Spring, a time for celebrating Mothers and Fathers, can be a particularly difficult time for infertility patients. Because dealing with these two holidays can be a challenge, I have some suggestions for ways to develop some good coping skills. To cope is to “develop the ability to manage in a difficult situation.”

Here are a few suggestions:

1. Give up any and all feelings of guilt for how you are feeling! There is no right or wrong way to experience Mother or Father’s Day.
2. Know your limits and stick with them. If attending a family gathering is too painful, then don’t. You can still write a caring letter to your parent letting them know how you feel about them. If you do feel comfortable attending a family gathering, then do.
3. Plan to do something that is unrelated to parenting.
4. Attend religious services if you are comfortable knowing that the focus may be on mother’s or fathers. Perhaps you can ask your religious leader to say a prayer for those who have not yet achieved parenthood or are dealing with some other sort of crisis.
5. Plan for how you will answer uninvited questions about how you are feeling. Remember, you are not required to tell them your entire “story!”
6. Communicate with your partner to let him/her know of your feelings. Even if you and your partner are feeling differently about Mother’s or Father’s Day, it may help to share. If you are single, call a friend with whom you feel safe to share your feelings.
7. If you think it might be helpful, please call the clinic and set up an appointment with me, at no charge. Our number is 415-834-3000.

– Peggy Orlin, MS, MFT

Stress is no stranger to most of our lives. The everyday, chronic strain of a demanding job, driving in traffic, dealing with relationships, taking care of the chores of life, all leave us feeling “stressed out.” “Does stress cause infertility?” No matter what the answer to the question, it is important to look at ourselves and determine just how stressed we are. We need to then take steps to attempt to reduce the stress. One undisputable fact is that it makes good sense to reduce our stress to the lowest levels possible. At the very least, you will feel better!

To provide you with the opportunity to assess your fertility stress, we have added a Stress Test domar© to our website at www.pacificfertilitycenter.com. Click on “for patients” then “support” then “infertility stress test.” The test is brief and it generates a stress level score with comments. You can take it as frequently as you would like.

The goal of stress reduction is to reach what Harvard physician, Herbert Benson calls the “relaxation response.” It’s like stress running backwards. We can calm our racing minds. We can soften our tense bodies. The relaxation response leads to a series of changes that take place in the body and mind as you calm down. Your heart rate, muscle tension, breathing rate, and oxygen consumption fall below resting levels. Your brain wave patterns become slower. There are many ways to elicit the relaxation response. The goal is to find the one that works for you, meaning that it reduces your stress and you will take the time to practice it!

One way to learn about all of these techniques is to participate in our Mind/Body class. We discuss and practice each of the following methods; progressive muscle relaxation, breathing techniques, yoga, visualization, mindfulness meditation, and journaling. It is a wonderful day where you get to meet others going through treatment, learn some new skills, eat some excellent food and de-stress.

In addition to learning specific techniques to reduce stress, it may also be helpful to consider the following suggestions:

-Give up any and all feelings of guilt for how you are feeling. There is no right or wrong way to experience infertility. Your feelings may run the gamut from indifference to intense anger and despair and everywhere in between.

-Choose the gatherings you attend carefully. If being around children or babies upsets you, gracefully decline invitations to events where they are likely to be present. Know your limits and stick with them.

-Continue to get moderate amounts of exercise. Eat healthy and get plenty of rest. You will feel better if you treat your body with care.

-Communicate with your partner to let him/her know of your feelings. Even if you and your partner are feeling differently it may help to share. If you are single, call a friend with whom you feel safe to share your feelings.

-Meet and talk with others who are experiencing similar feelings. Finding that you are not alone helps.

We offer these stress reduction workshops every quarter. There is no charge for PFC patients to attend. Join us!

In the June 2008 issue of the Fertility Flash, Dr. Isabelle Ryan answered a question on how to choose an egg donor from a medical perspective. This month I’ll focus on the psychological aspects of choosing an agency egg donor. As the Marriage and Family Therapist at Pacific Fertility Center, this is a question I address regularly. All PFC patients considering ovum donation will have a complimentary meeting with me

Choosing an egg donor may seem like a daunting and foreign process. You are undertaking an unfamiliar task that you probably never planned on. But now that you are here, it may help to remember that the gene pool is huge. No matter whose gametes create your offspring; your children will be a magical and unique blend of nature and nurture. DNA is not destiny. Your love, your values, your womb, all have an impact on the person your child will become.

I find the following to be helpful reminders as you move forward with choosing a donor:

• The experience of attachment to a child, the feeling of being in love with him or her, happens regardless of whether one or both parents share the child’s DNA.
• Mothers and fathers are the ones that raise and love a child. Donors are the ones that donated or helped.
• Most donors donate for a complex blend of altruistic and monetary reasons.
• Each of our PFC agency donors has a psychological interview with me. In addition they take a psychological test (PAI); this test assists me in assessing not only their personality, but also their honesty and reliability.
• The more stringent your criteria for choosing a donor, the longer it will take to find her.

So, how in the world do you choose a donor?

I think there is a relatively simple answer to this seemingly complex question.

Choose the donor that jumps off the page at you. Choose the donor whom you like best, resonate with, feel a connection to, are impressed by.

That donor may or may not look exactly like you, but she will be someone you might have chosen as a friend or you could imagine as your daughter.

I believe the goal in choosing an egg donor is to be able to look at your child and either say or think to yourself, “we couldn’t use my DNA, but we chose someone we thought was lovely, interesting, attractive, smart, motivated (add the adjectives of your choice) to be our child’s donor. “

Practically speaking, if you have a partner, it may work best to look at donor profiles separately from him or her. After each of you note your favorites, you should then come together and choose from the selections that you both indicated. This process helps assure you both were able to choose without pressure from your partner.

Finally, please remember there is no “perfect donor,” but that does not mean you won’t be blessed with the “perfect child.”

Every year, several Pacific Fertility Center professionals participate in ASRM’s national meeting. They evaluate the research and share their findings with PFC and Fertility Flash.

Among those attending the conference from PFC were Dr. Philip Chenette and Dr. Isabelle Ryan and Peggy Orlin, MFT. Their reviews cover the following topics: Update #1: Ovarian Stimulation Techniques, Update #2: PGD and Aneuploidy Screening Techniques, Update #3: Egg Freezing, Update #4: Acupuncture, and Update #5: Men and ART.

Update #5 Men and ART

The Mental Health Professional Group (MHPG) course entitled Men and ART: The Missing Voice, blended medical, psychological, ethical and legal information relating to men who participate in Assisted Reproductive Technology (ART).

The legal issues confronting single men and gay men considering the use of egg donors and gestational surrogates continue to be controversial. Adoption legislation in many states prohibits gays and lesbians from adopting. In a study reported in 2005 by Gurmankin, et. al, 44% of ART programs responded that they would not turn away gay couples seeking surrogacy with one partner’s sperm and 48% responded that they would turn them away. This is in contrast to the higher rate of acceptance of lesbian couples. In lesbian couples seeking treatment using donor insemination, 82% of ART programs agreed to treat versus 17% who refused to treat them.

Though often presented exclusively to women, men can also benefit from the use of stress reduction strategies and following a healthy life style which includes regular exercise, normal body weight, no smoking or recreational drug use and avoidance of environmental toxins. In addition, the effects of aging and cancer on sperm quality should not be overlooked when men seek reproduction assistance. (See articles on: Sperm Aging: Fertility Flash Feb. 2004, Sperm Fragmentation: Fertility Flash March 2005, Cancer and Infertility: Fertility Flash Oct. 2004).

The psychological component of this course was compelling. Approximately 50% of cases of infertility involve at least some degree of male infertility. Why is it that most infertility references are traditionally directed at women? By definition, Infertility is “…the inability of a woman to conceive after some months (12-24) without contraception, or the inability to carry a pregnancy to term.” (Institute of Medicine and National Research Council, 1989). Ancient biblical references and popular literature focus on women’s infertility – e.g. Sarah and Hannah in the bible, Sylvia Plath’s Barren Woman, Jane Smiley’s 1000 Acres. The list is long. Google hits by gender for infertility and psychology show 542,000 for men and 700,000 for women.

The cause of this discrepancy is multifaceted. There are fewer psychological studies on men simply because men have a lower study response rate than women. A variety of successful techniques have been developed to overcome male related medical issues. Additionally, most men spend less time in treatment and experience fewer invasive procedures than women. In general, it is more socially acceptable for women to express their feelings regarding infertility. The opposite is true for men whose fertility often is a taboo topic. Furthermore, some cultures protect their men from the unacceptable stigma of infertility and even falsely describe men as having “poor” coping skills.

Despite these discrepancies, men do have feelings about infertility and may need support and assistance to better cope with the diagnosis. A study by Mason MC in 1993 found that men felt guilt, shame, anger, isolation, loss and a personal sense of failure. This is not all that different from what women feel, but each individual’s coping mechanism is unique. We all, however, find ways to protect ourselves from what we perceive as painful information.

These coping skills can be divided along gender lines. There are ways that many, but certainly not all, men commonly protect themselves from the pain related to his or his partner’s infertility diagnosis. Frequently men are able to distance themselves from the feelings. They appear to have the ability to take painful information and put it in a little box that they then file away in the back of their minds. The box stays tightly shut. Other men want to problem-solve for their partner or avoid the topic completely, throwing themselves into work or hobbies. Some men become extremely optimistic to avoid or counter their partner’s pessimism.

These are different styles- not right or wrong. For many of us, particularly women, the closed box technique does not work. The box is opened often, and feelings appear to refuse to stay tucked away. When partners have different coping styles, it’s important to both learn to tolerate and support these differences. Sometimes that is easier said than done…

Peggy Orlin, MFT

Mind/body therapies are frequently initiated for groups with serious medical conditions, from lupus to multiple sclerosis to major heart disease. It is only natural that the more critical an illness, the more anxiety it can induce, thus potentially inducing accelerated and aggravated symptoms. Breaking this vicious stress/body cycle through the use of stress reduction techniques can provide an overall improvement in health. For those experiencing infertility, the hope is that breaking this cycle would lead to an improved ability to conceive.

Skeptics point out that millions of people, under extremely stressful circumstances, regularly get pregnant. But some facts are clear: ongoing chronic stress can affect menstrual function; change hormone levels; alter blood sugar; increase heart rate and change a person’s immune response.

Pacific Fertility Center’s team has examined the scientific, medical and anecdotal information surrounding the topic of stress and infertility. We have found that various stress reducing techniques are likely to have an overall positive impact on a patients’ general health. For this reason, PFC continues to offer classes modeled around Dr. Alice Domar’s mind/body practice (see PacificFertilityCenter.com for more information on Dr. Domar and Mind/Body@PFC Workshops).

Alice Domar, PhD has extensively probed the mind/body infertility correlation. She initiated one of the few controlled studies funded by the National Institute of Mental Health on this topic. Results of the research showed an improvement in pregnancy rates through the use of either relaxation techniques or the psychological support of joining a group. Based on the results of her research, Dr. Domar’s mind/body programs include instruction on relaxation techniques, controlled breathing and posture awareness; yoga, meditation, journaling, neuro-linguistic programming, and the joining of a support network. These techniques are designed to help women adjust their stress responses so their bodies might have a higher chance of conceiving.

It is our hope that the growing attention to the mind/body stress reduction methodologies will lead to the development of more critical scientific knowledge on the topic. Meanwhile, take a deep breath and review Peggy Orlin’s tips on relieving stress during this holiday season.  Carolyn Givens, MD and Isabelle Ryan, MD

Coping is developing the ability to manage in a difficult situation.
Excited children, crowded stores, decorations, and holiday parties are descending upon us. Yet because the winter holidays tend to celebrate families and children, these usually joyous occasions can bring up painful feelings when you are struggling to create and celebrate with a family of your own. In order to feel as good as possible during the holidays, you will need to develop some good holiday coping skills. Use whichever of these suggestions seem helpful to you. Do what feels right for you.

DO: Give up any and all guilt for how you are feeling. There is no right or wrong way to experience infertility. Your feelings may run the gamut from indifference to intense anger and despair and everywhere in between.

DO: Reach out to childfree friends. Their parties will be adult-focused.

DO: Choose the gatherings you attend carefully. If being around children upsets you, gracefully decline invitations to events where they are likely to be present. Know your limits and stick with them.

DO: Think of non-child centered holiday rituals. Take a vacation. Eat at a fancy restaurant.

DO: Continue to exercise moderately, eat healthy foods and get plenty of rest. You will feel better if you treat your body with care.

DO: Shop for the holidays online or from catalogs. You will avoid mall madness.

DO: Attend religious services at the time when there will be the least number of children. Attend a service on a university campus, which is more adult focused.

DO: Volunteer at a nursing home or homeless shelter. It may help others having difficulty coping and in turn may help you.

DO: Plan for how you will answer uninvited questions about when you’re going to have children. Remember, you are not required to tell them your entire “story!”

DO: Meet and talk with others who are experiencing similar feelings. Finding that you are not alone helps.

DO: Communicate with your partner to let him/her know of your feelings. If you are single, call a friend with whom you feel safe sharing your feelings.

Peggy Orlin, MFT

The American Society for Reproductive Medicine (ASRM) is the largest organization in the United States for medical professionals in the field of Reproductive Endocrinology and Infertility. In 2002, ASRM published medical and psychological guidelines for ovum donation. The psychological recommendations for donors are general guidelines for addressing moral, ethical and psychosocial issues that may confront ovum donors. Included are standards for what should be included in a psychosocial screening of donors and reasons to exclude donors. A few of the objective reasons for donor exclusion include known substance abuse, positive family history of heritable psychiatric disorders such as schizophrenia or bipolar disorder, or instability in donors’ lives. To determine “inclusion” I take a psychosocial history and administer a psychological test that informs me about the donor’s personality profile, including just how much they are trying to impress me – the “fake good” factor. I am also assessing motivation to donate and the donor’s “need” versus “desire for” the compensation. Stability, stress levels, and reproductive history are also part of an ASRM assessment of donors.

Although I would like to base my entire decision on objective information, much of my decision on donor acceptance must, in fact, be based on intuition. Throughout my 25 years as a therapist, I have found that my intuition is quite accurate, but it is not fool proof.

There is one major controversy in the field that may hinder a psychotherapist’s ability to screen donors. That is the hotly debated topic on compensation of donors. In August 2000, the Ethics Committee of The American Society for Reproductive Medicine concluded that there is no consensus on the precise payment that oocyte donors should receive. It was suggested, “sums of $5,000 or more require justification and sums above $10,000 go beyond what is appropriate.” Due to costs of living and the scarcity of available donors, there are significant regional variations that affect these rates.

The Society for Assisted Reproductive Technology (SART) has attempted to assist clinics and patients by creating a list of Egg Donor Agencies that have signed an agreement stating that they will abide by the Ethics Committee Guidelines governing the compensation of egg donors.

The debate centers on the fact that donors could feel undue inducement and exploitation in the process if the fee is so high as to be coercive. Part of the job of the mental health professional is to provide donors with informed consent. Might donors conceal pertinent medical information that could be important for themselves or offspring if the monetary incentive is so high? Will donors discount risks to themselves? How can the donor actually give informed consent about the medical procedure and pay attention to the risks if $$ signs are floating before their eyes?

Ethicists and some in the field of women’s health advocacy express concern “that lucrative payments are enticing young women with credit-card debt and steep tuition bills to sell eggs without seriously evaluating the risks.” Can the payment cloud someone’s judgment and can we assess that? How much is too much? Where is that line?

When I began working with PFC in 1998, we were paying first time egg donors $2,500. Nine years later, the compensation is $6,500 for a first time donor and $7,000 for any subsequent donations. Even adjusted for inflation, the payment is rising at a phenomenal rate. Competition, supply and demand govern these rises.

As part of my objective/intuitive approach to interviewing donors, I discuss money with them. What would she use the compensation for? How does she support herself? What kind and how much debt does she have? While $25,000 in student loans points to a person’s drive toward positive goals, the same amount in credit card debt speaks to me of impulsive behavior. How much have they educated themselves on ovum donation? Whom have they talked with about their desires? Do they have their own children? Are they science majors who may be more likely to view gametes as DNA and not their own children? Are their answers well thought out?

My goal is to provide the recipients of donated eggs with intelligent, healthy, and thoughtful young women who understand the implications of ovum donation both for themselves and for the recipients. Donors who are motivated by the “need” for money are more likely to provide inaccurate information on their applications, or leave out information that could be pertinent to the recipients or their offspring. It is my job and the job of the Egg Donor Agency to determine motivation.

Although impossible to attain, we would all like donors to be motivated altruistically. We may diminish altruism by making the donation about eggs for money. However, I believe we can increase altruism by helping the donors to have a greater understanding of who the recipients are and what their struggles have been.

Peggy Orlin, MFT

Ms. Orlin served as 2006-7 chair of ASRM’s Executive Committee of the Mental Health Professional Group, is a member of Resolve’s National Mental Health Advisory Board. She co-teaches PFC’s Mind/Body workshops.

To register for the September 8th Mind/Body@PFC Workshop, please phone 415-834-3095.

In last month’s issue we introduced our readers to Peggy Orlin, MFT, Pacific Fertility Center’s in-house therapist. This month we interviewed her about the key psychological issues affecting individuals and couples experiencing infertility.

What is the most common reason why someone comes to see you at PFC? At Pacific Fertility Center everyone who uses a known or unknown egg or sperm donor or a gestational carrier is required to meet with me. This is mainly an educational session designed to help people think through and discuss the issues involved with using a third party to assist them in building a family. Each meeting is custom tailored to meet the patient’(s) particular needs.

	Use of a third party for reproduction and its impact on a relationship.
	Attachment to a non-genetically related child.
	Disclosure of third party reproduction to family, friends and the child.
	Choice of meeting or not meeting with the donor.
	Use of a family member or friend as the donor.
	Multiple pregnancy (twins or triplets) and its impact on your lives.
	Support services during and after treatment.

What are some of the other reasons people seek your help?
Some patients have had a failed cycle and are having trouble coping with the losses. Other patients have experienced a miscarriage. Both of these scenarios can leave patients feeling bereft and not sure how to move forward. During a session, I can help them understand the grieving process and we can discuss ways that they might ritualize their loss in order to move forward.

The stress of infertility diagnosis and treatment often brings them to me either at the center or in my private practice. It is important to understand that no two people will have exactly the same experience and that infertility can strongly impact those within a committed relationship. A recent diagnosis of infertility, as well as the stress and/or disappointments of treatment, can lead to feelings of isolation and depression. Additionally, people may experience grief over the loss of fertility choices. It is not uncommon that I am the first person, other than their partner, with whom they discuss their feelings about their infertility challenges.

There are those who are at a critical decision point and are seeking help thinking through their reproductive alternatives. This may include deciding whether or not to do one last IVF, move on to egg donation, select an egg donor or complete their family through adoption or childfree living. In the therapy sessions, we discuss and explore the pros and cons of a decision from the unique perspective of their life beliefs and situation.

Others may need help with developing positive coping mechanisms and stress reduction techniques such as setting aside time each day to discuss infertility with their partner, rather than allowing it to be a constant topic of conversation. We may also discuss how they can reduce their isolation possibly by talking with others who are having similar experiences. We may even explore how to include moderate exercise in their schedule to reduce symptoms of depression.

What is your advice to those who are uncertain whether or not they should see a therapist?
For patients at the clinic, one exploratory visit can be helpful. Their doctor can refer them to me for one free session during which we can discuss any concerns they may have and talk together about whether or not seeing a private therapist might be useful for them. They are not signing on for long-term therapy by talking with me. As with stress reduction techniques-it can’t hurt and it might help.

Could you discuss the Mind/Body@PFC Workshop and who might benefit from attending?
The jury is still out on the connection between stress and infertility. Recent studies indicate that there may be a stronger connection between depression and infertility than between anxiety and infertility. The Mind/Body classes not only teach people simple ways to relax, but the small group class gives them the experience of being in a safe environment with others who are all experiencing infertility and know just what it’s like to be going through infertility treatment. This group experience helps to reduce stress and may be helpful to ease mild depression. (Call 888-834-3095 to register or Click here for more information)

How does your private practice differ from your practice at Pacific Fertility Center?
Clients in my private practice tend to be those who are interested in more than one session. Some stay for a few sessions and some want longer-term therapy. Many are couples who are struggling with how differently they are approaching and/or moving toward resolution of their infertility journey. Sometimes clients are self-referred for infertility issues and then as we meet, they chose to move on to other issues in their relationship or their lives. Although I have a specialty with infertility patients, my private practice is with adults experiencing all types of distress.

Depression frequently accompanies infertility. When should someone seek a therapist?
The experience of symptoms of depression which last more than a couple of weeks is an important reason to set up an appointment with me or a therapist of your choosing. Remember, everyone will feel some of these symptoms, some of the time. They become a problem when the number and intensity of symptoms increase and/or don’t abate.

Symptoms of depression:
Feelings of emptiness or extreme sadness
Loss of interest and motivation to do regular activities
Increased level of anxiety
Decreased level of energy
Difficulty sleeping or sleeping more than usual
Difficulty concentrating
Abnormal weight loss or gain
Obsessive thinking about your infertility
Feelings of isolation from friends and family
Extreme and persistent feelings of anger
Persistent thoughts of death or suicidal thoughts or attempts
Persistent feelings of inadequacy, or worthlessness

What is the best way to make an appointment with you?
PFC patients phone the front desk at (415) 834-3000 and ask to set up an appointment. Those who prefer to see me outside PFC can make an appointment for a visit at either my San Francisco or Berkeley office by calling (510) 528-2750.

– Peggy Orlin, M.S., M.F.T.

As many of us do, I began a career in one area and discovered my true passion along the way. I began as a teacher in Long Island. After working for several years as a teacher for students in special education, I moved to San Francisco in 1978.

During my early years in California, I continued to teach adolescents with special needs. I soon realized that what I enjoyed most of all was not teaching the classes, but the informal counseling and group sessions that happened outside of the normal classroom experience. This motivated me to return to the classroom for a Marriage and Family Therapist’s (MFT) degree.

Once I was licensed in 1984, I worked for a few more years in the school system as a counselor for Special Education students. Concomitantly, I began a private practice counseling women and couples. Both counseling settings were rewarding.

By the early 1990′s, after being inspired by work I did with another therapist, I left the school system and began training other counselors. It was exciting and a stimulating change of pace.

During this time I was going through some personal challenges. My husband and I had difficulty conceiving and subsequently underwent infertility treatments. Finally we became parents through adoption, a wonderful family building solution!

After the adoption, I took some time off from work to enjoy our daughter. Our daughter, adopted at birth, is a never-ending source of joy for both of us.

My passion followed my pain. During our trials with infertility we learned of Resolve and joined a support group. This greatly diminished our feeling of isolation. I went on to do adoption home studies, join the Board of Resolve of Northern California and lead support groups. Eventually, through word of mouth and referrals from Resolve, I began counseling infertility couples.

I have remained active in Resolve, coordinating their support services while on the board, speaking at conferences and agreeing to be the Keynote speaker in 1995. This year, 2006, I have been asked to sit on Resolve’s National Mental Health Advisory Board.

My career at Pacific Fertility Center began over 8 years ago with a referral from a colleague who knew of my work with infertility patients.

About that same time I began attending the ASRM Mental Health Professional Group (ASRM-MHPG) conferences. In 2001 I became co-chair of Internet Integration Task Force to organize a worldwide online community of therapists for the group (ASRM-MHPG).

I find the topics tackled by this professional group fascinating. It assists in developing guidelines for the infertility industry, especially on the many ethical issues surrounding egg donation as well as guidelines and protocols for protecting the donors and the recipients. As an active member of the MHPG community, I have served as secretary/treasurer, newsletter editor, program chair for the mental health portion of the ASRM conference in 2005 and am in the 3rd year sitting on the executive committee. I am looking forward to my new responsibilities as the 2006-7 chair of ASRM’s MHPG.

In general, this group allows me to learn from the mostly PhD/research oriented group and communicate with therapists dealing with infertility issues from all over the world.

My involvement with this research oriented group has piqued my interest in developing a study at Pacific Fertility Center which would further our understanding of stress as it relates to infertility.

– Peggy Orlin, MFT

Undergoing infertility treatment can be overwhelming for some patients. The time and energy that is needed, both physically and emotionally can drain even the staunchest crusader. To cope most effectively with the stresses of infertility treatment you will need support. While friends and family will prove to be invaluable allies, there is nothing like connecting with like-minded individuals who might also be going through your very experience.

Not surprisingly, the Internet offers an abundance of resources for infertility support. A Google search for “infertility support” garners 7880 hits! The topic of infertility “emotional support” nets 46,500 sites. Even narrowing the search with a specific diagnosis, such as “endometriosis support,” 13,300 responses does not seem like much of an improvement. When you are feeling lonely and isolated because of your infertility the last thing you need to do is wade through thousands of sites.

So, we at Pacific Fertility Center have waded through them for you. Here are some of the most helpful sites with a bit about what you might find. Many of these can be directly accessed from our website at InfertilityDoctor.com. These sites may also link you to other sites.

We would like to offer a warning about chat rooms. While it is amazing how many women share their experience and offer you words of encouragement via Internet chat groups, please be wary of fellow infertility patients offering medical advice based on personal experiences, anecdotal evidence and/or fuzzy research. It is important to realize that while your medical situation may be “similar” to someone else’s, the details of your case are what make the difference. Your physician is the best resource of sound medical advice.

ACOG.org American College of Obstetricians and Gynecologists – Excellent patient education pamphlets, books and updates on legislation affecting women’s healthcare.

www.cdc.gov/ncbddd/bd/abc.htm ABCs of having a healthy pregnancy – Centers for Disease control and Prevention: National Center on Birth Defects and Developmental Disabilities’ informative website.

theAfa.org American Fertility Association – Education, referrals, research, support, chat room.

ASRM.org American Society for Reproductive Medicine – Patient section offers fact sheets on infertility and adoption. ASRM is the nation’s largest professional organization of fertility experts.

b4pregnancy.org Information and resources concerning healthy lifestyle changes in separation for pregnancy.

Childofmydreams.com Resource for infertility and adoption.

DCNetwork.org The Donor Conception Network – A British network of parents with children conceived with donated sperm, eggs or embryos, adult offspring and those contemplating or undergoing treatment.

Ferre.org Ferre Institute – Resource and information on medical genetics, infertility, adoption, including special sections for those of color, LGBT and other cultural issues.

Fertilehope.org Fertile Hope – Information, support and hope to cancer patients facing infertility.

Hopeforfertility.com HOPE for Fertility – Volunteer emotional support for fertility and adoption challenges.

Hygeia.org Hygeia® – Support for Perinatal Loss and Bereavement

MissingGRACE.org Missing GRACE – International support and resources for infertility, loss, and adoption. Grieve, Restore, Arise, Commemorate & Educate.

Protectyourfertility.org Protect Your Fertility – Information for women and men about infertility produced by the American Society for Reproductive Medicine.

Resolve.org RESOLVE – National education, support and advocacy groups for infertility and adoption. Local chapters

Seronofertility.com and Fertilityneighborhood.com Pharmaceutical company sponsored sites with informational options including news sites.

Singlemothers.org Single Mothers by Choice or Chance – Support network for single mothers with local chapters.

Each couple must grapple with the decision about whether or not to meet their donor. For some it is a simple decision; for others it may be a longer process. There is no correct answer to the question of whether or not to meet her.

Some recipients feel concerned that by meeting the donor they will be giving up their anonymity or signing on for a long-term relationship with the donor. While it is true that the donor may then be able to identify you in public, there is no identifying information shared, no last names, addresses, college names, etc. And during each meeting we discuss how the recipients would like to handle an unexpected encounter.

Most importantly, there is no expectation of an ongoing relationship with the donor!

Some couples feel complete satisfaction with no face-to-face contact with the donor; for them, not meeting is the best choice.

For those of you considering it, here are some concrete reasons you might want to go forward:

• It will reassure you that your donor is as wonderful as you had hoped;
• It will reassure you that the donor is completely clear that YOU are the parents;
• It will offer you the opportunity to ask questions that weren’t answered on the bio: what kind of baby she was, what are her family members like, etc.;
• You will be able to say an “in person” Thank You to your donor;
• This is the time for a picture with your donor;
• You can discuss how the donor feels about your child contacting her when your child is grown;
• You will be able to tell your child that you met the donor.

At PFC, it has been our experience that the donors love the meetings. It personalizes the experience for them. Instead of a faceless recipient or couple, the donor is working for you, making an already positive experience more special.

The meetings can be enlightening, awkward, touching or funny. What they all share is that they are memorable!