What to Say & What Not to Say to the Infertile Patient

By: Dr. Craig R. Sweet, Medical Director & Founder

(Reprinted from Florida Parenting News, February, 1994, revised September, 1999 and again April, 2011.)


Infertility affects nearly one in six couples. Approximately 40% of the time, the problem is related to the female partner, another 40% is related to male difficulties and 20% of the time both partners will have medical problems. Most of the time, infertility is a symptom of an underlying disease process, a disease process that the infertile patient has no control over. To these patients, infertility can be a crisis of the deepest kind. Every menstrual cycle represents a failure and is a time of grief for the potential child that never came to be.

The infertile patient or couple will often express their feelings through anger, frustration, feelings of inadequacy, depression and guilt. Relationships with family members who have children can suffer, marriages and relationships are strained and well-meaning friends and family can overload the patient with advice and pressure. Family and social gatherings become a reminder of infertility. Baby showers can be a traumatic experience. Mother's and Father's Day are often very, very difficult.

We want to offer some tips that provide support to patients who have not yet had the blessing of a beautiful child to love. With your assistance, most patients going though the process of trying to conceive can maintain a positive attitude.

What Not To Say…

Don't ask a childless person when they are going to have a child. They may be going through the process of trying to conceive, but have not yet achieved success. Asking them only reminds them of their problem and they need no extra reminders.

Don't relate stories of your fertility to them. Hearing “my husband just has to look at me and I get pregnant” is very annoying. While well meaning, the statement is insensitive and unhelpful.

Don't give advice such as “just relax,” “you are trying too hard” or “take a vacation.” All of these very common comments imply that patient has control of their fertility. Most of the time, these patients have absolutely no control over their fertility. Implying control leads to feelings of failure and guilt when this advice doesn't work. It simply is not their fault and they are doubtfully doing anything wrong in what they have done thus far.

Don't offer advice such as sexual timing, position, herbal medications or other totally unproven therapies. There are literally hundreds of old wives’ tales that, when followed, can drive an infertile patient nearly crazy. Their physician will have covered those natural aspects of their care that may maximize their chances for conception. Once again, please to not imply that they have a sense of control as they lost it long ago.

Don't express your derogatory personal opinions regarding insemination procedures, test-tube babies or adoption. Sometimes, these are their only hope for having a child. These are your opinions and uninvited advice is rarely neither desired nor constructive. You are absolutely entitled to your opinion; simply keep it your own. If they ask for your advice, then feel free to state your opinions, but do so in a kind and considerate manner.  Please, do not be judgmental.

Don't place blame by accusing the couple of exercising too much, eating the wrong foods or drinking alcohol. These patients may already be blaming themselves. Their physician will have already covered the medical and reproductive consequences of obesity, smoking, alcohol and recreation drugs. Support them in the cessation of these activities and minimize the guilt associated with their consumption. The guilt rarely leads to cessation but often moves the individual to increased consumption.

What You Can Say and Do…

Do provide couples with plenty of emotional support by saying “It must be difficult to go through this” and “I'm here to listen if you need to talk.”

Do remember that men can be just as emotional about the problem, sometimes even more so. They may feel their masculinity is at risk. Be sensitive to their egos and personality traits.

Do understand the couple's need for privacy.

Do try to understand that if they are your employees, frequent doctor's appointments may be necessary during business hours. Please try to accommodate them as much as possible. Not doing so may also be construed as a form of discrimination and place you at legal risk.

Do understand why they may not make it to a baby shower or a holiday event. These frequent events can become overwhelming for an infertile patient.

Do tell the infertile couple that there is hope.

Please remember that the vast majority of infertile patients have minimal control of the diseases that causes their infertility. Giving them emotional support during this trying time is a wonderful way to assist them. Giving them subtle hints that they have control plants the seeds of personal failure in the minds of the infertile patient.

Please be kind, be thoughtful and always be supportive.


No Longer Silent – National Infertility Awareness Week

national infertility awareness weekEach year, physicians such as myself, fertility patients, their caregivers and families dedicated to raising awareness about the disease of infertility which affects 7.3 million Americans. RESOLVE, the national infertility association, has coordinated this week, April 24 through the 30 and we fully support it and encourage you to speak up in support as well. For information on how you can get involved in infertility awareness projects around the country and upcoming Advocacy Day on May 5, visit RESOLVE at www.resolve.org/takecharge.

At SRMS, we are committed to providing the highest quality care and support to patients and their families. Infertility is a disease, it is important and we are working to raise awareness on your behalf. For more information, visit www.dreamababy.comor call 239-275-8118.


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Compassion, Understanding and Respect are Desperately Needed While We Discuss Three Important Perspectives on Gamete & Embryo Donation

I will admit that I was a bit overwhelmed with all that transpired recently on this blog.

My original goal to discuss the potential gender discrimination existing regarding the recommended ages for gamete donation was usurped into a rather emotional discussion on merits and evils of gamete donation itself. Some of the posts were so inflammatory that I have been advised by others to wipe out all the comments so as to do no harm to others that may eventually read them. For at least now, they will remain.

So many very complex issues were discussed simultaneously; some that were reasonable while others quite unreasonable and I was not even sure where to begin. To carefully start, I believe there are three perspectives that need to be better understood involving the gamete donor, the gamete recipient and the donor-conceived offspring.

The gamete donor’s perspective

Donors may donate for a host of reasons that may include monetary reimbursement, but nearly all will donate, at some level, so that individuals who might not otherwise raise a child can do so. Many donors will already have children or may have somehow been touched by infertility though a family member, friend, loved one, or even through media stories.

Some donate blood and/or their time and others donate their money. The difference with egg and sperm donation is that they involve individuals clearly giving a part of themselves. Do donors all understand the long-term effects of the donation? Perhaps some do, but not all. Do they wonder about the children their DNA helped to create? Perhaps, yes for some. Do they regret the donation? A vocal group will say “yes” but the many gamete donors who are content, at peace and even proud of their decision are silent in the wings, not feeling the need to make their past decision to donate known. Does that mean they are embarrassed by their past decision? Perhaps a few but I suspect most will simply state it was a private decision and not for others to judge or be involved in.

Was it wrong for them to have donated eggs or sperm as some might lead us to believe? I would emphatically answer “no.”

The gamete recipient’s perspective

Most patients who accept donated eggs and sperm do so reluctantly. Single women and same-sex couples may not have many options available to them and may enter the process more willingly. For the majority using donor gametes though, they are doing so because they or their partner are unable to use their own gametes to create and raise a child. Reluctance is the common denominator in their decision.

To simply state patients seeking donor eggs and/or sperm should adopt is naive. Many patients can’t adopt for a host of reasons including age, social situations, overall costs or personal medical history. Still, adoption is a viable option for some and infertile patients go through adoption all the time.

Others patients still want to experience pregnancy and birth. Is it selfish that they want this? I do not believe it is inherently selfish to want to experience something so basic in life as reproduction. It is a drive that goes to the core of all species. The reproductive process brings them and their partner (when they exist) closer in ways that are difficult to otherwise replicate. If one condemns reproduction using donated gametes as selfish, I suppose one should condemn all reproduction as basically selfish, especially when there are existing children who could be adopted. Many patients feel that reproduction comes close to an inalienable right that is not to be interrupted or disturbed by those who disagree.

Patients that reproduce using donated gametes are not “social parents,” as some would like us to believe while trying to diminish the importance of these parents. They are parents in every sense of the word. As I have written before, being a parent has to do with being there emotionally, physically and financially for future decades to come. Being a genetic parent may only take a few quick minutes of sexual activity. I will state the genetic contribution is important, but in the scheme of things, only a very small part of the creation of a child and a family.

DNA does not a family make – it is only part of the equation.

The donor-conceived offspring’s perspective

This is where the issues of gamete donation become so complex. As I have written before, I feel that my field has not paid enough attention to the perspectives of these individuals because they were never our patients. In fact, their very existence would not be was it not for our work bringing donors and recipients together. As a result, we have an inherent responsibility to donor-conceived offspring, having assisted in their creation.

Is it better that they never should have been conceived and born, eventually experiencing all that the world has to offer? I don’t see how that could ever be thought of as true. Inherent good is created when these special individuals grace our world.

Do they have a right to know their genetic background? Perhaps they do have a moral right to know, but this frequently comes into conflict with the right of privacy of the gamete donors and recipients. Would I want to know? I think the answer is “yes.” If I were a recipient of a donated gamete, be it eggs, sperm or both, would I want to be able to make the decision about telling my donor-conceived child? I also think the answer is “yes.” So, how can we possibly reconcile these potentially conflicting rights?

We need compassion, understanding and respect.


We need to be better aware of how donor-conceived offspring feel. They will be curious about the donors. They will be interested in connecting with half-siblings, especially when they have no other siblings in the family in which they were raised. We need to consider how the donor-conceived offspring will tell their future or current partners about their genetic family. We need to understand that they will want to tell their own children about their ancestry.


We need to better understand how disclosure will affect all parties involved. There is a great deal of angst and fear regarding disclosure with the recipients fearing most that their donor-conceived child or children will not love them anymore after they find out they were a product of gamete donation or after they connect with the gamete donor. We need to help move society and religion forward so donors and recipients will not be at risk for condemnation by friends, family or retaliation from their own religion. This will take a great deal of time and patience.

We need follow-up and well-designed research examining the effects of disclosure on all parties. Only by gathering information can we can share with donors, recipients and donor-conceived offspring the likely outcomes of disclosure and open-identity. We need to move from uncertainty to knowledge and from fear to hope.


There is a great deal of disrespect abounding on the topic of gamete donation and passions are running very high as was evident in the recent comments on my blog. The perspectives have almost become religious in character with extraordinarily narrow and unbending belief systems incapable of contemplating another viewpoint. Zealots want to indoctrinate all, bringing everyone to their own perspective, which they view as the only right one. We all need to take a step back and breathe. If we all realize that we are in this together, trying to do what is best dealing with all three perspectives, then we will work through our differences and come up with alternatives that will work best for the greatest number of people. We will never please the zealots but we can try to care for the greatest number possible.


Possible solutions

I don’t pretend to have all the answers here and I’m not even sure I have asked the right questions yet. Having worked in this field for almost 23 years though, perhaps I have a perspective that could have some value.


A central registry, where information about donors, recipients and donor-conceived offspring could be stored, is an alluring concept but important practical issues abound. Who will pay for it, what information will be stored, who will have access to the data and will the information be truly secure are all questions that need to be answered before we undertake such a venture and before we put patients and families at risk. Understanding that we have already succeeded in collecting and reporting ART data though the CDC/SART, I do feel that we might be able to successfully build a data collection system for egg, sperm and embryo donation procedures. A multi-disciplinary discussion guided by the ASRM or a yet-to-be-formed special interest group is probably the best place to start working closely with our peers in other countries who have already initiated this process. I am concerned if we do not do this voluntarily, politicians who may have a meager understanding of the true issues will force it upon us.

Open identity

Creating gamete donation procedures with expanded open identity options would seem potentially to be the best of all worlds. It doesn’t mean that all donations must be open identity (i.e., it shouldn’t be mandated or legislated) for if we force this option on all, we take choice out of the hands of those involved and risk depletion of the gamete pools that are needed for so many.

I do not necessarily agree that open identity will be the answer for all of the problems but it could, most of all, benefit the donor-conceived offspring. Additional work must be done to also decide how and when the identity of the donor should be presented to the donor-conceived offspring. If we are creating an open gamete donation option for the children’s good, it is hard to argue that this information must not be released until they reach age 18 or 21. For the good of the child, having some sort of connection to the donor might indeed be best if initiated in the truly formative years and, certainly, before age 10.

Summary comments

Egg, sperm and embryo donation procedures are not inherently evil. They build families where they would otherwise not exist, an inherent good. We all need to better understand the three perspectives of donors, recipients and the donor-conceived offspring and, through compassion, knowledge and respect, work better together for the betterment of all the parties involved. This issue is a moving target and I beseech all those that feel so strongly on this topic to honor and listen to the opinions of others, understanding there is no right answer for everyone any more than there a single correct religion. I ask all to try to reign in all the emotion and focus this valuable energy towards discussion rather argument, compassion rather than condemnation, education rather than persuasion and respect rather than intolerance.

We have a long way to go but I feel we can get there together by understanding that each of us has much to learn from each other.

Craig R. Sweet, M.D.
Reproductive Endocrinologist
Moderator, www.SweetFertility.com

P.S. For those that would like to review a somewhat scholarly summary on disclosure in embryo donation from the perspective of the embryo donor, embryo recipient and the donor-conceived offspring, I encourage you to read one of my somewhat long, but comprehensive reviews on the topic by visiting my embryo donation blog by clicking here.


Polycystic Ovarian Syndrome: A Review Written for Patients

How common is polycystic ovarian syndrome?

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine diseases affecting about six percent of reproductive age women. PCOS is one of the main reasons women have difficulty conceiving. About half of all women who do not ovulate on a regular basis will be diagnosed with PCOS.

In recognition of PCOS Awareness Month, I've developed this review for patients dealing with this disease.

How is PCOS diagnosed?

As a syndrome, PCOS is a constellation of findings. Alone, it really is not a disease but simply a label. But physicians use these labels to our patients’ advantage. If we suspect PCOS, we will search for the problems that commonly accompany PCOS, minimizing their effect while possibly changing the course of the illness.

PCOS requires at least two of these three problems for a diagnosis:

  1. Ovulatory dysfunction: irregular cycles or blood progesterone levels that indicate failed ovulation.
  2. Ovarian hyperandroginism: excess male hormones including an unusual amount of facial/body hair or elevated male hormones, such as testosterone, in blood tests.
  3. Polycystic ovaries on transvaginal ultrasound: more than 12 small 3-9mm follicles within each ovary as seen on an ultrasound. At times, we will see the signs of a classic “necklace,” with small cystic follicles located on the periphery of the ovary and which look like a pearl necklace.

Clinically, there seem to be two main types of PCOS: 1) Patients who were essentially born with the problem and have never really had normal cycles, and 2) Patients who have had normal cycles but demonstrate symptoms as they gain weight. Upwards of 80% of all PCOS women are heavy, but 20% can be quite slender.

Other issues include thyroid problems, elevations of the pituitary hormone prolactin and a handful of rare inheritable enzyme deficiencies. These problems need to be screened for and ruled out before settling on the diagnosis of PCOS.

PCOS is probably the single most common diagnosis we see in our patients. Its incidence has been increasing over the last 20 years as the US population has shifted from normal weight to the overweight, obese and morbidly obese categories.

How do you diagnose pre-diabetes in the PCOS patient?

To diagnose insulin and glucose problems, commonly called pre-diabetes, we prefer a 10-12 hour fast with baseline glucose and insulin levels rather than fasting glucose levels alone. The endocrine system is then challenged by having the patient drink 75 grams of glucose (Glucola®), which is called a Glucose Tolerance Test (GTT). Two hours later, insulin and glucose levels are repeated to complete the study. We do not require blood tests every 30 minutes as some protocols suggest, since the fasting and two-hour results are sufficient.

Insulin resistance or actual diabetes is present in nearly half of all PCOS patients. The more the patient weighs, the more likely the diagnosis.

What really causes PCOS?

While many women believe their hormone imbalance is mainly caused by testosterone, insulin seems to be the key hormonal culprit. Excess insulin stimulates the ovaries to produce excess male hormones. Also, excess insulin predisposes the PCOS patient to numerous medial problems, including cholesterol elevation, hypertension and possibly heart disease. Insulin is the key.

How is PCOS best treated?

Treatment in the overweight PCOS patient includes diet, exercise, weight loss and aggressive prevention and treatment of pre-diabetes (insulin resistance and/or glucose intolerance).

Beyond this basic treatment, there are generally two treatment pathways: the “quality of life path” and the “pregnancy path”.

Quality of Life Path

PCOS patients who are not trying to get pregnant should follow the quality of life path and focus on treating the signs and symptoms. Because they don’t shed the inner endometrial lining on a regular basis, PCOS patients are at greater risk for abnormal uterine bleeding, anemia, endometrial polyps, pre-cancer and eventually, even cancer of the lining of the uterus. Hormonal control is used in this pathway. We also suggest aggressive treatment for hair growth, including the use of hormones, electrolysis or laser hair removal. The psychological affects of excess facial and body hair on women should not be minimized and may be the primary concern for PCOS patients.

Pregnancy Path

We recommend that PCOS patients who want to get pregnant use a winning combination of diet, exercise, weight loss and anti-diabetic medications such as metformin (Glucophage®) that are combined with ovulatory medications. Metformin helps in a number of ways including dropping male hormone levels in half and assisting in weight loss. Gas and diarrhea results when too many carbohydrates are consumed while taking metformin, so patients must learn to eat better to avoid the symptoms.

Our practice commonly uses letrazole (Femara®) to stimulate ovulation but sometimes we need to prescribe the old tried and true clomiphene citrate (Clomid®). We occasionally have to suppress the adrenal male hormones through the addition of dexamethasone. We need to be very careful about prescribing injectable follicle stimulating hormone (FSH) medications for PCOS patients since they tend to open the floodgates, resulting in a release of multiple eggs and the potential for a multiple pregnancy. Overstimulation of the ovaries can also lead to significant illness.

Miscarriages seem to occur more often in the PCOS patient. It may have to do with their weight and abnormal insulin levels. While somewhat controversial, even PCOS patients without obvious glucose/insulin problems may benefit from metformin treatment. It must be understood that while these drugs have been extensively studied in the treatment of diabetes, insulin resistance, glucose intolerance and PCOS, the FDA has not granted official approval for the use of these drugs for PCOS.

PCOS patients also more commonly experience gestational diabetes during pregnancy. Weight gain during pregnancy should be held in check as excessive amounts of weight gained can result in insulin dependent diabetes during pregnancy and even afterwards. Pregnancy complications are more common in patients with gestational and insulin dependent diabetes, so an obstetrician will need to carefully monitor a PCOS patient during her pregnancy.

What are long-term concerns for the PCOS patient?

Women with PCOS are at significant risk of developing insulin and non-insulin dependent diabetes mellitus, uterine cancer, elevated lipids, hypertension and cardiovascular disease.

Will a PCOS diagnosis and treatment be covered by insurance?

The coverage of PCOS will depend upon the insurance company. Your physician will try to emphasize the medical diagnoses that are seen with PCOS, such as an ovulatory dysfunction, hirsutism, glucose intolerance or insulin resistance, but coverage cannot be guaranteed. The diagnosis of infertility for the PCOS patient is less often covered but it entirely depends on the particular insurance plan. Medications such as metformin are commonly available free at some pharmacies and supermarkets, so co-pays aren’t even necessary to obtain the medication.

Can PCOS be cured?

In patients that have always had menstrual issues, even when young and slender, an actual cure has not yet been found. However, in the population who became symptomatic after weight gain, diet, exercise, weight loss and medications may actually result in a cure. This “cure” continues as long as the patient’s weight remains close to the level when ovulation and regular cycles returned.

PCOS is a metabolic disease and will require careful control for most patients throughout their lives. That doesn’t mean that the PCOS patient can’t have a family or will always have to suffer the symptoms. Through dedication by the PCOS patient with the assistance of your obstetrician/gynecologist or your friendly neighborhood reproductive endocrinologist, the signs and symptoms of PCOS can certainly be controlled and minimized.

Craig R. Sweet, M.D.
Medical & Practice Director
Reproductive Endocrinologist
Specialists In Reproductive Medicine & Surgery, P.A.

Documents of Interest to the PCOS Patient:

ASRM PATIENT FACT SHEET, Ovarian Drilling for Infertility

ASRM, Hirsutism and Polycystic Ovarian Syndrome, Patient Information Series

ASRM, Patient Fact Sheets, Polycystic Ovarian Syndrome

ASRM, Patient Fact Sheet. Ovarian Drilling for Infertility

PCOS Links of Interest:

The PCOS Challenge:



Embryo Donation – Option for Infertile Couples & Waiting Lives

I recently had the opportunity to be on Theresa Erickson's Internet radio show, Voice America. Known as the Surrogacy Lawyer, Theresa is renowned for her work on behalf of many patients faced with infertility looking for third party options. During my interview, we discussed the option of embryo donation  from the physician, recipient and donor perspectives.

One of our donors, Tori, discussed her infertility experience as well as her and her husband's  decision to donate their remaining embryos following a  successful IVF procedure culminating in the delivery of her twins. You can see a picture of her twins and information regarding her amazing embryos by visiting our website.

Tori's Twins!

Tori and her husband decided that they wanted to “pay it forward” to other infertile couples. Here is a combination of her own words during the interview and some other comments she told me separately:

“Donating the embryos brought on a wide range of emotions; some expected such as the happiness to help another infertile couple, peace in setting the embryos ‘free’ by finally making a decision on their fate and others were a bit of a surprise  such as a brief feeling of sheer panic that I ‘forgot’ something after leaving the clinic. The donation experience to me is like paying it forward to other infertile couples. I did not see any reason to leave the embryos suspended in time, did not want to see them destroyed and there was no reason to donate them to stem cell research when there are so many infertile couples in the world going through the same anguish I went through.

That feeling of anguish kept coming back, that longing and yearning for something that was so easy for others to have, yet so very difficult for me to obtain. I wanted to help someone relieve that awful feeling and by donating my embryos, I had a very good chance of doing just that.”

To listen to the show, please visit our Audio Gallery and click the play button to the right.

I am so thankful for people like Tori and other donors who consider giving their frozen embryos life while helping other people building their families at the same time. If you'd like more information on the process, please visit our embryo donation page on our Website, contact us at (239) 275-8118 or e-mail us at Fertility@DreamABaby.com.

Also, for additional details on surrogacy or fertility via third party assistance, I encourage you to read Theresa's book: Surrogacy and Embryo, Sperm and Egg Donation: What were you thinking?

Please stay tuned for the launching of our expanded embryo donation program called Embryo Donation International! I hope that many couples will consider to “pay it forward” just as Tori and her husband did.

Your thoughts and comments are always welcome.


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Thoughts on "The Switch"?

Did you see the new Jennifer Anniston movie, “The Switch” this weekend? What did you think about how it portrays the subject of infertility? Did you appreciate its humor or just find it way off base? If you didn’t see it, do you plan to? Share your thoughts!

Sorting out fertility fact from fertility fiction

How many times have your friends and family told you to “just relax and you'll get pregnant,” “don't let him ride a bike,” “point your head to the North during sex to have a boy,” “don't exercise,” “wear boxers instead briefs,” just to name a few? The list goes on and on. Some may have a touch of fact while others are total fiction. Ever want to ask your doctor but afraid you would be thought of as silly? I guarantee that if you have the question, others will also want to hear the answer!

I’ll be sorting out fertility fact from fertility fiction! Privately e-mail the question to fertility@dreamABaby.com. Please indicate if you want us to use your name or e-mail address. Or list the question on Facebook or our Blog. You can be entirely anonymous or we can include your name and/or e-mail address so others can share their experiences directly with you. We will then place the questions in order and explain away. I promise that I will sprinkle a touch of humor, a pinch of history and gallons of information in answering these questions.

Trying to get pregnant? More answers to your questions

Couples trying the “old-fashioned way” of conceiving often ask, “How often should we have sex to become pregnant?”

Our response is that having sex every 36-48 hours in the middle part of the women’s menstrual cycle is ideal. Couples that have sex five times a week get pregnant faster than those who have sex less often. Throw away the daily temperature charts and just have fun!  Taking a temperature every morning is also a lousy way to start the day. Have fun, go on dates, keep it as spontaneous as possible, remember why the two of you are together and don’t make creating a baby a second job!

Do you have a question about fertility? Submit it below or email me directly at fertility@dreamABaby.com.

Question of the week: Is it true that eating pineapple during IVF helps the embryos stick?!

If you are trying to conceive, then you are likely familiar with some of the common myths of achieving pregnancy. For example, the “hips up theory” – is it the best position for achieving pregnancy? Send in your questions and I’ll sort out fertility fact from fertility fiction.

What to expect, when you’re trying to expect

What can you expect when going through fertility testing and treatment?  Visit our website at www.dreamababy.com for answers to your frequently asked questions and information to help guide you through the process. And of course, our compassionate staff is always willing to answer your questions by calling 239-275-8118.