Recently a patient of ours who is growing her family using a gestational carrier (GC) reached out to us. She wanted to share her story and perspective. I thought this would be a great segway to a multi part blog series regarding gestational carriers; what are they, where do you find one, and the emotional and financial impact. For a little background information, a gestation carrier is an arrangement in which a woman carries and delivers a baby for someone else. Here is her story:
Wow, what a whirlwind couple of years. I originally had the plan of giving my daughter, Lilias, a sibling as soon as possible. Unfortunately after becoming pregnant that pregnancy resulted in a miscarriage. I had used Clomid in my past two pregnancies because of PCOS and after the miscarriage we figured we were ready to move forward with fertility treatments.
We met Dr. Groll at SpringCreek and liked him, and his treatment plan for me. We decided to go directly to in-vitro fertilization (IVF) with pre-genetic screening (PGS) testing in hopes of eliminating as many chances of failure as possible. We transferred two perfect embryos and they both did not take. I was heartbroken. This was supposed to be the best treatment plan possible and it did not work. I tested for/and did have a high natural killer cells number so we moved forward again another transfer of two perfect embryos. This time also resulted in a failure. I was feeling pretty hopeless. I tested positive for a couple gene mutations and after another retrieval we tried a third time with Lovenox. This time it worked!! I was pregnant with a boy and a girl!
When I went in and saw the two heartbeats I was so thrilled. Finally, something was going right! However, when I came the following visit one baby had slowed down. Heart was still beating, but at a lower rate and growth was behind. I was told it could go either way. Weeks later I learned that baby had passed. I felt fortunate for the one healthy heartbeat still going strong. It’s a unique situation to lose one twin, a mixed feeling of pain and hope. A horrible few weeks followed after the twin died, from lots of bleeding to insanely painful migraines. It was brutal but I was just so happy to be carrying a baby. I was also curious to find out if it was a boy or girl; I wasn’t sure which survived. When I hit 14 weeks I went to a boutique ultrasound place to see if they could tell the gender. I drove to Columbus excited to hear the news. After an antagonizing silent ultrasound, with a tech in need of sensitivity training, I found out the baby did not have a heartbeat. I was crushed. How could this be happening again? I felt so completely defeated and doubting in my ability to carry a baby, we decided it was time to stop putting ourselves through this pain, but we were determined to grow our family and so we decided to move forward with a gestational carrier.
With a gestational carrier, we use our embryos, my eggs and my husband’s sperm, and then we do an embryo transfer to another uterus, which is different from a traditional surrogate where the child is biologically the surrogates. It was a place I never thought I would be, but I was so thankful that there was a woman I knew who would do that for us. We have had the easiest relationship and it has taught me to be less proud and that depending on others is not a weakness but strength. I was so thrilled when the transfer took a first time and we heard two (!) heartbeats that have continued to thrive! I was shocked when three months after the transfer I discovered I was pregnant and I am now well into my second trimester doing well.
What fascinates me is not that I conceived naturally soon after moving forward a carrier, but more because of the lessons it taught me. I did not necessarily get what I wanted, I wanted to be able to carry all my children myself, but I got so much more. I now have such an amazing friend that was once an acquaintance and I learned the value in not being able to accomplish something. I have a husband that I know will be by my side through anything that comes at us.
In addition, each of my children has taught me so much. My three-year-old daughter taught me about enjoying and being in the moment. I never once had the chance to become depressed after the losses because I had to make sure she knew that she was loved. I had to make sure that I didn’t miss out one day from her amazing childhood and growth. Because she was what I had and that was so very much (she also would have never let me because she is so persuasive and energetic).
My losses have taught me that life goes on. You are stronger then you think you are and even when the pain feels so encompassing at times, it will pass and you will be okay.
My twins have taught me about perseverance. I have never worked so hard for anything in my life as I worked for them. Running a fashion business in NYC was walk in the part to all the surgeries, shots, appointments and legal work it took to get them here. It also taught me to be flexible with my determination. I was so determined to carry them, giving them to a carrier has been the most humble thing I have had to do and it has made me a better person.
My baby in me now how taught me about miracles. Sometimes when it seems impossible…it happens, and she is my proof.
Stay tuned…more to come with the series.
Ovulation Predictor Apps – What’s all the hype?
What is with all of the ovulation predictor apps? How do you use them? What do they mean? Well, we are here to help you.
These ovulation predictor apps help you determine and keep track of your fertile window. Your fertile window is the couple of days during each cycle that conception is possible and when ovulation is expected to occur. By using fertility charting to track your natural fertility signs you can learn more about when your fertile window will likely be. What in the world is fertility charting? It involves observing and recording your fertility signs. Some of the signs that are recorded include basal body temperature (BBT) or cervical fluid. Using this information the app assists you in determining when your fertile window is.
Not all apps are looking for the same data. Like we mentioned above, some look at BBT, cervical fluid or mucous membrane consistency, but some also use ovulation predictor kit (OPK) test results to help give you precise details about your personal cycle.
So how does this all work? Your fertility is driven by hormones, allowing the cycle to be predicted based on the expected hormone changes. The figure on the right shows you what is going on during your cycle. As many of you know cycle day one is the first day of menstruation. Ovulation happens when the Luteinizing Hormone (LH) surges. This is what OPKs are looking for. The LH surge typically happens on day 14 of your cycle, if you have a “normal” cycle. With your LH surge, the BTT is known to increase as well. After ovulation your progesterone rises providing an optimal environment for attachment of an embryo by thickening the endometrial lining. The lining then sheds in the event implantation does not occur. For this reason these apps are great for tracking your cycle and helping you determine more specific details about your own menstrual cycle. One thing you might notice is that some of the apps become more accurate the longer you are using them. Some will also adjust each month if your cycle started early or late.
Fertility Friend seems to be one of the top and easiest apps to use. This app takes your personal data entry into account to determine your most fertile day’s base on your own personal patterns. It even allows you to track intercourse. Best part is you can use it online to track in addition to the app. Another neat feature is that you can track fertility treatments in the same app including when you take fertility medications, when you have IUI’s, IVF retrievals, and IVF transfers. This app can even help you connect with others within the community who might be going through similar fertility journeys.
There are many great FREE apps. What is your favorite fertility app?
Here is a video from Dr. Groll discussing natural family planning.
Here is a video from Dr. Groll discussing fertility apps.
What is infertility and who does it effect?
More than 7.3 million American couples, 1 in 8, experience infertility. Infertility is not uncommon and you are not alone. Did you know that infertility is one of the most common diseases for people between the ages of 20 and 45?
What exactly is infertility? Infertility is a disease of the reproductive system that inhibits a couple’s ability to have a baby. It is defined as not being able to achieve a pregnancy after 6 months of unprotected intercourse. This includes the time when you are not “trying” to get pregnant but are not using any form of birth control to prevent a pregnancy. Based on the study of National Survey of Family Growth, 7% of married women aged 15-24, 9% of married women aged 25-29 and 30-34, 25% of women 35-39, and 30% of women 40-44 all suffer from infertility. Typically, in a young healthy fertile couple, 80% will conceive during the first year while attempting to achieve pregnancy.
Interestingly enough, both men and women contribute to infertility equally without discrimination. Approximately 35% of fertility problems are due to female factors and 35% of fertility problems are due to male factors. Approximately 20% is a combination of both male and female factors affecting fertility. In about 10% of cases, the problem is “unexplained” meaning all testing yielded normal results. For this reason both partners should actively participate in the diagnosis and treatment process. There are many different contributing factors to fertility.
Fertility in Women
Female fertility can be affected by all of the following including age, polycystic ovary syndrome (PCOS), endometriosis, irregular ovulation, uterine abnormalities, sexually transmitted infections (STIs), thyroid disease, reproductive organ surgery, smoking, premature menopause and cancer treatment.
Fertility in Men
On the male side, age, abnormal or low sperm production, testicular surgery or injury, exposure to chemicals/recreational drugs, exposure to significant amounts of heat, sexually transmitted infections, hypothalamic/pituitary dysfunction, congenital disorders, structural abnormalities, hormonal and receptor abnormalities, and testicular cancer can all affect male fertility.
So what’s the big deal?
Women are born with a fixed number of eggs that decline with age. A woman’s fertility peaks in her mid-twenties and begins to decline around 27 and drops significantly after the age of 35. A woman’s fertility is measured by her ability to achieve a pregnancy on a given month. At the age of 30 a healthy woman has about a 20% chance per month of conceiving and by the time a woman reaches 40 her chances drop to 5% per month. For women, the ability to conceive is tied to the quality of her eggs. As women age, hormonal changes begin to take place which decrease egg quality. Decreased egg quality means it becomes more difficult for the sperm to fertilize the egg naturally.
How does it work?
When it comes to fertility there are multiple steps in the process that need to work perfectly for a pregnancy to occur. First of all, a sperm and an egg must meet – meaning that during a natural conception the sperm must be able to swim through the cervical mucus, into the uterus and into the fallopian tubes. At the SAME time the egg must be released, picked up by the fallopian tubes and then allowed to travel through the fallopian tube. Then, when they meet, the sperm must be able to penetrate the egg in order to fertilize it, creating an embryo. Then implantation must occur where the embryo attaches to the uterine wall. After implantation, maintaining the pregnancy is also very important. With the intricate process the body goes through to become pregnant there are many steps that must occur in the right order to achieve a pregnancy, as well as maintain it through the duration of the pregnancy. That being said, problems with any one or more of these steps can be a contributing factor to one’s fertility outcomes.
When it comes to diagnostic testing for infertility, both men and women should be tested for possible influences. By beginning with labs and performing a 3D saline sonogram for her, and getting a semen analysis for him, your doctor will be able to determine the best treatment plan for you and your partner’s future family planning.
Treatment for infertility
Based on your specific situation, your doctor will explain to you what options will provide the best opportunity for pregnancy for you and your partner. Fertility treatments include interventions aimed at correcting the identified cause for infertility, as well as treatments to enhance fertility in couples with unexplained infertility. Fertility medications can improve the timing and quality of ovulation as well as correct hormonal deficiencies. In some instances women may need minimally invasive surgeries such a as laparoscopy to remove scar tissue, endometriosis, or to open a blocked fallopian tube. Some may also need a hysteroscopy to remove uterine septum or endometrial polys.
The treatment options available for infertility treatment include but are not limited to, monitored time intercourse, intrauterine insemination (IUI) and in vitro fertilization (IVF). Unfamiliar with these treatment options? Download an information sheet comparing the 2 treatments here: IUI vs. IVF IUI’s seek to improve the probability of more sperm reaching the egg by washing and concentrating the sperm and placing the sperm past the cervical mucus directly into the uterus. In combination with fertility medications (both oral and injectable) and ultrasound monitoring IUI’s can greatly increase the chances of egg and sperm interacting. Almost 60% of couples are able to conceive with this type of therapy and for the majority of couples it is very successful. Of the 40% of couples who are unable to conceive pregnancy with the above treatment or in whom this treatment would not be appropriate, the vast majority are able to build a family with the help of IVF. IVF involves the use of injectable fertility medications to increase the number of eggs produced, removing the eggs directly from the ovaries and uniting the eggs and the sperm together. Fertilization and cell division are confirmed before the embryos are replaced directly into the uterus. Follow up testing then ensures that pregnancy has occurred.
Who should seek treatment?
If you are a women who has been unsuccessful in trying to conceive for over 6 months, we recommend seeking medical advice to help you with your fertility needs and future family planning. Additionally, males who have a known or suspected low sperm count, woman who have had a tubal ligation or blocked/surgically removed tubes, recurrent miscarriages, or a history of pelvic inflammatory disease, painful periods, or irregular periods should seek treatment sooner.
Dealing with infertility can be a very difficult time for many couples. Many emotions are experienced during this time and it can be very stressful for couples, too. The emotional roller coaster is unpredictable and you never know when you will get good news; you’re left constantly wondering. You may feel self-deprecated, “What is wrong with ME?,” or guilt for not being able to provide a child for your partner, or even disappointment as every periods feels like another failure. Many experience sadness for wanting something so desperately, and for some, comes the added devastation of getting pregnant only to miscarry. Dealing with infertility takes an enormous amount of courage and emotional strength.
Here are some tips to help you deal with the emotions that come with infertility:
Talk with your partner – Don’t let guilt or embarrassment keep you from sharing your feelings. Individuals communicate differently, you might want to approach your spouse over a nice walk or an extended car ride rather than across the table. This will help your partner to share their feelings too. You may both find strength, comfort and acceptance in your honesty and sharing your feelings can increases one’s sense of intimacy.
Share with close friends or family – Talk to family or close friends about your struggles with conceiving. Sometimes verbalizing fears and frustrations can alleviate some of the shame and stress of hiding the secret. Support groups are another great way to share your experiences, especially with people who are undergoing similar struggles. SpringCreek Fertility offers a support group that could definitely be what you’re looking for.
Explore Online Support – if you are uncomfortable sharing your personal struggle with those who know you, search out websites and chat rooms where you can be anonymous and stay connected to people going through similar experiences. Keep in mind that many times women who write or blog are the ones having the most difficult circumstances. You should always confirm with your health care professional what you read to make sure it is medically accurate and the advice given is something that would be beneficial in your efforts to conceive.
Sweat it out – Exercise can help clear your mind and pump up endorphins. Moderate exercise is good for you and can be just the boost you need during this journey.
Foster your mind, body and spirit – Try yoga, meditation, hypnosis, acupuncture, massage, circle of bloom, or take a mind/body class – anything to get back in touch with your beliefs and inner strength. A great way to learn more about different whole body, holistic options is to join the Fertile Pathway’s meetings at SpringCreek Fertility.
Take a break from “baby brain” – Allow yourself up to an hour a day to educate yourself about conception, lurk on the internet etc. but that’s it. After that, read a steamy novel, get your nails done, go dancing, take a walk, watch a funny movie, go on a date, or do anything else you enjoy that doesn’t involve babies.
Seek help when needed – While all the emotions are completely normal and understandable, if you feel they are interfering with the way you function or negatively affecting your relationships, talk to your doctor, look into support groups in your area, or seek counseling. You already have enough on your plate to deal with; don’t let depression rear its ugly head and take over your life!
Although it seems that baby bumps and babies are following you everywhere, 7.3 million Americans or 1 in 8 couples experience infertility. At SpringCreek Fertility we are here to support you during this journey. Reach out if you’re looking for emotional support; we will be there to help you every step of the way.
What do you need to know about Vitamin D?
Vitamin D is a fat soluble vitamin that is necessary for many functions in our bodies. The body makes vitamin D from cholesterol through a process that is triggered by the sun’s ultraviolet B rays. Interesting fact: a study showed that non-Hispanic black subjects require 6 times the amount of UV radiation to product a serum vitamin D concentration similar to that found in non-Hispanic white subjects1. Vitamin D can also be obtained through diet, although most dietary sources of vitamin D do not contain sufficient amounts to satisfy daily requirements. Some of the foods that have high amounts of vitamin D are oily fish such as wild salmon, fortified products, and egg yolks. The daily recommended allowance of vitamin D is 600IU for adults.
Vitamin D is important for calcium balance and optimal skeletal health. One of the major functions of Vitamin D is to help increase the calcium and phosphorus absorption from the small intestine. For proper mineralization of bone both calcium and phosphorus are needed. Another major function of Vitamin D is involvement in the maturation of osteoclasts which play a role in the re absorption of calcium from the bones.
Vitamin D deficiency also is important during pregnancy. Studies show that a maternal vitamin D deficiency at 18 weeks of gestation was associated with multiple problems with the resulting children, including impaired lung development, neurocognitive difficulties, increased risk of eating disorders and lower peak bone mass2. This suggests that vitamin D plays an active role in fetal development particularly with the brain, lungs and bones.
Interestingly enough, one study showed that nearly two-thirds of healthy young adults in Boston were vitamin D insufficient at the end of winter3. It is common for vitamin D levels to be lower in the fall-winter because of the decreased sun exposure and higher at the end of summer. Most commonly there are no symptoms of having a vitamin D deficiency or insufficiency. Some may experience a depressed mood. Your vitamin D levels can be tested through a blood draw and it is recommended to be tested yearly.
So why should you care about your vitamin D levels? Studies show that better IVF outcomes are achieved when a patient has sufficient levels of vitamin D4. Another study showed that supplementation of vitamin D resulted in a 12% reduction in the odds of an acute respiratory infection5. Additionally, low levels of vitamin D have been linked to increased cardiovascular disease6. Another study showed a strong relationship between lower rates of a variety of chronic diseases and a higher level of vitamin D. Finally, low vitamin D is associated with osteoporosis and osteopenia, and an increased risk of hip and non-vertebral fractures. Many studies have suggested a link between low vitamin D levels and an increased risk of cancer7. Another theory is that vitamin D deficiency could also contribute to autoimmune diseases.
So what can we do about your low vitamin D? Depending on your vitamin D levels different recommendations are made. Some need a prescription twice a week or once a week to supplement with until vitamin D levels are normalized then continuing on a maintenance dose. Your clinician can make the best recommendation for you based on your individual situation.
- Clemens TL, Henderson SL, Adams JS, Holick MF . Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. The Lancet. 1982; 319(8263):74-76. http://www.sciencedirect.com/science/article/pii/S0140673682902148
- Prue HH, Lucas RM, Walsh JP, et al. Vitamin D in Fetal Development: Findings From a Birth Cohort Study. 2015; 135(1):e167-e173. http://pediatrics.aappublications.org/content/early/2014/12/09/peds.2014-1860
- Tangpricha V, Pearce EN, Chen TA, Holick MF. Vitamin D Insufficiency among Free-Living Healthy Young Adults. Am J Med. 2002; 112(8):659-662. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3091001/
- Paffoni A, Ferrari S, Vigano P, et al. Vitamin D Deficiency and Infertility: Insights From in vitro Fertilization Cycles. The Journal of Clinical Endocrinology and Metabolism. 2014; 99(11): e2372-e2376. https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2014-1802
- Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017; 356. http://www.bmj.com/content/356/bmj.i6583
- Abuannai M, O’Keefe JH. Vitamin D and cardiovascular health. Primary Care Cardiovasc J. 2011;4:59–62. http://www.jcpcarchives.org/full/vitamin-d-and-cardiovascular-health-136.php
- Lappe JM, Travers-Gustafson D, Davies KM, et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007;85:1586–1591. http://ajcn.nutrition.org/content/85/6/1586.long
Endometriosis: What am I dealing with?
This month is endometriosis awareness month. Did you know endometriosis affects at least 6.3 million women in the U.S. You are not alone. So what exactly is endometriosis? First of all, endometrium is tissue that normally grows inside of the uterus. Each month during a woman cycle the endometrium, your uterine lining, is shed. For women with endometriosis, they have endometrial tissue outside of the uterus. This tissue can be on the ovaries, fallopian tubes, bowel, bladder and tissue lining the uterus. This endometrial tissue is influenced by hormonal changes therefore each month the tissue builds up, breaks down, and then sheds. This can be a painful chronic disease. This process causes internal bleeding and inflammation resulting in pain, infertility, scar tissue formation, and bowel problems.
Interestingly, some women with unexplained infertile have undiagnosed endometriosis. So, how do we diagnosis it? A definite diagnosis cannot be given until a laparoscopy is done. A laparoscopy is a minor surgical procedure done under anesthesia that allows for the surgeon to see the location, size and extend of implants. This procedure can be expensive and invasive, but during the surgery the doctor may be able help reduce symptoms if endometriosis is found. However, depending on the symptoms of the individual women, surgery may not be required for treatment. Some of the common symptoms women have is chronic pelvic pain, pelvic pain before and during periods, fatigue, painful urination or bowel movements during periods, painful intercourse, and other gastrointestinal upsets such as diarrhea, constipation, or nausea.
So now you’re probably wondering what can be done about you endometriosis. Although there is no cure for endometriosis, there are a variety of treatment options. The goals of treatment can include relieving/reducing pain symptoms, shrinking or slowing endometrial growths, preserving or restoring fertility, and preventing/delaying recurrence of the disease. Some of the common over the counter pain reliever medications used are Ibuprofen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aleve. There are also hormonal treatments that are aimed to stop the cycle of tissue stimulation breakdown and bleeding. The third treatment is a laparoscopic surgery where the surgeon removes or destroys the endometrial growths within the abdominal cavity. This can help relieve pain and may allow pregnancy to occur in some cases.
Dealing with the diagnosis of endometriosis can be overwhelming and difficult. But know you are not alone and your team at SpringCreek Fertility is working hard to help you get through this.
Keeping the Spark Alive!
In light of Valentine’s month, let’s talk about keeping the spark alive in your relationship. While going through infertility treatments it can be difficult for couples to maintain intimacy. Many couples find that being intimate has become a chore. Let’s change that!
One way to help reconnect with your partner is using conversation starters from different apps and websites. A couple of the apps I came across were Conversation Shaker, JustAsk Lite, and Ice Breakers for Couples. The conversation questions allow you to ask your partner anything you have ever wanted to know. These are great to do over dinner, provoking new conversations, and reignite the spark with your partner.
Massage is also a great way to reconnect with you partner, physically and emotionally. The best part is that massage helps you relax and it just might develop into great foreplay. Massage aids such as lotions, oils, and heat packs are great to use to enhance the experience as well.
Dressing for Bed – This is your chance to dress or success so to speak. For women, Lingerie = sexy, self-esteem, and confident. When picking the perfect lingerie, find one that accentuates your figure and allows you to breathe and feel comfortable. The best part is your partner will love seeing you in lingerie. For the guys, invest in some silk pajamas. Or maybe you are both more comfortable in t-shirt and shorts –the point is to remember that for your partner, you are the most perfect present, so why not let your partner “unwrap” you!