisome, keep all of your health care providers in the loop. That way we can work together as a team for the benefit of you and your hoped-for baby.

~ Dr. Sonja Kristiansen M.D.

DIY Artificial Insemination Just Adds to Infertility Stress

Gone are the days of uninformed consumers and all-knowing experts. Now with just a flip of the webpage, you can find step-by-step instructions on everything from remodeling a bathroom to getting pregnant with artificial insemination. DIY conception used to be the only means available for people who couldn't get pregnant "the old fashioned way." It's a real good thing we've come a long way from those days.

But have we? It turns out there's an underground, online market for sperm, where women can access prospective biological fathers for their children without the intervention (and guidance, and screening, and medical and legal protections) of reproductive professionals.

Newsweek's Tony Dokoupil called one related website "a weird blend of Facebook, Match.com and a traditional sperm bank" in this article for ABC News.

"What's wrong with the DIY approach to getting pregnant, Dr. Kristiansen?"

Here's a quick list of why I think you and, more importantly, your potential children are far better off going the more conventional routes to accessing sperm for getting pregnant:

Without standard controls by the Food & Drug Administration and the policies and procedures of reputable clinics like the Houston Fertility Center, you risk transmission of infectious diseases and genetic conditions, to both the mother and child.

Engaging in activity within this level of intimacy, even if sexual intercourse isn't on the agenda, with people whom you've only "met" online is simply not as safe as using professional services.

Agreements made between individuals about level of parental responsibility and involvement in the child's life may not be binding without proper legal representation and execution.

If you've found the whole process of getting pregnant stressful, just imagine the additional burden that comes with using what amounts to be an unknown substance to conceive. Worry about the cost of artificial insemination? It just doesn't compare to worrying about your personal safety and your child's health and future.

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.

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.

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.

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

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

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?

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

Safer Fertility Treatment Must Be Made Available

The New York Times' recent series on "21st Century Babies" provides a distressing glimpse into an unpleasant side of reproductive medicine.

Besides being the Medical Director of Houston Fertility Center, I am a mother -- and one who is especially sensitive to NICU issues. My first-born spent the first week of his life in the NICU.

It was several days before we knew if he would live. Although he was not a twin, I cannot imagine how awful it would be to wonder if two or three of your children would die before coming home, or have long-term sequela.

Because of this heightened sensitivity, and because assisted reproductive techniques have become so finely tuned, I encourage single embryo transfer in indicated situations.

The NYT series, by Stephanie Saul:

The Gift of Life, and Its Price

Grievous Choice on Risky Path to Parenthood

Experts weigh in on the subject on the blog
The Trouble with Twin Births

The Embryo Dilemma

Recent news reports brought up again the ongoing questions surrounding embryo creation via IVF. Actually, the questions aren't so much about the creation side of things as they are about disposition of extra embryos.

As reproductive medicine specialists, we have focused mostly on the best ways to help individuals and couples conceive biological children. Success is very often a matter of numbers: the more eggs a woman ovulates, the more sperm a man has available, the more embryos created... the greater their chances at getting pregnant.

For years now, we specialists have been boiling down the science and finely tuning the techniques toward the ultimate goal: how best to unite only as many eggs and sperm necessary to create only as many embryos needed to make one healthy baby.

Single embryo transfer is a true possibility for some patients, but almost a pointless, expensive protocol for others.

At this point, it remains common for IVF patients to wind up with at least some "extra" embryos -- that is, too many embryos to transfer within the same treatment cycle -- so the question of what to do with the surplus continues to be answered.

In the study recently published in Fertility & Sterility, more than 1,000 infertility patients were surveyed about the choices they've pondered and made to address their own embryo surpluses.

Among other things, the survey results reveal a broad consensus of disappointment -- with the options offered at various clinics and with the level of pre-IVF information made available to them.

Fertility treatment centers are like any medical practice: filled with professionals who are people first. Different practices have varying policies based on many factors, including the personal beliefs of the professionals. Another component that steers clinic policies is the availability of resources.

Patients and professionals need not have all their beliefs in common, but there are sometimes "bottom lines" that patients use to make their choices about which fertility practice to turn to for assistance with getting pregnant and about which treatments to use. In the past, some practices were so results-driven, so focused on success rates, that even crucial issues like the disposition of surplus embryos were side-stepped or, at least, addressed with as much brevity as possible. The dilemma of extra embryos is very real and can no longer be seen as ancillary.

I'll discuss specific related options for patients of Houston Infertility Clinic in a follow-up blogpost.

Article in Houston B.A.B.Y. Magazine

[Edited 11/26/08: We now have a copy of the article in PDF format on our BabyLater.com site. Read it here...]

I'm featured in an article for Houston B.A.B.Y. Magazine, a publication of Houston Family Magazine. The October issue is available in digital format here (click on the cute baby face cover), and you can find print issues at Krogers, and in OB/Gyn and pediatrician offices.

The article is called "From Cancer to Parenthood: Reproductive Expert Helps Survivors Create New Life" and includes a pretty interesting photo of Dr. Stoddart in the lab.

I'm glad the feature highlights my efforts at bridging the gaps between oncologists and reproductive specialists. Patients are the prospective losers if the facts about fertility preservation aren't immediately available at that very first discussion about cancer treatment. Making those physician-to-physician connections well in advance of patient need will be the key to enabling more survivors to become parents later.

Please feel free to share this article with your physicians and friends.

For easy sharing by email and for printing, I recommend this: find the article on page 16, click on the article title words "From Cancer to Parenthood" to display the article in easy-print format. From there, you also have options to post the article on your Facebook, MySpace, and other favorites. (Technology is great, but tricky at times...)