Navigating the Land of IF- A Melissa Ford Interview

By: Trina Leonard

Written as a "travel guide" to the Land of IF (the online abbreviation for infertility), Melissa Ford's new book, Navigating the Land of IF: Understanding Infertility and Exploring Your Options, offers a refreshingly candid perspective on the emotional and social aspects of infertility, as well as practical information about testing, treatment, handling invitations to child-centered events, talking with friends and family and more. Ms. Ford is well known for her widely-read blog on infertility, http://www.stirrup-queens.com/ , and as a contributing editor for BlogHer. In a recent conversation with GIVF, Ms. Ford discussed her blog, her experiences as an infertility patient and her tips for current travelers in the "Land of IF."

When she began her own journey by trying to get pregnant naturally, Ms. Ford says she was shocked when conception failed to occur. "Before that, I had trekked through life pretty successfully, in school and in work," she says. "For the first time, when I began trying to get pregnant, I put in the 'work' and wasn't seeing results." Thanks to IVF, she eventually became the mother of twins, but her infertility experience changed her, including her attitudes about treatment. At first," she says, "I had lots of 'won'ts' and 'can'ts' in my vocabulary. Now, I would eliminate those and leave myself open to the possibilities."

She says that patients should do their best to maximize their visits to the doctor so that "you don't leave with questions unanswered because you forgot to ask them." To use both the patient's and the doctor's time well, she says: 1) Always be honest and upfront. Better to over-report than miss telling your medical team something important. 2) Write questions down before the appointment. Know what you need to ask. 3) Use a journal to record your questions, the answers and other information about medications or the process. "I kept a spiral notebook in my purse and wrote everything in one book," she says.

Traveling in the Land of IF is an emotional as well as a physical journey. Ms. Ford says, "It is very important not to ignore your emotional needs. Having the emotional side addressed makes getting through the physical side easier." She launched her "Stirrup Queen" blog in 2002 after participating in an online patient organization, but not finding the kind of information and support that she really wanted online. Now, more than 2,000 people visit her blog each day, reading her thoughts and sharing their own experiences - both physical and emotional. Online support is a valuable adjunct to "face to face" support for infertility patients. Ms. Ford says,"In online support, you constantly have new people you can connect with. There is always someone who will listen to you and who may have had a similar experience."

Although most blogs and books about infertility focus on women, Ms. Ford zeroes in on men's needs, too. "Men's emotional needs are sometimes overlooked, because they process their emotions differently. My husband is very male and can compartmentalize. When he was at work and I'd call or email him about some aspect of our treatment, sometimes I didn't think he cared as much as I did, but eventually I learned that just because he wasn't talking about it didn't mean he wasn't affected."
Melissa Ford offers the following tips for offsetting the emotional aspects of infertility:

-Engage in a physical activity that isn't related to fertility.

-Go out, perhaps with friends or a partner.

-Join a support group.

-Find a therapist who specializes in infertility.

"Although I didn't choose infertility, I would never wish that I hadn't had it," she says. "I've learned a lot. I've also become a more patient, more sensitive listener. Before I started to blog, I didn't know that there were so many people with so many different stories about infertility. I learned to set aside what I thought I knew and listen to what people were really telling me. Everybody has a story."

Use An FSA To Fund Your Fertility Treatment

A Flexible Spending Account (FSA) is an account set up through your employer for medical expenses not covered by insurance such as office visit or prescription medication copays, dental or vision expenses, over-the-counter medications, or medical procedures such as infertility treatment. All expenses must be intended to treat or prevent a specific medical condition. Money is taken out of each paycheck, then you submit a request for reimbursement whenever you have a qualifying expense. All expenses must occur during the calender year- January 1st-December 31st.

The benefit to FSA's is that the money deducted from your paycheck for a FSA is not subject to payroll taxes. FSA's are also "prefunded" by your employer meaning the entire amount of money you select to put in your FSA is available on January 1st. If you are terminated or leave your company before the end of the calender year you do not have to reimburse your company if you already used the entire amount. One of the drawbacks to FSA's is the "use it or lose it" policy- if you do not use all the money in your FSA before the end of the calender year you lose it.

Typically toward the end of the year (October-December) companies allow you to select your benefits for the following year including health insurance and FSA's. So now is a great time to start thinking about setting up a FSA for 2010 or using up the rest of the money in your FSA for 2009!

Doctor, Tell Me About Clomid

By: Stephen R. Lincoln, MD, FACOG Reproductive Endocrinologist

Clomiphene Citrate

How does it work?
Clomiphene Citrate is an oral medication that stimulates the release of FSH (Follicle Stimulating Hormone) from the pituitary gland. In turn, FSH stimulates the production and release of follicles from the ovaries. Clomiphene may be given to patients who do not ovulate regularly, who have an ovulation dysfunction, patients with unexplained infertility, or patients undergoing intrauterine insemination.

How is Clomiphene Taken?
Clomiphene is administered orally with starting doses of 50-100 mg/day for five days (cycle days 3-7, 4-8 or 5-9). The dose of Clomiphene may be increased by 50 mg increments in order to achieve desired clinical results. Ovulation is expected to occur 4-8 days after the last tablet of Clomiphene is taken. The time and dose may be different depending on your medical history.

How do we determine that Clomiphene is working?
If you have not been ovulating regularly, the presence of menstrual flow at the end of the treatment cycle is the most obvious sign of appropriate response to Clomiphene. Other methods of monitoring ovulation include basal body temperature charts, serial ultrasounds, urinary ovulation predictor kits and blood measurements of progesterone. Pregnancy is the ultimate confirmation that Clomiphene is working.

What side effects can be expected?
Temporary hot flashes are the most common side effects of Clomiphene citrate. Temporary ovarian enlargement may cause abdominal discomfort. Less frequent symptoms include breast tenderness, headache, nervousness, moodiness, dizziness, nausea and vomiting, fatigue and visual disturbances. About 10% of women experience side effects, usually mild, from Clomiphene citrate. Approximately 90% of pregnancies resulting from Clomid are singleton births. Twins occur in approximately 9-10% of pregnancies and <1% result in triplet pregnancies. The incidence of congenital malformations (birth defects) in children conceived while using Clomiphene is the same as in the general population. Additional information on Clomiphene is available on the pharmaceutical manufacturer's package insert, or directly from the manufacturer.

Does Clomiphene Citrate cause cancer?
Clomiphene Citrate has been on the market for over 30 years. Some studies have suggested a small increase in the lifetime risk of ovarian cancer for patients who have taken the medicine for over 12 cycles. There is no evidence of any increased risks for patients who take Clomiphene for less than 12 cycles. We generally recommend a 3 - 6 month course of treatment and then moving on if no pregnancy has occurred.

Swine Flu And Infertility Treatment/Pregnancy

The swine flu (H1N1 virus) is a new strain of influenza virus first identified in April 2009. The virus is spread by coughs or sneezes or by touching contaminated surfaces and then touching your nose or mouth. The symptoms of swine flu are similiar to other seasonal flus: fever, coughing, sore throat, and fatigue or weakness. The CDC notes that most cases worldwide have been mild. Most hospitalizations and deaths are in people who have underlying health problems such as asthma, diabetes, obesity, heart disease, or a weakened immune system.

Here are the current CDC guidelines as related to pregnancy (or those trying to conceive):

• Swine flu may be more severe in pregnant than non pregnant women



• Pregnant women (and those attempting pregnancy) should recieve the vaccine when available



• If pregnant and suspected of having swine flu you should stat treatment immediately (do not wait for confirmation from lab tests) with Tamiflu or Relenza.
  

The H1N1 vaccine is currently in clinical trial and may not be available until October.

New Egg Screening Technique

The first baby was born in Britain using a new screening technique which examines eggs for chromosome abnormalities allowing physicians to select the best eggs to use in fertility treatment. Baby Oliver was born to parents who had thirteen previous failed IVF attempts. The test is called Comparative Genomic Hybridisation (CGH) and uses a sample of a "spare" set of chromosomes that are expelled by the egg during fertilization. These chomosomes are compared to a normal set of chromosomes identified by the Human Genome Project.

The researchers believe that this technique could double IVF successs rates. Professor Simon Fishel, lead researcher for study states, “Up to half of the eggs in younger women and up to 75 per cent in women over 39 are chromosomally abnormal. Array CGH is used to screen eggs or embryos in an IVF cycle, evaluate all the chromosomes and select the most chromosomally normal embryos." Experts caution that this new technique needs further research in a well designed clinical trial.