your great life

Embryo Freezing as a Lifestyle Choice

This morning on the Lorraine show (ITV), the presenter interviewed a woman, Gillian, by satellite from New York regarding the couple's choice to freeze their embryos at age 30 for a pregnancy later in life. The twist was that this couple is young, healthy and fertile. Gillian spoke about not being ready to become a mother and thinking that she and her husband would perhaps be ready to use the frozen embryos at around age 40.  She wants to be more settled, with a higher level of income/assets. Is there ever a perfect time to become a parent?

Some of the questions brought up by Lorraine Kelly and Dr Hilary Jones were:

• Is a child born to wealthier, "more settled" parents likely to be aware of, or any happier because of their parents' financial status?
• Is there ever a perfect time to become a parent?
• How Gillian would feel if, upon readiness, she finds herself unable to conceive, even with the frozen embryos used?
• How Gillian and her husband would feel if their frozen embryo resulted in a handicapped or special-needs child, because the safety/stability of long-term frozen embryos is unknown?
• What Gillian and her husband would do if they never felt ready to become parents and had frozen embryos in storage?

This was an unsatisfying interview for me, with questions hanging in the air and few definitive answers. I'm sure that Gillian and her husband thought about what they are doing very seriously, but the choice itself seemed an extravagant and frivilous one to me. They are healthy, fertile people of childbearing age, spending a lot of money and using a facility meant to help infertile people have a chance at becoming parents, for the sake of lifestyle convenience. Yes, the medical science is there to achieve the delayed pregnancy. No, they aren't taking anything away from anyone else. But, it doesn't sit well with me, in the same way as using a surrogate so you don't gain weight or get stretch marks wouldn't sit well. Perhaps it's because there are so many couples who would bear that child at any age if they could, regardless of convenience, and can't. Perhaps it's because it's down to money, which this couple clearly has to spare and so many who need it, don't.

Where do you sit on this issue? Please leave a comment below.

 

Chana Medical Conference will speak to Jewish concerns re fertility issues

Chana, a Jewish organisation concerned with fertility, is hosting its 1st Annual International Medical Conference in North London on Monday the 31st of January, 2011: "Facing the Fertility Challenge Together." Both medical experts and rabbis will present topics, being especially sensitive to Halachic (Jewish legal) implications. The workshops include Matters of Relationship Intimacy, Advances in Fertility Treatment, PCOS - Something to Fear?, Latest Developments in the Treatment of Recurrent Miscarriage and Endocronological Aspects of Fertility for the Jewish Woman.

I will be attending the Conference with a double-pronged interest:

1. reporting what I learn here and in other media; and
2. furthering my understanding of the unique perspective of Jewish law and culture toward fertility treatment, so that I can better serve the Jewish community as a fertility coach. 

If you have any questions you would like me to bring with me to the Conference, feel free to email them to me at [email protected].  I will do what I can to have them answered by one of the experts there on the day.

If you would like to attend the Conference, contact Chana at 020 8203 8455 or email [email protected]  Registration for the conference and all workshops is essential.

 

Steering IVF patients toward adoption from the start

How would you feel, if on your very first visit to the doctor regarding IVF, you were given an information pack about adoption?

Last week, there was a news report that Tim Loughton, the UK government minister for children and families, announced an initiative to prime childless couples for adoption, rather than fertility treatment. Loughton is concerned that there are too many children in care and too few being placed with families. Only 70 babies were adopted in the UK last year. He has a point. Is it too obvious to state that it is preferable to give a child a stable, loving family environment than to have them grow up in orphanages or foster care? He has good intentions, and the need is present, however, I wonder whether you have thoughts about the method he intends to employ?

Loughton apparently wants to get to childless couples before they begin the medical process to attempt assisted conception. His reasoning is that "they are clearly committed to bringing up children." He may be right, but I think he's missing a step here. At that point, on their very first appointment, they are committed to having and bringing up their own children. I fear that his proposed leafletting might be damaging, both emotionally to the infertile couple and in having the counter-productive impact of sending potential parents running. 

First,  a couple that has just begun to wonder why it's taking so long to conceive is hardly going to think of themselves as childless...yet. They may just be coming around to the realization that they need medical help to have a child, and think that once it's sorted, they will go along their merry way and have the family they want.

Second, it's jumping the gun a bit to approach a couple about adoption, when they are just exploring how medical treatment can help them to have their own child. Children aren't commodities. It's not like going to the shops to place an order for a sold-out product, and being offered a returned item instead.  I believe that with the vast majority of patients, the highest priority will be placed on having their own biological child at that point in the process. They will only be seeking guidance and approval on how to go about it. Some will find this type of information premature and disregard it; others may take comfort that it provides them with a Plan B, while still others may find it hurtful, intrusive or insulting.

Third, for many infertile people, the idea of being like "everyone else" and having a child who joins them as a couple and has recognizable, family traits is the ultimate choice.  We are romantic beings, wanting to recognize in our babies a mother's eyes, a father's smile, a grandparent's colouring or  a sibling's mannerism. With the advent of sperm and egg donation making the experience of pregnancy available to those who would otherwise have missed out, adoption is still seen by many as a last choice. There is not necessarily an immediate leap of consciousness from "why haven't I gotten pregnant this year?" to "let's adopt."

Mr. Loughton, finding out that you are infertile can be very difficult. If medical science can overcome infertility and give a couple what they want most, why shouldn't they go down that route? Additionally,a couple may need to go through a grieving process for the child they will not be able to bring into the world. They will not be receptive to your information packs until they have dealt with their grief. Sensitivity, time and coaching or counselling may be required to achieve acceptance of their situation and mental clarity about what IVF would entail in comparison to adoption. At present, adoption is not all that simple in the UK.

 I suspect that the difficult adoption process is the reason why only 3,200 children a year are adopted. Some people won't even bother trying because they have heard how notoriously difficult, intrusive and judgmental the process can be. The upper age limit for potential adoptive parents ranges between the ages of 35 and 40. Ironic then, that it is being proposed as the preferable option to IVF when many of those seeking treatment will be women in precisely that age range, cutting their chances rather close. Because people are getting married older, and women's fertility goes into rapid decline from age 35, it is often not until this age that they will seek IVF as an option to help them conceive.

It should be pointed out that besides the current, upper-age limit on adoption, the NHS cuts off funded IVF treatment at age 40. We might conclude from this that the government position has been that women aged 40 and older should not become parents, but apparently that's more about cost-effectiveness of treatment for women who have few healthy eggs remaining because of their age.  I wonder if cost plays a part in Loughton's new scheme, as diverting younger couples toward adoption would help both the NHS and Social Services reduce the stress on their budgets.

Adoption is a wonderful thing to do for an unwanted or parentless child and can create families where there would have been none. Thankfully, Tim Loughton wants to address the difficulty of adopting as well as shepherding would-be parents in that direction. He is quoted in The Sunday Times as saying that "the major consideration is [whether there is] a stable, loving environment to bring up a child [now] in care. There shouldn't be a hard and fast age limit or BMI (weight) index. We have older foster carers and we should consider older families to adopt."  He proposes that the upper age limit be lifted.

Tim, I couldn't agree with you more. But, please don't shoot yourself in the foot by pouncing too early on infertile couples who dream of having their own child. I propose that:

• the restrictions on adoption in the UK be revised first, so that more people can adopt;
• Then, a public awareness campaign can reach out to those who previously thought adoption was out-of-reach for them.;
• Only then would I target couples seeking IVF, in the sense of offering them alternatives to explore;
• Perhaps a simple, non-judgemental leaflet and questionnaire sent after an initial medical consultation could encourage those who would consider adopting instead of going through IVF;
• Couples who are willing to explore the idea of adoption could be offered coaching to help them weigh the pros and cons of IVF v. adoption as they apploy to them specifically, find common ground with each other on their values and priorities and make a positive choice for one or the other.

 

Where will you go from here and how will you get there?

Do you feel exhausted by your attempts to conceive this past year? I wouldn't blame you. If you are on the side of the world where December is the darkest month in the calendar, or even worse, you live in a place where the sun forgot to shine this week at all (yes, you Londoners!), you may feel just a bit hopeless. If you spent a substantial amount of time during the Thanksgiving to Boxing Day month in close proximity to women who are pregnant, or who have recently become mothers, you may feel more than a bit discouraged by your personal lack of success in that area. Or frustrated, fed up, resentful or downright furious. The big question is where are you going to go from here?

January is a great month to re-assess your position. It may be the cliche of out with the old, in with the new, but hey, if it works then why not follow it?  I'll be writing more about this during the next few weeks, including a new coaching programme that will help you solidify your intentions, streamline your actions and recognize shifts as soon as they show up in your life.

What I do want to get across to you today, is that what worked for you last year may not be what is working for you now, or what will work for you in the next 12 months. Why? Because we are always evolving; not static. You are a year older, your body may either be more or less fit, fertility treatment and/or miscarriage may have taken its toll, you may be recovering from positive surgery to clean up endometriosis or from an unexpected diagnosis, your stress level may have changed, your financial situation may have changed, and more. When creating your plan for 2011, it's essential that you do a physical and emotional audit, so that you and your partner, and even your doctor, have your eyes wide open to how you feel right now.

Instead of looking at your infertility as one long haul, it can only help to stop and assess where you are now and whether any changes need to be made. The answer may be that you are satisfied with the way things are, and you can continue on with confidence. However, if your exploration of the way you are going about life brings up questions about what can be done differently, or better, for a more effective outcome, we can work out some of those issues together. 

It would be great if you could begin jotting down notes now, as thoughts occur to you. Then, you will be ready to work with me as I introduce each step of the process in the coming weeks.  Ease yourself in gently, so you don't feel like it's hard work or get overwhelmed. My favourite first purchase every year is a new journal. I love starting fresh with the clean pages, whether I am using an old-fashioned black-and-white speckled Composition Book or a pretty and cheerful, designer journal. Just make sure it is big enough that you can use it for several months, or buy more than one, so you can continue on.

Watch for more news on the launch of this new programme.

 

 

 

NHS fertility treatment suspended in West Sussex until the new fiscal year

Some people would say that if you get something for free, you really shouldn't complain too much if it's faulty, late, slow, or not all that. If you moan when Twitter goes over capacity, or all your followers disappear, you may very well get messages telling you to chill out, be grateful and get a life. However, when it's medical care that you're seeking, does that apply?

Okay, so the NHS medical care isn't "free." It's subsidized. Everyone pays in to the system, but we are meant to benefit from medical care based upon need. Coming firmly down on the side that says fertility treatment constitutes a need, not just a desire, I think it's well within our rights to moan, whine and bitch when it's withheld, or even postponed, because of budget constraints. Why? Not just because I like a cause. It's because the NHS is a government scheme, thus a political machine that becomes complacent if ignored and responds to public pressure. It needs to be held accountable for its decision-making.  If we want a particular level of service, we have to be vocal about it.

Patients in West Sussex have just learned that all fertility treatment has been put off now until the NHS's next fiscal year, beginning in April, 2011. Not just fertility treatment, but also treatment for obesity, varicose veins, vasectomies and even knee operations.

Acting medical director Andrew Foulkes said*: “Our ageing population means that more people rely on the NHS when they are affected by cancer, stroke, dementia, diabetes, and many other serious conditions. “We have invested heavily in improving these services in recent years. “To make sure that we can all access services when we need them, it is necessary to prioritise how the budget is spent although we know that for some patients this will mean waiting slightly longer for treatment."

What is the real impact of this decision? Take into account that:

• It often takes a couple over a year to consult their GP about a failure to conceive;
• Couples are often sent away for several more months with well-meaning suggestions of how often to have intercourse, how to de-stress and make other lifestyle changes;
• Once the GP agrees to make a referral for fertility treatment, there can be lengthy waiting times; and
• Each couple has a window of opportunity for NHS treatment, based upon the woman's age.

The impact could be that a woman who is coming up to her 40th birthday could be denied treatment before the cut-off date and miss out on NHS-funded fertility treatment entirely. Foulkes said “It is also important to remember that there is no blanket ban for any treatment – if someone has a compelling medical need, they will be treated.” Will a woman's imminent 40th birthday be considered a compelling medical need?

My other question relates to the amount of fertility treatment available as a percentage of the NHS budget. If 4 months worth of postponed procedures are being shifted to the new fiscal year, that suggests that there is 1/3 less fertility treatment being performed than was originally budgeted. That doesn't mean that the missing 1/3 is being added to next year's procedures; rather, they will be coming out of the new budget. Unless the budget is increased substantially, which is very unlikely to happen in this economy, another 1/3 of patients will find their fertility treatment postponed or disallowed. The postcode lottery has just had its odds increased.

*As reported by Siobhan Ryan in The Argus.

Fertility advice from the Jeremy Kyle Show?

Did anyone (in the U.K.) see the Jeremy Kyle show this morning? He called it his Morning Surgery. Now, I NEVER watch that show because I HATE the format, the type of issues he covers, the type of people who are his guests, the shouting, accusing, and what I see as emotional manipulation. How do I know what it's like if I never watch it? Simply, I dislike the entire genre of talk shows that primarily exist to surprise, shock, allow their guests to attack each other's character and encourage the audience to loudly express their opinions. More specifically, I watch Daybreak and Lorraine in the morning while getting the children ready for school and see the promos for the Jeremy Kyle Show. On certain occasions when thechildren are in the kitchen with me, I have even had to turn off the TV if something really offensive is being promoted for the JK Show. It's the attitudes and behaviour...

That being said, I am always interested in how infertility is portrayed in the media, so I watched the entire show today for the first time. Jeremy had two doctors on with him this morning, *Dr Arun Ghosh  and *Dr Stacey Palastrand. 

There were four fertility "stories" told on the JK Show this morning:

• the couple who haven't conceived after 4 years of unprotected sex;
• the couple who have endured multiple miscarriages and the heartbreaking loss of their son only a few hours after his full-term birth, and are now 23 weeks pregnant; and
• the woman who gave birth at 57 to a child conceived through IVF  in a Russian clinic (I believe); and
• a 35 year old single woman, an employee of the JK Show, who decided it was time to be proactive about having what she really wanted in life, a baby.

The Pros and the Cons of this show:

• Pro:  the story of the 60 year old mother to a toddler was not overly sensationalized
• Pro/Con:  Dr Ghosh said that there should be an age limit on IVF because of the danger to the mother, the higher percentage of genetic abnormalities in children born to older mothers and the "limited money in the pot" for their care. While I applaud his intentions of keeping both mother and child safe and healthy, it wasn't clear at what age he would cut off women from having IVF... I must have heard wrong, because I thought he was saying over 35!
• Con:  Dr Ghosh kept talking about how unethical it is to treat women with a small chance of success with fertility treatment.  As long as there is no danger, as in the doctor doing harm, and there is no question of the woman's mental health being in danger, isn't that what freedom of choice is about?  Yes, it's emotionally difficult, however, so is remaining childless if you want a baby more than anything.
• Pro:   Thankfully, Dr Palastrand gave a  more balanced viewpoint on the issue of older women becoming pregnant and giving birth.  My understanding is that there is very little danger to the mother if healthy and given good medical care. Also, everyone is entitled to testing for genetic abnormalities in pregnancy, so surely there wouldn't be a large number of babies born with genetic defects.
• Pro: When asked whether having a toddler isn't exhausting for a woman of her age, the older mother answered with some feistiness, that it wasn't as hard as caring for an elderly person, which she had done for more than 15 years before having her baby at 57 years old. She had also worked with special needs children. (It's worth pointing out that her husband is substantially younger than she is.) It just goes to show that the decision of whether to provide fertility treatment should be done on a case-by-case basis, rather than a uniform ban on women over a certain age.
• Pro:  JK asked the question "Isn't it preferable for a capable, older woman to have a baby she will love and care for, rather than the unwed teenagers who neither want nor can care for the babies they are having?
• Con: Not enough was made of the infertile couple's admission that they both smoke. Surely, if they really want a baby and have been unsuccessful for 4 years, they would be committed enough to make this lifestyle change. They should have been told in no uncertain terms that smoking is not acceptable, not least because it could cause miscarriage or low birth weight if they do become pregnant.  It also made me wonder whether the JK Show couldn't have chosen a couple who have tried absolutely everything to conceive. 
• Pro/Con:  the couple with the previous losses were given a 4D scan of the foetus. This could have been a huge emotional shock to them if there was something wrong. Thank Gd everything seemed well.
• Pro/Con:  the scan and sperm sample given to the infertile couple were good for illustrating what could be an obstacle to conception, however, the Drs seemed to just say you're both fine and should have no problem conceiving. There could have been more discussion of the types of further medical investigations that should be done to discover why they haven't conceived in 4 years and how to access them. "Unlucky" was mentioned...that's not good enough.
• Pro: the single mother was able to see her 15-week old foetus and found out that she is having a boy. That was a feel-good moment for everyone.
• Con: Why did the JK show feel it necessary to pad out the program with a cosmetic procedure? It could have actually gone deeper with fertility issues and explore one more issue or give more substantive advice than it did.
• Pro/Con:  the Drs kept their advice simple and sensible, but perhaps too simple. Dr Ghosh's top 5 tips for conceiving are: 1) have sex 2 -3 times a week, 2) stop smoking, 3) maintain a healthy weight, 4) relax and 5) go see your Dr.

Interestingly, Dr Ghosh's profile on his Twitter page describes him as a "UK media GP" who runs a prescription addiction clinic in Liverpool, specialising in sexual health, obstetrics & gynaecology, weight management & CBT. Dr Palastrand doesn't appear to have a Twitter page, but completed her GP training in 2008, with aspirations to be a "salaried GP in a semi-rural practice." Although I would have liked to see more substantive information and advice from the two doctors, and links to helpful resources for viewers, they both came off pretty well and gave a balanced view of the issues.

 

The key to reversing overwhelm: create a big picture or break it down into bits

I have written several times about the overload of information, as well as the sheer weight of emotion, that infertile people are subjected to while trying to conceive. It's rare that I come across a person, or couple, who has not felt that way at one point or another in the process. Some, more than others, of course. Our ability to handle these phases and move through them has to do with focus. As with any other challenge, if you keep your eye on the desired result, you will be able to re-group after a minor glitch.  Without focus, a minor setback can blow up out of proportion and create an obstacle that has the potential of throwing you off course. 

An example of this is the attrition rate from IVF. When Dr Sam Abdallah of the Lister Clinic spoke recently at the Fertility Show about the success rates for a fertility clinic, he pointed out that in a first cycle, approximately 30% of women under the age of 35 may become pregnant. Of the remaining 70%, half of them will give up and half will go on to a second cycle, and so on. So, take 100 women who cycle, in IVF terms, together. Of the 70 women whose cycle did not result in pregnancy, approximately 35 of them will decide for whatever reason that they cannot go through that experience again.  30% of the 35 who do repeat the IVF will conceive, making a total of approximately 42 of the original 100 pregnant, and so on.

Of those who drop out of an IVF program, their individual reasons may include financial stress, marital stress, the medicalization of what should be a natural, intimate process, the impact of the fertility drugs on their system, the imbalance in their lives caused by the obsession with conception, etc... In one way or another, they felt overwhelmed by the odds and decided that the trade-off wasn't worthwhile. I would bet that if these women were able to turn the overwhelmed feeling around before it became so big that it eclipsed the desire to go through IVF again, the numbers would be different.

Think of how it feels to be overwhelmed. You may disconnect from whatever you are involved in and shut it out. You can get a headache or migraine which interferes with your ability to listen. You may feel dizzy. You may be aware that someone is trying to talk to you, but feel that there is an invisible, glass wall between you. You may fantasize about being at home under the comfort of your duvet. You can feel very tired. You will have difficulty concentrating. Maybe nothing makes sense. To keep pursuing conception under those circumstances may be counter-productive as stress and negativity can suppress the hormones you need to conceive.

Create a big picture - There are times when we have to look at the big picture for everything to make sense. A rather literal example of this is a painting in the pointillist style, such as those by artist George Seurat.  The image created with hundreds, if not thousands, of small dots of colour on a canvas may be difficult to decipher, however, in taking a step back from the painting, the eye sorts out the play of light, shadow and shapes and the "big picture" is revealed.  In a similar way, all that you are thinking, questioning, learning, doing, feeling and discussing can overload your senses to the point that you lose sight of where they each begin and end or how they fit together. Step back from the process of trying to conceive and look at why you are doing it, to reinforce your priorities and justify the amount of effort you are putting in. Then, begin to break down that picture into small bits.

Break it down - The other way to reduce your anxiety is to identify all the different aspects of your life that are contributing to the overwhelmed feeling. It may seem more manageable to deal with each one of them individually, either one or a few at a time.  Once you remove the first few obstacles, the renewed sense of control will allow you to tackle some of the more difficult or complex obstacles. At this point, you should be able to put the rest of the obstacles into context and order them by priority. Before long, the feeling of overwhelm should be gone.

Change the way you process responsibilities -

1. Look back at what set you off in the first place. Were there any warning signs that it was all getting too much for you? If you can, list those signs so you will recognize when you are in danger of feeling overwhelmed again. 
2. Learn to respond rather than react. Don't let it all pile up on you to the point where you burst out of frustration or stress.
3. Analyze each situation, thinking "what is being asked of me?" Is this something I am capable of doing?  If so, put it on a to-do list; if not, figure out whether the best course would be to delegate, ask for help or say "No."

Example of overwhelm: You are hoping for the go-ahead from the fertility clinic for treatment. In the meantime, you're busily researching the condition you think you may have (let's say endometriosis), as well as every medical term you have heard in your appointments. You are trying to find the right fertility charting software, so you are trawling the online forums for recommendations. You have found a fertility-friendly food and fitness plan but your cabinets are full of high-fat and high-sugar snacks you have to finish first. You have been told by the nutritionist to get a fortune's worth of vitamin supplements.  You have to use your lunch hours to see the acupuncturist, while 2 evenings a week are spent on webinars given by the big-name clinics.  You're only a few pounds overweight, but you don't want any obstacles to conception, so you are cutting down your food and weighing yourself 3 times a day. You want nothing more than permission to get started, but the thought of injecting yourself with the fertility meds in a few weeks makes you so uptight you can't breathe.  You feel exhausted and are having mood swings.  Lately, if anyone so much as uses a sharp or impatient tone, you get tearful and run from the room.

First, list everything that is overwhelming you in the most simple terms, leaving out any description or emotional language. So, the above situation can be broken down like this:

• medical tests
• learning about endometriosis
• find the best infertility glossary
• find the best fertility charting method/software
• start posting on a fertility forum and "friend" some regulars
• clear out the larder/freezer of junk food
• get the vitamin supplements into a workable system
• find time for the acupuncturist
• lose 5 pounds
• reduce the fear around self-injecting

Put it away - Once you have made your list, I would recommend that you put it away until the following day. Some people will look at the list and panic that it is so long, while others find a sense of relief just from getting this far. Knowing that the list exists may be enough to feel some of the weight temporarily lifted. That part is due to personality, but it doesn't need to affect the end result.  When you return to the list, categorize the entries under headings in a new list, such as: medical, informational, connections, diet and nutrition, complementary therapy and emotional wellbeing.

Let's take Diet and Nutrition, under which you will have listed:

1. Banish junk food
2. Take vitamin supplements
3. Lose 5 pounds

Then, under each entry, break down the goals further into manageable tasks with time frames:

Ex. - Banish junk food

1. Over the weekend, remove all sweets, crisps and high-fat food from kitchen cabinets to a box and put in the boot of the car and possibly donate as "party food" to a local group;
2. On garbage-collection day, throw out all high-calorie, high-fat and high-sugar frozen and refrigerated food.
3. Make a list of healthy, lower-calorie foods and plan meals for the week.
4. Go grocery shopping with  list to replace junk food with healthy food.

The immediate result of making your list is that you will begin to focus on a narrow area. Intially, you may only be able to picture the tasks and the desired result, but once you begin acting on them, you will recognize a new sense of control and the context; how it relates to and impacts upon the whole process of trying to conceive.  By focusing, you will cease to worry about the enormity of everything you have to do when taken in total.  In fact, by following this path, you will see a knock-on effect that will shine a little light elsewhere as well.

Ex. - Eating more healthily may mean you can reduce the vitamin supplements you take, and give you more energy. Eat better -> less tired -> less moody -> lose a few pounds -> you may experience a boost to your self-esteem. What next? Perhaps, feeling good will make introducing yourself on a fertility forum that much easier. Be friendly -> attract followers -> share your experience of the diet and nutrition plan -> earn friendship, gratitude, support -> ask for recommendations of fertility charting method and other peoples' stories of how they dealt with the fear of self-injecting -> feel connected and supported -> the feeling of being overwhelmed goes.

You can see the process. If you are committed to creating  family, you are in for some hard work, but you can handle it. If it ever seems like it's all too much for you; step back to give you the time and space to identify the essential actions required of you.  Break down the elements into manageable portions and systematically tackle each one separately.  Use the positive results in one area to motivate you in another area. When you feel that some control has been restored, start looking at the separate parts in the context of the whole process again, so that it makes sense.

What I took away from the Fertility Show; knowledge, contacts and a rubber model sperm among them!

I planned to write all about my visit on Friday to the Fertility Show, however, yesterday I went back for a second visit.  On the first day, I circulated among the 109 exhibitors' stands, saw one of my clients, sat in on a few of the seminars on offer and met with colleagues in the fertility support community: among them, Karin Thayer of Fertility Planit, Sarah Holland of Fertile Mindset, Kristen Hayward of Positive Birth, Camille Strachan of To Hatch, Sophia Villiers of Nourish Naturally and Jane Karsten of Windsor Reflexology. It was a fantastic opportunity for us to meet and see what we each bring to the table for people hoping to conceive and/or pursue an alternative method of parenting. 

At the end of a packed day, I struggled home with bags of leaflets, business cards and quirky branded items like one of Santa's elves dragging a sack behind him. My family was bemused to see me unload my bounty on the kitchen table: stress balls, numerous pens, chocolates, a diary, a pregnancy test and a rubbery model of a sperm!  The bonus of the weekend, in terms of assisting my professional work, was an Embryo Replacement Catheter courtesy of Smiths Medical/Wallace.  It wasn't one of the items they were giving away to the general public, but after a demonstration and at my request, they kindly gave me one to help calm possible fears of clients who are anxiously awaiting IVF. 

Yesterday, I went back for another full day. I was able to meet more of the exhibitors, go to one more seminar and found Sandra Walker, a reflexologist from Hatfield, whose interests coincide with mine. I met some amazing colleagues from the fertility community, from hypnotherapists to embryologists, and was able to see the fire in their eyes when they spoke about what they do to help people conceive the baby they want so much. It took my understanding of them and their work "off the page" to a different level.  There are several people from both the UK and the U.S. I look forward to talking with further, working together or feeling comfortable enough about to refer my clients.

Of course, there were people on various stands who seemed to be more the "pack them in and sign them up" type, but that was good to see too. I won't name anyone here.  While a worried and impressionable couple might be drawn in by the slick efficiency of that type of fertility clinic, seen in isolation, it's my belief that they stood out like a sore thumb when viewed side by side with the more personal, caring approach of their competitors. Yes; success rates, cost of treatment and location of a clinic are all important, however, not as stand-alone factors. Take them together, and with other factors such as language spoken, accessibility, after-care and patient support offered, a willingness to listen to your concerns and flexibility of approach.

Of the seminars I attended, the one that impressed me the most was given by Dr Sam Abdalla, Director of the Lister Fertility Clinic: Is anyone too difficult to treat? While conceding that not every woman will be able to conceive, Dr Abdall's philosophy is not to turn anyone away if there is some chance, however small. He did state that if a woman had zero chance of conceiving, it would be unethical to treat her.  However, rather than only taking in patients under a certain age (there were those at the Show that had a cut-off) , or with a high chance of success, as a means of keeping the clinic's success rate high, he believes that the best policy is to inform the patient of her options, her chances and give her the choice of whether to proceed. Remember, whereas years ago, a woman with low ovarian reserve may have been out of luck, now of course, she has a good chance of conceiving over several cycles of IVF, with different tratment options or with donor eggs. The choice is hers.

I will be writing more this week on some of the topics that came to mind during my visit to the Fertility Show, including how to get the best patient services from your fertility clinic, questions relating to going abroad for fertility treatment and how to decide whether complementary therapies are right for you.

Were you at the Fertility Show? If so, I would love to hear what you thought of it.  I am actively seeking comments, as I am trying to decide whether it would be beneficial for me to take a stand for next year's event.  Please let me know what you thought of the Show.

More UK celebs talk about IVF; Jacqueline Gold's bittersweet story of life and loss

The other day, it was Emma Thompson talking about her IVF in the weekend papers and yesterday it was Jacqueline Gold, known as the dynamo who turned UK lingerie chain Ann Summers into a mult-million pound business. But, whereas Emma's IVF in her early forties was unsuccessful, Jacqueline gave birth to twins at 49. Sadly, one of Jacqueline and her husband Dan's babies, Alfie, died at eight months old in March of this year. Jacqueline spoke to a Sunday Times reporter, Laurel Ives, about their experiences.

By all accounts, Jacqueline Gold has always been a driven businesswoman. However, beyond the public eye, she and her boyfriend Dan started trying to conceive almost immediately after they met ten years ago. Quickly realizing that they would need the help of assisted reproductive techniques, they decided to undergo IVF. The stress of three failed cycles over a period of five years led to their split. Jacqueline's career at Ann Summers took over until she and Dan re-united two years later and decided to give IVF another chance; this time in the States. This time, the IVF worked and they conceived twins, born in July 2009. Unfortunately, though, theirs is a bittersweet victory over infertility.

While Jacqueline was pregnant, doctors discovered that one of the twins had a rare condition, alobar holoprosencephaly, which causes severe brain damage. Jacqueline and Dan opted not to terminate the affected fetus as they were worried about its risk to the healthy baby. No one expected the fetus to survive outside the womb. When Jacqueline gave birth to both twins, she was devastated to find out that Alfie, the ill baby, couldn't see, think or feed and was in constant pain. The next eight months were a mixture of joy with daughter Scarlett and pain on seeing Alfie suffer.

Jacqueline Gold is obviously a very strong woman. She has had to move on from a the life-altering experience of the death of her child, and according to the Sunday Times article, is doing very well. Here are some of the things to which Jacqueline attributes her healing:

• the love and support of her husband Dan, who she married two months after Alfie's death
• knowing that in his eight months of life, Alfie was well cared-for at the Children's Trust Tadworth, that his pain was managed and it gave her the time to know him
• creating a pirate-themed treasure chest for Alfie's mementoes
• her work, which gave her some normality
• that she was able to hold Alfie and say goodbye as his feeding tube was removed
• being a mother to Scarlett, now 16 months old

Jacqueline also spoke in the article about their experience of IVF, which I pass along here so that those who are going through it now, know that they are not alone in finding it difficult:

• She may have pursued her career vigorously during her fertile years, but the delay in trying to conceive was also about her personal life, "when you're older you're more confident, relaxed, resourceful and having the right partner is very important." She met husband Dan when she was 40.
• "IVF is such a rollercoaster. There is a big build-up and then such disappointment - it can be overwhelming."
• "[Y]ou don't have enough time on your side to take a year off." In one IVF cycle, Jacqueline had embryos implanted the day before her mother's funeral.
• After 3 IVF cycles, she and Dan split up for 2 years. "We had stopped communicating...everything had just broken down."
• They went to America for their final round of IVF "They are so much more supportive and positive about the process there, and the success of the treatment has a lot to do with how you are feeling."

There are lessons to be learned in Jacqueline's words, above.

1. A balanced life and a relaxed, empowered attitude are important ingredients in the "readiness" that many women seek;
2. Good paths of communication are essential to a healthy relationship in the face of stressful fertility treatments;
3. Pay attention to what else is going on in your life and how it might affect your chances of conceiving. A time of grief and emotional stress is not going to be the optimum time to focus all of your positive energy on conception; and
4. The support and trust in your medical team can have a positive effect upon your acceptance of treatment and eventual results.

On a final note, I would have added the link to Laurel Ives' article in The Sunday Times Style section, however, I was unable to get it without paying to subscribe online. Since I already pay for my subscription to the paper copy, I wasn't willing.

Actress Emma Thompson had secondary infertility

Why is it important for us to know that celebrities like Emma Thompson suffer with infertility?  Yesterday's Daily Telegraph carried an article, by Gordon Rayner - Chief Reporter, about the actress Emma Thompson's depression over the failure of multiple IVF attempts to have a second child in her early forties. Thompson and her husband, Greg Wise, already had one daughter, Gaia, but wanted more children. Several cycles of IVF failed to fulfill their dream.

Infertility strikes indiscriminately, without regard for who you are, how many children you dream of having or how much money you have. A beautiful, talented, wealthy actress has no edge over the rest of us merely beautiful women when it comes to the tricks that our reproductive systems can play in the baby-making game. Thompson is quoted in the article as saying that she was so devastated by her inability to conceive that she was unable "to get dressed or leave her house" some days. I'm sure that a lot of you can relate to that feeling, as I can.

The difference, perhaps, between Emma's situation and many other women, is that she was able to afford to pay for several cycles of IVF in her forties, beyond the age of entitlement to NHS fertility treatment. Having suffered from depression on previous occasions, Emma sought counselling and was treated with prescription antidepressants during this difficult time.  She continues to see her therapist weekly. This, in itself, is helpful for infertile women to hear. Knowing that someone you may admire has had emotional support for the feelings associated with infertility can persuade a depressed, stressed or merely confused person to seek help themselves. It can help validate their feelings, make them accept that there is a problem and hopeful to know that it is one which can be helped.

The name given to an inability to conceive after having a child is secondary infertility.  It's a shame that the Telegraph article didn't mention that, because people who read the article just because it's about Emma Thompson, could be made aware that this is a medical condition. A woman who has one child and hasn't conceived another, may seek help from her doctor as a result. Others, who wonder why a couple has only had one child may realize that it is not necessarily by choice and be careful about insensitive remarks they may otherwise have made.

There can be the tendency, whenever someone is struck ill or a medical condition arises that appears to be random and particularly unfair: Why me? We think that it doesn't make sense. We look at ourselves and wonder what we did to deserve this. I'm sure that Emma Thompson had these thoughts while she was struggling with secondary infertility. There is no answer to this question. No one deserves it. Sometimes, the way life unfolds answers the question in unexpected ways. Emma later went on to adopt a 16-year old Rwandan boy, a former child-soldier, in 2003. The Telegraph quotes her as saying that it convinced her that it was "probably a good thing" she hadn't become pregnant again.