WHAT EVERY MAN AND WOMAN IN THEIR TWENTIES AND EARLY THIRTIES SHOULD KNOW.

Wednesday, November 24, 2010

Men: often overlooked in the feelings department

There are many articles, discussions and blogs about how fertility challenges (I hate the word infertility) affects women, but men and their feelings are so often overlooked. We tell people when faced with a challenge to "man up" sometimes and perhaps that accidentally points to one of issues - men are expected to be the strong, resilient and unemotional ones. So often times people take the view that they don't need support. To be otherwise is girly and, therefore, perceived as weak.

So let's start right here and now and correct the assumption - men feel the pain of struggling to conceive and stay pregnant too. I am not going to go into degrees of whether it is equal, more or less - in truth I don't know the answer but I suspect that it varies from case to case and that more often than not it is the same more or less. He wants to be a dad as much as the woman wants to be a mom. He doesn't suffer the biological interventions necessarily to the same degree, but he still feels.

I have observed many different approaches and reactions to the male component:

1) men are often less likely to discuss the challenges they are facing or emotions that they are feeling with friends or family: They are more likely to bottle up their feelings. This doesn't mean they don't feel though. The fact that they don't confide in someone can make it harder for them at times, I think. Even if they say it is their 'coping mechanism' they still struggle and suffer deep within. The lack of externalising one's own emotions sometimes can be harmful in the long run - I have seen the stress come out in physical manifestations of all kinds of ailments, such as stomach complaints, which at first blush you might assume are unrelated;

2) people often forget to ask the man how he personally is managing and coping: men often get asked by friends and relatives, particularly male friends and relatives, about how their other half is dealing with it. However, somehow people can be reluctant to ask men how they are feeling. I have no idea why this is. I know it frustrates the living daylights out of me, because to me it feels like not wanting to mention the elephant in the room. But it could also be more a reflection of the person asking in the first place: maybe they assume that because the exterior that they see is all calm and collected, that all is fine; may be they don't know how to deal with the answer they get, be it curt or an unexpected out-pouring of emotion; maybe it is because they feel that the listener will work out that it is implied from their silence?;

3) men are expected to be tough and not feel the impact of the challenge as much as women: I have observed men be told about pregnancies of persons close to them and be told they just have to accept it because 'it is what it is'. And then the person has to hear all about the details of those pregnancies with only rarely, if at all, being asked as to how they are doing, how they are coping, or do they need anything in the way of support. It may well be that the speaker does feel compassion deep within, but it isn't expressed. Being the complex creatures that we are, a man as much as a woman can struggle to interpret the silence and lack of acknowledgment - is it lack of interest, lack of sensitivity or simply that the person doesn't know how to deal with the 'softer' aspects of the situation? Is there an assumption that the man is less affected by the infertility so that he doesn't need the same level of compassion and sensitivity as a woman does?

4) the holiday season can be challenging to men too: parents may elect to visit their children with offspring ahead of their 'infertile' children. The 'infertile' children can be told they will be visited in the New Year. If the 'infertile' child is a male, there can be a habit of delivering the message in a very matter of fact way without any attempt to bolster feelings and self-worth as you would if speaking to a woman. Again, it may be that parents think that men don't need the 'soft language' or cannot deal with it. But you can never assume. It can hurt a man as much as a woman to feel excluded.

People struggle with how to respond or deal with women in this situation, so if there is one take-away, it is don't assume men are necessarily light years away from feeling the same as you might expect of a woman. They may just be better at hiding it. Boys do cry, even if they always don't shed tears or have emotional outbursts in the same way.

Now to finish here is the ultimate piece of irony, and one to dispel all stereotypes and generalisations that I/we may ever make about men! Along our journey of challenges so far, it has been a man who has been the best at managing the right balance of level-headed 'it is what it is' approach with compassion and support. The fact that they were expecting a child was relayed to us at the same time as everyone else, and the excitement and nerves wasn't hidden from us and yet at the same time, there was never a conversation where a portion of it wasn't dedicated to being supportive, offering help to us and asking how we were doing. It was recognising the bitter-sweet nature of the situation but with equal respect to each. We felt respected for the honesty and not being treated as social lepers and also respected and appreciated for not being forgotten in our times of challenge - and very appreciative that the person still found the time to think of us even when consumed with his own busy life.

Tuesday, November 23, 2010

Painkillers in pregnancy and male babies


In the written press as well as on the internet these last couple of weeks, particularly in Europe, articles have started to appear, stating that common painkillers could be linked to male reproductive disorders. It was reported that scientists had found a link between the use of mild painkillers in pregnancy and the risk of giving birth to a son with undescended testicals with the possible consequences of having both poor sperm quality, as well as the potential for the emergence of testicular germ cell cancer in later life.

The study was done by researchers from the University of Copenhagen as well as other academic and medical institutions in Denmark, Finland and France.

The study featured both an analysis of pregnant women’s medication use and also data on animal research studies which analyzed testes development in rats; one potential outcome of the study indicated that the timing and duration of the mild painkiller use during pregnancy was linked to the risk of undescended testes in male babies. The research also suggests that ibuprofen, aspirin, and other nonsteroidal anti-inflammatory painkillers act as hormonal "endocrine disruptors" thus interfereingwith normal male sexual development. The greatest window of risk appears to be in the second trimester of pregnancy in humans.

To anyone reading the headlines these articles might be worrying at first blush. For example, it seems to suggest that even paracetemol (acetaminophen) may increase the risk in male babies (to a lesser degree).

In addition, there are many women presently being prescribed low dose aspirin during pregnancy to address cases of miscarriage risk or blood-clotting disorders (it is important to note that low dose aspirin is only a quarter of the regular, standard dose). Women in this situation may feel in a conundrum about what to do when managing the relative risks of both taking, and not taking, this medication. First up the advice to anyone pregnant that has taken such painkillers and is concerned about these findings is clear: consult with your doctor.

The British NHS Choices website states: "It is preliminary but important evidence, although at the moment, it is unlikely to change the current recommendations to pregnant women. These are to: avoid medications in general and to use paracetamol rather than ibuprofen or aspirin if painkillers are needed. However, advice should always be sought from a GP or midwife before taking medication." And if your doctor has recommended that you take medication, such as low dose aspirin, consult with him or her as to what to do, if anything.

Some believe that there are shortcomings to the research, for example, small sample sizes and the number of analyses involved reducing the certainty of its finding. The direct causal link has not firmly been proven. Nor does it examine the case of women who have been taking low dose aspirin (quarter the standard dose). Also, there are many other studies which show the benefits and upsides of taking the low dose for miscarriage risk/blood clotting issues on doctor's recommendation. Therefore the reports do need to be read with caution. What is clear is that this is an important area which needs more urgent research. While the rates of undescended testes seen in the study were still relatively low, it seems, as unfortunately happens with reporting in the press, the risk factors quoted can vary from article to article and some of the headlines can be alarmist, suggesting a 'global sperm decline'.

The NHS Choices website concludes: "Overall, this study does not prove a link between use of painkillers in pregnancy and this reproductive disorder in boys but it does suggest an important avenue for more research." Let's hope this research and investigation happens swiftly. As always, it is better to be informed than ignorant, however, information such as this may put a lot of pressure on the reader to think critically as a result - which is easier said than done if it affects you personally.

No matter how level-headed you are normally, to anyone who has suffered or is suffering from primary or secondary infertility, reading such an article could prove to be quite unsettling. Whatever your situation, it is essential to consult with your doctor if you are or have been taking mild painkillers and are worried in order to address any concerns you may have.

Wednesday, November 17, 2010

A thought .....

Following on from the work and efforts of Dr. Mary Herbert as mentioned in the last blog entry, here's a suggestion:

How about each of us try and have a word with our nurse and/or doctor the next time we visit them to see if they will get information evenings and leaflets running in their practice on the topic of raising fertility awareness to our young men and women? In particular to raise awareness to those in their 20's and 30's who are in the age range who need the information the most.

We have a wonderful example to refer to now.

Thanks!

Monday, November 15, 2010

Bravo Dr Mary Herbert of Newcastle University

http://www.independent.co.uk/life-style/health-and-families/health-news/revealed-why-risk-of-infertility-and-birth-defects-rises-with-age-2069229.html

Back in September this year Dr Mary Herbert of Newcastle University in the UK, reader in Reproductive Biology at the Institute of Ageing and Health, led a team whose research showed that declining levels of proteins called cohesins, which act like a glue holding chromosomes together, are the key to reproductive ageing, and why infertility and birth defects rise with age.

As part of the article on her research (see link above) it was reported that obstetricians have warned that the "bio-panic" women used to suffer on their 30th birthday has moved to their 40th. It further went on to say that some experts have predicted that a fertility time bomb hangs over Britain over the coming decades as women delay childbearing. One in seven couples have problems conceiving, and this could rise to as many as one in three if present trends continue.

With respect to her research and this issue, Dr. Herbert stated that:

  • "We are at the stage of saying how the engine works and what is broken. The next stage is answering the question: can it be fixed? Could you add cohesin that would do the job [of holding the chromosomes together]? A lot of effort is going into answering that."

  • However, no solution to infertility was imminent. "The main message is for women not to delay childbirth. The best way for women to avoid the problem is to have their children earlier. If there are social reasons why they are delaying then we should look at these and make it easier for them."
    Bold

I wrote to Dr. Herbert saying how much I had enjoyed reading about her study and in particular her conclusion about clearly messaging to women to not delay childbirth, and highlighted that the message she advocated sadly is not conveyed in any way properly or sufficiently to women so that they know the risks, and working women are particularly at risk. I asked for any support or guidance that she could provide in order to raise awareness on this topic, and I would just like to share with you all the wonderful response I received from her today.

As part of my letter to Dr Herbert, I raised her attention to this blog and mentioned that in it suggestions are made for improved education and awareness as well as referenced the study in Canada where it warns women could risk being unintentionally childless due to their lack of awareness of how fertility declines with age. I also pointed out the poor success to date in my attempts to raise awareness at the levels that have the authority and gravitas to make a change: I highlighted the letters I had written to the UK's Department of Health, the Department of Education, HFEA, the Royal College of GPs and the Royal College of Obstetricians on the need for improved education and the disappointing response - either a plain vanilla 'we are looking into it and aware of the issue' or else no real acknowledgement as in the case of the RCOGPs who simply said it was already on their curriculum but did not acknowledge that GPs and nurses weren't having the conversations with patients on the topic at pill checks and pap smears. And I pointed the the young women's magazines that I contacted to see if they would be interested in covering the topic and explained that I also had had no response from these.

Dr Herbert responded to me today and I am over the moon with her support:

After consulting with her colleagues about the problem of getting the reproductive ageing message to the family planing practitioners, she indicated that the general feeling is that targeting the practice nurses might be the most effective way to raise awareness. And that the Royal College of Nurses ('RCN") might be a good place to go.

She had also spoken with the head of nursing here at Newcastle Fertility Centre about the possibility of organising information days and/or leaflets for GP practice nurses who was enthusiastic about the idea and therefore hopefully something would begin to happen in that direction.

I will follow this up with the RCN but I would just like to say here and now a massive thank you to Dr. Herbert for her efforts here - this really is the wonderful type of support that will make a change and make for a better informed set of twenty and thirty somethings for the future. And hopefully avoid the 'fertility time-bomb' that some experts warn about.





Tuesday, November 9, 2010

The assumptions we make of those with fertility challenges

One life lesson that I always seem to never quite learn is that you should never make assumptions about others, because you can realise how wrong you are if you do so without asking any questions or getting the facts. I was very recently reminded of this all over again.

We were talking about someone that we actually don't know, who we had heard was having fertility challenges, and who we were told had said did not want to do IVF. The assumption made was that the person had investigated this with fertility specialists before coming to that conclusion. But it then transpired we may be wrong and I felt very bad.

Here's the thing - even those of us that battle with fertility issues can forget that everyone's experience is different. We shouldn't assume anything. We cannot assume to have an idea of what that person's feelings and thoughts are, and we shouldn't even for a nanosecond pretend to try and second guess. This whole situation certainly made me think a little more about the issue of fertility challenges.

  • It can cause a great deal of anxiety and we all react to it in a different way. In someone like me who is such a 'do-er', it translates into wanting to do all the investigation and steps I can to work out what I can do to increase the chances of a successful pregnancy. In others that anxiety can have a paralyzing effect. And there are others who are very relaxed about their chances of success and feel that there is nothing which they need to do. Some of us may need help however, to relax, some of us may need someone to lend us a hand to help us out of our 'mind fog' and some of us may need nothing more than a friend or someone to be there. The biggest challenge is for the person themselves to work out which type they are and for others to help them in this process - this sounds easy but it can be very hard.

  • There is an assumption that the cure to all fertility issues is IVF. Because it is so popular nowadays, we take for granted that this is the only way to go in order to deal with fertility issues but actually that is not the case. There are some fertility specialists who are of the view that people move on too quickly to IVF before trying other things first. And if someone feels that IVF is not for them, for whatever reason, they really shouldn't feel there is nothing they can do. There are certainly lots of things people can try besides IVF which can be helpful and many promote natural fertility remedies.

    My personal view is that the two can be complementary - you can pursue traditional medicine and also do natural things like reduce toxins, for example eat organically and do acupuncture to maximize your chances; but you should be open with your practitioners as to what you are doing to be sure the two do not clash with each other. And we should never criticize someone if they don't want to do IVF - it is a personal choice, we should remember to be supportive to alternative things they may wish to try. In my opinion, people can sometimes be too quick to dismiss natural and alternative remedies.

  • We should never forget to stretch out a hand to others - you can never make someone come to you for help, but you can extend a hand and say you are there if they need to speak or point them in the direction of someone who can help. Even if you don't know the person, be there for them, particularly if you know what it is like to be there yourself.

  • I realized how lucky folks in the US actually are. There are many wonderful organizations such as The AFA that are there to help support folks through their family building experience. These organizations are truly active, enthusiastic and progressive. Speaking with counterparts back in the UK, I realize how much more the help and support in that country is ad hoc and just not on the same level - it is changing and getting there, but not quite yet. (If any UK person is reading this and doesn't agree I apologize - this is just my personal view.)

So where does this all take me? Well probably not very far. But if nothing else it underlines to me how difficult and challenging dealing with fertility issues is. Nobody should ever underestimate this and assume that everyone reacts the same way. Stretch out a hand and seek to understand the person. This isn't about you - it is about them.



Posting on the AFA website: http://theafa.typepad.com/theafablog/2010/11/the-assumptions-we-can-make-of-those-with-fertility-challenges.html

Wednesday, November 3, 2010

Blastocyst Chromosome Screening - new test trials

Article in UK press:
http://www.colocrm.com/NewsEvents/10-02-12/Randomized_Control_Trial_for_Blastocyst_Comprehensive_Chromosome_Screening.aspx

Blastocyst Chromosome Screening (BCS) can spot chromosomal mistakes in outwardly normal-looking embryos that may prevent pregnancies or lead to miscarriages. It is still in the trial stage but if successful, it could help increase the IVF success rates as it will help doctors to pick out the 'best' embryos. The trials run so far have focused on the female age bracket 35 to 45 it seems (late thirties in the UK and 38 to 45 in the US).

There is one thing to be said about IVF and it is that innovation trail blazes on. I had never heard of BCS and I thought that my research on IVF was fairly thorough - clearly not! ;) I picked up on this new technology recently in the UK press referring to the first trials in Europe but it is already being done in the US as part of a trial at CCRM - see the second link above.

Back in February of this year, CCRM as part of its notice calling for people to take part in a randomised control trial said that preliminary results from their initial phase trials indicated higher implantation rates, lower miscarriage rates and higher live birth rates following BCS.

I don't know where the UK press take their following statement from, "evidence from the US suggests the procedure can boost the chances of a viable pregnancy after In-Vitro Fertilisation from around 35 to 75 per cent" but if true it is not insignificant.

So what is my lesson learnt? Well, the very institutions themselves will not always tell you about these trials they are running - I am not sure why - but having done an IVF at a CCRM sister clinic I do wonder why they did not tell us about this trial; perhaps we did not fulfil all the criteria? What I would say to anyone out there in the 35 to 40 age bracket is to ask about this! I do not know if it is the answer to your prayers but it is worth asking the doctors about.