Welcome to your August issue of Connections, The American Fertility Association’s monthly e-newsletter. In this issue, you’ll find:

1. A Message from the Executive Director
2. Trying to get pregnant? New Advances in Technology for Ovulation Induction and Treatment
3. The Adoption Option—Making the Transition from Infertility to Adoption
4. Alternatives
5. Support Services
   • Support Group: Women Over Forty
   • New York City In-Person Couples Support Group Now Forming
   • West Coast Programs
6. Fertility Dream
7. Stay Connected

A Message from the Executive Director

Pamela Madsen

Dear Friend of The AFA, Separate and Unequal Recently the New York State Court of Appeals upheld a ban on gay marriage. The New York decision came in tandem with an unsurprising—but still very depressing—ruling from the Georgia State Supreme Court. That court upheld a state constitutional amendment prohibiting gay partners from marrying or claiming benefits under a civil union. In fact, July 2006 turned into a banner month for bias when a federal appeals court in Nebraska reinstated a ban on same-sex marriage that had been approved by voters in 2000 and overturned by a federal district judge last year. Tennessee’s State Supreme Court cleared the way for a challenge to a proposed constitutional amendment to ban same-sex marriage on the November ballot. At the same time, The American Fertility Association is eyeball deep in preparing products and services to support family building in the GLBT community. Our mission has always been to help people build the families they want and deserve, regardless of sexual orientation, economic or marital status, race or religion. This recent rash of sorry rulings only reinforced our determination to fight discriminatory practices, laws and attitudes through our education and advocacy initiatives. Putting roadblocks in the path of those who want to and can provide wonderful home environments for children simply because they do not fit the stereotypes is itself a crime. And where does it stop? Who’s next? Single women? Single men? Ultimately, it is as New York’s Chief Judge Judith Kaye put it in her dissenting opinion, “…(A) tradition of discrimination—no matter how entrenched—does not make the discrimination constitutional. As history has well taught us, separate is inherently unequal.” Sincerely, Pamela Madsen Executive Director

Trying to get pregnant? New Advances in Technology for Ovulation Induction and Treatment

By: G. Wright Bates, Jr. MD

The cliché “The clock is ticking” often comes up during discussion of fertility. While this phrase can have a negative connotation and often denotes the difficulty in conceiving associated with getting older, using the clock or more precisely the correct timing may actually enhance one’s fertility. Traditional methods of home fertility testing identify the surge in hormones (LH and/or estradiol) that precede ovulation. However, these older modalities typically only give a couple 12 – 24 hours notice before ovulation. In addition, monitoring for urine LH may give false results with certain conditions such as PCOS (polycystic ovarian syndrome). Although it is the least expensive, many experts feel that basal body temperature charting is the least accurate method of ovulation testing. Devices like OVWatch™ and OvaCue® are two of the latest methods to detect a woman’s fertility window based on fluctuations in the salts (chloride, sodium or potassium) that occurs throughout the menstrual cycle or prior to ovulation. The OVWatch™ is a lightweight biosensor worn on the wrist while sleeping. The OvaCue® relies on daily sampling of the saliva and use of a vaginal probe around the middle of the cycle to predict ovulation. The detection of the chloride surge occurs 3 days prior to the estrogen surge, 4 days prior to the LH surge and 5 days prior to ovulation. This early notice of the impending ovulation is crucial, as numerous studies have indicated that fertility can be optimized and the time to conception shortened with correct timing of sexual relations. While sperm may remain viable for up to a week in the female reproductive tract, the egg appears to only remain capable of being fertilized for 12 – 36 hours after ovulation. In essence, sperm must be present in the fallopian tubes before or at the time of ovulation for pregnancy to occur. In head to head comparisons, the OV-Watch™ identified the entire fertile window in approximately 6 times more women than a urine LH monitor. This longer window of opportunity reduces the stress of many couples and can increase the pregnancy rate by two-thirds in just 6 months. Preliminary data also indicates that the OV-Watch™ may be used to monitor response to treatments or time inseminations after clomiphene citrate.

Women who have irregular cycles or those in whom testing indicates no evidence of ovulation must rely on medical therapy to induce release of an egg or oocyte. Clomiphene citrate (Clomid, Serophene) and letrozole (Femara) are medications that increase the signals from the brain (FSH, LH) to induce ovulation. Although, clomiphene has been the primary oral agent for ovulation induction, many women experience significant side effects (hot flashes, headaches, mood swings). In addition, clomiphene may have an anti-estrogenic effect on the uterine lining and cervical mucous that reduces the response to treatment. Letrozole was developed as a treatment for breast cancer and is used off-label as an alternative to clomiphene. The primary advantage of letrozole over clomiphene is that letrozole has a much shorter half-life making the anti-estrogenic side effects less likely. Pregnancy rates are comparable with both and the incidence of multiple pregnancies is predicted to be lower with letrozole. Letrozole and clomiphene citrate appear to be equally safe when used prior to pregnancy. Women who are not ovulating and overweight may also benefit from lifestyle modification with increased exercise and weight loss. Likewise, metformin has been shown to increase pregnancy rates and decrease miscarriage rates in women with PCOS. Women who do not respond to these therapies may need consultation with a fertility specialist, injectable medications or In Vitro Fertilization.

G. Wright Bates, Jr, M.D., joined Atlanta Center for Reproductive Medicine in 2005 after a distinguished career in the United States Air Force where he served as the IVF director at Wilford Hall Medical Center.

Dr. Bates completed his fellowship training in Reproductive Endocrinology and Infertility at Brigham and Women’s Hospital – Harvard Medical School. At the completion of his fellowship, he served as a Reproductive Endocrine faculty member in the OB/GYN residency at Wilford Hall Medical Center, Lackland Air Force Base. During his tenure, the IVF program achieved the highest pregnancy rate in the country for women less than 35 years of age.

In addition to his clinical expertise, Dr. Bates also expresses great interest in caring for patients struggling with Polycystic Ovarian Syndrome (PCOS) and premature ovarian failure. He takes special care to treat each patient with genuine warmth and empathy. Dr. Bates places a high importance on treating the whole patient instead of just the problem.

You can reach Dr. Bates at www.atlantafertility.com

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The Adoption Option
Making the Transition from Infertility to Adoption

By Joni S. Mantell, LCSW, CSW

There are both emotional and practical aspects to deciding whether adoption is for you. For many, making the emotional decision to adopt can be the hardest part of this journey. Once the emotional hurdles are cleared, you can learn the practical aspects of adoption are easy!

Adoption is a multi-layered experience and knowing when you are ready to begin isn’t always clear. Many people report a mixture of feelings like:

Adoption raises many feelings - some that may make sense to you and others that may seem incomprehensible. Many people feel an unsettling mix of all or some of these feelings. So don’t be surprised or disappointed if you lack an anticipated level of excitement about adoption.

Remember you are grieving.

You are grieving the loss of a biological child-one of the biggest disappointments imaginable-and this painful experience needs to be fully absorbed. Like the layers of an onion, this experience will look different depending on which layer gets peeled back.

Given this reality, it’s not easy to start anew with the process of adoption. Adoption is a new language, a new system and requires new professionals to work with. It takes work and emotional energy to learn all the nuances and options. But people do it and move on to build beautiful and loving families. The question is: how did they make the shift from infertility to adoption?

Face the Grief: without truly having faced the grief and mourned the loss of a biological child it is too easy to jump quickly into anything that will help ease the pain. Making adoption choices to escape pain tends to shift your focus to speed or encourages you to make fear-based decisions without thinking through the short or long term implications of your actions.

Facing grief instead of running from it will center or ground you. This allows you to move forward with the ability to make better adoption decisions.

Be clear about the choices: There are many choices to make-and none should be made without research and consideration. Think about what is required of you to pursue these choices and the long term implications of the decisions you make. If you enter this process in an uncertain and emotional place, you run the risk of letting an agency or attorney seduce you into signing up when they tell you what you want to hear.

Rethink the importance of speed: Don’t be pressured until all of the options are clear. Agencies or attorneys that push quick adoptions sometimes get less birthparent or child referral information. Or, they may withhold potentially disturbing, yet important information. Worse still, they might coerce you to throw money at the situation when it is unnecessary. Unfortunately, with adoption, if it is too good to be true, it usually is.

Think about the long term: It will help smooth out the process for you. Try to shift your focus from the immediate idea of getting a baby as fast as you can, to the long term goal of becoming a “forever” family formed via adoption. A counselor with expertise in adoption can help you make good and timely decisions that take into account the long-term family issues as well as the twists and turns in your adoption journey. Since adoption counselors do not do adoptions they can offer you a neutral opportunity to get educated and a safe place to grieve.

Learn all you can: about adoption-the process and the longer term issues. Surround yourself with support and information- meet adoptive families, attend educational workshops, or join adoptive parents support groups. Education will help you feel more in control and make better choices.

With some grief work and education behind you, you will make better adoption choices. And while you may not start the adoption process excited, there will likely come a time when you shift from ‘if we adopt’ to ‘when we adopt’-and that’s when you will feel the joy and anticipation about forming your family through adoption that you have wished for.

Joni S. Mantell, LCSW, CSW, Director of IAC Center is a psychotherapist who has been providing individual, couples and group counseling for infertility and adoption issues since 1993. She has a Masters in Social Work from the University of Pennsylvania and completed a 4-year certification program in psychoanalysis and psychotherapy at the Post-Graduate Center for Mental Health in NYC.

Joni can be reached at the Infertility & Adoption Counseling Center, LLC Pennington Point West, 2 Tree Farm Road, Suite A200, Pennington, NJ, 08534 Phone: 609-737-8750

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Alternatives

Massage is a wonderful way to relax and many believe can actually assist in you in your efforts to conceive. The Reproductive Wellness Center in San Diego, California offers this ‘do it yourself’ technique that brings the spa to you!

Materials: Castor Oil (purchase at Health Foods store), heating pad, gauze and Saran Wrap

1. Lay out square piece of Saran Wrap
2. Place four pieces (depending on size) of gauze on Saran Wrap
3. Pour ½ cup Castor Oil on gauze
4. Place oil side (gauze should be touching abdomen) down on lower abdomen
5. Place towel over Saran Wrap, and put heating pad over that
6. Do this for 15 minutes daily

Support Services

Support Group: Women Over Forty

Starting on September 14, 2006
Thursdays from 7:30 to 9 P.M.
17 East 96 Street, New York City
Five weeks at $30 per session

Contact Susan Frank, LCSW
(212)427-4193
susanfranknj@yahoo.com

New York City In-Person Couples Support Group Now Forming

This group will focus on how during fertility treatments couples are often at "different places" on what paths they are ready to pursue during their decision making process. The participatatnts will learn techniques in helping them resolve their differences, even when partners are in disagreement in how they desire to pursue parenthood.

Facilitated by Joan Winograd, LCSW, and AFA Support Group Leader. Space is limited.

Contact Joan at 212-362-4003 or e-mail at Joanwino@aol.com with your contact information.

West Coast Programs

Four Seminars Offered

• EGG DONATION: WORKING WITH A THIRD PARTY
• CHOOSING SINGLE PARENTING
• CREATING A SUCCESSFUL SURROGATE ARRANGEMENT
• GAY AND LESBIAN PARENTING

The American Fertility Association is sponsoring separate discussion groups for patients considering alternative family building options. The emotional, medical and practical aspects of each of these arrangements will be explored, such that prospective parents can make an informed decision about whether these plans are the “right” choice for them.

Elaine R. Gordon, Ph.D. is a licensed clinical psychologist with a specialty in reproductive medicine. She has worked in the field for twenty years helping individuals and couples build families through non-traditional options. She is the author of “Mommy, Did I Grow in Your Tummy? Where some Babies Come From”.

Ellen Speyer, M.A., M.S., MFT. is a psychotherapist with twenty years with working with assisted reproduction, pregnancy loss, surrogacy, and adoption. She is a retired Chair of the Education Committee for the Mental Health Professional Group of the American Society for Reproductive Medicine.

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The American Fertility Association (AFA) presents

Building Families One Step at a Time

Fertility Dream races and walks are breaking new ground,
promoting health and a sense of unity within the fertility
community and among our supporters nationwide.

Join us in 2006 to build fertility awareness and raise funds for
research and advocacy. Join our cause and say:
“ Together we can do what we cannot do alone”

Anyone can participate in Fertility Dream races and walks:
fitness enthusiasts, elite runners, and even those who have never
participated in a race before. The AFA will help find the pace that
is right for you.

The Fertility Dream Calendar

September 10 ~ Danbury
(Fertility Dream 5K)
January 7, 2007 ~ Los Angeles
(OC Marathon)
Boston
(TBD)

Anyone raising $5,000 or more in pledges will receive an all expense paid trip to a
Fertility Dream race. Round Trip Airfare, Two nights lodging, Meals, and Race entry.
See Website for details.

For more information, call (888) 917-3777 or visit www.theAFA.org

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Online Education Session Schedule—August-September 2006