Welcome to your October 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. Kokopelli Ball 2006
3. Implantation Failure
4. Adoption Option - Adoption Today
5. Support Services
   1. Infertility Support Group
   2. New York City In-Person Couples Support Group Now Forming
   3. Westchester Women's Group
   4. Ovum Donation Seminar - Fall Series 2006
   5. AFA Adoption Series - Fall 2006
   6. Join Us For a FREE Telephone Coaching Group Support Experience
   7. West Coast Programs
6. Stay Connected

A Message from the Executive Director

Pamela Madsen

Dear Friend of The AFA, I know it is October but I love November! It’s one of my favorite months. I know, I know. It gets dark early and there’s the premature sting of winter. But it’s the month of the brilliant light that illuminates the night sky only once a year: The AFA’s annual fertility dance, The Kokopelli Ball, aka The K-Ball. Every year, we are privileged to host 600 of our nearest and dearest as we honor the remarkable people helping all of us in our family-building endeavors. The K-Ball is our way to publicly recognize the often-heroic efforts of members of the scientific, medical, legal, advocacy and business communities who work with uncommon devotion on our behalf. This November 6, The AFA’s luminous and passionate spokesperson, Brenda Strong (yes that Brenda Strong, star of the TV screen and the voice of Desperate Housewives) will be there. Our honorees also confer their own brand of glitter. They are: Richard Scott, Jr., MD, FACOG, HCLD, recipient of The Howard and Georgeanna Jones Lifetime Achievement Award; Mark Hughes, MD, PhD, recipient of The Robert Edwards Scientific Award; and Family Building Award honorees Michael M. Alper, MD, Elizabeth Grill, PsyD, Mark P. Leondires, MD, FACOG, Daniel Potter, MD, Robert J. Stillman, MD, FACOG, Susan Treiser, MD, Paul S. Weathersbee, PhD. It also doesn’t hurt that the K-Ball is a total blast. Great music, fantastic food, a wonderful excuse to dress to the nines and wear out your dancing shoes. And you’re all invited. Just click on the hyperlink on The AFA’s website, buy your ticket and come join us. I promise, you’ll have a night to remember. Just as important, you’ll be helping The AFA raise important funds that enable us to provide the support, service, outreach and advocacy you’ve come to expect. For me, this November’s gala, the 10th anniversary of the Kokopelli Ball, carries special significance. It’s a benchmark in history of The AFA, an organization that has metamorphosed from a “check for information” kitchen table group to a formidable engine for change. We’ve expanded from an infertility-only focus to embrace the whole range of issues that affect our ability to create family—however we, as individuals, define it. We’re educating women and their health care professionals about protecting and preserving fertility. With project ReachOUT, we’re working with OB-GYNs, other frontline women’s health care providers to deal with reproductive problems early, get appropriate treatment sooner to increase the chances of conception. This year, The AFA launched a program to shed light on the relationship between sexuality and fertility, the link between intimacy, reproductive health and family planning. We’ve dramatically expanded our support and information for people who elect to adopt as well as for those who choose adult-only families. And we’re developing pregnancy and parenting programs for our members who’ve overcome reproductive difficulties but find they feel different than those who didn’t go through the experience. The AFA’s mission matures right along with its members and its staff. We are protean, vibrant with possibility and promise. The AFA is yours, mine and ours. It is the family building resource. The K-Ball is one way we can celebrate that together. Cheers, Pamela Madsen Executive Director

KOKOPELLI BALL 2006

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Implantation Failure
By Michael A. Feinman, MD, FACOG

Michael A. Feinman, MD, FACOG

Implantation failure, in theory represents the major cause of infertility and treatment failure in many patients. For women with conditions like endometriosis or unexplained infertility, it is reasonable to believe that eggs are occasionally being fertilized in the tubes, but not implanting in the uterus. For women who require ovulation induction or undergo IVF without conceiving, implantation failure is more obvious.

Unfortunately, the science of understanding implantation failure has not kept up with the other advances in reproductive medicine. This is largely due to the lack of funding available to study the subject and the difficulty in obtaining material from patients. It is hard to study embryos or endometrial tissue in women undergoing treatment.

Breaking the problem down to its essential components, implantation failure can be due to problems with the eggs, the sperm, or the uterine environment. In contrast to the latter two problems, it is clear that many embryos are not competent due to chromosomal abnormalities that occur at the time of ovulation and fertilization. These errors increase with maternal age.

This article will briefly review what is known about sperm and the uterine environment.
Over the past decade, new research has illuminated the potential role of sperm in creating non-viable embryos. Similarly, some workers have developed tests that may identify women whose endometrial lining is the cause of implantation failure. Finally, the controversial role of the immune system will be discussed.

Before discussing these newer and controversial areas, it is important to remember that the simple things should be checked first. The most important of these is the shape of the uterus. Through the years, we have seen many women with repeat IVF failures or miscarriages who have a uterine septum that was either ignored or missed by her doctors. A septum can be diagnosed by hysterosalpingogram, hysteroscopy, and MRI. In the hands of a good observer, a septum can be detected on sonohysterogram too. The most common error in diagnosis is made with hysterosalpingogram. It is important to have your doctor view the actual films before accepting the diagnosis of a normal uterine cavity. When in doubt, a hysteroscopy is definitive. In our experience, repairing these abnormalities greatly improves IVF outcomes. Thus, the discussion below only applies to women with normal uterine cavities!

Over the past decade, a number of tests have been developed that evaluate the stability of sperm DNA under harsh conditions. The most well-known version of these tests is the Sperm Chromatin Structure Assay (SCSA). These tests have been shown to be more predictive of fertility than the routine semen analysis. Men with poor test results are less likely to fertilize eggs (even with ICSI), resulting embryos are less likely to implant, and pregnancies are more likely to miscarry. Some evidence is mounting to suggest that the presence of a significant varicocele in the male may be the source of an abnormal test. Thus, in couples with longstanding unexplained infertility or repeated treatment failures, a SCSA or similar test may be indicated. If the test is poor, an examination for a varicocele can be considered. If there are no correctable explanations for the poor test result, allowing embryos to develop to the blastocyst stage and transferring more than the usual number may be a reasonable option.

As with the male factor, tests have been designed to assess the endometrium’s role in implantation failure. These tests measure so-called “implantation markers” in the uterus. At least two tests have been reported in the literature with good predictive value of outcomes and are clinically available. These are the beta-integrin test and the endometrial function test. Both tests are performed on an endometrial biopsy taken on specific days of a natural or hormone replacement (“mock”) cycle. Abnormal results have been shown to predict lower success rates with IVF. Possible causes of abnormal results are the presence of hydrosalpinges, endometriosis, either extreme of the weight range, and stress. The originators of these tests have individual patient stories showing that women conceived after correcting the biopsy result. It is important to remember that no test is perfect. Despite abnormal results, some women still conceive, and this fact is well-reported in the literature.

Finally, a great deal of attention has been paid to the possibility that the immune system may play a role in implantation failure. A myriad of tests have been developed to look at the possibility that the woman rejects her own tissue (autoimmunity) or her husband’s genetically foreign body (alloimmunity). Few people doubt that these phenomena may occur. The problem is that there are very few clinical trials that prove the predictive value of these tests, or the effectiveness of suggested treatments. Some of the recommended treatments can be expensive or potentially dangerous. For example, one of the treatments known as leukocyte injection therapy (LIT) was banned by the FDA. While there may be a role for this evaluation and treatment in a small number of women, it is clear from the above discussion that embryo and endometrial factors account for the majority of implantation failures.

In the face of longstanding infertility or repeat treatment failures, a thorough review of the history and previous tests is the appropriate first step. We have seen many women with undiagnosed or untreated uterine septums in this setting. If everything checks out, tests like the SCSA and the endometrial biopsy for implantation markers should be considered. If all the above prove normal, tests for immune factors may be appropriate for these few cases.

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Adoption Option

Adam Pertman

ADOPTION TODAY
An Interview With Adam Pertman

Here, Carolyn Berger, AFA Adoption Coordinator, gets an up-to-the-minute overview of the adoption landscape from Adam Pertman, Executive Director of the Evan B. Donaldson Adoption Institute.

Adam Pertman, Executive Director of the Evan B. Donaldson Adoption Institute, and the author of the groundbreaking Adoption Nation: How the Adoption Revolution Is Transforming America, is also the adoptive parent, along with his wife, Judy Baumwoll, of two children (both adopted): Zachary 12, and Emilia, 9. The Adoption Institute’s award-winning website is www.adoptioninstitute.org.

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Support Services

In New York City:

Infertility Support Group
Start: October 12th (sign up now)
Thursdays 7:30 to 9 pm
174 E. 74th Street, NYC
Runs for 5 weeks @ $ 30 per session
Contact: Emily Laitmon LCSW
laitmon@aol.com 914 633 4224 (after 9/10/06)

Here's an opportunity to meet with other women who are also challenged in their attempts at a successful pregnancy. You are invited to share emotions in a safe, confidential environment (frustration, sadness, anger, anxiety) while also exploring changes in relationships with family, friends, work and friends. Current techniques plus alternative treatments will be discussed with coping strategies to offer maximum benefit to you. PLEASE JOIN US! You are not alone!

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.

Westchester Women's Group

A support group for women with infertility is commencing In Larchmont/ New Rochelle. Here's an opportunity to share emotions and concerns while acquiring information on current procedures and alternative treatments. A confidential and safe environment contributes to your ability to explore options and know you're not alone in your quest for a successful pregnancy.

5 Wednesday evenings beginning Nov. 8th

OVUM DONATION SEMINAR
FALL SERIES 2006

The American Fertility Association is sponsoring a six week Ovum Donation Seminar Series beginning Tuesday November 7th and continuing weekly on Mondays for a total of six consecutive weeks. Topics that will be discussed by our distinguished faculty will include:

AFA ADOPTION SERIES
FALL 2006

The American Fertility Association is presenting a 5-week series of workshops designed for people who are considering adoption and want to learn about their options.

Topics to be discussed by adoption experts include:

Join Us For a Free Telephone Coaching Group Support Experience

Phone based telephone coaching groups provide a convenient way for you to take part in a supportive and educational group experience from the comfort of your home or work place. These groups meet for one hour via a phone bridge line. A bridge line allows all participants to hear and speak with each other via the telephone. No special phone is required. All groups are led by licensed mental health professionals with an expertise and personal experience in fertility treatment.

TOPIC : Conquering the Holiday Season: Tips for surviving the holidays with the least pain and the the most pleasure

Fertility issues are particularly difficult to deal with during the holidays. Come join us to share ideas that can alleviate stress and generate effective coping strategies to use during this holiday season.

For more information, please contact:
Sara Barris at 718-544-0932 or sarabarris@aol.com or
Joann Galst at 212-759-2783 or jgalst@aol.com

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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Online Education Session Schedule—October-November 2006