For those of us somewhere along the continuum of trying to conceive (“TTC to the cognoscenti), there are times when getting started feels more like getting stuck. It’s like the movie “Groundhog Day.” You know that flick? It’s the one in which Bill Murray plays a TV weatherman destined to replay the same day -– a day he despises with snarky disdain -- over and over until he gets it right.

Well, if you’re doing everything you know to get pregnant and, nothing, life can morph into a surreal, endless loop re-do. It’s the third, fourth or sixth month and the net result is a running tab at the pharmacy for ovulation predictor kits, pregnancy tests and maybe, some vitamins. So you gird your loins for the next month, for sex that feels increasingly fraught and mechanical. But you’re determined to keep at it until you get it right!

The instinctual response to repeated disappointment may be anger at yourself, at your partner, at every pregnant woman and cheerful young family that crosses your line of sight. It doesn’t feel good, but it’s normal.

The trick is to take action, to do something that takes you out of the victim-of-fate frame of mind and reassert control. Maybe it’s learning how to tame stress or recapture romance. Maybe it’s actually learning about the complex choreography of conception and how to have procreative sex.

And maybe, if you’ve done all that, it’s time to bid farewell to the do-it-yourself

The American Fertility Association wishes to gratefully acknowledge Ferring Pharmaceuticals for generously underwriting Getting Started, underscoring Ferring's commitment to advancing patient care through education.

approach. Perhaps you’ve got to tell your gynecologist thanks, but it’s time to move on. You’re going to see a fertility specialist.

No one actually wants to have to take that step. Booking an appointment with a Reproductive Endocrinologist is an acknowledgment that you’re not getting pregnant the way you think everyone else does –- without effort or much thought.

But when you’ve been at it for a year (for the 35-and-under crowd) or six months if you’re looking back at 35 and conception hasn’t occurred, this is the smartest thing you can do for yourself. And a kindness for everyone whose head you’ve been biting off.

You may not get the news you were hoping to hear. Still, getting a handle on what the obstacles might be and coming up with a coherent, solid baby-making strategy could really help blunt that crazy-anxious edge.

In case you find the prospect a little daunting, you can take comfort and learn a thing or two from Laura Kaslow in her charming and candid account, “Taking the RE Leap.”

If there’s one overarching theme in this Getting Started it is that you can and should take control. No one ever has an iron-clad guarantee that things will work out as planned, but we can take steps to turn dreams into reality.

And remember to log on to www.theafa.org, The American Fertility Association’s 24/7 resource. Join “No Barriers,” the no-cost membership that gives you access to a rich library, message boards, Tuesday night chats, and more. Need to talk to someone for calm advice and referrals? Call the toll-free support line at (888) 917-3777.

Like the song says, whenever you need us, we’ll be there.

With warm regards until next time,

Anne Adams
Editor-In-Chief
Director, Policy and Programming

Muscle-building nutritional supplements may help men bulk up, increasing muscle mass and strength. But they’re tricky. Many of these body-bulkers have an unintended consequence that may affect users for the rest of their lives: compromised fertility.

The negative effects of steroids and the damage they can cause are well documented. This is why it is illegal to take them for their muscle-building properties and why many states have classified them as controlled substances.

Here’s the thing: Some nutritional supplements may cause the same damage as steroids. But unlike regulated steroids, they are still readily available on the market.

These supplements contain natural products that are converted to testosterone, testosterone-like hormones (androgens) or other hormones within the body. Some of them mimic the action of testosterone without actually containing testosterone. Still others will push the body to produce an inappropriate and dangerously high level of testosterone.

These supplements can cause acne, high blood pressure, elevated hematocrit, and changed mood. A particularly troubling effect is the negative impact on sperm production, since it is usually young boys and men (mostly athletes) who take them to bulk up. These supplements will raise the level of male hormones (androgens) in the blood, suppressing the testis’ ability to make sperm, either partially or completely.

No one knows for sure which of the supplements will suppress sperm production. Many of them don’t contain testosterone and have innocuous-sounding ingredient lists. This leads to almost accidental steroid abuse for those athletes who don’t recognize the signs.

Most men recognize that steroids are not safe and will avoid them. Supplements are less clear. In the past, this market has not been well regulated. There’s some promise that the Food and Drug Administration’s new Good Manufacturing Practices (cGMP) will help address some of these concerns. The new regulations require supplement manufacturers to meet certain standards with their products.

However, many consumers of muscle-building supplements will not find out about the risk to sperm until it is too late. The problems may be discovered years later when these men try to have children.

During a recent clinical trial, the M.A.Z.E. Laboratory screened a series of students from a local college football team for a sperm

study. These students would not normally have their sperm investigated at this stage in their lives. All 15 of these students failed the screening. The problems with their sperm ranged from low counts to poor morphology (shape) to low motility (movement). Most students had problems with more than one aspect of their sperm. In addition, those that were tested had elevated testosterone levels and low follicle-stimulating hormone (FSH), which showed that somehow their production of sperm was being suppressed.

Upon further questioning, it was found that all 15 students were taking a muscle-building nutritional supplement. The players believed this supplement was safe since it was on the market. Taking the supplements was the only common factor for these men that could affect sperm count.

These men, like all college athletes, are too young to be making possibly irreversible decisions regarding their fertility, especially unknowingly.
In the current medical climate, where testing is not done on supplements, men should be very careful what they ingest. However, those who are trying to start a family should be especially careful. Men must also be aware that it takes 78 days from the time sperm begin to divide until they are ready for ejaculation. Thus, if they stop supplements, it will take a minimum of three months for sperm quality, if affected, to begin to regenerate.

Any man with a history of supplement use should have a semen analysis early in the course of trying to achieve conception with his partner. There are medical treatments that can help the testis rebound more quickly. Ideally, no men would take these supplements in the first place.

Dr. Michael A. Werner is a board-certified, fellowship-trained urologist whose practice is limited to male infertility and sexual dysfunction. Dr. Werner is the medical director of M.A.Z.E Laboratories in Purchase, N.Y., and Clifton, N.J., as well as in private practice. www.wernermd.com

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Taking the RE Leap
By Laura Kaslow

Love was definitely in the air. I was on my honeymoon, sipping champagne on a balcony overlooking the ocean with my new husband, Kris. I was 34 at the time, he was 39, and my son from my first marriage was 4 years old. We had created a perfect little family and we definitely wanted to add to it immediately. I looked over at him, the sunset casting a warm glow on his skin. “I hope you are ready for this, because as soon as we quit using birth control, I will get pregnant.” He replied he was more than ready.

Fast forward to six months later. We had been trying to conceive every month since we had gotten married. Every month I hoped that I would be “with child” and every month I had been disappointed. There was one month where I was sure I was pregnant. My breasts were sore and I was a bit nauseous, but my home pregnancy test only registered one line. Maybe it was defective? My period proved that the home pregnancy test was in good working order. Negative. Again.

The doubt started creeping in. I wasn’t sure what was wrong, if anything. I had gotten pregnant with my first husband purely by accident. The sex wasn’t accidental, but we had been using the rhythm method and I had messed up on the timing. That resulted in my beautiful son. About a year later, we had a similar “timing” snafu and I became pregnant again. I was definitely fertile, perhaps overly so. I miscarried at 9 weeks, but I certainly had not had problems conceiving. So why were we having problems now? Which pregnancy goddess had I angered?

Not long after, I happened to be explaining the pregnancy “delay” to a friend of mine when she suggested that I see a Reproductive Endocrinologist or RE. She was a newer friend of mine, and I had no idea that she was having trouble conceiving. She urged me to see her doctor because I was “older” and “you just never know.”

A reproductive endocrinologist? I had never given it any thought. I was happy with my gynecologist. I liked my gynecologist. I always had my yearly check-ups and always checked out fine. My menstrual cycles were regular. I had been pregnant before. I was now 35, but was that really considered “old?” Did I really need to see a specialist? Couldn’t my ob-gyn handle it? After too much internal dialogue, I decided to talk to my husband about it.

“We don’t need to see someone. Maybe we are just missing your fertile time,” he responded. We were newlyweds and I knew we weren’t missing it! I told him I wanted to make an appointment to see the

RE. My instincts were telling me, “better safe than sorry.” I thought that it would be good to have a plan. I figured that we would most likely have to start monitoring with an ovulation predictor kit, or the worst-case scenario would be artificial insemination. I priced out some predictor kits at the drugstore, just so I would know how much extra to allot for in our monthly budget.

I called the RE my friend had recommended. Our insurance would cover the visit. The first appointment they had available was in a month. That seemed like an awfully long wait. The RE was either very popular or there were more people with these concerns than I was aware of. I booked the appointment and was sent a huge packet of forms for my husband and me to fill out. They were detailed questions regarding our medical, sexual, psychological and reproductive histories. We sent them back and waited for the appointment.

My husband was given a sperm analysis, and I was scheduled for what I was told was “day three” testing. On the third day of your monthly cycle, an RE will test your blood for levels for certain hormones. Abnormal readings on these tests can help the RE pinpoint where problems might be. The same is true of the sperm analysis.

It was all pretty easy, and I was told we would receive a call after they reviewed both of our results. Now all I had to do was wait. Wait for the call that would drastically change both of our lives.

Getting that call is one of those moments that are flash-frozen in time. I will never forget it. “Hi, Laura. This is Joan. I am the nurse coordinator at the doctor’s office. I called to give you your results. Do you have a pencil and paper?” In retrospect, when a doctor or nurse asks you if you have something to write with, you should brace yourself for serious news. I got a pencil and paper.

“Well, your testing came back normal. Everything looks good.” OK, this is not so bad, I thought. “The problem is with your husband,” she added. My heart sank. “We received some abnormal results on the sperm analysis. His motility is fine; the count is on the low side at 23.2 million. The real problem is the morphology.” I interrupted to ask what morphology was. “Morphology is the shape of the sperm, and unfortunately your husband has morphology of less than 1% normal. You will have to go straight to In Vitro Fertilization with ICSI if you want to have a baby.”

It was at that point I felt the world being pulled out from under me. The nurse explained the basics of the scheduling, the medications and procedures involved. I took copious notes, but it was still too much to take in all at once.

I got off the phone and immediately broke down in tears. I distinctly remember standing in the corner of our bedroom, face to the wall, just crying my eyes out. I was scared for both of us. How do you tell your husband he is infertile? And all the procedures sounded extremely daunting. I was going to have to have my eggs surgically extracted in the hopes of getting pregnant. It didn’t sound like too much fun.

My husband, stellar pragmatist that he is, took it pretty well. It was a bit of a shock at first, but we both came to be of the mindset that if this was how things had to be, then we might as well “get with the program.” We did our first fresh IVF cycle and unfortunately it was negative. We had enough frozen embryos to do two frozen embryo transfers. I became pregnant off the first frozen cycle but miscarried at seven weeks. The second frozen cycle was negative. We are gearing up for our second fresh cycle, and I will start the shots in two weeks. This will be our fourth cycle in 17 months. It’s a bit of a push, but if we bring home our baby, it will be well worth it.

I am glad that we went to see the RE when we did. Had I buried my head in the sand, we would have wasted precious time fruitlessly trying to conceive a child that could not have been conceived without expensive medical intervention.

Yes, our RE is expensive. We were fortunate to have insurance, but we have almost reached our lifetime limit. We are primarily paying out of pocket for this current cycle. Is cost a consideration? Of course it is. If you can use your ob-gyn for basic testing or entry-level treatments such as Clomid cycles, you should. Our diagnosis precluded such treatments, but if I could have done them with my ob-gyn, I would have. And if I am fortunate enough to get pregnant for more than seven weeks, I will use my ob-gyn for my obstetrical care. It’s been a while since they have seen me, but I can think of no better reunion than to walk through their doors and tell them, “Guess what, I am finally pregnant!”

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