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.

My infertility journey started when I was only 17. I was diagnosed with endometriosis and underwent my first laparoscopy. I had temporarily relief and then my symptoms returned. I tried various alternative treatments but they too offered only temporarily relief. This was not the life that I wanted to have as a young adult who wanted to have children more than anything in the world.

Surgery after surgery, specialist after specialist, my quality of life was slowly going down the drain. Initially, I told doctors that I didn’t want to have a hysterectomy but later, something had changed. I was eight surgeries into my journey and I asked my doctor if I could have just my uterus removed so I could still try and have a biological child. He said yes and I was quite relieved. After the surgery, I felt better for a while, but the pain still continued. I had to evaluate my life and decide what was important to me. I knew I wanted to live, but the pain had me in and out of the hospital and often times feeling suicidal. I had no other choice but to have my ovaries removed.

Luckily, I thought about freezing embryos and called Pacific Fertility Center. I met with Dr. Isabelle Ryan and she changed my life. My boyfriend and I knew we wanted to get married and I was on a limited time line until I had my ovaries removed. We only had one chance to do this and we were determined to do it right. We underwent one cycle of In Vitro Fertilization and froze all of our embryos. We froze our embryos at a 2PN stage* per Dr. Conaghan and Dr. Ryan’s request. This would help our chances of having them thaw better but we don’t know how they will turn out. We were willing to take that chance.

Two weeks later, I had my ovaries removed and then felt I was ready to move on with my life. My boyfriend and I got engaged and together dealt with the loss of having me carry our child. In our counseling session with Peggy Orlin, MFT at Pacific Fertility Center, we talked about what if a gestational cycle didn’t work. We knew that we would be parents no matter what and if it wasn’t our biological child we could be ok with that.

From time to time, I still grieve the loss of being pregnant, but know that I did everything that I could. Since then we have gotten married and have been offered the opportunity of a lifetime. A dear friend has said that she would like to carry our child. She has restored our faith in humanity. What an offer!

As we are working out the details, we are thankful for her commitment to us and our journey. We will transfer some of our embryos into our gestational carrier and hope for the best. Dr. Ryan and all of the staff at Pacific Fertility Center have been so supportive of us that we can’t wait to come back when we are ready to do our transfer.
Anonymous, San Francisco

* A note from Laboratory Director Joe Conaghan, PhD:
Embryos can be frozen at different stages of development, usually 1, 3 or 5 days after oocyte retrieval. In general, the earlier they are frozen, the better they tolerate the freezing process. Embryos frozen on day 1, or at the 2 pro-nuclei stage, survive freezing and thawing at a rate over 95%.

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!

Couples who are at risk of passing on an inherited disease are probably familiar with genetic counselors. However, those who have decided to undergo IVF with Preimplantation Genetic Diagnosis (PGD) will need to see a genetic counselor who is specialized in the procedure of PGD itself. It is important to make sure that the mutation in question can be diagnosed by PGD since not all heritable diseases have DNA probes. And sometimes there are other means of using PGD to determine mutation likelihood.

In cases where there is concern about chromosomal abnormalities rather than single gene defects, Preimplantation Genetic Screening (PGS) is another option that requires a genetic counseling session. The genetic counselor can help patients understand the basics of chromosomes, how they affect the health of embryos and what this testing conveys about the embryos.

Some of the common reasons why patients undergo PGS include:
1. Age (eggs of women >35 years old have a higher risk for chromosome abnormalities),
2. Unexplained recurrent pregnancy loss,
3. Gender selection for genetic disease,
4. History of unexplained unsuccessful IVF cycles.

Who Are Genetic Counselors?
Genetic counselors are health care professionals with graduate degree training in genetics and counseling, and certified by the American Board of Genetic Counseling. Genetic counselors practice in several subspecialty areas of genetics including assisted reproduction technologies, infertility genetics, and prenatal diagnosis. Because your genetic counselor can see you to discuss PGD or PGS, as well as prenatal testing options once you are pregnant, you will receive continuity of care. He/she will help you understand the complex information involved in your PGS cycle, and encourage your own decision making according to your needs. He/she will also serve as a liaison between you, your fertility doctors, and the PGD/PGS laboratory.

What Happens During A Genetic Counseling Visit?
There are two main objectives:
1. Family History Review: Your genetic counselor will take a three generation family tree (pedigree) to identify any additional genetic risks. This process ensures that the type of screening being offered is correct, and to identify any additional testing needed. Medical records may be requested for review.
2. Informed Consent: Informed consent includes an in depth discussion of the PGD/PGS process, from beginning to end, and a review of the information in the consent form, which is designed to inform and protect patients. Important information contained in the consent form includes risks and limitations of PGD/PGS, as well as the purpose of the procedure and the diagnostic technique. Your genetic counselor is available to answer questions regarding its content and to help you thoroughly understand it before signing. For those who have already gone through IVF, the beginning of the IVF with PGD/PGS cycle will be familiar. However, as complex as IVF is, embryo testing adds yet another layer of complexity. Additional steps include biopsy procedures, screening of a single cell for specific chromosome abnormalities or DNA mutations, and reviewing the results prior to embryo transfer. Only a genetic counselor is especially trained to mentally guide you through this process before you are actually in cycle so that, hopefully, there are no unanticipated outcomes.

How Can I Find Out More?
Please contact the Certified Genetic Counselor working with Pacific Fertility Center: Lauri Black at (415) 600-6371.

– Carolyn Givens, MD and Lauri Black, MS, CGC contributed to this article

I have learned that things in life do not always turn out the way you might have thought that they would. What seems to be the “standard” life may not be so easy to attain. I just turned 45 years old and have just found out that I am pregnant for the second time since working with Dr. Chenette. We have a four year old son who we conceived the “old-fashioned” way after Dr. Chenette removed a polyp from my uterus. We wanted a second child, and somehow I thought that if we did it once, we could do it again. I have of lost track of the cycles, but over several years, we have done IVF at least 3 times with several incomplete cycles and hysteroscopies in between. After failing the 2nd IVF, egg donation came up in our meeting with Dr. Chenette. My husband was ready to do it the next day because the odds were much better. I was more hesitant and felt that I needed to try a 3rd IVF cycle with “my eggs” first. In the meantime, we entered counseling and I joined a donor support group. The counselor was wonderful and so was the support group. The idea of egg donation grew comfortable for me as an option. After our 3rd cycle failed, we started looking for a donor. Although a strange process, something became clear. The look, the height, the intelligence etc., were not as important as just finding a nice, happy person who seemed to approach life the way that I do.

I looked for “nice eyes”- for I believe they tell you about a person. We found a donor and I really like her. Now, everyone probably works through this process in their own way, and that is the point. To find what you and your partner are comfortable with, and to take it one day at a time. I try not to worry – it’s easier and more fun to be positive. I envisioned myself at this point in my life to be like a Mrs. Cleaver with a couple of kids and a fancy hairdo like a grown-up. But I met my husband later in life (and learned a lot up until then…). I still feel young. I am healthy and we all really want a second child. We are hoping that it is meant to be, and we are grateful to Dr. Chenette, the special nurses (Sue, Ann, Pat, Carol and the rest), and the nice staff at PFC for their services and their support.

–A.W. in Oakland

Following Halloween, the holiday season suddenly looms. Excited children, crowded stores, decorations, and holiday parties are all set to descend on 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. Coping is “developing the ability to manage in a difficult situation.” Here are a few suggestions. Use whichever of these suggestions seems helpful to you. Do what feels right for you.

DO: 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.
DO: Reach out to childfree friends. Their parties will be adult-focused.
DO: Choose the gatherings you attend carefully. If you are upset by being around children or babies 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 get moderate amounts of exercise. Eat healthy 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. Or attend on a university campus, as those services tend to be more adult focused.
DO: Volunteer at a nursing home or homeless shelter. It may help to help others having a difficult time at the holidays.
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 to share your feelings.

Stress reduction through mindful well being… while this may sound like a new age mantra, the medical community is growing in consensus about a mind/body connection that can positively impact a patient’s health. No other physician has probed the mind/body infertility correlation deeper than Alice D. Domar, Ph.D., who has written extensively on health and stress, conducted research and designed a comprehensive workshop series. Included in these mind/body and mindfulness health and wellness programs are relaxation techniques involving controlled breathing and posture awareness; yoga, meditation, journaling, neuro-linguistic programming, and joining a support network. Dr. Domar’s techniques are designed to help women treat their own stress responses so their bodies might have a higher chance of conceiving. Pacific Fertility Center’s team has examined the scientific, medical and anecdotal information surrounding the topic of stress and infertility. And because various relaxation inducing/stress reducing techniques are likely to have an overall positive impact on a patients’ general health, PFC is offering classes modeled around Dr. Domar’s mind/body practice (see Mind/Body@PFC) Indeed, infertility clinics all over the country are offering similar programs despite the lack of scientific consensus about how stress affects fertility. Skeptics point out that millions of people under extremely stressful circumstances, even kidnap and rape victims, 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. 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 serious an illness, the more anxiety it can induce in a patient, thus potentially bringing on accelerated and aggravated symptoms. This vicious stress/body cycle, when broken through stress reduction techniques, can provide overall improvement in health. Dr. Domar’s 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 using either relaxation techniques or though the psychological support of joining a group. With so much growing attention into the mind/body stress reduction methodologies, there is bound to be a greater body of critical scientific knowledge gathered. Meanwhile, take a deep breath and consider your own stress response strategy.

– Carolyn Givens, M.D. and Isabelle Ryan, M.D. contributed to this article