Come Meet Dr. Bankowski in San Francisco !!

Hey kids - This just off the presses!

Dr. Brandon Bankowski, a board certified reproductive endocrinologist at Oregon
Reprouctive Medicine, will be in San Francisco, CA meeting with prospective patients on October 7th and 8th, 2012.

Private and complimentary consultations are being scheduled now.

Sunday, October 7, 2 p.m. - 6 p.m.
Monday, October 8, 9 a.m - 4:30 p.m.
Sir Francis Drake Hotel
Private Conference Room
450 Powell st.
San Francisco, CA 94102

These appointments are filled on a first-come-first-served basis.

Bring your questions and discuss your options with one of the leading physicians working in the field of infertility.

Request an appointment by email or phone.

Jonathan Kipp, schedulerjkipp@portlandivf.net
503-243-4938

SART Statistics are just spring board – a place to start

With the SART statistics recently published there’s been lots of rumblings about some of our beloved clinics and their success rates taking a hit for 2010. I think before we become too concerned about our clinics and their success rates we need to remember the following:
• No two treatment programs are alike; each clinic has its own set of statistics (success rates), protocols, and procedures.
• SART and CDC success reports are always two years behind. For instance at the time of this writing it’s February 2012, and SART’s reports are for 2010. That means that the success rates you are reading for 2010 may not be at all reflective upon current success rates for that specific clinic.
• Becoming familiar with SART and CDC statistics in instrumental to choosing a treatment program. They are a great place to start and can help you narrow your choice of potential clinics.
• While doing your research, keep in mind that statistics are going to fluctuate from year to year for many reasons. That’s why it’s really important to look for success rate trends: Is a clinic generally improving its success rates each year? Are they maintaining and/or growing the number of (DE) cycles they complete each year? Do the statistics illustrate an overall consistency of success?
• The SART success rates for each clinic report a “live birth rate” or what we refer to as a take home baby rate. Some feel this isn’t entirely fair on the part of the infertility clinic because once your Reproductive Endocrinologist releases you to your OBGYN/Perinatologist they have no control over your pregnancy and cease to monitor your pregnancy or its care.
What I am learning is that sometimes it’s virtually impossible to compare clinics and SART rates. Why?
• Some clinics for instance are under one company name but have clinics in different places and they don’t all use the same lab but SART will gather their statistics and lump them into one big fat statistic.
• Individual doctors are listed by success rate – which I think they should be.
• And SART reports on live birth rates, or take home baby rates which I think is unfair. Your clinic should be rated on initial pregnancy or pregnancy to heart beat as measured on ultrasound, not live birth rate. From week 12 to week 40 there’s a lot that can happen and after the first trimester your pregnancy is out of your clinics hands.
So with all this being said – sure start with statistics. But make sure to do your homework and call the clinic you are interested in being treated at. Ask tons of questions – “Are your success rates based on single DE IVF cycles, or are your success rates based on three attempts at your clinic”. Ask about their FET policies. Does the clinic return emails or phone calls in a prompt and timely manner? Is their staff kind and courteous and accurate in the information they relay to you?

It’s not just about the statistics – it’s about the whole package.

Good luck on your DE journey!

Embryo Donation International Has Finally ARRIVED!!!

This is big news and something PVED is very very excited about!


Embryo Donation International (EDI), one of the few, non-faith-based, non-discriminatory embryo donation facilities in the United States, officially opened today to provide cost-effective embryo donation options to people around the globe desiring to build a family.    This program is based out of Fort Myers, Florida and was founded by Dr. Craig R. Sweet in 2011 as an expansion of their 10 year-old embryo donation program (sometimes incorrectly referred to as embryo adoption), they are one of the most experienced and cost-effective embryo donation centers in the United States.

EDI's dedicated mission is to reduce the number of frozen embryos abandoned or discarded by matching embryos to patients in need regardless of race, religion, ancestry, sexual preference or marital status.  EDI is a subdivision of Specialists In Reproductive Medicine & Surgery, P.A. (SRMS), which has been providing embryo donation for 10 years as well as compassionate reproductive endocrine and infertility care for over 20 years.

"Our first public discussion on this sensitive topic took place during the week after '9-11' in 2001," said Dr. Craig R. Sweet, EDI Founder, Medical Director and board certified physician in Reproductive Endocrinology and Infertility. "When so many lives were lost, we spoke about the unclaimed potential life held in cryopreservation within our practice due to abandonment. Today's announcement is the result of our passionate advocacy for pairing frozen embryos with patients in need based on EDI's ethical values of nondiscrimination and our core belief that embryos deserve a heightened level of respect and should not be abandoned or discarded."

In 2003, the nonprofit research institution RAND estimated there were at least 400,000 embryos cryopreserved in the United States (Fertility & Sterility, May 2003, Vol. 79, No. 5). EDI's goal is to encourage patients to use their embryos to expand their own families but otherwise consider embryo donation rather than abandonment or discarding them.

For more information about the company's history, philosophy, services and devoted staff, you can contact Dr. Sweet at 800.334.2184, 239.275.5728 or visit www.EmbryoDonation.com.

Surrogacy Shopping After 40

This article was originally featured at Flower Power Mom's site and it was so good I had to re-run it here.  And a little about "Flower Power Mom" Angel La Liberte.  

Against the odds and well into her forties, Angel La Liberte, conceived and gave birth to two healthy children (in 2002 and 2005) without the aid of medical fertility treatments.  Unwittingly, she was soon drawn into the rising international cause célèbre in the baby-making stakes—the fast-growing population of ‘mid-life moms’.


While Angel herself isn't a mom via egg donation, she sure celebrates, empowers and supports every woman regardless of age but especially 40 and beyond when it comes to motherhood!  Which is why PVED LOVES HER!

Angel launched a national awareness campaign—Celebrating Motherhood After 40—to help relieve stigma faced by “older” mothers.

The campaign message was widely featured in US media—Angel participated in a live national debate on CNN, interviewed on radio programs, including WINS 1010 in NYC, and was quoted key newspapers such as the Minnesota Times and Baltimore Sun.

She now writes a monthly column for Bay Area Parent—part of the www.parenthood.com organization—on parenting after 40.

This article features PVED board advisor Sharon LaMothe, who works tirelessly in the field of Third Party Reproduction  with more than a decade working in the infertility community, and serving as an advisor to organizations like Parents Via Egg Donation (PVED) and OBGYN.net Women’s Health Forum.

Motherhood through surrogacy is not ‘all smoke and mirrors’—an impression that sensational media coverage of celebrity diva-moms like Nicole Kidman or Sarah Jessica Parker might convey.


According to WA state surrogacy consultant, Sharon LaMothe—a gestational carrier twice over who gave birth a second time at 41—“surrogacy is not out of reach” for the average gal next door.

But, for women over 40, there may be an added ‘caveat emptor’ when choosing a fertility clinic.
LaMothe—with more than a decade working in the infertility community, and serving as an advisor to organizations like Parents Via Egg Donation (PVED) and OBGYN.net Women’s Health Forum—says “a lot can go wrong” with surrogacy agreements.

Women thinking about becoming a parent through a surrogate should “ask a lot of questions” and not “run into it blindly.”

“The old adage ‘you don’t know what you don’t know’ is very true in the case of surrogacy arrangements,” says LaMothe, who says the majority of her female clients are over 40.

First, ‘commercial surrogacy’ is not legal in many states across the USA (including Washington) and the “intended parent” must have a medical reason for using a surrogate in states where it is.

“Age can be a big factor, but so is cancer, hysterectomy, and diseases like diabetes, and single women or same-sex couples.”

LaMothe, whose work involves educating and assisting intended parents and their surrogates, knows the “do’s and don’ts” on their path to parenthood.

While “the list is a mile long,” there are some key issues not to play around with.

“Do not download sample surrogacy contracts from the internet,” she warns.

LaMothe urges that both the intended parent and the surrogate are better off hiring an attorney experienced in reproductive law.

“Make sure that all parties attend at least one session with a mental health service provider who is experienced in surrogacy evaluations,” she continues.

And to avoid the risk of things getting ugly over money, “use an escrow account for disbursements.”

When shopping for a fertility clinic, LaMothe advises her clients to look carefully at the clinic’s “take home baby” statistics, compared to their rate of successful pregnancies.

While conceiving is great; a failed pregnancy is a disappointment to everyone.

And this is where fertility clinic selection can get sticky for a woman of 40 or over—as in a recent FPM blog article—who wishes to conceive with her own eggs.

“Once you hit that magic 4-Oh, your eggs are not as viable as those of a younger woman,” says LaMothe.
“Some fertility clinics may discourage women over 40 from using their own eggs because they are concerned about their ‘take-home baby’ statistics,” she admits.

In these cases, says LaMothe, a woman of 40+ may have her “opportunity to .choose” her own eggs “taken away.”

There are other clinics who are more inclined to work women over 40 and it’s important to find a provider who is a good fit.

Once the surrogate is chosen, the pregnancy and birth can only take place in a state that allows surrogacy arrangements.
“Once the surrogate mother has passed stringent exams including a mental health evaluation,” says LaMothe, “she and the intended parents sign a legal agreement.”

The fertility clinic then places the surrogate and the intended mother or egg donor on a schedule that includes medicals, blood tests and ultrasounds.

The embryo transfer to the surrogate usually takes place about 3 to 5 days after the egg retrieval.
Two weeks after the transfer, the surrogate will have her blood drawn to see if she’s pregnant. Most contracts allow for up to 3 IVF attempts.

If an ultrasound taken 4-6 weeks after embryo transfer shows a baby’s heartbeat, the pregnancy is “confirmed.”

Approximately 10-12 weeks after the transfer, the surrogate mother is then released to the care of her OBGYN or midwife.

Of course, there are the common concerns of the expectant mother developing an attachment to the unborn baby.

LaMothe, who was a gestational carrier (meaning no biological relation to the child) twice says that she “did not have the same feelings” she had while carrying her own two children.

“Women who want to be surrogates,” she continues, “already have a family of their own.”

“There is compensation involved, but giving the gift of life via surrogacy is a very personal and life-changing experience.”

“Not everyone can be a surrogate,” she adds.

Given the virtual obstacle course of decision making, LaMothe’s advice is practical.

“Deciphering all of the surrogacy programs, laws and relationship concerns can be overwhelming.”

“Do your homework and, if you become overwhelmed, hire a consultant who can take away the stress of figuring out how the whole thing works.”

Notes for this blog:
Angel La Liberte is the founder of the website Flower Power Mom—The Truth About Motherhood After 40 (www.flowerpowermom.com), a regular blog featuring news, commentary, real mom stories and expert advice about motherhood after 40.
Sharon LaMothe’s websites, blogs and services:
Infertility Answers, Inc.
http://infertilityanswers.org/
LaMothe Services, LLC
http://lamotheservices.com/
LaMothe Surrogacy Consulting
http://lamothesurrogacyconsulting.com
Sharon LaMothe’s 3 blogs:
The Business of A.R.T.
http://theagencyangle.blogspot.com
Surrogacy 101~Learn more about Third Party Family Building
http://surrogacy101.blogspot.com
http://infertilityanswers.typepad.com/surrogacy

Radical Acceptance

What the heck is radical acceptance? Well, I heard the term in my therapist’s office as we were talking about grief. Even though my child is going to be turning 10 this year I sometimes have a tough time with the fact that I am never going to have another child – that I am done reproducing. My reproductive life is over as I know it. And sometimes that’s a tough pill for me to swallow.

Radical acceptance is accepting life on life’s terms – and learning to find effective ways to cope with whatever is going on with your life at that moment. It doesn’t mean you have to like what’s happening, or that you need to be passive, roll over, and not change the situation. But it’s about accepting “what is” – and with that the understanding that “you” and you alone have the power to change things, or the power of choice. Radical means simply “complete and total” It happens when you truly accept something from deep down inside of yourself – from the depths of your soul. It happened for me when I accepted my diagnosis in my mind, my body and my heart. It was then it was total and complete.

I chose to learn about radical acceptance and choose to practice radical acceptance because it’s amazingly effective at easing stress, or depression, and it really does wonderful things towards enhancing the quality of my life.

So how do we get “there” – to a place that we can radically accept what’s happening to us in our lives and still be happy you might be asking yourself.

I know for a fact that everyone experiences something extraordinarily painful at one time or another in their life.

For those of us who have received the diagnosis of diminished ovarian reserve or premature ovarian failure the idea that we will never ever have a child from our own genetics is simply devastating. The number of painful things that can happen to us in our lives is endless but the responses to that pain aren’t endless. So, after really listening and learning about pain I realized that there are only four things I can do when painful issues crop up in my life.

I can try and solve the problem by either remedying it, or ending the painful event, or maybe even leaving the situation that’s painful. This is the first thing I can do is solving the problem.

The second thing I could do would be to try to change how I feel about what’s happening and take that negative feeling and make it into a positive. You know, turn that frown upside down. So, that’s the second thing I could do.

My third option is accepting the problem. Just accept it. It happened, and accept it.

My last option of course is to stay absolutely miserable. So here you see you have four things you can do – solve the problem, change how you feel about the problem, accept the problem, or stay completely miserable.

The idea of “accepting” a problem was so foreign to me because I grew up with the mentality that accepting a problem meant I had to like it, and I could never change the situation.

Wow – was I wrong.

What I learned was something called “Reality Acceptance Skills” – there are three of them – radical acceptance, something called turning the mind, and then of course willingness.

Let’s go back to when we all received our original diagnosis. That would qualify in my book as a time when we all felt and faced a really serious problem coupled with an intense or serious pain. This is something of course that made us incredibly unhappy and it wasn’t something that we could change.

I admit when I first received my diagnosis I was miserable. Oh my gosh was I miserable. And then through many counseling sessions I accepted the reality that I had experienced many many miscarriages, that I was an infertility patient, and I had Premature Ovarian Failure. During those counseling sessions it was then I realized and accepted my diagnosis and realized if I really wanted to become a mother that it was going to be without my genetics and through egg donation.

It was then I figured out a way to accept the reality of my own life. I didn’t want to be miserable anymore.

And so I have learned about and practice radical acceptance.

When I learned to radically accept my diagnosis I stopped fighting it. I stopped fighting with reality.

Does this mean that life has been a cake walk since?

No not at all – it’s something I work on every.single.day with many different things – not just infertility.  Radical acceptance is something that is inside each and every one of us – it goes on deep inside of us. We’ve all done it with different things in our lives. If you really think about this you will find some place in your life when something has happened in your life that you have just plainly accepted, whether you liked it or not, whether it was painful or not—and you have just accepted the situation. That’s what radical acceptance is. It’s letting go of that struggle and fight. Often when we accept we feel released, empowered and centered. It doesn’t mean that you won’t have sadness or grief. When we accept things we often have lots of sadness, but even with sadness we can feel that release. And when we accept we are ready to move on with our lives.

That’s what happens to many of us when we take that next step towards egg donation. We have radically accepted the fact that we will not have a child with our own genetics and in doing so freed ourselves to move on to explore another avenue of building our family.

I hear a lot – “I am stuck, I can’t move on, I am suffering.” We know that pain is pain. Pure and simple. If we add non-acceptance we then move into agony or the suffering mode. Radical acceptance truly changed suffering into ordinary pain. Pain we can actually work with and work through.

“There’s three parts to radical acceptance and the first part is accepting that reality is what it is. The second part is accepting that the event or situation causing you pain has a cause. The third part is accepting life can be worth living even with painful events in it.” (Dr. Marsha Linehad)

When we accept that every event and every situation has a cause we then stop saying “why me”

The best part about radical acceptance is that it’s helped me become a better parent, wife, friend, sister, and person – I have learned that acceptance is all about the word yes. It’s yes to the moment, to reality and to just what is.

I am not suggesting that radical acceptance is going to make your ovaries produce eggs, or fix your lining, or remove polyps, fibroids, or find you an extra 35k lying around to have a donor cycle. What I am saying is that radical acceptance will help you with the grieving process or whatever else is going on in your life – and if you let it, it will help you to free yourself and move on with your life however that may be.

Who Are The Infertile?

I read this week another sensationalism piece about egg donation. It's clear the author didn't do his homework (is that a surprise?), had he done his homework and actually talked to real patients who undergo treatment through egg donation he might have written an entirely different article.

Articles like the one above used to really make me angry but now my reaction is a roll of the eyes as I mutter "whatever" under my breath as I go on about my day. To be honest, I am not sure which is worse and less productive -- being angry or apathetic. Regardless it's clear the media doesn't have a clear idea who we are, what we endure, or what we want. And so they just write whatever to sell papers, articles, and advertising.

The industry is partly to blame because they really don't know who we are, what we endure, or what as patients we need or want. If you look at RESOLVE the faces on resolve are so serious and somewhat sad. Then there is ASRM -- most of what you see on ASRM's site mostly revolves around menopausal women -- and then add The American Fertility Association into the mix, as well as INCIID, and even PVED, and you now have four other organizations all representing different things.

Now that in itself isn't a bad thing -- I think different organizations portraying different types of patients are clearly showing that infertility doesn't affect just one group of people, we are a huge melting pot after all, and infertility is an equal opportunity disease. What I am meaning is that the message coming from each of these organizations isn't the same -- and I feel strongly that we as a collective need to have a summit of sorts and agree on one core message that we are wanting to say and then say it. A launching pad of sorts I guess.

I had this really great discussion with Dr. Evelina Sterling, PhD about the above article and other sensationalistic articles and books about infertility that have been written over the past two - three years and Dr. Sterling reminded me what the Breast Cancer folks did regarding their message.

The media had covered Breast Cancer for years and the message they portrayed was horrible. It was negative, down trodden, sad, and for the longest time if you uttered the words "breast cancer" the immediate thought was "death sentence". The Breast Cancer folks decided they'd had enough and banded together to present a unified message of who their patients were, what treatment options there were, that breast cancer was not an automatic death sentence, that patients due survive and they survive quite nicely and often come back strong, and sometimes stronger than before. They made an effort to develop relationships with the media to get their message out. And now that message is out and the stuff we now see in the media about Breast Cancer is what? Positive, strong, empowering, educational. It's not sensationalism at all. And why?

Because it's not tolerated, that's why.

And the same should be said and done for those of us struggling with infertility. We need to band together and say "Okay, we are no longer to buy into or ascribe to the ridiculous pieces the media chooses to write because the media is ill informed. We are going to educate the media so they really know what they write about. We are going to form relationships with the media and help them learn about what we go through. And then and only then will we be represented fairly."

Being a parent is not a luxury

This whole healthcare reform bill has my knickers in a knot. Why? Because there are so many unknowns. It's not just about everyone have health care insurance and having the ability to go to the doctor (which is a good thing) -- it's about what's going to be affected.

In examining the bill there is nothing in the bill regarding the coverage of infertility. One benefit of the universal healthcare plan is that insurance companies cannot deny coverage to couples who suffer from infertility because it was deemed a pre-existing condition. However, in terms of covering infertility treatments or in-vitro fertilization, none of that is made mandatory under the bill for insurance companies.

So where does this leave us? In the same exact place as we were before. Some states cover infertility as it's a state mandate while the majority of the others do not cover infertility, IVF and what not.

This totally fries me. Why? Because having a child is NOT a luxury. I am so tired of Reproductive Endocrinology being compared to cosmetic surgery. There's a huge difference. Having a child is not the same breast augmentation, tummy tucks, face lifts, or Botox injections. It's about getting the help our bodies need to do something we should be able to do naturally. Even if it's something that's elective and we choose to do.

I can't tell you how many conversations I have had with individuals who don't understand or get what egg donation is all about who are more than happy to tell me they think that we "Mom's over the age of 40 who are contemplating having children should realize this is totally a luxury much like cosmetic dentistry or cosmetic surgery.

"Why don't you just adopt" or "Why don't you become a foster parent?" "There are worst things in the world than being childless, send money to a child overseas."

Ugh!

Infertility is a disease just like Diabetes, Coronary Artery disease, Cancer, or Rheumatoid Arthritis. We would never ever deny a diabetic insulin, a heart patient cardiac medicine, a cancer patient chemo, or an arthritis patient medication. We would treat these patients appropriately and partner with them regarding their care.

Why can't the same be said for infertility? Why is infertility treated as the red-headed step-child? And how is having a child even remotely considered a luxury? I recognize that we have the Bobbi McCaughey's, Kate Gosselin's, and the Nadya Suleman's of the world who have had high order multiples. I recognize that having that many babies all at one time is not always the best choice in the world. But ask these mothers if they were to do it all over again what they would do and they are going to tell you they couldn't imagine their life without the children they bore and they'd do the same thing all over again.

I will be the first to tell you that the solutions to the health care issues we have in the USA are not easy. I am not even sure myself what they would be -- but I do know that it would be nice just for once if we the infertile could be cut a break for once, receive some help without having to be for it and most importantly have our infertility recognized for what it is. It's not something we have caused through diet, lack of exercise, too much exercise, eating too much bacon, or having one too many martini's. Infertility is generally a genetic thing that affects 6 million individuals in the USA every year. So this isn't something that's only affecting a "handful" of individuals each and every year. This is affecting oodles of people each and every year.

Now I realize that the infertility industry is a billion dollar a year industry. Everyone wants a piece of the pie. I have even had conversations with others in the industry who say that RE's really don't want a cure for infertility because it would take away from their bottom line.

I could approach this two ways. I could be appalled at the very idea that RE's would really feel this way or I could have the attitude of - "Okay everyone needs to make a living, if they can help me have a child then I am thankful for the technology." However, if my fellow diabetics and cancer patients are receiving help from their insurance companies (which they should) to help pay for treatment for their disease why can't we?

I am here to tell you - being a parent is not a luxury I don't care what anyone says.

Infertility, Sex and a Healthier You…..

Pamela Madsen, one of the nation's most outspoken and recognized fertility educators and patient advocates, is bringing her 20-plus years of experience into the service of East Coast Fertility. As East Coast Fertility’s new Director of Public Education, Ms. Madsen is reaching out to women-- and men—to integrate infertility prevention, protection and treatment into the general health care continuum.

From sexuality to conception, Ms. Madsen is picking up the threads of the national dialog she began as the founder and first Executive Director of the American Fertility Association, a national patient education and advocacy organization. Over the last two decades, Ms. Madsen has helped shatter the myths and taboos that surrounded fertility, infertility and its treatments. She has been one of the leading voices for full reproductive rights for everyone regardless of marital status or sexual preference. She has made the biological clock, one of the most poorly understood aspects of reproductive life, a key element in her unique approach to fertility preservation education.

Ms. Madsen forcefully represented patient views before major state and federal government agencies, including the President's Council on Bioethics, to move policy toward universal access to fertility care, mandated insurance and fertility preservation information.

This is another one of Ms. Madsens outstanding commentaries.

Sometimes sexperts give really stupid and meaningless advice that someone thinks looks good on paper - but we all know it is a complete line of bullshit. Take this response to an infertility and sexuality patient question on the new and fabulous Sex & a Healthier You website brought to us by The Association of Reproductive Health Professionals.

This patient shared that after months of trying to conceive a child that there was simply no passion or spark left to their sex life. No kidding? Been there - done that, got the tee shirt and wore it out. This is not a new complaint among those trying to conceive - in fact this sorry state of sexual disconnection, body image issues compounded by infertility plus the stress and pressure of having to perform on command is the bane of existence for most of the trying to conceive population. And it is the most ignored at fertility centers. Sex can make people uncomfortable - in case you didn’t know.

Part of the advice that was offered was to “First, take a break from trying to get pregnant. Take two or three months off—that won’t make much difference in the long run, and it could do wonders for your marriage. During that time, schedule a vacation. If money is tight, the “vacation” could be to a friend’s weekend house or even just a couple of days in a local hotel—anything to get into a new environment with no reminders of fertility issues. Or, have a “staycation”—take time off, stay at home and simply enjoy the time alone with your partner”.

Hmmmm…….really? Take a vacation from your infertility? Are people with cancer able to take a vacation from their cancer? Does this sexpert really believe that people are able to turn off a life crisis? And even if we were able to - is there any reality at all that two or three months of some kind of mental and physical vacation from infertility could possibly repair the damage caused by infertility enough to turn folks back into sex kittens? I truly doubt it. It took me years and I am as resilient as they come.

Sexuality and Infertility are especially difficult because the two are intertwined. Pat answers about vacations and bubble baths don’t even begin to touch the surface for recovery.

For women turning off infertility is especially difficult since they have a direct physical tie to their sexuality and infertility all in one when they bleed on a monthly basis. There is no vacation from that. There is no vacation from the time pressure or the urgency. For many couples putting off conception for two or three months is a very big deal. And no….I don’t think that having sex in different rooms - or positions is going to help very much either.

So…what do I think? I think that the most important message of all to communicate to infertility patients is that what they are feeling is perfectly normal. That’s it. The big advice! You are not alone.

It is so important for people to know that they are not alone in their disconnect from sexual pleasure and their lack of desire for physical intimacy during this time. Simply knowing that they are not broken as sexual beings when they are feeling like failures in their ability to reproduce can be incredibly healing all by itself.

By giving this message, there is an acknowledgment of normalcy when this couple is feeling incredibly not normal and broken in the most intimate part of their marriage - reproduction.

This is a really hard time for them. Acknowledge it deeply - and let them know again and again that what they are feeling is normal.

I think that the best advice after letting couple know that they are completely not alone in their feelings is to simply encourage couples to spend time holding each other.

Offering each other physical comfort by cuddling, holding, hugging, and offering each other massage can go a long way in helping couples reconnect to each other. Encouraging individuals who are struggling with infertility to make time to get regular body work in the form of massages can also help people who are struggling with infertility. Massage not only reduces stress - but it feels good! Getting physical reminders that our bodies can give us pleasure is so important when we are going through so much physical and emotional discomfort.

Massage therapy reminds us that our bodies can give us pleasure, and can help us to reconnect to our own physical selves in a loving way. When people are going through a tremendous amount of physical discomfort they can forget that our bodies can also be a source of pleasure.

I often shudder when I read advice to couples about sexuality. Perhaps it is because the sexperts feel like they have to be politically correct or too careful in the loaded world of sexuality. We all want to talk about sex - yet it all still makes us nervous. So “vacations”, and “try sex on the kitchen table” comes up a lot in advice columns. I wish that we could get more real sometimes - and say what is so.

It’s really hard to want sex for anybody when your sexual organs are being prodded and poked. When you have to give sperm samples. When you have to face your body shifting shape every month because of fertility drugs. When you core sexuality is deeply associated with your femaleness and maleness - and it is not working! So let’s say it - it is hard and it is normal - and you may feel broken and exhausted. But you are not sexually broken - you are simply done in - and what you are feeling is normal. Forgive yourself, forgive your body and forgive your partner. Perhaps that is the best gift you can give your sexuality and your marriage.

For us “experts” - giving permission to couples not to want sex can also be really healing - and in a time when there are no easy answers - it certainly feels more real.