Big thank you to all of the people who wrote and told me how to create this blogroll. I always have big plans on how I’m going to use the Web, and then I sit down at the computer and realize I have no clue how to do…well…anything other than post to this blog. Thank you also to DH who sat on Bloglines for an hour this afternoon trying to figure it out while I lazed on the sofa. Lazed on the sofa? I mean, did important important important research. With my eyes closed.

Another hope we have for this blog is to make it a clearinghouse for all other blogs in order to connect newbies to those more experienced. I gained so much information on infertility from other people on the Web. I knew the right questions to ask. I knew how to be a better advocate for myself. I knew what was “normal” and what was setting off warning bells.

I have a book on infertility stories that was a fantastic resource. Reading about someone else’s experience with IUI BEFORE I had the procedure let me know what to expect. Again, which questions to ask. And a blog is a living, breathing version of that stagnant book. It’s a space that will be updated as experience continues. There is an opportunity to ask questions.

So I am slowly creating this blogroll. It will take me a while to add all of the blogs I’m already reading. One way you could make it go a lot faster is to email me with a link to your blog so I can click-and-add. You can email information about this blogroll to other IF bloggers. Also, once you’re added, if your category drastically changes (for instance, if you go from the male factor category to the pregnancy/parenting after IF category), please let us know so we can move you. As always, our email address is thetowncriers@gmail.com.

Most people will fit into more than one category. We’ve chosen one for you in order to get you on the list. If you think you fit somewhere better, let me know. Again, it would be best if you emailed me with a link to your blog.

There are lists like this out there, but as we started getting more and more hits, we realized that we could also make this space a clearinghouse for all other blogs. Especially since we’re addressing general thoughts on IF and not just our own personal journey. So if you have a great list that you think could help us put more links on this blog, send that along too.

Wheeew…

I read a lot of infertility blogs.

A lot.

Of Blogs.

There’s a lot of infertility out there. I’ve heard anywhere between 1 in 5 to 1 in 7 Americans. And what is the best way to vent and destress than to start a blog. So there are a lot of infertility blogs out there. I read other blogs too–Amalah, Dooce, Postsecret, Miss Snark…(ahem…)…Celebrity Baby Blog (mutter, mutter). Yes, I have many degrees and I’ve read every Shakespeare play. And I am a lover of People Magazine and Celebrity Baby Blog. And I can admit that. With only a bit of a blush.

Every time I read something I love, I want to send it out to everyone I know. Which is how I came to the idea to do the Friday Blog Roundup and comment publically on a few things I read this week. There is plenty that I read that also moved me, but since space is limited, I must pick-and-choose.

On a side note, I am still trying to figure out how one posts links to other blogs on the side column. Once I get that figured out, I’d love to start a list–a clearinghouse of IF blogs–so if you’d like to be included, let me know.

First off, Dead Bug (http://www.deadbugs.blogspot.com/) had a great post on Monday about Beginning Day, the transfer day for her daughter who she conceived on her second IVF. It’s the thin silver lining of IF–the ability to know the conception date of your child. Would I rather not know the date AND not have had to jab myself in my stomach with sub-cue needles? Sure. But I do love having the family holiday of Conception Day (which will, from now on, be known as Beginning Day–I love that).

Next off, Richard (http://the-end-of-my-line.blogspot.com/) has a fantastic blog overall that discusses donor insemination. We’ve been emailing back and forth. Knew literally NOTHING about the UK’s open-donor policy and it’s after effects until I started reading his blog. There is a huge shortage of sperm donors in the UK due to a new policy that does not allow donors to remain anonymous. Head over there to have your eyes opened about medicine on the other side of the Atlantic.

Carrie (http://lifeinthesoupbowl.blogspot.com/) has tons of information about egg retrieval/transfer from her procedure this week. She has an amazing story about a friendship which goes above and beyond anything between Oprah and Gayle (has Gayle ever donated an egg! Experienced shots for Oprah!). She is in the two-week-wait, so please send tons of good thoughts her way. May she only hear good news this week.

Lastly, Serenity ) is going in for a transfer next week (so channel a bit of the good energy you’re sending to Carrie her way as well). Third time IS a charm. I’ve loved reading about the Ali Domar dance this week–the deep breathing, the mindfulness, the peace. It is so hard. Lying down and NOT thinking about IF is so hard. I tried Domar’s book and it did bring me moments of peace. And moments of peace is better than nothing. If you are extremely stressed, head over to her blog and learn more about Domar’s book. And then go pick up a copy for yourself.

Hope everyone has a wonderful weekend. I’m off to harvest tomatoes from the garden. Make a salsa that will knock you out…

Diagnosis: Premature Ovarian Failure

by Hannah Wept, Sarah Laughed

What Premature Ovarian Failure Means and Its Impact on Fertility
Premature Ovarian Failure (POF) is when ovarian function ceases before age 40. It has previously been referred to as premature menopause, and this cessation of function is not considered a natural, though premature, menopause because it is happening at such an early age. POF can occur as early as the teenage years, although the average age of onset is 27. POF may be caused by a number of factors, from autoimmune disease to surgical intervention; many times, the exact cause is undetermined. While POF is probably one of the least likely diagnoses of infertility, it is estimated that between 1-4% of the female population has POF. For whatever reason, the ovaries cease to function, whether that means a loss of eggs entirely, a dysfunction of the eggs or egg production, or as a result of surgical removal of one or both ovaries. With regard to infertility, a woman carries a statistically small chance (6-8%) that she may become pregnant using her own eggs, but there has been no definitive protocol or treatment to ensure who the 6-8% will be. A woman can be diagnosed with POF and not be able to utilize or conceive with her own eggs at all, but still be in fine health to carry a donor gamete pregnancy to term.

Diagnostic Process
POF can be a particularly tricky diagnosis to obtain, as many other factors can mask the actual problem. The first most obvious symptom of POF is a lack of periods (amenorrhea), as the ovaries are not ovulating and thus, not setting the menstrual cycle into motion. Women using birth control are not necessarily at an increased risk of POF; rather, it is more difficult for women on birth control to know there are any issues with their ovarian function since the birth control replaces and simulates naturally occurring ovarian hormones. Typically, a need for diagnostics occurs when a woman ceases birth control only to find that her periods are not returning. Other symptoms may include those found with naturally occurring menopause later in life: hot flashes, night sweats, insomnia, and/or vaginal dryness. The biggest challenge many women face in trying to obtain a diagnosis is being told that their symptoms are stress-related and may require persistent, informed advocacy on the part of the patient.

Blood work is often the first step, specifically measuring the following hormonal levels: estradiol (estrogen), FSH (follicle stimulating hormone), LH (lutenizing hormone). (A thyroid function workup may also be performed at the same time, depending on your prior thyroid function history.) Very high FSH values (above above 40 mlU/ml) usually indicate POF; most doctors will perform a second round testing these same hormones in one month to confirm that the initial tests were not a fluke. If FSH values remain the same or higher, a diagnosis of POF is usually confirmed at this point. Doctors will then try to determine the cause: autoimmune diseases producing anti-thyroid (Graves’, Hashimoto’s) or anti-adrenal (Addison’s) antibodies often result in creating anti-ovarian antibodies thus inducing POF. Other autoimmune diseases such as lupus and rheumatoid arthritis have also been linked to POF. Blood tests to measure the presence of these antibodies may be performed. Genetic testing (karyotyping) may also be performed to determine if there is a genetic cause to the disease.

Treatment Options
POF carries health risks beyond infertility, as the body is depleted of vital hormones that are normally present until age 40 or the onset of natural menopause. Younger women with POF often begin some kind of hormone replacement therapy (HRT) to supplement the hormones lost, although each woman should discuss and work with their doctor accordingly to determine what type of and if HRT is the safest choice for them. Increasing calcium intake and doing weight-bearing exercises on a regular basis help to prevent osteoporosis, as women with POF are at an increased risk for both osteoporosis and heart disease.

With regard to infertility, ovarian stimulating drugs have little effect on women with POF to encourage their ovaries to produce their own eggs. There is anecdotal evidence (less than 1%) to suggest that some women may be able to stim their ovaries using a round of recombinant FSH injections or even by taking birth control pills for 6 months and then stopping them suddenly. However, these are dicey gambles at best- expensive, emotional failures at worst (with particular regard to pricey Follistim or Gonal-F injections). Women diagnosed with POF are often told to seek the use of donor egg with IVF or to consider family building through adoption. As a diagnosis of POF essentially precludes the possibility being able to conceive one’s own genetic child, women and couples coping with this diagnosis often face extreme grief not unlike the death of a spouse or close loved one. Individual and couples’ counseling can thus be a vital compliment to the diagnostic and treatment process.

Personal Experience
When I was 18, I had my left ovary removed in an emergency surgery for a torsioned ovarian cyst that killed my ovary. I was on birth control pills from that point on, and experienced regular the periods that are associated with taking the pill. My periods suddenly stopped for 7 months when I was 25, but my doctor assured me it was stress and put me on a higher dosage of birth control pills. After stopping birth control pills for a neurological migraine contraindication when I was 26, my periods did not return for 3 months. I went to my doctor, who again told me it was stress, but referred me to the reproductive endocrinologist in their practice for follow up. I was diagnosed with POF at age 26 after two high FSH tests and almost no estrogen. My POF is caused by an autoimmune thyroid disorder (Hashimoto’s). At present, I have not begun HRT as my thyroid function needs to be stabilized before going on HRT (as my thryoid medication will have to be adjusted again once I begin the HRT). I have been informed that my best chances at children will be to pursue donor egg/IVF or adoption, as I have little hope to ever producing my own genetic children. Emotionally, this has been a rollercoaster for my husband and me. I have felt everything from a crisis of faith to panic, despair, and deep grieving. Essentially, I’m grieving for the genetic child of me and my husband that will never exist, and it’s a daily process to navigate emotionally, as every little thing can be its own landmine. For now, I’m working on getting my thyroid stabilized and keeping in general good health to prevent further health complications related to POF, and my husband and I are actively investigating the best options to build our family.

Kids just know. They smell infertility on you–it’s like they have babedar. Thirty adults in the room and they’ll make a bee-line for the infertile woman. Cling to her leg. Stare up at her with those big eyes. I once was throwing a dinner party. We were having cocktails and I was sitting on the floor because we’re too cheap to buy more chairs. A friend’s daughter crawled into my lap and said, “let’s pretend you’re my mommy!” Excuse me, little girl, but you sort of have your knee exactly on one of my stomach bruises from the Follistim while you twist that dagger into my heart. If you wouldn’t mind scooting it a bit to the left…

My niece once made me watch the “Baby Mine” scene in Dumbo three times in a row with her. It’s like she had caught a whiff of something and couldn’t quite put her finger on it. But it certainly clicked on our third viewing when she started asking, “don’t you want a baby? Don’t you want a baby to love and hold? Don’t you want a baby, Aunt Rissa?”

FOR THE LOVE OF G-D!

I was staying with them and my sister went to work, leaving me at home to play with her daughter. In the middle of a game of dress-up, my niece asked if she could call me Mama. I told her that she already had a Mommy and that I was her aunt. She kept asking why she couldn’t have an extra Mama; why I couldn’t be that Mama. I mean, come on, Aunt Rissa, it’s not like you have children.

Or anything.

After my final “no,” she responded with an exasperated: “well, can I call you Mama Bird?”

How do you answer that? It didn’t feel right, but yet I couldn’t put into words why (1) that still wasn’t appropriate and (2) why I couldn’t even handle the concept of motherhood in another species. She had worn me down to a nub with her questions, obviously fueled by her babedar. I caved. I became Mama Bird for the rest of the day.

She laughs when I tell her these stories now. She’s six. She seems to have lost a bit of her babedar. Maybe it’s one of those senses that dulls as you age–sort of like smell.

But my daughter yesterday took over the job. She spent the afternoon reminding me: “no baby in Mommy’s belly.” I hear you, sweetheart. Loud and clear. I’m infertile! I’m barren! Thank you for reminding me! Okay! Please stop! “No baby. No baby. Mommy’s belly? No. No baby in Mommy’s belly.”

Is it an evolutionary survival instinct? Drive women crazy and they’ll be too depressed to continue trying to reproduce, therefore leaving more food for the exisiting children? Seriously, where are the social scientists to study this phenomenon?

During our weekly trek to the organic supermarket (doesn’t that sound so left wing? Organic supermarket? Just wait, it gets better…), I ended up with a copy of Mother Jones in my basket. I am not normally a reader of Mother Jones—even as a liberal I don’t like agreeing points-of-view spoon-fed to me. But this month’s issue promised “Icebox Orphans & Fertility Gods: the hot war over frozen embryos / who’s going to thaw out 500,000 ‘microscopic Americans’ / love, politics, and the perils of high-tech baby-making.” It had the accompanying visual of plastic babies encased in an ice cube tray. Do you honestly think I’m going to be able to pay for my organic yogurt without picking up an issue? Mother Jones is banking on the 1 in 7 Americans experiencing infertility.

I’ve only read one of the articles so far—“Breeder Reaction” by Elizabeth Weil, which chronicles the lawsuit brought by a lesbian couple against a fertility clinic that refused to serve them as well as addressing the larger questions of regulations, insurance, and big government. The couple had been trying for two years to become pregnant using donor sperm. When they weren’t successful, they turned to an RE who refused to serve them because she said it was against her religious beliefs. The couple ultimately sought the help of another clinic and successfully had two pregnancies. But the question remains whether fertility doctors are the best judges of who is “fit” to become a parent.

The statistics are staggering. Only 59% of fertility clinic directors agreed that everyone should have the right to have a child. Who do the other 41% believe are not fit for parenthood? Strangely, “44% believe that fertility doctors don’t have the right to decide who is a fit parent.” Shouldn’t that number be closer to 59%?

The article raised interesting questions, many of which I couldn’t comfortably answer with rational words though I knew how strongly I felt about these topics with my heart. Should infertility be diagnosed as a “medical problem?” Would it save money in the long run if government regulated fertility treatments but also forced insurance to pay for the procedures? The article covered concepts such as fertility tourism and the RE as a businessperson.

In the end, the question I kept returning to was the idea of regulations. We all know that it can be a slippery slope when government gets involved in deciding things as intimate as reproduction. But what if there were simple regulations in place—mandatory single embryo transfer is the one mentioned in the article as a regulation in place in other countries—in exchange for mandatory coverage? What regulations would you be willing to live with? What about age cut-offs? What about marriage? In reality, the article points out, these regulations exist today—they aren’t dictated by the government, but are instead the policies of fertility clinics. Therefore, one fertility clinic may be willing to help you and another is not.

So the question of the day: would you be willing to accept government regulations on fertility treatments in exchange for coverage and what are your limits with government regulations?

The answers will obviously reflect to some extent your own situation. Why would I put regulations in place that limit my own procreation? But…then…I ask our government, why would you put those limits (that you don’t want on yourself) on someone else? Don’t we still have a Golden Rule in place somewhere? A little tarnished? Can’t we polish it up? And not to be a buzz kill, but Mother Jones states in the same issue that “mining the gold to make one 1/3-ounce 18-karat ring produces at least 20 tons of waste” therefore, we may want to recreate the Golden Rule in a different metal.

Back to Mother Jones and their next article about frozen embryos. What a way to spend my afternoon…