Thursday April 28, 2011
Once again, it's time to bust a myth in honor of National Infertility Awareness Week and RESOLVE's Bust a Myth Challenge.
Today's Myth: You cannot pursue fertility treatment and consider yourself a believer/religious.
This myth plays out in two ways. One is that accepting help or treatment somehow implies a lack of faith in God. As if infertility is a sign from God that you are not worthy of carrying a pregnancy or becoming a parent, and therefore, finding and accepting help is wrong.
The other way this myth plays out is that fertility treatments are religiously unacceptable, specifically IVF. Some religious groups believe that conception should never occur outside of the body, or they fear that embryos will be destroyed or indefinitely frozen.
This is especially a problem for fertility challenged Catholics, and for Christians who oppose intentional destruction or freezing of embryos.
What's Wrong with This Myth
Plenty of religious people experience infertility and seek out treatment without going against their beliefs. If you're against IVF treatment, there are other options available, including GIFT (more on that below).
As for saying that treatment seeking shows a lack of faith in God, it's no different than taking antibiotics for an infection or having your appendix removed for appendicitis. If you accept medical treatment for other illness, then logically there's no reason not to accept treatment for infertility.
What's (Possibly) Behind It
Obviously, I can't speak to God and get answers. So I'm limited on this one.
What I can do is dispel some misunderstandings regarding fertility treatment options, provide some food for thought on the topic, and provide a Biblical example of an infertile women seeking help to get pregnant.
And I must apologize that this post speaks mainly to Christians and Jews. I have to stick with what I know here. But if you have answers for other beliefs, please do share in the comment section.
First, let's tackle the idea that fertility treatment somehow goes against God's will.
There are those that believe that infertility is some sort of religious curse or punishment or that it is a sign that it is not God's will that you have children.
The fact of the matter is that we have no idea why bad things happen to good people. (And I think we can all agree that infertility is something that happens to many good people.) The Bible has quite a few examples of infertility happening to righteous individuals, including Sarah, Rachel, and Hannah.
To say that you are infertile as punishment would be like saying Sarah, Rachel, and Hannah were being punished, and I don't believe the Bible implies that their infertility was a punishment. It certainly caused them all heartache, however, and somehow was essential to them becoming the amazing women they became.
Also important to note is that the fertility challenged women of the Bible did not accept their infertility. They prayed and begged God for children. If they thought this was simply a matter of God deciding they were not meant to be mothers, why pray?
Rachel even sought an herbal fertility treatment:
"During wheat harvest, Reuben went out into the fields and found some mandrake plants, which he brought to his mother Leah. Rachel said to Leah, 'Please give me some of your son's mandrakes.'" -- Genesis 30:14
Mandrakes were an ancient fertility treatment. Rachel felt so strongly about needing them that she exchanged a night with Jacob for the fertility herb. Unfortunately, the mandrakes were not helpful for Rachel, but this is still a good example of a righteous biblical figure seeking out the treatment of the time for infertility.
Fertility Treatment, Embryos, and Conception Outside the Body
IVF, in vitro fertilization, means fertilization that takes place in the lab, and some have religious objections to conception taking place outside of the body.
However, if this level of assisted reproductive treatment is necessary, there is another option - GIFT. GIFT stands for gamete intrafallopian transfer. With GIFT, the woman's eggs and man's sperm are placed together directly into the fallopian tube. Hopefully, the sperm will fertilize the egg or eggs, and pregnancy will occur. With GIFT, conception occurs in the same place it occurs naturally.
The success rates for GIFT are not nearly as good as they are for IVF, it is a more invasive medical procedure, and you may need to search for a doctor experienced with this rarely used treatment. However, it is an option, and one you should know about.
If fertility drugs or other treatments are not successful for you, and you are against IVF, talk to your doctor about GIFT.
Let's talk a bit about those who don't have a problem with conception outside the body per se, but do not want embryos frozen or intentionally destroyed.
You can speak to your doctor and specifically ask them not to create more than one or two embryos at a time. Your chances of getting a good quality, strong embryo may go down, and so you may need more cycles of IVF for success. Also, depending on the reason for infertility, this option may be unlikely to work. But for some couples, this is a real option to consider.
You can also consider donating any extra embryos to another infertile couple. Be sure to talk to your doctor about this option before you start treatment, as certain tests and paperwork may need to be done before the embryos are created.
Also, you should know that embryos are never created and then destroyed intentionally without your consent. (Dead embryos may be thrown away, but you can always talk to your doctor if you want them disposed of in a special way.) They will be your embryos, and you can choose what to do with them once they are created. You can freeze them and choose to transfer them until you have used them all up. (If you get pregnant with one transfer, you would just use the next ones for the next pregnancy.)
In fact, if some embryos are too weak to lead to a pregnancy or have already died, but you are against them being thrown in the trash, ask your doctor about transferring them anyway, either in that cycle or a future cycle. They will then leave your body with your period.
Some fertility clinics offer religious supervision, where a religious figure, sometimes a rabbi, oversees how the embryos are handled. You don't have to be Jewish to use these services, and if you want added security that your embryos are cared for according to your wishes, this is a possible option.
What the Facts Are
No one really knows what God thinks, and bad things happen to good people for reasons we do not understand. No one can say whether what happens is "meant to be" or not.
Accepting fertility treatment is no different than accepting help for any other medical problem. If you would accept herbs, drugs, or medical treatment for your non-fertility problems, there's no logical reason to turn it away for infertility. Remember that Rachel of the Bible took a fertility herb of her time.
There are options for fertility treatment that may help avoid whatever religious or ethical problems you have. Remember that 85 to 90% of infertile couples can be treated with drugs, surgery, or other low tech treatments, and IVF may not even be necessary.
But if IVF is recommended, you have options, like GIFT, single embryo creation, embryo donation, and transferring the frozen embryos until you have used them all up.
More on infertility and spirituality:
More on infertility myths:
Wednesday April 27, 2011
As I did yesterday, I am busting another infertility myth today in honor of National Infertility Awareness Week and RESOLVE's Bust a Myth Challenge.
Today's Myth: The majority of infertility is caused by careerism (leading to late motherhood) in women or STD infections.
In other words, the majority of infertile couples wouldn't be infertile if they either avoided STDs with safe sex practices, or if they didn't wait too long to have kids.
What's Wrong with This Myth
There are a wide variety of causes for infertility, and the majority of them are not preventable. (More on this below.)
Yes, it's true that there is an increasing number of women dealing with age-related infertility. More couples are deciding to start their families later in life. But this still does not make up the majority of infertility cases.
It's also true that STD infections, which lead to pelvic inflammatory disease (PID), are a leading cause of preventable infertility. They are not, however, a leading cause of infertility itself.
What's (Possibly) Behind It
When you read about infertility in the media, it seems the stories can be put into three basic categories:
Celebrity news, especially the "dirt" and gossip. Who is using a surrogate, what "offensive" terms are they using, did they or did they not use IVF, and so on. There are few positive celebrity infertility stories.
News on the extreme or controversial and rare side of things, like talking about women looking for surrogates in India (interesting, but far from 95% of infertile couple's experience), or Octomom stories, or egg donors who had an unfortunate experience (rare, but it happens.)
Preventable infertility stories, either on age and fertility, weight and fertility, or STDs.
But why does the media seem to focus on infertility this way?
With celebrities, it's obvious and not unique to infertility. The media reports on what celebrities eat for breakfast, so we can expect them to report on their family building ventures. The extreme stories also make sense, as they sell the most papers or garner the most page views.
But why when talking about every day folk do they choose to focus on age, weight, and STDs? How come there aren't more articles on Primary Ovarian Failure and varicoceles and endometriosis and fibroids? Where are the articles on PCOS that do not only focus on the weight angle? Why aren't we reading about unexplained infertility? Where are those stories?
My theory is that people feel much safer when they can blame you for your health problems, than consider the idea that life is unfair and disease sometimes randomly affects people (even those living healthy lives). It's much easier to tell you to "just adopt" or to pay for infertility treatments yourself when they can point their fingers and say, "You did this to yourself, stop whining about it already."
Harsh? Yes, but it's probably true.
If people would admit that infertility can affect anyone, then they have to consider the frightening possibility that their close friends or they themselves can experience it. It would lead to feelings of vulnerability, and in general, people don't like feeling vulnerable.
I'm not saying the world is full of uncaring people who like to blame others for their health problems. I'm saying the world is full of vulnerable people who are afraid that health problems (and other tragedies) might not always have a preventable cause, and therefore, subconsciously prefer to blame rather than empathize.
What the Facts Are
So what does lead to infertility in most couples? There have been a number of studies, but I think one of the best to consider is one done in Israel, and only recently published in 2011. I like this study because in Israel, fertility treatment and testing is paid for by government mandated insurance. So unlike studies done by fertility clinics in America (where you can expect more bias towards those with insurance or money), you can get a better view of the general population.
This study looked at a nine year period, at two clinics, and included 2515 couples altogether. This is some of what they found:
- The mean age for the patients was 29.6 years, with about a 6 year range on either side. The youngest were 23, and the oldest were 36.
- Primary infertility accounted for 65% of couples. That means that 35% were experiencing secondary infertility (or infertility after already having had at least one child.)
- Male factor infertility affected 45% of couples.
- Problems with ovulation affected 37% of couples.
- Tubal damage affected 18% of couples.
- Infertility affected just the female partner in 30.6% of cases, and solely the male partner in 29.2%.
- Unexplained infertility was 20.7%, and was likely from undiagnosed endometriosis.
By looking at these statistics, you can already see that age is not the major cause of infertility. In these two clinics, most patients were under 35 years of age, and 45% of cases involved male infertility (which means even when dealing with a woman over 35, her age would be an additional issue, not the sole issue).
You can also see that STDs are not to blame for the majority. How can you tell? STDs cause tubal damage, so at most, only 18% of the couples possibly had STDs to blame for their infertility. But since there are a variety of reasons for tubal damage, and it's unlikely that all 18% of the tubal factor infertility cases were due to STD damage, even that would be an overestimate.
The bottom line? The majority of infertility is not caused by age or STDs. The majority of infertility is not preventable.
And I think it's important to say that even for those who do experience preventable infertility, they still deserve our empathy, concern, and care. We don't look at a 70 year old having a heart attack and say, "Well, he's old, why should I care?" We don't look at a woman with diabetes and say, "Well, she is obese, why should insurance pay for her insulin?" That's crazy.
Should people do whatever they can to prevent health problems? Yes. But our job is not to ignore them or brush off their troubles. We should not stand here in self-righteousness and use blame to push away uncomfortable feelings in ourselves.
We should all stand, together, and do what we can to treat and support every couple who wants a child but struggles due to infertility - regardless of cause.
More on infertility myths:
More on causes of infertility:
Tuesday April 26, 2011
In honor of National Infertility Awareness Week, and RESOLVE's Bust a Myth Challenge, I'll be busting some infertility myths this week.
Today's myth: Birth control pills cause infertility.
And I obviously don't mean it keeps you from getting pregnant while you're taking it - I mean it leads to infertility after you stop taking it.
What's Wrong with This Myth
Research on birth control pills have found them to not have a long term effect on your fertility. In fact, as soon as you stop taking them, you're possibly fertile, even before you get your first period.
Birth control pills are even used as part of fertility treatment. During IVF, birth control pills may be used to help regulate and time the treatment cycles, especially in the case of donor eggs but also non-donor cycles.
Also, for women dealing with clomid resistance, birth control pills taken for one cycle before treatment have been found to boost success.
What's (Possibly) Behind It
They say that behind every myth there is a grain of truth. Where does this idea come from that birth control causes infertility? (And I mean besides the anti-birth control people who try to spread lies to scare people away, for whatever reason.)
Many women begin taking birth control pills at an early age, whether that is as early as high school or later in college. Because birth control pills regulate your cycle, determining the day you start your period each month, you will have regular periods as long as you are taking them.
Now let's say you stop taking them, and your cycles are irregular, or worse, completely absent. You may assume the birth control pills are at fault. In actuality, your cycles may have been irregular even before you started the pills. But being so long ago, and way before you started thinking about trying to get pregnant, you may not have noticed or remembered. (Plus, when your cycles just start, slightly irregular periods are normal.)
Another possibility is that your cycles are irregular due to the natural aging process. But because the pills were regulating your cycle before you stopped taking them, you didn't experience any cycle changes yet.
What the Facts Are
Birth control pills are not to blame for infertility. Birth control pills can mask symptoms of infertility, however, and so if you stop taking them and have irregular cycles for a few months, speak to your doctor.
A Controversial Side to the Birth Control Myth
There's another side to the birth control myth, and that is that the ease of birth control pills are to blame for women experiencing age related infertility. Some say that birth control pills gave women the false sense that medicine can control the body so well, that getting pregnant after 35 or 40 shouldn't be a problem.
Others say that birth control pills are so easy to use that they make it easy for women to "forget" about reproduction, leading them to wait too long before having a baby.
In my opinion, both of these ideas are ridiculous.
Birth control pills are no more to blame for over-confidence in the power of medicine than antibiotics, over-the-counter pain killers, or any other drug or medication. We as a society are guilty of imagining that any illness has a cure, as long as you find the right doctor. This is not true, sadly.
The fertility challenged are not the only ones around who face this sad reality, and birth control users are not the only ones who are shocked to discover that medicine doesn't always have a simple answer.
As for saying that birth control pills make it easy to forget about reproduction, that is also just ridiculous. I imagine a man must have come up with that myth, since a woman knows that you (typically) get your period even on birth control pills. That's a monthly reminder of fertility, even if it's a non-fertile cycle due to the hormone control. Not to mention the fact that you have to take a pill each day, another constant reminder of your fertility.
Plus, saying birth control pills make women forget about having babies denies the very real societal pressures to build a family and the psychological and human desire to have children. The pills stop ovulation - not your desire to one day have kids.
If you want to blame someone or something for age related infertility, blame the doctors who prescribe birth control pills without mentioning on a somewhat regular basis to their patients that fertility declines with age.
Doctors are so afraid to offend that they remain silent. This is a mistake. You don't have to be rude about it. (In other words, don't say, "You're getting old, you know. You might want to have some kids!") But perhaps offering a pamphlet that talks about age and fertility to women on a yearly basis, just as a basic education, might be a good idea.
Not to pressure anyone, not to imply that all women have to have kids by a certain age, or at all. But only so that women can make informed choices. Few women are taught that fertility starts a gradual decline at age 27 and a more rapid decline at 35. Doctors should be talking to women about this each year at the annual exam, whether they are taking birth control pills or not.
More on age, fertility, and infertility myths:
This is part of the About.com Health Channel blog carnival on contraception, hosted by About.com Guide Dawn Stacey.
Thursday April 14, 2011
In just two more weeks, National Infertility Awareness Week (NIAW) will be here. NIAW, a project of RESOLVE, is April 24th to 30th. There are so many things you can do to raise awareness about infertility during the week.
Maybe you'll dedicate your Facebook status to infertility awareness, or maybe you'll commit to attending Advocacy Day on May 5th in Washington, D.C.
Or if you have a blog, you can enter the Bust a Myth Blog Challenge. RESOLVE wants you to answer on your blog the following questions:
What is the biggest infertility myth and how has it affected your life or the life of your friends and family members?
Once you've written your blog, be sure to submit it for award consideration here at the RESOLVE website.
Will you be busting a myth in honor of National Infertility Awareness Week? Feel free to link to your myth busting blog post in the comments of this post, if you'd like to share. (Just be sure to ALSO submit your link to RESOLVE, since posting here won't include you in the official challenge.)
More about infertility awareness:
