Welcome to your December 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. Advocacy Alert
3. Adoption Option - Adoption: Up-Close and Personal
4. Weight Loss Benefits Fertility Treatments
5. Support Services
   1. New York City In-Person Couples Support Group Now Forming
   2. Westchester Women's Group
   3. West Coast Programs
6. Stay Connected

A Message from the Executive Director

Pamela Madsen

Dear Friend of The AFA, I don’t want to get too excited here, but there is some evidence that we may be heading into a more enlightened era when it comes to human reproduction and general health. The Centers for Disease Control has come out with “preconception guidelines” that actually begins to address the long-term planning and protection of women’s childbearing capabilities. For years, The AFA has been on the stump about fertility preservation –for men and women--and the lifestyle factors that can enhance or diminish any individual’s chance to conceive. In our fact sheets, “Lifestyles of the Fit and Fertile” and “Too Stressed for Success” (scope them out on The AFA website) we hit the big ones: nutrition, exercise, weight, drugs (prescribed and recreational alike), emotional and mental stress, environmental elements and modes of contraception. We’ve built a whole public awareness campaign around thinking clearly about and starting early to conserve and boost fertility. It’s the best way we know to avoid unnecessary reproductive difficulties. It opens the door to true family planning. So it was gratifying to see The CDC weigh in on the importance of early actions that protect babymaking capacities in its report “Recommendations to Improved Preconception Health and Health Care" (www.cdc.gov). Inevitably, it gives rise in certain circles to concern that we’re all urging people to live in a state of chronic prepregnancy. Nonsense. We’re simply urging people to pay attention to wellness and do what you can to lead a healthy lifestyle. Most of it is common sense. Look in this issue of Connections to read about weight control and managing PCOS’s adverse impact on fertility. Some of it is a little more obscure but worth the effort. Log on to www.theafa.org to read about these issues in more detail in our fact sheets and special issues of infocus magazine, on our moderated message boards and in selected on-line educational seminars (check the schedule). Actually, there’s one infocus I’m thinking of that might be especially useful during the holiday season, when anxieties about having children – especially if you want them and are running into trouble—tend to rachet up. It’s devoted to Complementary Medicine and the remarkable contribution it can make to de-stressing your life. Believe me, everyone –from those trying to conceive or in the middle of IVF and those pursuing adoption – tends to have a hard time during this merry season of ho-ho-hos and endless family reunions. The techniques and therapies discussed in that inFocus may be just the ticket for helping you maintain your sanity, and maybe even your sense of humor. So after you’ve gone through this installment of Connections, with its insightful pieces on adoption, New Jersey’s same sex court ruling and weight and fertility treatment, scroll through the rest of The AFA website and help yourself to our offerings. They’re there to help you. Until 2007 (Yikes!), my warmest regards, Pamela Madsen Executive Director

Advocacy Alert
By Melissa B. Brisman, Esq.

Melissa B. Brisman, Esq.

NEW JERSEY SUPREME COURT MAKES LANDMARK RULING

On October 25, 2006, New Jersey’s highest court ruled on Lewis v. Harris, a case brought by seven same sex couples claiming that the New Jersey constitution affords same-sex couples the right to marry and to the same civil benefits available to heterosexual married couples in New Jersey. The suit argued that the State was in violation of its constitution by denying same sex couples access to marriage and the rights and privileges that flow therefrom.

The Courts decision was twofold. The court ruled, with a 4-3 majority, that yes, New Jersey’s constitution did entitle same sex couples to the same rights as heterosexual married couples; however, the court stopped short of calling such a relationship marriage. Rather than the sweeping victory advocates of same sex marriage had hoped for, the court ordered the legislature to either include same sex couples in the current marriage statutes or come up with new “civil union” statutes specifically for same sex couples in which the term ”marriage” would be conspicuously absent. This would result in laws which resulted from a similar ruling made by Vermont’s high court in 1999. The New Jersey Supreme Court went on to order that the legislature complete this task of revising and/or drafting the new legislation within 180 days. Justice Barry T. Albin wrote for the four-member majority, stating “Although we cannot find that a fundamental right to same-sex marriage exists in this state, the unequal dispensation of rights and benefits to committed same-sex partners can no longer be tolerated under our state Constitution.”

It is unclear at this time which tack the legislature will take, although most law makers in the state believe that the pendulum seems to be swinging to the side of civil unions rather than marriage.

On November 15, 2006, a Burlington County, New Jersey Family Court Judge ruled in favor of a lesbian couple seeking to have both their names listed on their child’s birth certificate without an adoption. Although this is not the first time a lesbian couple has been granted the right to have both their names listed on their child’s original birth certificate, this is the first time the recent court decision in Lewis v. Harris was used as the basis for the request before the Family Court. A statement from the New Jersey Assistant Attorney General advised that New Jersey will begin to issue birth certificates to same sex female couples, without a court order, provided the couples are registered domestic partners under New Jersey’s Registered Domestic Partnership Act. Same sex male couples (who must employ a gestational carrier) may have to wait until the legislature provides a definitive process; however, it is probable that male couples will still need a court action to establish their parentage.

Although it seems New Jersey is following Massachusetts lead (Massachusetts is the first and, to date, only state to legalize gay marriage), the acts of New Jersey’s legislature may result in two significant differences. First may be the absence of the term “marriage” to describe the legal relationship, which would make New Jersey more akin to Vermont than Massachusetts. The second and farther reaching point is that the Massachusetts ruling as applied to Massachusetts’ current statutory scheme, limited the right of same sex marriage solely to residents of Massachusetts (although a current court action in Massachusetts is challenging this interpretation of the law). New Jersey’s Supreme Court ruling did not specifically exclude residents from other states from coming to New Jersey to solidify their same sex relationship. In addition, New Jersey does not have any laws denying marriage to out of state residents.

Melissa Brisman, Esq. can be reached at info@reproductivelawyer.com or 201-505-0078

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Adoption Option

Adoption: Up-Close and Personal
By Carolyn Berger, LCSW

Carolyn Berger, LCSW

One of the best pieces of advice I have ever received came from an old family friend who said, “In life, when you feel trapped by a situation beyond your control, if you can’t get out through the door, try a window.”

For those of us who find the doors to having a biological child locked and bolted, there is a window we can try—adoption. But how do we know that finding that window and climbing out of it is going to bring us the family we dream about?

I talked to adoption experts and adoptive parents known by The AFA, asking them for critical insights into adoption and an understanding of what if feels like to choose this way to build their families. Their answers were helpful and also deeply moving. As we approach the end of 2006 and the beginning of a new year, I would like to share their thoughts with you.

Lisa Schuman, LCSW, a psychotherapist with specialties in adoption and infertility, says, “When I was a young girl we had a metronome on top of our piano. I enjoyed watching the even movements and relished the fact that no matter how I changed the speed, it would continue to retain an even rhythm. I have found in my own life, and in working with my clients, that significant life experiences often help us to see our true and individual rhythm and speed. When you are deciding to adopt and then beginning the adoption process there are many ways in which you can find your special child but there is no right way. The answer is to know the facts. Once you know the facts you can find how your personal metronome works within those facts and how you and your partner can balance your personal metronomes to make your dream happen.”

Interestingly, Joann Paley Galst, Psychologist and Co-Director of Support Groups for The AFA, also talks about adoption in the context of time: “One of the stories I like to relate to people waiting for their family to materialize, is the story of cronos and kyrios. Both are Greek words. “Chronos,”or clock time, goes by so slowly as we watch the clock and wait. However, kyrios, or the “right time,” goes by just as it is supposed to and, in due time, brings us just the right child for us.”

Sam Pitkowsky, adoptive parent and Co-President of the Adoptive Parents Committee NYC Chapter, tells us about how his vision of being a parent propelled him toward adoption: “I remember my dreams always centered on the things I would do with my children. My father used to take me to the Bronx Zoo on weekends and holidays. It was our special place where we bonded. I couldn’t wait to spend that kind of special time with my child. My dreams were never about my wife’s pregnancy or about her giving birth. They centered on the child who would one day be ours. Adoption gave me the chance to live my dream of being a father. No matter what infertility treatment we might go through our success rate was about 40%. The success rate for adoption is more like 99%. I liked those odds much more! Keeping our genetic line going was never my goal. I didn’t need a child who looked like me (frankly, she is lucky she does not!). What I really wanted, and what I certainly got through adoption, was someone to call me Daddy.

Kathy Brodsky, LCSW, adoptive parent and Director of the Ametz Adoption Program,
Jewish Child Care Association, shared this: “I guess the thing I remember most was realizing that being a parent was the goal, not giving birth, and that switched the gears from biology to adoption for me. There were still a lot of questions and anxiety, but parenting was within reach. The process itself was filled with more uncertainty and bumps along the way, but the day my daughter was placed in my arms, the whole process started to fade away. There she was, “my daughter.” It seemed so unreal and magical. As if, like many others have said, all I had gone through was necessary in order for us to find each other.”

Amanda, a member of the AFA who just brought her daughter home, tells this story: “My husband and I had gone through years of medical intervention. Finally, I didn’t want to put my body through any more of it. My husband was ready for adoption before I was, and he let me come to adoption in my own time. We tried independent domestic adoption, then moved to agency adoption in the U.S. When we didn’t get any calls, we did our paperwork for China. I breathed a sigh of relief when we completed all the forms thinking that at last we were guaranteed a child—it was a program that was very successful and went pretty much like clockwork. Then, a few months ago, we got an unexpected call: A birthmother in the U.S. had chosen us! We saw our daughter Sarah eight hours after she was born, and brought her home two days later. We are totally in love. I can’t remember life without her. Sometimes I tell her that if Mommy had known she was coming, she wouldn’t have been sad all those years. I was the last person I thought would ever adopt. Sometimes I think that I gave birth to her, and my social worker at the agency has told me this is not uncommon. It took many twists and turns to find Sarah, but she is finally home.”

How do we know when we are ready to adopt? Dawn Smith-Pliner, adoptive parent and Executive Director of Friends in Adoption, an agency in Middletown Springs, Vermont, tell us “If your desire is to become a family and you are able to celebrate that whether you conceive or adopt, then start to explore your adoption journey now!”

Aaron Britvan, adoptive parent and adoption lawyer, tells us how he came to adoption. “Although I grew up in a family with four adopted cousins, when it was time to start my own family I thought that my wife’s giving birth was how it was supposed to be. Time went on, and although the thought of adoption seemed alien at first, my wife and I suddenly decided that the desire to love and nurture a child was the most important thing. The realization that we were ready to adopt just clicked in our heads. My family got started with the adoption of my oldest daughter and was completed after the biological births of my two younger daughters. Having three wonderful daughters who adore each other, I often quote from the movie “Immediate Family”: “Having a child biologically is a wonderful act of nature, and having a child by adoption is a wonderful act of God.” I know this is true because I have lived it.”

Will we love an adopted child as much as a child born to us biologically? Adam Pertman, Executive Director of the Evan B. Donaldson Adoption Institute and author of Adoption Nation gives us some insight: “Adoption was our second choice. But the mistake many people make with that knowledge is concluding that second choice means second best. We adoptive parents know better. To love my son and daughter any more than I do, I would have to grow a second heart.”

The message I got from all the people I spoke to for this article led me to one conclusion: adoption works. It is the answer to an age-old problem: A child is born to parents who are not ready to raise a child, and that child is placed with people who are more than ready to raise a child but are unable to give birth. Can you think of a greater collaboration than this? It is a case of birth parents and adoptive parents reaching across divides of race, culture, age, geography and biology to find each other so that a child can grow up in a home where he or she can be well-loved.. And whether we are the birth parents or the adoptive parents in this equation, that makes us all good parents in the end, doesn’t it?

Carolyn Berger, LCSW, is the parent of two sons, one adopted and one biological. She is the Chair Emerita and Adoption Coordinator of The AFA.

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Weight Loss Benefits Fertility Treatments
By Laurence A. Jacobs, MD

Laurence A. Jacobs, MD

The adverse effects of obesity on fertility and pregnancy outcomes are overwhelming and indisputable. Even with fertility drugs or in Vitro Fertilization (IVF) treatments, pregnancy rates are adversely affected by obesity. Morbid obesity is defined as BMI of 40 or greater; obesity is defined as BMI over 30. In obese women with excessive adipose tissue, abnormal hypothalamic and pituitary hormone secretions are common, leading to anovulation (lack of ovulation). Obesity is seen in the majority of polycystic ovarian syndrome (PCOS) patients.

Most women with PCOS and/or obesity have an endocrine imbalance known as “insulin resistance” in which the body doesn’t handle insulin normally. Women with insulin resistance may have normal blood glucose levels, but because the cells of their bodies are resistant to insulin, the body compensates by producing even higher levels of insulin to keep their blood glucose levels normal. The resulting higher insulin levels lead to more fat storage (obesity) and also disrupt proper ovarian hormone production (increased male hormone), thus preventing ovulation. Insulin resistance ultimately can produce all the symptoms of PCOS…anovulation, infertility, obesity, and hirsutism.

When women with PCOS are able to correct the insulin resistance with proper diet, exercise, and/or insulin-sensitizing drugs, such as metformin (Glucophage), normal ovarian function (ovulation and normal female hormone production) often returns. Use of metformin, regular exercise and/or weight loss of 5-10% of body weight can each independently lead to spontaneous pregnancies as well as dramatically improve pregnancy rates with all fertility treatments.

Many studies confirm that obese women who do conceive have an increased risk of pregnancy complications and adverse perinatal outcomes. The take home message from these studies is that women need to be informed that obesity seriously hampers fertility; they need to be counseled about the serious dangers associated with obesity and pregnancy complications. Obesity is a chronic but treatable condition. The problem of obesity can be solved, but requires motivation, counseling, and behavior modification.

I have recently helped create a fitness and weight loss program (Fit & Fertile) for my overweight fertility patients willing to make a serious commitment to using proper nutrition and physical conditioning to aid their fertility therapy. Remember, as little as a 5-10% weight loss can dramatically improve fertility treatment pregnancy rates. I have personally battled weight issues my entire life. Not long ago, I found success in conditioning and weight loss with the help of a new device, the X2 Vest. The X2 is an adjustable weight vest that can easily be worn in the gym, outdoors, or just around the house. The X2 Vest works safely and effectively allowing the individual to add weight to their CORE (the mid-section of the body) in one-pound increments. Adding weight to your body requires more muscle fibers to be called into action, thus requiring more calories to be burned, which allows muscle development and weight loss, and most importantly in my patients … potentially improving pregnancy rates. The X2 Vest serves as a catalyst to motivate patients to exercise. For more information about the success of our program and this novel fitness product go to www.X2FitandFertile.com.

For women who actively manage their obesity or PCOS via good nutrition, proper exercise, and help from a Reproductive Endocrinologist with expertise in the latest treatments, the chances of conceiving are extremely good.

Dr. Jacobs completed medical school and his residency in obstetrics and gynecology at Northwestern University. He practiced obstetrics and gynecology for seven years and then completed a two-year fellowship in reproductive endocrinology and infertility at the Mayo Clinic in Rochester, MN in 1988. Since 1995 he has been the Section Head: Division of Reproductive Endocrinology at Lutheran General Hospital, Park Ridge, IL. Dr. Jacobs authored numerous articles for journals and books, and has a monthly column called "Focus on Fertility" in the Pioneer Press newspapers. He has been honored as a 'top doctor' by Castle Connolly in all its editions of America's Top Doctors and Chicago's Top Doctors (2001-2006). Ladies' Home Journal chose him as one of America's 'top infertility doctors' in 2002. Chicago Magazine chose him as a 'top infertility doctor' in the Chicago area in 2004 and 2006. Dr. Jacobs is committed to providing patients with the most comprehensive care available to make their dreams of a family come true.

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Support Services

In New York City:

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 Dec. 5th

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—December 2006 - January 2007