Dr. Deborah Simmons will be speaking at the annual conference of Resolve, the National Infertility Association on April 21st at Calvary Lutheran Church in Golden Valley, MN.  She will be speaking on gestational surrogacy, depression and infertility, and decision-making about ending treatment.  Join with the Resolve community for information on Western and holistic fertility treatment and adoption.  For more information, go to Exploring Paths of Hope: 28th Annual Infertility and Adoption Family Building Conference

 (Brought to you by Deborah Simmons, PhD, LMFT)

I have long wondered how nutrition affects our fertility.  This study from The Journal of Reproductive Medicine lends credence to the notion that our high-carbohydrate diet may well explain why some women suffer from unexplained infertility.  My colleagues at Partners in Healing, Dr. Nate Champion and Dr. Nita Champion, specialize in naturopathic medicine and nutrition.  Contact us at 763-546-5797 or info@pih-mpls.com for a holistic team approach to fertility treatment.

Increased Celiac Disease Prevalence in Women With Unexplained Infertility

ScienceDaily (Aug. 18, 2011) — A recent study demonstrated increased rates of celiac disease in women who present with unexplained infertility.

Published in the May-June 2011 issue of The Journal of Reproductive Medicine, the study evaluated 191 female patients presenting with infertility. Each participant underwent serologic screening for celiac disease as well as routine infertility testing. The 4 patients who had positive serum test results were advised to seek evaluation with a gastroenterologist. All 4 patients were confirmed to have celiac disease. They then underwent nutritional counseling to change over to a gluten-free diet.

Among the 188 patients who completed testing, the prevalence of undiagnosed celiac disease was 2.1%. While this rate was not significantly higher than the expected 1.3%, the diagnosis of celiac disease in women with unexplained infertility was found to be significantly higher at 5.9% (3 of 51 women). Interestingly, all 4 patients found to have celiac disease conceived within a year of diagnosis.

Though the study numbers are small, the findings suggest that, at least for some women with infertility, dietary measures may help bolster fertility. "Diagnosing celiac disease in an infertile woman would be particularly beneficial if the low-cost (and low-risk) therapy of pursuing a gluten-free diet could improve chances for conception," says lead author Janet Choi, MD, a reproductive endocrinologist at the Center for Women's Reproductive Care at Columbia University. Co-author Dr. Peter Green, director of the Celiac Disease Center at Columbia University Medical Center, said that these results should be added to the increasing body of knowledge concerning the impact of undiagnosed celiac disease on women's reproductive health.

Brought to you by Deborah Simmons, PhD, LMFT

This article by Dina Roth Port speaks to the secrecy that surrounds fertility challenges.  Many of my clients suffer silently through fertility treatment, feeling misunderstood and alone.  The yearning to be a parent is painful enough without the silence of shame.  If you are suffering, please know that there is help.  RESOLVE and the American Fertility Association are excellent sources of help and contact.  And come see me and our fertility team at Partners in Healing for compassionate help. 

Infertility: The Disease We Need to Start Talking About

Dina Roth Port

Silence might be golden in some circumstances, but in the case of infertility it has been downright destructive.

Recently RESOLVE, one of the only organizations dedicated to infertility, made a bold announcement on its website: "People with infertility are being ignored." I always knew that insurance coverage for treatments such as in vitro fertilization (IVF) is scant at best, and that many doctors still don't treat infertility as a major health issue. I've learned that blatant misconceptions persist when it comes to our reproductive health. And it's no secret that the media doesn't cover this subject as often as it should.

However, what I didn't realize is that infertility patients' reluctance to discuss their struggles and advocate for change is directly preventing those affected from getting the support and funding they deserve. As Barbara Collura, executive director of RESOLVE, explains, "Infertility is not being discussed in the general public health realm -- it's not taught in health classes, it's barely touched upon in medical schools, and it's not a priority of any government entity. Yet how can we expect health care providers, educators, our government, and insurance companies to pay attention to infertility when the patients themselves aren't even talking about it?"
Why the silence? People battling infertility are certainly not alone -- a staggering one in eight couples face it -- yet many feel like it is an extremely personal matter not to be shared with anyone but anonymous women and men on message boards. Some say they feel shame for not being able to procreate or for having faulty plumbing, so to speak. Also, in our somewhat still Puritanical society, we've been brought up to believe that sex is a private matter. Discussing it in some circles, even when it pertains to a medical condition, is taboo.

Of course, not everyone feels that way. For instance, while plenty of celebrities would never admit having gone through IVF (even when so many give birth to twins in their 40s), Giuliana Rancic has helped break the mold by publicly sharing her fertility battle via her reality show Giuliana & Bill. "We had signed on to do this show and when we started having trouble getting pregnant, we decided we were going to be honest and reveal what was really going on," says Rancic, who suffered a miscarriage last year after undergoing IVF treatments.

The result of her candidness was both surprising and inspiring. "I started getting up to 100 emails a day from people telling me that I helped them because hearing my story made them feel less alone and ashamed," Rancic explains. "I was shocked by the fact that so many people go through infertility because so few talk about it. And while experiencing it myself has been more difficult than I could have ever imagined, I've found there really is a comfort in numbers."

However, Rancic is still in the minority: It seems that for most men and women facing infertility, it's easier to deal with something so emotionally, physically, and financially draining without having to field questions and opinions from every well-meaning friend, co-worker, or family member. Such comments like "Just go on a vacation, relax, and you'll get pregnant," or "You can always adopt," are far too painful to even acknowledge, so people figure that by remaining silent they'll avoid opening themselves up to such commentary in the first place.

It doesn't help matters that there's no general consensus on how to label infertility. In 2009, the World Health Organization officially defined infertility as a disease. Yet many individuals, organizations, and insurance companies still say that having children is a lifestyle choice and that infertility is not a serious medical issue. Some even liken fertility treatments to cosmetic surgery. But ask the millions of couples desperately trying to get pregnant whether or not having children is a necessity. Why would they subject themselves to months or years of such turmoil if, to them, it weren't essential that they try?

Certainly, there are plenty of valid reasons while this secret exists, but it needs to end. Thirty years ago, breast cancer was where infertility is today -- women just didn't talk about it (a topic I touched upon in a recent blog post). There weren't countless support groups, fundraising walks, and an entire month enveloped in pink. Women battling breast cancer did so in silence and, in turn, many felt isolated and ignored. However, now because there is such an international dialogue about the disease, breast cancer receives multi-million-dollar grants each year in research funding and patients are inundated with an outpouring of support and understanding.

Other cancers, AIDS, and many other illnesses follow the same path from shame to global support and advocacy: Once people start talking about it, the awareness, funding, and answers follow. "The silence is one of the key reasons why the infertility movement is not where it should be," says Collura. "By people speaking out and letting the world know that these are real issues affecting real people, that would impact advocacy, public education, and public policy."

What will it take to bring infertility out of the closet, so to speak? Possibly it would help if more celebrities like Giuliana Rancic came forward and if the media started covering the topic more extensively (as SELF magazine did with a groundbreaking piece on the subject). Maybe we need thousands of infertility patients and advocates to come to Washington D.C. for their Advocacy Day on May 5th rather than a few hundred like in years past. Or perhaps we just need the domino effect -- once a few people experiencing infertility open up, more will follow suit.

I don't know what the magic ingredients are that will take infertility from an issue no one talks about to a banner "pink ribbon" type of cause. The bottom line is that far too many people are suffering. But by suffering in silence, the stigma persists and the advances we need to overcome infertility will never become a reality. As Collura points out, it starts with those struggling with infertility saying, "We matter."

And when they do, the rest of the world must start listening.

Dina Roth Port, a freelance writer for publications such as Glamour, Parenting, and Prevention, is author of Previvors: Facing the Breast Cancer Gene and Making Life-Changing Decisions.

Brought to you by Dr. Deborah Simmons

A good percentage of my practice is spent working with people with reproductive problems.  This article in Science Daily offers guidance on reproductive treatment between family members.  

Intrafamilial Medically Assisted Reproduction

ScienceDaily (Jan. 22, 2011) — The European Society of Human Reproduction and Embryology (ESHRE) has published on January 20, 2011 a position paper related to intrafamilial medically assisted reproduction (IMAR).This particular type of assisted reproduction can raise various ethical and controversial issues, due to the involvement of a family member as a third party.

The ESHRE Task Force on Ethics and Law acknowledges the benefits that IMAR may bring to those choosing this approach and concludes that certain forms of IMAR are morally acceptable under certain conditions. The group advises to evaluate each request for IMAR individually, based on four ethical principles in health care: the respect for autonomy, beneficence and non-maleficence and justice.

The Task Force explains that the right for individual autonomy is elementary: any individual should have the principle of choice with whom to reproduce. It is understandable that couples wish to preserve some sort of genetic identity with the child, and hence may wish to choose a donor in the family. IMAR may facilitate a child's access to its biological roots and enable it to have contact with the donor or the surrogate mother. Often faced with no realistic alternatives due to long waiting times or lack of donors, IMAR may also be the only option available to these patients. The ESHRE group recommends that fertility doctors should take into account the relevant regulations in their country when they assist a couple with IMAR. In some countries IMAR is illegal and the relevant laws against incest and consanguinity apply to protect the offspring from genetic risks and to avoid possible social disruptions and conflicts. "Doctors should assess any possible psychosocial and medical risks related to the treatment," says Dr. Wybo Dondorp, deputy coordinator of the Task Force. "Doctors must therefore consider the principles of beneficence and non-maleficence together and aim at producing net benefit over harm for all parties involved."

Potential risks may affect several parties, including the future child. These risks can arise from intrafamilial conflict if parents feel threatened in their parental role or if they have different views from the collaborators on how the child should be informed of its genetic origins. Especially in cases of intergenerational IMAR, there are concerns that the child may be confused about his role in the family. The possible pressure on the donor or surrogate to collaborate can also lead to psychological problems. Adequate information on possible risks should be given to all parties. This includes both combined and separate counseling of recipients and collaborators to assess the voluntariness of the donation and to reduce potential conflict situations. According to the principle of justice, doctors should treat similar cases in the same way. So if sister-to-sister oocyte donation is accepted so should brother-to-brother sperm donation. The justice principle also applies where IMAR may circumvent unjust exclusion if waiting times for donors are long or the treatment costs are too high without intrafamilial donors.

It is of paramount importance that recipients and collaborators give their informed consent. The ESHRE group is in favour of disclosure of information to the child if other relatives are aware of the familial collaboration. The counselor should offer support in any case and various strategies may be equally justified; while some would give priority to the child's right to know, others would be more concerned about the risk of confusion and accept a parental preference for secrecy.

Doctors should not accept a minor relative as a gamete donor or a surrogate. In the case of intended surrogacy the Task Force considers parenthood by the surrogate to be a precondition in order to collaborate in IMAR. The paper gives special attention to (rare) cases of consanguineous IMAR, involving the mixing of gametes of persons that are genetically closely related. "The Task Force considers consanguineous IMAR between up to third degree relatives as acceptable in principle, subject to additional counseling and risk-reduction," says Professor Guido de Wert, coordinator of the ESHRE Task Force. "Here, genetic counseling is appropriate to assess the increased risk of conceiving a child affected by a serious recessive disease."

Part of adequate genetic counseling and good clinical practice in such cases is to offer carrier screening for those disorders that are more prevalent in the particular ethnic group. Given that fertility specialists have a co-responsibility for the welfare of the child, it may be morally justified to offer such genetic testing as a condition for access to assisted reproduction.

The group concludes that in some situations IMAR is morally acceptable as long as counseling of recipients and collaborators is applied in order to reduce potential psychosocial and medical risks. First-degree intergenerational IMAR needs special scrutiny, also in view of the increased risk of undermining autonomous choice. First- and second degree consanguineous IMAR is at odds with the spirit of anti-consanguinity and anti-incest legislation in most countries and should not be offered. The group encourages more research into the psychosocial implications of IMAR to contribute to adequate and moral guidance.

Background Depending on the degree of familial closeness, there can be different types of IMAR.  The relationship between donor and acceptor can be either:

(1) first degree such as between siblings or parents and children,
(2) second degree such as for example between uncle and niece and
(3) third degree such as between cousins.

The collaboration between the different parties (those providing donor gametes, a surrogate uterus or both, and the acceptor) can be in the same generation (such as for example sisters) or between generations (for example mother and daughter). IMAR can involve different scenarios such as sperm, egg or embryo donation by a family member and/or surrogacy which can be full surrogacy (surrogate provides the eggs) or partial surrogacy (surrogate carries the IVF embryo). In practice, a common form of IMAR is sister-to-sister oocyte donation. Most cases of IMAR are non-consanguineous. Consanguinity, which is defined as reproduction using gametes (eggs and sperm) from individuals that are closely related genetically, may lead to an increased genetic risk for the future child. The magnitude of this risk depends on the degree of consanguinity. In any general population the risk of having a child with a handicap or a major disease is 3%. In third degree consanguinity, the risk is estimated to be around 5-6%. If the applicant and the intended collaborator carry the same disease, there is a 25% risk of conceiving a child affected with that particular condition.

(Brought to you by Dr. Deborah Simmons)

ScienceDaily (Jan. 13, 2011) — A recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM), found higher Bisphenol A (BPA) levels in women with polycystic ovary syndrome (PCOS) compared to controls. Furthermore, researchers found a statistically significant positive association between male sex hormones and BPA in these women suggesting a potential role of BPA in ovarian dysfunction.

BPA is a very common industrial compound used in food and drink packaging, plastic consumer products and dental materials. PCOS is the most common endocrine disorder of women of reproductive age and is characterized by excessive secretion of androgens which are masculinization-promoting hormones. The syndrome raises the risk of obesity, type 2 diabetes, infertility and heart disease.

"Our research shows that BPA may be more harmful to women with hormonal and fertility imbalances like those found in PCOS," said Evanthia Diamanti-Kandarakis, MD, PhD, study co-author and professor at the University of Athens Medical School in Greece. "These women should be alert to the potential risks and take care of themselves by avoiding excessive every-day consumption of food or drink from plastic containers."

In this study, researchers divided 71 women with PCOS and 100 healthy female control subjects into subgroups matched by age and body composition. Blood levels of BPA were nearly 60 percent higher in lean women with PCOS and more than 30 percent higher in obese women with the syndrome when compared to controls. Additionally, as BPA levels increased, so did concentrations of the male sex hormone testosterone and androstenedione, a steroid hormone that converts to testosterone.

"Excessive secretion of androgens, as seen in PCOS, interfere with BPA detoxification by the liver, leading to accumulation of blood levels of BPA," said Diamanti-Kandarakis. "BPA also affects androgen metabolism, creating a vicious circle between androgens and BPA."

(Brought to you by Dr. Deborah Simmons)

I see many couples who are struggling with fertility challenges.  The holidays can leave many couples feeling pressured by their families to be happy.  The winter holidays focus on children, which can feel like salt in a wound.  I hope that this article by my friend and colleague, Patricia Mendell, LCSW, will be helpful to you or someone you know and love.  Please feel free to share this article.   Know that there is hope. 

When Couples Don’t Agree

By:  Patricia Mendell, LCSW
The American Fertility Association http://www.theafa.org  

The holidays are a stressful time for couples.  Another year has passed and there is still no baby.  It is not uncommon for partners to view plans for the holiday differently. One may feel unable to say no to family and friends while the other feels unable to say yes.  Each can view the other’s decision as unsupportive of the other’s feelings. Each partner may feel that they must present a united front;  either they both go or they don’t.  When this is the case think about “a compromise”.

One partner may opt to attend the holiday dinner and one may not…if that is the decision anticipate in advance what will or will not be said to family members about the absentee partner .  It is important that the partner who is attending the holiday anticipate with some key phrases questions or comments about the missing partner. For the non-attending   partner it is important not to grill the other partner about the event and criticize what or what was not said.  Accept the fact that your partner did the best they could.  For the partner that attends the advice is try not to get caught in the trap of reporting back all the “insensitive comments” that were said because it will just continue fuel more problems in your relationship and your family.

If you decide as a couple to attend the holiday dinner for a specific length of time, then stick to it.  The worst fights between couples often occur because the agreed upon plan or time gets forgotten by one and ends up forcing the other partner to stay beyond their limit or create a scene that only makes them feel even worse.  Anticipate what you will say when you leave early or decide to tell all in advance that you will there for this set amount of time.  Both should be in agreement as to what will be said to others about why you are leaving the party.

 If one partner agrees to go to the holiday dinner on the condition that the other partner stays by their side, then there should be no exceptions.  Often couples will establish these rules and then forget once they walk through the front door at the party.  Running off to watch the football game or going out to run errands is a typical example of what can happen and again be a source of tension for couples which can easily be eliminated if each remains mindful of the other’s feelings and the agreed upon plan.

The final word of advice for this stressful time is, try not to tell your partner that their feelings are stupid or that they are being ridiculous because it makes you feel uncomfortable or is not what you would like to do for the holidays.

          Authored by Deborah Simmons, PhD, LMFT

As a member of the American Society for Reproductive Medicine, I provide psychoeducation for people who seek to conceive a baby with a gestational carrier, also known as a surrogate.  My colleague, Sharon LaMoth, owner of Infertility Answers, Inc., wrote this article recently for East Coast Fertility.   There are definitely rules that can make third party reproduction safe and a life-giving experience.  My advice?  Take your time and do your due diligence about all necessary psychological, legal, and medical steps.  They are part of this extraordinary journey.  Do you have questions about the emotions of fertility treatment?  Just give me a call at 763-546-5797.  I am here to help. 

Intended Parents who are considering surrogacy to complete their family, Gestational or Traditional, independently should do their research before making this life changing decision. Often times, when trying to cut financial corners and when desperation and vulnerability are a part of the picture, some Intended Parents may find themselves in a courtroom fighting for their baby just because one (or more) of these top 10 mistakes were made. Although some of these tips seem to be common sense, others may not have been a thought until it's too late. Most Intended Parents think they are saving money by not hiring a consultant or an agency but the harsh reality is that they spend more money and time in the long run then they save.  

Top 10 Don'ts When Planning a Surrogacy Arrangement  
10) Don't work with a woman under the age of 21

9) Don't work with a woman who has never given birth to a child of her own  

8) Don't use a contract downloaded from the Internet with no legal guidance  

7) Don't use the sperm from an ex boyfriend  

6) Don't work with a Surrogate who lives in a state that makes "commercial surrogacy contracts" unenforceable  

5) Don't 'do' in-home inseminations  

4) Don't have the compensation payments to your surrogate come directly from you-use an escrow agent/account  

3) Don't forget to pay all the bills regarding the surrogacy and pregnancy in a timely manner  

2) Don't have your surrogate stay with you for more then a week if at all possible (offer a hotel or condo nearby)  

1) Don't forget or forgo the Psychological Evaluation  

Even if all of these mistakes are avoided any surrogacy arrangement will still offer its own unique challenges. It's always a good idea to have periodic meetings with a psychologist or mental health professional who is an expert in Third Party Family Building and can guide both the Intended Parents and their Surrogate throughout the pregnancy, birth and for at least six weeks after leaving the hospital. The best case scenario is to hire a full service agency.   

Authored by Dr. Deborah Simmons

I have been meeting with many intended parents lately who seek to use in-vitro fertilization (IVF) with anonymous donor eggs.  Donor eggs "reset" fertility treatment, offering new hope of successful pregnancy, after often years of procedures without pregnancy.  While my clients are comfortable with the idea of third party reproduction, they often worry about how to tell the child or children about having been born from  donor eggs.  From the adoption world, we have learned that telling the child's adoption story early allows the child to incorporate the information in a natural, developmental way.  The same applies to a child born from donor eggs.   With young children, parents often use gardening metaphors (e.g., "A kind young woman offered her seeds to help our family's garden grow.  You are the beautiful flower who grew!)  There is no right or wrong  way to tell the story.  Parents need only to trust themselves and their child(ren) in an atmosphere of love.  Here is a video of a young woman born from donor eggs talking about her experience.