Talk: Male Infertility

Infertility is often believed to be a woman's problem. However, studies indicate that 30 percent of infertility is related to male factor problems such as structural abnormalities, sperm production disorders, ejaculatory disturbances and immunologic disorders. Infertility is a couples' problem and one that must be faced as a team.

Discovering the source of infertility often isn’t the “Aha!” experience a couple may hope it to be. While patients may be relieved to know what the barriers to pregnancy are and how to address them, there is often a challenging emotional reaction for both men and women. Men can feel particularly “alone” in their journey, and it may prove difficult for them to discuss their feelings with their partners, family and friends. Fortunately, there are many support groups available for men, and for couples, struggling with infertility. Many are moderated by trained social workers and infertility specialists, while others are organized by people who have themselves been diagnosed with infertility. Speak to your health care practitioner about support groups in your area, contact a national fertility organization for listings or explore online groups and message boards such as those at ivillage.com, babycenter.com and webmd.com.

Share your comments below. For more information on infertility, visit http://www.dreamababy.com/ or call 239-275-8118.

Get “Sharps Smart” – Dispose of needles properly

If your fertility care includes giving yourself shots at home, the “sharps,” or needles and syringes, need to be disposed of properly to prevent injuries or infections to you, your family and the waste disposal workers. Click here for information on sharps collection: http://www.dreamababy.com/downloads/Sharps%20Collection%20Patient%20Information.pdf

We want to hear about your fertility journeys. Visit our patient diaries and share your story!

Do you have a personal story to share?  Are you trying to conceive?  Going through treatment?  Do you have your own “Sweet” success story to share?  If so, visit our “Patient Diaries.”  You can post your experience, comment on other posts or simply read the stories from others. For more information, please call 239-275-8118.

Male Infertility: Living the Fertile Life

Just as there are many things a woman should do to safeguard her reproductive health and promote the well-being of an embryo when trying to conceive, studies show men's fertility is also affected by nutrition and lifestyle choices. It isn't stress that affects sperm, it is what men do with their stress. Smoking, overeating, which can result in pre-diabetes or diabetes, and consuming alcohol or taking recreational drugs can wreak havoc on sperm. Many people worry about heat, but the body usually reduces the temperature near the testicles with perspiration. Boxer shorts, unless his partner really likes them, will doubtfully do much to cure infertility. Hot tubs will briefly reduce motility (the sperm's ability to move to the egg for fertilization) for a few hours. That stated, we do not suggest that men read the entire New York Times while sitting in a hot tub. Contracting sexually transmitted diseases can damage the prostate, testicles and the scrotal contents resulting in reduced fertility and even sterility. While there are as many “old wives tales” as there are “old wives,” speak to your friendly neighborhood Reproductive Endocrinologist for the real facts on a fertile life.

For more information, visit http://www.dreamababy.com/ or call 239-275-8118.

Looking for Emotional Support?

We understand that our patients may have some difficulty dealing with the emotional stress of infertility and other medical conditions. If you feel you would benefit from psychological counseling, please mention this to us and we will make an appropriate referral to a professional experienced in the specific areas of concern. We recognize the importance of caring for the whole patient and that brief psychological counseling may be an important aspect of treatment. If you are looking for support, please call 239-275-8118 and our staff will help you find the resources you need.  In addition, RESOLVE, The National Infertility Association, has a list of resources that may be of help to you.

Don't forget to tune in to The Fertility Chase this weekend!

Don’t forget – “The Fertility Chase” airs on this Saturday at 8:30 a.m. on WEtv. A story appeared this week in the Naples Daily News featuring a Naples couple’s journey through infertility: http://bit.ly/aG8fnk

This week is National Women’s Health Week; empower the women in your life!

This week is National Women’s Health Week, a weeklong observance to empower women to make their health a top priority. Preventative health care is especially important to women trying to conceive through both natural and assisted reproductive options. Here are a few important tips:

  • Exercise regularly (if undergoing assisted reproduction, discuss with your physician)
  • Eat a nutritious diet
  • Visit a health care professional to receive regular checkups and preventive screenings
  • Avoiding risky behaviors, such as smoking and not wearing a seatbelt
  • Pay attention to mental health, including getting enough sleep and managing stress

For more information, call 239-275-8118 or visit www.dreamababy.com.

The Fertility Chase, Episode 2, WE TV, 5-8-2010

I liked today’s show a great deal. There was an abundance of information offered at a dizzying pace. Sorry, in advance, for the long post, but there was much to cover.

Single Embryo Transfer:
The University of Iowa Hospitals & Clinics discussed the concept of what is commonly called “elective single embryo transfer” or eSET. Bradly J. Van Voorhis, M.D., Director of the IVF program, was one of the physicians featured. The idea discussed was to transfer only one healthy embryo at a time significantly reducing the risk for multiple pregnancies. He published on this topic in 2007. In today's story, they claimed a 68% delivery rate with a single embryo transfer procedure. According to their previously published data, this probably included egg donation cycles where eggs are removed from very young women and then provided to women who need them.

There is no question that it is ideal to perform an eSET but there are two issues I need to bring up. In many IVF programs, ideal patients are the exception, so eSET may really only be practical for a minority of the patients. Second, other studies have shown a reduction in take-home rates with eSET compared to two embryos, so many patients still request two embryos, even after being warned of the many risks of a multiple pregnancy. It is rare that I am able to convince a patient to electively transfer a single embryo, especially if IVF is not covered by insurance. Americans love a two-for-one sale, even when told of the risks a multiple pregnancy involves.

Cancer and Reproduction:
The second story came from the University of Colorado. This involved the heart-wrenching story of Meghan and Barton. Meghan was diagnosed with some sort of cancer (never described), underwent surgery and radiation, had a recurrence two years later and then received additional surgery, chemotherapy and radiation. I was so very impressed with both of them, especially Barton who so lovingly supported her throughout the process. There was a great picture of the two of them bald probably after the chemotherapy. What a life partner!

After several attempts, a total of four embryos were frozen (cryopreserved). Meghan found an Oncologist who suggested transferring these embryos before the cancer came back, which seemed like an inevitability. I was impressed by Dr. William Schlaff’s honesty explaining the chances that these four cryopreserved embryos would result in a live birth were slim because of her past cancer treatments. I have heard Dr. Schlaff speak before and have always been impressed by his honesty and integrity.

Amazingly, Meghan and Barton became pregnant with the thawed embryos and we were able to see an ultrasound image of an early pregnancy. This case also brings up a very sensitive and difficult side of cancer and reproduction. For patients who have cancer and recurrence, it is really uncertain if they will remain disease free. Many of these patients want to experience life, which often means reproducing. For some, this means having children to fulfill their lives even understanding that some will not survive to raise the child. In addition, by having a child, a part of the cancer patient, a legacy of sorts is left with the surviving partner. I don’t know what cancer Meghan has or her prognosis but it would seem that she might have more trouble ahead. I think they are amazingly brave. She deserves to experience parenthood, which robs so many other cancer patients. Barton is a rare life partner and I truly wish them only the very best.

Dual Training of the Reproductive Endocrinologist:
The University of Colorado facility is unusual in that the Reproductive Endocrinologist are trained to evaluate male infertility. Those types of physicians are rare and are great to have around since one physician is then truly able to care for the couple as a whole rather than trying to get two separate physicians to communicate and agree on a treatment plan. I was fortunate to have been similarly trained and I estimate that at least 25% of my new infertility patients are male.

Egg Freezing (Oocyte Cryopreservation):
Continuing under the theme of cancer, Charles Coddington, III, M.D., Director of the Reproductive Endocrinology Division at the Mayo Clinic, brought up the story of Sarah. Sarah was diagnosed with breast cancer and underwent a double mastectomy, such a difficult decision for such a young woman. In her case, she eventually underwent an egg freezing procedure (oocyte cryopreservation). It is uncertain how many eggs were actually frozen. I thought this piece was well done showing what is possible with today’s technology. Tina was also featured in the segment electively freezing her eggs so she could have a “reproductive insurance policy”.

Trying to Not Create Excess Embryos:
The story of Ceresa and Jonathan was next wherein they tried to only fertilize enough eggs to transfer embryos and then freeze the excess eggs but not have any excess embryos frozen. From what I could tell, two IVF cycles were needed to freeze a total of five eggs. The two fresh embryo transfers resulted in one failure and one miscarriage. For the third procedure, the five eggs were thawed four survived, three fertilized and were transferred resulting in a twin pregnancy.

My personal experience with trying to not create cryopreserved excess embryos has almost always resulted in failure. Trying to get as many healthy embryos as possible, transferring the best and freezing the remaining still provides the best chance for success. Playing the game of fertilizing only a few eggs and freezing the rest does not improve success rates but, in all likelihood, reduces them. It also increased the costs of the cycles. Excess cryopreserved and thawed embryos can be transferred in the couple later or donated to needy patients, so I would almost always suggest fertilizing all the eggs, transfer fresh and free the excess embryos rather than freezing only a few eggs and hoping for the best.

The only issue I had with this entire topic was that it was never made clear that oocyte cryopreservation was experimental requiring a true study with a review board’s oversight. We here at SRMS do have an ongoing oocyte cryopreservation study. We had to go before the hospital Institutional Review Committee (IRC) to give us permission to move forward with the study. I know how careful the IRC is and they would have required to review this segment of The Fertility Chase should this have been my topic. I couldn’t tell if the Mayo Clinic had checked with their IRC before airing their segment but the fact that it was never mentioned that egg freezing was experimental makes me think the committee was never approached.

Please do not misunderstand my writings. I feel this is a very important area of reproductive medicine with the potential to liberate women much as the birth control pill did years many years ago. The reality, however, is that we need to emphasize that oocyte cryopreservation is really experimental and not over promise what we cannot consistently deliver.

Outsourcing Surrogacy:
Next came the couple Karen and Jean. Jean clearly had some difficult luck in that insemination procedures and egg donation cycles didn’t succeed wherein she was then diagnosed with breast cancer. In comes Proactive Family Solutions, which outsources surrogacy to Mumbai, India. From the best that I could tell, Jean’s sperm was combined with an egg donor (American?) and some of the embryos created were placed into an Indian surrogate.

There is no question that surrogacy can be expensive. I couldn’t find any information as to the overall costs Proactive Family Solutions charged but it is undoubtedly less than some locations here in the states. I suspect the option of embryo donation may very well compete in price with Proactive Family Solutions. I would really like to see a head-to-head comparison of the costs to see where the costs here in the states make surrogacy out of reach wherein we should do whatever possible to bring this process back to the states.

Next Week:
Lastly, I felt honored that our piece on embryo donation was the teaser for the next show. Please be sure to tune in next week. I guarantee you will not be disappointed!

Coping with Mother’s Day

At Specialists in Reproductive Medicine & Surgery, P.A., we recognize that Mother’s Day can be particularly difficult. Acknowledging those feelings and preparing emotionally can help.

Focus on your own mother, mother-in-law, sister, grandmother or other special woman in your life
Plan ahead and make this day about your own mom or other special woman in your life. Or, if you have other friends suffering with infertility, plan a girl’s day out for shopping, dining, movies or a spa day. Take this opportunity to do something special for yourself or celebrate with others in your life. 

Recognize difficult situations
For example, restaurants often ask if you are a mother and offer complimentary items. Be prepared on how you might respond so that you are not taken off-guard.

Consider joining a support group
There are a number of support groups online and through RESOLVE, the National Infertility Association. Support groups will help you feel less isolated, empower you with knowledge and validate your emotional response to the life crisis of infertility. Visit the RESOLVE Calendar of Events to find a support group in your area.

Speak to your minister, a rabbi or a therapist for support
Talk with your clergyperson and educate him/her about the experience of infertility. Perhaps he/she would be willing to say a prayer or offer words of support for those struggling with this crisis. Or, seek a professional mental health therapist for support.

Plan an enjoyable day with your significant other
You are not alone. For couples facing infertility, it is important to work together during these difficult days. Plan a fun day together such as hiking, bicycling, or walking on a beach. See that movie you've wanted to see or create a special meal.

It is our hope and goal that each of our patient families will soon experience their first of many Mothers’ Days! For more information, visit http://www.dreamababy.comor call 239-275-8118.

What is Infertility and What Causes It?

One of the main focuses of National Infertility Awareness Week (April 24 – May 1) is creating awareness. Sometimes, understanding infertility and explaining it to others can be challenging so we try to offer a simple description for an often complex disease. Infertility occurs when a couple has unprotected intercourse for one year without conception. Around 15 percent of all couples that try to conceive over a 12 month period will not succeed. Forty percent of women have problems such as damaged Fallopian tubes, endometriosis, advanced age, ovulation problems and hormone imbalances. Forty percent of the time it is due to the male caused by hormone imbalances, a scrotal varicose vein, obstruction, infections, chronic medical conditions and antibodies. The remaining 20 percent of couples have issues on both sides. For more information, please call 239-275-8118 or visit www.dreamababy.com. A visit to a reproductive endocrinologist is a good first step to diagnosing, understanding and treating your condition.