amoreena@gmail.com

I’d like to talk a little about grief. Of course Kubler-Ross’s work was seminal and set the stage for fantastic advances, partly by taking grief out of the closet. I have taken lots of grief courses over the years and what I have learned is no family endures it the same: some are livid, other members are sad, and some are positive. The point is that every death and grief experience is different, and the same holds true for infertility.

I get asked a lot from patients: Is what I’m feeling normal? My response is, “What is normal? You are allowed to feel any way that you do.” You see, we get so caught up in being perfectly put together, it’s alluring to think that if we try just hard enough — add another acupuncture session, eat raw food, swear off cranberry bliss bars, then we will “deserve” a baby. And what I have to tell you from the front lines of reproductive endocrinology is that there is not fairness. There is biology, and there is human reproduction which any Ob/Gyn will tell you is very inefficient. There are flawed gametes and counterintuitive hormones. So, yes, whatever you feel is normal. And whenever you feel it, it is normal. The Pampers aisle in the store is a for sure, certain commercials, women pushing carriages, Hallmark anything, and people at work who love to recount the details of their labors. All of these and many more are triggers — even years after losses.

In sum. Grief is a patient, wily beast, which will strike from a position of power and seem to render you useless. This is an abject lie. In your grief lies your strength to persevere, to protect yourself, to help others and to prepare for parenthood — however you ultimately become parents. And, yes, I really believe that if you stay the course, you will become parents one way or another.

It’s not a surprise to you and me that you may be more stressed out than other people. It’s incredibly stressful to feel like you’re some kind of freak, your body is out of control, or that you can’t have a baby.

It’s also no secret that you are more likely to be depressed, feel anxious and have low self-esteem.

But it may surprise you that there appears to be a link between stress, your brain, and problems such as depression and low self-esteem.

It’s important to note that women with infertility are inclined to produce more stress hormones (like cortisol) than other women do in a given situation.

Over-production of stress hormones like cortisol is not good. For example, too much cortisol increases abdominal fat.

And, according to the Montreal Neurological Institute, it is associated with shrinkage of a section of the brain called the hippocampus. Shrinkage of the hippocampus has been associated with Alzheimer’s as well as reduced self-esteem and feelings of self-control.

Unresolved chronic stress can’t be ignored, simply because it worsens the psychological and physical aspects of infertility.

According to research at UCLA, meditation creates stronger connections between regions of the brain. It also appears to slow down shrinkage of the brain as people get older.

It could be that meditation reduces stress and thus protects your brain.

Find a meditation book or program that appeals to you and give it a try! Start with only 5 minutes a day and don’t worry that your brain what shut up…that’s what’s supposed to happen!

It’s perfectly normal to be angry about your infertility, as well as intensely sad.  The level of depression and anxiety in the infertility population is the same as in cancer, heart disease, and HIV-positive patients.

To hate pregnant women is a normal, natural, negative thought. It’s the pain and grief speaking. Mixed emotions are natural, too. You can feel happy for the good fortune of a friend, while feeling like life has cheated you at the same time.
In a nutshell, it’s OK to be angry and all right to be sad. Jealousy is part of the package, too. Those feelings don’t make you a bad person. They make you a real person, with real feelings. Feelings that happen to hurt like hell right now.

Be Selective about how and where you hang out:
What’s the one topic that dominates the conversations of all pregnant ladies and new mothers? Babies. Intelligent women with masters degrees, exciting careers, stimulating hobbies, and a passport full of stamps from around the world are suddenly unable to discuss anything except runny noses and car seats. It’s not their fault, of course. Nature gives relatively sane women a bad case of baby tunnel vision for the sole purpose of the perpetuation the human species. But all that baby talk can be total agony for someone who can’t participate. Pick social situations that you can handle.

I recommend that women get back to the interests and activities that they enjoy. Our whole life can become our fertility treatments and women feel like their not doing anything useful when they are not in cycle.

Infertility is a medical condition that takes a heavy physical and emotional toll on every woman who lives with it. Between the fertility drugs, the surgeries, the egg extractions and the acupuncture, our bodies become misused and exhausted. Add in the mindless comments from strangers, plus the way we tend to mentally beat ourselves up for our “failures” and it’s no wonder our self-esteem spirals downward and our psyches crumble.

Now, more than ever, is a time to look inward. I think it’s important to do a lot of self care because we want to do the antithesis of what will add to our depression. I recommend some form of relaxation and says to take care of your relationship since baby making can become all-consuming.

Therapy is another great option. There’s also an organization called Resolve whose goal is to “provide timely, compassionate support and information to people experiencing infertility.” It’s a national group with regional chapters set up to provide local support. And more informal support groups, such as the Advanced Fertility Issues message board on BabyZone, can give you a place to vent, get information and support, and be with others who understand your situation.

Whether the pregnancies of others make you happy, make you cry, or leave you with a mixed bag of emotions, always remember that you have the power to choose the situations and conversations you’ll join. And own up to the fact that infertility is a major life crisis that affects your well-being and relationships, so take time out to take care of yourself.

Infertility can put a wedge between husband and wife like nothing else. But trying to have a baby can also bring a couple together and bond them in new ways, if they let it.

When my husband and I tried to get pregnant, we struggled.  There were miscarriages, multiple IUI’s and an IVF. Infertility creeps into your marriage in small ways. Intimacy seems futile and unproductive, making it seem like a chore rather than love. Resentment starts. And the hardest part is, both husband and wife feel sad, frustrated and alone because they can’t discuss their feelings with their spouse for fear of hurting them.

My bout with infertility lasted 3 years, but my husband and I made it out with our marriage intact because of three things. First, we decided we were in it together. No matter what happened, there would be no blame and no fault. Second, we continued to live our lives. We tried to enjoy the moment together instead of focusing on the children we wanted and didn’t have. Third, we sought outside help (counseling and support groups) because we realized this was bigger than us and even though we were a strong couple it had the potential to ruin what we had.

There were some dark days, of course. There were days I felt utterly alone. My heart goes out to anyone struggling with infertility, and I hope somehow you are able to not let it consume you or your marriage. You will have the family you are meant to have. Talk to your husband. Talk to a counselor. Get into a support group. Get the help you need to get through this time together.

I now run support groups in Oakland and Orinda as well as see individuals and couples in the East Bay.

There isn’t much discussion of what happens when you get older.

According to one study from Erasmus University Medical Centre in The Netherlands, there is some good news. They followed 254 PCOS women for up to 7 years.

Based on their research, it appears that as you get older, you’re more likely to have a more normal cycle as well as some reduction in male hormones and a decrease in insulin resistance. These are desirable developments.

However, a Swedish study did not agree with these findings. In this study, 84 middle-aged women with a previous diagnosis were compared to 87 women who did not have PCOS.

The Swedish researchers discovered that 23% the women with PCOS had metabolic syndrome whereas only 8% of the other women had metabolic syndrome.

Metabolic syndrome has many similarities to polycystic ovary syndrome, including overweight, belly fat, high blood pressure, high blood sugar, heart disease and high blood fats. Some researchers consider PCOS to be a variation of metabolic syndrome.

We previously reported that other Swedish and Finnish studies showed that, compared to normal women, pre-menopausal and menopausal PCOS women still had more hirsutism (unwanted hair growth), higher male hormone levels, poorer regulation of blood sugar, and more chronic inflammation.

So what’s the bottom line here?

Apparently, some aspects of PCOS may improve but many of the underlying health issues and abnormalities remain.

The best way to minimize PCOS and its consequences later in life is simply to take very good care of yourself. How? By learning and maintaining good health practices.

Good health practices include a healthier diet consisting of mostly whole, fresh foods. Add to this a great deal of physical activity, regular exercise, stress management and reduction, living in the cleanest possible environment, getting enough sleep, and taking selected nutritional supplements as needed.

Sources:
Brown ZA et al, The phenotype of polycystic ovary syndrome ameliorates with aging, Fertil Steril. 2011 Nov;96(5):1259-65.
Hudecova M et al, Prevalence of the metabolic syndrome in women with a previous diagnosis of polycystic ovary syndrome: long-term follow-up, Fertil Steril. 2011 Nov;96(5):1271-4. Epub 2011 Aug 26.

What can we do with this? Well, one thing we can do is laugh about it. Yes, laugh!

I don’t know about you, but I always feel much better after having a good laugh about something. It seems to relieve the grimness and heaviness of even the worst situations.

Medical research has proven that laughter has physical, psychological, social, spiritual, and quality-of-life benefits. For example, laughter can help to reduce levels of the stress hormone cortisol. Too much cortisol damages your body and increases belly fat.

Another benefit of laughter is that it costs nothing and has no side effects!

So have you laughed today? Did you laugh yesterday?

The therapeutic effectiveness of laughter result from spontaneous laughter (triggered by external stimuli or positive emotions) and by self-induced laughter (triggered by yourself at will), both occurring with or without humor.

The brain cannot distinguish between these types of laughter so it doesn’t matter what you do to laugh. It doesn’t matter how or why you laugh. The important thing is to just laugh.

Watch a funny movie or read a humorous book. Have someone tell you a joke or funny story. Play an amusing game with someone.

You don’t necessarily need humor to laugh. You can laugh by intention. For example, you might try “laughter yoga”, a group exercise where you simulate laughter with eye contact and childlike playfulness, which soon turns into real and contagious laughter. Maybe there is a local laughter yoga group that you could join.

Sources:
Mora-Ripoll R, The therapeutic value of laughter in medicine, Altern Ther Health Med. 2010 Nov-Dec;16(6):56-64.
Shahidi M et al, Laughter yoga versus group exercise program in elderly depressed women: a randomized controlled trial, Int J Geriatr Psychiatry. 2011 Mar;26(3):322-7.

One thing you can do for a better outcome is carefully review your use of pharmaceutical drugs while pregnant.

A Canadian study has revealed that women who take either antidepressants or NSAIDs (non-steroidal anti-inflammatory drugs) while pregnant have a significantly higher rate of miscarriage.

Women taking an antidepressant while pregnant had up to twice the abortion rate of those who did not take antidepressants. Paroxetine, venlafaxine or the combined use of different classes of antidepressants were the most risky.

Women taking NSAIDs during the early stages of pregnancy had 2.4 times the risk of miscarriage compared to women who did not take NSAIDs.

Individual drugs have different risks. Diclofenac tripled the risk; naproxen (Aleve) had a 2.6-times increased risk, and ibuprofen (Advil, Motrin) doubled the risk. Combinations of drugs were associated with a 2.6-times increased risk.

We all have little aches and pains at times. This is usually caused by inflammation. You can actually reduce chronic inflammation by improving your diet. There are also many natural herbs, antioxidants and other natural products you can take as well. None of these have the side effects that NSAIDs have.

As soon as you become pregnant, please consult with your doctor about the benefits and risks of every pharmaceutical drug you take.

Some specialists prescribe baby aspirin or progesterone pills in the first trimester, but again this is something you need to consult your Dr. on because everyone’s situation is different.

Source: PCO review

Right now there is an important discussion happening at HHS, and we want to make sure people with infertility are included in that discussion.  The Essential Health Benefits, part of the Affordable Care Act, will be determined this year.  We have a small window of time to ensure that infertility treatments are considered an Essential Health Benefit by our government.

Tell HHS and Secretary Sebelius that you want to make sure that infertility treatment is an essential health benefit and that people with infertility matter!

Once you sign the petition, we will add your name to the list. Don’t forget to share the petition with everyone who cares about you!

https://secure2.convio.net/res/site/Advocacy?cmd=display&page=UserAction&id=367

Secondary infertility is also defined as an inability to get pregnant after about a year of frequent, unprotected sex. The difference here, though, is that secondary infertility refers to trouble getting pregnant after having already gotten pregnant and had a child in the past.

This can lead to frustration just as infertility for couples who do not have children, as it may leave couples even more confused as to why they cannot get pregnant after having done so already. It often sneaks up on people and can lead to a good deal of stress just like infertility can be stressful for couples who do not have children. Note that secondary infertility may not be present if one’s partner has changed since their first pregnancy.

The causes of secondary infertility are similar to those of primary infertility, as it may include problems with the production, function or the delivery of sperm. As for female infertility, it may be caused by fallopian tube problems, ovulation problems, endometriosis or various uterine conditions.

Don’t forget that changes in various lifestyle habits or risk factors, such as advanced age, weight or taking medications may affect infertility after having already gotten pregnant. Certain problems or complications from a previous pregnancy may lead to problems with getting pregnant in the future.

Whether you’re experiencing primary or secondary infertility, it’s important to seek consultation with a trained healthcare professional specializing in fertility and reproduction. You may be put through various tests and evaluations to help determine the cause of the problem so that you may begin considering and exploring different treatment options.

Don’t be too embarrassed to seek help. Secondary infertility is nothing new to fertility specialists. They deal with it all of the time. A good support system can also go a long way in dealing with secondary infertility, so talking with your partner, friends and others you trust can be helpful, too. I find groups or individual therapy critical for clients going through this.  There is no need to feel guilty because you have one child already…it is still a loss every month and can be more isolating because not even the women that are struggling to have one child will understand.

Treating secondary infertility is the same as treating primary infertility. Fertility drugs may be used to boost egg production, while intrauterine insemination (IUI) and in vitro fertilization (IVF) may be used to achieve pregnancy, too. Surgical procedures may be necessary to repair damaged or blocked fallopian tubes or to remove certain fibroids or endometriosis deposits. Just like with primary infertility, the preferred treatment methods for secondary infertility vary depending on the cause of the condition. For this reason, it’s important to seek professional consultation.