Being told to “just relax” when you have been trying to get pregnant, much less when you are dealing with the stress of infertility and medical treatments, just isn’t very helpful and can actually be very hurtful. Although it is usually said to make you feel better, people don’t realize the impact of those words – “just relax” – or just how impossible it can be to relax when you feel like you’re failing at something as important as having a child. Being told that “if you just relax, you’ll get pregnant”, implies that you are somehow responsible for not being able to get pregnant. It suggests that if you could just get your stress under control – and get a grip – nature will take care of the rest.

The reality is that despite all the cliché comments about how easy it is to get pregnant (e.g., “I just have to hang my nightie on the bedpost and I’m pregnant”), for most people achieving a viable pregnancy takes time. And the relationship between stress and fertility is not entirely clear. For example, we know that sometimes women get pregnant during a sexual assault – and there likely isn’t a more stressful situation. On the other hand, there is some research to suggest that stress reduction techniques such as regulated breathing, meditation, and yoga can help people cope with the stress of infertility and may improve the success of IVF. Clearly the relationship between stress and the ability to achieve a pregnancy is very complex.

If you know someone who is trying to get pregnant or who is going through fertility treatments, instead of trying to comfort them by suggesting that they “just relax”, it may be a lot more helpful to provide a supportive ear and shoulder for them to talk about their feelings.

Read more about the likelihood of achieving a pregnancy here.

Read more about the relationship between chronic stress and fertility here.

Social egg freezing is when a woman chooses to have some of her eggs frozen, usually before the age of 35, for the purpose of avoiding the decline in fertility that is associated with aging. This is called social egg freezing because the process is being undertaken for personal rather than medical reasons (such as cancer treatment).  Similarly, social sperm freezing is when sperm is frozen for later use.

Sperm Freezing

Sperm freezing involves the cryopreservation (freezing) of a semen sample, usually produced by masturbation. Sperm cryopreservation has been used for over 50 years. Although frozen sperm are less sensitive to cryopreservation damage than many other cell types, the process does cause some reduction in sperm motility and fertilization capacity compared to fresh sperm (1). That said, there have probably been over 1 million babies born from frozen sperm with short- and long-term follow-up demonstrating no greater rates of abnormal development than with fresh sperm. This means social sperm freezing is a very viable form of fertility preservation. Twenty-one years is the longest length of time sperm has been successfully frozen and thawed and resulted in a healthy baby (2). There is legislation in some countries which limits the length of time sperm can be frozen for, although there is no legislation at present in Canada. Overall, producing sperm for freezing involves little risk to the man and although the fertility potential from frozen-thawed sperm is slightly less than fresh sperm, it is still a very effective way of preserving fertility in men. The costs of social sperm freezing are not currently covered by provincial health care plans in Canada, and range from $200-$500 to initially freeze a sample and then $200-$400 per year for storage.

Egg Freezing

Egg freezing is more complex. This process involves some small risks to the woman and requires more time, more treatment, and more medical monitoring than sperm freezing. It is also significantly more expense. To obtain eggs for cryopreservation (freezing) the woman has to go through ovarian stimulation (as if she were going through IVF). This involves a variety of different treatment regimens designed to stimulate the ovaries to produce multiple eggs. This stimulation carries a 1% risk of ovarian hyperstimulation syndrome – a serious complication that may necessitate hospital admission. In order to retrieve the eggs a needle is inserted into the ovaries through the vagina – this carries a small risk of pelvic infection (1/200-1/500 cases) or serious bleeding (1/5,000-1/10,000 cases) (3). Until fairly recently, egg freezing was not a viable way to preserve fertility. However, new methods of rapid egg freezing have led to the establishment of egg freezing as a more viable option for women who wish to preserve their fertility. Current cryopreservation techniques are very encouraging. However, the fertility potential from frozen-thawed eggs is still reduced compared to fresh eggs. And with under 5,000 babies born from frozen-thawed eggs, there isn’t enough long-term follow up to know if there are higher rates of congenital or developmental abnormalities with egg freezing versus spontaneously conceived pregnancies. Until there is more data, we still don’t know how effective social egg freezing is as a strategy for fertility preservation. With that in mind, it has been suggested that women should freeze their eggs before the age of 25 years (4) and certainly before the age of 35. The length of time eggs can be frozen is unknown – so far there have been no cases of pregnancy and delivery where the egg has been frozen over 10 years. Social egg freezing is not covered by provincial health plans. Costs across Canada are in the range of $6,000-$15,000 for the medical process and initial egg freezing. The costs of medication may be extra – typically in the range of $2,000-$5,000 depending on the woman’s age. Continued storage is in the range of $300-$700 per year.

References

1. Cross NL, Hanks SE. The effects of cryopreservation on human sperm acrosomes.  Human Reproduction 1991; 6: 1279-1283

2. Horne G, Atkinson AD, Pease EH, Logue JP, Brison DR, Lieberman BA. Live birth with sperm cryopreserved for 21 years prior to cancer treatment: case report. Human Reproduction 2004; 19: 1448-1449.

3. Ludwig AK, Glawatz M, Griesinger G, Diedrich K, Ludwig M. Perioperative and post-operative complications of transvaginal ultrasound-guided oocyte retrieval: prospective study of >1000 oocyte retrievals. Human Reproduction 2006; 21: 3235-40.

4. Wunder D. Social freezing in Switzerland and worldwide – a blessing for women today? Swiss Medical Weekly. 2013; 143: w13746.

Share your thoughts on Dr. Buckett’s post in the comments section below, or submit your “Ask an Expert” question here. 

Perhaps the first and most important consideration is whether you feel you can open your heart and your home to a child who is not genetically related to you. In the majority of cases if you adopt, you will be given very little information about your child’s genetic background or familial, social or medical history. You may not know whether particular traits or illnesses run in the families of your child’s birth parents or whether the birth mother was able to take good care of herself during her pregnancy. So you must ask yourself whether you can accept and live with these unknowns, and commit to the journey that is parenthood – with all its ups, downs, and uncertainties.

If you answered yes to these questions, the next important consideration will be whether to pursue a domestic (i.e., public or private) or international adoption. Research your state or province’s legal requirements and regulations regarding adoption, as well as those in the country in which you are intending to pursue adoption if you are adopting internationally. If you are single or a gay or lesbian couple, it will be important to determine in advance whether there are restrictions on your eligibility to adopt.

A home study is a common requirement for approval to adopt. This can be a time consuming and invasive process, but very important in helping you determine the type of adoption and child that would be a good fit for you and your family. Are you comfortable pursuing an open adoption (i.e., where contact is maintained with the child’s birth parents), and if so, what level of contact would you be willing to have with the birth parents? Are there certain characteristics that are important for you to see reflected in your adopted child (e.g., racial and ethnic background)? Would you be willing to adopt an older child or a child with special needs? If you already have children, how will you integrate your new child into your family?  How will you discuss the adoption with your children, your family members, and others in your life? Can you afford the costs of adoption (particularly international adoption)? These are just some of the many questions that you will need to address, if you are considering adoption.

Although the adoption process can feel overwhelming at times, there are many resources you can access to help you through your journey to becoming an adoptive parent. It can be very useful to connect with a reputable adoption agency to help you navigate the process. It can also be very helpful to connect with other parents who have adopted children in the same province, state or country from which you are hoping to adopt.

To learn more about this topic click here and here.

After dealing with the ups and downs and costs of 3 failed treatment cycles, I finally got pregnant on our fourth cycle. Cara and I were over the moon excited! We started talking names for the baby and planning our work schedules around one of us always being home during our son or daughter’s first year. But a few weeks ago I started bleeding. My doctor immediately sent me to the hospital. Cara held my hand while the doctor told us that I was having a miscarriage. Our hearts broke when we heard the news. How could this possibly be happening? After all, we had made it to the 12 week mark when things are supposed to be OK. When the doctor spoke the dreaded word miscarriage I could barely believe the words. How could this be happening to us? I wracked my brain for something I must have done to cause it – was it because I’ve been really stressed at work lately? Or was it because I ate a hamburger and fries the other day even though I usually eat pretty healthy?

The doctor reassured me that losing the baby was not because of anything I did.  He said these things sometimes just happen – that nature has a way of taking care of itself – and that they would do some tests on the fetal tissue to determine if there was something abnormal. Are you kidding me – “fetal tissue” – that was our baby he was talking about. He then went on to say that we should wait at least 3 months before trying again to get pregnant – as if losing this baby was no big deal and we could just hop back in the stirrups and try again! I couldn’t believe he could be so insensitive.

It’s been a few weeks now since we lost the baby. Despite the doctor’s assurances, I can’t help feeling like my body has failed me! I’m worried that Cara blames me too, and that she may not want to start treatment again. I’m not even sure we can afford – financially or emotionally – to do more donor IUI cycles. I know I should just talk to Cara and we’ll work through things as we always do, but losing this baby has devastated us both. The hard part is that only Cara and I know that we were pregnant. We were going to tell our parents after we made it to the 12 week mark. So we’re pretty alone in our pain. It seems kind of strange to tell my family now – “oh by the way, we were pregnant, but now we’re not.”

Although the loss feels pretty intense right now, I love Cara and know she’ll make a great mother. When we’re both ready, and it doesn’t hurt so much, I’m sure we’ll try again. Maybe we’ll get luckier next time.

Share your thoughts on Grace’s story in the comments section below, or submit your own fertility story here.

While creating a family in another country may be a positive choice for some individuals and couples, some experts warn that travelling abroad for fertility treatments may be risky – medically and legally. Although in some cases, patients travelling to other countries may experience a better quality of care than in their home country, experts express concerns about the quality and safety standards of some overseas fertility clinics, and the potential for incompetence and negligence in patient care. In addition, some clinics offer no psychological support to patients, and do not provide patients with adequate information about possible health risks resulting from fertility treatments (e.g. ovarian hyperstimulation). If you are considering going abroad for fertility treatments, it is important to check into the credibility and safety record of the clinic you are considering.

Even if patients receive a high quality of care while undergoing fertility treatments in another country, they may encounter legal difficulties after their children are born. For example, Chicago native Ellie Lavi travelled to Israel for fertility treatments, and eventually conceived twins using donated eggs and sperm. Since she held dual citizenship in both Israel and the US, Lavi resided in Israel and gave birth there. After applying for US citizenship for her daughters, she was shocked to discover that the State Department rejected the application on the grounds that Lavi could not prove that the eggs and sperm used to conceive her twins were donated by an American. Although legal experts suggest this is a rare case, it highlights the importance of familiarizing yourself with the relevant laws in the host country and in your home country specific to parental rights and citizenship issues, before deciding to seek fertility treatments abroad.

Read more about this issue here.

Read more about legal implications of fertility tourism here.

Read about one couple’s experience with creating a family with a surrogate mother living in another country here.

Zoll delayed motherhood until the age of 40 and when conception did not progress naturally, she and her husband did what many couples in their generation do: they optimistically signed up for fertility treatments. According to Zoll:

“Neither one of us was prepared for the science-fiction world we would enter – a world filled with medical promises and seduction, unknown health risks, and the bioethical quagmires of creating new life in the realm of profit-driven science.”

As she pursued more extensive treatments the beliefs Zoll had held to be true ––“that reproductive medicine had finally eclipsed Mother Nature and women really could have it all”––began to erode. Over time, she came to believe that something was seriously amiss with the information she and her generation had received from the media and the unregulated U.S. fertility industry. In her memoir Cracked Open, Zoll offers a critical consumer’s perspective of a globally expanding fertility industry.

Read more about Miriam’s personal story here.

Dr. Kompanje recently published a paper in the Scottish Medical Journal which reviews studies exploring the relationship between men’s fertility, sperm production, and the temperature of the scrotum. The available research suggests that men who wear kilts rather than pants may have better sperm quality and be more fertile. A man’s testicles apparently need to be 3 degrees Celcius lower than his body temperature in order to produce normal levels of sperm. That is why tight-fitting underwear and pants have been linked to impaired male fertility – in part because they raise the temperature around a man’s groin. That is why wearing a kilt may provide a better environment for sperm production.  According to Dr. Kompanje:

“Kilt wearing likely produces an ideal physiological scrotal environment, which in turn helps maintain normal scrotal temperature, which is known to be beneficial for robust spermotaogenesis (sperm production) and good sperm quality”.

He suggests that men may want to consider wearing kilts and avoid wearing pants during the time they are trying to conceive a child.

Read more about this issue here.

Read the study abstract here.

You are in a very difficult and painful position and I have worked with many women struggling with exactly your concern. In terms of options, you may choose to get your fertility assessed at a fertility clinic. However, this may or may not alleviate your anxiety.  If the results indicate you need to act sooner rather than later, you may still be in the difficult double bind given that you do not feel you are in a position to parent on your own and you haven’t met a suitable partner.

In terms of preparing for the possibility of not having children, I sense that your anxiety is likely about fear – fear of not having the children you have longed for and of not having the life you have imagined for yourself. I suspect at this moment, when you allow yourself to consider your future without children, you become overwhelmed with feelings of loss, grief, sadness – feelings of missing out on one of life’s great joys, feelings of not belonging with or of being left behind by friends who do have partners and children. I imagine you may feel you are disappointing your parents who desire grandchildren or you may wonder what you have done wrong that you have not been able to create a family with a significant other and children. I imagine you may doubt your ability to have a meaningful life without children and resist even considering that possibility because the pain of this reality is too great.

Generally speaking, when our lives do not proceed in the direction we imagine they will and we come to a place of great uncertainty about whether or not we will live the life we have dreamed, it is time to expand our consciousness. With great courage, compassion, and support we can face the possibility of not achieving a longed for experience. We can open ourselves to feeling our grief – we can share it with a supportive other, and we can cry, rage, and despair until the tears stop. We can allow the feelings to arise and allow them pass without the negative “story” that surrounds it, that is, without shame (what is wrong with me?), without blame (I have made bad choices), and without fearing the future (I will never be happy).

When we have cried all we can cry for now, when our hearts are a bit more open, we can start to imagine possibilities we could not have imagined when our hearts were filled with grief. Now there are possibilities – uncertainty yes, but also possibilities. Now we can open ourselves to creating a meaningful life in ways we never considered. Questions such as, what do I do with the abundance of love I have that I want to share? What can I do to make my life meaningful? What are my values about how to live a full rich life? This is what it means to expand one’s consciousness.

In your situation, some people build meaningful lives by creating relationships with other children as a special “auntie” or “godmother.” Some adopt a pet that they can love and nurture. Some decide to contribute to their community by volunteering with children, older adults, or people with disabilities. Some focus their energy on developing their creativity, intellect, spirituality, athleticism, or by learning about other cultures through travel. There are numerous ways of filling this space in meaningful ways. In addition, you do not know what the future may hold. You may meet a partner who has children for whom you can care. Even if you meet a partner when you no longer are able to conceive using your own eggs, you can bring children into your lives through adoption, egg donation, or embryo donation.

As you figure out what your life is going to look like, perhaps imagine connecting with that older woman that will be you – the older woman who is reflecting back on her life and is proud of herself because she did not allow grief to hold her back from living fully in whatever way that has meaning for her. A quote from Pema Chodron, an ordained Tibetan nun, author and teacher, whose words often inspire me when I am dealing with difficult experiences says, “When there is great disappointment, we don’t know if that is the end of the story. It may be just the beginning of a great adventure.” I strongly encourage you to reach out to someone (psychologist, trusted friend, spiritual leader) who can help guide you as you walk along this path.

Share your thoughts on Dr. Kranz’s post in the comments section below, or submit your “Ask an Expert” question here. 

However, in other cases, sperm is donated by someone known to the individual or couple – for example, a trusted acquaintance, friend, or family member. Known donations are more complex socially – in terms of whether the donor’s identity will be disclosed to the child and others, and what role, if any, the donor will have in the child’s life. They are also more complex legally – in terms of the donor’s subsequent rights and responsibilities to any offspring created through his donation. All too frequently informal arrangements are made regarding these issues – with both the donor and recipient(s) “trusting” that these informal arrangements will be honoured in the future. However, a lack of legal documentation outlining the roles and expectations following the birth of a child conceived using donor sperm can create many difficulties, for all parties involved.

A recent Canadian case highlights the importance of legally documenting clear roles and expectations following sperm donation. After agreeing to donate his sperm to a lesbian woman, an Ontario man contested their initial arrangement after the birth of the child, and filed a law suit against the lesbian woman and her partner – claiming parental rights and requesting shared custody of the child. In the end, a Justice at the Ontario Superior Court formally declared the lesbian couple as the child’s legal parents and restricted the donor from having legal paternal entitlement, or access to the child. In another recent case in the United States, a known sperm donor was later forced by the government to pay child support, when the lesbian couple to whom he donated his sperm, fell upon hard financial times and were forced to go on welfare.

If you are considering using sperm from a known donor to create your family, it is very important to consult a lawyer well in advance. You should come to a legal agreement on such important issues as the donor’s future role, access, and responsibilities to the child or children produce through his donation. It is also important to familiarize yourself with the laws in your province or state, and country, regarding these collaborative reproduction arrangements.

Read more about this issue here:

Paternity case settled out of court leaving sperm donor laws far from clear [National Post]

Read more about sperm donation here.

Read more about issues to consider when creating a family using donor sperm here and here.

Shortly after my husband and I began trying to conceive, we learned that I had endometrial cysts on my ovaries. Those were removed surgically and after another year of trying to become pregnant we decided to sign up for fertility treatments. There was such an optimistic buzz about the promise of reproductive technologies, and everyone in our immediate circle – health care providers, colleagues, family and friends ­­– optimistically encouraged us on our journey.

Despite my age and our doctor’s suggestion that we immediately try donor eggs or adoption, my husband and I plunged forward with IVF treatments. The success stories were so compelling we truly believed they would work, regardless of the odds that seemed to be stacked against us.

Like millions of people facing a diagnosis of infertility, after the first two IVF cycles failed, we sunk into some kind of psychological denial and eagerly signed up for more treatments. When the fourth cycle failed, the doctor recommended we try donor eggs. That was an extremely painful decision to make because it meant I would never birth a child I was genetically related to. I suffered enormous depression at this time, and when I somewhat recovered, my husband and I chose a 21 year old donor from a reputable agency.

Believe it or not she turned out be infertile due to a genetic disease. We then selected a second donor who was also infertile. You can imagine our devastation. Not only were we coming to terms with the unavoidable diagnosis of age-related infertility, we were also realizing that the promise of the science was far less than we had been led to believe and that there were no consumer protections in place.

It was only after I completed treatments that I began to research aspects of the industry that are not reported in the media and began to write my book, Cracked Open: Liberty, Fertility and the Pursuit of High Tech Babies (May 2013). The fact is, in the United States, there is virtually no oversight of any aspect of the industry, and few if any long-term studies tracking the health of women undergoing treatments or the babies born from them. The only requirement is the Fertility Clinic Success Rate and Certification Act of 1992­­––a “law” that loosely mandates clinics to report their annual “success rates” to the Centers for Disease Control.

In the course of my research I discovered that the vast majority of assisted reproductive technologies fail. Around the globe in 2012, approximately 1.5 million ART cycles were performed, with an estimated 1.1 million failed cycles (76.7 percent). In 2010 in the United States, the most recent data available from the Centers for Disease Control reveals that of the estimated 150,000 ART cycles conducted, approximately 103,000 (68.6 percent) failed.

It is my hope that by speaking publicly about the six failed cycles I experienced––and the physical and psychological risks and traumas that accompanied them––others will begin to speak out, as well. Generating more balanced discussions about these technologies will hopefully help people avoid involuntary childlessness due to a lack of transparency from the industry, and misinformation disseminated in the popular culture.

Miriam Zoll is the author of the new memoir,“Cracked Open: Liberty, Fertility and the Pursuit of High Tech Babies” (Interlink Books-May 2013). She is the founding co-producer of the Ms. Foundation for Women’s original Take Our Daughters To Work Day and a member of the board of Our Bodies Ourselves.