We are offering free yoga classes especially for women who are trying to conceive and their partners. No yoga experience is required. In order to accommodate safe COVID – 19 practices, these classes will be held offsite, outdoors, and participants must bring their own yoga mats and supplies.

Dates:  July 11, July 25, Aug 8, Aug 22, Sept 12, Sept 26 AND Saturdays (2nd and 4th of the month)

Time:   8:30am to 9:45am

Location:  the West Hartford area; directions will be provided on registration

Registration: To register for yoga classes please go to:

https://Carissaschedule.as.me/FertilityYogaOutdoors

About the Class:

This in-person outdoors class is full of support and nourishment for your body, your mind, and your emotions.

* Participants must bring own mat & supplies

* Share Circle to Introduce Ourselves and Build Support

* Readings/Poetry/Meditation to support our path

* Visualizations and tools for stress reduction and manifestation

* Gentle, all levels class- no experience needed

* This class is safe for any phase of fertility or treatment

* Partners of all stripes are more than welcome to attend

* Open and affirming class for anyone on a fertility journey

* Fertility Tip given at the end of every class

**If weather doesn’t allow us to meet an email with zoom link will be sent for class

Taught by a registered yoga teacher and former fertility patient, Carissa Spada, the classes require no previous yoga experience and all levels of yoga are included for everybody.

Shoreline
Shoreline yoga classes in Branford continue to be on hold. Stay tuned!

In order to be compliant with the Tri-state travel ban that went  into effect Wednesday, June 24 at midnight the following will apply to patients at CARS:

•If a non-cycling patient, or member of the patient’s household, has traveled to any state on the ban list after Wednesday, June 24 at midnight that will trigger a 14-day quarantine before the patient can resume treatment at CARS.

•If a patient who is about to start a cycle or a member of a patient’s household has traveled to a banned state prior to Wednesday, June 24 at midnight, a negative COVID test will be required prior to cycle start [baseline] and then again mid/end-cycle per current protocol.

•If a patient who is currently cycling, or a member of the patient’s household, has traveled to a banned state prior to Wednesday, June 24 at midnight an immediate COVID 19 test will be ordered and then again mid/end-cycle per current protocol.

Currently, the states include Alabama, Arkansas, Arizona, Florida, North Carolina, South Carolina, Washington, Utah, and Texas. Our policy will stay in place so long as there is a travel ban and change based upon additions/deletions the state makes to this list.

By Stanton Honig, MD

June is Men’s Health Month and we want to heighten awareness of preventable health problems and encourage early detection and treatment of disease among men and boys. We are highlighting men’s infertility.

Male factor infertility accounts for approximately 50% of all infertility. For this reason, the evaluation and treatment of the male are critical to a comprehensive program for the infertile couple. Because there are many treatable, reversible, and preventable causes of male factor infertility, early evaluation and treatment are very important.  While in-office visits are returning, we have developed a telehealth program for patients who are not ready to come to the office for a consultation. 

In 1994, Drs. Honig, Jarow, and Lipshultz reported the incidence of significant medical conditions associated with the evaluation and treatment of male factor infertility. In 1% of patients, a significant medical condition, sometimes life-threatening (such as a cancer of the testis, brain, or spinal cord tumor) caused male infertility. Subsequent studies have shown a significantly higher incidence of testis cancer in infertile men despite variable semen quality. Early intervention was crucial to treat the life-threatening condition and improve the couple’s overall chance of conceiving.

Early evaluation of the male should include a semen analysis. If this is abnormal, an early consultation with a urologist well-trained in male infertility disorders should follow. This should occur before or in conjunction with assisted reproductive technologies.

What can be done as “preventive medicine” for male factor infertility?   

Prevention starts with avoiding lifestyle issues that may be detrimental to sperm quality. Acquired causes of male infertility include exposure to substances that can be toxic to sperm such as illicit drugs (marijuana, cocaine, anabolic steroids), heavy alcohol use, cigarette smoking, medications, and excessive heat to the scrotal area.  

It is becoming increasingly clear that recreational drugs can have an adverse effect on the testes and sperm quality. Chronic marijuana use may lower testosterone levels and affect sperm quality. This has become more of a problem since laws requiring marijuana use have loosened. Cocaine has been shown to have direct effects on the testis and may affect sperm concentration, motility, and DNA of the sperm. Anabolic steroids used for bodybuilding clearly have direct effects on the testis by lowering the body’s ability to make its own testosterone. It also decreases spermatogenesis and may cause temporarily no sperm in the ejaculate, which is sometimes irreversible. Education of high school and college students regarding the negative impact of anabolic steroids and other recreational drugs is critical to prevent male fertility problems down the road.  

Cigarette smoking and heavy alcohol use have been shown in clinical and research studies to affect hormone levels, as well as direct toxic effects on the testicle. Basic science data has shown increased testicular injury when exposed to environmental toxins. 

Many medications used for the treatment of unrelated medical conditions may have negative effects on sperm quality, as well. It is the job of the reproductive specialist to educate physicians and the public on these effects. Some medications that may affect sperm quality are testosterone, calcium channel blockers for high blood pressure, sulfasalazine (Crohn’s disease-bowel disease), cyclosporine (organ transplants), and chemotherapy for cancers or rheumatologic disease and anti-virals utilized for severe COVID disease.

Many of these medications can be interchanged with similar drugs that have less toxic side effects. For example, we have seen a MAJOR increase in the use of testosterone in men of reproductive age. This has been driven by the sense that testosterone will bring “the fountain of youth”. Unfortunately, this “overuse” in men has resulted in the lowering of sperm counts, in some cases to zero. Luckily, most of the time, this is reversible. In addition, there are other medications that can increase testosterone via the hypothalamic pituitary axis that can be utilized instead to improve libido, sexual function, energy level, etc. With high blood pressure, it appears that calcium channel blocker medication may directly affect the sperm’s ability to bind to egg receptors. Switching to a different medication may remove this risk. In irritable bowel disease, mesalazone may be substituted for sulfasalazine having less reproductive side effects with similarly good disease control results.  

Chemotherapy for cancer and other chronic diseases (like rheumatoid arthritis, renal disease, autoimmune illnesses) can also affect sperm quality. Important considerations include freezing sperm prior to starting any toxic drug regimens and using the least toxic chemotherapy regime with equal survival results. Younger males with prostate cancer should be asked about future fertility interests prior to definitive therapy. Radical prostatectomy, radiation therapy, and hormone deprivation therapy have specific deleterious effects on sperm and/or sperm transport.

Occupational exposure to toxins may also affect sperm quality. Agents like pesticides, cadmium, lead, and manganese may interfere with male reproduction, so checking and removing work exposures is important.  

Direct heat to the testis can be a major cause of diminished sperm quality and male infertility. Varicoceles are one of the most common, treatable, and reversible causes of male factor infertility. Although the exact mechanism of how varicoceles affect sperm quality is not known, it is believed that this is usually through an increased heat effect. Multiple studies have shown that scrotal temperature is increased in patients with varicoceles. Varicocele repair has been shown to improve sperm concentration, motility, morphology, and the DNA of sperm. Minimally invasive ligation of varicoceles can significantly improve the chances of pregnancy as compared to natural intercourse. In varicocele-associated infertility, multiple studies have shown that it is more cost-effective to perform varicocele repair as compared to going directly to IVF/ICSI in moderate male factor infertility cases. In addition, varicocele repair may upgrade semen quality to allow couples to proceed with less invasive/less costly hyperstimulation/IUI as opposed to going directly to IVF/ICSI. 

External heat effects on the testis may affect semen quality as well. We recommend abstinence from hot tub use or lowering the temperature to 97 degrees (same as scrotal temperature). It is unclear if the illness-related effects of COVID-19 will have a temporary or permanent effect of sperm but one study did show a drop in sperm quality in patients with severe effects of COVID-19.  On a lighter note, wear whatever underwear you want. Conventional lay information regarding types of underwear is vastly overplayed. Scientific studies have shown that there is no difference in sperm quality between boxer shorts and briefs.

Coital factors are extremely important in achieving pregnancy. Although timing intercourse with ovulation may be tedious, it is critical with male factor patients. Timing with basal body temperature or ovulation predictor kits is extremely useful. Intercourse every 24-48 hours around the time of ovulation is critical to achieving pregnancy naturally. Some patients maintain good semen parameters despite frequent ejaculation, and in these patients, intercourse every 24 hours or so may be beneficial. In addition, avoidance of spermatoxic lubricants such as K-Y jelly, surgilube and lubrifax, is important. A natural lubricant, such as “Replens” or “Pre-seed”, may be substituted and is not sperm toxic.  

Are vitamins and supplements helpful? The answer is… sometimes.

Scientific data is quite mixed. Some supplements used for other reasons (depression, memory loss, “prostate health”) may affect semen quality in a negative way, while others have been studied to determine if they’ll improve semen quality in patients with male infertility. Below are vitamins and supplements that are recommended:

Vitamin C   500-1000 mg/daily

Carnitine and/or L-acetyl carnitine         3gms/daily 

Vitamin E  400 -800 iu/daily

There is a large amount of literature evaluating the effects of antioxidant vitamins (C and E) on sperm. These studies have been performed on patients taking these vitamins by mouth as well as mixing them with semen. It appears clear that some male factor patients have an increase in “reactive oxygen species” or oxidants in their semen. Reactive oxygen species may have effects both directly on the sperm and indirectly on the sperm environment. Vitamins C and E are antioxidants and may serve to lower the level of reactive oxygen species and, therefore, negate its negative effects. 

Carnitine appears to play an important role in both the function of the epididymis and possibly in sperm energy/motility. Some studies from Italy have suggested some benefit in using this supplement (mostly with improvement in sperm motility), with no significant side effects. We recommend 3gms of carnitine and L-acetyl carnitine. Be careful with supplements that claim they are “Male Fertility Supplements”, as they may contain only tiny amounts of the recommended supplements.

Most other supplements (such as zinc, selenium, folate, coenzyme Q-10) are not necessary if a balanced diet is maintained since most are present in healthy foods. Not all nutritional supplements are good for sperm. Saw palmetto may have a negative effect on sperm production and ejaculate volume. It is thought that saw palmetto lowers levels of dihydrotestosterone (DHT), which is thought to be important for sperm production and ejaculation. Studies on the effects of 1 mg of finasteride (Propecia-for male pattern baldness) showed no negative effects on sperm quality. Saw palmetto may work similarly to a higher dose of this drug used for benign prostate enlargement. It would be my recommendation that any patient trying to achieve a pregnancy stop using saw palmetto until further studies show that there are no deleterious effects.   

Summary

Preventive medicine has an important role in male factor infertility. A thorough evaluation and physical examination by a physician familiar with male infertility are important to identify treatable, reversible, and potentially life-threatening conditions. In addition, modification of behaviors, and avoiding toxic recreational drugs such as anabolic steroids may improve the chances of pregnancy. Avoiding supplements that may negatively affect male infertility and using other vitamins and supplements that may positively impact male fertility-related disorders are important to consider, as well.

Patients should ask their physicians and seek out organizations like RESOLVE, the American Society for Reproductive Medicine (www.asrm.org), The Society for the Study of Male Reproduction (www.ssmr.org), American Urological Association (www.urologyhealth.org/urologic-conditions/male-infertility).

In Vitro Fertilization Cycle Starts
We resumed IVF starts May 11 on a limited basis to test the system relative to CT State COVID 19 data, personal protective equipment [PPE] supplies and new operational systems designed to keep patients and staff safe. The plan is to re-evaluate the situation in a month [around June 15]. Our hope is provided all things continue to move in a positive direction, we will be able to resume normal IVF volumes sometime in June/July.

COVID 19 Testing for IVF patients
This is a fluid situation due to the availability of tests and timely results. As of 5/19/20, we are requiring IVF patients have at least one COVID 19 negative test between Baseline and day of Retrieval. Our staff will provide you with testing site options and instructions on the day of Baseline. As testing options improve we hope to move to testing day of Baseline and then again within 48 hours of Retrieval. Any patients testing COVID 19 positive during an IVF cycle will be managed on a case per case basis.

The Clara study was suspended by our sponsor, Ferring Pharmaceuticals, at the start of the COVID-19 pandemic. At the same time, cycle starts for non-study patients were also suspended. Based on recent favorable indicators, we are able to begin procedures the first and second weeks of May for non-study patients. Although currently at a reduced capacity, these scheduled procedures will be increased over the coming weeks. While we have not yet received approval to resume the Clara study, we anticipate recruitment and screening to resume in late June or early July.

As soon as we receive information from the sponsor it will be shared with you. We understand the desire to start the process and continue to work with Ferring to make that possible.

Over the past few weeks, we have implemented numerous processes to maximize patient and staff safety. These include personal protective equipment (PPE) standards for all persons while inside the Center, social distancing through waiting in cars rather than inside, and a phased approach to re-starting procedures. We look forward to seeing each and every one of you back in our offices soon.

4.23.2020

Virtual Waiting Room

In order to maintain social distancing and control traffic through the building, we are asking patients who are coming to the offices to remain in their car until we are ready for their visit to start. Once you arrive at the office parking lot please text your name only to one of the numbers below. A member of the staff will call you to begin the check-in process and/or text when you may enter the building.

Farmington          860 470 4679

Hartford & New London          860 704 9160

Branford          860 704 9221

Resuming Operations

On behalf of The Center for Advanced Reproductive Services [CARS], we hope in the midst of these challenging times this letter finds you and your family safe and healthy. As Connecticut is now experiencing a flattening in the number of new COVID-19 cases and a decrease in hospitalizations, we are writing to update you regarding the resumption of fertility treatments at CARS.

At each CARS office, policies & procedures are being developed to optimize physical distancing and other mitigation strategies to minimize the risk of exposure for patients and staff. Our goals over the next couple of months are:

•Resume operations at approximately 50% of normal volumes for IUI & IVF until we are certain Connecticut has successfully flattened the curve and we have had a chance to refine our new COVID – 19 office procedures. The clinical team will be prioritizing patient starts during this time.

•Maintain strong social distancing standards for patients and staff.

•Implement strong personal protective equipment [PPE] and mitigation strategies to limit the risk of exposure for patients & staff.

Tentative Schedule

•Monday, April 27: Resume sono-hystograms, hysterosalpingogram [HSG], trial transfers, pregnancy scans, and semen analysis.

•Monday, May 4: Resume intrauterine insemination [IUI] cycle starts, frozen embryo transfer [FET] starts, endocrine blood testing, clinical follow up appointments for Telehealth patients

•Monday, May 11: Resume in vitro fertilization [IVF] cycle starts.

Practicing medicine, especially fertility treatments, in a COVID – 19 world is going to look and feel very different than it did a month ago. There are a number of interventions we are implementing as part of our efforts to keep everyone safe.

Patient Visits

•Effective immediately all patient visits at CARS will be scheduled at a specific time. This includes morning ultrasound and blood monitoring, and Quest blood draws throughout the day. No more walk-ins of any kind.

•For the time being all new patient visits, IVF consultations [1B] and established subsequent office visits will be telehealth via Microsoft TEAMS.

•MD clinic visits on site will be limited to ultrasounds, procedures, emergencies and clinical follow up appointments for telehealth patients.

•Every attempt will be made for onsite visits to be as efficient as possible. There will be limited on-site counseling and instructions. Discussions can occur immediately following your visit with a call from your car or we can call you later when you’ve arrived home. Our doctors and nurses will have access to Microsoft TEAMS for video conferencing.

•Semen analysis appointments will be scheduled and patients asked to produce at home. Specimen collection kits will be provided to patients in advance via a repository by front doors at each office.

•Please stay in contact with us and call your nurse or financial services representative [FSR] when you intend to start a cycle. Your physician team will review your personal case and follow up with next steps.

•All patients undergoing care once we go back up will be required to provide an active credit card on file so we can run co-pays, deductibles, etc so front desk and financial staff are protected from handling credit cards, money, checks, etc.

Health Screening

Staff and patients are asked about relevant exposure and health information upon entry into the offices daily and temperatures are being assessed. All staff and patients must wear a mask at all time when in our offices. If you have a mask at home [homemade cloth masks are fine] we ask that you use it or one will be provided.

We will get through this together.

Thank you for your continued patience and understanding during this time of uncertainty. The COVID-19 pandemic has changed many things including the way we practice fertility medicine, but one thing that has not changed is our commitment to helping our patients build families. We have been thinking about you during this difficult time and eagerly look forward to safely making your family building dreams come true. If you have any questions or concerns please contact Paul Verrastro, CARS CEO at 860.321.7082, EXT 8005.

 

Thank you.

This week is National Infertility Awareness Week. Typically, the Center would be incredibly busy with events designed to recognize this special week. This year, we all feel a sense of loss, particularly as this was always a fun opportunity to interact with so many of our many wonderful patients.

One of the events we had planned this year was the unveiling of the 2020 Wall of Hope. Since we couldn’t make it happen, Janine Fazzina Boudo, a former patient and photographer at Bella Blue Photography, put this montage together for us.

Wishing everyone a very happy National Infertility Awareness Week.

 

By John C. Nulsen, MD
Medical Director, Center for Advanced Reproductive Services
Professor of Obstetrics and Gynecology

This is an unprecedented and challenging time, made all the worse by the fact that we do not know when the COVID – 19 pandemic will subside and come under control. As we move through this threat, please know that you are not alone. As part of a medical community, we are focused on how to best help quicken the resolution of this pandemic, so that we can get back to serving you as quickly and as safely as possible. These efforts focus on helping to bend the viral transmission curve to assist in ensuring our region’s hospitals and ICUs are not overwhelmed and have the necessary equipment and personnel, and on helping to ensure that our services to you continue uninterrupted. 

ASRM Guidelines

The American Society for Reproductive Medicine (ASRM), the global leader in reproductive medicine, has issued guidance for its members as we manage patients in the midst of the COVID-19 pandemic.  Many elements have contributed to the success of CARS over the years, in particular, our strict adherence to ASRM guidelines. Developed by an expert Task Force, of physicians, embryologists, and mental health professionals, the ASRM COVID – 19 guidelines, effective March 18, 2020, are as follows:

1. Suspension of initiation of new treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF) including retrievals and frozen embryo transfers, as well as non-urgent gamete cryopreservation;
2. Strongly consider cancellation of all embryo transfers, whether fresh or frozen;
3. Continue to care for patients who are currently ‘in-cycle’ or who require urgent stimulation and cryopreservation;
4. Suspend elective surgeries and non-urgent diagnostic procedures;
5. Minimize in-person interactions and increase utilization of telehealth.

In addition, as a licensed ambulatory surgery center in Connecticut, we have to be mindful of recommendations set forth by the state’s Department of Health. Connecticut Department of Health [DPH] Guidelines:

• Currently the order to stop performing surgeries/procedures in outpatient surgical facilities is not addressed in the executive orders or Commissioner Orders.  There have been recommendations from the Centers for Medicare and Medicaid Services (CMS) to cease elective surgeries/procedures to stop the spread of COVID-19 and to conserve PPE.  So, the decision to cease performing procedures is a business decision for the individual facility;

• Family planning services (including IVF) were exempted in the governor’s order.
• DPH strongly recommends licensed Ambulatory Surgery Centers follow guidelines set forth by Center for Disease Control [CSC].

What CARS is Doing

CARS continues to be operational and is here for you. All clinical provider patient schedules have been transitioned to phone calls or video conferencing. Patients can call our main number to schedule appointments.

Each of our offices remains open with minimal staff to address urgent and emergent patient care needs such as confirmatory pregnancy scans, pain, bleeding, onco-fertility, etc. Our goal is to keep patients out of emergency rooms and the already strained regional hospital system.

All IUI and IVF services have been temporarily suspended. We continue to follow recommendations from ASRM, CT DPH and closely track regional COVID – 19 data. We hope to be able to resume treatments in at least some limited way by June 1.

The majority of our dedicated staff are working remotely from home but remain available to you throughout the day and weekends by calling our front desk. Although we remain open, all doors are locked so as to control health screening and admission into our offices. There are intercoms on front doors to call for entry. Upon entry, everyone is screened for social/health history and temperatures before being allowed into any clinical area. If you need to come to the office, we are asking that you do so alone. If a partner needs to drive, we are asking they wait in the car.

Through our partnership with Quest Diagnostics we continue to provide urgent and emergent blood draws in our Farmington location 9:30 am to 3 pm. 

Treatment Interrupted

We know it is extremely difficult to consider postponing fertility treatments. Most people have gone through tremendous loss and grief by the time they get to the place where they are doing an IUI or IVF cycle. In addition, navigating the cost and insurance coverage aspects is daunting. Many having come so far on their fertility journey are now dealt a huge unknown with the COVID-19 pandemic; wondering if they should proceed, or start, this medical treatment. It should be somewhat helpful to hear that there is no evidence that delaying treatment for a month or two will ultimately affect anyone’s ability to have a child, even those with concerns about advanced age and/or diminished ovarian reserve (low egg supply). The ASRM recommendations will be continuously reviewed and updated, as we know that many people do have concerns about waiting longer than two months. 

How Does Covid-19 Impact Fertility and Pregnancy?

Research is still ongoing in this area. There are no studies indicating that the virus has any impact on fertility. While Coronavirus fears have caused some people to seek out egg freezing, there is no known medical indication to seek out egg freezing as a preventive measure.

If you have tested positive for COVID-19, the Society for Assisted Reproductive Technology (SART) recommends avoiding getting pregnant for now and waiting until one fully recovers before attempting conception (either naturally or via assisted reproductive technology).

According to the World Health Organization (WHO), pregnant women don’t appear to be at a greater risk for illness related to COVID-19 — and only 1% of pregnant women infected have experienced severe illness that required medical attention. However, the American College of Obstetricians and Gynecologists (ACOG) notes that very little is known about the effect of COVID-19 on pregnant women and infants. It is unclear if COVID-19 can cross the placenta. Because pregnant women are at greater risk of severe complications from similar respiratory infections, they are considered an at-risk population for COVID-19.  A study was conducted on nine pregnant women infected with COVID-19 in Wuhan, China. All women recovered from their illness and all nine had live births without any evidence of transmitting the virus to the baby. The virus was not detected in samples of cord blood, amniotic fluid, or throat swabs from the newborns, or breast milk. However, the COVID-19 infection was recently found in a newborn, so “vertical transmission” (meaning passage of the virus from mother to baby during the period immediately before and after birth) cannot be excluded at this point.

Support

Infertility treatment under the best of circumstances can be stressful. The conditions created by the COVID-19 pandemic certainly add to that stress. There are things you can do to help reduce that stress. CARS has an in-house, trained reproductive mental health provider who can consult with you on how to manage the stress and emotions surrounding this extremely difficult set of circumstances. Dr. Kim Crone is offering telehealth options to fertility patients and is available by calling our front desk.

The National Infertility Association (www.resolve.org) and RESOLVE of New England (www.resolvenewengland.org) have resources and various ways to get support. Both have an online support community, local support groups (now meeting virtually), webinars, and other content to help patients connect, get support, and stay informed. Also, we are continually adding patient support content to our Facebook page, https://www.facebook.com/uconnfertility/.

Together, we must stay focused on fighting the present viral threat. We can do this in numerous ways – by reassuring and educating you through telehealth, helping to “bend the curve”, by implementing social distancing mechanics for patients and staff, and ensuring both our own emotional and physical well-being, as well as that of our patients, staff, colleagues, and friends and family remains a priority. At CARS we are convinced we will come out of the current test stronger; as a community of women’s health professionals, as a nation, and as a global society. 

Be healthy. Be safe.

Thank you to everyone who entered our Q1 2020 Fertility Massage Therapy Grant! There were 26 nominations and while The Center’s jury of 4 [all Center employees] struggled to make a choice, in the end, Kimberly’s heartfelt nomination of her wife Amanda was the winner. You both touched and inspired the jury with your story and commitment to your vision for your future family. Congratulations!

Kim’s nomination of Amanda:

My name is Kimberly West-Herzog and I would like to nominate my amazing and wonderful wife, Amanda Herzog, to receive this grant for Fertility Massage Therapy. We are both patients at The Center. Our journey with The Center started in October 2017, with my first intake with Dr. Schmidt. We got engaged in February 2018 and my first IUI attempt was in June 2018. My second IUI attempt was in August 2018. My third and final IUI attempt (September 30th, 2018) was six days before Amanda and I got married (October 6, 2018). Through every blood draw, ultrasound, Clomid pill, ultrasound, having to pee on a stick, Amanda was right by my side. Our three IUI attempts were unsuccessful, and thus we embarked on the journey of IVF in October if 2018. Although I was the IVF patient, Amanda took the lead on all medication administration. She mixed the Menopur; she dialed and injected me with the Gonal-F. She did it all. Our first IVF attempt (my attempt) resulted in the one embryo, which failed to cleave on day two. Our second IVF attempt (my egg, donor sperm, my uterus) yielded in a day three transfer. We were pregnant for 13 weeks and six days. Throughout my pregnancy, Amanda was amazing. She was patient and kind, caring and loving, and dealt with my nausea and mood swings like a seasoned champion. She was the perfect partner, the perfect wife, and the perfect mate. Sadly, we lost our son on May 1st, 2019. In June, Amanda became a patient of record at The Center. Now we were both cycling. Her first retrieval surgery was July 2019, my caregiver became the patient and I mixed her Menopur and dialed up her Gonal-F. As of today, February 10, 2020, I have gone through four retrieval surgeries (my fifth retrieval surgery is coming on Wednesday, February 13, 2020). My wife Amanda has had two retrieval surgeries, with her third retrieval surgery is coming up this weekend. On Monday, September 23, 2019, we had our retrieval surgeries on the SAME day. What are the odds?!

I am nominating my wife because of everything we have gone through in this IVF journey. From the unsuccessful IUIs to the loss of our son (Trisomy 13), she has been by my side, in my corner, and has had my back since day one. She’s been the most amazing wife and most amazing support system – all while being an IVF patient too.

I think she would greatly benefit from these fertility massages as she continues our pathway towards parenthood by continuing with her IVF. I know that this acknowledgment and these massages will greatly improve Amanda’s fertility journey as she has earned some extra TLC with everything, everything she’s done for me, for herself, and for our future family.

Amanda’s Quote: 

“I am absolutely honored that my wife nominated me for this recognition. In our fertility journey, we’ve gone through hell and back, and we continue to walk and march forward, up this rugged road; and, there’s no one on this Earth, but my wife, Kimberly, with whom I could endure and preserver through this adventure.  Our love story started with me tricking her into our first date and continued with “I do.”  Our story contains triumph, tragedy, heartbreaking setbacks, and beautiful awakenings.  She’s everything that I needed in a life partner –but never knew I needed.  She’s my everything. Despite her humble, meek, mild, and gracious determiner, she’s a tough, formidable fighter and the sole reason why I fight so hard as we traverse through the rough terrain of fertility.  I love her. Endlessly. And forever.”

Whether or not you’ve completed a cycle before or this was to be your first, hearing from the Center that your treatment is being put on hold due to the coronavirus outbreak is undoubtedly disappointing, and that’s probably an understatement.  In the meantime, you’re dealing with all of the anxiety the rest of the world is feeling about coronavirus, with the added concern about its unknown impact on fertility and pregnancy. It’s a lot to take.

The rational side of you probably understands that this decision was made in accordance with the recommendations from the American Society of Reproductive Medicine in an attempt to protect you and your potential pregnancy.  But the emotional side of you is devastated and grieving the hope of conceiving this spring. You have been living with uncertainty about conceiving already; the added uncertainty brought on by the coronavirus crisis might feel overwhelming. And the hormones aren’t helping either.   

You are probably experiencing lots of emotions right now: anger, sadness, frustration, disappointment, grief, anxiety, or all of the above.  These are all completely understandable and normal. No one can tell you differently. You are the one going through this and owning the emotional response you’re having is only fair to yourself.  But what’s not fair is to believe you have to continue feeling that way. These are very strong emotions, and they will fade. Own your negative emotions, then try to figure out ways to get past them.  They aren’t helping you feel better.    

Let’s talk about some strategies that might help you feel more in control of your emotions right now.  Here are some techniques aimed at coping with the negative emotions related to your treatment being put on hold and the crisis our country is in at present:  

Keeping Perspective: Although it’s very tempting to start catastrophizing, whether it be about coronavirus or your fertility treatment, this unhealthy thought pattern serves no purpose. It just pushes you further down the dark rabbit hole. Everyone is confronting challenges right now, and trying to remember those things in your life for which are grateful can keep you from falling into that hole. Whether it be your partner, your friends and family, your job, your home or the excellent blueberry muffin you had for breakfast, gratitude can go a long way in helping you keep perspective. So can remembering that others are dealing with worse and scarier situations at the moment.  And lastly, remember that this is a crisis, and crises are temporary. No one knows how long this will last, or when cycles at CARS will get back to normal, but rest assured they will get back to normal. Keeping in mind the temporary nature of this unpleasant situation can help you get through it and remain hopeful about what awaits on the other side! 

Self-nurturance: Now more than ever, this is the time to take care of yourself, both physically and emotionally.  This is an opportunity to get as healthy as you possibly can so that you can be in a really good place for your next cycle.  This might include eating healthy meals, exercising regularly, and getting plenty of sleep. It might also include pampering yourself so that you can feel as good as possible during this difficult time.  Take some time to do something that is soul-nourishing for you. Some examples are: Learn a new skill or brush up on a foreign language. Read a book or magazine that you haven’t gotten to (I usually save Elin Hilderbrand for my summer beach reading, but I just ordered a few of her books for my coronavirus reading–we all need some happy endings right now!) Take a mindful walk, appreciating the outdoors, fresh air, and extra time you have.  Make a decadent dessert that you haven’t had time to make before. Learn to knit. Binge watch that show everyone has been bugging you to watch. Practice deep breathing, meditation or visual imagery (you can find some great videos on YouTube or on the fertility coping app–FertiCalm, which I recommend highly.) Anything that helps you feel better–you deserve to feel better!     

Social Connection:  Social distancing doesn’t mean social isolation.  If you have shared your fertility journey with others, reach out to them now for support and distraction.  If you have kept this journey private, possibly consider opening up to at least one trusted person in your life for support and as a sounding board.  It can be a huge relief to open up about what you’re going through. But be patient with people–no one can say the exact right thing all the time. They mean well and are trying.  If that’s all too much, and you still want to keep things completely private, still reach out to a friend or loved one for mutual support in this difficult time.  

Take a Break from Media Coverage: Right now, hearing about the details of the pandemic over and over again can essentially result in re-traumatization and can be exhausting.  Take breaks from watching the news and reading about the crisis. This includes social media–especially if you tend to be drawn to the more heartbreaking stories.  I know we are all yearning for some reassurance and confirmation that we are doing the right things to get through this. And it’s OK to watch some news coverage or check out a news source you trust.  But focus on getting facts, and if you find yourself feeling overwhelmed, stop! At least for some time, most of the statistics are going to get worse before they get better and none of us needs to hear bad news getting worse.  So be selective in what you are taking in and know your limits.     

In uncertain times, finding some aspect of your life that you can control can be beneficial.  These coping strategies can help give you a healthier sense of control and remain hopeful about the future.  Pick and choose which ones of these fit best for you. Your goal is to be healthy, energized and ready to go when it’s time to get back to CARS and get closer to your dream of growing your family.  

Take care of yourself and be well!  Feel free to call me at (860) 830-8862 to discuss some additional support options.

Kim Crone, PhD
Psychologist, Center for Advanced Reproductive Services