Codeine and Postpartum Pain

Codeine is often prescribed for postpartum pain. However, it may not be safe for infants who are being breastfed. Codeine may cause central nervous system depression and apnea in infants. Infants have been found to be more sensitive to codeine's effects than older children, and certainly, adults. Patients may wish to discuss this with their physicians.

Maternal Licorice Consumption

Women who consumed large amounts of licorice while pregnant have children with poor verbal and visuospatial abilities, less narrative memory, and increased aggression and rule infractions.

Maternal Obesity

Maternal obesity is a very important factor in reproductive care. The most common risk factor for maternal mortality in developing countries in obesity and is associated with many adverse effect on pregnancy. Self-reporting of obesity by age 18 is correlated with maternal obesity. However, while bariatric surgery can be very successful, should also be counseled about their plans for effective contraception, as well as postoperative pregnancy.

Screening for PCOS in at Risk Adolescents

A recent study has found that there are certain risk factors available to assist physicians to identify adolescents at risk of PCOS, even though the signs can be masked by the normal physiological changes of puberty. It is important for doctors to screen and diagnose adolescent PCOS in order to prevent the development of future infertility, type II diabetes, cardiovascular disease, and endometrial cancer. Lifestyle modification, i.e., healthy diet and exercise, is of the greatest benefit for adolescents to manage their condition.

Treatment for PCOS

A recent study concluded that short-term, high dose metformin exerts minimal effects on both metaboli markers and reproductive hormones in a small sample of overall morbidly obese women. Those who are struggling with PCOS should consider reducing your weight prior to fertility treatment by eating a healthy diet and getting a moderate amount of exercise.

New Mothers and Suicidal Thinking

New mothers who were severely depressed and their babies were recently studied. The mothers suffered from depression, isolation, and extreme difficulties in parenting their infants.Many of these mothers believed that their babies were better off without them, wanted to die, wished to hurt themselves, and felt that killing themselves was the only way out of their terrible situation.

Additionally, these women felt anxious, mentally confused, felt a greater loss of self as a result of having a child, and were more emotionally labile. Importantly, the women felt guilty for feeling poorly after the birth of their child. This is especially important for those who previously experienced infertility and think they should feel happy and grateful that they were able to conceive and give birth.

The women who were studied believed they were less prepared for mothering and were not reacting to the cues their infants gave. Furthermore, their children smiled infrequently and were more fussy than other infants. The depressed mothers were less engaged with their children and were somewhat passive in their styles of mothering.

The study concluded that although the mothers may have been somewhat prepared for the birth of their babies, they were not emotionally prepared and discounted that their lives would need to substantially change. Women who experience postpartum depression can benefit from seeing a psychologist to help them adjust to the new dynamics of their family. Psychologists can help new mothers structure their day, identify tasks that need to be completed each day, and offer guidance about how to tap into their babies' needs so that they can be more attuned to their child. Moreover, learning how and when to tap into their social support system is essential.

Lack of Social Support Predicts Antenatal Depression

Perinatal and postnatal mental health are both important factors to assess. Interventions with an interpersonal focus may prove particularly effective as lack of social support appears to be a significant predictor of antenatal emotional distress.

Migraine Headaches and Cancer Risk

Hormonal changes cause both migraine headaches and breast cancer. Researchers in Seattle, Los Angeles, Philadelphia, Atlanta, Detroit, Bethesda, and Springfield, MA., collected data that supported the fact that a history of migraines may be associated with a reduced risk of breast cancer in both premenopausal and postmenopausal women.

Obesity and Labor

Maternal obesity was studied at two New York hospitals. It was found that obesity is associated with longer labor.

Hypertension, Endometrial Cancer, and Type 2 Diabetes

A recent study found hypertension was prevalent in approximately 40% of type 2 diabetic pregnant women but only 10% of the non diabetic controls. Those with an increased body mass index were found to have chronic and gestational hypertension, but not pre-eclampsia. Thus, hypertensive diseases did not affect the pregnancy outcome of women in this study.

However, another study recently reported very obese women aged 20-54 have an elevated endometrial cancer risk, which appears heightened by early menopause.

anxiety and yoga

Participation in a two month yoga class may lead to significant reduction in perceived levels of anxiety in women who suffer from anxiety disorders. Yoga can be considered as a complementary therapy to psychotherapy for anxiety disorders. For many years research has been conducted to determine whether yoga can help patients going through infertility treatment. Although not directly responsible for improved pregnancy rates, yoga can help women through this difficult period of time through anxiety reduction. Warning: no hot yoga, however!

Vaginal and IM Progesterone Supplementation

There were found to be no significant differences in treatment outcome between those who took vaginal vs. intramuscular progesterone supplementation. Thus, there were similar rates of pregnancy, miscarriage, and live birth rates in the two methods of treatment.

Postmenopausal Weight Gain and Your Brain

The change in a woman's pre- amd post menopausal body mass index, when she has had a substantial weight gain, may account for a greater reduction in her gray matter volume. In other words, to be smarter gain less weight!

Reflexology and Ovulation

A small study concluded that foot reflexology does not have an effect on patient's ovulation.

Obesity and Pregnancy

Obesity can stop ovulation and the capacity for pregnancy. Additionally, obesity increases the risk of miscarriage and other complications of pregnancy, such as gestational diabetes, pre-eclampsia, etc. Lifestyle modification, i.e., weight loss, exercise, etc., may improve ovulation and increase the likelihood that a woman can become pregnant and maintain the pregnancy. Should changes in one's lifestyle be insufficient, ovulation induction should be considered as the first line of treatment. Should clomiphene citrate fail to help conception, the second stage of treatment could include exogenous gonadotropins or laparoscopic ovarian surgery. Finally, IVF should be considered. However, Metformin, which is used in polycystic ovarian syndrome, should be used exclusively by women who have a glucose intolerance.

Abortion: More than a Woman's Choice; a Good Choice

First trimester surgical abortion is a very common, effecective, and safe procedure (Tristan et al.,2009). Psychological counseling, along with medical advice can lead to good outcomes. Complications of first trimester abortions result in only 0.5% of all cases which includes incomplete abortions, infections, uterine perforations, etc.
Infectious complications may result in death. However, in places where abortions are legal, the actual risk of infection is low, and rarely results in death or sepsis. Yet another very significant finding that supports legalized abortion.

Children's Book Explaining ART

A new book entitiled "Where Do I Come From?" by Narelle Wickman, published in Australia, discusses sexual intercourse, various assisted reproductive technologies used in conception, and adoption. The book provides information for children regarding donor insemination,IVF, surrogacy, and adoption in non-judgemental language and is appropriate for children.
The book has sparked controversy among some, including conservative Christians, because they believe the author does de-values the "traditional" family, (whatever that is; emphasis mine). Many patients who conceive through the ARTs state they would explain the high-tech methods used in conception to their children if they had guidelines or an accurate "script" to follow. This book may assist parents wishing to disclose the truth about the methods used in their children's conception.

Depression and Heart Disease

Studies have associated depression with an increased risk of heart disease. Researchers have shown that depression is associated with an accumulation of visceral fat, which has been proven to increase the risk of cardiovascular disease and diabetes. Visceral fat is located between one's internal organs and collects around one's waistline, which is why apple-shaped individuals are more likely to suffer from heart disease than pear-shaped people. Depression's link to this type of fat was made by researchers at Rush University Medical Center.

Appetite and Postpartum Depression

Although changes in appetite may be one of the symptoms indicative of depression, loss of appetite was not associated with postpartum depression. Rather, the better discriminators were lack of concentration, and/or motor retardation or motor agitation.

depression and SSRIs During Pregnancy

Depressed pregnancy women who were using SSRIs or were untreated both were at risk for preterm birth, with rates exceeding 20%. Infants who were exposed to either SSRIs or depression in utero were more likely to be born preterm when compared with infants with no exposure or partial exposure to either. The use of SSRIs did not increase the risk for minor physical anomalies for infants, or reduced maternal weight gain. Infant birth weights were equivalent, and other neonatal outcomes were similar except for the 5 minute APGAR ratings.

Although we have no knowledge regarding caffeine withdrawal symptoms, apparently drinking up to three caffeinated beverages daily does not effect birthweight, prematurity, or fetal growth. Thus, a study by Jahanfar et al., showed no benefit to those women who avoid caffeine intake during early pregnancy.

Chronic Pain and Psychotherapy

Cognitive Behavior Therapy (CBT) and Behavior Therapy (BT) were used to help people who experience pain and/or disabilites change their behavior. CBT additionally worked to change some of the thoughts and feelings of people who experience chronic pain. Although both types of therapies worked to help with negative affect, i.e., anxiety and depression, it is still unknown exactly what is the best format of treatment or for how long the psychological therapy should continue. This could be useful for those simultaneously experiencing both pain and infertility.

Complementary and Alternative Medicine

Dr. Jackie Boivin, a member of the MHPG of the ASRM recently published an article in the April volume of Human Reproduction. Dr. Boivin found that concurrent use of complementary and alternative medicine (CAM) with assisted reproductive technologies (ART) was associated with a 30% lower pregnancy rate. The findings were not found to be related to poor prognosis, such as age related fertility decline, or life style factors, such as smoking or ingestion of alcohol. Unfortunately, no specific complementary or alternative choices were most associated with the lower pregnancy rates. However, this study places them back on the radar screen for future studies to examine. The results of this study do suggest that use of CAM(s) should be carefully monitored during ART treatments.

Unrealistic Beliefs about Fertility

Female college undergraduates were found to be aware that fertility declines with age. However, they inaccurately reported higher and unrealistically optimistic chances of pregnancy for older women. These same university students also believed that the chances of miscarriage were higher for women of all ages, but did not attribute a woman's age as a causal factor for pregnancy loss. Although there have been efforts to educate the public in the past, it is obvious that additional and more precise instruction would improve the public's comprehension, and might help reduce the rate of age related infertility, as well as pregnancy loss.

Cost of IVF Babies related to a Woman's Age

Reaearches in Europe found costs per live birth for women over age 40 were 2.5 times higher than for women age 35-39 y/o. The cost per ongoing pregnancy was a staggering three times higher for the older group. These costs included the IVF cycle, as well as early pregnancy care for the mother and care needed after giving birth.

Just Another Reason

I have been in favor of stem cell research from the start. However, if I wasn't before, the following would have convinced me. In the UK, scientists have created human inner ear cells from fetal stem cells. What this means is that there is potential to replace abnormal or damaged inner ear cells with stem cells obtained from frozen embryos. Hopefully, permanent hearing loss could be reversed and a variety of different cell types could be developed. Currently this does not yet signal a cure for deafness. If research is adequately funded and, as indicated by the new administration in the White House, given the green light, we can hope to see many and varied advances using fetal stem cells.

Fertility and Sexual Problems

As fertility treatment continues sexual problems frequently arise. Often people who are experiencing infertility have sexual intercourse at times when one or both members of the couple are clearly not in the mood. Sex on demand is unromantic and often mechanical. Sex becomes something one must do to achieve the end goal, which is pregnancy. Both men and women, therefore, may develop sexual problems.One such problem is dyspareunia, which is genital pain that is associated with sexual intercourse, usually occurring during, but also possibly occurring before or after intercourse. Symptoms range from discomfort to sharp pain, and cause distress and interpersonal difficulty.At least one episode of male erectile difficulty has been reported in approximately 90% of men who are in fertility treatment. Erectile problems can infrequently or regularly occur.Hypoactive sexual desire, also known as inhibited sexual desire, may occur early, late, and/or intermittently throughout fertility treatment. One or both partners may begin to look at their sex life as a total failure, because it never leads to conception. Situational depression and anxiety are common reactions to infertility and individuals do not feel particularly sexy or attractive when their emotional state is negatively affected.Both men and women misread their partner's lack of sexual interest, and begin to feel ambivalent toward sex. Each may feel unattractive to his or her partner or may feel sexually inadequate. If either had a poor body image prior to being diagnosed with infertility, the likelihood that this will become more pronounced is high. This, in turn, may lead to a rigid or routine approach to sex that may cause additional problems for the couple.Guilt is another emotional reaction to infertility. The person with the physical problem leading to infertility may feel guilty that he or she is unable to provide his or her partner with a child. Guilt may also occur when one no longer desires sexual activity, even though it is the rule rather than the exception. There are many ways to stop the downward spiral, but more often than not, physicians and nurses do not inquire whether sexual problems are occurring during fertility treatment. You may need to be proactive and take responsibility for having this discussion with your doctor. A good source for referrals to mental health professionals who deal with sexual problems is the AASECT website: www.aasect.org where you can find a certified sexual therapist.
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3/29/09
by Judith E. Horowitz, Ph.D.

In an attempt to make their product more affordable, Xytex International, a sperm bank located in the United States, has reduced the price of obtaining sperm that has been provided by some of their more frequent (read: copious) donors. The 30-35% savings may help those who otherwise might find the prices for donor sperm prohibitive. Additionally, Xytex has announced a reduction of fees charged for the sperm to be used for ICSI and IVF. It is possible for them to provide the recipients using those ART procedures with a smaller quantity of sperm vs the amount needed for a cycle of IUI. Cost cutting by the other sperm banks may ensue.
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ginger capsules while pregnant

Ginger capsules of 1,000 mg. have found to be effective in treating nausea and vomiting in pregnant women. Although this was not a double blind study, the researchers concluded that for women who are experiencing both nausea and vomiting the ginger capsules were effective. The study should pave the way for additional, rigorous studies. Hopefully, physicians will immediately start to recommend this treatment to their patients, even though it is an herbal remedy and has not been subjected to double blind testing.

Higher Pregnancy and Birth Rates with SET

Two studies recently reported in Human Reproduction found the transfer of a single embryo during IVF may result in both better pregnancy and birth rates. As multiple births is an undesirable consequent of IVF, this is heartening news for couples going through the assisted reproductive technologies. The practice of elective single embryo transfer (eSET) could reduce the problems impacting the infants who result from multiple births such as prematurity, low birth rate, longer hospital stays, as well as those that may impact the woman who carries the pregnancy, i.e, the mother or GC, such as a greater likelihood of gestational diabetes, high blood pressure, and being confined to bed rest.



This information could reassure patients who seem afraid to transfer fewer than two or three embryos per IVF cycle. Hoping for a bigger "bang for the buck," many IVF patients do not believe the potentially devastating problems will happen to them. However, it is also more cost effective to do a SET, especially if there is the ability to cryopreserve any untransferred embryos for future use in future cycles.

“NO INNER RECESS WAS LEFT UNEXPLORED, UNPROBED, AND UNMOLESTED.” “It’s like donating your body to science while you are still alive.”

Common Emotional Reactions to the Diagnosis of Infertility
1. Shock
2. Denial
3. Fear
4. Anger
5. Disbelief
6. Guilt
7. Loss of Control
8. Isolation
9. Sense of Failure

Sexual Problems that Occur in Conjunction with Infertility

1. Dyspareunia (genital pain that is associated with sexual intercourse, usually occurring
during, but may also occur before or after. Dysparenunia can affect both men and women.
Symptoms range from discomfort to sharp pain, and cause distress or interpersonal
difficulty.
2. Male erectile disorder (aka: impotency)
3. Hypoactive sexual desire (aka: inhibited sexual desire)
4. Rigid or very routine approach to sex
5. Poor body image
6. Depression
7. Guilt
8. Ambivalence toward sex
9. Feeling loss of attractiveness
10. Feeling sexually inadequate
11. Both men and women misread lack of sexual interest

Three areas of sexual difficulty:

1. Actual physical condition causing infertility or resulting from infertility treatment
2. Sexual intercourse becomes only a means of reproduction rather than an intimate or
pleasurable activity
3. Global psychological impact of the infertility treatment

AXIOM: The longer the time in infertility treatment, the lower the levels of sexual satisfaction

IN SUMMATION:
1. The ability to reproduce is intimately tied to sexuality, self-image, and self-esteem.
2. Although sexual problems can occur during infertility, sexual difficulties are not universally
experienced by infertile individuals and/or couples.
3. The majority of infertile couples do not develop diagnosable sexual problems requiring intensive treatment, although they may experience episodic, transient problems, warranting education and support.
4. The medical assessment and treatment for infertility may interfere with the infertile couple’s sexual pleasure due to performance demands, treatment requirements, emotional responses to treatment, or the diagnosis of infertility.
5. Most sexual problems may be addressed by the infertility counselor if he or she is educated about the impact of infertility on sexual functioning.
6. It is important to volunteer that you are experiencing sexual problems, as most caregivers do not specifically ask questions about sexual behavior as part of the comprehensive medical history, particularly when the couple is actually having sexual intercourse on a regular basis.
7. When sexual dysfunction is the presenting cause of infertility, assessment and therapy for the individual or couple is necessary and should preclude medical treatment for infertility.
Infertility is sometimes caused by sexually transmitted infections (STIs).
The most common are:
1. Syphilis
2. Gonorrhea
3. Human papiloma virus (HPV)
4. Genital herpes
5. Trichomoniasis
6. Human immunodeficiency virus (HIV)
STIs adversely affect fertility through pregnancy loss, neonatal deaths, the obstruction of either male or female reproductive ducts, impaired semen parameters, and the risk of transmission of HIV to partner or child.
STIs resulting in infertility require that we examine our:
1. Personal decisions,
2. Partner choice(s),
3. Cultural circumstances,
4. Drug and alcohol use and abuse,
5. Social life, and
6. The availability of quality medical care.

The Fertility Shrink: Practice Statement

As a licensed psychologist, I believe all people have the right to be treated with kindness, dignity, and respect. I collaboratively and ethically work with my patients towards the achievement of their goals. My objective is to eliminate emotional distress and promote psychological well being. I achieve this through teaching clients the skills necessary to cope with their emotional needs. This, in turn, enables patients to flourish and make sound decisions. I strive to help clients become autonomous and independent individuals. I make every effort to help patients become better equipped to consistently make excellent personal choices, so they may fully enjoy life, which, in my opinion, includes possessing the ability to connect deeply and meaningfully with others.