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 patients receiving medical care for infertility will use cryopreserved (frozen) sperm, oocytes and/or embryos at some time during their treatment. Here in the PFC laboratory, we routinely cryopreserve sperm and embryos. We also receive specimens from sperm banks nearly every day. All of these specimens are stored on-site in our secure tanks with continuous monitoring. All specimens are stored in liquid nitrogen at -196ºC. Movement in or out of the tanks only happens when specimens are transferred post freezing or retrieved for thawing or shipping. We store sperm and embryos for our patients for an annual fee as long as we are able to maintain yearly contact with them and the annual storage agreement is renewed.

The shipping of tissues that are frozen and stored at such a low temperature is not easily accomplished. The liquid nitrogen in which they are stored is not toxic in any way, but it is extremely dangerous and can cause serious injury and even death if not handled properly.

In attempting to transport tissues that are normally stored in liquid nitrogen, we have to use a device that will keep the tissues in their same deep frozen state. This is accomplished using a “Dewar” which resembles a large thermos. A Dewar is a vacuum insulated container, mostly filled with an absorbent lining that soaks up liquid nitrogen. The Dewar is “charged” prior to use by filling it with liquid nitrogen over successive days until it will absorb no more. Once saturated, the excess liquid is poured off and the Dewar is then ready for use. Specimens are loaded into the hollow core and they are maintained in their frozen state by the cold nitrogen vapor evaporating from the surrounding absorbent layer. The Dewar holds an appropriate temperature for as long as nitrogen remains inside. Loss of nitrogen by evaporation happens continuously. Typically a fully charged Dewar maintains temperature for between 7 and 30 days depending on its size, how often it is opened and how well it was charged before use. With any Dewar however, loss of refrigeration occurs after a certain period of time, unless more nitrogen is added. In addition, dropping the Dewar or otherwise damaging it in any way can crack the container and this will result in instant failure of the vacuum seal with subsequent loss of nitrogen and thawing of the contents.

When we receive a shipment of sperm from a bank, there is always a risk that the Dewar was damaged or that there was a shipping delay that was longer than the life of the liquid nitrogen in the tank. If the specimens have thawed, typically the sperm bank will replace them at no cost. However, their liability is limited to replacing the sperm, and if you just lost the last 3 vials of your favorite donor, you’ll have to choose a new donor.

Shipping of embryos is a much more risky proposition. Embryos can’t be replaced in the same way that a sperm sample can be replaced, if they can be replaced at all. The major shipping companies such as FEDEX, UPS and DHL will not knowingly accept embryos for transport and therefore would not have any liability for loss. At PFC we discourage shipment of embryos due to the risks involved. We will not ship embryos from our laboratory on your behalf, however you can come and collect your embryos in person and ship them yourself. We will ask you to sign papers releasing us of any liability once the embryos leave our office. We cannot accept any liability for embryos that are being shipped in from elsewhere; it is a practice that we discourage.

If you absolutely must ship embryos, we suggest that you contact a company that has the expertise and the experience to make this type of shipment as safe as possible. Locally, we recommend “Swift Stork Courier” (www.swiftstork.com) who will arrange collection and delivery of the embryos and ensure appropriate and safe handling during transport. For long distance shipments, we put patients in contact with “Kynisi Courier Systems” (email: kosta@kynisi.com), a company based in the UK that specializes in shipping embryos. If you want to send your embryos from

San Francisco to Detroit, or Dublin or Dubai, Kynisi is the only company we know that can get embryos on airplanes without being x-rayed in security. They also get advance clearance to make sure that embryos don’t get delayed in customs as they cross international borders. Kynisi can also arrange for an embryologist to travel with your embryos, and they can organize for the embryos to travel in the passenger cabin of the aircraft, as opposed to being thrown in the luggage compartment with the other cargo. This is important, as a Dewar left lying on its side will lose nitrogen more rapidly than when upright. Kynisi’s services aren’t inexpensive, but considering that the embryos are priceless, there really isn’t a good alternative.

For those patients considering moving their frozen tissues to a facility that offers long-term storage at reasonable costs, we recommend “ReproTech” (www.reprot.com) in Reno, NV. ReproTech is experienced and knowledgeable, and gives great customer service. They too can arrange safe movement of your tissue from us to them, and back again with minimal inconvenience. They often take the extra precaution with embryos by splitting them into 2 groups that are then shipped separately. ReproTech shares the PFC philosophy of thinking of embryos as irreplaceable, and they take every known precaution to ensure a safe and efficient shipment. However, despite the good work of ReproTech, Kynisis and others, I recommend that you do not ship your embryos. The risks are too great.

Joe Conaghan, PhD

DonateYourEggs.com

Pacific Fertility Center provides an in–house egg donor agency as a convenient way for our patients to find carefully screened egg donors. Our Egg Donation Agency is always looking for new egg donors to add to our registry. Do you know a college graduate, a student, a young professional or an exceptional woman who might be willing to make a life-altering difference? She could be a young woman who has chosen to delay childbearing or has decided to be childless and wants to help others become parents, or she could be a mother who wants to share the joy of parenthood through the gift of egg donation.

Please send them to our agency’s Egg Donor website. The website has more information about becoming an egg donation and also has an online application.

Please note: Because age is a critical factor in the success of IVF with egg donation, egg donors must be healthy and between the ages of 21 and 29.

Click here: PFC Egg Donor Agency for information about the services we provide egg donor recipients.

We are pleased to announce that our egg donor registry is now available on-line to both current and prospective PFC patients. For many intended parents, having an on-line donor registry affords optimum privacy and convenience when it comes to the egg donor search—an intimate, private, and time-consuming experience. The on-line donor registry is valuable for intended parents living outside of the San Francisco-Bay Area as well. Those wanting to view our donor registry in-person can still do so by contacting our agency in order to schedule an appointment.

The on-line donor registry provides a wealth of information about the egg donor to both current and prospective PFC patients. Prospective patients are eligible to receive “Level 1” access, which allows you to view a donor’s photo along with basic information about the donor. “Level 2” access is available to current PFC patients only and allows you access to additional photos and the donor’s application. Both “Level 1” and “Level 2” access allow the intended parent to search for donors based on criteria such as eye and hair color, ethnicity, region, as well as by certain keywords. The interface is highly intuitive, providing a convenient drop-down menu allowing the intended parent to narrow down the search to meet their particular preferences. For instance, if the intended parent is looking for a blonde donor with blue eyes, the drop-down menu will narrow down the search accordingly. “Level 2” access, however, gives the intended parents the opportunity to review the donor’s entire application and multiple donor photos. Information on the application includes the donor’s personal and family medical history, educational background, and personality traits. The EDA works with PFC’s medical board to cautiously screen each of our donors to increase your chances of having a healthy baby.

In order to access our on-line registry, visit pacificfertilitycenter.com, then select the Egg Donor Agency link to the left, then select Search Egg Donor Registry. The intended parent will be prompted for a username and password. If the intended parent does not have this information, they should call our Egg Donor Agency at 1-800-734-2015. Given the private and personal nature of egg donation—for both intended parents and donors—we have gone to great lengths to ensure that our on-line donor registry has met our rigorous internet security standards.

If someone would like to learn more about our egg donation services and egg donor registry, the first step in the process is to call our Egg Donor Agency or visit our website. Egg donation can be an outstanding family building option for those wanting to conceive but are unable to use their own eggs. Our new on-line egg donor registry will streamline the process of selecting an egg donor, making it easier for intended parents while ensuring privacy for all parties involved.

We are pleased to announce that Pacific Fertility Center (PFC) received a 5-Star rating and an informational listing in the 2005 parenting publication, Babies by the Bay, 2nd edition by Michelle L. Keene and Stephanie S. Lamarre. This comprehensive parenting resource delves into numerous aspects of pregnancy and parenting, including health care resources, pre- and post-natal fitness, maternity clothes, and parenting organizations, to name a few. Most of the parenting resources included are based in the San Francisco-Bay Area. Nevertheless, the book does provide a framework for identifying available parenting resources…regardless of the locale.

PFC is profiled in the Infertility chapter. (PFC’s 5-star rating is the highest rating an organization can receive.) The profile lists PFC’s physicians and provides center contact information.

Additionally, Babies by the Bay highlights worthwhile infertility support groups such as RESOLVE and SOREI. Valuable background information on infertility is provided as well. For instance, there is a section dedicated to the prevalence of infertility as well as steps for identifying proper treatments—from speaking with an OB/GYN, to assessing doctor credentials, to evaluating infertility clinic success rates.

Babies by the Bay provides tremendous flexibility for the reader. Chapters are organized intuitively, coinciding with the different stages of parenthood. Sections on childbirth are located in the beginning, and are followed by sections on schools, and after school activities.

Given its breadth of information, Babies by the Bay makes a valuable addition to the library of any prospective or new parent in the Bay Area.

A Few Good Eggs; Two Chicks Dish on Overcoming the Insanity of Infertility is one of the best books about infertility written from the patients’ perspective. Julie Vargo and Maureen Regan have written a very readable and entertaining book presenting the entire gamut of the infertility experience covering diagnosis, procedures and the psychological challenges faced by patients – mainly women – facing infertility.

The book is organized chronologically starting from the early disbelief after realizing that one might be infertile, through the testing procedures, physician diagnosis and ultimately treatments.

Back-up options for those women and couples for whom treatments are unsuccessful are also explored. Along the way, the authors provide stories of their own experiences as well as the experiences of other women with whom the authors have met and talked in order to write the book. These two women personally went through many of the procedures and shared the same emotions that most fertility patients experience, their unique perspective brings a human touch to their writing. This is a refreshing contrast to the books written for the consumer by physicians or other health care professionals that work in the field.

However, because the book is written by patients and not reproductive endocrinologists (REs), there are some areas that not all REs will agree with, such as their perspective on immunology and infertility. The authors also seem to have gone through their treatments some years ago as the list of drugs is not current with some of the drugs now commonly used for ovulation induction. For example, they mention Pergonal, which is not currently available and do not cover the recombinant FSH medications most commonly used today, Gonal-f and Follistim. Plus, I doubt that a reproductive endocrinologist proofread the chapter on medications because they misnamed Repronex as “Repromax.” I also think their description of the side effects of these drugs is frightening and not typical of the side effects experienced by most women using them in treatment.

The book does provide a lot of useful information in a personal and accessible fashion. Most of the facts are correct. And most of all, the publication encourages women not to wait to get help if they think they may be infertile.

– Eldon Schriock, MD

In conjunction with National Infertility Awareness Week, Northern CA Chapter of RESOLVE’s annual educational event will be held on Saturday, October 29, 2005 from 8:15 AM to 6:00 PM at Holy Names University in Oakland.

This year’s theme is Options 2005: A Family Building Symposium.
PFC is a Platinum sponsor and will have speakers participating in sessions I and II.

Session l: Getting Ready to Choose an egg Donor: Eldon Schriock, MD
Assessing Ovarian Reserve: Isabelle Ryan, MD
Session II: The Latest Developments in ART: Eldon Schriock, MD
Avoiding Mix-ups in the IVF Lab: Joe Conaghan, PhD

For more information and to register go to www.resolvenc.org

Dr. Carl Herbert and
Kari Kawada of IFC

Living in California, with its open attitude, makes it difficult to imagine that some of the treatment choices we take for granted may not be available in other parts of the world. In Japan, IVF is available, and it is now accepted as one of the normal infertility treatments. Unfortunately, there are many restrictions. IVF is allowed only if the couple is legally married. Permission for PGD is determined on a case-by-case basis by the Japan Society of Obstetrics and Gynecology committee. So far, only one case has been approved. Egg donation programs are being considered, but the government and the Japan Society of Obstetrics and Gynecology’s unrealistic proposed guidelines would make it virtually impossible to establish a program. This same governing body has decided surrogacy is illegal in Japan. Through the world wide web, TV and other media, frustrated Japanese infertility patients have been learning of the more extensive services offered by IVF programs outside of Japan. Some fly over 9 hours from Tokyo to California, with hopes that their dreams of parenthood will come true.

This is where IFC, International Fertility Center, comes into the picture.

IFC has been working with PFC, Pacific Fertility Center, exclusively since 1997 to help Japanese couples become parents. IFC informs their clients about the services at PFC, prepares their medical history in English and provides transportation. IFC attends all patient appointments and provides translation and support throughout their entire IVF cycle with the ever-patient and efficient help of PFC’s Janet Debow, RN, IVF coordinator. IFC also works with donor/surrogate agencies, attorneys and Japanese-speaking infertility counselors to make the program happen even while the patients wait in Japan. Ever since we brought patients to Dr. Carl Herbert and his partner physicians, we have been impressed with their thoroughness of care, their generosity of time and understanding and their ability to deliver sometimes painful, but much needed, straightforward diagnoses. Unfortunately, we have discovered that many of our clients, prior to coming to IFC and Pacific Fertility Center, have undergone numerous IVF cycles- as many as 20 or more. Many of these patients would have benefited from egg donation, however egg donation does not exist in Japan. Using the only treatments available to them, these patients continue to hope that their next IVF cycle will be successful and do not have the heart to put an end to their infertility treatment. They stop only when their doctor tells them they are too old. The most wonderful thing about working with PFC is that the physicians, nurses, embryologists, and the rest of the support staff, are so understanding and hard-working. They bend over backwards to make the patients feel welcomed and relaxed, while providing the world’s top-level medical care. IFC had the option to select any infertility specialist’s practice in the Bay Area, and we have never regretted our choice to work with Pacific Fertility Center. The practice is state-of-the-art, ethical, honest, and warm. The PFC-IFC collaboration has been successful and is considered to be a good example when considering the future of reproductive medicine in Japan.

Kari Kawada speaking at the 6th Annual Japanese IVF Conference

As director of IFC, I have been invited to speak about our collaboration at various medical conferences in Japan, including the IVF Conference, Ethics Committee of Japan Fertilization and Implantation Society, Jichi-Medical School, and Tokyo Medical and Dental School. My work has been published in the Japanese OB/GYN periodicals and I have been interviewed for a variety of Japanese media. Our work with Pacific Fertility Center has resulted in many happy Japanese families that remember San Francisco as the place where they truly left their hearts. They all promise to come back with their children one day – to the place where their dreams came true and new life began.

– Kari Kawada, Director, International Fertility Center

•••

Infertility Care Outside the USA
Even though the United States continues to battle out issues related to abortion and stem cells, it would appear that advanced reproductive technologies are here to stay. Few other nations match the quality, number of clinics and the choice of treatment options that couples enjoy in the U.S. even with recent tightening of FDA regulations regarding donors and donated embryos. Without summarizing every nation’s policy, it is worth describing at least a handful to help put into perspective what American infertile couples may take for granted. Besides the Japanese regulations described in the article; New laws just passed by the government in Scotland have removed all donor anonymity. As a result, childless couples in Scotland needing either sperm or egg donation face a wait of up to five years because of a chronic shortage of both sperm and egg donors.

In general, European Union countries with egg donation programs do not allow the egg donors to be compensated for their oocytes – resulting in severe shortages of willing donors and delays in treatment of 2-5 years unless one has a friend/family willing to volunteer.

In Victoria, Australia, non-married people and same-sex couples are fighting to legally receive infertility treatment. Currently they must travel elsewhere.

This past June a voter referendum was unable to overturn one of the most prohibitive laws set in place by the Italian legislature in 2003. This law completely prohibits any donation of egg or sperm, as well as surrogacy arrangements. Only heterosexual couples that prove themselves to be in a stable relationship are eligible for infertility treatment. Also, only three embryos may be created at a time and all three must be implanted simultaneously. Freezing of embryos and sperm is prohibited and unused embryos must be kept until they perish.

In South Africa an organ smuggling scandal caused the country’s egg donor program to be shut down for 18 months even though the two were proven later to be unrelated.

In the last ten years or so in the U.S., we have seen an explosion in the number of over-the-counter dietary supplements for all manner of ailments as well as for the promotion of general health. Some are vitamins with well-known beneficial properties. Some are herbal supplements with a history of traditional Chinese medicine yet with little in the way of Western scientific studies to substantiate their use. Many other supplements contain elements and substances with very little known benefit.

Now there are several preparations being marketed to promote fertility. In this article, I chose to review three of the major products being actively marketed for the purposes of improving sperm.

The oldest supplement is ProXeed™. ProXeed™ is a citrus-flavored powder and can be dissolved in juice or other cold beverages. It is recommended by the manufacturer to be taken twice a day. The active ingredients in Proxeed™ are L-carnitine, L-acetyl carnitine and fructose. The cost is approximately $335.00 per 3-month supply.

Fertile One® is a pill that contains L-carnitine, anti-oxidant vitamins (ferulic acid, vitamins C and E, garlic, co-enzyme Q10 and selenium), ginseng root, zinc and B-complex vitamins (B-6, B-12, B-9 and folic acid). Cost is approximately $273.00 per 3-month supply.

FertilityBlend® for Men is a supplement containing L-carnitine, ferulic acid, vitamins E, B6, B12, and the elements selenium and zinc. The cost is only about $80.00 per 3-month supply.

Several studies have shown that the amino acid L-carnitine may promote sperm development. In a recent clinical trial¹, 102 men with low sperm motility were treated with L-carnitine and acetyl L-carnitine. There was a significant correlation between higher levels of carnitine in the seminal (sperm) fluid and better sperm concentration, total sperm count, sperm total motility, rapid forward progression, live sperm count, membrane function, nuclear DNA integrity, capacity for cervical mucus penetration, linearity of spermatic movement, and amplitude of lateral sperm head movement after 3 and 6 months of L-carnitine/acetyl L-carnitine treatment. Another high quality study, a randomized, placebo-controlled trial of L-carnitine and acetyl L-carnitine showed that after 6 months of treatment increases were seen in all sperm parameters and the most significant improvement in sperm motility was present in patients who had lower initial absolute values of motile sperm (<4 million forward or <5 million total motile spermatozoa per ejaculate)². There are no published randomized controlled trials looking at pregnancy rates on L-carnitine.

Several studies on the B Vitamins have been published showing anti-oxidant effects and virtually all find some benefit to the addition of this group to a daily vitamin regimen.

Ferulic acid is found in various medicinal herbs, has recently been shown to scavenge oxygen free radicals and increase the intracellular cAMP and cGMP (energy molecules). The only published article on ferulic acid involved adding this substance to previously ejaculated sperm specimens where it was shown to improve sperm motility³. A medline search did not reveal any studies on sperm after ingestion of ferulic acid.

It is interesting that Fertile One® contains garlic; at least one study has reported an inhibitory effect on garlic on sperm motility and survival in human and mouse sperm⁴ and crude extracts of garlic bulbs have been shown to immobilize ram sperm and are being investigated as a potential male contraceptive⁵.

Selenium is a trace mineral that is incorporated into several anti-oxidant proteins. It has been shown to improve human sperm parameters⁶ and fertility improved slightly when selenium-deficient mice were treated with it ⁷. What is not clear is whether most men with a normal diet would be selenium-deficient.

Folic acid supplementation may also be beneficial, especially for men who smoke Cigarettes⁸. Treatment of men with folic acid and 5 mg zinc improved sperm counts by 60% and also improved morphology (shape)⁹. Vitamin E has also been shown to improve sperm parameters and sperm-egg binding¹⁰. Co-enzyme Q10 has been shown in one small uncontrolled study to improve sperm motility in males¹¹ but studies of men with a varicocele (dilated scrotal veins) suggest that high levels of seminal fluid Co-enzyme Q10 are found with men with the lowest sperm motility, suggesting that Co-enzyme Q10 would not be beneficial for men with a varicocele¹².

Considering all these studies, there does seem to be a beneficial role for dietary supplementation for men with low sperm counts and low motility. The supplement marketed as FertilityBlend® for Men has almost all of the most well studied ingredients and is considerably less expensive than the others. Avoidance of garlic extracts and further supplementation with folic acid may also be beneficial.

– Carolyn Givens, MD

References:
1. Correlation between seminal carnitine and functional spermatozoal characteristics in men with semen dysfunction of various origins. De Rosa M, Boggia B, Amalfi B, Zarrilli S, Vita A, Colao A, Lombardi G. Drugs R D. 2005;6(1):1-9.

2. A placebo-controlled double-blind randomized trial of the use of combined l-carnitine and l-acetyl-carnitine treatment in men with asthenozoospermia. Lenzi A, Sgro P, Salacone P, Paoli D, Gilio B, Lombardo F, Santulli M, Agarwal A, Gandini L. Fertil Steril. 2004 Jun;81(6):1578-84.

3. Effects of ferulic acid on fertile and asthenozoospermic infertile human sperm motility, viability, lipid peroxidation, and cyclic nucleotides. Zheng RL, Zhang H. Free Radic Biol Med. 1997;22(4):581-6.

4. Spermicidal effect in vitro by the active principle of garlic. Qian YX, Shen PJ, Xu RY, Liu GM, Yang HQ, Lu YS, Sun P, Zhang RW, Qi LM, Lu QH. Contraception. 1986 Sep;34(3):295-302.

5. Sperm immobilization activity of Allium sativum L. and other plant extracts. Chakrabarti K, Pal S, Bhattacharyya AK. Asian J Androl. 2003 Sep;5(3):230.

6. Male fertility is linked to the selenoprotein phospholipid hydroperoxide glutathione peroxidase. Foresta C, Flohe L, Garolla A, Roveri A, Ursini F, Maiorino M. Biol Reprod. 2002 Sep;67(3):967-71.

7. Sperm oxidative stress and the effect of an oral vitamin E and selenium supplement on semen quality in infertile men. Keskes-Ammar L, Feki-Chakroun N, Rebai T, Sahnoun Z, Ghozzi H, Hammami S, Zghal K, Fki H, Damak J, Bahloul A. Arch Androl. 2003 Mar-Apr;49(2):83-94.

8. Low seminal plasma folate concentrations are associated with low sperm density and count in male smokers and nonsmokers. Wallock LM, Tamura T, Mayr CA, Johnston KE, Ames BN, Jacob RA. Fertil Steril. 2001 Feb;75(2):252-9.

9. Effects of folic acid and zinc sulfate on male factor subfertility: a double-blind, randomized, placebo-controlled trial. Wong WY, Merkus HM, Thomas CM, Menkveld R, Zielhuis GA, Steegers-Theunissen RP. Fertil Steril. 2002 Mar;77(3):491-8.

10. A double-blind randomized placebo cross-over controlled trial using the antioxidant vitamin E to treat reactive oxygen species associated male infertility. Kessopoulou E, Powers HJ, Sharma KK, Pearson MJ, Russell JM, Cooke ID, Barratt CL. Fertil Steril. 1995 Oct;64(4):825-31.

11. Coenzyme Q(10) supplementation in infertile men with idiopathic asthenozoospermia: an open, uncontrolled pilot study. Balercia G, Mosca F, Mantero F, Boscaro M, Mancini A, Ricciardo-Lamonica G, Littarru G. Fertil Steril. 2004 Jan;81(1):93-8.

12. Coenzyme Q10: another biochemical alteration linked to infertility in varicocele patients? Mancini A, Milardi D, Conte G, Bianchi A, Balercia G, De Marinis L, Littarru GP. Metabolism. 2003 Apr;52(4):402-

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.