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Infertility Counseling (Therapy)

Infertility Counseling
By Ellen

Many people experience increased feelings of depression, conflict, family tension, and anxiety during infertility. An experienced and supportive infertility counselor can help individuals and couples understand and cope with the stress and confusion of infertility. This counselor might be a licensed psychiatrist, psychologist, or social worker. The academic degree itself is not important in most cases; what is important is the counselor’s understanding of and approach to infertility issues and treatments. Some clients prefer a counselor who has personally experienced infertility, but a good counselor will be able to help a client regardless of his or her background.

Compared with support groups, infertility counseling has many advantages. Some people enjoy the energy of group sessions, but others feel that group sessions are too dramatic, do not like the personalities of some members, or do not feel comfortable speaking candidly to a group. Inevitably, there will be pregnancy announcements, which can seem like “graduations” to those who are still trying to conceive. Also, some issues are too serious and pressing to be adequately addressed in a group setting, such as persistent depression, marriage problems, and conflict over the next step in treatment or ending treatment.

Finding an Infertility Counselor

Because infertility counseling is so specialized, it can take some work on your part to find a good counselor. The first place to begin your search is your reproductive endocrinologist’s office. Many fertility clinics offer individual or group counseling sessions and keep lists of recommended counselors. Also, the RESOLVE website features a list of mental health professionals and groups (/PageServer?pagename=cop_mhpart). Unfortunately, this list is very short, and many states are not included. If you can’t find a counselor in your city or state on this list, you can contact your local RESOLVE or infertility support group for recommendations. Message boards such as IVF Connections are another good resource. Don’t forget to check adoption support groups and message boards; many people who adopt after infertility have worked with a counselor to resolve their feelings about infertility. Some adoption social workers also offer infertility counseling services, but keep in mind that this type of counselor may be somewhat biased against treatments such as IVF. If you know that adoption may be in your future, though, this counselor might be a good choice. Finally, you can contact marriage and family therapists and ask them whether they have worked with other clients experiencing infertility.

Costs

Counselors usually charge per session and can be very expensive if you have to pay out of pocket, but as with anything related to infertility, triple-check your benefits plan! Many health insurance plans allow a certain number of sessions per year or may cover it as mental health services, and you only have to pay your general co-pay. Counseling sessions provided by psychiatrists and psychologists, and any travel costs to these sessions, are also deductible as medical expenses if you meet the IRS requirements (http://www.irs.gov/taxtopics/tc502.html).

What to Expect

The first counseling session usually begins with the counselor asking you to explain how long you have been trying to conceive and what led you to seek counseling at this time. This first session is mostly for the purposes of getting to know you and offering some general coping tools or new ways of thinking about infertility.

If you can afford the cost and time, schedule sessions at least twice per month. In the world of infertility, time is measured in 2-week increments, and your emotions may be vastly different from one week to the next. Regularly scheduled appointments will be helpful to you and also to your counselor, who will better understand your entire infertility experience if he or she sees you at different times in your cycle.

You might wonder whether your counselor will ask your partner/spouse to attend a session or two with you or alone. Some counselors may do so, but as a general rule, the counselor is there to help you as an individual and will refer you to another marriage counselor, if necessary, so that your partner doesn’t feel that the counselor is biased or taking your side.

Other Options

It is normal to occasionally feel antagonistic toward your counselor or question the benefits of a particular counseling session. However, if you find that the negative feelings outweigh the positive ones or you are not comfortable with your counselor after a few sessions, you should look for another counselor or consider alternatives to one-on-one counseling, such as attending a support group (in-person or online), reading about infertility’s psychological impact (the book Unsung Lullabies by Jaffe, Diamond, and Diamond is very good), blogging and journaling, or practicing the mind-body exercises described in Dr. Ali Domar’s book Conquering Infertility.

July 26, 2006   2 Comments

Blogging Abbreviations

Reading blogs can be confusing if you don’t know the commonly used abbreviations. Here is a list (and add more in the comments section below) of ones utilized by the American infertility/pg loss/adoption community (non-Americans sometimes have different terms such as EPU–egg pick up instead of ER–egg retrieval).

2WW–two week wait (post ovulation until beta)
AD–adoptive parent
AF–aunt flo (your period)
AH–assisted hatching
AI–artificial insemination (an old name for IUIs. No longer commonly used)
AO–anovulation
ART–assisted reproductive technologies
BBS–boobs
BBT–basal body temperature
BCP–birth control pills
BD–baby dancing (having sex. More commonly used on bulletin boards instead of blogs)
BF–biological father
BFN–big fat negative
BFP–big fat positive
BG–blood glucose
BH–braxton-hicks contractions
BIL–brother in law
BMom–biological mother
BP–biological parents
BP–blood pressure
B/W–blood work
CBAVD–congenital bilateral absence of vas deferens
CCAA–china center for adoption affairs
CCCT–clomid challenge test
CD–cycle day
CM–cervical mucous
D&C–dilation and curettage
DD–dear daughter
DE–donor egg (sometimes also donor embryo)
D&E–dilation and evacuation
DH–dear husband
DHS–department of homeland security
DI–donor insemination
DIUI–IUI with donor sperm
DIVF–usually IVF with donor eggs but could be any donor gametes
DOR–date of referral
DOT–date of travel
DP–dear partner
DP3DT–days past three day transfer
DP5DT–days past five day transfer
DPO–days past ovulation
DS–dear son
DTC–dossier to china (or DTV, DTE–dossier to…)
DW–dear wife
Dx–diagnosis
E2–estrogen level
EDD–estimated due date
Endo–endometriosis
ER–egg retrieval
ET–embryo transfer
EWCM–egg white cervical mucous
FC–foster care
FET–frozen embryo transfer
FF–fertility friend (online charting service)
FIL–father in law
FRED or FRER–first response early detection (peestick)
FSH–follicle stimulating hormone
GnRH–gonadotropin-releasing hormone
GS–gestational surrogate/surrogacy
hCG–human chorionic gonadotropin
HPT–home pregnancy test (also called a peestick)
HS–home study
HSG–hysterosalpingogram
HTH–hope that helps
ICSI–intracytoplasmic sperm injection
IF–infertility
IF–intended father (surrogacy)
IM–intramuscular
IM–intended mother (surrogacy)
INS–immigration and naturalization
IP–intended parents (surrogacy)
IUGR–intrauterine growth restriction
IUI–intrauterine insemination
IVF–in vitro fertilization
IVIG–intravenous immunoglobulin
Lap–laparoscopy
LH–luteinizing hormone
LMP–last menstrual period
LP–luteal phase
LPD–luteal phase defect
M/C–miscarriage
MF–male factor
MIL–mother in law
O–ovulate (or O’ing)
OB/GYN–obstetrician/gynecologist
OHSS–ovarian hyperstimulation syndrome
OPK–ovulation predictor kit
P4–progesterone
PAP–potential or prospective adoptive parents
PCOS–polycystic ovarian syndrome
Peestick–home pregnancy test
PG-pregnant
PGD–preimplantation genetic diagnosis
PID–pelvic inflammatory disease
PIO–progesterone in oil
POAS–pee on a stick (take a pregnancy test)
POF–premature ovarian failure
PROM–premature rupture of membranes
PUPO–pregnant until proven otherwise
RE–reproductive endocrinologist
RI–reproductive immunologist
RPL–recurrent pregnancy loss
Rx–prescription
SA–semen analysis
S/B–stillbirth
SFC or SFBC–single father by choice
SHG–sonohysterogram
SIF–secondary infertility
SIL–sister in law
SMC or SMBC–single mother by choice
SPC or SPBC–single parent by choice
TCOYF–taking charge of your fertility (book by Toni Weschler)
Temp–taking BBT
TS–traditional surrogate/surrogacy
TSH–thyroid stimulating hormone
TTC–trying to conceive
Tx–treatment
U/S–ultrasound
UTI–urinary tract infection
UU–unicornate uterus
VBAC–vaginal birth after cesarean
xfer–transfer

July 26, 2006   8 Comments

Questions for Choosing an Adoption Agency

This post originally appeared on Weebles Wobblog on December 7, 2007.
Reprinted with permission from Lori.

When we decided to go the domestic infant adoption route, we were fortunate that through no real calculated effort, we happened to fall into an excellent adoption agency. And by “excellent,” I mean two specific things:

  • An excellent agency counsels hopeful adoptive parent on two fronts: (1) processing grief to heal the wounds of infertility, and (2) living in open adoption.
  • An excellent agency is squeaky-clean in its dealings with both hopeful adoptive parents and expectant parents. Ethics toward expectant parents may not be high on your agency checklist at the front end of an adoption, but make no mistake. It is in your long term interest, and that of your future child, to make sure that your child’s firstparents are also treated ethically.

So plan on doing some research once you hone in on an agency or two. Ask to talk to past customers of adoption services (adoptive parents) and consumers of pregnancy counseling services (firstparents).

20 Questions: A Girlfriend’s Guide to Choosing an Adoption Agency
Needless to say, choosing an adoption agency is one of the biggest decisions you face, because you need to go where your child will be. My advice is to follow both your head and your heart.

How? First, your head. Research the agency by interviewing its counselors and asking to speak with both adoptive parents and firstparents they have served.

Ask the agency

  • What’s the shortest wait you’ve had? What made it so short?
  • What’s the longest wait? Why do you think this couple had such a long wait? What did you do to help them?
  • What is a typical wait?
  • How many couples do you have actively waiting at one time?
  • How many placements did you have last year?
  • How do expectant parents find you?
  • What is your counseling approach for expectant parents? (Information on parenting should be easily available to people coming in for pregnancy counseling. The agency should never push, but rather provide information and support.)
  • How often do expectant parents decide to parent after being matched with adoptive parents?
  • At what stage of the pregnancy do you suggest expectant parents choose adoptive parents? (Many professionals suggest not entering a match until at least 7 months into the pregnancy. Expectant parents go through a lot of ups and downs, and you don’t want to be riding that roller coaster for more than 2 months.)
  • Please explain your fee schedule. (A large portion — up to 1/3 of the total — should be due only after placement.)

Ask adoptive parents

  • How long was your wait?
  • What kind of grief counseling did the agency offer? (Expect some support in healing from infertility so you are ready to parent whole-heartedly).
  • How active was your agency?
  • What kind of after-adoption support is available? (Look for an agency that provides post-adoption counseling or parenting classes as part of the supervision process).
  • What kind of relationship do you have now with your child’s first family?

Ask firstparents

  • How did you come by your decision to make an adoption plan? (A good agency will let the expectant parents take the lead and not push them into ANY option. This is crucial to reducing the risk of expectant parents changing their minds. The decision has to be freely made, and I would run fast from an agency that puts pressure on expectant parents to “give up” a baby.)
  • To what degree did you feel supported by the agency?
  • If you had a friend who was pregnant and needed help deciding what to do, would you recommend this agency?
  • How did you hear about the agency?
  • What kind of relationship do you have now with your child’s family?

Look for healthy situations where both parties feel well-served and well-represented by an agency. A good agency will make the adoption process collaborative (with the child as the focus), rather than adversarial (where one side’s loss is the other’s gain).

After you gather the facts, let your heart weigh in on the decision. Sit quietly and find out what your intuition tells you. If you have a “feeling” about an agency, go with that feeling. Adoption — like parenting — is a very intuitive process. Adopting with your head and heart will prepare you to parent with your head and heart.

July 26, 2006   2 Comments

Diagnosis: PCOS

PCOS (Polycystic Ovarian Syndrome)
by Jen

What PCOS Means and Its Impact on Fertility

PCOS stands for Polycystic Ovarian Syndrome. It is also known as PCOD (Polycystic Ovarian Disease) and Stein-Leventhal Syndrome.

The name of the condition is a bit of a misnomer because PCOS is a broad diagnosis for a host of problems, which may or may not actually involve cysts. PCOS is the most common endocrine disorder and affects as many as 1 in 10 women. The cause of PCOS is unknown. There is no cure for it and there are a host of symptoms.PCOS is treatable through diet, exercise and medication, most often a combination of the three.

“In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to be present if 2 out of 3 criteria are met: (1) oligoovulation and/or anovulation, (2) excess androgen activity, (3) polycystic ovaries (by gynecologic ultrasound), and other causes of PCOS are excluded” (from Wikipedia).

The most common manifestation is anovulation (no ovulation) or oligoovulation (infrequent or irregular ovulation).Women with PCOS often establish normal cycle routines only with chemical induction.

Other symptoms include dark hair growth on the face and body, excessive weight and weight gain, especially around the midsection, acne, oily skin and hair, thinning hair, and in some cases, more serious health risks such as high blood pressure and high cholesterol.

PCOS is often accompanied by insulin resistance, and for unknown reasons, can eventually lead to Type II diabetes.

Because of the frequently associated ovulation problems, PCOS is one of the most common causes of infertility in women because the patient does not have the advantage of time, predictability or statistics. Fortunately, if the symptoms of an individual’s case are treatable, often this resolves the fertility issues.

Medication, diet and exercise can all assist the body in ovulating and with a combination of the three, PCOS women are frequently able to achieve pregnancy. It should be noted that PCOS women do have an increased risk of miscarriage and as such, your doctor will likely keep you on Metformin through your first trimester of pregnancy.

It is important to note that because of its increased risk factors for more serious health problems, PCOS should be diagnosed and treated regardless of whether or not a woman is trying to achieve pregnancy.

Diagnostic Process

While PCOS is often an umbrella diagnosis for a host of manifestations, it does require specific tests for diagnosis. Your doctor will conduct a full medical history (including menstrual history) and physical, as well as a complete blood panel to check various hormone, glucose and insulin levels. Your physician may also order a pelvic ultrasound to check for cysts on the ovaries, especially if you have been experiencing abdominal pain.Cysts may eventually disappear on their own or may be treated with hormones and medication, and in other cases, may require surgical removal. Provided that the cyst is relatively small in size and not tangled in anything, this surgery can usually be done laparascopically, resulting in little discomfort or recovery time for the patient. In the case of women who do experience a semi-regular cycle, your doctor may ask you to chart your cycle before and after diagnosis to search for detectable ovulation signs.

Your doctor will likely complete a metabolic panel on you once a year after diagnosis, to ensure that your glucose and insulin levels are normal and kidneys are unaffected. This is done through a simple blood draw and lab analysis.

Treatment Options

While PCOS has no cure, it is a very manageable condition.The effects of PCOS are often worsened by excessive weight or weight gain. Though the hormonal abnormalities of PCOS make weight loss more difficult, losing weight statistically shows overwhelming improvement in PCOS symptoms, including ovulation related symptoms.

Your doctor may recommend a diet that is high in fiber, protein and fruits and vegetables and low in carbohydrates and sugars, especially if your PCOS is accompanied by insulin resistance. Tailoring your dietary habits may help with weight loss, insulin levels, and gastro-intestinal response to medications.

Through the combination of diet and exercise, PCOS women can often reduce their symptoms to a point of not needing medical regulation.

Regular cycles (and at least 4 a year) are essential for total wellness and long term health maintenance. There are two primary courses of medication to assist in producing regular cycles.If a woman is trying to avoid pregnancy, a doctor may prescribe hormonal birth control.

If a woman is seeking pregnancy, her doctor will often prescribe Glucophage/Metformin to help induce ovulation. Often Glucophage/Metformin is introduced at a small dose, and increased if the body is unresponsive. If Metformin is not enough to induce ovulation, a doctor may pair it with Clomid or Femara. Metformin often produces unfavorable gastro intestinal reactions but is often managed by switching to an extended release version, and/or changing dietary habits. Often the body adapts gradually, resulting in less complications. Some patients (this author included) experienced relief or reduction from GI problems by taking over the counter acidophilus tablets (available at any health food store) along with the Metformin.

Not only is the Metformin and/or Clomid route helpful for stimulating cycles as beneficial in their own right, this also often leads to increased fertility as patients begin to ovulate regularly.

If inducing ovulation is not enough to help you achieve pregnancy, there may be other factors at play, such as suppressed egg release (eggs are produced but not released in to the system so your body thinks it is cycling regularly but eggs never actually drop), blockage from cysts and/pr scar tissue and other various problems.In some cases, injection FSH and LH drugs are introduced along with the Metformin and Clomid.

If fertility problems persist despite improvements in PCOS conditions, your doctor may order additional pelvic ultrasounds to check for new cysts, and/or a Hysterosalpingogram to investigate for additional complications related to other conditions.

PCOS is a fairly common disorder and can often be diagnosed and managed in its beginning stages by an OB/GYN. However, if normal course of treatment does not help, seek out the care of a Reproductive Endocrinologist.

Personal Experience

My PCOS came as a surprise because I’d always had regular (though long) cycles. We discovered that my cysts result from suppressed egg release so each month the follicle dies and attaches itself to the previous month’s follicle. The suppressed release explained why I still had regular cycles. I did produce eggs regularly and my body knew that (hence its response and my cycle)—the eggs just never successfully dropped down. I had a 4cm ovarian cyst removed 2 years ago, detected after increasing, regular pain on my lower right abdomen and confirmation through a pelvic ultrasound.I initially responded very poorly to the Metformin (frequent trips to the bathroom, especially following any meal) to the point where I stopped taking it. I have begun a new diet and exercise routine and have found that even with moderate weight loss and the new programs, I can tolerate the medication much better and need a much lower dose to produce the same results. We have not successfully conceived due to other fertility problems, but we have seen sign
ificant improvement in my PCOS symptoms, and in my insulin levels, with the combined treatment approach.

In the early stage of my diagnosis I did a lot of reading and research and found the following websites to be invaluable:

SoulCysters Website: http://www.soulcysters.com
SoulCysters Message Board: http://www.soulcysters.net
PCOS Association: http://www.pcosupport.org/
US Department of Health & Human Services PCOS Site: http://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.cfm

Additional Information:
“I am currently on Actos which did more that the Met in helping with the symptoms.”–Tammy

July 26, 2006   12 Comments

Call For Help #1

Finishing up a chapter and I need feedback/comments. We’ve been compiling a list of the usual suspects—comments and questions presented by the non-infertiles to the SQs and SPJs of this world. We drew these either from our own personal experience or your comments thus far on the blog. We’ll be posting a list of quotes that we’re using in the chapter when the chapter is complete.

The chapter is presented like this: the statement or question leads the section; we state what is probably the intended meaning (or why the non-infertile thinks this is a good thing to say); we state how the SQ or SPJ takes these comments/questions; and whenever possible, we give a better way to say the same thing (or warn them repeatedly to stay away from trying to say certain things in any manner).

The list of questions/comments follows below. Obviously, there are many variations that fall into each category—we’ve just listed the umbrella phrase. Please let us know if we’ve left off an important topic that we need to cover. Also, write in with any stories concerning these questions/comments. We’re trying to give many personal examples. As always, your name will be changed for the book.

Thanks, SQs and SPJs. What would I do without you?

The List

1. When are you going to have a baby?
2. Just stop thinking about it (or trying so hard) and it will happen.
3. Just relax (or you just need to take a vacation) and it will happen.
4. Unsolicited advice (have sex more/less often, lose weight, different positions, etc).
5. This is G-d’s (or nature’s) way of saying that you’re not fit for parenthood.
6. Are you sure you want to do this? Fertility treatments are dangerous!
7. You can always adopt (and the ever popular—if you adopt, you’ll get pregnant)
8. I know exactly how you feel… statements.
9. You’re so lucky that you’re not pregnant (that you don’t have kids) because… statements.

Also covered in this section is when infertile couples are not invited to children’s birthday parties.

July 26, 2006   Comments Off on Call For Help #1

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