Summer Reading! Budgeting for Infertility By Evelina Weidman Sterling & Angie Best-Boss : A LaMothe Book Review

Especially important in our current financial crisis, Budgeting for Infertility is a timely and accurate depiction of what it takes to pay for Assisted Reproductive Technology (ART) to complete a family. I found this book not only assists with budgeting but also educating Intended Parents on all aspects of ART including treatment terms, how to choose a clinic, finding affordable fertility medications, understanding the financial options and even exploring adoption. I especially liked reading the comments from Intended Parents who know first hand what it's like to travel down the road of infertility treatments. I highly recommend this book for anyone starting out, or even in the middle of their own personal infertility journey. Well worth buying and passing along.

Synopsis
Having a baby can be one of the most wonderful times of your life -- but if you need help to conceive, it can swiftly become a staggeringly expensive undertaking. With the average cost of infertility treatments ranging from $35,000 to $85,000 in the United States (most of which is not covered by insurance companies), many women and couples find themselves having to make difficult choices about building their families.
Getting a grip on your finances is one of the few things you can do to regain control of this process. Infertility experts Evelina Weidman Sterling and Angie Best-Boss have created the ultimate guide to ensuring the most cost-effective care with the highest chances for success. With anecdotes, interviews, and advice from both doctors and patients, you can easily apply these specific money-saving strategies to your own unique situation.

Learn how to:
- Select a fertility clinic with a high rate of success
- Convince your insurance company to cover more of the costs
- Track down the most affordable fertility drugs
- Travel abroad for cheaper care or international surrogacy
- Avoid the scams and unnecessary expenses every step of the way
Personal and professional, Budgeting for Infertility is an invaluable resource that shows you how to pay for infertility treatment...and still have money in the bank for diapers and day care.

Sharon LaMothe
http://infertilityanswers.org/

6 common tips you can use to facilitate the Surrogacy process with your clinic.

Below are 6 common tips you can use to facilitate the Surrogacy process with your clinic.



1. Your clinic will need to have the contract signature page at the very least (they may require the entire contract) on file or an affidavit from the contractual attorney, indicating that the contract is complete and has been signed by all parties.

2. The medical information forms need to have been signed by all parties and given to your clinic for their files.

3. The Surrogate Mother/Carrier is the patient. Information on medication, transfer, and follow up must be conveyed to her through the clinic and not the Intended Parents although they should be informed as well.

4. The Intended Parents need to make sure that they have a credit card on file with the clinic for all medication and procedures that involve the Surrogate Mother/Carrier and/or Egg Donor.

5. The Surrogate Mother/Carrier or Egg Donor should not receive ANY BILLS. She is not responsible for any payment of bills and this is usually stated in the contract between the Intended Parents and Surrogate/Egg Donor.

6. IVF costs should not be attempted to be billed through the Surrogate Mother/Carrier's insurance. (Blood tests, pap smears, OB appointments etc. are usually ok.) Remember the Surrogate Mother/Carrier is not the infertile woman and billing her for IVF costs can cost her the insurance policy and possibly pose insurance fraud accusations. Medicaid should not be used under any circumstance.



Sharon LaMothe
Infertility Answers, Inc.
http://infertilityanswers.org/
LaMothe Services, LLC
http://lamotheservices.com/
*Please note: Sharon LaMothe is not a MD, is not an attorney nor does she hold a mental health degree. All advice given is solely the experienced opinion of Ms. LaMothe. If you have any medical, legal or psychological questions or concerns, please contact your own Doctor, Attorney or Mental Health Professional.

Secondary infertility: Why can’t I get pregnant again? By Melissa Chapman

I had the pleasure of being interviewed by Melissa Chapman regarding my experiences with secondary infertility for Pregnancy and Baby (http://pregnancyandbaby.sheknows.com/pregnancy/Detailed/Secondary-infertility--Why-can_t-I-get-pregnant-again-6494.htm) Although secondary infertility was very frustrating to me I was one of the lucky ones who eventually had my 2nd child without the help of an infertility Dr. My daughter is 9 1/2 years younger than her brother and we are grateful every day to have her in our lives!



Sharon LaMothe
Infertility Answers, Inc
http://infertilityanswers.org/

Secondary infertility: Why can’t I get pregnant again?

By: Melissa Chapman

If you're dealing with secondary infertility, you are not alone in your struggle with trying to get pregnant again. When my daughter was two and a half, the barrage of questions as to when we were going to have another kid came fast and furiously. Initially I did not mind, however after nine months of trying to conceive the old-fashioned way—and even incorporating some romantic accessories to take the drudgery out of our mandatory “lovemaking sessions” -no amount of hot wax or fur-lined handcuffs were able to procure us a viable fetus. We went the route of meeting with a reproductive specialist, who flat out told me that I’d be unable to conceive without intervention.

Unable to fathom the information, being that our first stab at conception happened almost by accident, we chose to get a second opinion. Unfortunately the physician diagnosed me with secondary infertility and advised us that our best odds at conceiving were via medical intervention.

For my husband and I, the whole process of dealing with our diagnosis of secondary infertility and the battery of tests which ensued; having my fallopian tubes essentially snaked and his sperm scrutinized—months of painful injections, blood test, sonograms and insane mood swings all took a very heavy toll on our marriage. I also vividly recall wanting to deck every friend and family member, who during those difficult months- endlessly questioned me about when I was going to expand my family. In fact I even toyed with the idea of blurting out- on more than one occasion to a handful of relatives this very statement; “Well I’ll tell you how our next insemination goes, after my husband ejaculates into a cup and we rush it over to our doctor's office.”

Secondary infertility diagnosis

According to RESOLVE: The National Infertility Association over three million Americans are affected by the painful experience of secondary infertility. Dr. John Rapisarda of the Fertility Centers of Illinois says infertility, whether primary or secondary, is defined as one year of attempting to become pregnant without success. Evaluation is often recommended for individuals over 35 who have been unable to conceive after six months.

Causes of secondary infertility

Although they are pretty similar to primary infertility, Dr. John Rapisarda admits that age factors play more of a significant role in individuals with secondary infertility relative to those with primary infertility. These causes are broken down into three main categories such as male factors, hormonal factors and pelvic/tubal factors.

Male factors include: Changes in sperm quality may occur due to medication use, changes in health or in testicular function, or may be the result of hormonal or environmental changes.

Hormonal factors in the female include: The natural decline in ovarian function that occurs with age, other hormonal imbalances such as hypothyroidism, lifestyle changes, and change in weight, change in health or certain medications.

Pelvic/tubal factors can be the result of infections that damage the Fallopian tubes (sexually transmitted/ruptured appendix), endometriosis, pelvic or abdominal surgery that can lead to scarring in the pelvis or uterus, cervical surgery and growth of fibroids or polyps in the uterus that may interfere with implantation.

Secondary infertility treatment options

Depending on the factors that have been diagnosed Dr. John Rapisarda says there are several medical interventions to help couples experiencing secondary infertility. These include:

Surgery to remove scar tissue, excise endometriosis, or remove fibroids/polyps

Hormonal therapy to correct ovulation disturbances, or other hormonal imbalances

Fertility medications, such as clomid, to increase egg production in someone who is suspected of having reduced egg quality, or with unexplained factors.

Insemination for mild sperm abnormalities.

IVF to bypass pelvic/tubal abnormalities, for severe sperm related abnormalities, or for someone who has failed other interventions

Use of a sperm or egg donor.

Emotional toll of secondary infertility

“Infertility always takes an emotional toll on those experiencing it, whether primary or secondary. It is stressful and frustrating and often associated with a sense of a loss of control," says Dr. Rapisarda. “Those with secondary infertility are always grateful that they have a child(ren) at home, but when they begin their attempts at becoming pregnant again, they have the expectation that they will be able to add to their family without a problem. When this doesn’t happen it can lead to the above feelings as well as a feeling of guilt that they might have waited too long, or done something else to cause their secondary inability to conceive. Physically, the treatments may lead to weight gain and other symptoms associated with hormonal changes.”

According to Sharon LaMothe, co-owner of Infertility Answers, Inc., who, after experiencing her own bout of secondary infertility, gave birth to her second child and went on to become a gestational surrogate twice.

“I was put on Clomid (which made me very moody and emotional) and told to chart my temperature. That's when it starts to take a toll on a marriage,” says Ms. LaMothe. “I have to say that my husband was really great about talking about anything that I felt like talking about but mostly he said that he was grateful for whatever we had in the way of family.“

Ms. LaMothe admits that having her husband take the pressure off of her to "perform my god-given duty to populate the earth" was the best gift he could give. However she believes that as women we do put a lot of pressure on ourselves and when we can't have children we can sometimes feel worthless.

“No matter when you are infertile in your life it is still a heart breaking experience. You can't have what everyone else has "naturally". You have to "work at it" and spend money on "it" and talk about "it" and IT becomes a huge elephant in the room," says Ms. LaMothe. “And the reason why the elephant becomes so big is because we feed it our resentment, our grief, our money, our time, our anger, and sometimes our marriage and for sure we feed it parts of ourselves.

Five tips to ease the impact of secondary infertility

Sari Eckler-Cooper LCSW a sex therapist s well as a sexuality educator who has been in private practice for 18 year offers these tips to deal with the social and emotional impact of your secondary infertility:

Dealing with feelings of guilt: Many couples, experiencing secondary infertility struggle with the guilt they feel about wanting another child since they already have one. It pushes their “buttons” of feeling too selfish, and not feeling grateful enough for the child they have. I would first have a talk with yourself, write in a journal, and discuss these feelings with your spouse so you can figure out where your beliefs stem from (parents, religion, and culture). Then articulate a response to these held beliefs which help you to feel at peace with your decision to pursue the second pregnancy. Write them down if you need to, memorize them and have them in your back pocket.

Dealing with personal questions: The first part is to discuss with your spouse/partner who in your circle of family and friends you want to share the details of what is going on. You may have differing views around this and may need to negotiate a compromise. Once you do this stick, with the agreement, it will minimize tension in your relationship and at times like this you need to be as supportive a team as possible. Once the rules or boundaries are set it will be easier to say the following:

“I’m a very private person and I don’t discuss personal issues like this with anyone outside my immediate family”. With this comment you’ve actually drawn a circle around your intimates with whom you have shared details of your infertility treatment (like your spouse, sister, best friends) and let the person in question know that these are your boundaries. You could also say: “We’re working on it and that’s the most I’m willing to talk about at this time”. If they take this as a tempting opportunity to dig for more information you can say: “I would ask you to please respect my boundaries as I respect yours”.

Dealing with the emotional toll on your marriage: A husband/partner not going through the physical symptoms may just not understand how frustrating and emotional the pursuit and the medications are to your body and mind. The other point is that sometimes a spouse is ready to give up trying before you are. You need to talk things calmly and slowly and try to come to an agreement about how much money, time, and pain you’re each willing to invest and then come to a compromise. Talking with a therapist about these issues is extremely helpful and can clarify the issues more calmly.

Check out our trying to conceive and infertility message boards to connect with other women going through the same struggles.

Take a mini-vacation from the topic: Just as you have to be aware of timing and schedules when you go through the process of trying to have another baby, you can carve out time not to think or talk about the process, a mini-vacation so-to-speak from the topic. This allows you, your spouse and your child the opportunity to focus on other events and activities in your life that are also important. Your child feels that you are genuinely “present” with him/her, not distracted by worries or thoughts about the baby you’re hoping for.

This takes focus and organization on your family’s part. It will also help in the bedroom since sex has now most probably become solely about getting you pregnant and lost some of its fun, relaxing qualities that are so important in releasing tension and bonding you and your partner. If you feel you’re not being understood, that you’re fighting too much of the time or slowly losing connection then it's time to seek help from a counselor or therapist.

The next step - adoption or surrogacy: This answer is only yours and your partner’s to make. Some clients of mine stop after one IVF and others have had 5 before either deciding not to have the second child, adopting, or go through the surrogate route.

“My last piece of advice is to seek out a spiritual path or practice that helps you keep you present, focused and calm,” says Ms. Eckler-Cooper. “It helps to imbue your path with meaning that resonates for you. Whether that’s the religion you were brought up in, meditation or a new practice, your soul is as much a part of this process as your mind and your body.”

Infertility and Partner Abuse Witten by: Judith E. Horowitz, Ph.D

After several years of unsuccessfully trying to conceive many patients finally seek help with a reproductive endocrinologist for infertility. They may decide to use donated oocytes, after having tried intrauterine insemination cycles and several cycles of IVF using their own gametes. These efforts may leave young couples struggling financially.

As many as one in four women are physically or sexually abused during pregnancy. Neither partner can anticipate the mountain of debt they may accrue as a direct result of fertility treatments. Occasionally it has been reported that due to one’s dire financial straits, heavy drinking occurs along with blame towards the wife. Furthermore, without warning previously gentle husbands may start physically abusing their spouses. Although they may apologize and promise not to do it again, the drinking may continue which lowers their inhibitions and may lead them to become verbally and physically abusive.

The wife may become embarrassed and feel she can’t tell anyone about this, for fear of being harshly judged, especially if she has remained married to her abuser and stayed in their home. It can be difficult to admit that you are in a relationship where abuse has occurred. Abusive relationships may include constant monitoring by one’s partner, criticism for even minor things, accusations of unfaithfulness, and control of the ways money is spent. Additionally, the abusive partner may humiliate his wife in front of others, destroy property or things his wife may care about, and threaten to inflict harm on their already existing children (as is the case with secondary infertility) or pets. Furthermore, the violent partner may force his wife to have sex against her wishes, blame her for his outbursts, and threaten to use a weapon against her. The physical violence may include hitting, shoving, pushing, and kicking, and an abuser may also bite and beat his partner. Partner abuse can also be in the form of intimidation, constant belittling, and frequently the abuser will isolate the woman from her friends and family, and restrict her access to resources, including her car, which can cause additional isolation and dependence.

Intimate partner abuse is generally part of a pattern of abusive behavior and is rarely a onetime occurrence that resolves itself without intervention. Most abused women will experience multiple acts over time. Physical violence in an intimate relationship is almost always accompanied by psychological and sexual abuse. Intimate partner violence is experienced in both heterosexual and homosexual relationships.

Domestic violence is a violation of human rights, and is a worldwide epidemic that physically, emotionally, and financially impacts women and families. Children who are raised in homes where abuse occurred are more likely to be abused themselves or to become abusers. Domestic violence may lead to depression, high levels of stress, low self-esteem, and post traumatic stress disorder.

Unfortunately a woman’s response to abuse is often dictated by the options available to her, as may occur to women who have spent their savings on fertility treatment. Those women of limited means of economic and emotional support or who are concerned for the safety of their children are less likely to leave an abusive relationship. Emotionally dependent women or those who are unrealistically optimistic, hoping their partner will see the error of his ways and change often stay in relationships where there is domestic violence. Moreover, women who are fearful of being socially stigmatized infrequently reach out to others for assistance. Often, as a result of her years of suffering from infertility, these women already feel stigmatized, and different from those who easily conceived.

There seems to be no one factor, though, that directly leads to violence, but rather a number of factors that combine to raise the likelihood that a particular individual in a particular environment may act abusively toward a woman. Apparently, one’s social and cultural milieu combine with the abuser’s individual factors (i.e., whether he, himself, was abused or witnessed abuse), and determine the likelihood (s)he will become an abuser.

Many women who are battered during pregnancy will continue unhealthy habits due to stress, such as smoking, resorting to drug use and improper nutritional habits. These also affect the pregnancy. Immediate effects on the pregnancy can include: low birth weight; blunt trauma to the abdomen; hemorrhage (including placental separation); uterine rupture; miscarriage and/or stillbirth; preterm labor; fetal injury or death; and premature rupture of the membranes.

For those being abused, please remember that violent behavior is an abuser's choice.

Psychologists studying violent behavior have concluded that an abuser's behaviors are not about anger and rage because: 1) he does not batter other individuals, except perhaps his already existing children and 2) the violent partner waits until there are no witnesses and abuses the person he says he loves. Often the abuser will escalate his behavior from pushing and shoving to hitting in places where the bruises and marks will not show. If he were truly in a blind rage, he would not be able to direct or limit where his kicks or punches land.

If you feel you are in physical danger immediately call 911, the local police, or for anonymous and confidential help call the National Domestic Violence Hotline at 1-800-799-7233 or 1-800-787-3224 T T Y



Judith E. Horowitz, Ph.D. is a licensed psychologist in private practice in Broward County, Florida. After graduating Phi Beta Kappa from the University of Florida, she received her doctoral degree from UF, Gainesville, Florida, as well. Dr. Horowitz is a member of the American Society for Reproductive Medicine (ASRM) and is a certified Sexual Therapist and Diplomate of the American Association of Sex Educators, Counselors, and Therapists (AASECT). Judith is also a Diplomate of the American Board of Medical Psychotherapists and Psychodiagnosticians.

As an active member of the American Society for Reproductive Medicine since 1994, Dr. Horowitz was instrumental in developing and establishing the Mentoring Committee of the Mental Health Professional Group (MHPG) and served as its Chair. Judith also served on the MHPG Membership Committee, as well as the ASRM Membership Committee, and recently was appointed to the Steering Committee for Funding Development of the ASRM. Judith will act as the Chair of the e-Communications Committee of the ASRM MHPG 2009-2011.

Dr. Horowitz is a member of the American Psychological Association, the Florida Psychological Association, and the Broward County Psychological Association. Judith is also a member of the American Fertility Association (AFA), fertile Hope, and the Egg Donation and Surrogacy Professional Association (EDSPA). Dr. Horowitz is a contributing author for the Parklander Magazine and writes a monthly column. She has published numerous articles on the psychological impact of infertility and has lectured nationally. Dr. Horowitz has authored Ethical Dilemmas in Fertility Counseling, which is being published by APA Books and due to be released in 2010.



Sharon LaMothe
Infertility Answers, Inc.
http://infertilityanswers.org/
LaMothe Services, LLC
http://lamotheservices.com/
*Please note: Sharon LaMothe is not a MD, is not an attorney nor does she hold a mental health degree. All advice given is solely the experienced opinion of Ms. LaMothe. If you have any medical, legal or psychological questions or concerns, please contact your own Doctor, Attorney or Mental Health Professional.