your great life

Menopause predictor may give women a false sense of reassurance

A new test that can pinpoint the time when a woman enters menopause to within 4 months, has been in the news this week.

In a 1998 Iranian study of 266 women aged 20 - 49, researchers measured levels of a hormone known as the anti-Mullerian Hormone (AMH) produced by the women's cells. AMH controls follicle development in female ovaries. Using the AMH concentration as a model, the researchers were able to predict the actual menopause of 63 study subjects. Then the women were tracked every 3 years to the present. The results were announced this week at the European Society of Human Reproduction and Embryology (ESHRE).

Claudia Hammond of BBC World Service interviewed Dr Ramezani Tehrani, who led the research team. Dr Tehrani discussed the reasons a woman would want to know, as early as her 20s, when she would enter menopause, citing higher education, career plans, osteoporosis and cardiovascular illness, breast cancer and endometriosis as important factors. She expressed confidence in her study, saying that the simple blood test is ready for use immediately.  I can see that there are potential benefits of such a test. There are all sorts of health reasons a woman may want to know when she will enter menopause, including:   

• it may prompt a woman to build preventive health measures into her lifestyle, like weight-bearing exercise and calcium supplements for bone strength; 
  
•  it would be easier to diagnose and treat the symptoms of peri-menopause within the context of the test results;
  
• armed with knowledge of how long they would be fertile, all being well, women could plan ahead about long-term use of the birth control pill, or IUD v. other means of contraception; and
  
• it is thought that women's migraines, and aspects of their emotional health, could be due to or affected by their hormones.  Diagnosis could be more precise and medication more accurately prescribed.
  

There are social reasons also. Think of these as the 'Sex and the City' reasons. While those film characters dated, worked, broke up, partied and obsessed about the men in their lives, they all thought that parenthood and menopause were for later or someone else.  If women like Carrie and Charlotte knew the exact number of years between then and menopause, they might have had more peace of mind about finding the right man.  In real life, just as in gthe SATC version of women's lives, there are predictable scenarios:

1)     Let’s say a woman in her late 30’s hears the ticking of her biological clock, but is unsure of whether her boyfriend is marriage-and-father material. If test results tell her that menopause is going to begin at 51 years old (average age of onset), she knows there is still time to find the right man, rather than marrying the wrong guy for the purpose of having that child.

2)    If a woman places high value on having a baby, but knows that she only has a small window of opportunity, she may decide that she doesn’t want to run the risk of time running out. She has a big decision to make: baby v. stressful position at work, single mother v. part of a couple?

Now, here’s the flip side.  It doesn’t seem like a large enough study group for the results to be claimed as extremely accurate.  Only 63 of the women went the distance within the study and I haven’t seen any statistics about the other 203 women.  It seems that the research group was only correct in a little less than a quarter of the women originally tested.  While most of the 63 women experienced the predicted result, within 4 months of the date, some were as wide apart as 4 years. t’s still a positive result, but only a handful more than those that big, multinational cosmetics companies use to say that 78% of 46 women agree this conditioner reduced their frizzies. I would caution women about relying on its results exclusively. It seems that Stuart Lavery of the British Fertility Society agrees with me: “The issue where we would have a concern is if people become too reassured by this.” My concerns exactly!

Women, who have no reason to believe that they are infertile, could be harmed by false reassurance that they could conceive up until the predicted onset of menopause. Many women can spend 2 to 3 decades following their first sexual experience, trying to avoid pregnancy. It’s already easy, with stories of women having babies later in life, to become complacent about putting off pregnancy. The danger is that a woman may lose out on years of healthy eggs and/or corrective treatment for undiagnosed obstacles to conception. When she decides that it is the right time for her to have children, she may be shocked to find that other conditions, such as endometriosis, blocked fallopian tubes, ovarian cysts, high or low thyroid count, could keep her from achieving that.

It was suggested that this blood test would be available as a home-kit, on sale to the public in 3 years. I would prefer to see the blood test available via gynaecologists, or even general medical practitioners, so that the limits of its application could be explained to the patient. At the very least, the insert in a kit should state the caveat, that knowing when you will reach menopause does not mean that you are fertile and able to conceive without assistance up until that point.

Hanging out the dirty laundry

I've had 2 friends tell me this week that Americans are so much more open and willing than the British to confront personal adversity, both in conversation and in personal exploration. One of them made "open and willing to explore and talk about their feelings" sound like a negative trait. He likes making deadpan, inflammatory generalizations about Americans, so I knew not to rise to the bait. In fact, I only remembered it when my second friend was thinking out loud about how I can make my services accessible to a bigger proportion of the IF community in England. 

This second friend, also British, was using a much more even-handed approach. She was musing about the generations of English folk who embedded a behavioural code; keep your personal life private.  There was an old-fashioned saying used in both countries: "Don't hang your dirty laundry out to dry." It was meant to avoid criticism or public shame. With the enormous popularity of reality TV shows in the U.K., you might think that the saying is obsolete; On Big Brother and I'm a Celebrity, Get Me Out of Here, the dirty laundry is the least of it. I think that the British public has two sets of rules:

1. They hide their own (and their family's) bad news to maintain their privacy and position of respect, however;
2. They like the titillation of watching someone else's fall from grace, especially if it's about someone who thought they had it made (career, money, fame, talent or beauty).

Americans, on the other hand, believe that if you need help with something, you may as well use what you have got, whether that means knowledge, connections, media attention, telling Oprah or putting it on a billboard.

As an American, by birth and upbringing, and a British resident for 15 years, I can say that there are myths and misconceptions on both sides. Let me dispel some of them.

1. Not every American has "a shrink," life coach and personal trainer, without whom they could not function. That is a British myth, and frankly, more British could use them than do.
2. IVF isn't a trend (like Botox or colonic irrigation) in either country.
3. Not every American will blab in public about their most private issues, contrary to what Brits see on the Ricki Lake, Maury Povitch or Jerry Springer shows. In my opinion, those shows exist only to give their guests 2 minutes of fame and make most other people grateful that it isn't them doing the accusing, shocking, arguing or brawling.
4. Class is still an element of British life. Initially, people use accent to guess each other's socio-economic backgrounds. Second, there will be questions about where you are educated. Politicians like to be seen as salt-of-the-earth, regular folk to get the popular vote, but when it's a 2-man (or 3) race, and they all have posh origins, they can relax about it because no fingers are being pointed. You only have to watch British TV shows like Jeremy Kyle, Eastenders and Emmerdale to know that there is a working class and then there is low class.
5. There is a generalization that Americans are all optimistic and British are all pessimistic. That's not entirely true; let's settle on 60/40.
6. On the one hand, Brits think that most of the U.S. population is obese. On the other hand, they also blame the U.S., and in particular L.A., for the Size Zero woman. They may be right on both counts, but the British shows like Trinny & Susannah, 10 Years Younger, How to Look Good Naked, Super-size v. Super-skinny and  Fat Families-Second Helpings, show that fat and skinny look the same on both sides of the Atlantic Ocean.
7. For all their obsession with "value for money," the Brits prize appearances even more, and would never ask for a "doggie-bag" at a restaurant.
8. Americans need those "doggie bags," not because they are cheap, but as time savers. They lead very busy lives, with all those visits to the shrink, life coach and personal trainer.
9. Just because the U.K. operates a National Health Service does not mean it's a socialist country.
10. The U.S.A. is not, as a whole, racist, homophobic, ethnocentric or untravelled. That's just the middle of the country (kidding, I swear).
11. You can tell alot about a country by its natives' favourite idioms; in America it's "have a nice day" and in England it's "Sorry?"
12. It's quite apparent that Americans of all types believe in purposeful self-improvement. Community adult schools and universities offer classes in everything from small vehicle maintenance to the History of Maoist China.  Elderhostel, which takes seniors on fascinating study tours worldwide, is an aspiration of many still 10 years too young to qualify. British people may be doing the same with the Open University or other adult learning scheme, but you wouldn't know it because, "Shhh!" they don't talk about it.
13. British people think that America does everything in a larger-than-life way, especially when it comes to food, loudness and cosmetic surgery.  They don't look at their own society in the same way, but they should. There are those football yobs, the need for Asbos, high-fat takeaway food, plenty of Botox, boob jobs and lip augmentation.
14. There are more CCTV cameras on UK streets than in any other European nation. We are always being watched. It's meant to reduce traffic violations and anti-social behaviour, which probably includes nose-picking, applying eyeliner and mascara while driving, talking on mobiles while cutting you off, throwing cigarette butts out the window and looking at their GPS instead of the road.In contrast, America really does feel like the Land of the Free.
15. The British visit the US for shopping in NY, seeing Disney in Orlando, foot-long hot dogs and super servings of everything else, including the hotels and casinos of Las Vegas. Americans visit the UK for the accent, London cutting-edge designers, cream tea at the Ritz, exorbitantly priced, gorgeous tins of tea, biscuits and chocolates from Harrods or Fortnum & Mason, and to see the Changing of the Guard. Really, not so different from each other.

So, back to the personal adversity I brought up at the beginning: In my experience, English people keep topics of a medical nature quiet for ages, only revealing details on a need-to-know basis, even among their own family.  Suddenly, they are close to dying and you think, "why didn't anyone tell me?" Americans don't seem to feel the same shame attached to illness or other medical condition. In fact, it seems that the prevailing thought is that the more people who know about it, the more support and referrals to specialists or ground-breaking treatments they will get. In the UK, because you have little control over the type of treatment you will be offered and not needing to find the specialists yourself, there is no obvious advantage to putting the awful news out. 

There are advantages and disadvantages to both concepts of privacy, so whichever works for you is what you should do.  In the little world that I occupy, I have no trouble talking about business being slow, children going through a naughty phase, having had IVF, seeing a coach or counsellor, or answering with something other than "I'm fine." The people I attract either speak with the same attitude, or wish they could. Note that speaking up on my own behalf is not the same thing as coach-client confidentiality, in which I adhere to a Code of Ethics. There, it is the client's privacy that needs protecting, not my own.

Do you have an opinion on this? Please leave a comment.

Only 2 days to catch up on a week of ICLW!

Most months, by this time of ICLW week, I am well into my blog reading and commenting. This month, unfortunately, I am not starting until day 6. It's nothing personal. There just hasn't been the time for me to cruise the list of blogs, read and really enjoy them and comment. I will probablybe up quite late on Saturday and Sunday, doing all of that. If you are reading this, you can help me catch up by leaving a comment and I will both reply and visit your blog. Please cheer me on in the wee hours, so I can meet my quota of blog comments!

This morning, I am going into London for the Destination Health Exhibition. It's all about medical tourism; traveling abroad for medical treatment. It was meant to take place 2 months ago, but was cancelled because of the volcanic ash that grounded all airplanes.  I am going for 2 reasons:

1. out of curiosity, to see who goes to the exhibition; and
2. to attend the noon talk on fertility treament abroad. I would like to find out whether traveling abroad for fertility treatment is a trend, a necessity, or a kill-2-birds-with-one-stone holiday.

For those of you who don't know me already, I am a fertility coach, advocate and writer. Going to events like Destination Health is part of the job; keeping me up to date on anything to do with reproductive or maternal health, news, opinion pieces, medical trends, but most of all what the infertile community needs, thinks and uses.

When an infertile gets to the stage in treatment where they either have reached their maximum number of cycles on the NHS, feel the financial pinch or have lost faith in their doctor, the resulting stress could be:

• emotional
• financial
• marital
• job-related
• social
• low self-confidence
• physical, both in body image and physical symptoms
• reproductive malfunctions

That is where I come in; helping individuals and couples to feel more positive, make necessary lifestyle changes, find the right clinic for them, explore options and make decisions about continuing or stopping treatment, or trying something different. I help people to ease that stress, re-establish their commitment to having a biological child of their own, communicate their needs better and heal emotional wounds. Taking one step forward, such as informing yourself about options like foreign, medical "tourism" can immediately remove some of the stress manifestations in the list above.

I would really like to know what you think, and whether you would ever consider a 2-week trip or even combining it with a vacation for your fertility treatment. Watch this space, as I will report back to you on the Destination Health Exhibition next week.

P.S. I met Veronica Little of Barbados IVF Centre this past week. Astonishingly, we live about 10 minutes apart in the Greater London area. I was curious to know how their service for international patients could be both effective, with a very good success rate, and at the same time, relaxing and enjoyable. If you want to know more about their particular set-up, go to http://barbadosivf.org or follow them on Twitter @barbadosivf. * I do not have an affiliation with Barbados IVF Centre, however, you are welcome to tell Veronica that you heard about BFC from me.

He doesn't get it, but that's okay

Tell me, truthfully...do you really want your partner to feel the same way you do about everything? You may think that would make life so much easier.  Haven't we all moaned at one time or another: "Why can't they be more like us?" Sure you have.

If you haven't ever thought about it that way, make a list of all of the important aspects of your life: marriage, parenthood, friendship, health, money, career. in-laws, infertility. Then, make a list of those personal traits in others who figure in your life right now and how each affects you. Relationships. Fairness. The way a boss treats us. The expectations a parent or parent-in-law has of us. The insensitivity of a friend. The rudeness of a doctor. The stonewalling by an insurance company agent.

Q: How does your husband react?

A: "He doesn't get it. He thinks I'm overstating it. He doesn't understand."

Q: How would you like him to react?

A: "He should (flashing red light here) feel the same way I do."

Think about this: You have a problem and you want to talk about it. He thinks "uh-oh, there goes NCIS, or the World Cup."  You try to explain it to your husband and you get a minute or two of focused attention. Sometimes, you get useless advice, like "don't let it get to you"  or "it's going to be fine. Have you ever raged about something to do with job, family commitments, or fertility treatment and been answered with "What do you want to do? Do you want to quit?" Look at your husband as if he's crazy and truly doesn't get it. You will probably be rewarded with an infuriating "What do you want me to say?" 

If you're anything like me, you often wish you had told one of your best girlfriends instead.  Even if she doesn't have any experience of the event that upset you, she will have experience of a supporting role and she will know what is required. So, she listens attentively and doesn't try to kill two birds with one stone by fixing a broken power tool at the same time.  Best girlfriends know when to stay silent and when to speak, what tone of voice to use, when to offer a hug, a drink, a pint of Ben + Jerry's, some scathing words for your nemesis, when to drag you to a soppy movie and when to cry with you. She'll understand that you need to get it out, but that quitting isn't an option.

Ex. you and your husband are having fertility treatment to conceive. He comes home from work, happy to see you. Within minutes you are telling him how much you hate seeing one of the doctors at the clinic, because he's dismissive. It's stressing you out and you are supposed to avoid stress.  You worry that if you complain about the doctor to someone at the clinic it could compromise their commitment to your treatment. Stress, frustration, anger, stress.... 

What is his response? Would it be helpful if both of you occupied that emotional space?  "No, but..." you still want him to mirror your feelings. It won't happen that way. He isn't on mood-altering drugs. He isn't being subjected to daily visits to the clinic, but when he goes with you, he doesn't pick up on the nuances of your welcome by the receptionist, your abandonment in an empty room with nothing more than a hankie to cover your body, the tone of voice the doctor uses and his haste.

Why do we think that our male partners should see or feel things the same way we do?  There's so much contradiction there. We have all heard that "opposites attract." Then, we hear people say that they are "soul-mates." I'm not that cynical a person, but that word always makes me wince. Even when men demonstrate some insight into your feelings with such clarity that you wonder how you could have misjudged him  all this time; the next shock will be how he reacts in the same, old, male way to the next crisis. You will wonder whether you imagined it all.

Think about it; If you and your partner both absorb painful experiences in the same way, you have twice the potential of collapsing under the weight; of falling apart. Misery loves company, but what you really need when you're in a state is someone who can help you see the light when YOU are ready to open the blinds.

My husband and I have remarked over the years how it's good that we are rarely ill at the same time.  Additionally, we hardly ever feel emotionally low (okay, depressed) at the same time.  Maybe it's because we are complete opposites.  Maybe because we are each vulnerable and need someone in the cheering section to bring us back up. When I feel confused, frustrated or angry, it reassures me that my husband seems steady and calm. If I want someone to take over when I am ill or an actual shoulder to cry on, he's there. If I want more intuitive understanding and support, my girlfriends are there.

Take the pressure off your man to empathize completely and see how he practically skips on air with relief. It doesn't mean he's off the hook completely; he has to at least make some effort to understand. However, I think you will find that it can actually feel quite freeing to not feel that dependency on him to confirm that you are right. Just assume you are and go to the best source you know for agreement.

*Wide-ranging generalizations about men's limited capacity for emotional intelligence have been used for the writing of this story. Please don't write to tell me that I hate men (I don't) or that my assumptions are presumptuous. If your man has a generous share of feminine qualities, and agrees with everything you think, feel and say, just count your blessings and let the rest of us whinge.

Indian surrogates are very cooperative?

This Tweet appeared in my timeline tonight:

#Surrogate mothers in #India are very co-operative and never cause any legal issues & also they don’t fight for ur kid http://bit.ly/aTSEa7

In the blog, Dr Shilpa Saple talks about how surrogates in the U.S. reserve a right to claim the child they bear. She wants to reassure interested parties that this legal right doesn't exist in India, therefore they won't run the risk of a custody battle. 

Does anyone else think that sounds really suspect? I hope that its the stiff use of English as a second language that makes this sound like the surrogates are like penned innocents with no rights.  Let me state right away, that I am in favor of people being able to travel abroad for the best medical care at the best price.  I don't have any direct experience of Rotunda IVF and have no problem with either them or the country of India as they relate to fertility treatment.  I would commiserate with any couple who found themselves involved with an "uncooperative" surrogate, who Gd forbid, decided to stake a claim to they child she carried for them.

Maybe it's my middle-class, Western political correctness coming out.  I once read a novel about a society in which a separate class of women were used as breeders by the upper class, but not allowed any emotional involvement. They were meant to accept their lot in life; even be proud of doing their duty. It also reminds me of the Stepford Wives. Except in India, the women are real.

Taking on surrogacy is an enormous decision, involving the woman's physical and emotional health. I don't object to the commercial aspect of surrogacy at all; I just want reassurance that it is being done with good will, regardless of how much it paid. I have read stories of poor Indian women traveling from their villages to the cities to become surrogates, so they can bring a substantial payment back to help their own families.  As long as it is completely voluntary, fairly compensated and will actually allow the women to achieve that better life they want, it makes some sense to me. I just don't want them to sign away any rights that they will need if all doesn't go to plan.

In regard to the suggestion that the Indian surrogates are being exploited by well-off Westerners who pay for whatever they want, I think the issue is more about how they are managed and treated by the IVF clinic itself.  One could argue that it is the Indian clinic and surrogates are the ones doing the exploiting, since they see a market demand and are rushing to fill it, helped along by their different economy. The $6,000 the woman might earn goes a long way in India.

What do you think? Is the Tweet at the beginning of this post poorly worded, or suspect? I'm sure that Dr. Saple has the best interests of her patients and clients in mind.  Perhaps it is just the sweeping generalizations she makes in her blog that make me worry; not just about this topic, but also about how American gay couples live in isolation and how they are offered only impaired children to adopt. I can't help but think that she needs a ghostwriter or editor.

Please leave a comment about how you see this situation. Thanks xx

How I Use Twitter; one year on

Family and friends don't understand why I use Twitter.  I guess that, compared to those people who know virtually nothing about Twitter, I know quite a lot. Even when I bubble over about it, they look at me with raised eyebrows and hunched shoulders of the unconverted. But, among my more savvy and/or geeky friends, I am the one who asks endless questions (thanks especially to @AbsolutePA and @gina_romero) and learns by doing, in an often painstakingly slow trial and error. 

If you have yet to discover Twitter firsthand, or have only made half-hearted attempts at it, this is how I use Twitter and these are some of the people I follow.  I started by searching subjects I found interesting and if I liked what someone said, I followed them.  Through visiting their Twitter pages, I made my next level of decisions ("unfollow" is a great tool) and found other people to follow. 

I don't follow everyone who follows me, and I don't expect everyone I follow to follow me back.  If you do follow each other, you can comment on each other's tweets, and send each other either public or direct messages in Twitter "conversations."  After a while, it seems like we know each other, but it's also good to remember that you only see what someone else wants you to see. Unless you're in it just for the numbers, following is based upon the value of what appears on your Twitter page; I value useful content and networking, but also amusement, attitude, valuable links, friendship, finding "lost" friends from 20 years ago, keeping in touch with busy friends and laughs.

If you know nothing about Twitter and have no one to follow, you could do worse than to sign up and follow my friend Jane Milton, a.k.a. @foodnetworking. As far as I know, Jane makes the best use of Twitter, to do research, set up appointments, publicize her food industry networking group, re-tweet for her friends and colleagues, keep is in touch with her very full life and career (jetting off to the Cayman Islands, sailing around the Isle of Wight or enjoying the best food London has to offer.).

I have 2 Twitter pages, one with the username @lisamarsh and another username @yourgreatlife. There is a reason for that.  @lisamarsh is more for me as a woman, a wife, a mother, a writer, a networker, a friend.  @yourgreatlife is, for the most part, used for my life as a fertility coach, fertility advocate, support group leader, infertility, my frequent Miscarriage Support and Fertility Support Tips (now 128 of each), news about women's health, reproductive health, fertility treatment, relationship stress, links and more.

There are some grey areas, when I tweet something personal on @yourgreatlife, or something relating to fertility on my @lisamarsh page.  When you add up the number of followers from my two accounts, it means I can send my original content, or re-tweet someone else's to about 1,000 people. I sometimes follow people on both of my Twitter accounts, for no other reason than that it helps not to have to switch back and forth when looking for their posts. There is no distinct line between them because they are both me and life has fuzzy edges like that. 

This morning this tweet made me smile:

retreatsforyou Morning world - and tweeters. This morning I am completely captivated by beauty and colour of a huge bowl of blueberries and raspberries. 

I love this quote, posted by Naomi Richards, @thekidscoach:

Great minds discuss ideas; average minds discuss events; small minds discuss people.- Eleanor Roosevelt - fab quote! I "met" Naomi on Twitter and the unexpected bonus is that several months later, we met in person too.

This tweet caught my eye: PregnancyAssist Women Seek Holistic Approach to Fertility Over 40 http://bit.ly/bqYTRT  leading me to this press release: “I believe very strongly in an approach that includes the mind, body, and spirit. "Women facing fertility challenges need the support of a team that treats the whole person. Infertility is more than just a medical problem, it is an emotional and spiritual challenge that can exhaust even the strongest woman.” Oakland acupuncturist Maria Yung. She stated what I believe about infertility and the need for support and care, in as graceful a way as anyone could. 

Random tweets can take me where I didn't know I could go. After meeting Anne-Marie Mittelman, a virtual assistant in Hertfordshire, at an Athena Network meeting, I followed her on Twitter. This morning, she tweeted about an event she is attending this week. I asked for details and 45 minutes later, I had them:

 AVirtualAngel @lisamarsh Morning Lisa, the details [for the Inspired Entrepreneur event, Building a Successful Spare Time Business] are here: http://ow.ly/213Hk

This is one of my tweets from this morning. It wasn't sent out to any specific person; just to the Twitter-world.  I wonder if I will get an answer.

  lisamarsh Wd like advice on how 2 get rid of the fox visiting our garden + neighbors 4 past few wks. Last nite's bbq had 2 b moved inside. Kids scared 

Here's a great example of how Twitter helps us spread useful information to specific users, whether we follow each other or not:

 Original tweet: @Fertility_RMACT #Infertility, Sex and #Weight. Does it Get More Embarassing? http://hub.am/aZVNYJ2

I followed the link to Path to Fertility and Infertility, Sex and Weight:   

"Two uncomfortable subjects being discussed this week on this blog. Luckily, we have two wonderful experts to speak on the subject. Dr. Mark Leondires, Medical Director of Reproductive Medicine Associates of CT  and Carolyn Gundell, MS."

Not only am I interested in seeing what these 2 experts have to say, but I'm sure that some of my 735 or so followers of @yourgreatlife would be interested also. So, I re-tweeted the link, adding a few extra touches that will help people find it.

 My Re-Tweet: experts answer Q's RT @Fertility_RMACT #Infertility, Sex and #Weight. Does it Get More Embarassing? http://hub.am/aZVNYJ #fertility The hashtags will ensure that anyone searching for infertility, weight and/or fertility, will come across this tweet. (I didn't give sex a hashtag, because I doubt the Infertile community and those who work with fertility matters would search "sex" on its own. Also, #sex might lead to SPAM tweets coming to my page.)

Unexpectedly, Twitter also brings some quite special people into my life.  During National Infertility Awareness Week, @MiriamsHope tweeted a link to a video she produced for Resolve's (also see @StirrupQueen)  NIAW campaign "What IF?". I was blown away by Keiko Zoll's strength, creativity and vulnerability and contacted her.  We both mark that week as a transition within ourselves, from being one person wanting to raise some awareness of infertility, serve our individual needs and support others, to being a voice; stepping up to the challenge of being an advocate for fertility in a wider world.  If you haven't read Keiko's guest post, please do.  Now, we use Twitter to exchange information, support and develop a friendship, like these:

MiriamsHope Two bits of good news: formal offer going in first thing tomorrow morning & my m------- came back normal. #hallelujah

yourgreatlife @MiriamsHope That's as good a reason as any to feel celebratory. Wishing you all the best. L xxx

Finally, it's important to consider why someone would follow you. In an ideal world, all of your followers would be people who really want to know what you want to tweet about.  So, for instance, @lisamarsh would attract followers who think my perspective on family life is amusing or helpful, my opinions are interesting, we have similar interests in food, writing, days out, holiday cottages, best beaches, New Jersey, life in a London suburb and/or funny things my kids teach me.  Likewise, @yourgreatlife would attract followers who can benefit from my Support Tips, want to be alerted to my new blog posts, women who are trying to conceive, being treated for infertility, informed on all things fertility-related, or want to network with me. Not to mention, people who may want me to work with them...fertility clinics, peers in the field of fertility, women's magazines and clients.

I guess I'm pretty lucky that I haven't attracted too many spammers or completely inappropriate people who swear more than the very occasional "f---ing this and f---ing that."  I haven't indulged in the automated "add-followers" schemes. Even when I was intrigued enough by @DuncanBannatyne and his #duncansdream (was that it?), I still asked for followers who were interested in fertility matters. I think I gained 2 or 3 followers for that. I can't deny that I like when I log on and see I have gotten a few more followers, but I'm going for quality. (If you are already a follower, you ARE quality!)

I am by no means a Twitter expert, but I love it, I'm on it every day and yes, it has rewarded me with business contacts, news practically as it occurs, new acquaintances, a higher profile than I could achieve without it, a new friend or three, and more than a few laughs. I'm at a slight disadvantage, not having it on my phone, but as soon as I get an IPhone, I will be able to detach myself fom my PC and tweet, waiting for my children while they swim, tumble, trampoline, etc. Don't take my word for it. Try it. You'll like it. Why? Because it's fun and useful and you're worth it.

IF Community: Start acting like consumers

There is an obstacle between the IF community and the medical community as they walk down the road of fertility treatment together: it's like two substantial thighs chafing as you walk; always there, but not immediately noticeable, needing each other, but co-existing with slight discomfort.  We, who have been on the patient side of the relationship, know well the feelings that go along with pursuing medical treatment for infertility.  On the one hand, it's a relief to have a doctor diagnose a problem that he or she believes they can help you overcome. On the other hand, otherwise intelligent and functional people can become intimidated and mute before the medical gods. The tendency is to hang on their every word, follow every one of their suggestions twice over and give them carte blanche to control your life.  Then, we complain about them behind their backs, which doesn't change anything for the better.

Let me say first, that there are fantastic fertility clinics with specialists who are revered for good reason.  No, they are not actually gods, but when it is within their power to fulfiI a patient's most fervent wish: their very own baby, you can see why they may feel and act exalted.  If you are the happy patient with the long-awaited new baby, you probably put all your little gripes aside while praising your god-like specialist who-can-do-no-wrong. Each time you do, it's money in the bank to the medical practice. This industry thrives on positive word-of-mouth.

My guess is that medical schools and medical practices don't give classes in bedside manner or how to sustain a good relationship with patients.  Judging by the criticism of doctors in the IF community's individual blogs, they often get it wrong. It's not just the doctors themselves; their staff can be equally to blame.  Some of the complaints I have heard time and again:

• Waiting hours for a phone call to be returned by the doctor or a nurse at my clinic, only to be spoken to sharply "when I dared to call a second time."
• Reduced to tears by a consultant who leafed through my file for 5 minutes in front of us, then closed it and said "with these results, I'm surprised you even got through to see me."
• "I've lost my faith in my RE. She doesn't have an original thought in her head. She just keeps saying we can try again."
• My new doctor skipped past all my questions about IVF, telling me that "egg donation was my only hope. I still don't understand why."
• The appointments secretary "won't work with me at all to schedule appointments with the doctor so I don't lose my job." The next closest clinic is an hour away.

My initial reaction upon reading of another person's poor treatment by their doctor, was to side with the patient. I got emotional, remembering my own anger, frustration, fear, awe, hope and confusion, when I was in their position.  Then I realized that my mental state back then was fragile, not helped by the side effects of Clomid, which made me ultra-sensitive and paranoid. I was scared, impatient, intimidated and had unrealistic expectations. Doctors see patients come and go, acting out already established patterns, so may not pick up on any hints that a patient is unhappy.  The relationship between doctor and patient is a tenuous one; infertility and trying to conceive being such emotive concerns. 

The truth is that not all doctors, nurses and office staff at fertility clinics are nice, patient, flexible or sensitive. They have good and bad days at work, just like the rest of us. They can fall into the trap of going overboard with the professional demeanour, erring on the side of cold and brusque.  They can be overworked, possibly because they over-schedule their appointments, starting too early in the morning and going too late in the day. They can be guilty of not treating patients as individual people, with unique circumstances. They expect you to understand about a thousand medical acronyms.

The truth is that not all patients are easy to deal with. How many times have you sat in the waiting room and heard another patient being demanding and difficult at the receptionist's window? Have you ever noticed how some patients manage to make it seem like they need priority attention? "Oh, sorry, you don't mind if I go in first, do you? It's only that I have a very important appointment to get to." As if you don;'t have a life outside that waiting room. What about the woman who looks shell-shocked or who weeps every time you see her at the clinic? Remember your own appointments, when you haven't understood half of what was said to you? You then end up phoning the nurse later for a full rehash of the information, while she has a dozen more blood tests to take before she can sit down.

What it boils down to is this: You are engaging a doctor's services, for which they are paid handsomely. This is a commercial transaction.  While they cannot guarantee you a successful result, you can expect the fertility specialist to:

• perform investigations of your medical condition and fertility status;
• give you a diagnosis within the parameters of their expertise; 
• explain medical terms in a way that you can understand;
• suggest possible options for the result you seek;
• explain any risk factors;
• recommend a course of action, i.e. give you their opinion of what they believe you should do, including both what you can do to help yourself and what they can do to help you;
• treat you and your condition with responsibility, care and respect; and
• perform agreed procedures to the highest standard, or refer you to another doctor who can do so.

Most patients say little about their dissatisfaction to the people directly involved. What they do is leave the clinic with confusion, annoyance or fury and complain about it at home, with their friends and on their blogs. Not only do they resent their infertility, but they resent the very people they depend upon to help them beat it. Meanwhile, the people who got them all worked up keep doing it and it is perpetuated. No one wins; your stomach churns with your anger. Even the medical practice loses, by delivering poor service and getting away with it. Your word of mouth, added to others, hurts their business reputation.

I don't believe that most doctors, nurses or scanners go into the area of fertility treatment just for the money. It's an area of medicine that has a relatively small success rate, so for all of the happy patients who bring home a baby, there are 2 to 3 times that many who don't.  I believe that, for all their professional detachment, most of them sincerely share the joy they can give and regret the inability to give it to every one of the unsuccessful patients.  Though, there's always the odd exception.

Think like a consumer: If you were contracting for another service, would you:

• accept rudeness as the price you have to pay to have that specific person do the work for you? 
• accept a substitute who turned up unexpectedly, in lieu of the contractor you chose?
• stay, if you arrived on time for an appointment and were kept waiting for 2 hours?
• use the company again that closed for the day without contacting you with vital information?
• recommend a business where the receptionist did not acknowledge your presence for 10 minutes?

I do understand that once your fertility treatment is underway and you have been billed, you are stuck until the end of that cycle. However, there are steps you can take, including those listed below.

Act like a consumer. If you believe that your doctor or his staff have not acted appropriately, fulfilled their promises, or even been less than polite and helpful, you are entitled to:

• speak to the doctor and/or the practice manager, letting them know you are dissatisfied with your treatment;
• refuse to have unknown staff or trainees watch your examination;
• request a second medical opinion;
• have your files transferred in a timely and complete manner to another fertility practice;
• let the doctor and practice manager know that you will not be recommending their clinic/hospital to other women and/or listing them on your closely-followed blog; and
• in extreme circumstances, lodge a complaint with the appropriate medical board.

A caveat: If your husband/partner has a tendency to boil over, you may want to agree a plan before speaking to anyone about your complaints. Men can come over all macho and protective when the woman they love is particularly vulnerable. It appears as aggression. If you do need to stay with this clinic, you don't want to be barred, or even worse, feel apologetic every time you visit.

A caution: The doctor you loved for being warm and friendly may seem smarmy to another couple. One consultant whose very name causes me to tense up, was most-loved by a couple I met recently.  If the difficulty was specific to you and the doctor/nurse, be careful before you spread his name and your feelings about him on your Facebook or Twitter  page or in your blog. Just in case you need to know:

• Slander 1 the utterance of false charges or misrepresentations which damage another's reputation, 2 a false and defamatory oral statement
• Libel 1a. the harming of a person's good name or reputation by means of published writing, print, or pictorial representation b. an act of publishing a false and insulting statement

If you have a gripe with your medical team, before you do anything, look inward. 

• Is there anything in your own expectations which was unrealistic?
• Have you brought so much emotional baggage into the fertility program that nothing they do could make your experience better?
• Has it escaped your notice that the clinic has other patients, all of whom want personal attention, quick responses and convenient appointments?
• If you got off on the wrong foot, but still want to be seen at that clinic, forget your pride...you can win back some of their forgiveness with a simple gesture. A tray of muffins or cookies, accompanied by a note that says "Everyone has a bad day now and again...yesterday was mine. Thank you for your continued support." will go far.

Fear another miscarriage? Eight ways that fertility coaching can help you heal and move forward

Do you fear that a previous miscarriage will be repeated in a subsequent pregnancy?  It would be entirely understandable if you do.  If it was your first pregnancy, it is likely that your doctor will give you statistics about how many first pregnancies end in miscarriage.  Assuming that you are otherwise healthy, your doctor may not even do any tests to investigate the cause of your miscarriage. While down-playing a miscarriage is meant to be reassuring, as in “it’s not a big deal,” most women don’t see it that way.  It is a big deal.

The age-old adage “time heals all wounds” is true to a large extent.  While you will never forget your miscarriage, in time, the feelings you have about it will dull.  It’s part of our survival instinct. If you grieve at the same deep level of pain for the rest of your life, as when you miscarried, you would lose the ability to function in some areas of your life; appreciation of other children you may have, joy in life and expression of other emotions. It’s a heavy burden to carry.

Instead of waiting to see what Time does for you; take a more proactive approach to healing. Assuming that you will want to conceive again, it is really important to take enough time between pregnancies to address your feelings and restore your confidence.  With a specialist fertility coach, you can face and work through many, if not all, of the feelings you have and help you move forward.  A miscarriage deals a double blow; causing you to feel both physical and emotional emptiness. 

Fertility coaching can help put your mind to rest, restore your confidence and regain hope for future pregnancies.  Below are eight ways that fertility coaching can help you heal more quickly and learn new coping skills to sustain you through difficult times:

1. Emotional release - While it may seem that you have done nothing but cry, or talk about your miscarriage, you may also feel you have to appear “okay” to others, so they won’t worry.  In your coaching session, you are relieved of that responsibility toward others.
2. Focused attention – Even in the hospital, once you have been checked over, you are left to cope with your miscarriage on your own.  Doctors rush off, nurses ask routine questions and scanning technicians go silent. Afterward, people may be curiously absent or quiet because they are afraid to upset you.  You can experience the uncomfortable feeling of being scrutinized and ignored at the same time.  In a coaching session, you can be open and feel secure.
3. Understanding – While it isn’t strictly necessary for a coach to have experienced the same as their clients in order to work with them, sharing the experience of miscarriage adds another dimension to the level of understanding a fertility coach will have of you.
4. Closure – Human beings are capable of compartmentalizing our memories, for lateral thinking and multi-tasking.  Eventually, you will need to put a top on this box so that you can start fresh and put your mind and heart into a new pregnancy.
5. Support - Whether you are processing your thoughts and feelings, healing, looking into your options or embarking on a new journey, you will need support.  It can come from several different sources; your partner, family, friends, doctor, coach, another woman who has miscarried, or a support group.  One of the most important skills you can learn from a coach is how to identify the different types of support you need and the person best placed to provide it.
6. Options – If you want to conceive and there’s no reason to believe you won’t, you may be offered medical, therapeutic and lifestyle options to help prevent another miscarriage.   It may be the most important step in the process, since making plans for the future show that you are ready to move forward.
   
7. De-stressing – The questions you have about your miscarriage, uncertainty about what to do next, having to make decisions and worrying about the consequences, all cause stress. Sorting out some of those questions and decisions with your coach will help you throw off that stress.  Treating yourself well (which I strongly advocate!) with relaxing therapies and healthy activities helps too.
8.  Forgiveness – Women are apt to assume that when they want to have a baby, it will happen; that they are in control of their reproductive health. However, what seems so uncomplicated at first can turn into a mystery if it doesn’t go according to plan. It’s one of those areas where we think we have the “equipment” so our bodies should be able to do the job required. After a miscarriage, you can feel like your body let you down.  By increasing your knowledge, you can forgive your body and put your faith back in it, to do the job as it was meant to be done.

Unlike in infertility, where the puzzle is why you can’t achieve conception, women who have miscarried have a two-step process to get to their goal of giving birth.  First, they need to achieve a healthy conception, after which they must maintain a healthy pregnancy all the way through to childbirth.  There may be hard work to do in the run-up to conception; identifying and overcoming sources of stress, boosting physical health by giving up smoking, alcohol or coffee, and achieving a healthy weight.  You will be able to succeed in many, if not all, of these challenges much more quickly and effectively with the guidance and support of a fertility coach. who will be there to remind you of your motivation and help keep your vision of your future family alive.

Personal Ad - Friend Wanted

Friend Wanted - Age, looks, profession and financial status unimportant. Must be open, welcoming, inclusive, considerate, compassionate, good listener, patient, trustworthy and supportive. High degree of emotional intelligence required. GSOH and/or psychic ability would help. Best if you have experienced infertility and/or miscarriage.

What would you think if you saw this ad in a print or online Personal Ad? Is your initial thought "that's what I need?" It might be that you already have a friend like that, without whom you would not have gotten through the medical appointments, insurance obstacles, assisted conception procedures and the 2WW.  The point is that everyone, who is battling infertility and trying to conceive, needs a support network.  Not just any support network, but one of the highest quality.

How do you attract quality supporters?  It's sort of like attracting followers on Twitter. You can have a lot of them, but if they aren't interested in what you have to say, it's like posting your thoughts into cyber-space. A very small percentage of followers will actually interact with you, answering your questions, re-Tweeting your statements and links, being accessible to you, making you smile and caring if you don't show up for a day or two. Be congruent about what you are thinking and feeling and observe whose attention you get as a result.

The difficulty is that, unlike the Personal Ad above, you aren't being sent applications for the position. Unlike a job, the post is un-salaried. It won't be served to you on a silver platter. To have a quality support network, you must work hard to find them and you have to keep your eye on the characteristics outlined above. Not everyone will fulfil every criteria to the same degree. Your unique set of values will determine how much that matters to you.

What kind of support do you need most?

• If it's a shoulder to cry on that you need the most, look around for a person who is accessible, warm and sensitive.
• If you need a friend who will listen patiently while you release all of your hisses and moans, and won't judge you harshly, consider:

1. someone who has a lot of time, who cares about you and understands that you don't expect them to provide a solution; or
2. a paid professional who is trained in active listening and can help you achieve perspective.

• Is there anyone in front of whom you can show your uglier side?  You know, when you get jealous, bitter, bitchy, scared, resentful, or just plain angry. This is where trustworthiness comes in. I like either:

1. a very dear friend who has moved away. Distance is sometimes very helpful. You won't see this friend at the mall, having a great time with the person you recently slagged off. Or;
2. a very new friend who doesn't know any other people in your life, but to whom you can spill and vent without it being repeated. Perhaps a gym buddy?

• Is there an intuitive person who can tell when you are isolating yourself and seems to know what you are going to say before you say it? This person is probably the hardest to find, but if found is an emotional lifesaver. It could be another infertile woman, a receptionist at the clinic or a colleague; anyone really.

•  A friend who has natural compassion. You can be completely honest, because they will understand through the ups and the downs. They forgive you for days when you are not yourself, knowing that you will be back on track the following day.
• Someone who will include you in the group no matter what, believing that you are entitled to make your own decisions about what to do. Helps you change your mood purely by providing distraction. A shopping buddy? Dinner and dancing? A great DVD and some Chinese takeaway?

It's all up to you. No one is walking around with a sign around their neck stating "Friend Available." Friend may not even be the appropriate term for all of them. It may be "confidante." Decide what you want. Determine who could provide it. Try it out, with or without their knowledge. Show your appreciation. Keep them in the loop and don't drop them the moment you don't need their support anymore.

The two caveats here are:

1. Don't allow it to be completely one-sided. Find ways to give as well as take; and
2. Don't overburden one or two people with your troubles.  If they feel like they are your only source of support, they may feel suffocated, threatened, or guilty that they want to do something else.

Who do you have in your support network?

Aborting IVF Babies; a follow-up, including the actual HFEA statement

I don't usually feel the need to post twice in one day, but a follow-up to this morning's blogging seems appropriate. First of all, I want to address a statement by a doctor, Mohamed Menabawey, consultant infertility specialist at The London Bridge Fertility Centre, that appeared in a Daily Mail article this evening. He wrote:

"Personally, whatever their situations, I find it incredibly sad that even one woman would choose to abort a child she has suffered so much to conceive.
Even one IVF abortion a year is one too many. As any other IVF doctor will tell you, we do this job because we find genuine delight in helping people to become parents.
We truly believe we're creating a family, and bonds between a parent and child that will never be broken.

The days we receive those 'It's a boy!' or 'It's a girl!' cards take us through the difficult times - the times when couples who so deserve a baby and would be wonderful parents simply fail to conceive."

I applaud Dr Menabawey's delight in helping people become parents and echo his sadness over aborted IVF babies. However, I can't help but feel that he has taken the notion of the abortions personally; that the families he and his colleagues have "created" should last forever. In reality, abortions occur for non-medical reasons all the time. Dr Menabawey's belief that the bonds of family, parent and child will last forever when, or because, his medical expertise enabled them, is naive. He stated his belief clearly and bravely; that he does not approve of any abortion that is not based upon overriding medical reason.  I have no argument with him there, as he is entitled to his opinion. However, I do object to his classifying all other abortions as "social," which makes them sound frivolous, for two reasons:

1. There is no substantiation for the true reasons these abortions took place, and 
2. Dr Menabawey's statement carries the weight of his medical status and will therefore influence public opinion.

I will allow myself to speculate here that, whatever their reasoning, the women who aborted their IVF babies felt unsupported, frightened and inadequate, rather than mercurial. Perhaps doctors' genuine delight and compassion aren't communicated sufficiently to the patient, such that they could admit their changed circumstances and ask for help.

I would like to think that the release of these statistics will awaken the medical community to the fact that fertility patients need support and a personal touch.

I would like to think that as a person trained and dedicated to providing that support, I could help practices, such as the London Bridge Fertility Centre, serve their patients in such a way as to prevent even one, if not many terminations of the pregnancy so desperately wanted. Feel free to contact me any time to discuss the value my fertility coaching program can bring to your fertility clinic and your patients.

Additionally, I want to provide you the actual HFEA statement that is at the heart of the matter.  I am copying it below in full, so as to avoid any misinterpretation. 

HFEA statement regarding pregnancy terminations following IVF

07 June 2010

‘The HFEA has published data on the number of terminations following IVF treatment on our website every year since 2007. This is part of our long term data analysis and the next update is due later this year.

IVF is not a procedure that is undertaken lightly and we know what it means personally to the many women who make this decision every year. All patients who undergo IVF are assessed, as are the implications for any child that might be born, in advance of the decision to treat.

The HFEA does not regulate terminations of pregnancy.

On average, the number of terminations every year is less than one percent of all pregnancies through IVF. We do not collect data on the legal grounds for the termination, although we do ask centres to describe the reason given by the patient. The number where the reason given is ‘social’ or ‘psychological’ is very few compared to the total.’

	Pregnancies	Terminations
2004	4,435	50
2005	10,253	90
2006	11,600	90
2007	12,645	97
2008*	6,723	52

*Half year data

The HFEA is the independent regulator for IVF treatment and embryo research. Our role is to protect patients and the public interest, to drive improvement in the treatment and research sectors and to provide information to the public and policymakers about treatment and research.