How to Make a Family: The Blog

Crazy Rant Idea Time: How would infertility patients teach reproductive health?

Here's a crazy idea: What if all kids, boys and girls, were required to learn about reproductive health?

If your ears automatically translated “reproductive health” to “sex,” then I suggest you fall in line with the class, too.

Everyone knows that “SEX EDUCATION” is a hot topic of public and political debate. I'm not talking about teaching kids about sex. They get plenty of that now from the media. I'm suggesting we step up whatever they call it nowadays in some places – hygiene? Health class? – so that girls learn about more than menstruation and boys learn about more than... whatever it is they learn about in those classes (nocturnal emissions?) And that those classes need to be more than a one-shot attempt at vaccinating our children against unplanned pregnancy.

Okay, Junior High happened for me well before the Internet, I'll give you that. But from my work in infertility, it seems to me that either reproductive health classes aren't happening at all or classes that are supposed to be covering that topic are failing woefully. If young women are seeing the same shtick that I did in the 1970's, then they're getting an eye-full of how to handle your period with the right name-brand products plus a fleeting mention of how the menstrual cycle is related to getting pregnant. That's not reproductive health education, folks.

Most cases of female infertility (and some of the male-factor cases, too) that are seen in specialists' clinics today started off as preventable conditions. And just like every other thing in this fix-it-now society of ours, the focus has been so intensely on getting those folks pregnant after the fact, that most attempts at prevention education have been half-hearted at best.

Hold up, you're saying – this is old news. True, and there are already a lot of existing organizations and services with the goal of “reproductive health”, but you and I both know that most of that is focused on contraception. Nothing wrong with that. It's good, even. But zeroing in on contraception is either short-sighted or not connecting the dots to the bigger picture. I know that big NGOs and smaller agencies have their hands full with the relateds – HIV & other STD prevention, the legal and social rights related to gender, sexuality, and healthcare, and contraception, contraception, contraception. But take a look at this little post on the International Planned Parenthood Federation website and you might get an idea of how education about fertility (or infertility) gets lost in the shuffle.

So what, you say – isn't it more important to prevent pregnancy than to promote it, overall? No way could I address that directly without a firestorm ensuing. But I will add this to that: The Fertility Industry is a several-billion dollar industry of elective medicine. (I know that “elective” sounds caustic to some fertility patients' ears, but let's be honest here – you won't die or even be physically debilitated if your infertility is left untreated.) That a handful of physicians and their staff and all the people swirling around their energy are able to make a very good living off of helping people get pregnant is not wrong, in and of itself. What is wrong is our seeming disinterest in taking the cart and putting it behind the horse again. It's not just a bass-ackward waste of energy to put all of our focus on how well the cart wheels turn; the horse that's supposed to pull it is not only behind the cart, it's practically starving to death.

In short, people reach reproductive age without a clue as to how their own bodies work, let alone how those bodies function when they are sexually active with a partner. The result is not just unplanned pregnancy. The result is plainly growing numbers of inability to achieve pregnancy even when it is very thoroughly planned. And both are preventable with comprehensive reproductive health education.

So, you ask: what the heck made your coffee bitter this morning? It might seem unrelated, but you know me... all roads seem to lead to this industry. Here's what set me off today: a report issued by the CDC that reveals one percent of pregnant women binge drink, i.e. have 4 or more drinks on one occasion.

Um. Infertility... pregnant women drinking... um...

Okay, here's my mind today: I saw the report and immediately raced to “Other than maybe someone with alcoholism, seems to me I cannot imagine a single woman I've ever known who went through infertility later binge drinking during her kid's gestation period.”

From there, it was just a quick step to “What we should try is having infertility patients – current and past – teaching young people about reproductive health! That might add some emphasis to self-care before and during pregnancy!”

And that's how a rant is born. But you have to admit, I have a point.

 

Quick Hit: Pioneers Have More Babies

While you're wondering and worrying about why you and yours are having trouble disseminating your DNA, here's a short blogpost about an interesting population study, kindly passed on by my scientific Roomie.

It's not so helpful in terms of your own fertility struggles to know things like "Pioneers tend to have more babies" -- but data about unassisted fertility in populations might give you pause to think.

I wonder all the time about long-term consequences of reproductive medicine success in terms of the species. Part of that's the influence of my roommate, the mathematical biologist, but related notions have been bumping around in my head since way back when I was trying to force my own DNA to descend. 

Do you ever wonder what the Big Picture will look like for humans once we've truly nailed this whole "I want a baby, therefore, I will have one" thing? I ponder it constantly. Beyond the concept of "rights" -- the umbrella question is how will we wind up once we're decades past adherence to "laws of nature"?

If you're not up to reading the blogpost or study, here are a couple of snippets:

The study analyzed marriage and birth records in Canada’s Charlevoix Saguenay Lac-Saint-Jean region (northeast of Quebec City) and found that “families living on the edges of the expansions had 20 percent more children than families living at the settlement’s core. They also married one year earlier, on average, and contributed up to four times more genes to the region’s current population.”

and

Pioneering ancestors with high fertility had children who also eventually had high fertility...

Sharing News That's Not Really News

Here we go again. Me, ranting. But it's been so long, I thought I owed you one. So here you go.

I like hearing about data points that help the monkeys leave the cage. And as some of you may recall with a wince, I'm not exactly pro-medicine. Not anti-medicine, either, but I do indeed believe that we hairless monkeys have bought way too hard into The Search For Magic & Hopefully Instant Cures.

For example, I dig when something like nutrition gets a hand up in the clambering for attention we call "media". I'm into the idea that the stuff the earth provides might be all we need, if we can just figure out how to make use it well (and "well" includes sustainably).
 
So on a related note, since this blog is about fertility topics, my eye was drawn today to this headline: "Antioxidants may help treat infertility" which was followed immediately by "Antioxidants can help with infertility: Study".

Wow, I thought, two headlines in a row on Carrots Vs Infertility -- must be good!
Me being me, I scanned the first piece to find the names of the researcher and the publication in which the study could be found. Along the way I ran into this additional headline: "Antioxidants of Growing Interest to Address Infertility, Erectile Dysfunction".
 
In three headlines, antioxidants went from being possibly helpful to helpful and then to merely interesting.

And in fact, there's no real news to share. It's bonus points for the study authors of "Antioxidants to enhance fertility: Role of eNOS and potential benefits", published in Pharmacological Research. Their paper is an analysis of data that's been culled by other research, the sum of which author Tori Hagen calls "equivocal" due to study size and focus. She says that while the "jury is still out," data from previous lab studies is "very robust". Says we can look forward to "enormous" potential benefits.
I'm all for telling the monkeys where the key and the lock are located. I get that it's harder to instruct them on using those tools together to open the cage door. I'm just a disappointed monkey when headlines lead me to think that I'm going to be told more than "Yep, there's the lock and there's the key."

Btw, Toronto Sun loses with their version of the "story"... 

Follow-up note, from Jessie Gruman's PreparedPatient Forum at the Center for Advancing Health:

... health care journalists are under pressure to excise the uncertainty inherent in scientific inquiry and medical practice from their coverage.  Learning about the uncertainty is what we need but not what many of us want. 

What she said. 

Make Your Mark: Sign Up For the IFRR

I'm not sure why it took so long for me to get around to this, but I finally signed up as a volunteer participant with the Infertility Family Research Registry (IFRR). I'd like to encourage others to do the same. But I know I might be sort of odd this way...

I'm one of those people who actually digs marketing survey phone calls (as long as they're not too long and don't come at dinner time), mostly because I did enough research as an undergrad to have pity on study authors. I've also earned a buck or two over the years in focus groups. What's not to like about getting a check for telling folks' your opinion on products and services?

I don't expect dinnertime calls from the IFRR; in fact, I'm not so sure they'll even be contacting me ever. After all, my experience as an infertility patient is a fortunately fading memory now. But that's just it -- good research often depends on good controls. Current patients might be exposed at clinic visits to queries for study participants, but how often are those of us who've been-there-done-that anywhere near that information pipeline? And frankly, once you've 'resolved' your infertility in whatever way, how inclined to help do you feel after the fact?

The IFRR was announced at last year's ASRM gathering and is fully SART-approved. I've asked around the 'in the know' circle. IFRR is not only legitimate, it's just about the only attempt of its kind. The purpose of this registry is "to maintain a list of individuals who can be contacted about participating in research studies of infertility treatment including health risks." The Registry aims to cull together patients and former patients, but also people who've never needed to darken a fertility expert's door. Naturally, they also want to bring in any form of third-party reproduction -- egg and sperm donors and gestational or surrogate carriers. The fertility gamut, in registry database form.

So I took some time -- all of 15 minutes on the library's Ubernet -- to sign up and fill out the questionnaires. Piece o' cake, and there aren't many of us who don't like being asked a few simple questions about our attempts at pregnancy and our outcomes. Quick multiple choice stuff. So now when some researcher wants to conduct a large-scale study (often the best kind), it may be simpler for them to find the number of subjects needed to render strong conclusions.

Now, I get that some folks are leery about revealing personal data online, and the first thing participants must do is sign (either on paper or online, your choice) a document typical of research studies that, among other things, spells out that you can bail at any time. If I'm contacted by a researcher using the IFRR database, I can choose to participate or not. Also, there are scattered throughout the questionnaire plenty of options to check "Would rather not say" or "I don't know". You can reveal what you want. Then be on-call for studies or not.

I'm pretty sure I missed my calling as a scientist. I'm just enough of a geek to adore research, but I'd really rather yammer about the forest than conduct tree-to-tree studies. And since I'm lucky enough to not only have resolved my own infertility but also to make a living (of sorts) from it, I think the least I can do is put a few of my story's details on a list for future use. 

Captain Fertile Tries Brain Surgery

[Editor's note: Judging from my last post here on HTMAF, I'm thinking a change of scenery is in order for all of us. So, here's a post from Guest Blogger, Captain Fertile, who asked for anonymity to preclude any sticky situations in the event he runs for public office...]
 

Trying to get pregnant is one of the weirdest experiences I’ve ever had as a male. The most accurate way to describe it, if we want to use metaphors that really get to the core of the matter like a diamond-tipped drill through hot butter, is like doing brain surgery on someone trying to seduce you while she herself is trying to draw up architectural blueprints for the 8^th wonder of the world.

 

As any freelance brain-surgeon-for-food off Skid Row will tell you (make sure they clean the rust off their knives, at least reasonably, before any surgery is attempted), it’s rather difficult to seduce someone you are performing brain surgery on. You may think of many reasons why this is so, including the inherent difficulty of seducing someone under general anesthesia, the concentration required during the surgical process that would preclude concentrating on your pick-up game, the smell of operating rooms etc., but there’s only one reason that’s relevant to this discussion:

 

Brain surgery just isn’t that sexy. And neither is trying to get pregnant.

 

Moving over to eastern metaphors, trying to get pregnant is like the Kama Sutra from Hell. You’re both sitting there, waiting for your respective temperatures (physically, I mean) to reach optimum. You, the male, sitting on an ice bag, she, the female, holding a mercury thermometer under her tongue for that magic number.

 

And then, when the moment (temperature) is just right, you come together like one of those Icy Hot pain relief pads, while you try to match the Kama Sutra from Hell to maximize flagellum motility at optimum womb angles.

You begin to curse all the fantasies you have ever had as a young adolescent of all your crushes combined…I am Captain Fertile.

 

The writer is the Marketing Manager for Zoara.com, a diamond jewelry store you should check out by clicking the stork banner on the right! He hopes you got the Captain Planet reference.

 

baHAHA... Schadenfreude Time Again, Guys

I know it's cruel, but I can't help it. Every time I see yet another study -- and especially reviews of multiple studies! -- that point a finger at men's role in subfertility... well...

Sorry, that's just me being ugly, as my mother would say.

But seriously. For how many decades were women the ones who were not only poked and prodded but also told to Straighten Up & Fly Right To Get Pregnant? 

Wow. I had no idea that this much emotion about the topic was still laden in my underpinnings. 
You might already know that my main problem with trying to have a baby back in the Dark Ages was recurrent miscarriage. Getting pregnant, we could do. Every six months, in fact. But keepin' the little suckers around long enough to develop from a fetus into a baby... not my forte. So in my mid- to late-30's, I started living like a nun. You name it, I gave it up. Even yoga. I did the best I could afford diet-wise and pounded supplements, near as I can recall. 

I won't tell you about the healthy lifestyle "efforts" (or lack thereof) that my son's dad engaged in at the time, because it would be tantamount to slander. And I really do like the guy and have no intention of rocking his world now. Thing is, nobody asked him to do anything different once that semen analysis came back normal. So why should he?

But studies here and there have been sneaking up on men, and the researchers are finally tsk-tsk'ing them to change their ways or risk not passing those fantastic genes on.

An intervention review published in this month's Cochrane Review looked at 34 trials with 2876 couples where the study objective was to find connections between men taking antioxidant supplements and their reproductive outcomes. 

The conclusion of this review: Pooled findings support increases in live births and pregnancy rates with the use of antioxidants by the male partner. Further work is recommended to confirm these findings.

YES!!

In a press release, lead researcher Marian Showell, Obstetrics and Gynaecology at University of Auckland, said more comparisons between different supplements are needed to understand whether any one antioxidant is performing better than any other. Still, she and her colleagues believe the evidence is strong enough to state, “When trying to conceive as part of an assisted reproductive program, it may be advisable to encourage men to take oral antioxidant supplements to improve their partners’ chances of becoming pregnant.” 

So, go to it, guys. And if you're past baby-making age or stage, then take it upon yourself to educate the young men following in your footsteps. Making babies is *not* strictly a woman's job any more.

Showell MG, Brown J, Yazdani A, Stankiewicz MT, Hart RJ. Antioxidants for male subfertility. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD007411. DOI: 10.1002/14651858.CD007411.pub2 

Spreading More Love, This Time Like Jalapeno Jelly

On another blog where I also ramble in me.me.me mode (but with a focus more on generic family stuff), I recently wagged a finger at myself for how -- well -- just how All About Me I can get on the Internet and how I need to spread more love.

Today's the perfect day to do something similar here, where I yada yada yada about the baby-making industry. My friend and yours, Pamela Madsen, is coming out. Way out. And I can tell you, because I know, that it's been a few years in the prep phase, this Party o' Pammy's -- and just like the best sex, today's 'peak experience' is really just the beginning of a steady heatwave.

Y'all know Pam -- I used to rant against her, right here on this blog. Funny thing about such tenuous connections, they sometimes transform into friendships of the most genuine kind. I give Pam Madsen most of the credit for how I softened up to her. She is one persuasive woman.

Okay, before this gets any gooey-er -- here's the hot stuff: Pam's book, "Shameless: How I Ditched The Diet, Got Naked, Found True Pleasure and Somehow Got Home in Time to Cook Dinner” (Rodale), is finally out. 

Wait There's More: She has also produced, with Circle + Bloom, a companion audio program for the baby-makers among you. Now *that's* hot.

I don't wade around the bookstores or even libraries much any more to see what's on the shelves to help fertility-minded couples get their mojo back. Nor do the related publishers send me the stuff any longer. (Yay! Let's hear it for moving on and down the road of life!) So I could be wrong, but I'm thinking this Shameless Baby-Making program is a first. And you know me -- yawning every morning at the "infertility news" marketing re-treads that are out there... it's good to wake up and see bona fide pioneering Adventures in Infertility.

Have I read the book? Well, not in its entirety yet, but I will. I'll confide this: I got to read a first draft of some parts of it way back when. :::big Yay Me grin::: Have I listened to the audio program? No, and I'll be honest -- I'm almost 50, folks. I love, love, love my one and only hard-to-finally-have child. So while sex may be on the top of my Personal List of Things To Do, baby-making most certainly is not. Still, knowing Pam's "Put It Out There" style and just a tiny slice of her experiences in practicing Shameless living, I'd be willing to bet that even I might need to pull over and take care of business if I were indulging in a listen on one of my long country roadtrips...

Congratulations, Pam. I know you know it, but I also know that some of us cannot hear it enough: you are SO deserving of this party.

Did The Pill Create An Infertility Epidemic?

A reporter's choice of words can produce a ripple effect that sometimes goes unseen at first. In this piece by Deborah Kotz of U.S. News & World Report on the 50th anniversary of The Pill, my eyes grew wide upon reading her #2 way in which "the pill has changed our lives":

"2. The pill made infertility into an epidemic."

True, she downshifts immediately, offering that "ovulation usually resumes within a month or two after going off the pill." So Kotz isn't referring to individual women's infertility experiences; she's talking about a societal shift.

Her point: that The Pill's widespread use increased the ability of women to delay childbearing, resulting in a booming number of women who struggle to conceive primarily (and sometimes only) because of age-related infertility.

I can agree with that. I think, though, that to make the first claim -- that this societal shift can be referred to as a medical epidemic -- is simply alarmist. It worked. The seven-word line got me over to the website where I otherwise would never have traipsed.

Good thing I'm not currently a 20-something who wants to have kids in the future and who's wisely chosen for now to prevent an untimely pregnancy by way of oral contraceptives. I might take such alarming statements by reputable publications out of context.

 

"It's marketing"

Thanks to Tara Parker-Pope and Dr. Jamie Grifo for their NYT commentary on the latest book being hyped, The Fertility Diet.

The book isn't the first to try and draw easy conclusions about connections between what we eat and how well our bodies procreate. This one, though, is getting tons of press because it came out of Harvard and a large national study.

Like any well done research, the Nurses' Health Study contains both believable science and points to be proven (or not) later. When stuff comes out of Harvard, readers get excited. Algorithmic how-to answers to our dilemmas always go down easier than complex systems integration. Even just writing that last sentence is no fun.

So Tara called it like it is, and Jamie Grifo chimed in -- readers be wary of book titles.

Reminds me of a few years ago when a respected colleague worked long and hard to come out with a book that pointed to the benefits of traditional Chinese medicine for fertility enhancement... I was privileged to read the pre-publication galley and interview my friend, the TCM physician-cum-author, for a review. While she certainly has her professional biases, she also has the wisdom to understand the grey areas of medical diagnosis and treatment, that there is no One Answer for all. She confided that her book's title, The Infertility Cure, had been a point of discomfort for her, having been proposed by the publisher as the right label in order to get her message out. She felt it was misleading yet in the end, resigned to follow the advice of those with book-selling experience.

It was a wise business choice -- the book was a huge success. The author wound up on TV, radio, the Web, and in print magazines. Numerous books in the same vein followed. Her business is thriving.

It is a good book. She is a respected physician. The moral of the story is not to develop a wall of distrust toward all writings put forth as answers. Rather, readers will do well to simply remember that books (and websites, etc.) are creations not only of ethical professionals who mean only goodwill toward readers, but also of publishing businesses that mean primarily to sell books.

Urine Is Funny. No, Really.

Because people who are TTC can't get enough of peeing on sticks... Coming in a few days to a TV near you: a freaky commercial for one of the many at-home pregnancy test wands. See it now on MediaPost and be the first in your group to envision a giant urine stream in outer space.