Title: The Fertile Kitchen Cookbook

Can diet influence fertility? Can altering your diet help you conceive? Is it true that you are what you eat (and so is your baby)?

At age 40 and after trying to conceive for over a year, Cindy Bailey and her husband Pierre Giauque were told that they were unlikely to conceive. With disconcerting medical test results and failure in conven tional treatment, alternative therapies seemed the best option. After trying a fertility-friendly diet, to their surprise, their son was conceived four months later.

The Fertile Kitchen is one couple’s story of overcoming the odds against conception while using common sense and easily executed measures to optimize health. Using fresh, high quality, organic ingredients, and reducing wheat and dairy; the couple developed a nutritional plan that they feel contributed to their success. These authors found that optimizing the basic ingredients for life, adjusting calories, carbohydrates, fats, and proteins into a regimen that has the potential to optimize pregnancy rates, should be considered in a given fertility plan.

Science is still catching up to medical concerns about fertility and diet. As an example of this emerging science, it is known that women with abnormal body fat levels, either high or low, suffer from lower pregnancy rates, and that improvement in body weight and body fat levels improves fertility rates…Certain types of animal protein are potentially problematic for fertility, whereas vegetable protein sources seem to carry less risk. Calorie source, simple sugar versus protein, makes a difference in treating anovulatory women. Irregular menstrual cycles can be optimized by changing diet. Omega-3 fatty acids are related to uterine artery perfusion pressures, and supplementation seems to provide some clinical improvement in these parameters. Studies are showing a role for B-complex vitamins, folic acid, and dietary fat in regulating ovulation.

It is unfortunate that some people have serious challenges to fertility that cannot be addressed with a change in diet. Diminished ovarian reserve, male factor, and tubal occlusion are problems that go beyond what can be remedied with diet alone. With that said, fertility treatment programs, regardless of the health issues, should include a healthy diet, as a good preventative measure for already healthy women wishing to conceive. The recipes in this book are easy to follow and the ingredients are amply available at most grocery stores.

Fertile Kitchen Media Kit (pdf)

— Philip Chenette, M.D.

My husband and I have been riding the infertility roller coaster for almost 3 years now. The ups and downs have included invasive diagnostic testing, four failed intrauterine inseminations (IUIs) and most recently an unsuccessful in-vitro fertilization (IVF) attempt. Each wave of excitement over the hope brought on by the next treatment cycle would come crashing back down with the negative news. While I am confident I am receiving the best possible medical care with the team at PFC and am keeping “hope frozen in time” with my frozen embryos, it can still be a hard road to travel.

Considering my first attempt at IVF failed, you would think I would be at the lowest point of my journey towards parenthood. But, amazingly, I am not. I am sharing my story to tell you how I survived the ups and downs and was able to feel more grounded and

Lisa Wickham.

regained a sense of control in my life while continuing treatment.

This is what saved me: A powerful combination of group support and mind/body techniques.

My PFC acupuncturist (seeing tears stream down my face) recommended a Mind/Body class to help ease my obvious difficulty in coping with the emotional stress I was under. This was huge. This was the first step I would take in reclaiming my 0ormer self. What are Mind/ Body techniques? They are tools including deep breathing, meditation, guided imagery, progressive muscle relaxation, cognitive reframing, light yoga, tai chi and journaling exercises. My first thought was, “Will this be too ‘new age-y’ for me?” I could barely comprehend the fact that I was doing acupuncture regularly, let alone meditate.

The great thing about Mind/Body is that it is a tool box, so you pick what works for you. I never really did learn to meditate, but the regular use of relaxation CDs for deep breathing, muscle relaxation and guided imagery has given me profound peace of mind. Cognitive reframing (learning to recognize destructive thoughts and “reframe” them) was also powerful for me. I used to hear a tape playing in my head over and over, “I’ll never get pregnant, I’ll never get pregnant”. I learned to challenge the truth of that statement and rethink how it made me feel. A 10-week Mind/Body course I took was a key turning point. PFC offers a one-day workshop that offers an introduction to Mind/Body and is free for patients.

The other key component to my peace of mind has been meeting others who “get it”. It’s hard to explain to someone not experiencing infertility themselves just how this takes over your life. Well-meaning family and friends try to understand, but they truly cannot. Only my best friend, who also experienced difficulty in trying to conceive “got it”. That is, until I did my first IUI. Having to explain washed sperm to her and describe what it’s like to have your legs in stirrups as the washed sperm is inserted into you was beyond depressing. I knew I needed to meet others going through similar situations.

Lisa and Jonathan Wickham.

I attended my first Open Path group support meeting last year and had no idea what to expect. I only knew I needed to at least talk to someone else who knew what an IUI was. Open Path (fertilityandadoption.com) is a Bay Area organization that provides regular group support. There I met two amazing women and we are now a larger group of women who meet regularly and support each other over email, coffee and even cocktails in between cycling. We are a Sisterhood of Infertility. We all have different stories whether doing IUIs, IVF, using donor eggs, considering a gestational carrier or considering adoption. We have different personalities, some are quiet, some are loud, some blog their innermost thoughts to the online world (google “Stirrup Queens”), some are “closeted” with their infertility secret to all but a few. But our common thread is infertility. We all wear the red, pomegranate string around our wrists as a reminder that we are not alone (you can google “infertility’s common thread” to read more about this). We support each other when we are down and we celebrate our victories (small and large) together. While most of us could not find it in ourselves to feel happiness for friends we had known all our lives that got pregnant, we were able to give loud cheers of joy when one our IF Sisters did. This was healing beyond words. And this gives us hope.

I’ve heard the statistics about Mind/Body and group support increasing pregnancy success odds, but, for me, even more important than getting pregnant, was the peace of mind that came.

My hope is that my story can, in some way, help bring peace of mind to someone else as they navigate their own path. You are not alone. You do not have to do this alone. And there are concrete ways you can make yourself feel significantly better while undergoing treatment.

Try these resources for more information:

• Mind/Body @ PFC – pacificfertilitycenter.com/support/relax_workshop
• Open Path – fertilityandadoption.com
• Resolve – resolve.org
• Resolve support group listings: http://www.resolve.org/site/PageServer?pagename=npac_peer_groups

— Lisa Wickham, Current PFC Patient, San Francisco, CA

Pacific Fertility Center is pleased to announce the launch of our in-house mind-body medicine program. We are offering on-site acupuncture and mind-body groups to further support your treatment choices.

Over the years, Pacific Fertility Center (PFC) patients have elected to receive acupuncture treatment in combination with IVF and other fertility treatments. These treatments have been provided at outside facilities. We now offer acupuncture on-site, to minimize the stress of visiting numerous providers during your treatment cycle. We recognize that family building choices are diverse and want to support you throughout your important, personal decisions on your journey to parenthood.

This new service offers the expertise of acupuncturists who specialize in reproductive care. Our acupuncture team will work in close communication with the physicians of PFC. The result is a program that supports you with safe and convenient treatment. This exceptional new team is comprised of four licensed acupuncturists (LAc) who hold Masters of Science degrees in Traditional Chinese Medicine from accredited schools in California.

The medical team at Pacific Fertility Center is proud to provide this new service. While current studies do not show improved pregnancy rates with the combination of IVF and acupuncture treatment, we look forward to collaborative research studies to clarify these important questions. Together, we are launching exciting research projects that will investigate the scope and effectiveness of combined acupuncture and assisted reproductive technologies. Fertility Flash will provide readers with more information as the research program develops.

We hope you will enjoy getting to know the acupuncturists and take advantage of these new treatment options.

Pacific Fertility Center continues to offer the Mind/Body@PFC Workshop. At the workshop, our experienced, Alice Domar-taught instructors help patients learn healthy, positive ways to relax and decrease the symptoms of stress during their fertility treatments.

It is our hope that these offered services will provide a more comprehensive approach to your journey through fertility treatment with us at PFC.

Learn more about the acupuncture program at PFC

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 Trans fat, found in processed foods, may play a role in infertility. Implicated in prostate cancer, heart disease, and diabetes, and long thought to be a significant hindrance to good health, trans fat has been associated with ovulation disorders, according to a new publication¹.

Trans fats are created in food processing. To avoid rancidity in foods, manufacturers heat oils under pressure to convert natural unsaturated fat to partially saturated fat, adding hydrogen molecules to change the bonds between carbon atoms in the long fatty molecule. Saturated and partially saturated fats are sometimes called partially hydrogenated fats. Saturated fats melt at a higher temperature, and are more stable on the grocer’s shelf. Partially saturated fat is resistant to oxidation and damage, melts at a higher temperature, and does not take on rancid odors and taste. Crisco, partially saturated cottonseed oil, was the first commercial product to be produced with the technique in the early 1900s.

Foods prepared with partially saturated fats can contain up to 45% trans fats. French fries, cheeseburgers, fried chicken, cookies, and chips are common offenders. An order of large French fries can contain 15g of trans fat. Oreo cookies contained trans fat until a lawsuit in 2003 induced Kraft Foods to alter its recipe.

Ideal for a manufacturer interested in long-term storage, saturated fats are not so well tolerated by the human body. Raising levels of LDL and lowering levels of HDL cholesterol, saturated fats have been implicated as a prime cause of the rising risk of coronary heart disease through the 20th century. According to the Nurses’ Health Study², each 2% increase in trans fat calories doubles the risk of coronary artery disease. Since trans fats carry no health benefits and are potentially risky, experts have recommended reducing trans fats to trace amounts in the diet.

Infertility has been associated with trans fat intake. A study published in the January issue of American Journal of Clinical Nutrition from a group of researchers at Harvard University found that women with ovulation-related fertility problems tended to eat more trans fats than fertile women. Obtaining just 2 percent of total calories from trans fats was associated with a doubled risk for this type of infertility. The study showed that each 2% increase in dietary trans fat calories was associated with a 73% increased risk of ovulatory infertility³.

It has been difficult to separate out the effects of total fat and trans fat, since a diet high in trans fat diet is often high in total fats. In contrast to trans, higher total fat is known to decrease the risk of ovulation problems, improving ovulation, whereas women with a diet high in trans fat have an increased risk of ovulation disorders.

Dietary fats have been linked to markers of inflammation, a possible mechanism of trans fat effects⁴. In a randomized crossover study, 50 men consumed diets for five weeks that varied in trans fat content. Inflammatory protein markers were higher in men after the trans fat diet, showing that dietary fatty acids can modulate markers of inflammation.

The data is preliminary, but concerning. Since trans fats have no benefit and carry potential risks, they are best limited in the diet. Labeling requirements now include listing of trans fat content for foods. Lawmakers in several major US locales have passed regulations banning trans fats. Tiburon, California, on a voluntary basis was the first city to have trans fat free restaurants. Restaurants in New York City and Philadelphia are barred from using trans fat containing frying oils and spreads. The ban will be expanded to all restaurant foods next year. California is considering a statewide ban on trans fats.

Reducing processed foods and avoiding trans fats in your diet is an excellent goal for all, but patients with infertility may have special concerns. While more research is required regarding infertility and diet, there is no question a healthy diet is important. A diet of diverse and balanced carbohydrates, proteins, and fats, including omega-3 fats, will provide personal and possibly reproductive benefits for years to come.

Philip Chenette, MD

References:

1. Chavarro JE et al., May 2007, A prospective study of dairy foods intake and anovulatory infertility, Human Reproduction, 22 (5): 1340-1347.

2. Hu, FB et al. 1997 “Dietary fat intake and the risk of coronary heart disease in women”. New England Journal of Medicine, 337 (21): 1491-1499.

3. Chavarro JE et al., January 2007, Dietary fatty acid intakes and the risk of ovulatory infertility. American Journal of Clinical Nutrition, 85 (1), 231-237.

4. Baer DJ et al., June 2004, Dietary fatty acids affect plasma markers of inflammation in healthy men fed controlled diets: a randomized crossover study. American Journal of Clinical Nutrition, Vol. 79, No. 6, 969-973.

As a patient undergoing fertility treatment, the many months of testing, uncertainty and waiting had begun to take its toll. Dividing my life into two week increments no longer had the same hope and anticipation that defined my first few months of trying to conceive. Seemingly harmless questions from friends and relatives, like “So…any good news to report?” had become annoying questions that received a snappy response.

Attending the Mind/Body workshop was a valuable experience on many levels. We began the day with a tasty breakfast and coffee while we introduced ourselves and spoke briefly about our own experiences trying to conceive. PFC instructors Peggy and Allison presented the research on the stress/infertility connection, and spoke about the isolating nature of infertility. Because the topic of infertility is not openly discussed in social situations, the person or couple going through treatment often lacks social support.

Next, we were introduced to relaxation techniques, which Allison and Peggy call “Minis” because they are short and easy to incorporate into daily life. We lay on yoga mats in a darkened room and slowly counted our breaths, letting go of the tension in our arms and legs. We were led through some basic tai chi moves, and then ended with a guided relaxation that put me immediately to sleep.

After a delicious lunch the discussion moved to the cognitive distortions that frequently emerge during stressful periods and cause people to magnify their problems. Peggy and Allison led us through some cognitive restructuring steps, which can help identify a true thought versus a magnified and distorted fear.

Questioning negative thought patterns is a difficult but extremely helpful way to take some of the blame off of myself and ease the level of stress I was feeling. Hearing that others had the exact same thought patterns as I did was also extremely reassuring and made me feel as though I was not alone in my challenging journey.

The next part of the day was my favorite. We learned a variety of yoga postures that can easily be done in a desk chair or in front of a computer. My co-workers may think I look funny, but I have been contorting myself at my desk ever since, and found that it truly does relieve the physical stress of staring at a computer all day, and provides me with a nice mental break before I start a new task.

After another guided relaxation session, which again left me in a deep sleep, we convened as a group to review the day. Peggy asked us to think about what brings us joy, and how we incorporate those things into our lives. As I looked around the room, most people were smiling as they wrote down the things that bring them joy – everything from pets, partners and family to bubble baths, traveling, and good food.

As we finished the day with questions, answers and good-byes I left feeling refreshed from my mini-naps and excited to have some tangible skills to utilize whenever I find myself too stressed to relax. From our very first discussions over breakfast to our final activity, I felt the isolation of my own stressed out perspective melting away. I’m grateful that I attended the Mind/Body workshop, both for the feeling of community and the concrete relaxation skills I came away with.

The Mind/Body Workshop was an invaluable experience. I came away feeling like I had:

• Gained tangible relaxation and yoga skills that I can use in my daily life.
• Decreased feelings of isolation and anxiety.
• Finished the day feeling calm, centered and ready for my journey to parenthood!

Erika Linden

Infertility can cause extreme feelings of stress and isolation. From diagnosis to treatment, the stress of infertility can affect every area of life including marriage, job, and family relationships. Pacific Fertility Center’s Mind/Body Workshop is designed to address the emotional and physical strain caused by infertility treatment and the far-reaching effects it has on one’s life. These workshops are run by Pacific Fertility Center’s Peggy Orlin, MFT and Allison Chamberlain, RN, who were both trained by Alice Domar, PhD, a Harvard Medical School expert and pioneer in the subject of the mind/body connection to fertility. The next Mind/Body Workshop will be held on September 8th. Please call 888-834-3095 for class information, fees and your registration form. This one-day workshop is a loving and supportive environment in which you can gain self-awareness and practice techniques that will give you strength as you travel on your journey.

- Allison Chamberlaine, Mind/Body Instructor and Clinical Coordinator The workshop provides people with a safe space to learn relaxation techniques and to connect with others that know how difficult the infertility experience can be.

- Peggy Orlin, Mind/Body Instructor and Marriage and Family Therapist

Many women are aware that very low body weight and low percentages of body fat can compromise ovulation and chances for successful conception. What many don’t realize is that excess body fat can also affect one’s chances.

A review of the literature shows that the majority of studies published report decreased chances of conceiving with in vitro fertilization (IVF) if a woman in significantly overweight. IVF data is useful to study this issue because all the women undergo similar treatments and because follow-up data on pregnancies is usually readily accessible to researchers. It may also be true that excess body weight is a negative factor in spontaneous conception and non-IVF treatment as well.

How much of a factor is weight in decreasing conception? One study from the Netherlands reported a higher cycle cancellation rate due to poor response to stimulation and lower fertilization rates¹ than normal weight women. Another study from Norway reported higher requirements for stimulation medications and a higher miscarriage rate in the first 6 weeks of pregnancy². One of the largest studies was from Cornell and reported on 960 women undergoing IVF. Although they did not find a statistically significant decrease in clinical pregnancy rates, rates of cycle cancellation were higher and gonadotropin dose requirements were greater in the obese patients³. Another large study from Iowa (1,293 patients) looked at outcomes in women who were obese and morbidly obese. Again, this study found that clinical pregnancy rates per egg retrieval were similar to normal-weight women but cancellation rates and gonadotropin dose requirements were much higher in the obese women. Furthermore, rates of pregnancy complications such as preeclampsia, gestational diabetes and cesarean section were higher in the obese women⁴.

How much weight is significant for this effect? Most studies calculate weight as Body Mass Index, or BMI. This calculation takes in weight vs. height. To calculate your BMI, many websites such as the one at the Centers for Disease Control ( www.cdc.gov/nccdphp/dnpa/bmi/index.htm) can provide a calculator. There is also a chart at the federal government’s website www.consumer.gov/weightloss/bmi.htm. You just need to know your height in feet and inches and weight in pounds. A normal BMI is between 18.5 and 24 and overweight is a BMI of 25 to 30. A BMI of 30 or more is considered obese and 40 or more is considered morbidly obese.

In general, it appears that excessive body weight can negatively impact a woman’s chances for conception and for a healthy, uncomplicated pregnancy and birth. It makes sense that being a normal body weight and in good shape is a good idea and should be a goal for aiding successful conception.

Carolyn Givens, MD

References

1. Gynecol Obstet Invest. 2005;59(4):220-4. Epub 2005 Mar 7. Obesity and Clomiphene Challenge Test as predictors of outcome of in vitro fertilization and intracytoplasmic sperm injection.van Swieten EC, van der Leeuw-Harmsen L, Badings EA, van der Linden PJ.

2. Hum Reprod. 2004 Nov;19(11):2523-8. Epub 2004 Aug 19. Impact of overweight and underweight on assisted reproduction treatment. Fedorcsak P, Dale PO, Storeng R, Ertzeid G, Bjercke S, Oldereid N, Omland AK, Abyholm T, Tanbo T.

3. J Reprod Med. 2004 Dec;49(12):973-7 Obesity and in vitro fertilization: negative influences on outcome. Spandorfer SD, Kump L, Goldschlag D, Brodkin T, Davis OK, Rosenwaks Z.

4. Obstet Gynecol. 2006 Jul;108(1):61-9. Obstetric outcomes after in vitro fertilization in obese and morbidly obese women. Dokras A, Baredziak L, Blaine J, Syrop C, VanVoorhis BJ, Sparks A.

While many factors leading to female factor infertility are out of a patient’s control (genetics, for example), there are several measures patients can take that will help optimize their chances of conception.

At the forefront is receiving routine gynecological care. During the preconception phase, it is important that the patient have an up-to-date Pap smear and mammogram. Furthermore, the patient should undergo testing for infectious diseases (Hepatitis C, Hepatitis B, syphilis) and immunization status for varicella and rubella and hormones which can affect ovulation (prolactin and TSH). Any fibroids or polyps the patient has should be evaluated to make sure they wouldn’t adversely affect the chances of conception. Also, the patient should be taking essential prenatal vitamins as prescribed by her OB/GYN.

Certain behavioral factors should also be assessed and, in some instances, eliminated prior to trying to conceive. Smoking and drinking should be eliminated and exercise should be moderated. Incorporating a regular exercise program along with a balanced diet is recommended. The diet should include lean proteins, a colorful variety of fresh fruits and vegetables, combined with a limited intake of processed and fatty foods.

Women who are extremely thin or very heavy should seek the help of a nutritional counselor to attain a healthy weight without fad or crash diets. Embarking on a new, strenuous exercise regimen or crash diet just before attempting to become pregnant is not recommended. Medications being taken for preexisting medical conditions should also be evaluated to ensure they won’t compromise a pregnancy.

If the patient requires a fertility specialist, it is recommended the following tests be performed prior to seeing a specialist. This will streamline the diagnosis process and expedite them on their path to proper treatment. This includes testing of the ovarian hormones, follicle stimulating hormone (FSH), Estradiol; a semen analysis (for the male partner) and an HSG (dye study) to assess tubal patency. See more about fertility testing…

Age is a critical factor in the outcome of infertility treatment and it is important for patients to be more proactive the older the patient gets. At Pacific Fertility Center (PFC), our guideline for patients is to seek help from a fertility specialist after: 1 year of trying for women less than 35 years of age; 6 months of adequately timed intercourse or inseminations for women ages 35-39; 3-6 months of trying for women over 39. See more about age and fertility…

Again, time is of the essence when it comes to getting treatment from a reproductive expert, and, keeping that in mind, there are several tests that we do not encourage patients to take prior to seeing an infertility specialist based on their limited usefulness.

They include:

• Post coital test
• Sperm penetration assays
• Endometrial biopsy
• Serum antisperm antibodies
• Cervical cultures
• Laparoscopy
• Autoimmune factors

Ultimately, conceiving through assisted reproductive technology (ART) is a team effort involving the patient, OB/GYN, and fertility specialist, with the process beginning several months before the patient steps foot in an IVF clinic.

Click here for more information on pregnancy preparation.

– Eldon Schriock, MD

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.

Stressed or anxious attempting to conceive?
Attend a Mind/Body@PFC workshop and learn healthy, positive ways to reframe your journey to pregnancy.

Saturday December 10th from 9AM to 4PM
This workshop is taught by our experienced fertility caregivers Peggy Orlin, MFT and Allison Chamberlaine, RN who are both trained by Alice Domar, PhD, a Harvard Medical School pioneer in the development of mind/body programs for infertility.

Peggy Orlin, MFT is a Marriage and Family Therapist who specializes in the emotional aspects of infertility, third party family building and adoption. She has been a therapist for over 20 years and affiliated with PFC for the past 6 years. Her personal history of infertility led her to specialize in infertility counseling.

Allison Chamberlaine, RN is a registered nurse with 15 years of experience in the field of infertility. Ms. Chamberlaine has taught meditation and relaxation techniques for over 20 years and has been with PFC since 1996 where she now coordinates care for individuals involved in third party family building. Her personal history of infertility led her to specialize in infertility nursing.

Who Can Benefit from the Workshop?
Couples or individuals who are attempting to conceive and are experiencing emotional distress, and/or stress in their life. (You DO NOT need to be a PFC patient and/or currently in fertility treatment.)

What to expect at the Workshop?
A nurturing, supportive workshop where you will learn how to:
• Identify the potentially adverse impact of lifestyle behaviors on your reproductive health
• Employ multiple relaxation and stress reduction strategies
• Reduce your feelings of isolation related to infertility
• Decrease your symptoms of stress

How do I register?
Please call (888) 834-3095 for fee and workshop information and registration forms.
Space is limited.