Creating families / Créons des familles by Fertility Matters Canada

Supporting you every step of the way...

t LifeQuest, we use the most advanced reproductive technologies to help couples have children. Our technology is better, so our pregnancy rate is higher. We are leaders in providing PGD, Blastocyst Transfer and Spindleview techniques. We’d like to help your dream of starting a family come true. For more information about how we can help, and a complete list of the services we offer, please visit our website www.lifequestivf.com.

Our Medical Team: Carl A. Laskin MD, FRCPC Ken Cadesky MD, FRCSC Sony Sierra MD, FRCSC, REI Beth Gunn MD. FRCSC, REI Kaajal Abrol MD, FRCSC, REI Judith Perry MD Email: Phone: Toll Free: Fax:

info@lifequestivf.com 416-506-0804 1-866-543-3046 416-506-0600

When it’s time, we’re here. www.lifequestivf.com

-JGF2VFTU $FOUSF %PXOUPXO 5PSPOUP t 655 Bay Street, 18th Floor, Toronto, Ontario M5G 2K4 -JGF2VFTU $FOUSF 5IPSOIJMM $MJOJD t 7330 Yonge Street, Suite 218, Thornhill, Ontario L4J 7Y7

Creating FAMILIES Créons des familles

EDITOR-IN-CHIEF

PLATINUM SPONSORS

Gloria Poirier gloria@iaac.ca

Merck EMD Serono

EDITOR Véronique Robert carotexte@videotron.ca TRANSLATIONS Véronique Robert ART DIRECTOR / GRAPHIC DESIGN Sheldon Kravitz sheldon.kravitz@sympatico.ca

Ferring Pharmaceuticals GOLD SPONSORS CReATe Fertility Centre

IVF Canada & The LIFE Program

LifeQuest Centre for Reproductive Medicine

London Health Sciences Centre, The Fertility Clinic

MUHC Reproductive Centre SILVER SPONSORS ARTUS Centre Aurora Reproductive Care Fertility Centers of Illinois

I A A C NATIONAL BOARD OF DIRECTORS

First Steps Fertility

PRESIDENT • Jocelyn Smith

Genesis Fertility Centre

VICE-PRESIDENT • Janet Takefman Pamela Burton • Ellen Greenblatt Dalit Dell Hume • Sherry Levitan Al Yuzpe

Grace Fertility Centre

Mount Sinai Centre for Fertility & Reproductive Health ONE Fertility Ottawa Fertility Centre Pacific Centre for Reproductive Medicine Regional Fertility Program Shady Grove Fertility True North Imaging

Hannam Fertility Centre Heartland Fertility & Gynecology Clinic

BRONZE SPONSORS

ISIS Regional Fertility Centre

Outreach Health Services

True North Imaging is proud to be the leading provider

of fertility imaging services in Ontario, with locations across the Greater Toronto Area and Kitchener/Waterloo Regions. Our team of professional staff has been providing high quality care and superior imaging services for over 20 years. For more information about the services we provide and our locations, please visit our website at www.truenorthimaging.com.

Créons des familles • SPRING/PRINTEMPS 2014

14 FERTILE FUTURE

26 CONVERSATION INAUDIBLE AU COEUR DU DÉSIR

DEPRESSION AND INFERTILITY IN WOMEN

WHATEVER HAPPENED TO MRS. I.?

Canadian Magazine of Reproductive Health • Revue canadienne de la santé reproductive

COLUMNS / CHRONIQUES

Creating FAMILIES Créons des familles

President’s Message . . . . 8 Message de la présidente . . 9 What’s New? . . . . . . . 10 - 13 Quoi de neuf ? . . . . . . 10 - 13 Adoption Corner . . . . . . . . 42 Adoption in Ontario Patient’s Perspective . . . 48 Parenting After Infertility La communauté LGBT. . . 54 Les femmes LBQ et l’in/fertilité

SPRING / PRINTEMPS 2014

FEATURES / DOSSIERS

The Naturopathic View ... 60 Melatonin and IVF

My Emotional Journey Through Infertility ................................................... 38 by SARAH KOVAL

The Doctor’s Column . . . 68 Donor Eggs

Emotional Support Before and After Pregnancy ......................................... 64

La chronique du médecin . . 69 Ovules de donneuse

by REBECCA HODSON

Reader’s Corner . . . . . . . . . . 70 Le coin des lecteurs . . . . . 71 The opinions expressed in this magazine are personal and do not necessarily reflect those of Creating Families. Les opinions exprimées dans ce magazine sont personnelles et ne reflètent pas nécessairement celles de Créons des familles.

The Infertility Awareness Association of Canada (IAAC) L'Association canadienne de sensibilisation à l'infertilité (ACSI) 475 Dumont Ave., Suite 201, Dorval, QC H9S 5W2 • 514 633-4494 • 1 800 263-2929

www.iaac.ca SPRING/PRINTEMPS 2014 • Creating Families

PARENTING AFTER INFERTILITY

President’s

Photo by Lisa Minnini

MESSAGE

willing to help out! Get involved! You’ll be happy you did! Our online version of Creating Families is a hit. We are getting great feedback. If there is something that you would like to know or a subject you would like to read an article about, please send it along to info@iaac.ca. Ideas for new articles are always welcome.

I know I say this every time but, guess what? This issue is fabulous. Have you ever wondered what you would need to do if you were considering adoption? Did you know that Fertile Future offers support to Jocelyn Smith cancer patients who want to preserve their AAC and Spring mean a couple of fertility? What is different about parenting things to me. First it is the end of short, after infertility? How much do you know cold, snowy days. But maybe more imporabout the pros and cons of antidepressants tantly it reminds me that the Canadian for treating depression and infertility? Infertility Awareness Week (CIAW) is just These questions are answered in this issue. around the corner. As we plan for the 8th We hope you will appreciate, as we did, edition of this week-long series of advocacy My Story, which relates one couple’s and awareness events, we invite you to paremotional journey through infertility; a ticipate in great numbers in our kickoff fascinating look at infertility in developing events on May 25th. Please check our webcountries shared by an renowned expert in site for more details, and please register for the field, and last but not least, we have a the events as it allows for better planning! third collaboration with Nathalie Courcy Our goal during CIAW is to bring togethwho offers us this time an imaginary and er all parties who have an interest in raistouching exchange between would-be ing awareness about infertility. The more parents and a child-in-waiting. We people join in, the louder our voice as we promise to translate this into English for advocate for access to fertility treatments. the Summer issue. A huge thank you to all We’ll be looking for volunteers to speak to of our contributors – we don’t say it often the media and participate in on-site video LISA SHATFORD:LISA SHATFORD 7/16/07enough. 9:11 AM Page 1 recordings, and for photographers who are

25 years experience helping clients navigate the stress of infertility and its treatment, understand the implications of treatment options, and make sound choices in family building. Consultation, assessment, stress management, education, and psychotherapy. Individual and couple support. Psychologist fees are covered by most employee benefits plans.

As some of you already know there have been some changes in our board of directors. The “old” guard has completed (and then some!) their mandate and are moving on to other things. I would like to take this opportunity to thank Dr. Al Yuzpe, Dalit Hume, Pam Burton, Fern Levine and Dr. Ellen Greenblatt for their unwavering support of both IAAC and myself. And I would like to welcome Janet Fraser, Antonina Wasowska, Glenna Owen, and Paula Chorney as new Board members. I look forward to working with you. Several board members are staying on while the transition from the old to the new happens. They would be Dr. Janet Takefman, Sherry Levitan and myself. I think once we have welcomed a few more new members and everyone is feeling comfortable with their new responsibilities we will let the new guard take over. As always I ask that you share this magazine with your friends and family. With our new online format it’s now easier than ever, by simply sharing the link. Better yet, share it with your friends on Facebook, or tweet it! All of these actions will help us expand our readership and make our advocacy voice resonate louder. Please encourage your family members, close friends and practitioners to become members of IAAC – you’ll find all the information you need on our website (www.iaac.ca). If you still have questions, please call us. IAAC is about awareness. The more members we have, the stronger our voice – so please become a member. Have a wonderful Spring, and I hope to see you at CIAW!

Dr. Lisa Shatford

Registered Psychologist

Sincerely,

25 Imperial Street Suite 310A Toronto, Ontario M5P 1B9 416.795.5183 drlisa@sympatico.ca

Jocelyn Smith

Créons des familles • SPRING/PRINTEMPS 2014

MESSAGE

de la présidente

’ACSI et le printemps signifient plusieurs choses pour moi. En premier lieu, la fin des journées courtes, froides et enneigées. Mais, surtout, cela me rappelle que la Semaine canadienne de sensibilisation à l’infertilité (SCSI) arrive à grands pas. Nous planifions en ce moment la 8e édition de cette semaine d’événements de sensibilisation et nous vous invitons à participer en grand nombre au coup d’envoi de la SCSI le 25 mai. Visitez notre site Web pour plus de détails et veuillez vous inscrire aux événements car cela facilite notre planification ! L’objectif de la SCSI est de rassembler toutes les parties qui ont intérêt à accroître la sensibilisation au sujet de l’infertilité. Plus nous serons nombreux, plus notre voix sera forte pour réclamer l’accès aux traitements de fertilité. Nous aurons besoin de bénévoles pour parler aux médias et prendre part à l’enregistrement de vidéos sur place et de photographes disposés à nous aider ! Participez ! Vous vous en féliciterez !

Canadian Infertility Awareness Week Semaine Canadienne de Sensibilisation à l’Infertilité May 24 - 31, 2014 du 24 au 31 mai

Notre version en ligne de Créons des familles est un succès. Les commentaires sont très positifs. S’il y a quelque chose que vous aimeriez savoir ou un sujet que vous aimeriez voir traité dans un article, s’il-vous-plaît faites-nous le savoir en écrivant à info@iaac.ca. Les idées d’articles sont toujours les bienvenues.

Je sais que je dis cela chaque fois mais, devinez quoi ? Ce numéro est fabuleux. Vous êtes-vous déjà demandé ce que vous auriez besoin de faire si vous envisagiez l’adoption ? Saviez-vous que Fertile Future offre du soutien aux patients atteints de cancer qui souhaitent préserver leur fertilité ? En quoi est-ce différent d’élever des enfants après avoir vaincu l’infertilité ? Que savez-vous sur le pour et le contre des antidépresseurs pour traiter la dépression et l’infertilité ? Vous trouverez les réponses à ces questions dans ce numéro. Nous espérons que vous apprécierez autant que nous la rubrique My Story qui raconte le parcours éprouvant d’un couple jusqu’à son heureux dénouement ; un regard fascinant sur l’infertilité dans les pays en développement que porte un expert réputé dans ce domaine et aussi, pour notre plus grand bonheur, une troisième collaboration avec Nathalie Courcy qui, cette fois, nous propose un échange imaginaire très touchant entre des parents prospectifs et un enfant à venir. Un immense merci à tous nos collaborateurs – nous ne le disons pas assez souvent.

Certains d’entre vous savent déjà que notre conseil d’administration a connu des changements. La « vieille » garde a rempli (et comment !) son mandat et ira relever d’autres défis. J’aimerais profiter de cette occasion pour remercier le Dr Al Yuzpe, Dalit Hume, Pam Burton, Fern Levine et la Dre Ellen Greenblatt pour leur appui indéfectible à l’ACSI et à moi-même. Et je

souhaite la bienvenue aux nouveaux membres Janet Fraser, Antonina Wasowska, Glenna Owen et Paula Chorney. J’ai hâte de travailler avec vous. Plusieurs membres du conseil restent en poste pour assurer la transition, soit Janet Takefman, Sherry Levitan et moi-même. Je pense qu’une fois que nous aurons accueilli quelques autres nouveaux membres et que chacun sera à l’aise dans ses nouvelles responsabilités, nous céderons la place à la nouvelle garde.

Comme toujours, je vous demande de faire circuler ce magazine. Avec notre nouveau format en ligne, c’est plus facile que jamais – il suffit d’envoyer le lien. Mieux encore, partagez-le avec vos amis sur Facebook ou Twitter ! Tous ces gestes nous aideront à élargir notre bassin de lecteurs et nous permettront de plaider la cause des patients d’une voix plus forte. S’il-vous-plaît, encouragez les membres de votre famille, vos amis et ceux qui vous soignent à devenir membres de l’ACSI – vous trouverez la marche à suivre sur notre site Web (www.iaac.ca). Si vous avez encore des questions, n’hésitez surtout pas à nous téléphoner. Sensibiliser, telle est la mission de l’ACSI. Plus nous aurons de membres, plus nous ferons une différence – alors faites-nous le plaisir de vous joindre à nous !

Je vous souhaite un merveilleux printemps et j’espère vous voir à la SCSI !

Avec mes plus cordiales salutations,

Jocelyn Smith

SPRING/PRINTEMPS 2014 • Creating Families

What’s New? Headlines in the fertility world

Percentage of triplets and higher-order multiple births that fertility drugs were responsible for in the United States in 2011, according to a study published in The New England Journal of Medicine in December of 2013. Only 32% were due to IVF.

What Ce que Daddy eats papa mange matters! compte aussi!

Numerous studies have emphasized the importance of folate (Vitamin B9) in the mother’s diet before and during pregnancy, the reasons for which include avoiding malformations such as spina bifida. Now a McGill University specialist in epigenetics, Dr. Sarah Kimmins, tells us that folate in the father’s diet may very well influence the newborn’s health. In her study, published in the December 10th issue of Nature Communications, her team found a 30% higher incidence of birth defects in mice litters when the father’s diet was low in folates.

Créons des familles • SPRING/PRINTEMPS 2014

Maintes études ont souligné l’importance de l’acide folique (Vitamine B9) dans l’alimentation de la mère avant et pendant la grossesse, notamment pour éviter des malformations telles que le spina bifida. Voilà que la Dr. Sarah Kimmins, spécialiste en épigénétique à l’Université McGill, nous apprend que l’acide folique dans la diète du père pourrait également influer sur la santé du nouveau-né. Dans son étude parue dans le numéro du 10 décembre 2013 de Nature Communications, son équipe a constaté une hausse de 30 % des malformations congénitales chez les portées de souris dont le père avait une alimentation pauvre en acide folique.

45 Pourcentage des triplés, quadruplés et autres naissances multiples aux États-Unis en 2011, attribuables aux médicaments visant à stimuler l’ovulation, selon une étude parue dans The New England Journal of Medicine en décembre 2013. Seulement 32% de ces naissances étaient dues à la FIV.

Quoi de neuf ?

Les manchettes dans le monde de la fertilité.

First Canadian Fertility Referral Network for Cancer Patients is Born As of last January 13th, oncologists in Canada have been able to make on-the-spot online referrals for cancer patients who wish to preserve their fertility. Set up by the Cancer Knowledge Network, the Oncofertility Referral Network (OFRN) allows for the organization of time-sensitive treatment. The new network should translate into a higher number of referrals of cancer patients to fertility clinics. According to a recent survey, most clinics report monthly referrals ranging between 0 and 2 patients.

Premier réseau canadien de référence en fertilité pour les patients atteints de cancer Depuis le 13 janvier 2013, les oncologues canadiens peuvent référer sans délai en ligne les patients atteints de cancer qui désirent préserver leur fertilité. Mis sur pied par le Cancer Knowledge Network, l’Oncofertility Referral Network (OFRN) permet l’organisation de traitements tenant compte des contraintes de temps. Le nouveau réseau devrait générer une augmentation du nombre de patients cancéreux référés aux cliniques de fertilité. Selon un sondage récent, la plupart des cliniques se voient référer entre 0 et 2 patients par mois.

Difficulty conceiving? Go to the dentist! Poor oral hygiene may delay conception by two months, according to Dr. Roger Hart, professor of Reproductive Medicine at the University of Western Australia. The results of a study he conducted over 3,400 women suggest that gingivitis could be one of several factors which could be modified so as to improve chances of pregnancy.

Difficulté à concevoir ? Allez chez le dentiste ! Une hygiène buccale déficiente peut retarder la conception de deux mois, selon le Dr Roger Hart, professeur de médecine de la reproduction à la University of Western Australia. Une étude menée auprès de plus de 3 400 femmes indique que la gingivite pourrait être l’un des facteurs susceptibles d’être modifiés pour augmenter les chances de grossesse.

SPRING/PRINTEMPS 2014 • Creating Families

What’s New?

Nine Swedish women have undergone a uterus transplant

Nine Swedish women, who received a transplanted uterus donated by a close relative, are doing well and hoping to become pregnant. These women were either born without a uterus or had it removed for medical reasons. As the donated uterus is not connected to their fallopian tubes, pregnancy will be attempted via IVF using their own eggs collected before the operation. The donated uterus will be removed after two pregnancies, so that recipient women can stop taking antirejection drugs, which can have unpleasant side effects.

Lower chances of IVF success for Asian and black women A study of 1,517 women treated with IVF at a British fertility clinic between 2006 and 2011 reported a significantly lower rate of success for Asian and black women compared to white women. Overall, 44% of white patients gave birth after IVF, compared with 35% of non-white patients. Researchers wonder whether this might be due to genetic, social or environmental factors.

Créons des familles • SPRING/PRINTEMPS 2014

Neuf Suédoises se sont fait transplanter un utérus

Neuf Suédoises à qui on a transplanté un utérus donné par une parente proche se portent bien et espèrent devenir enceintes. Ces femmes sont nées sans utérus, ou bien elles ont dû subir une hystérectomie. L’utérus transplanté n’étant pas relié à leurs trompes de Fallope, toute grossesse devra être obtenue par FIV de leurs ovules prélevés avant l’intervention. L’utérus sera retiré après deux grossesses pour que les récipientes puissent cesser de prendre des médicaments anti-rejet, qui peuvent entraîner des effets secondaires indésirables.

La FIV réussit moins bien aux Asiatiques et aux Noires Une étude portant sur 1 517 femmes ayant subi une FIV dans une clinique de fertilité britannique entre 2006 et 2011 rapporte un taux de succès peu élevé chez les Noires et les Asiatiques. En moyenne, 44 % des femmes blanches ont donné naissance après une FIV, contre 35 % des femmes d’autres origines. Les chercheurs se demandent s’il faut attribuer ce fait à des facteurs géntiques, sociaux ou environnementaux.

Quoi de neuf ? 10 – 20%

Percentage of infertility cases worldwide for which no cause is found.

10 – 20%

Pourcentage des cas d’infertilité inexpliquée à travers le monde.

Male infertility: a Canadian breakthrough will reduce need for surgery

Infertilité masculine : une percée canadienne réduira le nombre de chirurgies

Until now, the only way doctors could find out whether viable sperm could be retrieved in the testicles of men with zero sperm counts was to perform a biopsy. This soon will no longer be necessary. Researchers from Toronto's Mount Sinai Hospital have identified two proteins in sperm that can predict if usable sperm is likely to be found, thus eliminating the need for many surgeries.

Jusqu’à présent, la seule façon de déterminer si des spermatozoïdes viables pouvaient être prélevés dans les testicules d’hommes aspermiques était de pratiquer une biopsie. Cela ne sera bientôt plus nécessaire. Des chercheurs de l’Hôpital Mount Sinai, à Toronto, ont identifié deux protéines dans le sperme capables de prédire la présence de spermatozoïdes sains, ce qui évitera de nombreuses chirurgies.

SPRING/PRINTEMPS 2014 • Creating Families

Fertile Future Helping Preserve Cancer Patients’ Fertility

Freezing their embryos by Jessica Séguin No one ever plans to be faced with infertility, nor does anyone ever plan to be diagnosed with cancer. Imagine unsuccessfully trying to conceive and going for a fertility consultation only to discover that the problem is more serious than initially expected.

Créons des familles • SPRING/PRINTEMPS 2014

gave her the ability to focus on her cancer treatment along with

Over the decades, the issue of infertility has been at the bottom of the list of concerns for so many faced with a cancer diagnosis, as the news of the diagnosis itself often overshadows decisions that need to be made in the immediate future when it comes to preserving fertility.

the hope that being a mother was still a possibility after cancer.

Trudy’s story Trudy’s story started with fibroid surgery at age 36, but pathology reports returned devastating news: cancer. Several biopsies later, she

She felt guilty even thinking about fertility when her family just wanted her to be free of cancer, but the prospect of not being able to have children was more devastating to her than the cancer itself. Trudy and her daughter

was told that her whole uterus was cancerous and that she would need to have a total abdominal hysterectomy and bilateral salpingo-oopherectomy. Called TAHBSO for short, this operation involves removing both fallopian tubes and both ovaries. Trudy began to research fertility preservation options. Was it even an option? Could anything be done? She felt guilty even thinking about fertility when her family just wanted her to be free of cancer, but the prospect of not being able to have children was more devastating to her than the cancer itself. She was able to secure an appointment with a fertility clinic in Toronto and began treatment immediately as her oncology surgery was less than two weeks away. She only had one chance to have the egg retrieval done. Trudy’s cancer surgery was successful and she was able preserve eggs to create embryos for the future. Once in remission, she searched for a surrogate and in early 2012 her daughter was born.

Caylee’s experience Caylee’s story began a few months after her wedding. She started experiencing abdominal pain that prompted her to seek medical attention. It was originally thought that she had a ruptured cyst and should come back a few months later for a follow-up. However the pain escalated and after numerous tests and nearly a year later, she was diagnosed with endometriosis. Caylee and her husband had been ready to start their family, so they opted for surgery to have the endometriosis removed in order to improve their chances of conceiving. It was during this surgery that the doctors discovered she had a very rare form of cancer: pseudomyxoma peritonei, a type of appendix cancer. She was referred to one of the few surgical oncologists that treat appendix cancer. He informed her that she would need to undergo a very complex surgery, which involved the resection of numerous organs followed by a

hot chemo wash of her abdomen. The surgery also typically involved the removal of both ovaries and the uterus. Caylee was very fortunate that her surgeon understood how much she wanted children. He quickly referred her to the Calgary, Alberta Regional Fertility Program. Only a few hours after meeting with the oncologist, Caylee and her husband were at the fertility clinic discussing their options. They were told that they could freeze embryos but that they would need to start treatment the following day. With so much information in such a short time, they were overwhelmed, but their desire to have children prompted them to move forward with fertility preservation. They were very fortunate to have family and friends help with the financial end of the treatment, as it was a sudden and unexpected expense. They were successful in freezing seven embryos. Two weeks after the egg retrieval, Caylee was scheduled for surgery. Her surgeon was

SPRING/PRINTEMPS 2014 • Creating Families

The surgery also typically involved the removal of both ovaries and the uterus. Caylee was very fortunate that her surgeon understood how much she wanted children. He quickly referred her to the Calgary, Alberta Regional Fertility Program. Caylee, her husband and their two children.

unable to save her ovaries, but despite this disappointment, knowing she had frozen embryos softened the impact. After six months of recovery, Caylee and her husband were ready to move forward with building their family. They began with transferring their embryos. Unfortunately, using their own embryos was unsuccessful and so they turned to an egg donor. After several transfers, they became pregnant with twin boys. Caylee feels very fortunate that her surgeon took her desire to be a parent

seriously when discussing treatment options. Freezing their embryos gave her the ability to focus on her cancer treatment along with the hope that being a mother was still a possibility after cancer.

The Power of Hope Program Fertility preservation offers patients hope in the face of infertility-causing treatment, but so often the cost is beyond their

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Créons des familles • SPRING/PRINTEMPS 2014

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means. Imagine being 18 years old at the time of diagnosis – most teenagers haven’t started thinking about RRSPs, let alone having a family. That’s where Fertile Future can help. The Power of Hope Program was launched in 2010 to provide financial assistance for qualified men and women to help pay for fertility preservation. Liz Ellwood founded Fertile Future while she underwent treatment for ovarian cancer. After discovering firsthand how little information was given her at the time of her diagnosis, she decided that young cancer victims needed to be better aware of the reproductive options available to them. She also realized that these young patients faced financial obstacles. The Power of Hope Program can provide funding of up to $350 for men and $1,000 for women who qualify under the program criteria, but how many people even know that this program is available?

Telling statistics

Imagine being 18 years old at the time of diagnosis – Current statistics tell us: • Each year, an estimated 10,000 young Canadians face a cancer diagnosis like Trudy and Caylee did. Approximately 8,000 of them will win this battle. (Yee, FullerThomson, Dwyer, Greenblatt & Shapiro, 2011).

most teenagers haven’t started thinking about RRSPs, let alone having a family. That’s where Fertile Future can help. The Power of Hope Program was launched in 2010 to provide financial assistance for qualified men and women to help pay for fertility preservation.

• 69.7% of Ontario physicians specializing in medical oncology, radiation oncology, gynaecologic oncology, and urology have rarely/never referred female patients for fertility preservation consultation. (Yee, Fuller-Thomson, Greenblatt, & Lau, 2012). • Cancer patients are severely under-served by fertility clinics in Canada. (Yee et al., 2012).

• 9 out of 16 childhood cancer centres used Fertility Preservation pamphlets – all but one used adult-focused material only – and very little adolescent or parent-focused materials were made available. (Yee et al., 2012). • 81% of patients were unaware of any patient organization that had education materials on oncology fertility preservation. (Yee et al., 2012).

• 53.7% of referrals to the Fertile Future Power of Hope Program are from Ontario. (Fertile Future, 2014).

Furthermore, lack of information transmitted to patients is illustrated by the following figures:

SPRING/PRINTEMPS 2014 • Creating Families

Among all these statistics, how many patients have been left out because they didn’t speak up about their experiences? How many people didn’t know they had an option to find out more, to explore the possibilities? • 96.6% of physicians relied on verbal communication alone to discuss fertility preservation options. (Yee et al., 2012) • 81% of patients did not know of any additional information available other than what was provided verbally. (Yee et al., 2012) • 25-30% of clinics did not provide educational information to patients. (Yee et al., 2012) • 75% of clinics had no information on their websites. (Yee et al., 2012) • Oncologists’ knowledge of fertility preservation options is low: radiation oncologists are the least informed, whereas urologists and medical oncologists are the most knowledgeable. It should also be noted that knowledge of where to refer patients is generally low. (Yee et al., 2012)

Créons des familles • SPRING/PRINTEMPS 2014

Among all these statistics, how many

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Regional Statistics. January 2014.

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Yee S, Fuller-Thomson E, Dwyer C, Greenblatt

times each month we receive phone calls

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http://www.ncbi.nlm.nih.gov/pubmed/21539768.

are unable to assist these people directly, but by having a conversation with men, with

Yee S, Fuller-Thomson E, Lau A, Greenblatt EM.

women, with doctors, we can spread the

Fertility preservation practices among Ontario

word so that each patient becomes empow-

oncologists. J Cancer Educ. 2012 Jun; 27(2):362-

ered, so that each medical professional can provide options to their patients, and so that each person can keep the hope that fertility preservation can provide.

8. Doi: 10.1007/s13187-011-0301-4. http://www.ncbi.nlm.nih.gov/pubmed/22234424.

About the Author Jessica Séguin is the Executive Director of Fertile Future. She comes to Fertile Future with five years of experience in the not-for-profit industry. Like many Canadians, Jessica has been touched by cancer within her family and, more recently, with the passing of her best friend. Knowing how much children can enrich our lives, she is passionate about Fertile Future’s mission and about how many lives can be touched by its services. In her spare time, Jessica is actively engaged in health and wellness activities, fitness and almost anything that has to do with her two children. She can be reached at 613-440-3302 or toll free at 1-877-HOPE-066. You can visit Fertile Future’s website at fertilefuture.ca.

On Thursday, April 24th, 2014, Fertile Future will host the inaugural Capital Evening of Hope, a prestigious fundraising event celebrating our Canadian culture in the Capital City. The event will be held at the Museum of History situated on the banks of the Ottawa River. The Museum offers a spectacular view of the Capital City, Ottawa River and Parliament Hill. This evening will be an opportunity to enjoy our country from shore to shore with Canadian entertainment together with an exciting live and silent auction. Guests will enjoy fine cuisine in a lively environment with friends and colleagues. Drawing from Ottawa’s political, social, sports and business sectors, community and leaders will come together in an evening that is truly Canadian. Guests will arrive on the red carpet to be greeted by a Mountie in Red Serge to begin their Canadian journey. Making their way to the Riverview Salon guests will experience the sound of the Governor General’s Foot Guards Jazz Combo and enjoy a selection of beverages and food stations that truly reflect Canadian cuisine from British Columbia to Newfoundland. For more information, visit http://fertilefuture.ca/fundraising-events/

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SPRING/PRINTEMPS 2014 • Creating Families

Depression and Infertility in Women:

Pros and Cons of Antidepressants

Créons des familles • SPRING/PRINTEMPS 2014

by Alice D. Domar, Ph.D

For women, depression and infertility seem to go hand in hand. I would guess that every female infertility patient I have ever spoken to has reported some symptoms of depression. It makes sense. Procreation is the strongest instinct in the animal kingdom; wanting to have a baby is the most natural desire in the world. Think about the experience of most of my patients: They toss away the birth control, joyfully try for a few months, and then start to get a bit worried. As the months go by the worry turns to genuine concern and when they finally see a doctor, they wonder if they will ever get pregnant. By the time they see an infertility specialist, they have experienced the roller coaster of emotions every month, feel surrounded by pregnant friends, relatives, neighbors and co-workers, and if one more person tells them to “just relax,” they may be in danger of losing it totally… It doesn’t help that men and women tend to react to infertility differently. You and your partner might be upset that you are responding so differently to this crisis, let alone the impact it can have on your sex life. Add to that the effect it has on your relationships with friends and family, your finances, and even your religious/spiritual beliefs, and it is no surprise that almost half of infertility patients report high levels of depression and/or anxiety prior to their first doctor’s visit. Thus, symptoms of depression are incredibly common. They include tearfulness, not

looking forward to things as much as you used to, issues with sleeping and/or eating, not enjoying activities as you did in the past, and irritability. Every day, women come into my office and talk about how sad they feel. So in my world, feeling depressed as you are going through infertility is completely normal. How can you not feel sad when you want a baby more than anything in the world, and everyone you know seems to

By the time they see an infertility specialist, they have experienced the roller coaster of emotions every month, feel surrounded by pregnant friends, relatives, neighbors and co-workers, and if one more person tells them to “just relax,” they may be in danger of losing it totally… conceive effortlessly, but no matter what you do or how hard you try, it isn’t happening for you? Consequently, the focus for most of my career has been on treating symptoms of depression and anxiety in women as they struggle to become pregnant. Treating symptoms of depression is necessary for a variety of reasons: • It is unpleasant to feel sad most or all of the time; • Women who are depressed are more likely to drop out of treatment, thus limiting their

chances of conceiving; • Women undergoing treatment who are depressed may have lower changes of conceiving, even with IVF. There are a number of ways to treat depression. Since I am a psychologist trained in cognitive behavioral therapy (CBT), that is how I tend to treat my patients. But not everyone responds the same way to CBT. Until about two years ago my backup plan for patients who didn’t quickly improve with CBT was to refer them to a psychiatrist for a prescription for antidepressant medication, most often a selective serotonin reuptake inhibitor (SSRI). All of this changed when I attended a lecture by a high-risk obstetrician, Adam Urato, M.D., who specializes in the risks of taking antidepressant medication during pregnancy. During the lecture, he outlined the research on the risks to both mother and baby and he also reviewed some of the controversy about the efficacy of these medications for the treatment of depressive symptoms. And the takeaway message was clear. Although there are some benefits to some women, especially those with severe symptoms of depression, most women who experience mild to moderate symptoms should consider alternative, non-pharmacological approaches. After the lecture, I met with Dr. Urato to discuss the risk/benefit ratio of taking SSRIs for women who are experiencing infertility. Since there was little published information about this topic, we decided to research it together, and we published a review article early in 2013.1 Our basic conclusions include the following: • There is minimal research on the impact of antidepressant medication on fertility. There have been only a couple of studies, but both showed that women who were taking antidepressant medication had poorer outcomes from IVF than did women who were not

SPRING/PRINTEMPS 2014 • Creating Families

Although there are benefits to some women, especially those with severe depression, most women who experience mild to moderate symptoms should consider alternative, non-pharmacological approaches. taking antidepressant medication;

and preterm birth;

behavioral syndrome;

• Taking antidepressant medication during pregnancy is associated with a number of risks, including higher rates of miscarriage

• Babies who were exposed to antidepressant medication during pregnancy were more likely to experience complications as newborns, including a 30% risk of newborn

• Children who were exposed to antidepressant medication during pregnancy had some developmental delays (i.e. walking about a month later than babies who were

Créons des familles • SPRING/PRINTEMPS 2014

There is minimal research on the impact of antidepressant medication on fertility. There have been only a couple of studies, but both showed that women who were taking antidepressant medication had poorer outcomes from IVF than did women who were not taking antidepressant medication. not exposed) and there appears to be an increased risk of autism; • The long term neurobehavioral impact of antidepressant exposure in utero is unknown, but the animal research is quite concerning;

• Women who are trying to conceive, who are depressed and are contemplating taking antidepressant medication, should speak to their doctor about trying other nonpharmacological approaches first;

• Women who are trying to conceive and are already taking antidepressant medication should speak to a psychiatrist or other mental health professional about the pros and cons of remaining on their medication, versus tapering off their medication after they have successfully learned other strategies to treat their depressive symptoms.

The key issue is the safety and efficacy of non-drug treatments for depression. In our review, we examined the research on psychotherapy, exercise, relaxation training, yoga, acupuncture, and nutritional supplements, although there has been very little research specific to infertility patients.

Most of the research has been on psychotherapy, specifically cognitive-behavioral therapy (CBT), which is a short-term form of therapy in which the patient learns to recognize and challenge automatic and distorted thought patterns such as, “I will never have a baby,” “The infertility is all my fault.” The goal is to move towards self-talk such as, “I am doing everything I can to get pregnant,” and “I didn’t do anything to cause my infertility.” The research shows that CBT is equivalent to, or in some cases better than, antidepressant medication. In one randomized controlled study with infertile depressed women, 79% of those who received CBT reported significant decreases in depressive symptoms, compared to 50% in the antidepressant medication group and 10% of the controls. Other research on CBT delivered in a mind/body group format showed that depression scores returned to normal by the end of the 10-week program, and pregnancy rates were significantly higher in the mind/body group patients when compared to the control group.

Be aware that infertility is a temporary crisis. As Canadian researcher Judith Daniluk discovered when she interviewed women decades after they had experienced infertility, their level of happiness and life satisfaction was not

The research on exercise shows decreases in depressive symptoms in the general population, but no research has been conducted on infertile patients as yet. Acupuncture research is preliminary but does show promise in the

influenced by the outcome. SPRING/PRINTEMPS 2014 • Creating Families

treatment of depression in the infertile population. Yoga, relaxation training, and certain supplements show promise, but no definitive conclusions have been reached so far.

The vital issue here is that if you are experiencing symptoms of depression, or have in the past but the symptoms are well controlled by medication, you need to sit down with a mental health professional and carefully review the pros and cons of antidepressant medication versus the non-medication route. If you are experiencing mild or moderate symptoms, either individual CBT or a mind/body group program may effectively, safely, and quickly treat your symptoms. If your depressive symptoms fall into the severe category, you might want to consider taking a break from trying to conceive, going on medication, mastering the CBT strategies while stabilized on medication, and then tapering off the medication and using the CBT methods as you start to try to conceive again.

If you have concerns about your mood state, ask your infertility doctor to refer you to a local counselor who specializes in infertility counseling, ideally one who knows CBT. She/he can assess the severity of your symptoms and make recommendations based on how you are feeling, the availability of individual and/or group CBT, and your interest in incorporating the new skills into your life.

It is crucial now to find out if you are indeed depressed and, if so, to choose a treatment modality which will maximize the chance that you will quickly conceive a healthy baby. Be aware that infertility is a temporary crisis. You will not be feeling this way for the rest of your life. As the esteemed Canadian researcher Judith Daniluk discovered when she interviewed women decades after they had experienced infertility, some of whom had conceived or adopted, and others who had never had children, their level of happiness and life satisfaction was not influenced by the outcome of their infertility. But it is crucial now to find out if you are indeed depressed and, if so, to choose a treatment modality which will maximize the chance that you will quickly conceive a healthy baby.

Tara Sheppard,

B.A., M.M.F.T.

Individual, Ind ividual, Couple, Family & Gr Group oup Therapist

Therapy & counsel counselling ling services for people dealing

with infertility infertility,, the effects effects of AR ART, T, and donor issues. Assistance in dealing with complex conflicts, so that you and your loved ones can enjoy life in the pr present, esent, and feel hope for the futur future. e. Downtown WINNIPEG location

www.tarasheppard.com www.tarasheppard.com

a.sheppard @ mts.net tel : 204.880.3285 tar tara.sheppard

CrĂŠons des familles â&#x20AC;˘ SPRING/PRINTEMPS 2014

References: 1 Domar, A, Moragianni V, Ryley D, Urato

A. The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond. Human Reproduction, January, 2013.

About the Author Alice D. Domar, Ph.D., is the executive director of the Domar Center for Mind/Body Health at Boston IVF, and an associate clinical professor of obstetrics, gynecology and reproductive biology at Harvard Medical School. She is the founder of the Mind/Body Program for Infertility, the author of six books, including Conquering Infertility, and the chief scientific officer for TriaDea Integrative Healthcare.

Canadian Infertility Awareness Week Semaine Canadienne de Sensibilisation à l’Infertilité May 24 - 31, 2014 du 24 au 31 mai Join us on May 25th for our Kickoff event Creating Families

Soyez des nôtres le 25 mai pour le lancement Créons des familles

www.iaac.ca

FICTION

Conversation inaudible au cœur du désir par Nathalie Courcy

Dessins d'Alexane Bellemare, Lenya Bellemare et Nathalie Courcy

- Papa ? Maman ? Où êtes-vous ? Je vous cherche depuis si longtemps… Je suis votre enfant, celui que vous souhaitez mettre au monde depuis toujours mais qui n’arrive pas. Je suis piégé loin de vos bras et, pourtant, j’ai besoin d’un abri bien au chaud pour me lover et grandir sur Terre. J’ai besoin de parents qui m’accueilleront dans leur monde et qui m’enseigneront la vie. J’ai besoin de vous.

- Notre enfant chéri, tant désiré, déjà tant aimé… où es-tu ? Nous sommes ton papa et ta maman. Nous t’attendons depuis déjà si longtemps… Nous avons une place immense pour toi dans nos cœurs et dans nos vies. Nous avons besoin de toi pour pouvoir te combler de bonheur. Nous avons besoin d’un enfant comme toi qui nous enseignera la vie.

- Papa ? Maman ? Pourquoi n’êtes-vous pas au rendez-vous ? J’aimerais tant vous connaître, me blottir dans votre chaleur lorsque je me sens seul parmi les étoiles. Mes cris sont silencieux, votre réponse inaudible… Je ne reçois en retour de mes espoirs que les échos de mes attentes. Répondez-moi !

Créons des familles • SPRING/PRINTEMPS 2014

Bébé qui pense au bébé étoile qui a rencontré ses parents et qui a dû les quitter. - Notre enfant tant désiré, pourquoi n’as-tu pas encore trouvé le chemin jusqu’à nous ? Tout est prêt pour toi : un ventre bien douillet pour te bercer jusqu’à ta naissance, nos bras grands ouverts pour te cajoler, des grands-parents qui t’espèrent autant que nous, un lit bien moelleux pour accueillir tes rêves les plus doux, un lapinot en peluche aussi blanc que les nuages. Il ne manque que toi. Toi et tes gazouillis, tes risettes, tes larmes parfois, et tout ce que tu portes en toi. - Papa ? Maman ? Quand viendrez-vous me chercher ? Je m’ennuie ici. Je vogue parmi des millions d’autres enfants désirés qui n’ont toujours pas trouvé le chemin jusqu’à leurs parents, mais je me sens seul. L’autre nuit, j’ai même rencontré un enfant désiré qui avait

rencontré sa famille, mais il est revenu parmi les étoiles aussi vite qu’il était parti. Il est désemparé, il ne comprend pas quelle erreur il a pu commettre pour mériter son sort. Il essaie de retourner vers ses parents, mais il a peur d’avoir perdu sa chance. Moi, j’ai peur de ne jamais avoir ma chance. - Notre enfant tant désiré, quand viendras-tu à notre rencontre ? Quand pourrons-nous te serrer dans nos bras, admirer ta pureté, apprendre à te connaître, te présenter à ceux que nous aimons ? Nous sommes deux, mais parfois nous nous sentons seuls sans toi. Une partie de nous est portée disparue. L’autre nuit, nous avons rêvé à toi. Tu étais un ange parmi les étoiles. Tu étais triste. Qu’est-ce qui t’empêche de venir nous rejoindre ? Nous

voulons voir s’épanouir. Notre amour est immense et profond, mais sans toi il reste incomplet, comme une galaxie à laquelle il manquerait son soleil. Nous sommes un nid vide, sans oisillons à réchauffer.

Bébé qui pleure de ne pas pouvoir rencontrer ses parents.

- Papa ? Maman ? Si vous n’êtes pas là, qui choisira le prénom qui me ressemble ? Qui me bercera toute la nuit quand j’ai peur du noir ou de l’avenir ? Qui me lancera dans les airs en riant pour m’enseigner à faire confiance ? Qui tiendra ma main la première journée d’école pour m’amener vers l’autonomie ? Qui me consolera de ma première peine d’amour en me prouvant que je suis aimé infiniment ? Qui pleurera de joie quand je deviendrai parent à mon tour ? Qui m’aimera sans condition ? Qui m’aidera à devenir tout ce que je suis, à la mesure de mon infinité ? Qui me permettra de réaliser toutes mes possibilités et de dépasser mes impossibilités ?

- Notre enfant tant désiré, si tu n’es pas là, qui nous appellera Papa et Maman ? Qui pourrons-nous aimer plus que nous-mêmes ? Qui nous aidera à devenir de meilleures personnes, accomplies et épanouies comme individus et comme parents ? Qui nous forcera à nous dépasser chaque jour, chaque nuit de notre vie ? Qui bercerons-nous pendant les nuits d’insomnie ? Qui nous rappellera de garder bien vivant l’enfant en nous, celui qui rit aux éclats, qui s’émeut devant les couleurs de l’arc-en-ciel, qui cueille les brins d’herbe pour en faire un bouquet, qui chantonne même quand il est triste ? - Papa ? Maman ? Je suis si peiné de ne pas être déjà avec vous, mais mon désir de vivre grâce à vous me garde dans la lumière. La déception tord mon cœur chaque fois que je me perds sur le chemin qui m’amène vers vous, mais mon bonheur de savoir que vous me désirez autant que je vous espère me

avons l’impression que notre chance s’est égarée dans les dédales du temps. - Papa ? Maman ? M’avez-vous oublié ? M’avez-vous abandonné ? Je me sens minuscule et si fragile dans ce grand univers sans vous… Vous êtes mon rêve, ma force, la terre où plonger mes racines. Sans vous, je flotte au vent comme un drapeau sans nation. Je suis un oiseau sans destination et sans nid, une eau qui n’aboutit dans aucun océan. - Notre enfant tant désiré, nous ne savons plus comment vivre sans rêver de toi. Tu es notre souffle de chaque instant, l’astre qui guide chacun de nos pas. Parfois, nous avons peur que tu ne sois qu’une illusion, qu’un mirage qui s’émiette dès que nous approchons de toi. Tu es notre force, la fleur que nous

Bébé qui pense aux bébés étoiles qui essaient de rejoindre leurs parents.

SPRING/PRINTEMPS 2014 • Creating Families

nous avons l’impression d’avoir déjà fait tout ce qui était en notre pouvoir pour te trouver. Et si notre peine devant ton absence peut remplir des océans de larmes, c’est que nos pleurs de joie à ta naissance feront déborder l’univers de béatitude et de reconnaissance envers la vie.

- Papa ? Maman ? Je sais jusqu’à quel point vous me désirez et jusqu’à quel point mon absence vous bouleverse. Quand je regarde vers vous, je vois une intense lumière remplie de tout votre espoir. J’essaie de vous transmettre ma lumière d’étoile, mais elle n’arrive pas jusqu’à vous. Un mur nous sépare, nous empêche de nous rejoindre. Un dôme est placé entre vous et moi, entre nous et notre rêve commun de former une famille.

Tout est prêt pour le bébé tant attendu : les grands-parents qui espèrent, le lapinot tout blanc, le lit douillet, le ventre confortable, les bras pour bercer... réconforte. La tendresse que j’éprouve à votre pensée apaise la colère qui hurle en moi comme un geyser quand je pense à l’injustice qui nous harcèle. Pour tout l’univers, je suis un rien inutile et invisible, mais pour vous, je vaux plus que toutes les étoiles rassemblées. Le son de mes pleurs qui vous cherchent remplit le firmament, mais au jour de notre rencontre, l’éclat de mon rire envahira chaque cellule qui compose l’espace.

- Notre enfant tant désiré, nous savons que si tu pouvais, tu nous rejoindrais. Ne nous en veux pas, nous faisons tout pour t’aider à trouver le chemin jusqu’à nous. Quand nous regardons le ciel, nous voyons toutes les étoiles, et parmi elles, il y a toi dans toute ton unicité et ta chaleur. L’univers est gigantesque, mais malgré son infinité, nous te retrouverons, nous te choisirons encore, jour après jour, nuit après nuit, jusqu’à ce que nous soyons réunis. Et nous t’aimerons, que tu sois dans nos bras ou dans nos rêves. Nous t’aimerons encore et encore, parce que nous sommes tes parents, parce que tu es notre enfant.

- Papa ? Maman ? Je vous aime, et je vous attends.

Inc.

Aina Zhang - Notre enfant tant désiré, sache que l’intensité de notre tristesse de ne pas te connaître est à la mesure de notre volonté de te bercer un jour. Si nos déceptions sont si souffrantes chaque fois que notre rencontre n’a pas lieu, c’est que le bonheur de devenir ton papa et ta maman sera immense. Si notre colère contre le destin qui nous éloigne de toi est si pleine de rage, c’est que la tendresse que nous éprouvons à ta pensée est infiniment douce. Si l’impuissance que nous ressentons devant un parcours qui n’aboutit pas nous désespère autant, c’est que

Créons des familles • SPRING/PRINTEMPS 2014

« Un membre important de l'équipe de rêve de Céline Dion » - Le Journal de Montréal, 1er juin 2010

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4177 boul. Décarie s Montréal, QC s H4A 3J8 (514)

483-6669

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Poème à l’enfant envolé

Dessin de Nathalie Courcy

Tu es né dans notre cœur Dès notre premier regard Comme une œuvre d’art Qui jamais ne meurt.

Un oisillon sans nid et sans destination, qui pourrait trouver sa place auprès de parents aimants.

Tu as grandi dans nos rêves Comme une passion, une obsession Qui dépasse toute raison, Qui enfièvre sans trêve. Mois après mois, année après année, Notre désir de toi est resté vivant, Mais jamais nous ne partagerons notre sang Avec toi, notre enfant envolé. Va, notre trésor, notre lumière de firmament. Vole jusqu’au royaume des enfants désirés Danse, ris et dors en toute liberté. Nous ne t’attendons plus, mais nous t’aimons infiniment.

Dessin de Nathalie Courcy

À propos de l’auteure

Quand nous regardons le ciel, nous voyons toutes les étoiles, et parmi elles, il y a toi.

Aux dires de sa famille, Nathalie Courcy est « née avec un crayon dans la main ». Elle utilise l'écriture pour créer de la beauté et pour toucher les coeurs et les esprits. Docteure en littératures francophones, elle a enseigné cinq ans à l’Université de l’Alberta, à Edmonton. Elle prend actuellement une pause de l'enseignement pour s'occuper de sa famille et de ses quatre enfants, tous nés d'insémination artificielle avec donneur : Alexane, 8 ans, Lenya, 6 ans, FélixOlivier, 2 ans, et Izaac, né en décembre 2012. Elle a signé dans le numéro du printemps 2013 de Créons des familles le conte Bébés magiques, illustré par ses deux filles aînées et Lettre à mes enfants magiques dans le numéro de l’été 2013. Elle vit à Gatineau, au Québec.

SPRING/PRINTEMPS 2014 • Creating Families

Whatever Happened to

Mrs. I.? The tragedy of being an infertile woman in a developing country

by Hassan N. Sallam, MD, FRCOG, PhD (London)

Mrs. I. was born in a remote village in a subSaharan African country. Her parents were poor and belonged to those millions who survive on less than two dollars a day. She had a twin brother and her mother had breast-fed him but had bottle-fed her, as in her community boys always came first. Because the family was poor, she had never really received an adequate amount of milk and was always meager and feeble. At age four, her mother had taken her to the traditional healer to have a small operation to “purify her body.” This operation was performed on her external genitals without anesthesia and she remembers having suffered from pain for several days. She never went to school like her brother as her mother had told her that her real job in life was to get married and bear children. At age 10, Mrs. I. suffered an acute bout of pain in her lower abdomen. She was taken to the local hospital where the young doctor who had just qualified performed an appendectomy operation on her. Unfortunately, due to the lack of proper equipment or proper sterilization, lack of antibiotics and her poor general health, an infection developed and she spent three weeks in the hospital until the wound healed and stopped oozing pus. She had no idea at that time that this may have caused permanent damage to her fallopian tubes and would affect her future fertility and future life. When she was 12 her parents announced to her that she would be married to a man who

Créons des familles • SPRING/PRINTEMPS 2014

Increasingly, Mrs. I. was verbally abused by her in-laws and she was sometimes told that she was “useless” as she could not bear any children.

was at least twice her age. Like all decent girls in her community she happily agreed and enjoyed moving to her in-laws’ primitive premises. Having had an important part of her body removed in childhood, she did not fully enjoy her intimate moments with her husband but, as instructed by her friends, she pretended to. Unfortunately, Mrs I. did not become pregnant and, after a few months, her mother-inlaw took her to the local doctor who provided some treatment, but she did not conceive. Her mother decided to resort once more to the traditional healer, who was said to have “magical powers” to get women pregnant, but this did not work either. Finally, the family collected enough money to take her to the local hospital in order to see a specialist who came from the nearby town once a week. An X-ray with dye showed that her fallopian tubes were blocked and that her only hope was to have a “test-tube baby” operation done. This could only be performed in a private centre. When she inquired about the price, she learned that the operation would cost the equivalent of her husband’s salary for a whole year. Falling into despair, she soon realized the painful truth. Her in-laws’ attitude toward her began to change and her husband neglected her more and more. As was the custom in their community, his mother and sister started to look for a second wife for him. Increasingly, Mrs. I. was verbally abused by her in-laws and she was sometimes told that she was “useless” as she could not bear any children. The abuse escalated with time and on one occasion, following an argument with her husband, he pushed her and she fell to the ground. When the new wife arrived, Mrs. I. was expected to be friendly with her, which she tried to be. When the newcomer became pregnant, she was expected to help her,

When the new wife arrived, Mrs. I. was expected to be friendly with her, which she tried to be. When the newcomer became pregnant, she was expected to help her, prepare the meals for the whole family and do all of the cleaning. Moreover, she was not allowed to eat with them and had to be content with the leftovers. SPRING/PRINTEMPS 2014 • Creating Families

from infertility worldwide, and the majority of them live in developing countries. The World Bank defines developing countries as countries where the gross national income (GNI) per capita is less than 4,086 US$ per year. The list includes over 100 countries that are mainly in Africa, Asia and Latin America. Another definition of the “Least Developed Countries” is that of the United Nations Development Programme (UNDP); it takes

prepare the meals for the whole family and do all of the cleaning. Moreover, she was not allowed to eat with them and had to be content with the leftovers. By the time the baby arrived, she had become the servant for the whole family and this seemed to be her only future. She became a second-class person in her own house. She could not ask for a divorce. A divorce would be difficult to attain, and in the male-dominated culture of her country a divorced woman is frowned upon. Even if she could get one, she could not afford to live on her own. She was poor, uneducated and unable to do any work. Since her parents had died recently, there was nowhere else for her to go. She was totally depressed and had thought many times of committing suicide, but was afraid of doing so as this was forbidden by her religion.

Créons des familles • SPRING/PRINTEMPS 2014

She spent the rest of her life in poverty and misery, and when she died nobody went to her funeral. According to the traditions of her community, she was thought to bring bad luck; any woman going to her funeral would be cursed and would never be able to conceive.

Infertility in developing countries – how many sufferers are out there? Mrs. I. is only one of many million infertile women living in developing countries whose needs for infertility treatment are unfulfilled. According to Professor Mahmoud Fathalla, the past President of the International Federation of Obstetrics and Gynecology (FIGO), more than 80 million couples suffer

When she died nobody went to her funeral. According to the traditions of her community, she was thought to bring bad luck; any woman going to her funeral would be cursed and would never be able to conceive.

into consideration other development criteria including lack of human resources and economic vulnerability. The UN list includes 50 countries of which 33 are in Africa.

As stated in a recent study by Jacky Boivin, a psychologist at the University of Cardiff in Wales and a World Health Organization (WHO) expert, about 9% of couples worldwide are infertile and on average only 56% of them seek treatment. However, prevalence rate varies considerably: it can be as high as 25% in some African communities and as low as 3 % in other Western communities. This variability depends on many factors including the incidence of sexually transmitted, infectious, and parasitic diseases, health care practices and policies as well as exposure to potentially toxic substances in the diet or environment. In fact, contrary to the situation in Western communities where many cases of infertility are due to ovulatory disorders, the most common cause of infertility in developing countries is infection. Heli Bathija, another WHO expert who has studied 10,000 infertile couples from 25 countries, claims that infertility results from pelvic infection in one third of cases worldwide, but in twothirds of cases in Africa. The most common infections leading to blockage of the fallopian tubes were Chlamydia, followed by gonorrhea and other sexually transmitted diseases. This confirms the results of an earlier WHO report published in 1991, which found that

Healing Infertility

infection was the cause of infertility in more than 60% of instances in sub-Saharan Africa, compared to less than 30% in developed countries. Infection is the leading cause of tubal blockage, and as IVF is now the established treatment for these cases, many infertile women in developing countries in need of this treatment may not be able to afford it or even find it.

Counselling Coun Cou nsssel n elllliing el ing and and Support Sup Supp po p orr t o

Mind t Body t Fertility Amira Posner, MSW MSW RSW RSW tel: (647) 224-6933 224-6933

www.healinginfertility.ca www.healinginfertility www .healinginfertility.ca .healinginfertility .ca INDIVIDUALS, COUPLES AND GROUPS

Consequences of infertility â&#x20AC;&#x201C; the unspoken-of tragedy So what if a woman cannot bear children, some people may say? She can still lead a good, productive life and plan for a decent future. But this, as many of us know, is as far from the truth as we can get. The price infertile women have to pay applies everywhere, but even more so in developing countries. Being an infertile woman in a developing country is, all too often, nothing short of a tragedy. To start with, it carries a social stigma and in many of these communities, which equate womanhood with fertility, an infertile woman is marginalized, ostracized and made to feel useless to her family and the whole community. This of course leads to unhappiness, withdrawal from the community and psychological stress. Depression may ensue. Many of these infertile women think of committing suicide and some of them do. I

SPRING/PRINTEMPS 2014 â&#x20AC;˘ Creating Families

More than 80 million couples suffer from infertility worldwide, and the majority of them live in developing countries. have personally encountered a number of these cases and some of them had to be institutionalized. Once the husband and his family realize that the woman is infertile and that her treatment may be unachievable, marital and sexual problems start to surface. In communities where the extended family networks are important the infertile woman increasingly feels the pressure not only from her husband but from her in-laws as well. Her husband may neglect her or abuse her verbally or even physically. A study conducted by Dr. Ameh, a professor at the University of Ahmadu Bello in Zaria, Nigeria, shows that more than 40 percent of the infertile women included in the research had experienced domestic violence at some point in their marriage. This varied from psychological torture (51%), to verbal abuse (39%), being ridiculed (27%), physical abuse (17%) and deprivation (6%). The

husband was the person who abused the woman in 48% of the instances while the female in-laws were the perpetrators in 32% of the instances. Finally, the husband may opt to divorce his wife, and this may be on the advice of his family who may start looking for another wife. This may happen despite the fact that the man may himself be the infertile partner. Divorce is not an easy matter for women in developing countries. A divorced woman is unwelcome in many communities and she is always suspected of having committed something wrong. In many poor communities, she may not be able to go back to her father and mother. Her parents may be penniless and may have married her off for financial reasons, or may no longer be living. She may be uneducated and not able to enter the workforce to make a living. Moreover, she may have spent whatever money she had in order to seek medical help, as her husband may have refused to spend any money on “her problem.” In developing countries

Créons des familles • SPRING/PRINTEMPS 2014

where polygamy is still accepted and practiced infertile women may prefer to live with a second wife rather than be divorced. This may evolve into a situation where the infertile woman becomes the servant for the whole family, particularly when the second wife becomes pregnant. The infertile woman becomes responsible for cooking, cleaning and taking up all the household duties, while the new fertile wife becomes the darling of the house whose main or only job is to raise her children. This tragic situation may go on for a long time and in some communities the infertile woman may be deprived of any inheritance when the husband dies. When she passes away, people may not go to her funeral, as in some sub-Saharan communities she is considered to bring bad luck and must be avoided, even after death.

Too little, too costly – Current fertility services in developing countries Many of these problems could of course be avoided with better education, but also if infertile women had access to proper treatment for their fertility problems. In many developing countries, infertility services do not exist in the first place and, if they do, the personnel may not be trained to provide them. Services may only be available in distant communities and patients may not be

able to travel for long distances. Superstition may also play a role. For example, some patients in developing countries may believe that infertility is a curse from God because of some wrongdoing in the past – so they just accept their fate and refuse to go to the doctor. Some may believe that traditional healers are better than doctors and some again refuse to seek medical advice because their relatives or neighbors did not achieve a pregnancy in spite of going to the doctor. Some infertility services are available in developing countries but mostly in private practice settings, which are far beyond the reach of most citizens. As mentioned earlier, this is because many infertile women in developing countries have blocked tubes and need IVF treatment. According to Professor Frank Giwa-Osagie, a gynecologist-obstetrician from the University of Lagos in Nigeria, by 2010 very few IVF centers existed in sub-Saharan Africa. Even in Nigeria, which has the largest population in Africa (more than 150 million inhabitants), there were only 21 centers, performing 3,000 IVF cycles per year. The European Society for Human Reproduction and Embryology (ESHRE) has estimated the optimal need for IVF to be 1,500 cycles per million inhabitants. This means that in Nigeria, with 20 cycles per million performed every year, less than 2% of the needs are met.

Reproductive rights and reproductive wrongs Poverty of course is the main reason why patients in developing countries may not have access to treatments, even if they exist. Poor governments in developing countries spend very little on health services. The public share of the total health expenditure is only 29% in developing countries compared to 65% in high income countries. This means that infertile couples in most developing countries have to self-fund their treatment and cannot depend on any governmental support. In many developing countries, governments are

reluctant to provide infertility services claiming that “infertility is not a disease,” that “infertility is not a serious disease,” that “infertility treatment is not effective,” that “infertility treatment is expensive” or simply asking how the treatment of infertility can be a priority in an overpopulated country. This is the wrong argument and the wrong approach. According to the constitution of the World Health Organization (WHO) health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. This definition was drafted in the preamble to the Constitution of the WHO, adopted by the International Health Conference held in New York between the 19th and the 22nd of June, 1946, signed on 22nd of July, 1946 by the representatives of 61 states and entered into force on the 7th of April, 1948. Since then, nearly all countries which are members of the United Nations have signed and ratified the WHO constitution. More importantly, countries and governments should know that reproductive rights are human rights. According to Professor Mahmoud Fathalla, the past president of FIGO who coined the term, “reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. They also include the right of all to make decisions concerning reproduction free of discrimination, coercion and violence." The term was first suggested in the 1968 Teheran Proclamation announced during the International Conference on Human Rights and was later affirmed during the 1994 Cairo International Conference on Population and Development (ICPD) and in 1995 during the Beijing Fourth World Conference on Women. It is now part of human rights conventions and should be respected by all governments, who are responsible for providing

Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. They also include the right of all to make decisions concerning reproduction free of discrimination, coercion and violence. SPRING/PRINTEMPS 2014 • Creating Families

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Photo: Janice Hansell

family planning services as well as infertility treatment to all of their citizens.

A candle of hope - Some light at the end of the tunnel But at least somebody is caring. In 2008, a group of infertility specialists met in Arusha, a small town at the foot of the Kilimanjaro volcano in Tanzania, with the aim of bringing the technology to patients in need of fertility services at affordable costs in developing countries. The group is headed by Willem Ombelet, an infertility specialist and a professor at the University of Genk in Belgium, who spent part of his youth working in Africa. The group recognized that developing countries differ in their needs as some countries have no fertility services at all and, to start with, need simple facilities to provide essential services such as ovulation induction and artificial insemination. A second group of countries do offer these essential services but need to establish IVF procedures as well as basic diagnostic endoscopy. A third group of countries may provide some IVF services and may need to upgrade their capabilities by offering ICSI (intra-cytoplasmic sperm injection) as a treatment for male infertility as well as more advanced operative endoscopy procedures. The group evolved into the ESHRE Task Force for Infertility in Developing Countries in collaboration with the Walking Egg charity. In order to simplify the laboratory stages

of IVF, Ombelet collaborated with Professor Jonathan van Blerkom, an infertility scientist from Boulder, Colorado and a world expert on IVF techniques. In July of 2013, the group announced in London, England, during ESHRE’s annual meeting, the introduction of a novel kit which cuts down the cost of the laboratory component of IVF from about 1500 to 200 euros by eliminating the use of the expensive CO2 incubators. More than eight healthy babies have been born in Belgium using this new method. The work is progressing, and pilot studies will soon be underway in Egypt and South Africa to confirm that the simple technique can work as successfully there as it did in Belgium. The group is also conducting research on “mild stimulation protocols” whereby patients are given smaller doses of affordable drugs to stimulate the ovaries, and on methods to simplify the follow-up of patients using less expensive ultrasound and laboratory procedures. Future plans entail the establishment of pilot centers associated with government or university bodies in four or five developing countries before extending the program to more countries. The plan also includes training doctors, nurses, embryologists and laboratory technicians, helping them during the first phase of operation and establishing a troubleshooting program to help the centers from then on. The Arusha group is also working hand in hand with biology scientists, clinicians, social scientists and ethicists from

Western Europe and North America, as well as their colleagues in developing countries. The objective is to develop a holistic approach to the problem of infertility in developing countries without neglecting its social, psychological and economical aspects, all the while respecting local customs and traditions. The task is not easy as funding is always the problem. Philanthropists are always quick to donate money for causes such as cancer and AIDS where the problem and its resulting misery are obvious to all. However, with causes like infertility in developing countries, where the misery is hidden and the victims suffer in silence, it is much more difficult to convince philanthropists or granting agencies to donate money or equipment. However, an ever-increasing number of people are joining the cause and are now aware of the tragedy of the likes of Mrs. I. It is hoped that these efforts will continue with the aim of bringing happiness to the millions of couples who until now have been suffering in silence in many developing countries. Let’s work together so that one day other women may not share the terrible fate of Mrs. I. About the Author Dr. Hassan N. Sallam, MD, FRCOG, PhD (London) is a Professor in Obstetrics and Gynaecology at the University of Alexandria in Egypt, as well as Clinical and Scientific Director of the Alexandria Fertility and Assisted Reproduction Centre.

SPRING/PRINTEMPS 2014 • Creating Families

My Story My Emotional Journey Through Infertility by Sarah Koval

Wake up at 5:00 a.m.

A technician performs my vaginal ultrasound.

Rush downtown to be at the clinic just as the doors are opening (any later and my wait time would be multiplied).

Go back to waiting room #2 and wait for my name to be called.

Sign my name on three clipboards and then wait in waiting room #1 for my name to be called.

The doctor reviews my chart and updates me on my progress.

A nurse takes my blood. Move to waiting room #2 and wait for my name to be called.

A nurse reviews my medication and gives me my injection in the butt (she tries to maneuver

Créons des familles • SPRING/PRINTEMPS 2014

Rush to work and sneak over to my desk quietly, hoping my colleagues don’t notice that I’m late for the third time this week. Lather. Rinse. Repeat.

Go back to waiting room #2 and wait for my name to be called.

around the sore black and blue welts from the previous day’s injection).

This was my life as an infertility patient.

The news of our diagnosis and its repercussions hit me like a ton of bricks. I wasn’t prepared for this kind of news. IVF is how old people have kids. Isn’t it? It’s for women who wait too long while they’re

painful diagnostic tests. She told us that we would probably never be able to have a baby on our own. She said that we should try some less invasive treatments first but that at the end of the day, if we were to ever get pregnant, it would probably be through in-vitro fertilization (IVF). The news of our diagnosis and its repercussions hit me like a ton of bricks. I wasn’t prepared for this kind of news. IVF is how old people have kids. Isn’t it? It’s for women who wait too long while they’re busy pursuing their careers and then change their minds and realize they want kids after all. Isn’t it? We were young. We did everything right. This wasn’t supposed to be our fate. So many questions ran through my mind. What if IVF failed? There were certainly no guarantees. Were we prepared to

adopt? Could we live child-free? I made my way to work after the appointment and somehow made it through the day. I’m not sure how exactly. I think I was still in shock. I came home that day, locked myself in the bathroom and cried harder than I’d ever cried before. I sobbed with the realization that I may never have a baby. I may never have someone to call me “Mommy”. I may never see my husband as a Daddy. I was mourning for the life I was terrified I would never have. The year that followed was a blur of doctor’s appointments, diagnostic tests, pills, blood tests, needles, injections, hormones,

busy pursuing their careers and then change their minds and realize they want kids after all. Isn’t it? Until that time, my life had moved along as planned. I studied hard and got good grades. I got a great first job. I married a wonderful man who made me happy. I went back to school and got my MBA. I got another great job. My husband finished medical school and was in his second year of residency. We were mature, educated and financially stable. We were finally ready to start a family. Little did we know that having a baby was not something we would be able to plan.

I’ll never forget the day that we met with our fertility doctor after a slew of invasive and Sarah Koval with her hushand Joe and their daughter Mia.

SPRING/PRINTEMPS 2014 • Creating Families

It was hard not to feel jealous. I stopped going to baby celebrations. I stopped going to synagogue where there were babies and pregnant women everywhere. Seeing babies was a painful reminder of the life I thought I may never have. suppositories, speculums, vaginal ultrasounds, sperm tests, painful procedures, operations, bloating, flu-like symptoms, headaches, weight gain and exhaustion. Month after month, I went through the same vicious cycle; the same physical and emotional rollercoaster. I would go through another painful round of procedures and tests, endure all of the side effects that go along with the hormones I was injecting, and get my hopes up until I received the same call from the nurses at the clinic with my pregnancy test results. No, I was not pregnant. The treatment failed yet again. Would I like to try again next

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month? Yes, I guess I would. Hope is a powerful drug.

And so we continued to try. The longer it went on for, the more hopeless I became. The more depressed I became and the more I retreated into my own cocoon. I distanced myself from most of my friends because most of them either had babies or were pregnant. It was hard not to feel jealous. I stopped going to baby celebrations. I stopped going to synagogue where there were babies and pregnant women everywhere. Seeing babies was a

painful reminder of the life I thought I may never have. I started making up excuses as to why I couldn’t attend this event or that event – even places where I thought I might encounter the talk of babies or pregnancy were off limits. The mere mention of babies felt like a physical blow to the gut.

All the more so, hearing young moms complain about their children’s behaviour, their lack of sleep, their inability to go out at night anymore, etc. – was enough to make me want to scream. I couldn’t stand hearing comments

The moment I saw that second pink line, I rushed to call my husband and as soon as he picked up I burst into tears and immediately started hyperventilating while forcing out the words, “There are two lines! There are two lines! I think I might be pregnant.” like, “You’re so lucky you don’t have kids, you still have your freedom!” To me, these seemingly innocuous comments felt like the cruelest words anyone could ever utter and it

took all my strength not to burst into tears when I heard them. And so I avoided them altogether. While I used to live for the weekends, I now couldn’t wait to get to the office on Monday morning. Work was my escape from all things baby - a place where I could leave the world of infertility behind; where I was judged by my performance and not by my inability to procreate.

Helping to build families across acr oss Canada C anada and beyond. Extensive experience experience in surrogacy, surrogacy ogacy,, legal parentage, parentage, and egg, sperm and embryo dona donation. tion.

Sara Sara R. C Cohen, ohen, lawyer TTel/Fax: el/Fax: 416.907.2189 sar a@fertilitylawcanada.com sara@fertilitylawcanada.com www .fertilitylawcanada.com www.fertilitylawcanada.com

The day I finally found out I was pregnant (1 year and 8 months, 2 fertility clinics, 5 intrauterine insemination procedures, 2 IVF operations and $50,000 later) I was in absolute shock. Even though they advise against it, I took an at-home pregnancy test. The moment I saw that second pink line, I rushed to call my husband and as soon as he picked up I burst into tears and immediately started hyperventilating while forcing out the words, “There are two lines! There are two lines! I think I might be pregnant.” That moment of pure joy - that will be forever etched in my memory - was second only to the actual birth of my daughter.

And now, one year later, as I look down at my beautiful baby girl and watch her smile up at me and laugh her adorable little laugh, I know that I would do it all over again in a heartbeat.

SPRING/PRINTEMPS 2014 • Creating Families

Adoption Corner

Adoption in Ontario What You Can Do to be Prepared A Frustrating Story by David Nash, Partner with McKenzie Lake Lawyers LLP

There is no easy way to adopt. Most people start with the idea that they will try and find a child through the Internet or through friends, and then will they consider beginning the adoption process. They have it backwards. Being prepared means that you have gone through the necessary programs and had a very thorough home study completed.

CrĂŠons des familles â&#x20AC;˘ SPRING/PRINTEMPS 2014

A couple contacted us one day to indicate that they had identified an adoption opportunity through the Internet. They had exchanged online with a birth mother for a number of months. She was due anytime now and they were convinced that she was going to place her child for adoption with them. In our discussion we asked them about their home study and they gave us a blank look. We indicated that a home study as well as government approval were required prior to placement. We also pointed out that not every child is suitable for adoption placement with every couple; there has to be an appropriate match. The best interest of the child

has to be taken into account. The first reaction from the couple was frustration. They were a wonderful couple, they had a solid marriage, they wanted to parent a child or children and why should they be denied the opportunity they had developed? The fact is, had they done some preliminary research they would have realized very quickly that they had to be prepared to adopt, not only with respect to the background checks but with respect to counseling as well. Adoption is very special. We know a lot more today than we did years ago. Counseling does not involve someone sitting and lecturing you in a room and telling you how to parent a child, but is more based on a discussion of

Adoption Corner The first reaction from the couple was frustration. They were a wonderful couple, they had a solid marriage, they wanted to parent a child or children and why should they be denied the opportunity they had developed? your thoughts, your philosophy and how you will deal with certain circumstances in raising a child.

Prepare for the surprises Raising an adopted child is different from raising a biological child. The following are some examples of issues that may arise. You have to be prepared for the surprises.

Finally, the rights of the birth father as well as those of the birth mother must be taken into account. In meeting with this particular couple we asked about the birth father and they said that the birth mother didnâ&#x20AC;&#x2122;t want the birth father to be involved. When we explained that may not be her choice, they were surprised. A birth father may have rights depending on the circumstances. Sometimes a birth mother will say she doesnâ&#x20AC;&#x2122;t know who the birth father is simply to exclude him, but after a while we find out who the birth father is and we often have to include him. The child has a right to know. It is not appropriate for a birth mother to fail to disclose who the birth father is. That is what good counseling does: It prepares you so that you can anticipate many of the issues that can, and will, arise.

Health issues Finally, there are issues of health. The birth father and mother may have serious health issues which may be genetic, and the more information we get the better. The child may also be subject to serious problems as a result of the lifestyle of the birth parents.

Some prospective parents will indicate that they are willing to adopt a child regardless of the circumstances, thinking that that would be the natural unfolding of events if they were having the child themselves. This is not the case. If the couple qualifies for adoption they are likely not using drugs or abusing their bodies the way a birth couple may be. This type of naive approach is not fair to the child. The intended parents need counseling and need to be prepared. For the couple in question it was just too late. The child was born within a week and there was no way that we could get the application prepared in time for the child to be with them in any reasonable period of time. It was unfair for the child to be placed in a foster home for months on end while the adopters were getting their home study done and taking the counseling sessions. The lesson in all of this is: be prepared. If you really want to be considered for adoption then get your counseling completed, register for the programs that are necessary and have your home study completed. Once that is done, we can act on fairly short notice. Indeed, you may be investing in something that may never happen, but that is a risk you have to take.

Regardless of whether you say that you are going to treat the child as if the child had been born naturally to you, those around you, particularly relatives or friends may not do the same. It is not unusual for some family members to consider an adopted child to be different than children born naturally within the family. People are often surprised and disappointed with the way people react to an adopted child. The issue of how you tell a child about adoption, when you tell them and what you tell them is also very important.

SPRING/PRINTEMPS 2014 â&#x20AC;˘ Creating Families

Adoption Corner How much does it cost? Although each province has its own rules, some general principles apply. Many steps are involved in an adoption and the costs can vary. Private domestic adoption will usually cost approximately $15,000. International adoption costs range from $25,000 to $50,000.

Private Domestic Adoption

Disappointment Sometimes third parties call to indicate that there is an adoption opportunity because the birth mother is going to deliver within a few weeks and there is a recommendation with respect to an individual or a couple looking to adopt. We have to specify that nothing should be said at this time until we find out whether the individual or couple is ready to adopt. Often after having a general discussion about adoption with the prospective parent(s) we find that in fact they have not even begun the process because they didn’t feel they wanted to invest the money until they had a sure thing. There is no such thing as a sure thing. In these circumstances we certainly don’t tell the individual or couple that they have missed out on an opportunity, but we reiterate the fact that they need to be prepared. This kind of scenario has happened on a number of occasions and it is very sad because the person who wanted to place the child had a specific situation in mind. The lesson in all of this is, again, to be prepared. We have to advise that there are very few placements and, as a result, very few children available for adoption for many reasons.

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It is not appropriate for a birth mother to fail to disclose who the birth father is. That is what good counseling does: It prepares you so that you can anticipate many of the issues that can, and will, arise. The odds of having a child placed with you are not great but the odds are zero if you are not prepared. There isn’t anything we can do about the availability of children for adoption. You can only control what is in your hands and that is your own preparedness. Go through the necessary steps, as early in the process as you possibly can.

Adoption requires a very detailed investigation and review by an adoption practitioner who will look into your background, your relationship with your spouse or intended coparenter (if applicable, your motivation to adopt and your ability to adopt.) The adoption practitioner also looks at the appropriateness of the match. Although birth parents tend to prefer that a couple adopts their child, a single person may also adopt. The choice is that of the birth parent(s) not of the lawyer. The birth parent(s) have a different adoption practitioner. Their adoption practitioner will spend time getting to know the birth

Adoption Corner Licensees and agencies are well trained to facilitate adoptions and to handle matters both prior to birth and right up until the finalization in court.

Key Steps in the Adoption Process There are three significant steps that occur prior to and following the birth of the child that the licensee or agency is responsible for: 1. A child can only be placed for adoption after the licensee or agency has received government approval for the placement.

parent(s), preparing a social history and providing significant counseling. In some provinces, such as Ontario, an adoption licensee or agency is required to oversee the adoption process. A licensee is usually a lawyer but can also be a specially trained

social worker. An adoption agency is licensed by the government. The licensee or agency coordinates the adoption activities and arranges for the adoption placement. They are responsible for the child during the adoption process.

2. Birth parent(s)' consent(s) can only be given after the child is seven days old and the consent(s) maybe withdrawn within twentyone days. 3. Following the placement of the child in the home, the adoption practitioner visits the family and prepares a report on the adjustment of the child which is then forwarded to

SPRING/PRINTEMPS 2014 â&#x20AC;˘ Creating Families

Adoption Corner the government for their final approval to finalize the adoption in court. The birth parent(s) adoption practitioner continues to counsel the birth parent(s).

Examples of Issues Relative to the Court Process A court application is required to complete the adoption. In many cases the consent of one or both birth parents is not available. An application has to be made to deal with the absence of consent. The application to the court aims at dispensing with the consent of a birth parent. If the child is of aboriginal heritage then the Responsibility for Costs Regardless of pertinent Band has to be notified in advance the Outcome of the placement, as the child may have significant aboriginal rights that need to be proThe adopting applicants are responsible for tected. The Band may choose to intervene costs regardless of the outcome. In situations ,9)BDQQ&) /D\RXW $0 3DJH and this has to be anticipated. where birth parents change their mind prior

to placement or within the timeframe allowed to withdraw consent after placement, the applicants are responsible for all of the costs including legal costs. The costs include the fees of both adoption practitioners for providing counseling services. As a result, there are

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Adoption Corner The adopting applicants are responsible for costs regardless of the outcome. In situations where birth parents change their mind prior to placement or within the timeframe allowed to withdraw consent after placement, the applicants are responsible for all of the costs including legal costs. significant expenses associated with adoption and it is very important to understand those costs before you become involved. There should be a very thorough budget prepared outlining the various costs and risks associated

with the adoption so that you know exactly what you are getting into.

International Adoption Costs Many of the issues outlined above apply to international adoptions, but these involve more risks and procedures. For this reason the costs for international adoptions are higher. You first have to deal with the province where you live. That may require provincial government approval for placement, even before you go overseas. It should be remembered that the finalization of the adoption usually takes place in the province where you live, and it is rare that the adoption is finalized in the country were the child is born. However, there are still legal and administrative costs which must be

met in the country where the child was born. Finally, there are significant travel costs associated with adoption. You may have to spend weeks in the country in which you are adopting before the child is placed with you. There are inherent risks associated with international adoption and you need to be able to manage expectations. You want to get as much information upfront as possible. Each case is different and it is rare that adoptions follow exactly the same path. As someone said, “Adoption was a bumpy ride, very bumpy, but gosh was it worth the fight.” About the Author David Nash has been an adoption practitioner since 1976. He has been licensed in Ontario since the license system was implemented in the 1980s. He primarily deals in private domestic adoptions in the province of Ontario although occasionally has handled adoptions from other provinces and internationally. David is one of the few licensees in southern Ontario and the work that is involved for adoptions is outside the scope of practice of Family Lawyers. While David’s practice is varied, adoptions are the area that gives him the most satisfaction.

SPRING/PRINTEMPS 2014 • Creating Families

Patient’s Perspective

Parenting After Infertility

I don’t know why, but by Charmaine Graham

I was always aware of this imbalance between how I was

Parenting. For so long I wanted nothing more than to be a parent. I wanted to snuggle a newborn, feed them, love them, raise them, teach them. I was going to be a wonderful mother. And I was going to have FIVE children.

parented and how I

Part of my desire to be a great parent came from having experienced a rather challenging childhood myself. Due to my parents’ general financial and marital struggles, combined with alcohol issues, I spent quite a few of my formative years in survival mode. So while I did have loving parents, I don’t think they always provided the brand of role modeling most children need that will give them

about wanting to

Créons des familles • SPRING/PRINTEMPS 2014

wanted to parent my own kids. I was always very clear offer my child a better kind of parenting than what my parents were able to offer me.

the basic foundations for how to be a successful parent later on in their own lives. I don’t know why, but I was always aware of this imbalance between how I was parented and how I wanted to parent my own kids. I was always very clear about wanting to offer my child a better kind of parenting than what my parents were able to offer me. Every day of my childhood experience, I watched and listened all with one simple goal, one clear focus: to get out of the small town where I lived and make a better life for myself. That I did accomplish, quite successfully. After moving out of my parents’ homes (they were divorced, so I had multiple residences in my life), I went to university and met the man I would marry. I also made a very important friend, a woman named Mona. Mona had experienced a challenging upbringing as well, but she had made some great life choices and was a married woman and new mother when I met her. I found

Patient’s Perspective Mona fascinating and funny, and she became one of my closest friends. Mona was this self-confident, capable, strongwilled woman who balanced her absolute sense of clarity with a loving and compassionate approach to relationships. If you were hurt, she was there. If you were confused, she was there. If you wanted to laugh, she was there. Yet Mona was not just a great friend; she became a mentor to me as I watched her parent her son Charlie. Mona treated, approached and loved Charlie with the deepest sweetness I had ever witnessed in a mother. And as the years progressed, I watched her son turn into the poster child for wonderful. Over the years, I never turned a blind eye to Mona’s parenting. I was always collecting information from her, witnessing what I wanted to emulate, asking endless questions about her mothering techniques, querying her perspectives on different disciplines, and was

fascinated by her opinions on child psychology. To Mona, no child was ever bad, and you could never love them enough. To Mona, what might seem like a problem to others was just another opportunity to bond with and love a little human being. She was clearly an absolute natural at motherhood, and SHE was MY role model. I learned more from Mona about parenting than I learned from any other human being in my life. Period. Five years down the road, when my husband and I decided to have a child, it was a very exciting time for me. I felt I had made a good life, found a strong and faithful man to marry, built a great home, and had confidence in my ability to parent a child. But then I found out I was infertile, and my plans were completely derailed. I fought with determination for the next four years to have a child via IVF, and during this time, I now realize that my ideas of my parenting became rather black and white …

rather bitter, actually. I found myself feeling angry at any woman who wanted even a minute away from her child (how dare she not value what she had!). I wanted to berate any parent who found themselves frustrated with their child at any given time, even if the child had no idea (how could they not see what they had, which I had been denied?). I hated young parents, single parents, any parents, in fact. I was angry, and the anger was massive. I knew, I just KNEW, that when I had MY child I would not only be a great parent; I would be PERFECT and I would be HAPPY ever single minute of the day. What I didn’t realize then was that, when it comes to parenting, that level of perfection is not authentically attainable. Things started to shift the day one of my infertile friends, Maggie, finally had her first child. I went to see her at the hospital and I was shocked at what I found. My friend, who had so desperately wanted a baby and had finally become pregnant through IVF, was

To Mona, no child was ever bad, and you could never love them enough. To Mona, what might seem like a problem to others was just another opportunity to bond with and love a little human being. She was clearly an absolute natural at motherhood, and SHE was MY role model.

SPRING/PRINTEMPS 2014 • Creating Families

Patient’s Perspective sobbing in her hospital bed. The birth had been difficult, and her family members got to hold the baby before she did. She was in pain, exhausted, suffering, and she was sorely disappointed that her experience of childbirth was NOTHING like what she had expected. This revelation set me back and made me think: My friend had the same “infertile” perspective as I did in terms of how perfect it would be when she finally had her baby. How could she possibly experience anything other than the thrill of this glorious birth? Maybe, just maybe, we were wrong. Were we?

Five months later, another one of our infertile friends, Tammy, who had mortgaged her home to have one chance at IVF, had her baby. Since she lived too far away for me to visit, I phoned her and asked, “How’s it going, honey?”

She replied, “So wonderful. He’s perfect. I love him. It’s wonderful being a mother!”

I said, “You know, our other friend, Maggie, says it’s hard and exhausting. Isn’t it that way for you?”

I knew, I just KNEW, that when I had MY child I would not only be a great parent; I would be PERFECT and I would be HAPPY ever single minute of the day. What I didn’t realize then was that, when it comes to parenting, that level of perfection is not authentically attainable.

Tammy started sobbing. Apparently, it really was hard, exhausting, challenging and complicated. Apparently, just like Maggie, Tammy felt unable to have that picture postcard parenting experience we were all so absolutely sure we would have. I remember taking a deep breath and saying to Tammy, “You know, we are so different from other women because we can’t just go ahead and have a baby simply because we choose to. We are ostracized from our friends, we feel left out and hurt, we experience great pain. We just so want to be them. And now that you have a baby, isn’t it time you get to be just like them? Tired and overwhelmed?” It was then that it hit me: As infertile women, we raise our expectations of ourselves so high due to our loss and grief, and when we don’t have a child, we comfort ourselves by vowing

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Patient’s Perspective I accepted that I was allowed to be like every other mom out there. I was tired, irritated at times, and I felt a sense of loss at my own personal identity changing so drastically from “me” to “we,” even though I thought that four years of infertility had prepared me for it. that when we do, we will be better than all the other mothers out there. But maybe, just maybe, it’s important to realize that real life, real parenting is hard. Period. And after being denied the experience of motherhood for so long, when it finally arrives, don’t we deserve the right to just be exactly like every other new mother out there? It would be another year after that before I had my son. And when he came along, while

I understood and accepted that it wouldn’t be perfect, I was still in heaven. He was beautiful, delightful. He slept and ate well, but man, he was a handful! And having a baby wake me up every morning at 5 a.m. and having to hit the ground running was difficult. Being at home with a baby, not being able to just go out for a hike with my dogs when I felt like it, arranging everything around sleeping and feeding schedules – well, it was a big adjustment. And, quite quickly, I

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accepted that I was allowed to be like every other mom out there. I was tired, irritated at times, and I felt a sense of loss at my own personal identity changing so drastically from “me” to “we,” even though I thought that four years of infertility had prepared me for it. Some nights my husband would come home, and all I could see was another set of needy eyes looking for attention. I wanted to run errands without hauling around a bag full of diapers and bottles and a 30-pound car seat. But gradually I adjusted, and soon after, a daughter entered my life. Now I had two babies under two, and life was NUTS. It was nuts enough for me to realize that there was no way on God’s green earth I could ever manage five babies. Two was my limit! I adjusted, as does everyone else, and I learned to permit myself an occasional break from my children. I knew it was okay to say, “No, Mommy needs some quiet time right now” or to encourage self-play or let them work

02/08/2013 1:44:38 PM

SPRING/PRINTEMPS 2014 • Creating Families

everyone else. It’s your turn!”

through some tears. I think, in the end, I became a pretty balanced mom. Like the mom I saw in my friend Mona – though she was a pretty damn hard act to follow! In the infertility support group that I coordinate, a couple of the women have become pregnant. They are disappearing from the group. They say their absence is because they don’t want to make the other ladies uncomfortable, but I remind them that, to some degree, it’s different when infertile friends become pregnant. Yes, they are still pregnant, but they are still infertile. I am now coming to realize that perhaps it is as simple as them wanting to meld into our mainstream society, to be just another one of those “normal” pregnant women. I think that’s a positive thing. I think to myself, “Go. Be like

Créons des familles • SPRING/PRINTEMPS 2014

As for myself, I can honestly say that I feel like a “normal” mom now. I have two kids, a boy and a girl. I adopted them at birth through private, domestic adoptions. I had my babies. I am raising my babies. Some days are incredibly awesome, and other days they make me want to tear my hair out and bang my head against a wall. I allow myself these frustrations and blips, and I don't expect perfection from myself. I am also a very good, loving and wonderful mother and I think these little moments merely go to show my children that I am human too. These moments show my children how I cope with life, and provide a successful, positive and realistic example of parenting. I can tell you this though: Even during the times I allow myself a moment of frustration or irritation, I am STILL caught by the magnitude of my love for these two human beings. I am completely fascinated by their presence in my life. I still look at them every day for the miracle they are. I am surprised they are my responsibility to love and care for in this life. I am honoured that the universe fit us together through a million different serendipitous events. And I do believe that I go through this daily ritual of thanks more so than other moms who didn’t have to struggle quite as hard to have their babies. In fact, I know in my heart that my experience and path has lead me to a place where I am ALWAYS aware of how precious, amazing

and fascinating my children are. Yes, I am now a real mother with real frustrations, and I make real mistakes, but I love my children more than reality can ever know. I. LOVE. THEM. COMPLETELY. About the Author Charmaine Graham lives in Komoka, Ontario, with her husband Jim and their two domestically adopted children, Macarthur and Madeline. In 2005 Charmaine founded AdoptionProfiles.ca. Charmaine spends her extra time volunteering at the local family shelters, volunteering for multiple dog rescues, and is on the working board for the Children’s Health Foundation and the Graham Family EcoPark. Moved by her compassion towards people who are suffering under the various issues that accompany infertility, Charmaine coordinates infertility support groups and speaks on the subject of adoption in order to help people in Canada and the United States work towards realizing their dreams of parenting. She is always available if anyone suffering from infertility needs a listening ear. She can be reached at info@adoptionprofiles.ca.

La communauté LGBT

LES FEMMES LBQ et L’IN/FERTILITÉ by RACHEL EPSTEIN

« Nous entrons dans la clinique neuf fois sur 10 en imaginant simplement que nous avons besoin d’un peu d’aide pour l’insémination – et nous sommes traitées d’emblée comme si nous avions des problèmes de fertilité… Ce sera le cas pour certaines d’entre nous, mais nos besoins sont néanmoins différents. » - Dahlia Riback, animatrice de Still Trying La chronique de ce numéro se penche sur les expériences et préoccupations particulières des femmes cisgenres (non trans) lesbiennes, bisexuelles et queer (LBQ – ou queer, pour abréger) au cours de leurs périples de fertilité, et d’infertilité. Cet article porte spécifiquement sur celles qui choisissent la grossesse comme voie vers la parentalité.

Un chemin complexe vers la parentalité Bien que certaines femmes LBQ puissent devenir enceintes par suite de relations sexuelles hétérosexuelles, ce n’est pas le chemin qu’empruntent la majorité de celles qui envisagent la grossesse. Et même si plusieurs ont parfois un accès direct au sperme, par exemple celles qui ont pour partenaire une femme trans ou sont le coparent d’une femme trans, la plupart n’ont pas facilement accès au sperme. Planifier une grossesse peut impliquer énormément de temps, d’énergie, de réflexion et, souvent, de dépenses. Une participante à l’étude Creating Our Families (Créer nos familles, voir l’encadré ci-dessous) voit la situation dans ces termes : « Quand nous examinions les options pour fonder une famille, toutes

Créons des familles • SPRING/PRINTEMPS 2014

impliquaient une logistique complexe. Nous nous disions : « Wow ! Je savais que ça représentait du travail, mais je ne savais pas que ce serait difficile à ce point. Nous avons appelé ça le Projet Grossesse. C’était comme un emploi à temps partiel. Un jour, nous avons toutes les deux pris un congé maladie et nous avons passé la journée à faire des recherches et des appels téléphoniques, et à soupeser toutes les options qui s’offraient à nous. » La décision la plus complexe à laquelle sont confrontées les femmes queers qui planifient une grossesse tient au choix d’un donneur de sperme. Dans un premier temps, elles doivent Les citations dans cette chronique viennent toutes de participantes à notre projet de recherche Creating Our Families (COF). Le projet COF, subventionné par l’IRSC, était un partenariat entre le Centre for Addiction and Mental Health, le Sherbourne Health Centre, l’Hôpital St. Michael’s et l’Université York de Toronto. Dans le cadre de cette étude pilote, 66 personnes LGBTQ de tous les coins de l’Ontario ont été interviewées au sujet de leurs expériences avec les cliniques de fertilité. Pour plus d’informations sur l’étude ou pour télécharger les ressources bilingues issues du projet, visitez : www.lgbtqparentingnetwork.ca/resources.cfm Le projet a aussi donné lieu à une pièce de théâtre interactive (voir la chronique LGBTQ dans Créons des familles, Hiver 2012-2013) dont une vidéo sera bientôt présentée dans les cliniques de fertilité et autres services de procréation médicalement assistée. Pour plus de renseignements, ou pour soutenir le projet, veuillez envoyer un courriel à : parentingnetwork@sherbourne.on.ca.

La communauté LGBT Avant même de tenter de devenir enceintes, la plupart des femmes LBQ doivent passer beaucoup de temps à chercher de l’information, à explorer les options qui s’offrent à elles et à prendre des décisions compliquées. choisir un donneur d’une banque de sperme ou un donneur connu du(des) parent(s) d’intention. Si une femme opte pour la banque de sperme, elle doit choisir entre un donneur complètement anonyme et un donneur dit à identité ouverte – ce qui signifie que l’enfant aura accès aux renseignements personnels du donneur quand il ou elle aura 18 ans. Opter pour un donneur connu implique une autre série de choix et de négociations. Chacune de ces options suppose plusieurs problèmes différents et complexes dont les détails dépassent le cadre de cette chronique (mais pourraient être le sujet d’une chronique future !) Ce qui est vraiment significatif du point de vue de l’« infertilité » est le fait qu’avant même de tenter de devenir enceintes, la plupart des femmes LBQ doivent passer beaucoup de temps à chercher de l’information, à explorer les options qui s’offrent à elles et à prendre des décisions compliquées.

Une frontière floue entre « fertilité » et « infertilité » Selon la décision que nous prenons quant aux donneurs de sperme, nous pouvons choisir l’insémination à la maison (le plus souvent avec une seringue – et non pas avec la légendaire poire à jus) ou une référence à une clinique de fertilité. Nombre de femmes préféreraient procéder à la maison, mais aboutissent dans des cliniques à cause de leurs choix touchant la source de sperme ou parce qu’elles veulent se prévaloir de certains services et technologies disponibles en clinique,

par exemple le monitoring de leur cycle ou divers types de tests. Pour celles d’entre nous qui choisissent les cliniques de fertilité comme la première étape de leur périple, il y a plusieurs conséquences : parce que nous entrons dans un système conçu pour desservir les couples hétérosexuels et cisgenres aux prises avec l’infertilité, il y a souvent une frontière floue dans nos traitements entre « fertilité » et « infertilité ». « Ne pas avoir accès à du sperme et éprouver des difficultés lorsqu’on tente de devenir enceinte avec du sperme sont deux choses vraiment différentes… Je pense que l’idée qu’être « queer » – lesbienne, par exemple – constitue en soi un problème de fertilité est ridicule. Je pense simplement que [les services de PMA] ont besoin d’être entièrement repensés afin d’avoir du sens pour les gens qui les utilisent. » – Femme queer célibataire d’une petite ville qui a eu un enfant sans PMA

Lorsque nous pénétrons dans une clinique, nous nous heurtons à des formulaires d’inscription et de consentement et à un langage qui ne nous convient pas, ainsi qu’à des présomptions inexactes au sujet de nos identités de sexe/genre et de nos configurations familiales. Il en résulte une expérience fréquemment aliénante, et parfois blessante et frustrante1. Et parce que nous avons souvent consacré des mois, voire des années, aux recherches et à la planification, au moment où nous arrivons à la clinique ou commençons l’insémination à la maison, il se peut que nous nous sentions déjà épuisées et impatientes à l’égard du processus. Plusieurs personnes estiment que l’environnement de la clinique est en soi une source de stress :

Alors que de nombreuses femmes queers deviennent enceintes à la maison ou dans une clinique sans avoir besoin de recourir à un « traitement de fertilité », certaines femmes queers connaissent réellement des problèmes de fertilité. La question qui se pose est : comment leur expérience diffère-t-elle de celle des femmes ou des couples hétérosexuels ? La première réponse est : elle est semblable. L’infertilité et la perte d’une grossesse ou d’un bébé sont douloureuses, peu importe qui on est : « À plusieurs égards l’orientation sexuelle semble presque sans importance quand on est aux prises avec des problèmes de fertilité…parce que c’est cela qui devient le centre de nos préoccupations. » Par ailleurs, nos identités, nos configurations familiales et nos parcours vers la parentalité signifient que notre expérience comporte des particularités bien réelles.

Détection précoce des problèmes Le bon côté de notre recours précoce aux cliniques de fertilité est que nous pouvons parfois détecter tôt des problèmes de fertilité. Par exemple, le couple ci-dessous a découvert que toutes les deux présentaient un trouble sérieux de la fertilité qui nécessitait un traitement :

« Je suis certaine que j’ai mis longtemps à devenir enceinte parce que mon niveau de stress a fait un bond... Se faire inséminer par quelqu’un qu’on ne connaît pas n’est pas exactement propice à la relaxation. Cet objet de métal qu’ils vous entrent dans le corps… l’ensemble de la procédure n’est pas confortable, pas vrai ? » SPRING/PRINTEMPS 2014 • Creating Families

La communauté LGBT l’impression qu’on s’occupe de lui.2 Le choix éclairé, en revanche, implique que les patients prennent pour eux-mêmes des décisions autonomes, basées sur l’accès à une information complète. Les femmes queers qui ont recours aux cliniques de fertilité, comme tous les patients du système de santé, veulent avoir la possibilité de faire des choix éclairés au sujet des tests et interventions médicales qu’elles subissent.

« Elle se disait au début : « Nous n’avons pas besoin d’un spécialiste en fertilité, ce n’est pas comme si nous étions infertiles, nous avons simplement besoin que quelqu’un nous aide à obtenir une grossesse... » Puis nous avons découvert que ma partenaire fait de l’endométriose… Puis [après la naissance du premier bébé] j’ai subi l’examen avec un produit de contraste et cela a été terriblement douloureux, et il a dit : « Vos trompes sont bloquées, le colorant ne passe tout simplement pas. » Dans ce cas, les deux femmes ont été traitées sans délai, et toutes les deux sont devenues enceintes.

Consentement éclairé et choix éclairé Une autre conséquence de notre recours précoce à des cliniques est que, souvent, des femmes qui n’ont pas de problème de fertilité connu sont soumises à des tests et à des interventions médicales conçus pour celles qui en ont. Les cliniques ont une gamme de pratiques en rapport avec les tests et interventions ; et les femmes queers qui sont leurs clientes ont une gamme de sentiments en rapport avec cette situation. Certaines clientes sont heureuses de subir les tests susceptibles de fournir tôt dans le processus des renseignements précieux sur des problèmes potentiels : « Alors nous avons été référées à une clinique de fertilité pour la surveillance de mon cycle, un

Créons des familles • SPRING/PRINTEMPS 2014

hystérosalpingogramme et un bilan sanguin. L’idée était de voir ce qui se passait avant d’entamer véritablement le processus, parce que je voulais savoir si j’avais la plomberie nécessaire. » D’autres ne voient aucune raison d’effectuer des tests invasifs sans motif, et elles sont frustrées par le temps supplémentaire, voire les dépenses, qu’ils exigent : « Ma philosophie était – s’il n’y a pas de problème, ne faites pas d’examens… Parce que ce sont des tests vraiment désagréables. » « … ensuite j’ai dû subir un test avec un produit de contraste pour voir si mes trompes étaient ouvertes, alors ils ont fait tous les tests de fertilité comme si j’avais un problème de fertilité. On n’a pas présumé que le problème de fertilité était simplement que nous n’avions pas de sperme… Je n’avais jamais imaginé qu’il faudrait six mois avant de procéder enfin à l’insémination. Le processus a été beaucoup plus technique que ce à quoi je m’attendais, et beaucoup plus coûteux. » Ce que soulignent ces diverses expériences est la valeur du « choix éclairé », manière de penser et paradigme qui diffèrent du « consentement éclairé ». Le consentement éclairé suppose que la patiente donne son accord à une procédure ou à une médication recommandée par une autre personne, habituellement quelqu’un en situation d’autorité, un expert en quelque sorte. Comme le dit Spaeth (2010) : « Le consentement sous-entend une relation basée sur le pouvoir… Il n’engendre pas la confiance et ne donne pas au patient

Les questions financières Le fait que la clinique de fertilité soit souvent notre point d’entrée signifie également que nous ne pouvons « essayer tranquillement à la maison » pendant quelque temps avant d’encourir les dépenses de temps et d’argent associées aux « traitements de fertilité ». Même si les coûts sont un obstacle, parfois prohibitif, pour tous ceux et celles qui utilisent les services des cliniques de fertilité, les individus queers assument fréquemment ces coûts dès le début. Cela signifie que nous n’avons pas toujours les moyens financiers d’essayer chaque mois, même si nous le souhaiterions. Il ne faut pas oublier que plusieurs d’entre nous n’ont qu’un seul revenu et que, en tant que femmes queers, nous sommes systématiquement désavantagées dans le monde du travail par rapport aux hommes (c’est-à-dire sans revenu masculin).

Soutien (ou absence de soutien) de la famille et des collègues Les personnes aux prises avec des problèmes de fertilité comptent habituellement sur le soutien à long terme de leur famille, ainsi que de leurs amis et collègues de travail. Évidemment, ceci est également le cas des individus LGBTQ, mais parfois nos familles ne sont pas solidaires de nos orientations sexuelles, de nos identités de genre, de nos configurations familiales ou de notre choix d’avoir des enfants. Ce manque de soutien peut être exacerbé douloureusement par le stress de l’infertilité. Une femme décrit ainsi la réaction initiale de la mère de sa partenaire à

La communauté LGBT Parce que nous entrons dans un système conçu pour desservir les couples hétérosexuels et cisgenres aux prises avec l’infertilité, il y a souvent une frontière floue dans nos traitements entre « fertilité » et « infertilité ». leur relation, puis à la nouvelle que sa fille est enceinte : « Sa mère était furieuse lorsqu’elle a découvert notre situation, vous savez ; elle ne m’a pas parlé pendant un certain temps et elle n’était vraiment pas sympathique… Elle [ma partenaire] a mis du temps à tomber enceinte [ à cause de problèmes de fertilité ] et nous ne leur avons pas parlé du processus pendant nos démarches, et quand nous l’avons fait ils n’ont pas pu accepter la situation… Nous avons téléphoné et il y a eu un silence à l’autre bout du fil, puis il y a eu des cris et des hurlements ; c’était vraiment horrible, je veux dire, absolument terrible. C’est vraiment malheureux. »

n’ont aucun désir de devenir enceintes. Pour plusieurs, cette idée va à l’encontre de leur identité de genre et/ou de leur expérience corporelle. Un couple interracial, qui en fin de compte s’est rendu aux États-Unis pour obtenir un donneur de sperme aux origines ethniques souhaitées, décrit la présomption par le personnel de la clinique que l’une ou l’autre des partenaires pouvait devenir enceinte, peu importe laquelle : « Ils ont dit : « Pourquoi [votre partenaire] n’essaie-t-elle pas de devenir enceinte à la place ? Ainsi vous pourrez utiliser un donneur blanc and cela ne sera pas un problème. » Pourtant, nous leur avions dit au départ que je ne veux pas devenir enceinte, que cela n’était pas une option pour nous… C’était intéressant, parce que « ce n’est pas parce que vous avez la capacité de le faire que vous devez le faire.» Une autre femme raconte comment le genre de sa partenaire n’est pas reconnu à la clinique et, une fois de plus, comment on présume qu’elles sont toutes les deux interchangeables pour ce qui est de la conception :

Avoir un utérus ≠ Vouloir devenir enceinte

« Ma partenaire n’a pas une apparence typiquement féminine et elle se faisait toujours appeler « Monsieur »… Elle n’utilisait jamais les toilettes là-bas, et les techniciens l’ont appelée « Papa » à quelques reprises, ce qui l’a dérangée. Je les corrigeais parfois, mais elle n’aime pas que je corrige les gens parce que ça la gêne… Le médecin a essayé de convaincre ma partenaire de devenir enceinte, et elle répondait invariablement : « Non, je ne ferai jamais ça. »

Parfois, lorsque l’une des partenaires d’un couple de lesbiennes connaît des troubles de la fertilité, le personnel médical de la clinique tient pour acquis (quelle chance pour elles !) qu’un autre utérus est disponible, autrement dit que l’autre femme peut tenter de devenir enceinte. Cela peut arriver, mais souvent ce n’est pas le cas. Certaines femmes queers

Comme l’illustrent les citations ci-haut, il incombe à ceux et celles qui dispensent des soins aux femmes queers de s’abstenir de faire des suppositions au sujet des désirs et préférences de ces personnes en ce qui concerne leur corps et, en particulier, de ne pas présumer que le simple fait de posséder les

De la même façon, étant donné que nombre d’entre nous ne pouvons parler ouvertement de notre situation au travail, nous devons souvent cacher à nos collègues nos combats contre l’infertilité, la naissance ou l’adoption d’un enfant et d’autres événements qui changent la vie.

organes signifie que vous voulez vous en servir.

Les négociations avec les donneurs Celles qui s’inséminent à domicile avec le sperme de donneurs connus ont dû, en général, prendre part à des discussions parfois (mais pas toujours) gênantes avec leurs donneurs quant aux détails de pratiques sexuelles, à des demandes de tests et à la logistique au jour le jour du don de sperme et de l’insémination à domicile. L’apparition de problèmes de fertilité peut signifier encore plus de négociations et de demandes, dont certaines peuvent être délicates et augmenter encore le sentiment de gêne. Plusieurs participantes à l’étude COF ont exprimé le désir d’un contexte plus formel (par ex. une clinique de fertilité) où mener les négociations avec des donneurs potentiels, procéder aux tests médicaux et, si désiré, avoir accès à la surveillance des cycles en vue de l’insémination à domicile.

Le soutien psychologique Quiconque cherche à obtenir une grossesse, en particulier une personne aux prises avec des problèmes de fertilité, a besoin de soutien pour prendre des décisions éclairées au sujet d’options aux conséquences physiques, psychologiques, financières et logistiques complexes. Selon les termes d’une participante à l’étude COF : « Ces choses demandent réflexion, pas vrai ? Par exemple, quelles sont vos limites personnelles ? Allez-vous prendre des médicaments qui stimulent la fertilité ? Subiriez-vous une FIV si c’était nécessaire ? Accepteriez-vous les nouvelles technologies permettant de sélectionner un spermatozoïde et de l’injecter dans l’ovule ? Jusqu’où iriez-vous ? » En matière de procréation avec une tierce partie, la plupart des cliniques de fertilité exigent que les patients participent à au moins une

SPRING/PRINTEMPS 2014 • Creating Families

La communauté LGBT peuvent différer de ceux de leurs clients hétérosexuels.

Un endroit où s’exprimer

et que l’un d’eux, ou les deux, ne peut avoir d’enfant pour une raison ou une autre. »

Les personnes LGBTQ, dans le passé, se sont vu refuser le droit d’avoir des enfants et se sont fait retirer leurs enfants3. Cet historique a fait en sorte qu’on a beaucoup misé ces dernières années sur la création d’espaces sympathiques à la communauté LGBTQ, où les gens peuvent trouver l’information, le soutien et la communauté dont ils ont besoin pour faire entrer des enfants dans leur vie. Toutefois, une conséquence malheureuse, bien qu’involontaire, de cette situation est l’absence de discussion au sujet de questions difficiles comme l’infertilité, les fausses couches ou la perte d’un enfant. Comme l’exprime Shira Spector :

Comme les autres membres du personnel de la clinique de fertilité, les psychologues doivent prendre en compte les besoins et préoccupations spécifiques des clients LGBTQ et apprécier de quelle manière ils

« Nous assistons actuellement à un baby boom dans le milieu LGBT, et lorsqu’il y a un baby boom, il y a aussi l’infertilité et des fausses couches… Un des problèmes touchant

Diplômées de Dykes Planning Tykes avec leurs enfants

séance de counseling. Bien que certains psychologues connaissent les besoins de la clientèle LGBTQ et y soient sensibles, ce n’est pas le cas pour d’autres : « Pour l’entrevue avec le psychologue, ils ont un script et un protocole basés sur la présomption qu’ils ont devant eux un homme et une femme

Créons des familles • SPRING/PRINTEMPS 2014

La communauté LGBT l’infertilité et les fausses couches est ce grand silence chez les femmes. Personne ne veut vraiment en parler – c’est tellement douloureux et en même temps il est considéré comme complaisant de pleurer sa fertilité ou des grossesses non menées à terme. Alors on garde le silence quand ça nous arrive, sauf que tout à coup tout le monde a une histoire à raconter au sujet de quelqu’un qui a eu une fausse couche ou qui tente en vain de concevoir. C’est tellement fréquent, pourquoi n’en parle-t-on jamais4 ? »

Ce qu’elle demande apparaît sensé pour quiconque affronte des problèmes d’in/fertilité : du soutien, de l’amour et une aide pratique de la part du personnel médical, des amis et de la famille ainsi que de nos propres communautés. Les femmes queers veulent être intégrées dans le large cercle de celles avec qui elles partagent une expérience commune. En même temps, nos circonstances, configurations familiales et identités particulières doivent être reconnues, acceptées et considérées avec respect.

recommendations for assisted human reproduction services. Journal of Obstetrics and Gynaecology Canada. 2 Spaeth,

G. L. (2010). Informed choice versus informed

consent. Heltoen International: A Journal of Medical Humanities. 2 (2). (http://shar.es/KRAiV). 3

Epstein, R. (2009) Who’s Your Daddy? And Other

Writings on Queer Parenting. Toronto: Sumach Press. 4,5 Spector,

S. (2009) Red Rock Baby Candy in Epstein,

R. (ed.) Who’s Your Daddy? And Other Writings on Queer Parenting. Toronto: Sumach Press.

Shira mentionne ensuite ce qui pourrait aider : À propos de l’auteure « Voici ce que je voudrais pour celles d’entre nous qui vivent des difficultés : du soutien et de l’amour. Je sais que c’est vague, mais du soutien et de l’amour quand même. Que nos voix et nos histoires comptent autant que celles des autres, qu’elles soient aussi courantes et fassent autant partie de l’expérience d’avoir des enfants que pour n’importe qui, que l’on reconnaisse nos combats, notre courage et notre ténacité, que l’on fasse des études et que nous ayons accès à de l’information afin de pouvoir faire véritablement des choix éclairés quant aux technologies de reproduction et à leurs effets sur la santé des femmes, que nous recevions des conseils dans nos communautés et ayons une place aux tables où l’on discute de la parentalité queer.5 »

Rachel Epstein est une activiste, éducatrice et chercheure dans le domaine de la parentalité LGBTQ depuis plus de 20 ans. Coordonnatrice du LGBTQ Parenting Network au Sherbourne Health Centre, à Toronto, elle termine actuellement sa thèse de doctorat à l’Université York. Elle a préparé l’anthologie Who's Your Daddy? And Other Writings on Queer Parenting (Sumach Press, 2009). Références: 1 Ross,

L.E., Tarasoff, L.A., Anderson, S., green, d.,

Epstein, R., Marvel, S. Steele, L.S. (accepted August 2013). Sexual and gender minority peoples’

Still Trying est un groupe de soutien informel pour les personnes LGBTQ qui tentent de concevoir. Issu d’une initiative communautaire, le groupe est dirigé actuellement par le LGBTQ Parenting Network au Sherbourne Health Centre, à Toronto. Notre désir de soutenir cette initiative est motivé par le fait que nous avons observé l’accent placé sur l’expérience des couples hétérosexuels cisgenres à la plupart des ressources et groupes de soutien dans le domaine de la fertilité. L’animatrice Dahlia Riback s’est jointe au groupe par conviction que les individus LGBTQ vivent des expériences qui leur sont spécifiques en matière de fertilité et d’infertilité. Ensemble, nous avons noté un manque de soutien spécifique à la communauté LGBTQ qui intègre les personnes célibataires, les couples et autres configurations familiales. Les participants du groupe ne correspondent pas nécessairement aux définitions médicales de l’infertilité – en fait, nombre d’entre eux n’y correspondent pas. Notre intention est d’apporter du soutien à toutes les personnes LGBTQ qui cherchent à concevoir, peu importe que leur parcours soit long, court ou complexe.

Still Trying tient une rencontre une fois par mois, au Sherbourne Health Centre, situé au 333 rue Sherbourne, à Toronto. Visitez www.lgbtqparentingnetwork.ca/stilltrying pour plus de renseignements et pour connaître l’heure et la date des réunions. Ou envoyez un courriel à parentingresources@sherbourne.on.ca.

SPRING/PRINTEMPS 2014 • Creating Families

The Naturopathic View

MELATONIN and IVF Melatonin is the biological timekeeper of hormone by Judith Fiore, ND

secretion, although it is more widely known for controlling periods of sleepiness and

Melatonin is a hormone made from the neurotransmitter serotonin and it is secreted by the pineal gland. Until 1958, when scientific evidence showed that the primary function of the pineal gland is to manufacture and secrete melatonin, this pea-sized gland was thought to somehow be involved with the endocrine system. The ancient Greeks considered the pineal gland to be the seat of the soul, and in the seventeenth and eighteenth centuries, physicians thought pineal gland dysfunction was associated with severe psychological disturbances.

Créons des familles • SPRING/PRINTEMPS 2014

wakefulness, otherwise described as the sleep-wake cycle. The release of melatonin

Melatonin is thought to play a critical role in the synchronization of hormone secretion. The daily cycle of hormone secretion in the human body, known as a circadian rhythm, is governed by an internal clock that signals the secretion of various hormones at different times to regulate body functions. Melatonin is the biological timekeeper of hormone secretion, although it is more widely known for controlling periods of sleepiness and wakefulness, otherwise described as the sleep-wake cycle. The release of melatonin is stimulated by darkness which induces drowsiness, and this release is then suppressed by light.

is stimulated by darkness which induces drowsiness, and this release is then suppressed by light.

Melatonin’s antioxidants and the quality of eggs Existing studies that have looked at the use of melatonin with IVF have focused, however, on the antioxidant properties of melatonin.1

The Naturopathic View Higher levels of antioxidants are correlated with longer life span. Studies on rats have shown that melatonin supplementation leads to longer lives; the rats on melatonin lived an average of thirty-one months, roughly six months longer than rats not on melatonin.2 It is thought that the higher the level of antioxidants in the body, the more protected cells and tissues are, and that therefore life expectancy could be extended with use of melatonin, as was shown with animal studies. As we age, our secretion of melatonin diminishes. With regards to fertility, it has been postulated that melatoninâ&#x20AC;&#x2122;s antioxidant effects could possibly improve the quality of eggs, particularly in older IVF patients.

Still early to promote melatonin for IVF Several studies have suggested a positive impact of melatonin on the quality of eggs and embryos3,4,5,6 but it is still too early to promote melatonin use with IVF treatment. The study sizes have involved between 60 and 119 women, while accurate findings are

As we age, our secretion of melatonin diminishes. With regards to fertility, it has been

anti-aging medicine is full of research attesting to improved health with melatonin supplementation.7-13

postulated that melatoninâ&#x20AC;&#x2122;s

Food Sources of Melatonin

antioxidant effects could

Foods that are high in melatonin are (ranging from the highest to the lowest): tart (sour) cherry juice concentrate, tart (sour) cherries, walnuts, mustard seed, corn, rice, ginger root, barley grains, rolled oats, asparagus, tomatoes, fresh mint, black tea, under ripe banana (pulp), ripe banana (pulp), broccoli, pomegranate, strawberries, brussels sprouts, green tea, black olives, green olives, cucumber, sunflower seeds, Concord grapes (skin), red grapes (pulp), and red grapes (whole). Of this list of food sources of melatonin, the tart or sour cherry juice concentrate is quite high, and you may wish to add a few tablespoons to a glass of water in the evening to see if this helps you to fall asleep more easily.

possibly improve the quality of eggs, particularly in older IVF patients.

generally found with large scale studies involving several hundred women or more. It is also important to note that in these studies overall pregnancy rates have been lower than the average for IVF treatment, but this may be due to the melatonin studies recruiting women with a fertility history of poor egg quality and at least one failed IVF cycle. It may be that supplemented melatonin is most effective in women over the age of 35 undergoing IVF treatment. The field of

SPRING/PRINTEMPS 2014 â&#x20AC;˘ Creating Families

The Naturopathic View 3 Tamura H, Nakamura Y, Korkmaz A,

Manchester LC, Tan DX, Sugino N, et al. Melatonin and the ovary: physiological and pathophysiological implications. Fertil Steril. 2009;92(1):328–343. 4 Tamura H, Takasaki A, Miwa I, Taniguchi K,

Maekawa R, Asada H, et al. Oxidative stress impairs oocyte quality and melatonin protects oocytes from free radical damage and improves fertilization rate. J Pineal Res. 2007;44:280–287.

Important Considerations Melatonin can affect the secretion of other hormones such as estrogen, progesterone, LH, prolactin, and T3 and T4 thyroid hormones. In some patients, taking melatonin may suppress ovulation, especially if taking higher doses of 5 mg or more. Moreover, melatonin may interact with medications such as anticoagulants (blood thinners), medications for diabetes, immunosuppressants, and birth control pills.

In spite of what appears to be positive outcomes, it may still be too early to promote melatonin use with IVF treatment. The study sizes have involved between 60 and 119 women, while accurate findings are generally found

Unwanted side effects may include sleepiness during the day, dizziness, or headaches. Other less common side effects are abdominal pain, feeling anxious, feeling irritable, experiencing confusion, and short-lasting feelings of depression.

If you do decide to take melatonin, make sure you purchase commercial supplements produced in a lab and not supplements made from animal sources. Melatonin derived from animals may contain contaminants, especially viral contaminants. Above all, before you go ahead, it is very important to discuss taking a melatonin supplement with your fertility doctor and make sure he or she knows about all the medicines you are taking.

Créons des familles • SPRING/PRINTEMPS 2014

with large scale studies involving several hundred

5 Rizzo P, Raffone E, Benedetto V. Effect of the treatment with myo-inositol plus folic acid plus melatonin in comparison with a treatment with myo-inositol plus folic acid on oocyte quality and pregnancy outcome in IVF cycles. A prospective, clinical trial. Eur Rev Med Pharmacol Sci. 2010 Jun;14(6):555-61. 6 Eryilmaz OG, et al. Melatonin improves the

oocyte and the embryo in IVF patients with sleep disturbances, but does not improve the sleeping problems. J Assist Reprod Genet. 2011 September; 28(9): 815-820. 7 Pappolla MA, Chyan YJ, Poeggeler B, Frangione

B, Wilson G, Ghiso J, et al. An assessment of the antioxidant and the antimyloidogenic properties of melatonin: implications for Alzheimer’s disease. J Neural Transm. 2000;107:203–231. 8 Pohanka M (2011). Alzheimer’s disease and

related neurodegenerative disorders: implication and counteracting of melatonin. Journal of Applied Biomedicine 9 (4): 185–196.

women or more. 9 Sharma M, Palacious-Bois J, Schwartz G,

References: 1 Reiter RJ, Tan DX, Maldenado MD. Melatonin

as an antioxidant: physiology versus pharmacology. J Pineal Res. 2005;39:215–216.

2 Ishizuka B, Kuribayashi Y, Murai K, Amemiya

A, Itoh MT. The effect of melatonin on in vitro fertilization and embryo development in mice. J Pineal Res. 2000;28:48–51.

Iskandar H, Thakur M, Quirion R, Nair NPV (February 1989). Circadian rhythms of melatonin and cortisol in aging. Biological Psychiatry 25 (3): 305–319. 10 Brown GM, Young SN, Gauthier S, Tsui H,

Grota LJ (September 1979). Melatonin in human cerebrospinal fluid in daytime: its origin and variation with age. Life Science 25 (11): 929–936. 11 Touitou Y (July 2001). Human aging and

melatonin. Exp. Gerontol. 36(7): 1083–1100.

The Naturopathic View Keep in mind that melatonin can affect the secretion of other hormones such as estrogen, progesterone, LH, prolactin, and T3 and T4 thyroid hormones. In some patients, taking melatonin may suppress ovulation, especially if taking higher doses of 5 mg or more. It is therefore very important to discuss taking a melatonin supplement with your fertility doctor. 12 Sharman EH, Sharman KG, Ge YW, Lahiri

DK, Bondy SC (April 2004). Age-related changes in murine CNS mRNA gene expression are modulated by dietary melatonin. J. Pineal Res. 36(3): 165–70. 13 Acuña-Castroviejo D, Martín M, Macías M, Escames G, León J, Khaldy H, Reiter RJ (March 2001). Melatonin, mitochondria, and cellular bioenergetics. J. Pineal Res. 30(2): 65–74.

Chinese Acupuncture and Herbal Clinic • Acupuncture specialists (Dr.Ac.) • Chinese medicine doctors (C.M.D.) • Ph.D. from the University of Toronto • Trained in China with over 20 years experience • Board of directors of CMAAC We treat both men and women for infertility, pain, stress and more. Disposable needles only and group insurance covers the treatment.

About the Author Dr. Judith Fiore is a registered naturoNorth York: 6257 Bathurst St. Tel: 416 227 1686 Mississauga: 3450 Cawthra Rd. Tel: 905 275 8288 Toronto: 932 Bathurst St. Tel: 416 640 9166

Website: www.chinesehealthway.com

pathic doctor who has dedicated her naturopathic practice to helping individuals and couples improve their fertility for more than 13 years. She is based in Toronto, and can be reached through her website: www.naturalfertility.ca.

SPRING/PRINTEMPS 2014 • Creating Families

Emotional Support Before and After Pregnancy

As a previous infertility patient and current mother of two, I know from experience that I will always need some form of support and encouragement from other women. While I was undergoing infertility treatment, I felt I had no support and that nobody understood what I was going through. This experience opened the door for me to offer women and couples support in many different forms. I currently facilitate an infertility and miscarriage support group, I run a private infertility counselling practice, and I am a fertility yoga instructor. I also became a doula.

Grief and bereavement are some of the feelings most widely reported by infertility patients. Fear of the unknown takes centre stage and you start to feel pressure to succeed.

The benefits of positive strategies

by Rebecca Hodson

CrĂŠons des familles â&#x20AC;˘ SPRING/PRINTEMPS 2014

As little girls many women played with dollies and practiced being a mommy. For most of our lives we have dreamed about our wedding, pregnancy and motherhood. When our life plan is not going in the direction we had hoped, there is a tendency to become withdrawn and perhaps focus on the medical side of treatments. There is a sense of relief upon

There are support groups, infertility counsellors, fertility yoga and on-line forums to help you navigate the emotional and educational demands of any fertility treatment. This support network may help you reap the benefits of positive strategies in order to fight infertility more efficiently. initiating fertility treatments but this relief may turn into worry. If the treatments do not work right away we are left feeling anxious and out of control. Coping with an uncertain future is terribly hard. It is important to acknowledge how much youâ&#x20AC;&#x2122;ve endured, and consciously initiate the process of healing. Hope and faith waver but can be renewed with a bit of work! Here are some of the strategies that can help: Tap your inner strengths to conquer fear of the unknown. Infertility changes you. It changes the dynamic of your marriage. You look at the world differently and you may start to feel things you have never felt before. Grief and bereavement are some of the feelings most widely reported by infertility patients. Fear of the unknown takes centre stage and you start to feel pressure to succeed. You research everything from your diagnosis to things to eat that may help increase your fertility. If you have been in treatment for many months, you may be somewhat of an expert. You begin to better understand your body, but each month you may feel that it is letting you down. Will it ever happen? You need to discover and tap your innermost strength and resources to get you through each cycle. Accept that you must let go. Accepting that you may not know when or how your baby will come to you is part of letting go. Letting

go of certain things in life can bring a sense of peace and love. The only thing you have control over is your reaction to others or situations. Things do not change, unless a change is made. Give yourself permission to change something in your fertility routine this next cycle. As well, it is important to recognize all feelings associated with loss. Without sadness there would be no happiness. Learn to be patient, forgiving and trusting throughout the fertility process.

infertility. Thinking about your birth experience will allow your mind to focus on one thing. We tend to have many thoughts that are repetitive and negative. Positive thoughts lead to positive feelings and where attention goes, energy flows. You will not jeopardize the process of reproduction by planning your birth: You are actually reinforcing your beliefs, and this has a profound physiological effect for the reduction of stress, which can lead to a better response to IUI or IVF.

Practice visualization and affirmation. These are important tools that help you regain hope and enthusiasm. Have you thought about your pregnancy and imagined what it would be like to give birth? Many women find it difficult to use positive affirmations and visualizations about pregnancy during fertility treatment or after a miscarriage. Here is an exercise aimed at acquiring beliefs that will help to renew hope and positivity: Pick a specific time of day when you will be at leisure to use your imagination for the purpose of this exercise. Visualize yourself pregnant and what your labour will be like. Remind yourself that you are doing the best you can and that fertility treatments are hard. Imagine that you are ready to receive your baby and how you would look pregnant.

Be present and live in the moment. This is a great way to relieve stress, as many infertility patients enjoy few moments of pleasure in their life.

You may not know how or when your baby will come to you, but you can dream of the day your baby is born with the confidence that you will have ongoing support after

Know that you can count on a support network. Some couples build amazing relationships with the staff at their fertility clinics. This is invaluable. There is other help you can resort to for psychological support, such as support groups and sympathetic friends. Being able to count on a network of support from different backgrounds is the key to feeling your best.

Pregnancy after infertility When, at last, you get THE call from the clinic about a positive pregnancy result you may feel shock at first. Closing the door on fertility treatments means that a new door opens. You are finally part of the pregnant

SPRING/PRINTEMPS 2014 â&#x20AC;˘ Creating Families

Visualize yourself pregnant and what your labour will be like. Remind yourself that you are doing the best you can and that fertility treatments are hard. Imagine that you are ready to receive your baby and how you would look pregnant. club and your life is moving forward. It is normal to be worried about pregnancy loss, but former infertility patients tend to have higher levels of anxiety. You have been through so much to get pregnant and now you no longer have the 2-week wait – it is the 9-month wait! It will be difficult to fully relax until you are holding your baby in your arms.

Getting help from a doula A doula may help to make your journey through pregnancy more serene and

L-C Natural Fertility Program was designed by Dr. Diana Li and Dr. Franklyn Chen, with a combination of acupuncture and TCM. As a result 238-plus babies have been born in Nova Scotia alone. With over 30 years of expert clinical experience, including the presentation of clinical research paper on “Acupuncture for Infertility Cure” (International Conference, 2006), both Doctors have become renowned for their success. This program can be used alone or in combination with IVF to increase the chance of a pregnancy.

S-T/L-C Acupuncture & Natural Medicine Clinics 1306 Bedford Hwy., Bedford, NS 902-832-0688 6066 Quinpool Road, Halifax, NS 902-492-8839

www.FertilityClinicNS.ca

Créons des familles • SPRING/PRINTEMPS 2014

confident. A doula is a professionally trained labour assistant (through CAPPA – Childbirth and Postpartum Professional Association – or DONA – Doulas of North America). Normally, she provides educational, emotional, physical and practical support to a woman and her partner during pregnancy, childbirth and the postpartum period. A doula never takes the place of a husband, sister, mother or friend. She offers suggestions about how the husband or birth partner can help and become active in the labouring process. She is able to relieve husbands while they take a nap or have a break. Labour can be a long process and women do not know what they need until the moment arrives. A doula provides support for any decision the couple makes with respect to their comfort. She arrives at your home, birthing centre or hospital with a bag of tricks since many hospitals have limited resources such as birthing balls. A doula says the right thing at the right time and respects all the needs of the couple. Throughout your pregnancy, she will offer support via telephone, email and in-person appointments to help you navigate feelings and to answer questions. Couples who use donor egg/sperm to conceive may report feelings of grief during and after pregnancy. This is a normal reaction in processing and accepting the loss of a fully biological child. Grieving is a process with a definite start but no definite end. As one woman who used donor sperm to conceive put it, “I had no idea how much I needed emotional support and understanding during

the last few weeks of pregnancy. My doula was positive, enthusiastic and compassionate. I couldn’t have done it without her.” Labour has its own invasive interventions that can negatively affect the mother’s and baby’s birth experience. Some interventions are necessary, but others can be avoided if the mother receives proper support and encouragement. You have gone through countless tests and invasive procedures to become pregnant, so it is important to understand which interventions may not be necessary for your health and that of your baby. Some of the reasons for induction and epidurals are based upon impatience and lack of trust that your body will do what it is supposed to do. Although research is limited, some studies1,2,3,4 have shown that continuous support from a doula during childbirth can have some outstanding results: • A decreased use of pharmaceutical pain medication. • A decreased incidence of C-sections, forceps and vacuum extractions. • A decreased use of induction measures such as prostaglandin gel, Oxytocin (Pitocin) and premature rupture of the bag of water. • A less difficult childbirth experience. I am proud and honoured to be part of my clients’ lives in a personal and meaningful way. My heartfelt thanks go to all my past clients for sharing the dark and light moments.

Closing the door on fertility treatments means that a new door opens. You are finally part of the pregnant club and your life is moving forward. It is normal to be worried about pregnancy loss, but former infertility patients tend to have higher levels of anxiety. References: Benefits provided by a doula during and after pregnancy 1. Emotional reassurance, comfort and encouragement.

1 Gruber KJ, Cupito SH, Dobson CF. Impact of doulas on healthy birth out-

2. Education and suggestions about pain relief techniques.

comes. J Perinat Educ. 2013 Winter;22(1):49-58. doi: 10.1891/1058-

3. Guidance and support for loved ones.

1243.22.1.49.

4. Information about childbirth, infant care and the postpartum

2 Kozhimannil KB, Johnson PJ, Attanasio LB, Gjerdingen DK, McGovern

period.

PM. Use of nonmedical methods of labor induction and pain management

5. Tools to help speed labor, turn baby and relieve back labour — birthing ball (non-latex), Rebozo, calm or energetic music, organic aromatherapy, organic massage oil etc.

among U.S. Women. Birth. 2013 Dec;40(4):227-36. doi: 10.1111/birt.12064. 3 Edwards RC, Thullen MJ, Korfmacher J, Lantos JD, Henson LG, Hans SL.

6. Breast feeding support.

Breastfeeding and complementary food: randomized trial of

7. Practical parenting tips and tricks— sleep, understanding your

community doula home visiting. Pediatrics. 2013 Nov;132 Suppl 2:S160-6.

baby’s needs, bonding and confidence building for new mothers.

doi: 10.1542/peds.2013-1021P.