Tuesday, March 25, 2014

GIFT, ZIFT and ICSI: What’s the difference?

If you’re like me, you’re wondering what the heck these acronyms mean. All three are forms of assisted reproduction technology. At a (very) high level, here is what GIFT, ZIFT and ICSI mean.

GIFT, ZIFT and ICSI all involve egg and sperm collection in the same manner that is done for IVF, but after that, the process differs.

GIFT (Gamete Intrafallopian Transfer)
During GIFT, an incision is made in the abdomen and the collected eggs and sperm are placed in the fallopian tubes using a laparoscope. The hope is that fertilization occurs inside the body naturally, as opposed to fertilizing the egg outside the body before insertion.

ZIFT (Zygote Intrafallopian Transfer)
ZIFT is when the fertilized eggs (called zygotes) are placed in the fallopian tubes rather than the uterus. ZIFT is also done by a laparoscope, but the eggs are retrieved and fertilized on one day and the embryo is transferred the following day.

According to WebMD, In vitro fertilization accounts for at least 98% of all assisted reproductive technology procedures performed in the U.S., while GIFT and ZIFT make up less than 2%. GIFT and ZIFT are not recommended in cases where the woman has damage to her fallopian tubes.

ICSI (Intra-cytoplasmic Sperm Injection)
During ICSI a single sperm is injected directly into an egg to fertilize it. After a few days in the lab, any fertilized eggs are transferred to the woman’s uterus. ICSI is often recommended when the man has low sperm count, poor sperm motility or abnormally shaped sperm.

For more information, talk to your doctor or view additional resources at:

Have you done GIFT, ZIFT or ICSI? We’d love to hear from you in the comments! What resources can you share with our readers? What was your experience like?

Thursday, March 13, 2014

Endometriosis Awareness Month

Endometriosis 101

March is Endometriosis Awareness Month! Despite the fact that it affects 1 out of every 10 women, it takes an average of ten years for a woman to get diagnosed. Most people, including some medical professionals, will give an endometriosis patient a blank stare when they mention their disease.  The lack of awareness regarding this disease is appalling. The mistreatment of women on their journey to get properly diagnosed may be considered criminal or at the very least medically negligent. So in the spirit of the March, let’s talk about the basics of this disease.


ENDOMETRIOSIS is when tissue, very similar to the lining of the uterus, escapes the uterus and starts wreaking havoc in a women’s pelvic cavity as well as surrounding areas causing scar tissue, adhesions and painful lesions. How the disease originates is still disputed, but this tissue, that is reactive to a women’s hormones, can be present on the outside of the uterus, the ovaries, the bladder, the ureters, the rectum, the colon, and can go as far up as the diaphragm and the lungs and as far down as the sciatic nerves. There are also cases of endometriosis found in very odd places like the brain, but we won’t go there for now. 

How do I know if I have it?

Have you ever had to schedule events around your period because you were in so much pain? Do you have severe constipation or diarrhea around your period? Does it hurt to poop? Do you regularly feel like someone is stabbing you in your pelvis or back during any time in your cycle?  Do you need to have a bottle of wine before you have sex with your partner because the pain is so bad? Do you pee a lot or get frequent UTI’s? Do you have pain in your leg or hip that can be correlated to your cycle? Do you have unexplained infertility and pregnancy loss?  Do you have other weird immunological symptoms that are unexplained?  Have you seen 8 million doctors and yet have no explanation of why you feel the way you do? Have you been told you just have a low pain tolerance or that the pain is just in your mind? If you have answered yes to ANY of these questions, you may just have endometriosis.

Now what?

Here is the tricky part, getting a medically professional to believe that any or all of these symptoms are related and could be endometriosis.  Many doctors cannot see the “whole picture” of endometriosis. You need to find an endometriosis excision specialist. Excision surgeon is really the best way to get relief from the disease. 

How do you know if your doctor is right? 

You need to ask them the following questions: Do you use solely the excision method to remove endometriosis? If I have endometriosis symptoms that imply I may have it on my surrounding organs, like my bowels, bladder or diaphragm, will you work with other expert surgeons, during my operation, to remove the endometriosis? Can you make preserving my fertility a priority? If your surgeon answers “NO” to any of these questions, find another surgeon who will say yes to all.

But I can’t afford an excision surgeon right now, what can I do to help my disease in the mean time?

Not many excisions surgeons take health insurance. It is horrible. But they are worth every penny because you will feel so much better and have such a better quality of life. But in the meantime, eating gluten free and dairy free and all organic foods and going to see a chiropractor and acupuncturist could help lessen the inflammatory symptoms a little bit. Hormonal therapy and intervention help some women, but only for a short amount of time. Women who want to get pregnant, cannot get pregnant while on these drugs, and delaying conceiving to take these drugs could negatively impact a women’s fertility. Also, some women have bad side effects from this type of therapy and they need to research it thoroughly before agreeing to go on it.

Get involved.

Endometriosis is a very isolating disease. No one gets it. People think patients are just big whiners and can’t handle their “period pain.” I have heard these same people cry when they have gum boils on their lip. Well imagine 1 million gum boils all over your pelvis. That only begins to describe what endometriosis patients go through. If you are an endometriosis patient, connect with other patients on line in facebook groups like “endometropolis.” Come find me on twitter, @Chancesour, and I will introduce you to the amazing online community. Get involved with the non-profit, Endo Warriors, and see if they have a support group in your area or through their website buddy up with someone who lives near you and is also suffering with endometriosis to get community support. 

The Endometriosis Foundation of America has started the ENPOWR Program and is reaching out to teenagers in the school setting to teach them about the disease to hopefully promote early diagnosis. There is the first ever Million Women March for Endometriosis in Washington D.C. THIS WEEK to spread awareness about the disease. This initiatives bring me great hope.

In ten years, my ultimate hope is no one will say, “Endometri-what?” when a patient tells them about their disease. They will instead respond, “That is awful. I am so sorry you have that disease. Let me know how I can help you.”  March is Endometriosis Awareness Month. Consider yourself more aware.
Check out my endometriosis awareness video here:

Casey is a licensed social worker with many years of experience in the non-profit sector as a counselor, advocate and community organizer. Casey also has been a presence in the infertility community as a writer and activist, using her own struggle with endometriosis and recurrent pregnancy loss to help others. To learn more about her story and her work go to : www.CaseyBerna.com

Tuesday, March 11, 2014

Alternative Treatments for Infertility

There are many "traditional" paths to infertility treatments.  There are also alternative treatments.

Here are a few to consider.

Acupuncture:  Acupuncture is treatment that uses strategic placement of needles to stimulate energy points in the body.  It is becoming more and more common for RE's to recommend acupuncture with treatments.  My clinic highly recommends it and it is common for their patients to use acupuncture in addition to their treatments.

With each cycle we did, I saw an acupuncturist.  My acupuncturist (who I still see even though we are no longer pursuing treatments) has a specific regimen she uses with her infertility patients.  She bases it on the type of procedure being done.  When I had my procedure I went before and after.

Herbal Remedies:  Many times when you are doing acupuncture, your acupuncturist may recommend Chinese herbs in addition to acupuncture treatments.  The belief is that the herbs can provide a natural remedy in addition to the chemical medication.  The decision to include herbs should be discussed with your doctor.

Aromatherapy:  such as essential oils of rose maroc or rose otto may be prescribed.

Environmental Medicine:  certain chemicals (from pesticides to hair sprays), molds, stress, infections -- almost anything in the environment -- may trigger infertility. Treatment involves removing these substances or lessening exposure to them.

Nutritional Therapy: supplements and special diets can be effective with treating infertility.  A gluten free diet may be suggested by your doctor, or a low carb diet if you suffer from PCOS.

Mind/Body Medicine:  emotional counseling and meditative therapies can play a major role in treatment.  My RE clinic worked with an infertility therapist and suggested all couples have at least one session before pursuing treatment.

These are just a few options to consider in addition to traditional treatments.

Have you pursued an alternative treatment?  If so, share it with us!

Thursday, March 6, 2014

Infertility: Not Always a Woman's Issue

Before diving into the world of infertility back in 2007, I assumed that most reasons for infertility would be attributed to women. After doing research, I learned that about 30% of infertility is actually linked to male factor problems. According to the RESOLVE website, some male factor problems include: "structural abnormalities, sperm production disorders, ejaculatory disturbances, and immunologic disorders" (RESOLVE, 2014).

Identifying Male Factor Problems

Just like their female counterparts, males are first expected to discuss their medical history with a physician when infertility is suspected (typically one year after starting the trying to conceive process). Using this medical history, physicians can determine whether past medical problems or sexual history, such as STDs or ejaculatory issues, are contributing to the couple's infertility issues. In addition to discussing medical history, a physical exam is typically completed and blood is drawn to test FSH levels, testosterone levels, and prolactin.  Finally, a semen analysis is completed. This analyzes sperm count, motility, velocity, morphology, volume, and liquefaction. Results from the male infertility work up are used to determine whether or not there is a male factor issue linked to the couple's infertility.

Emotions Involved with Male Factor Infertility 

Males who are dealing with MFI may experience a wide range of emotions. Some males may not feel as sensitive about their infertility in comparison to women who are experiencing infertility. According to RESOLVE, "Our culture shields men from developing expectations of their role as a parent. This may account for many men's seeming detachment when they discover that childlessness may be in their future" (RESOLVE, 2014).

Males may also feel angry and discouraged by their infertility diagnosis; however, they may chose to hide their feelings and not share how they feel with their spouses/partners. An infertility diagnosis can make males feel like "less of a man", just as an infertility diagnosis can make a woman feel like "less of woman". No one starts the journey to starting a family thinking that their body may be standing in the way of achieving their dream of bringing children into the world. Just like females, males may feel isolated. They may not know of anyone else who is dealing with MFI. In many cases, males will not reach out for the support of others like many females do.

Ways to Cope With a MFI Diagnosis 

  • Do your research and talk to your doctor - learn more about your diagnosis and determine possible treatment options.
  • Express how you feel - keeping all your emotions bottled up isn't always a good thing. Talk to your spouse/partner or a close friend about your diagnosis. You don't have to go through this alone. 
  • Find support - RESOLVE offers support groups in many cities across the United States. There are also great resources and supporters in online forums such as Twitter and the blogosphere. Again - you are not alone in this. 
Treatment Options When Dealing With MFI

There are a variety of treatment options available to couples who are dealing with MFI (depending on the severity and circumstances surrounding the MFI). These treatment options include: Intrauterine Insemination (IUI), In Vitro Fertilization (IVF), Percutaneous epididymal sperm aspiration (PESA), or testicular sperm extraction (TESE). For more information on treatment options, couples should contact their physician. 

Tuesday, March 4, 2014

There's a Time for That!

For those who've been in the IF game for long, this post may not interest you.  You've "been there, done that" and possibly haven't even though about that for quite some time.  However, I wanted to share some information for those just starting out and may not be aware that there's more to IF treatment than IVF.

When my husband and I first started trying to conceive, I joined a my.space forum for women on various levels of trying and joined in the conversations about all the signs and symptoms of ovulation and timing of intimacy.  It was sort of fun at first....I mean, call up the husband and say "guess what, babe?  It's your lucky day!"  What guy wouldn't like that, right? Eh, that only last so long until you find yourself looking at the thermometer, obsessing over the graphs on Fertility Friend, and asking complete strangers in a forum if the ovulation predictor strip is positive or not....well, it becomes annoying, frustrating, mind-consuming, and just plain NOT.FUN.  So, whenever we decided we would move on from the dreaded Clomid (oh how I detest it, but that's a story for another day), our RE suggested timed intercourse (TI) with injectables.  TI with injectables is basically and IUI with se.x instead of a procedure.  Injectables consist of Gonadotropins (follicle stimulating hormones) and "trigger" shots (HCG).  There can also be a medication given if it looks like a possibility of hyperstimulating (again, another topic for another day).

There are a few different choices in medications to use for TI, and everyone responds different to each one.  It's ultimately up to you and your RE to decide what would work best for your situation (and sometimes it depends on what/if insurance covers one or not).  I have personally used Gonal-F and Follistim.   Gonal-F was the main one in each of my treatments.  I conceived each time, but miscarried twice.  On my final round, I used Gonal-F and then finished with a round of Follistim (it was just what I had, not necessarily part of the original protocol. My RE was very laid back with what I chose and understand cost was a concern).  I then used Ovidrel, as a trigger shot. We conceived my daughter (who just turned 1!) on that cycle.

For those unfamiliar with this type of protocol, let me give you an idea by sharing what we did:

  • Pro.metrium to bring on AF
  • U/S and bloodwork on CD3
  • Depending on result from above, begin Gonal-F day 5-8 (you'll get a fancy little sharps container to dispose in)
  • U/S and bw on CD8 and every other day (or possibly 3 days) after to monitor hormone levels and follicle growth
  • Sometime between CD15-20 (give or take a few days, depending on your body's response), trigger shot
  • Timed intercourse within 24 hours and then again around 36 hours
  • U/S and bw to varify ovulation 5-7 days after trigger shot (if no ovulation, may require another trigger)
  • Beta test via bw 2 weeks post trigger shot
Again, each person's protocol is going to vary depending on the doctor and your own body.  Your RE will sit down with you, prior to starting treatment, and go over the protocol, answer any questions you have, and explain how to properly use the medications.  Heads up on the ultra sound: it's an internal one, so prepare to get used to having someone all up your business for a few weeks.  The positive side is that the staff do this for a living and are not bothered.  You, on the otherhand, may feel a tad "exposed."  Some people find that they are more relaxed (if that's even possible?) by wearing a fun shirt or socks to make the experience unique.  If nothing else, they make for good conversation pieces with the staff.

Something else to be aware of is that, since you're injecting hormones into your body, you can expect to have fluctuating emotions.  Crying, irritation, depression, oh my! Yes, all that and then some.  Personally, I experienced worse symptoms when taking Clomid than the injectables, but that may just be me.  When (not if) these responses occur, try to remember that it's the medications causing it.  You are not going crazy, you're not falling apart...be kind to yourself.  If things begin to interfere with your ability to function, please talk to your RE.  Adjustments may be possible.

TI with injectables can be stressful at times because you are an emotional mess, sticking yourself every day, having other people in your business, all while trying to be intimate with your partner.  However, it is an option for those not able to do more invasive procedures (due to a diagnosis, religious, or financial reasons).  It allows you to still experience the intimate side of conceiving, while allowing science to assist your body where it needs a little help (with follicle stimulating or ovulating, or both).  If you are experiencing difficulty ttc, make sure to discuss all options with your RE.  Not every child born from IF tx is done through IVF, and you may have more options than you thought. 

Have you used TI with/out injections?  What were the pros/cons/outcomes?  What advice would you give to those considering this route of conceiving?

Thursday, February 27, 2014

Will my Marriage Survive Infertility?

Infertility damages so many areas of our life.  But one of the biggest ares it affects is the relationship with our spouse.

Relationships and marriage is difficult on it's own but when you throw infertility into the mix, it can be overwhelming.

So how do we survive?  Here are some ideas.

Keep the lines of communication open.
Allow yourself to talk about infertility, but try not to let every conversation to be about it.  When it's the only thing you talk about, it can consume you.  Set a time limit for each person to talk about infertility.  We have friends who set a timer and only discuss infertility issues for 30 minutes each day.  If you need more time, discuss it together and make an exception for the occasional longer talk.

Be sure to listen to your spouse.  Talking is important, but listening is just as important.  It helps your partner understand where you're coming from and that you care.

It's okay to disagree.
Sometimes you and your partner won't be in the same place at the same time.  There have been several times that I was ready to move forward with a treatment or hesitant to move forward and my husband felt the same way.  And that is completely okay.  The key is to be okay with being in differently places.  It's probably not healthy for this to go on for a lengthy time.  But respect that they will "get there" in their own time.

Go on a date.
Infertility treatments and adoption can put a financial strain on any relationship.  It's important to remember to have fun...and be cheap!  Rent a favorite move and watch it at home for a movie night.  Have popcorn and some of your favorite snacks ready.  Turn off your phone just like you would in the theater.

Be a local tourist.  Exploring the town we live in is one of my favorite things to do.  Look for free local events, or go the the park and have a picnic.

Have a game night.  Break out Yahtzee or your favorite video game.  Get some of your favorite snack food to enjoy.  Maybe even make a win/loose bet.  Looser has to wash dishes for a week.

Be honest.
There have been a lot of times that I was afraid to tell my husband exactly what I was feeling.  But when I did finally open up to him I felt better, and he understood where I was coming from.  It doesn't help anyone when you aren't open with your thoughts and feelings.

Educate yourselves.
One of the biggest areas of stress in infertility is the unknown.  When you educate yourselves it can ease a lot of fear.  And it is something you and your partner can do together.

- - - - - - - - - - - - - - - - -

These are just a few ways for you to strengthen your marriage.

What do YOU do?

Thursday, February 13, 2014

Nurturing Relationships

Maya & her bio great grandma
When I tell people we have an open adoption with our daughter's birth family I often hear "I could never do that!" or "isn't that scary?" or something along these lines. Usually, people are curious about what open adoption means.

To us, open adoption means our daughter has a giant extended family. What started with a phone call is evolving into a wonderful ongoing relationship. We had the privilege of being at the hospital during our daughter's birth and met many members of her birth parents' extended families. All of these people form Maya's birth family, but they also became part of our family when we became her parents.

We work hard at nurturing these relationships. It's not always easy (in fact, it's rarely easy), but it's definitely worth it. Every adoption story is different and you have to do what's best for your situation, but here are a few ways that we try to build relationships with our daughter's birth family.

Sharing Photos. I share posed photos of milestone ages, but I also send candid pictures of the goofy faces she makes or her first time eating solid foods or her first experience at the splash park. I want her birth family to see her personality through pictures. I want them to know she's happy and healthy. We share photos a few different ways, including snail mail, text messaging, FB, and a Shutterfly share site where I post pictures and they can visit the site and see them or order prints anytime they want. Find what works for you.

Staying Connected. I am friends with several members of Maya's birth family on Facebook. I love that they can view my photos and updates when they want. I also have a private YouTube channel where I post videos of her so they can see her crawling, taking her first steps, playing with her toys and just being a kid. I know other adoptive parents have used Dropbox or other sites to privately share letters and photos. There are tons of services and social tools out there - find one that works for your family and give it a try!

Spending Time & Celebrating Together. Maya's birth family celebrated her baby shower, her baptism and her first birthday with us (so far). But in addition to the big things, we like to spend time with them just hanging out. A few times a year we get together and go to the park or the zoo and just play. They have told me how much they love playing with her and pushing her on the swings or chasing her around the yard.

Adoption is a complicated and emotional journey, but usually the one thing that unites everyone is love. Our contact with Maya's birth family ebbs and flows. It's not always smooth or easy, but we do our best to stay in touch and keep the communication open and honest so she is always surrounded by love.

What works for our family may not be right for yours, but you can find ways to stay in touch that you are comfortable with. Let us a know in the comments how you nurture the relationships with your child's birth family, or how you hope to build that relationship in the future!


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