How to Make a Family: The Blog

One Big Happy Circle. Don't Ignore Infertility. But Remember Other Stuff More.

This is National Infertility Awareness Week®. It's an annual thing, and this year's theme by RESOLVE (the folks who trademarked the name), is "Don't Ignore Infertility." Some of my friends and other folks don't know that writing about fertility & reproductive medicine has been 90% of my livelihood for 15 years. Now you know.

Here's my requisite nod to NIAW. It features a woman whom I admire and respect a lot. And it alludes to my perspective that people experiencing infertility have a lot more to ponder than just how to get pregnant. 

And the awesome photo, featuring Jason Songhurst (aka The Roomie) and a big thunderboomer cloud, was taken a year ago off a highway that runs down the middle of a west Texas oil field. Proof that you just never know how things from yesterday and today and "tomorrow" will connect in this thing we call life.

And THAT is my NIAW message. 

 

Never Mind The Menopause. There's A Tsunami of Children.

I ran across this synopsis of fun facts about reproductive stuff via the headline "6,000 Women A Day Hit Menopause" -- and believe me, that's definitely not the most entertaining tidbit in the piece by Leslie Mann on the Baltimore Sun. In fact, I'm not sure why they chose to pull that one data point from the American Congress of Obstetricians and Gynecologists' "2011Women's Health Stats and Facts" to highlight, except that the editors might think it's alarming. 

Why do we think menopause is alarming?? Tons of reasons. Don't get me started. But for the record, I don't think the absolutely natural and normal cessation of menstruation and fertility warrants headlines. If it were up to me, I'd have pulled this fact to head up the article:

"Assisted-reproductive therapy, or ART, an infertility treatment, is on the increase, catering to women with an average age of 36, and resulting in more than 600,000 babies a year."

600,000 babies a year. From ART. 

Y'all know me. An earlier sentence in the piece ("Only 12 percent of women suffer from infertility.") had me grumbling and mumbling about how 12% isn't nearly as high as the industry likes you to think and how it all depends on your definition of the terms. I'm up to here with other headlines that shriek about infertility being "on the rise", while The Roommate (a much real-er scientist than I) says 12% is indeed pretty impressive.

When I got to the paragraph about offspring and read that aloud to The Roommate, he exclaimed, "600,000?!"

Me: "Yep. Crazy, huh?"

Roomie: "Yeah! That's like, like, like a..."

Me: "A tsunami?"

Roomie: "Yeah! A tsunami of wanted children!"

And I smiled. 

And that, my friends, is how perspective adds up to everything. And, fortunately, how quickly mine can change on a good day.

 

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...

Infertiles Speak Bigger Truths Than They Realize

Melanie Notkin writes about her truth as a woman who wants to be in a loving partnership before making a baby, and about how that truth is keeping her from that baby. She calls is "circumstantial infertility," a term that once applied to me. I like it a lot, that term. 

Most importantly, Melanie is writing about how life's circumstances are requiring her to re-write her personal story.

That's pretty much all our lives are -- stories we tell ourselves. Even documentable events can be spun and twisted to match our comfort level. The Infertility Chapter for most of us is one that we'd rather skip over. But here we are. And so we share it in hopes of "getting over" it. How selfish of us, no? Blathering on and on about our misery...

Here's the upside: I think it's possible, given how public conversations can be broadly influential over time, that all this infertility talk out in the open might actually benefit far more than just those who are struggling to get pregnant.

In a follow-up piece about being invisible, Melanie refers to the incredible viral nature of that first blogpost and to the many insensitive responses she received from readers. 

She hit a nerve.

I think it's possible that our discussions about parenthood and biological drives and obstacles in the mix might promote talk within the larger society about really tough ideas, concepts that are bigger in a way than just "who 'gets to' have a baby".

My own infertility struggle brought me face-to-face with myself, or at least the person I thought I was. I've seen countless others echo that experience. Many of us believed without even thinking the thoughts out loud in our heads that parenthood was It, The Pinnacle, The Reason We Are Here (both as individuals and as a species). We still find a lot of reasons to hang on to that notion.

But maybe all this talk about struggling to do something (get pregnant/have a baby) deemed by everyone from "Society" to our own tortured psyches to be the raison d'être to such an extent that we believe if we cannot clear those hurdles, we are doomed... maybe the conversation will finally take us beyond that singular drive.

I don't mean to minimize the emotions. I believe wholeheartedly in the impact of biological drives on virtually everything we think, feel, and do. But I think I'm hearing the winds of change, or maybe I should call it a breeze at this point, in online conversations as people start to think more deeply beyond the initial "OMG I can't have a baby! What do I do now?!"

Most people are not so lucky as to have life present them with opportunities to truly delve into their motivations. Infertility -- if used well -- will make you wonder why you want kids in the first place. And not just in that off-hand, silly way that haggard parents wonder ("What was I thinking?!" the mom said as the children climbed the walls.) But in a way that, for me and some others, required dredging the depths of my soul, murky and smelly, and bringing that muck and mire up to the surface to show it some light. And of course, as those of us who've done it know, once you see that stuff more clearly, it's easier to move on, whether that means keepin' on that TTC path or choosing a different truth about yourself.
I don't think the "infertiles" of the world should keep that life-changing exercise to themselves. 

For a second, just ponder what a world would be like if everyone of us clearly understood this drive to parent -- not as a species, but as individuals. And then imagine if that same world offered no societal bias about whether or not individuals became parents, so that each person could truly make that personal choice without fear of being judged or ostracized. Now, think about the children who might be created in such a world. 

It's a tough thing to do, re-writing our stories. Some of us find ourselves in circumstances that make those revisions essential to our existence here. Bringing it up out there in "the Fertile World" is our way of offering what we've learned, not about infertility, but about living life. 

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. 

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 

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.

 

The Internet & Infertility: It's Not All Bad

Just to prove that I haven't completely descended into Crazy Old Crone territory, I feel the need to say something nice about what fertility consumers can find in the online race for their attention.

Not many of you know this yet, but there's a relative newcomer to the crowded racecourse of Internet sites for health care information and community. The reason you don't know about it is the very reason that I think it's a worthwhile spot with which to be familiar.

There's usually not a lot of marketing money in University-associated collaborations that are interdisciplinary and transparent. So Medpedia relies on word-of-mouth to spread the good news of their existence.

How do I know about Medpedia?

Before the site went live last year, they made the rounds of fertility specialists and related sideshow folks, like me, asking for volunteers to offer up feedback as Medpedia grows and to field a few community questions. They've been around for about a year now, though they pushed out of the gate pretty quietly. Besides being because of that whole marketing-money issue, the folks who put Medpedia together wanted to be sure it's fully deserving of whatever claims they make about its benefits to "anyone with an interest in health, medicine and the body, including medical professionals, medical organizations (for-profit and non-profit), and the general public."

Speaking of the site's makers, feel free to 'meet' the group that funds and maintains Medpedia -- Ooga Labs. No, not "labs" as in medical laboratory. Ooga's a lab full of geeks.

And since I'm so keen on who's guarding the henhouse, here's Ooga's explanation of where Medpedia is coming from, so to speak:

"Medpedia integrates 1) a collaborative information resource (like Wikipedia, Yahoo Answers, etc.) with 2) a professional network (like LinkedIn), with 3) patient communities, and 4) a HIPPA-compliant tele-health communications platform to tie everyone together in real time. The company is funded by Ooga, run by a team of people inside Ooga, and is advised by an all star roster of Medical luminaries."
[from http://www.oogalabs.com/companies#medpedia]

And for further oomph, check out Medpedia's Record of Merit, which lists all the venerable groups and individuals who first came forward in 2008 to help birth Medpedia.

Why, there's even an Infertility Community. Yes, I'm one of its administrative members. No, those of us involved do not get paid. Near as I can tell, we medical geeks who signed up to hang out at Medpedia are doing so out of a sincere desire to make good information available to anyone who wants to find it. Some of us just like to write a lot, of course.

Why am I just now writing about Medpedia?

Well, my Facebook friends have already heard about it. So it's not exactly the first time. But the thing that's got my attention now is Medpedia's new Clinical Trials platform. You can search for a slew of opportunities where you might participate in research, sometimes with pretty nifty benefits like paid medication.

Besides just being a place where you can kvetch and ponder the plight of your physical condition, I think Medpedia is just about as thoroughbred as a Web community can get. It only needs a few spectators to get the ball rolling and we're talking the Wikipedia of medicine here, folks.

Tag. You're It. Spread the word.

STDs?! Me?!

The good people at Planned Parenthood have created a nifty online tool to help you figure out if you need to worry about sexually transmitted diseases. It's called “The Check”.

Okay, a couple of grumbles come up for me, right off the bat.

Snark #1: Isn't it about time that we all know that everyone should be concerned about STDs? Or at least, those of us who are sexually active?

I mean, after all, as it says right there at the top of the page: “Did you know that more than half of all Americans get a sexually transmitted disease or infection at some time in their lives?”

Snark #2: I took the little test – and it's only less than a minute's worth of questions – and I'm pretty clear that my own – ahem – checkered past isn't exactly the best for gauging the sensitivity and accuracy of this interactive questionnaire.

So in the interest of good journalism, I dutifully tweeted that I need assistance to figure out if this thing is really going to have impact beyond just being yet another fun little Internet pop quiz. I was hoping that among my small throng of followers, there'd be at least a few who didn't have history so sordid (and fun) that the end result won't always be “Your answers suggest that you may want to talk with a health care provider about testing...”

Funny. I didn't see a lot of retweeting going on, so I have no idea if they all ran over to The Check or not. Hm.

I don't know if this quiz is new or not, and that bugs me, too. I caught wind of it via Twitter just yesterday, and the page itself has no date details. Things like *when* health information is published versus when it's read isn't always crucial (like when a recent blogger described the Vagina Dialogues Survey -- published by the Association for Reproductive Health Professionals in 2003 -- as being "just completed"), but sometimes it matters. 

Why does publication date matter? (Why am I just being extra super crotchety lately? But I digress...) Because stats on communicable illnesses change. If you're going to be telling folks whether or not they have something to worry about, you'd best be using the absolute latest data. Tables do turn and incidence rates do change. I suppose I could just trust that Planned Parenthood would only offer health care information that is absolutely updated, but I'm just jaded enough to want to see it in black & white numbers.