Supporting you every step of the way...
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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 Gloria Poirier gloria@iaac.ca EDITOR Véronique Robert carotexte@videotron.ca
PLATINUM SPONSORS
ISIS Regional Fertility Centre
Ferring Pharmaceuticals
IVF Canada & The LIFE Program
EMD Serono
London Health Sciences Centre, The Fertility Clinic
Merck
Mount Sinai Centre for Fertility & Reproductive Health GOLD SPONSORS
TRANSLATIONS Véronique Robert Kelsey Angeley
Olive Fertility Centre ONE Fertility
LifeQuest Centre for Reproductive Medicine
Ottawa Fertility Centre
MUHC Reproductive Centre
Pacific Centre for Reproductive Medicine Regional Fertility Program
ART DIRECTOR / GRAPHIC DESIGN Sheldon Kravitz sheldon.kravitz@sympatico.ca
SILVER SPONSORS
True North Imaging
ARTUS Centre Atlantic Assisted Reproductive Therapies Aurora Reproductive Care
I A A C NATIONAL BOARD OF DIRECTORS
CReATe Fertility Centre
BRONZE SPONSORS
PRESIDENT • Jocelyn Smith
Fertility Centers of Illinois
Grace Fertility Centre
First Steps Fertility
Outreach Health Services
VICE-PRESIDENT • Janet Takefman Pamela Chorney • Janet Fraser Sherry Levitan • Glenna Owen Antonina Wasowska
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Créons des familles • SUMMER/ÉTÉ 2014
Genesis Fertility Centre Hannam Fertility Centre Heartland Fertility & Gynecology Clinic
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OUR ADOPTION STORY: THE HAPPY ENDING
WHAT TO DO WITH SURPLUS EMBRYOS?
COMMERCIAL SURROGACY IN INDIA
24 WHY AREN’T I HAPPY?
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 Patient’s Perspective . . 46 My Infertility and My Siblings
SUMMER / ÉTÉ 2014 The LGBTQ . . . . . . . . . . . . . 51 QUEER SPAWN: The Children of LGBTQ Parents
FEATURES / DOSSIERS My Story: What IVF is Really Like ............................................................. 18
The Naturopathic View ... 64 MYO-INOSITOL and PCOS
by MELISSA PENNARUN
Fiction: Silent Conversation in the Depths of Desire .................................. 32 by NATHALIE COURCY
CIAW 2014 /
The Doctor’s Column . . . 68 Lifestyle and Male Fertility
SCSI 2014 .................................................................... 36
La chronique du médecin . . 69 Mode de vie et fertilité masculine
Que faire avec son entourage .................................................................. 58 par SUSAN BERMINGHAM
The opinions expressed in this magazine are personal and do not necessarily reflect those of Creating Families.
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Les opinions exprimées dans ce magazine sont personnelles et ne reflètent pas nécessairement celles de Créons des familles.
INFERTILITÉ FÉMININE: QUE PEUT FAIRE LA CHIRURGIE ?
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 SUMMER/ÉTÉ 2014 • Creating Families
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President’s
aware of what infertility is all about.
Photo by Lisa Minnini
MESSAGE
Jocelyn Smith
s I write, the 8th annual Canadian Infertility Awareness Week has just come to an end. Each CIAW is more impressive from one year to the next! During the last week of May, events took place from coast to coast. In Gatineau and Ottawa, people from both the Ontario and Quebec side of the Ottawa River walked across the Alexandra Bridge to meet halfway, as a show of solidarity between the two provinces in support for equal access to fertility treatment. In Winnipeg, a demonstration took place on the lovely grounds of the Legislative buildings. Other events were organized in Calgary and Vancouver, drawing people eager to learn about infertility and how to prevent it. None of this would have been possible without the generous help of our volunteers and sponsors. A huge, heartfelt thanks to all of you! You made all the difference. It was amazing, AND it did what it is supposed to do: Make people more
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I love magazines. I love them in hard copy and I love them online. I always read the editor’s message. Often there is a little story about the writer having a baby or, as in a recent editorial, telling us that she is a soon-to-be grandparent. Not too sure why this last one got to me. Perhaps because of CIAW? It made me think of all the wantto-be grandparents out there, a group we tend to forget when speaking of infertility. It made me think about how they must feel knowing that their child is going through treatment. It made me feel sad for them. I then wondered: Whom do they talk to? Do they know about IAAC? What can we do to help them help their children? How can we get these people together to talk about their experience? If any of you have children struggling with infertility and would like to share your feelings or concerns, please contact Gloria at our head office.
I always think,“How are we going to top the last Creating Families?” Well, our writers have done it again. If you have gone through a period of doubt or depression following the birth or adoption of your child, the eloquent article by eminent researchers Judith Daniluk and Emily Koert will reassure you that you are not alone and that, yes, this is nothing to be worried about. Also in the hope department, the happy ending to Amanda and John’s story will lift your spirits if you were about to give up on your dream of becoming a parent. You have surplus embryos? Do Would you like to be more actively involved in not miss lawyer Susan supporting what we do? Precious’ Friends of IAAC campaign coming soon - a new consideraIAAC membership category specially designed tions on the for patients, their family & other supporters. legal aspects
COMING SOON!
of several options at your disposal. Ever heard of myo-inositol against PCOS? Our official naturopath Judith Fiore tells all about it. As does Dr. Kirk Lo, in the Doctor’s Column, about lifestyle’s impact on male fertility. Family support is all important for one faced with an infertility diagnosis – witness Charmaine Graham’s moving account in her Patient’s Perspective. And there is much more in this issue… The Infertility Awareness Association of Canada is non-for-profit association. We rely on the generosity of pharmaceutical companies, infertility centres and you, our readers, to help us be viable. In the last year our revenues have decreased. I am concerned that we won’t be able to maintain our standard of excellence unless we get more donations. I know that people donate to the causes they feel strongly about. Keep in mind that one in six couples suffers from infertility. So please give to IAAC – we need your support more than ever with the many advocacy actions coming up across Canada. Think about making a monthly donation. Perhaps you have ideas on how we can raise money; or you may have fund-raising experience? We always welcome new volunteers. In fact, as our bank of volunteers grows we see the need for a volunteer co-ordinator. Interested in helping out? Please be in touch with Gloria. I wish everyone a safe and sunny summer. And while you enjoy the nice weather, don’t forget to give some thought on how we can keep IAAC alive and working for you. Sincerely,
Jocelyn Smith
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Créons des familles • SUMMER/ÉTÉ 2014
MESSAGE
de la présidente
u moment d’écrire ces lignes, la huitième Semaine canadienne de sensibilisation à l’infertilité vient de prendre fin. Chaque SCSI est plus impressionnante que la précédente !
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Durant la dernière semaine de mai, des événements ont eu lieu d’un océan à l’autre. À Gatineau et Ottawa, des gens du côté ontarien et québécois de l’Outaouais ont marché sur le pont Alexandra pour se rencontrer à mi-chemin, pour montrer la solidarité des deux provinces dans la quête d’un accès pour tous aux traitements de fertilité. À Winnipeg, une manifestation a eu lieu devant l’édifice du Parlement. D’autres événements organisés à Calgary et à Vancouver ont attiré des gens désireux d’en savoir plus sur l’infertilité et comment la prévenir. Rien de tout cela n’aurait été possible sans l’aide de nos généreux bénévoles et commanditaires. Un immense merci à vous tous ! Vous avez fait toute la différence. La SCSI a été formidable ET elle a atteint son objectif : mieux faire connaître l’infertilité.
J’adore les magazines. Je les aime sur papier et je les aime en ligne. Je lis toujours l’éditorial. Souvent, l’auteure raconte qu’elle sera bientôt maman ou encore grand-maman, comme dans un édito récent. Je ne sais trop pourquoi le dernier texte à ce sujet m’a touchée autant. À cause de la SCSI peutêtre ? Cela m’a fait penser à tous ceux et celles qui rêvent de devenir grands-parents, et que nous avons tendance à oublier quand il est question d’infertilité. J’ai pensé à comment on doit se sentir lorsque notre enfant subit des traitements de fertilité. J’ai eu de la peine pour eux. Je me suis demandé : à qui parlent-ils ? Connaissent-ils l’ACSI ? Que pouvons-nous faire pour les aider à aider leurs enfants ? Comment réunir ces personnes pour qu’elles partagent leur expérience ? Si quelqu’un parmi vous a un enfant aux prises avec l’infertilité et que vous aimeriez partagez vos sentiments ou préoccupations, n’hésitez pas à contacter Gloria à notre siège social.
Je me demande toujours : « Comment allons-nous pouvoir faire mieux que le Créons des familles précédent ? » Eh bien, nos auteur(e)s ont répété l’exploit. Si vous avez traversé une période de doute ou de dépression après la naissance ou l’adoption de votre enfant, l’article éloquent des réputées chercheures Judith Daniluk et Emily Koert saura vous rassurer : vous n’êtes pas les seuls et, non, cela n’a rien d’inquiétant. Toujours au rayon de l’espoir, la fin heureuse de l’histoire de John et Amanda vous remontera le moral si vous vous apprêtiez à renoncer à votre rêve de devenir parents. Vous avez des embryons Aimeriez-vous apporter un soutien plus subsurnuméstantiel aux activités de l’ACSI ? raires ? Ne Une campagne LES AMIS DE L’ACSI sera lancée manquez pas bientôt - sous forme d’une nouvelle catégorie de les réflexions membre de l’ACSI conçue spécialement pour les de l’avocate patients, leur famille et autres sympathisants. Susan
Precious sur les aspects légaux de plusieurs options qui s’offrent à vous. Avez-vous entendu parler du myo-inositol contre le SOPK ? Notre naturopathe attitrée, Judith Fiore, nous en parle en détail. Le Dr Kirk Lo, dans la Chronique du médecin, fait de même pour ce qui est de l’influence du mode de vie sur la fertilité masculine. L’Association canadienne de sensibilisation à l’infertilité est une organisation sans but lucratif. Nous comptons sur la générosité des compagnies pharmaceutiques, des cliniques de fertilité et sur vous, chers lecteurs, pour survivre. Nos revenus ont diminué cette année et je crains pour notre survie si nous ne recevons pas davantage de dons. Je sais que les gens donnent aux causes qui leur sont chères. Songez qu’un couple sur six souffre d’infertilité. Alors, s’il-vous-plaît, donnez à l’ACSI – votre soutien est plus que jamais nécessaire au moment où nous entreprenons de multiples démarches en faveur des patients à travers le Canada. Envisagez de faire un don mensuel. Peutêtre avez-vous des idées concernant la levée de fonds ? Ou de l’expérience dans ce domaine ? Nous sommes toujours heureux d’accueillir de nouveaux bénévoles. En fait, puisque notre banque de bénévoles s’enrichit, nous aurons besoin d’une personne pour coordonner leurs réalisations. Vous aimeriez nous aider ? Gloria sera heureuse d’en parler avec vous. Je souhaite à toutes et à tous un été ensoleillé et reposant. Et pendant que vous profiterez du beau temps, n’oubliez pas de réfléchir aux moyens de garder l’ACSI en vie et au travail pour vous.
À VENIR BIENTÔT !
Cordialement,
Jocelyn Smith
SUMMER/ÉTÉ 2014 • Creating Families
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What’s New? Headlines in the fertility world
Le meilleur moment pour concevoir ? La plupart des femmes l’ignorent ! Best time to conceive? Most women have it wrong! According to a study recently published in Fertility and Sterility, 60% of women believe that having intercourse after ovulation offers the best chances of becoming pregnant. In fact, the opposite is true: the best time to conceive is before ovulation, as sperm may stay alive in the woman’s body for several days.
Selon une étude parue récemment dans Fertility and Sterility, 60 % des femmes croient qu’avoir des rapports sexuels après l’ovulation offre les meilleures chances de devenir enceinte. En réalité, c’est le contraire qui est vrai : le meilleur moment pour concevoir est avant l’ovulation, parce que les spermatozoïdes peuvent rester vivants plusieurs jours dans le corps de la femme.
600,000
600,000
Estimated number of frozen embryos that were in storage in the United States in 2012.
Estimation du nombre d’embryons congelés entreposés aux États-Unis en 2012.
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Créons des familles • SUMMER/ÉTÉ 2014
Quoi de neuf ?
Les manchettes dans le monde de la fertilité.
Weight loss surgery to improve fertility?
La chirurgie baryatrique pour améliorer la fertilité ?
In obese women, losing weight can restore ovulation, increase spontaneous pregnancy rates and lower the risk of miscarriage. When classical weight loss methods fail, bariatric surgery, which consists in restricting stomach capacity by installing an adjustable band or bypassing part of the stomach and small bowel, seems to have positive effects. The possible impact of nutritional restriction on the fetus has raised concerns, but most recent studies have been reassuring in this regard. Results are expected in the near future as to the management of the gastric band throughout the pregnancy.
Chez les femmes obèses, perdre du poids peut restaurer l’ovulation, augmenter les taux de grossesse spontanée et réduire le risque de fausse couche. Lorsque les méthodes classiques pour perdre du poids échouent, la chirurgie baryatrique, consistant à restreindre la capacité de l’estomac par l’installation d’une bande ajustable ou d’une voie de contournement de l’estomac et de l’intestin grêle, semble avoir des effets bénéfiques. L’impact éventuel de la restriction de nourriture sur le fœtus avait suscité des inquiétudes, mais les dernières études sont rassurantes à cet égard. Des résultats sont attendus sous peu en ce qui concerne la gestion de la bande ajustable pendant la grossesse.
From skin to sperm Scientists from Stanford University have succeeded in generating sperm cell precursors from stem cells taken from the skin tissue of infertile men after the stem cells were transplanted into mice. The study’s authors are hoping that this innovating way of creating sperm cells might lead to stem cell therapy for treating azoospermia, the most severe form of male factor infertility.
De la peau au spermatozoïde Des chercheurs de l’Université de Stanford ont réussi à générer des précurseurs de spermatozoïdes à partir de cellules souches prélevées sur la peau d’hommes infertiles puis transplantées sur des souris. Les auteurs de l’étude espèrent que cette méthode innovatrice de créer des cellules de spermatozoïdes pourra conduire à des thérapies basées sur les cellules souches pour traiter l’azoospermie, la forme la plus grave d’infertilité masculine.
SUMMER/ÉTÉ 2014 • Creating Families
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What’s New?
Fertilization mystery
SOLVED
Egg and sperm need to recognize each other for fertilization to occur. The sperm protein that recognizes the egg was discovered in 2005 by Japanese researchers who called it Izumo, after a Japanese marriage shrine. Izumo has found its bride: the matching protein on the egg is Juno – after the
Roman goddess of fertility – discovered last April by scientists at the Wellcome Trust Sanger Institute, in England. In addition to solving an old biological mystery, the British researchers think their breakthrough might help develop new contraceptives and improve fertility treatments.
Mystère de la fécondation RÉSOLU Pour que la fécondation ait lieu, l’ovule et le spermatozoïde doivent se reconnaître. La protéine du spermatozoïde qui reconnaît l’ovule a été découverte en 2005 par des chercheurs japonais qui l’ont appelée Izumo, mot qui désigne
Chances of becoming pregnant during each natural cycle, whether through intercourse or insemination.
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Créons des familles • SUMMER/ÉTÉ 2014
l’autel du mariage en japonais. Izumo a trouvé sa promise : la protéine équivalente sur l’ovule s’appelle Junon – d’après la déesse romaine de la fertilité – et elle a été isolée en avril dernier par des scientifiques du Wellcome Trust Sanger Institute, en
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Angleterre. En plus de résoudre un vieux mystère biologique, les chercheurs britanniques croient que cette percée pourrait aider à mettre au point de nouveaux contraceptifs et à améliorer les traitements de fertilité.
Chances de devenir enceinte au cours d’un cycle naturel, après une relation sexuelle ou une insémination.
Quoi de neuf ? Donated sperm and eggs
Sperme de donneur et ovules de donneuses
now allowed in Italy
maintenant permis en Italie
An Italian court has declared a ban on the use of donor sperm and eggs in fertility treatments as unconstitutional. Strict regulations concerning access to IVF and insemination have been the rule in Italy, where single people and same-sex couples are denied fertility treatment. The next step will be a battle to obtain that embryos may be screened for genetic disorders, a practice which is currently forbidden.
Une cour italienne a dÊclarÊ inconstitutionnelle l’interdiction d’utiliser le sperme de donneur et les ovules de donneuse dans les traitements de fertilitÊ. Des restrictions sÊvères touchant l’accès à la FIV et à l’insÊmination sont la règle en Italie, oÚ les cÊlibataires et les couples de même sexe se voient refuser les traitements de fertilitÊ. La prochaine Êtape sera la bataille pour obtenir les tests visant à diagnostiquer les troubles gÊnÊtiques chez l’embryon, pratique actuellement prohibÊe.
Services Offered: •
• A professional and sensitive approach to all your reproductive concerns is provided by our expert team of physicians: 'U 0DUMRULH 'L[RQ 0' )5&6& )$ $&2* 'U )D\ :HLVEHUJ 0' )5&6& 'U $ULDGQH 'DQLHO 0' )5&6& 'U .LP *DUEHGLDQ 0' )5&6&
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SUMMER/ÉTÉ 2014 • Creating Families
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OUR ADOPTION STORY:
The Happy Ending by Amanda and John The last time I wrote, I told a sad story of how our hopes to adopt a child were disappointed. It was a story of determination, dedication, learning to deal with grief and finding the strength to move past it and try again…
whatever time she needed to decide. Again, what was days felt like months. Then, one evening, as we were driving to visit my parents who live out of town, my cell phone rang. The call display told me it was our worker calling - at 10:30 p.m. We knew
before I even answered that it was good news – your worker just doesn’t call at that time of night to tell you that weren't chosen… She explained that we were chosen by the birth mom and we then set a date to meet her. It was the beginning of our dreams coming true!
Our caseworker said if we were to be considered we should hear back from her soon about the social and medical history of the birth parents. As we have found out, timelines go right out the window with regards to adoption. We waited. After a few weeks, she called to give us the info and find out if we were interested in being presented. We of course were ecstatic and said yes! We were advised that the agency was hoping to present our profiles to the birth mother by the end of the week and then she would take
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Créons des familles • SUMMER/ÉTÉ 2014
PHOTO: Danielle Renea Photography
This time I am pleased to be writing a happy ending! If you remember my last account, my husband and I were just getting through an adoption fall-through, where the birth mother changed her mind about two weeks after the baby was born in May of 2013. Fast forward to August of 2013, after a whirlwind getaway and lots of tears and soul-searching. We emailed the agencies and practitioners we were working with, asking if there was anything going on in the adoption world. Each said there wasn’t, save for our caseworker from the previous time who said she was working with a birth mom but that it was too early to tell whether or not she would be presenting us as potential adoptive parents. The response didn't give us any certainty, however it did give us hope.
We knew before I even answered that it was good news – your worker just doesn’t call at that time of night to tell you that weren't chosen. It is such a rush to finally get the phone call you have been waiting forever for. For those of you out there who are still waiting, it's exactly as you think it will be but it comes when you least expect it, which makes it that much more exciting. I was sweating; we were screaming in the car, we were thrilled to be back on the roller coaster so soon. But, as with all life-changing news such as this, there is always some anticipation and nervousness. Especially when we learned that the doctors said the baby could come any day. Not to mention that John’s parents, brother and sister-in-law were on vacation and would have to wait till their return to learn the news. We kept our exciting news under wraps for quite some time, which was very difficult.
our lives. We were excited but worried. There was now a big push to get all the paperwork completed as fast and as efficiently as possible. If the baby came too soon, he would have to go into foster care until it was done. Over the next couple weeks, I talked to Trish a lot while we waited for our bundle of joy to arrive. She told me about herself, we talked about music and movies but mostly about how she was feeling. I went with her to a few doctors’ appointments and even got to see an ultrasound! What an amazing and unexpected experience that was. It was one that I had never dreamed I would get. It was the end period of her pregnancy and Trish was tired, uncomfortable and in pain. I sympathized with her as best as I could, but having never been pregnant, I really couldn’t understand what she was going through. The days turned to weeks and it seemed like he was never coming. There were a couple of false alarms but finally I got the call that Trish was going into labour. We rushed to the hospital and shortly after we arrived, Trish was handing me our son, Cooper James. He was beautiful, and perfect and big – nine pounds three ounces! We stayed in the room with Trish, her mom and
her worker. We all took turns holding Cooper. What a beautiful, emotional experience. Trish was released and we stayed overnight in the hospital with Cooper. Our family came to visit us and we went home the following day. Our family was complete! The next few weeks are foggy as we had many visitors and very little sleep. I continued to talk to Trish via text almost daily. I updated her on how we were doing and she talked about how she was feeling and recovering. She even put together a scrapbook for Cooper, complete with ultrasound pictures! I am so proud of it and the work she put into it that I show everyone. It is something Cooper will have forever from Trish and I am sure he will appreciate it as much as we do as he grows up. The world of adoption is a big waiting game. You are always waiting for some kind of paperwork to be completed, or a phone call, or a date to come. Up until now, we were waiting for Cooper to be born, and after all the waiting we had already experienced, I think that wait felt the longest. Next, we had the 30-day waiting period during which the birth mother could change her mind about the adoption, and decide to parent herself.
The meeting went amazingly well. The first time we had no experience to measure against, but this time we did and it felt completely different. We had an instant connection with the birth mother. There was this flow and easiness to the entire meeting. We realized we had a lot in common and we could not have been happier or more excited after our first meeting. We agreed on an open adoption where Trish (the birth mom) would get photos, updates and visits. We were thrilled to have her as part of the baby’s and
SUMMER/ÉTÉ 2014 • Creating Families
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We had an instant connection with the birth mother. There was this flow and easiness to the entire meeting. One would think that after our first experience, when the birth mother did change her mind and decided to keep the child, this would be the most difficult part of our journey, but it wasn’t. This time around, I had a sense of peace as we moved through the 30day window. Don’t get me wrong, I definitely didn’t forget about the wait, and what could potentially happen, but I didn’t mark the days off on the calendar, either. I did what I had planned to do; I enjoyed each day with Cooper because regardless of what the outcome would be, I loved him from before I ever met him and no amount of time or “trying not to attach too much” was going to change that. We surrounded ourselves with family and friends who could not be happier
for us and we all shared in the love, awe and wonder that a new baby brings to the entire family. When the clock finally ran out on the 30-day window, John was at work and I was at home with one of my best friends, Jen, who happened to be visiting. Cooper was snuggled on my chest and tears of joy were in my eyes. And I can’t forget the late night congratulatory phone calls from a few special people. Since then, we have had two really special visits with Trish. Our relationship has this natural and familiar feeling, and it has a great easiness about it. I am very pleased that we had the time we did to get to know Trish and her family before Cooper came. The doctor’s appointments, the false alarms – it was so nice to be a part of it all and to also be a support for Trish. People ask about our relationship now and seem surprised at how much we talk. I think people expect that we would have a clear-cut definition of our relationship, but it’s not like that. It’s like any relationship; there is an element of give and take. Trish knows that we will be here for her throughout the years, and we know that we don’t have to hesitate to ask her questions about family history or whatever else as Cooper grows older. At the end of the day, the relationship is for Cooper. As time goes on he will know where he came from, he will know that he wasn’t abandoned and that the choice for adoption wasn’t made easily or lightly, but out of the purest love. He will grow to know the
Helping to build families across Canada and beyond. Extensive experience in surrogacyy, legal parentage, and egg, sperm and embryo donation.
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Créons des familles • SUMMER/ÉTÉ 2014
Sara R. Cohen, lawyer Teel/Fax: 416.907.2189 sara@fertilitylawcanada.com www.fertilitylawcanada.com
strength his birth mom has and the amazing person she is. We are asked all the time by people how we are “adjusting.” I am not sure what they are asking. Are they asking adjusting to the adoption, as in bonding, or are they asking how we are adjusting to having a baby at home? I just answer, “Great!” I can’t really explain why, but both John and I say that we really didn’t have an adjustment period. Once Cooper came home, it was like he was always here. Everything feels natural with him; I barely remember what life was like without him! I love him more that I could ever put into words and I am happier than I ever imagined. My heart is so full of love, happiness and gratitude.
This time around, I had a sense of peace as we moved through the 30-day window. People always said, “It will happen when it's meant to;” “Everything happens for a reason;” “God has a plan.” While I wholeheartedly believed all those things as our Faith is what kept us going every day, I didn't always want to hear it. There were days when I just wanted to scream at the person telling me that and retort with, “That’s easy for you to say, you have a family!” But I didn’t because I knew their intentions were good. What I didn't know was how true this really was and how
PHOTO: Danielle Renea Photography
much it would come to fruition. Everything just felt right this time. All the pieces just fit together. That is why the other adoption didn’t work out, because it wasn’t right. There is no doubt in my mind that we were part of a much bigger plan. Cooper is the child for us. I couldn't be more certain about that. But not only that, the relationship we have with Trish is amazing. I can't imagine having it with anyone else. Cooper was meant to be with us as much as we were meant to be a part of Trish’s life. The love, respect and gratitude I feel for her I can't put into words. I know now, we would have never had the same connection and relationship with Jane as we do with Trish and I am very thankful for our relationship. We are thrilled that she and her family will be a part of our lives and our family, forever. Although she gave John and me the gift of a son, she also gave a lot of others a gift too. She gave both John and my parents their first grandchild; she gave our family a nephew, a godchild, a great grandchild, a cousin, and so much more. I don't know if anyone will ever truly understand the relationship we have formed and the bond that we have. It is an inexplicable and overwhelming feeling, someone giving you the gift of a child.
As hard as the bad times were, I wouldn’t change a thing because each low, each disappointment, was part of the journey and was a learning experience and a chance to grow.
One thing that I have found overwhelming and that I couldn't ever have been prepared for is the outpouring of love that Cooper has been surrounded with and the pure joy that he brings to people. Knowing that he is so loved by our entire family, Trish and her family and all of our friends, neighbours and acquaintances leaves me with such an incredible feeling of peace, contentment and pride. He is indeed a very special little man. The road we took to Cooper was not without its ups and downs, and most of the time we described it as a roller coaster. As hard as the bad times were, I wouldn’t change a thing because each low, each disappointment, was part of the journey and was a learning experience and a chance to grow. The journey changed us in some respects and made us the people we are today – Cooper’s parents. I think because we had to work so hard to get to where we are today, and endure so much, we will never take Cooper for granted. He is very special and was chosen for us, long before he was ours.
“I didn’t give you the gift of life; life gave me the gift of you.” – Unknown
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My Story What IVF is Really Like by Melissa Pennarun
Although it may seem that I've been open about my infertility journey on Facebook, I have to tell you that there is a lot I have left out. While IVF treatment is free in Quebec, we have easily spent over $10,000 in travel expenses and medication and, if I figure in time lost from work, a heck of a lot more than that. I don't like to think about that part. But the financial toll is really just the tip of the iceberg. Consider that you need to start medication at least three weeks before the retrieval. You're getting three injections per day that have to be taken at precise times. For me, this involved conquering a needle phobia. You have other medication to go along with that. It's impossible to stop thinking about the process. You have to start preparing those vials 15 minutes in advance. You have to consider that sometimes you'll need an injection when company is over, when you're travelling, when you might have other plans. I've done injections in the car, in a Tim Hortons, at the train station, at a friend's house, at Eric's dad's house… Not to mention at least a week of ultrasounds in another city before the egg collection. The egg "collection" itself involves repeatedly jabbing a long needle through your vaginal wall into your ovaries. At our clinic, they do
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this while you are awake. Sometimes, they accidentally hit your bladder. Sometimes they have no choice but to go through your bladder because of the way your ovaries are positioned. They say, “Hang on. This is going to hurt a lot but try to stay still.” If you move because of the pain, that needle keeps on going in the direction it's pointed. When they let you get up from the stretcher after the procedure, it's covered in blood. Your abdomen becomes so swollen you look like you're pregnant. And when they call you the next day with the results, all your hopes could become crushed in an instant. All that you went through could be for nothing. You hold your breath waiting for the call. After three attempts, we got lucky and got one embryo.
The transfer isn't terribly bad if you don't mind a nurse pressing down hard on your full bladder while you contort yourself into different positions on the edge of a stretcher in an effort to help the doctor insert a tube through your vagina and into your uterus. I actually didn't mind that bit when it happened to me because it was the furthest we had come and I was feeling very grateful to have gotten that far. Then come the progesterone shots and estrogen patches. One of the side effects of progesterone is nightmares. One night I dreamt I kept falling asleep at the wheel and couldn't regain control of the car. I saw myself driving into other cars, rock cuts, driving off bridges… Another night I dreamt I was drowning. Yet another night Eric insisted
on carrying me on his back as he swam from New Brunswick to PEI. Another time I dreamt we went on a cruise - in a whale's mouth. That one wasn't so bad, although I did wake up feeling terrible about abusing a whale in such a way. It's just not right to dance or spill drinks on a whale's tongue.
And again, during what's called the two-week wait, you're stuck in limbo, you're on a schedule that you can't forget or you'll ruin all your efforts to that point. Eric and I meditated together before the injections. It became a part of our routine. In a twisted way, I actually started to enjoy that time. It was a way for us to connect and remember why we were doing all this. I started thinking it would be easy to keep going for another six weeks. I started feeling really hopeful.
By the time I got to the train station yesterday, I was so sure it was going to work this time. I imagined holding the baby in my hands on the ride there. I could feel his or her head in the palm of my hand, the tiny hand around my finger. The tip of my finger against the soft cheek. I felt the weight of a baby in my arms. I imagined singing and reading a book to him or her. I imagined the colour of the hair, the eyes, and smiled knowing that any colour would be perfect. I saw him or her growing up. I imagined the excitement of discovering his or her interests. The joy in that child's face. When I got the call at the train station in Montreal yesterday afternoon, I was so sure that I was pregnant that I could hardly understand what the nurse was saying. It seemed impossible that this child would not exist.
It still seems that way.
I'm putting this out there because I want people to understand that there is a grieving process that takes place after a failed IVF. IVF is not your ordinary medical procedure, where you go in for surgery and they make you all better. Your odds don't get any better a second time. It takes a phenomenal amount of courage to try again. A lot of people said, “Better luck next time.” Right now, just the thought of trying again makes me feel frantic. I feel very deeply that this was our last attempt. And I don't think it's cowardly of me to say that this was the last time. I am so proud of the people that Eric and I have become through this journey. But it's not one that can go on forever. At some point, you have to decide to live again.
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What To Do With Surplus Embryos? by Susan Precious One of the most discussed issues in reproductive law today is what to do with surplus embryos. During the course of an in vitro fertilization (IVF) cycle, eggs from an intended mother (or donor) are fertilized with sperm from an intended father (or donor), creating an embryo. One or several embryos are then transferred to the uterus of an intended mother (or surrogate) in the hopes of achieving a pregnancy. During the course of an IVF cycle, an individual or couple may create more embryos than they will use. The additional embryos are generally cryopreserved
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(frozen) at the fertility clinic where the treatment is taking place. The intended parents can then use the frozen embryos later in further attempts to get pregnant. At some point, however, intended parents will decide that they either have completed their family or no longer wish to continue with further pregnancy attempts. The question is then, what happens to any additional embryos that are frozen but no longer needed?
Legal status of embryos Before deciding what to do with any remaining embryos, it is first important to understand their legal status. While media coverage may lead you to think there remains a debate about the legal status of an embryo (are they unborn life? are they property?), in fact, Canadian courts have issued several decisions in the past few years confirming that gametes
(sperm and eggs) and embryos are personal property.1
A recent British Columbia decision, Lam v. University of British Columbia 2, dealt with an application by the Children’s & Women’s Health Centre of British Columbia, which is an agency of the Provincial Health Services Authority. The Centre sought an order permitting it to destroy unclaimed embryo and sperm specimens stored at the Centre’s fertility clinic. The issue arose because the fertility clinic closed its operations. The Centre went through extensive efforts to contact all individuals who had specimens stored at the fertility clinic. The fertility clinic received some responses and acted in accordance with those individuals’ directions, but despite extensive efforts to locate the other individuals, many specimens remained unclaimed. The fertility clinic likely had a contractual right to dispose
of the unclaimed specimens but sought the direction of the Court given the sensitive nature of the request. The Court ultimately ordered that the unclaimed sperm and embryo specimens could be destroyed. While embryos are property, they are a special form of property that are subject to some important restrictions on how they can be used. Some of those restrictions will be discussed below.
Restrictions on uses of embryos The Assisted Human Reproduction Act (AHRA), Canada’s federal legislation on assisted reproduction, sets out two important restrictions in relation to the use of embryos 3. First, surplus embryos cannot be sold. Section 7(2) of AHRA prohibits anyone from selling or purchasing embryos. The language in that section differs from other prohibitions in the act (for example, the prohibition on the purchase of eggs) in that there is no debate on the scope, i.e. the sale of embryos is prohibited under any circumstance. There are very significant penalties for violations. A person who sells or purchases an embryo is guilty of an offence and liable to a fine of up to $500,000 or up to 10 years in prison, or to both 4. Second, written consent from the intended parents is required before any use is made of embryos. Section 8(3) of the AHRA confirms that no one can use an embryo for any purpose unless the intended parents5 have provided written consent for a particular use. If there are two intended parents, the consent of both parents is required and they must both agree on how the embryos will be used. The AHRA Section 8 Consent Regulations also contain an unusual provision specifying that if an embryo is created from one genetic parent’s gamete and a gamete from a third party donor, and if that couple splits up before the
Embryo donation is an underused option. While you cannot sell your surplus embryos, you can donate them to other intended parents to build their family. embryo is used, consent is only required from the genetic parent.6
Options for use of surplus embryos There are six options available for future use of your remaining embryos: 1. Thaw and use the embryos for another attempted pregnancy; 2. Destroy them; 3. Donate them to other intended parents; 4. Donate them to improve assisted reproduction procedures; 5. Donate them to scientific research; or 6. Continue to store them (or if your clinic does not have long-term storage, transfer them to a facility that does).
Embryo donation is an underused option; however, it is one that exists in Canada and requires more attention. While you cannot sell your surplus embryos, you can donate them to other intended parents to build their family. There are of course many different reasons people may choose to pursue this route. For some, it may align with their religious beliefs. For others, they may simply wish to assist other people who are on the path to parenthood. From a policy perspective, it is a compelling solution to the dilemma caused by the prohibition on the purchase of embryos and the need for donor gametes in Canada. If you are interested in donating surplus embryos, you should speak with your fertility clinic. You may also consider speaking with a lawyer as parentage laws differ across Canada and depending upon your circumstances, an embryo donor agreement may be wise or necessary. Surplus embryos can be donated to scientific
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Surplus embryos can be donated to scientific research, most notably, to stem cell research. research, most notably, to stem cell research. Remaining embryos can also be donated to improve IVF procedures for example, to improve storing, freezing and implantation techniques. For many people, the choice of what to do with their additional embryos is not an easy one and involves weighing religious, psychological, financial and legal questions. Given the factors to weigh in deciding how to use surplus embryos, it is not surprising that many people find the last option of simply storing the embryos to be the easiest choice to make, at least in the short term. Indeed, there are many embryos being stored across Canada
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today. No one has exact figures on the number of frozen embryos presently in storage but the most recent survey counted 15,000 in 2003.7 That number has undoubtedly increased in the last ten years, particularly given that the number of fertility clinics during that time has doubled.
Issues with indefinite storage of embryos While storage of embryos is a valid option when considering what to do with additional embryos, it is a temporary solution. The longer the embryos are stored, the more difficult issues can arise.
The most common problem is that intended parents may move or change contact information and forget to pass on their new details to the fertility clinics, leaving the surplus embryos “abandoned”. Fertility clinics do not want to find themselves in the unenviable position of having to hold abandoned frozen embryos indefinitely because they cannot reach the intended parents to obtain their consent for disposition. This issue arose recently in an unusual British Columbia case where a long-standing fertility clinic closed its operations. The clinic went through an extensive process to try to contact all individuals who were storing unclaimed sperm and embryos at their facility. Some people asked that their specimens be transferred to other storage facilities while others asked that they be destroyed. However, many individuals did not respond and could not be located by the clinic. The continued storage of the remaining specimens was very expensive, costing close to $2000 per day. Against that background, the clinic approached the court for direction. The British Columbia Supreme Court stated that intended parents do not have a continued right to preservation of their embryos (in the context of that case and the particular storage contracts that were used - the scenario could differ on other facts). The Court found that intended parents did, however, have a right to be notified of the potential destruction so they have an opportunity to transfer the embryos if they wish.8 In addition to embryo abandonment, the other issue that has arisen is where intended parents no longer agree on what should be done with their additional embryos. This issue arose recently in another British Columbia case in the context of divorce proceedings where a couple had four frozen embryos in storage. The wife wanted to try to get pregnant again with the surplus frozen embryos while the husband wanted the embryos destroyed. The Court ordered an injunction against the destruction of the embryos while the divorce proceedings were being finalized.9
Conclusion By far the best way to avoid issues involving what to do with any additional embryos is to carefully consider your options at the front end before starting your IVF cycle. If you are going through IVF with a partner, the decision of what to do must be made jointly. You will need to discuss your options and come to an agreement on what you would like done with any additional embryos. Those wishes should then be set down in writing. Fortunately, most fertility clinics will ask patients to sign consent forms on the use of surplus embryos before commencing their IVF treatment, which will automatically generate thought and discussion on this important issue. References: C.C. v. A.W., 2005 ABQB 290, J.C.M. v. A.N.A., 2012 BCSC 584, Lam v. University of British Columbia, 2013 BCSC 2094, Lam v. University of British Columbia, 2013 BCSC 2142. 1
Lam v. University of British Columbia, 2013 BCSC 2142
Lam v. University of British Columbia, 2013 BCSC 2142 - parag. 38
Other restrictions apply, including the prohibitions set out in section 4 of the AHRA. Lam v. University of British Columbia, 2013 BCSC 2142
P. Fayerman, “Who owns frozen embryos? The fate of four at stake in this divorce battle.” Vancouver Sun (December 14, 2012) available at: http://blogs.vancouversun.com/2012/12/14/whoowns-frozen-embryos-the-fate-of-four-at-stake-inthis-divorce-battle/ (accessed April 15, 2014)
2
3
Assisted Human Reproduction Act, S.C. 2004, c. 2 section 60. 4
8
9
The language used in the AHRA and support regulation is of a “donor” rather than “intended parent”. 5
About the Author Assisted Human Reproduction (Section 8 Consent) Regulations SOR/2007-137 section 3(h). 6
S. Kirkey, “Abandoned embryos: Clinics ethically free to dispose of thousands of embryos frozen in time, doctors' group says” (September 9, 2013) available at: http://www.canada.com/health/Abandoned+embry os+Clinics+ethically+free+dispose+thousands+embr yos+frozen+time+doctors+group/8884700/story.ht 9:20 AM Page 1 ml7/16/07 (accessed April 14, 2014). 7
Susan Precious is a lawyer in Vancouver, British Columbia. She practices health law and provides advice to health profession colleges, health professionals and patients in relation to a broad range of legal issues, including reproductive law.
Regional Fertility Program Dr. Shu Foong / Dr. C.A. Greene / Dr. Jason Min / Dr. J.A. O’Keane Dr. S.G. Scott / Dr. B. Wong
We offer a full range of diagnostic and treatment programs for both male and female fertility disorders as well as for recurrent pregnancy loss.
The desire to have a child is an exciting and compelling part of most peoples’ lives. Unfortunately some couples will experience difficulty in fulfilling this wish. However, there are fertility treatments available at the Regional Fertility Program (RFP) that can assist many couples in overcoming these difficulties.
The physicians and staff at the RFP have over 20 years of experience in the diagnosis and treatment of infertility problems. The in vitro fertilization program at the RFP began in 1984 and since that time over 12,000 babies have been born as a result of this treatment. Today it is one of the most successful IVF programs in Canada, with patients coming from across the country to receive treatment in Calgary. As you continue on your path to establishing your family the RFP has the experience and resources to assist you in your care.
Regional Fertility Program, Cambrian Wellness Centre, Suite 400, 2000 Veteran’s Place NW, Calgary, Alberta T3B 4N2 Telephone: (403) 284-5444, Pharmacy: (403) 284-5401, DSL: (403) 284-9410, Fax: (403) 284-9633 www.regionalfertilityprogram.ca
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"Why Aren’t I Happy?" Adjusting To Parenthood After Infertility
by Judith Daniluk and Emily Koert
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You've waited years to become a parent. What you thought would be a relatively easy process turned out to be anything but easy. You suffered through months, or perhaps years, of invasive fertility tests and treatments. You faced gut-wrenching disappointments and losses. Each disappointment made your desire for a child even stronger, albeit more elusive. Your strength and coping resources were tested. The strength of your relationship was challenged. Your faith was put to the test. You suffered through very dark days and many times you wondered if you’d ever become a parent. But you persevered and maybe even beat
the odds. You finally heard the words you’d been waiting to hear: “You’re pregnant,” or if you applied to adopt a child, “A birth mother has selected you.” You held your breath for the first few months, telling no one about the pregnancy or pending adoption, just in case something happened. Then you ever so cautiously maneuvered your way through the remaining months, trying to keep that delicate balance between excitement and fear – hopeful that your pregnancy would go well or that the birth mother wouldn’t change her mind. Finally, after all the pain, suffering and anticipation, you have your new son or daughter in your arms. You’ve waited for this for so long, and dreamed about how you would feel – unbearable love, awe, amazement, excruciating joy, unbelievable tenderness, a sense of fulfillment. But what you never expected was to feel sadness, disconnection, and perhaps even despair. You’re confused. This child is what you’ve been waiting for – what you’ve turned yourself and your life inside out to make happen. So why aren’t you overjoyed and madly in love with your child? Why aren’t you happy?
Enduring myths about new parenthood The answer is two-fold. First, there are a number of common myths about new parenthood that we’ve all been led to believe – you will love this child instantly and intensely, you will feel overwhelming joy in this new role, you will intuitively know what your child needs and be able to respond to his or her needs, you will feel closer to your partner now that you’ve become parents together. Unfortunately, for many women and men these common beliefs simply aren’t true. In reality, the transition to new parenthood is one of the most significant and often stressful events in life. It is a transition filled with many changes and new challenges which, depending on your
background, personality, expectations, and particular life circumstances, you will be more or less prepared to deal with. These challenges are even greater if the transition involves twins or triplets, as is still the case for approximately 20% of Canadians who become parents through assisted reproduction.
You’re confused. This child is what you’ve been waiting for – what you’ve turned yourself and your life inside out to make happen. So why aren’t you overjoyed and madly in love with your child? Why aren’t you happy? Secondly, having been through months or years of dealing with fertility can have a significant impact on how you are able to cope with the transition to parenthood. Most “fertile” people come to new parenthood perhaps a bit tired or stressed from the demands of a pregnancy, particularly if there have been
problems during the pregnancy or delivery. However, those who have spent months or years dealing with the pain, distress, and disappointments of infertility and invasive medical treatments prior to becoming a parent are often emotionally and sometimes financially much more depleted before making this transition. Many infertile couples have had their sexual and intimate lives ravaged during the treatment process, and have had their selfconfidence eroded. It is against this backdrop of stress, grief, pain, and loss that you are making the transition to new parenthood – whether through a viable pregnancy or adoption. You may be incredibly grateful for being one of the lucky ones who finally had your dream of becoming a parent come true. But after years of seeing a child as the answer to your dreams and hopes and prayers, it is not unusual to find that the reality of new parenthood doesn’t live up to these expectations. With this context in mind, below we look at some of the common myths about the transition to parenthood. We try to balance these myths with what we know about this transition based on the available literature and our clinical experience working with infertile individuals and couples who make this transition. In so doing, we hope to help explain why you might not be feeling that ecstatic glow that all new parents are portrayed as experiencing, and why it is entirely normal to not be feeling that way.
Myth #1: You Will Love This Child Instantly and Intensely Most people assume that once they see their child for the first time, they will instantly fall in love. However, the reality is often very different. New parents often don’t feel instant love for their child – protectiveness, yes, but not necessarily love. Every parent needs some
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parenting without a partner, or if you don’t have friends and family members available to help out. It’s also hard to feel joy when you’re feeling overwhelmed with the demands of new parenthood. New parents often struggle to cope with the increased responsibilities related to caring for a newborn. Many struggle with the loss of freedom and independence – particularly the parent who is the primary caregiver. Research shows that women are at higher risk for depression, anxiety, mood swings, and fatigue in the postpartum period and during time to get to know and begin to “bond” with this new little person. This experience can be exacerbated by feelings of disappointment if their birth plan wasn’t realized, or if there were problems in the adoption process. It is not uncommon for new parents to feel disappointed if the child isn’t what they expected or pictured in terms of sex or appearance, or if the baby has health problems. If you feel this way, you’re not alone – it’s just that most new parents don’t talk about their sadness or disappointment, because they may feel ashamed or guilty. They may worry that something is wrong with them. There isn’t. However, if you’re worrying or feeling anxious about this, it may be more difficult to be present to meet the needs of your child, and to begin to bond with your baby. Be selfcompassionate – recognize that you’ve only just met this little person, and it may take some time for feelings of love to grow. Try not to worry or feel guilty. It is very likely that as you get to know your baby in the days, weeks, and months ahead, feelings of love will develop as you care for your baby’s everyday needs and as you get to know your son or daughter. It’s the routine daily activities – feeding, changing, and bathing – the calmness and pleasure of rocking your child to sleep while s/he nuzzles into your neck – the wonderful, clean smell of a newborn –
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that begin to sew the seeds of love. As with any relationship in life, it takes time to get to know another person and to develop a bond, which is what you’re doing with your child. Bonding can be a tall order, especially when you’re seriously sleep-deprived and your baby doesn’t soothe easily. Even when you’re at your most exhausted and are feeling at your wit’s end, you may be surprised to find your heart suddenly fills with love for your child when s/he smiles at you, coos, or giggles. That said, if, after a few months, when you’re through what we fondly refer to as “the night of the living dead stage of new parenthood,” you’re still feeling disconnected from your baby, talk to your family doctor. It may be that you need some additional support.
Myth #2: You Will Feel Overwhelming Joy in this New Role After surviving the challenges of infertility, most people assume that they will feel overwhelming joy when they finally become parents. However, it’s more common to feel overwhelming exhaustion, especially during the early months of 24/7 intensive parenting. The exhaustion will be even greater in the case of twins and triplets – especially if you’re
New parents often don’t feel instant love for their child – protectiveness, yes, but not necessarily love. Every parent needs some time to get to know and begin to “bond” with this new little person.
After surviving the challenges of infertility, most people assume that they will feel overwhelming joy when they finally become parents. However, it’s more common to feel overwhelming exhaustion. the transition to parenthood. If you’re finding yourself incapacitated with sadness and unable to take care of yourself or your child, you may be among the small percentage of women who experience postpartum depression. Speak to your family doctor about how you’re feeling, so you can get the treatment and support you need. During the transition to new parenthood emotional ups and downs and the “baby blues” are completely normal. Given that
most of the focus is on the baby at this time, there is little time for taking care of yourself. Eating well and getting some exercise often fall to the bottom of the “to do” list, which reduces overall health, well-being, and selfconfidence, which in turn increases the risk of depression. Research also shows that people who are lucky enough to become parents after having been through infertility often have much higher expectations of themselves as parents, and more unrealistic expectations of what it is going to be like to finally become a
parent. When the reality of new parenting doesn’t fit with these expectations, it can lead to disappointment with oneself, one’s partner, or with one’s child(ren). To add to the burden, after working so hard to become a parent those who have been through infertility, and sometimes those around them, often feel they don’t have a right to complain, irrespective of how difficult the transition to parenthood is. They are among the “lucky ones” who beat the odds! Unfortunately, this often results in greater isolation, and a reluctance to
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seek the support and assistance they could really use in managing and getting through this transition.
If you find yourself not feeling overcome with joy in your new role as a parent, try not to worry or feel guilty about it. With all of its highs and lows, most people don’t love every minute of new parenting, and you don’t have to either. So try to shift your expectations and give yourself a break. Enjoys the highs when they happen, and accept that there are going to be lows. Remind yourself that you’ve been through a difficult and emotional journey to become a parent – a journey that likely has left you and your partner pretty depleted. As well as the physical toll of infertility treatments, you may have emotional wounds that have not entirely healed.
There is a wise old proverb that goes something like this: “Joy shared is joy doubled, sorrow shared is sorrow halved.” If you’re feeling sad, isolated, overwhelmed, or inadequate – all common feelings shared by new parents – don’t keep it bottled up inside. Find someone you trust to talk with – whether that is your partner, a family member, a friend, your public health nurse, your family doctor, or a counsellor who has experience in this area. They say it takes a village to raise a child – so you don’t have to do this alone.
Myth #3: You Will Intuitively Know What Your Child Needs and be Able to Respond to His, Her or Their Needs Many new parents assume that they will be immediately tuned into their child’s needs, and that the parenthood role will come naturally to them. It is not uncommon for new parents to feel guilty when they don’t feel they’re the “perfect” parent, especially after
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wanting and waiting to become a parent for so long. The reality is that despite their best efforts, most parents don’t automatically or intuitively know what their child needs. Every child is different, and people – including all
those “specialists” who write books or blogs on parenting – have very different beliefs about the best way to raise a child. Even partners often find themselves on opposite ends of the continuum when it comes to decisions
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During the transition to new parenthood emotional ups and downs and the “baby blues” are completely normal. Given that most of the focus is on the baby at this time, there is little time for taking care of yourself. like whether the baby should be allowed to sleep in their bed, or if s/he should be soothed or allowed to cry him/herself to sleep. In reality, parenting is a bit of trial and error and new parenthood involves a huge learning curve. It’s hard to be the “perfect” parent, especially with multiples. This reality can come as a bit of a shock as new parents shift from their previous identity as a competent person in the other areas of their lives to a parent who is just beginning to “learn the ropes”. This is particularly the case for those who didn’t have younger siblings, or exposure to little ones in their lives or work setting before becoming a parent. Learning these new skills while sleep-deprived can be especially challenging, and make it more difficult to be able to respond to your child’s needs in the moment. These challenges are bound to be
even greater when parenting a child whose health is compromised. When you’ve come to parenthood after infertility and this may be your only shot at parenting, the pressure to “get it right” can be pretty intense. So, if you’re beating yourself up about not being able to intuitively sense your child’s needs, you need to give yourself a break. Be self-compassionate. Remember, you’ve just undergone a huge change in your life and taken on a new and very demanding role. Like any new role, it’s going to take some time to adjust and to adapt. Make sure your expectations of yourself and your partner are realistic. Remind yourself that parenting is a work in progress and nobody gets it 100% right all the time.
through “doing” and trial and error, there are also additional resources that may be of assistance. For example, you might find it helpful to join an on-line support group for new parents as a way of hearing what other new moms or dads who are going through, and picking up some tips on how they’re coping with the challenges. You may find it helpful to browse through some books on parenting, although more often then not the advice of one expert contradicts the advice of another. Remember, no one knows your child better than you do – so at the end of the day, you need to trust your instincts. The reality is that it will likely take some time to get used to your new role as a parent, and to get to know your baby’s needs, wants, and preferences. Like any new role, with time you’ll get into a routine and the learning curve will level out.
Myth #4: You Will Feel Closer to Your Partner Now That You’ve Become Parents Together After navigating the stresses of infertility couples often assume that new parenthood will bring them closer together and/or repair any
Although some parenting skills are acquired
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visits, and so on. One partner may feel protective of his/her role, believing s/he is “better” equipped for certain parenting tasks, and may find it difficult to share certain responsibilities with his or her partner. If this is a “miracle child” after beating the odds, feelings of overprotectiveness and hypervigilance are common, sometimes making it difficult to attend to and nurture the couple relationship (e.g., not wanting to hire a sitter, not wanting to leave the child with anyone else).
On-line Resources www.theafa.org/article/parenting-after-infertility/ www.pailbloggers.com http://jjiraffe.wordpress.com/2012/07/31/face s-of-adoptionlossinfertility-the-den-mother/ http://theinfertilityvoice.com/2013/03/theuntethered-boat-of-pregnancy-and-parentingafter-infertility/ Recommended Reading
strains in their relationship. However, it often doesn’t work that way. While both partners may be thrilled at becoming a parent, parenthood brings a host of new challenges and changes. Each member of the couple must learn to adapt to new roles – moving from being partners to being parents together. They have to negotiate childrearing responsibilities, which can bring a whole new set of challenges. During this time, old, firmly held family scripts and beliefs about childrearing often come to the surface. Differing beliefs about the best way to raise a child may become a source of conflict. Gender role socialization often kicks in when partners become parents, with many “non-traditional” couples finding themselves reverting to traditional gender role expectations on issues such as who takes time off work, who gets up for nighttime feedings, who does the laundry or cooking, who takes the baby for doctor’s
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If you’re feeling disconnected from your partner, don’t panic. It’s bound to take time for both of you to adjust to your new roles and responsibilities. It is important that you see yourselves as a team rather than working against each other. A little good will is likely to go a long way in helping you traverse these new parenthood waters. Keep the lines of communication open, and don’t let things fester. For example, if you’re feeling resentment about your partner’s parenting behaviors or ideas, it will only get worse over time unless you talk about it. Also, as new parents it’s very important that you try to find the balance between being parents and being a couple. To the extent it is possible, try to make time for each other. Don’t push your relationship to the bottom of your priority list. This can be particularly challenging in the early months of 24/7 intensive parenting. Remind yourself why you became partners in the first place and why you wanted to build a family together. Now that you have a baby in your lives you may need to shift your expectations of what “quality time” together looks like. Make a point every day of stealing a few moments together – perhaps checking in with each other after the baby (or babies) has been put to bed in the evening. Find time to be intimate. Touch can be especially important, so take advantage of opportunities to give each other a hug or a caring caress. Remember, you’re on this journey together, and you need to be there for each other, and for your child.
Glazer’s “The Long-Awaited Stork: A Guide to Parenting After Infertility” James-Enger’s “The Belated Baby: A Guide to Parenting After Infertility”
About the Author Judith Daniluk, Ph.D., is a professor of Counselling Psychology at the University of British Columbia. Her areas of clinical and research expertise include women’s sexuality and reproductive health and the psychosocial consequences of infertility. As well as contributing extensively to the clinical and scholarly literature, Judith is the author of Women’s Sexuality Across the Lifespan: Challenging Myths, Creating Meanings and The Infertility Survival Guide: How to Cope with the Challenges While Maintaining your Sanity, Dignity and Relationships.
Emily Koert, Ph.D., is a Registered Clinical Counsellor. Her area of interest and specialization is in women’s reproductive health. She recently completed her dissertation research on women’s experiences of permanent, unintentional childlessness after delayed childbearing.
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FICTION
Silent Conversation in the Depths of Desire by Nathalie Courcy
Translation by Kelsey Angeley Drawings by Alexane Bellemare, Lenya Bellemare and Nathalie Courcy
– Daddy? Mommy? Where are you? I’ve been looking for you for so long… I am your child, the one whom you wish to bring into this world, but who doesn’t come. I am trapped far from your arms, but I need their warmth to shelter me, to curl me up and grow me on Earth. I need parents who will welcome me into their world and teach me life. I need you.
– Our dear child, so wanted, already so loved…. Where are you? We are you father and mother. We’ve been waiting for you for so long… we have an enormous place ready for you in our hearts and in our lives. We need you so that we can fill you with happiness. We need a child like you to teach us life.
– Daddy? Mommy? Why did you not meet me? I want to know you, to nestle in your warmth when I feel alone among the stars. My cries are silent, your response inaudible… In return for my hopes I receive only the echoes of my tries. Answer me!
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Créons des familles • SUMMER/ÉTÉ 2014
Baby thinking about the baby-star who met his parents but had to leave them. – Our child, so wanted, why haven’t you found your path to us yet? All is ready for you: a cozy belly to cradle you until your birth; our open arms to cuddle you; grandparents who wish for you as much as we do; a soft bed to welcome your sweet dreams; a stuffed rabbit as white as the clouds. You alone are missing. You and your babbling, your little smiles, your occasional tears, and all that you carry in you.
– Daddy? Mommy? When are you coming to find me? I’m bored here. I’m popular among the other millions of wished for children who haven’t yet found their way to their parents, but I feel alone. The other night, I even met a
wished for child who had found his family, but he had come back among the stars just as soon as he had left. He is distraught; he does not understand what he could have done to deserve his lot. He tries to return to his parents, but he is scared that he lost his chance. Me, I am scared I will never have my chance.
– Our child, so wanted, when are you coming to meet us? When can we close our arms around you, admire your pureness, learn to know you, introduce you to the people we love? We are two, but sometimes we feel alone without you. A part of us is missing. The other night, we dreamed of you. You were an angel among the stars. You were sad.
Our love is immense and profound, but without you it is incomplete, like a galaxy without its sun. We are an empty nest, without nestlings to keep warm.
– Daddy? Mommy? If you are not there, who will choose the name that suits me? Who will cradle me at night when I’m afraid of the dark or of the future? Who will throw me in the air laughing to teach me trust? Who will hold my hand the first day of school to steer me towards autonomy? Who will console my
Baby crying because he cannot meet his parents.
first heartbreak by showing me that I am infinitely loved? Who will cry tears of joy when I become a parent in my turn? Who will love me unconditionally? Who will help me become all that I am, no matter what? Who will help me to realize everything I am capable of, and to overcome the impossibilities?
– Our child, so wanted, if you are not there, who will call us Daddy and Mommy? Who can we love more than ourselves? Who will help us to become better people, accomplished and blossoming as individuals and as parents? Who will force us to push ourselves each day, each night of our lives? Who will we cradle on sleepless nights? Who will remind us to keep the child in ourselves alive and well - the inner child who bursts with laughter, who is moved by the colours of the rainbow, who picks blades of grass to make a bouquet, who sings even when they are sad?
– Daddy? Mommy? It hurts me to not already be with you, but the desire that you give me to live keeps me in the light. Disappointment wrings my heart each time I become lost on my way to you, but my happiness at knowing that you want me as much as I hope for you comforts me. The
What stops you from joining us? It seems like our chance has been lost in the maze of time.
– Daddy? Mommy? Have you forgotten me? Have you abandoned me? Without you I feel so small and fragile in this universe… You are my dream, my strength, the earth where to lay my roots. Without you, I float in the sky like a flag without a nation. I am a bird without destination or nest, a course of water that leads to no ocean.
– Our child, so wanted, we no longer know how to live without dreaming of you. You are our breath each instant, the star that guides our steps. Sometimes, we are scared that you are no more than an illusion, a mirage that crumbles when we get near you. You are our strength, the flower that we wish to see grow.
Baby thinking about the baby-stars who try to join their parents.
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Drawing by Lenya Bellemare
because the tenderness that we feel at your thought is infinitely sweet. If the powerlessness that we feel before a path that does not end distresses us so, it is because we feel that we have done all in our power to find you. And if our pain before your absence could fill the ocean with tears, it is because our cries of joy at your birth will overflow the universe with beauty and recognition of life.
Everything is ready for the much-awaited baby: The hopeful grandparents, the snow-white bunny, the cosy bed, the comfortable belly, arms for rocking ‌
– Daddy? Mommy? I know how much you want me and how much my absence devastates you. When I look towards you, I see an intense light full of your hope. I try to send you the light of my star, but it does not reach you. A wall separates us, prevents us from meeting each other. A dome is placed between you and me, between us and our dream of becoming a family.
– Our child, so wanted, we know that if you could, you would join us. Do not worry about us; we will do all we can to help you find your way to us. When we look at the sky, we see all the stars, and among them, there is you in your uniqueness and your warmth. The universe is gigantic, but despite its infinity we will find you, we will still choose you, day after day, night after night, until we are united. And we love you, whether you are in our arms or in our dreams. We love you more and more, because we are your parents, and you are our child.
– Daddy? Mommy? I love you, and I am waiting for you. tenderness I feel at your thought calms the anger that screams in me like a geyser when I think of the injustice that harries us. In all the universe I am but the In ncreea asse IVFF preeg gnanccyy ra attee 43% % wiith i h Acccup pun nctu urree1 slightest thing, useless and invisible; but for you, I am worth more than all the stars put Aina Zhang ²´8Q membre important de la Dream Team together. The firmament is filled with the de &pOLQH 'LRQ¾ /H -RXUQDO GH 0RQWUHDO 01/06/2010: sound of my cries seeking you, but on our day o Dr of Chinese & Western Medicine (1982, China) of meeting, the burst of my laughter will o 0DVWHU¡V GHJUHH LQ *\QHFRORJ\ \ (1987, China) overrun every cell in space. o Over 30 years of clinical experience o Licensed acupuncturist in Qu Q ebec (1995) o Helped to make over 500 baabies (2010 ~ 2012) o Guaranteed every day acup puncture service – Our child, so wanted, know that the intensio P e r s o na l i iz e d h he r b ba l medic di i in ne to impr i ove pregnancy y ratee 2 fold2 ty of our sadness at not knowing you is the o Opened the first fertility y accupuncture clinic in Quebec (2005) measure of our desire to cradle you one day. If o Le c tu r e d the f irs t f e r til ity y ac a upuncture program in Quebec (2011) our disappointments are so grievous each time o Produced the first fertility y ac a upuncture DVD course in n the world (2011) we do not meet, it is because the happiness of becoming your daddy and your mommy will Clinique SinoC Care Innc. Creating New Life with Acupuncture be immense. If our anger at a destiny that leads 514 483 6669 4177 Decarie i Blvd. Montreal www.sin nocare.ca 1. The average of 3 studies in Fertility & Sterility 04 4/2002, 055/2006 /2006 & 06/2006 us farther away from you is so full of rage, it is 2.Efficacy of TCM herbal medicine in the management of femalle infertility
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CrÊons des familles • SUMMER/ÉTÉ 2014
Poem for the Flown Away Child You were born in our heart From our first look Like a work of art That never dies. You grew up in our dreams Drawing by Nathalie Courcy
Like a passion, an obsession That goes beyond all reason, A fever that does not break. Month after month, year after year, Our desire for you has stayed alive,
Fledgling without a nest nor destination, who could find a home with loving parents.
But we will never share our blood With you, our flown away child. Go, our treasure, our heavenly light. Fly to the kingdom of wished for children Dance, laugh, and sleep in all freedom. We no longer wait for you, but we love you infinitely.
Drawing by Nathalie Courcy
About the Author
When we look at the sky, we see all the stars, and among them there is you.
According to her family, Nathalie Courcy was born "holding a pencil". She uses writing to create beauty and touch people's hearts and minds. A Ph.D. in francophone literature, she taught at the University of Alberta, in Edmonton, for five years and now works for the federal government. She is blessed to have four wonderful children with her husband, all born from donor insemination: Alexane, 10 years old, Lenya, 8, Félix-Olivier, 3 and Izaac, 18 months old. In the Spring 2013 issue of Creating Families, she published the tale “Magical Babies”, illustrated by her eldest daughters, and “Lettre à mes enfants magiques” in the Summer 2013 issue. She lives in Gatineau, Québec.
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CIAW 2014 CIAW 2014 –
SCSI 2014 SCSI 2014 –
A Week of Awareness
Each year since its inception, the Canadian Infertility Awareness Week has evolved and grown. This year, we were proud to promote more events than ever before - 26 in total! We were present in public markets, on Legislative grounds, walking in the streets, at public talks, information sessions, workshops and virtual events! We were more visible than ever thanks to balloons and t-shirts. We handed out IAAC information pamphlets and bookmarks to hundreds of people and we shared many personal stories during the week.
Une semaine de sensibilisation
Photo : Martin Bouffard
Social media once again played an important role in reaching out to those who are not able to attend events. We proudly released our Visualizing Infertility Infographics over social media; this piece registered more than 12,000,000 impressions and more people view it with each passing day! For the first time ever, IAAC also hosted two 'Tea and Tweet' chats over Twitter. This was a fun and informative experience and we will no doubt use this format again in an effort to grow our readership and followers. It would be inconceivable to discuss the success of CIAW 2014 without shouting out a message of gratitude to our generous sponsors and to the dozens of volunteers who helped plan and organize these events. Without you, CIAW would simply not exist. Enjoy the photos and videos, and please, share these links on your own social networks!
To see photographs, videos and media coverage of CIAW, please click here: http://www.iaac.ca/en/ciaw-2014-3 36 Créons des familles • SUMMER/ÉTÉ 2014
Chaque année depuis sa création, la Semaine de sensibilisation à l’infertilité s’est transformée et développée. Cette année, c’est avec beaucoup de fierté que nous avons parrainé plus d’événements que jamais – 26 en tout ! Nous avons été présents dans les marchés publics, sur les collines parlementaires, dans les rues, by / par à des conférences publiques, à des séances d’information, à des ateliers et à Gloria des événements virtuels ! Nous avons été Poirier plus visibles que jamais grâce à des Executive Director of IAAC Directrice générale de l’ACSI ballons et à des t-shirts. Nous avons distribué des dépliants et signets contenant de l’information sur l’ACSI à des centaines de personnes et nous avons partagés des centaines d’expériences personnelles au cours de la semaine. Une fois de plus, les médias sociaux ont joué un rôle important pour nous aider à joindre ceux et celles dans l’impossibilité d’assister aux événements. Nous avons eu le plaisir de publier notre infographie « Visualizing Infertility » dans les médias sociaux –cette diffusion a enregistré plus de 12 000 000 d’impressions, et d’autres gens s’ajoutent chaque jour à la liste ! Pour la première fois de son histoire, l’ACSI a également animé des chats « Thé et Tweet » sur Twitter. Cette expérience s’est avérée aussi amusante qu’instructive, et nous ferons appel sans aucun doute à ce format pour élargir notre bassin de lecteurs et de personnes qui nous suivent sur les médias sociaux. Il serait inconcevable de parler du succès de la SCSI 2014 sans dire un énorme merci à nos généreux commanditaires ainsi qu’aux nombreux bénévoles qui ont aidé à planifier et organiser ces événements. Sans vous, la SCSI n’existerait tout simplement pas. Espérons que vous apprécierez les photos et vidéos, et ne manquez pas de cliquez sur le lien ci-dessous pour en voir davantage ! Pour voir des photos, des vidéos ou la couverture médiatique de la SCSI, veuillez cliquer ici : http://www.iaac.ca/fr/scsi-2014
Un des plus beaux cadeaux que nous avons reçus pendant la SCSI a été cette chanson composée par Alexane Bellemarre, 10 ans, de Gatineau. Nos lecteurs se souviendront qu’elle et sa sœur Lenya ont illustré le conte Bébés magiques que signait leur maman, Nathalie Courcy, dans le numéro du Printemps 2013. Alexane a composé cette chanson pour son petit frère qui n’a pas eu le temps de naître, mais qui demeure à jamais dans sa mémoire.
Bébé Étoile À six ans, quand tu m’as quittée, Je ne savais pas ce qui était arrivé. Mais quand je t’ai vu briller dans le ciel, J’ai tout compris.
Tu es parti pour toujours. On ne pourra jamais te voir, Mais n’oublie jamais que toi, Tu es toujours dans nos cœurs.
(Refrain) Oh ! Bébé Étoile Tu m’as quittée pour de bon, Mais dans le fond Tu es toujours là Dans mon cœur.
(Refrain) Oh bébé étoile… Oh mon bébé étoile…
Tu es parti sans me dire au revoir, Sans même me laisser le temps de te voir. Je n’ai pas pu voir tes beaux petits yeux, C’était trop tard... (Refrain) J’étais déçue que tu sois parti, J’aurais aimé m’asseoir et te bercer Au chaud dans mes bras tous les deux ensemble On ferait dodo (Refrain) SUMMER/ÉTÉ 2014 • Creating Families
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This infographic was immensely popular on social media during CIAW, with close to 13 million impressions around the world, including 6 million in Canada.
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Créons des familles • SUMMER/ÉTÉ 2014
Cette infographie a obtenu un immense succès dans les médias sociaux pendant la SCSI, avec près de 13 millions d’impressions à travers le monde, dont 6 millions au Canada.
COMMERCIAL SURROGACY IN
INDIA:
EXPLOITATION OR MUTUAL ASSISTANCE? Some call it India’s “next big par Vinita Lavania, Ph.D. in sociology Commercial surrogacy in India has grown into a multimillion-dollar industry since a Supreme Court judgement made it legal in 2002. Couples from around the world now travel to India to seek the services of surrogate mothers, at a cost that is only a fraction of what they would pay for comparable services in their home country. One pioneer in the field is Dr. Nayna Patel, who owns an infertility and IVF hospital in Anand, a small city in the state of
outsourcing business”, and commercial surrogacy’s most virulent critics call it a trade that involves exploitation of women. Gujarat, Western India. It all began in 2003, when Dr. Patel arranged for a local woman to carry her own daughter’s child following an IVF procedure. The daughter lived in the U.K. but the pregnancy took place in India.
When the surrogate mother gave birth to twins – who were at once her surrogate babies and her genetic grandchildren – the event attracted worldwide attention and Dr. Patel found herself fielding numerous requests for surrogacy.
Since then, other clinics have appeared in this area and elsewhere in India. According to Dr. Anoop Gupta, head of an IVF clinic in Delhi, most surrogacy cases concern couples from Israel, New Zealand, the West Indies, USA, Canada, the United Arab Emirates, England, Japan, and Germany. Fewer than 50% of surrogates are hired by Indians of the Diaspora – non-resident Indians settled in the US, the UK, South Africa and elsewhere – although several surrogates have been hired by upper class
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Couples from around the world now travel to India to seek the services of surrogate mothers, at a cost that is only a fraction of what they would pay for comparable services in their home country. professionals from different states in India.In most cases, the biological mother is the intended mother while the surrogate mother carries the pregnancy. Some call it India’s “next big outsourcing business”, and commercial surrogacy’s most virulent critics call it a trade that involves exploitation of women. It is sometimes referred to in very emotional terms like “wombs for hire”, “baby industry”, or “fertility industry”. Nevertheless, Dr. Nayana Patel defends the work she is doing. “There is a woman who desperately needs a baby and cannot have her own child without the help of a surrogate. And at the other end there is this woman who badly wants to help her own family. If this female wants to help the other one ... why not allow that? It’s not for any bad cause. They are helping each other.” Dr. Patel found a strong supporter in none other than … Oprah Winfrey. “A woman helping a woman! I love it!' exclaimed the television star during an interview she conducted with Dr. Patel. On November 1, 2007, the newspaper India Abroad proudly reported that Oprah had taken her crew to Anand, along with an American couple who could
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Créons des familles • SUMMER/ÉTÉ 2014
not conceive because the wife’s uterus was badly damaged. A poor Indian woman called Sonia (not her real name) was now carrying their baby created with the wife’s eggs and the husband’s sperm. The newspaper went on to report that Sonia was receiving $50 a month for food plus free housing and medication. She would cash in over $6,000 after delivering the child and hoped to buy a home with the money. “Counselling” is major part of the surrogacy process in India, but it takes on a special meaning here. The doctor tells the women to think of the pregnancy as “someone’s child com[ing] to stay at your place for nine months.” Amrita Pande, a sociologist at the University of Cape Town, conducted extensive interviews with commercial surrogates hired by the Hope Maternity Clinic in Anand. Her work is summed up in her 2009 article entitled “Not an Angel, not a Whore” which appeared in the Indian Journal of Gender Studies. Several of Amrita Pande’s interviewees said, “I will also have to give up my daughter once she is married, but I still remain responsible if she does something wrong; at least with this child I won’t be responsible once I give it up.”
The financial motivation Some clinics have expanded to include hostels where the surrogates are kept under constant surveillance during their pregnancy – their food, medicines, and daily activities are monitored. Amrita Pande reports in her article that all the surrogates “live together in a room lined with iron beds and nothing else. Husbands and family members are allowed to visit but not stay overnight. The women have nothing to do the whole day except walk around the hostel, share their woes, experiences and gossip with the other surrogates while they wait for the next injection.” Pande’s interviews with dozens of surrogates and their family members make it clear that financial gain was the main motivation for becoming a surrogate. In commercial surrogacy, the surrogate is paid a fee and is also compensated for any expense incurred during her pregnancy. Indeed, most of her subjects had family incomes below the national poverty line, and several confided that they had been persuaded or coerced into undertaking pregnancy-for-pay by their husbands. Economic incentive plays a part for clients as
well. India is becoming a cheap destination for foreigners wanting to use assisted reproductive technologies, and local clinics are promoting surrogacy arrangements because they are seen as lucrative ventures. For international couples hiring surrogates in India, the savings are substantial – the whole process can be completed for $5,000– $20,000 USD.
mothers. One fertility centre in Pune has not only advertised its surrogacy program for childless couples, it also openly invites women aged 25 - 30 years to join up as members of the service providing group. For most of the surrogates’ families, the money earned through surrogacy (anywhere between $3,000–$6,000 USD) is equivalent
pay for her son’s heart operation. She carried a child for a woman who had spent $200,000 USD trying to become pregnant through IVF and was considering spending another $80,000 USD to hire a surrogate in the United States. “We were so desperate, and it was emotionally and financially exhausting,” the woman told
to nearly ten years of family income.
the BBC reporter. After spending $20,000 USD to hire a surrogate in India the couple are now back home with their 4-month-old baby.
Dr. Patel found a strong supporter in none other than … Oprah Winfrey. “A woman helping a woman! I love it!' exclaimed the television star In India there are thousands of poor women with few economic opportunities, who will see this as a way of earning some money. The amount of compensation given to the surrogate mother is another particularly contentious aspect of commercial surrogacy considering that what is involved is the creation of life – a baby no less. It is telling that in surrogacy arrangements in the West up to 50 per cent of the total amount goes to the surrogate mother, while in India most of the money is appropriated by sperm banks, ART clinics and lawyers. The medical industry is quite open about this business and even engages in advertising. According to newspaper reports, at a hospital in Anand the doctor in charge openly celebrates the “income earning opportunities” she is providing for surrogate
On BBC World journalist Shilpa Kannan reported the case of Mrs. X – like most surrogates, she does not want to reveal her identity because she believes there is a stigma attached to surrogacy in India. Mrs. X is no ordinary mother. She had five pregnancies – two babies were her own, and the other three she carried for childless couples. A single mother, she was faced with financial difficulties and she first agreed to be a surrogate to pay for the education of her two sons. “I can’t earn this kind of money in a regular job,” she says. “I am educated and I know what this involves. This has helped me build a house and pay for the future of my two sons. I plan to do this again and again to earn as much as I can for my family.” Another surrogate wants to use the money to
Some opponents of commercial surrogacy foresee the day when “surrogacy brokers” become legal and mainstream. The proliferation of commercial surrogacy in a poverty-ridden and strongly patriarchal country such as India could lead to new heights of commoditization of women’s bodies and new forms of patriarchal subjugation. However, while there should be protection for those potential surrogates who are vulnerable to exploitation because of their economic circumstances, commercial surrogacy cannot be overlooked. Clearly, surrogacy raises a host of legal and
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In India there are thousands of poor women with very few economic opportunities, who will see this as a way of earning some money. emotional issues to which there are no right answers.
regulation bill tabled in 2013 is still pending with parliament. The Union Health and Home Ministers do not agree on whether singles could opt for surrogacy in India. The Women and Child Development Ministry suggests surrogacy should be allowed for everyone, including unmarried couples and those in live-in-relationships.
In search of a legal status Considering that surrogate motherhood has been a controversial practice worldwide, the need for guidelines and legislation on the subject is obvious. A factor that has contributed to the negative perception of surrogacy is the lack of a definite legal framework to deal with surrogacy and related issues. Even though commercial surrogacy has been legal in India since 2002, there are no laws as such governing surrogacy in India. The proposed ART
G-Smart (Global Surrogate Mother Advancing Rights Trust), an non-governmental organization, was formed in Chennai in January 2013 in order to protect the rights of surrogate mothers. G-Smart is also considering providing them with insurance. However, ambiguity surrounds the surrogate mother’s
Infertility ~ Miscarriage & Other Reproductive Losses ~ Pregnancy Relationships ~ Life Transitions Skype Counselling available s
s
rights. Because there is no specific legislation, the Indian Contract Act is applied to surrogacy cases. The Indian Association for Human Reproduction and the Federation of Obstetric and Gynaecological Societies of India (FOGSI) are currently formulating recommendations for legislation. In the absence of any formal laws, clinics follow “informal rules” for selecting surrogates – for example the woman should not be over 40, she should be medically fit with a healthy uterus, she should be married and should have borne at least one healthy child. In India a female can be a surrogate as many times as she wants and her health allows. In India couples usually identify a surrogate mother through a doctor at the fertility clinic. The woman who agrees to being a surrogate signs a consent agreement. While in India, the only thing a couple resorting to a surrogate has to do is sign a short contract.
Couples s Individuals s Groups
Louise Kirkhope
. C C 203-335 Wesley Street, Nanaimo, BC V9R 2T5 T 250 741 4421 E louise@conceivableoptions.com W conceivableoptions.com
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Créons des familles • SUMMER/ÉTÉ 2014
The Manji and Balaz cases Two cases in particular have highlighted the need for stricter regulations.
Suddenly baby Manji had three mothers – the intended mother who had contracted for the surrogacy, the egg donor and the gestational mother – yet legally she had none… A Japanese couple called Yamada travelled to India to hire a surrogate mother. Dr. Patel arranged for a married woman to be a surrogate. She supervised the creation of an embryo made from Yamada’s sperm and an egg harvested from an anonymous Indian woman and then transferred into the surrogate’s womb. In June 2008 the Japanese couple divorced and a month later baby Manji was born to the surrogate mother. Although Mr. Yamada wanted to keep the child, his ex-wife did not. Suddenly baby Manji had three mothers – the intended mother who had contracted for the surrogacy, the egg donor and the gestational mother – yet legally she had none… The surrogacy contract did not cover this type of situation. As far as Dr. Patel was concerned, the clinic had fulfilled its promise to produce a baby. In exchange for her services, the surrogate received a house worth US$6,825, a payment of $1,050 and $105 per month for living expenses while pregnant; the responsibility of the surrogate had ended when the baby was born. The anonymous egg donor had neither rights nor responsibility towards the baby – so none of the three mothers was legally responsible for baby Manji.
Because the Japanese civil code recognizes the woman who gives birth as the sole mother and does not recognize either the surrogate or the surrogate baby, baby Manji was not entitled to a Japanese passport. Yamada’s next hope was the Indian government. As Indian laws don’t address commercial surrogacy, the genetic parents of babies born via surrogacy are required to adopt them. However, the Guardian and Wards Act of 1890 does not allow a single man to adopt baby girls: It was clear that Yamada and Manji were caught between two legal systems. After a long legal process the Anand municipality issued a birth certificate to Manji Yamada stating only her father’s name. The official process application for a travel document to Japan could finally proceed. Baby Manji was five months old when the Japanese embassy issued a visa on humanitarian grounds. In the context of the Manji case the Supreme Court of India stated that commercial surrogacy is permitted in India. That again increased international confidence in turning to India for surrogacy. Then, in November of 2009, the Gujarat High Court rendered a landmark decision in
the case of twins Nicholas Balaz and Leonard Balaz, whose father is a German national who had no partner or spouse when he sought surrogacy services. An unidentified woman from India had donated the ova which were fertilized with the sperm of Jan Balaz. The resulting embryo was transferred into the womb of a woman in Anand who gave birth to twins. The babies were issued an Indian passport. However, after Balaz’s nationality and the surrogacy issue became known, the father was ordered to surrender the passports. After a long struggle that involved considering case laws pertaining to surrogacy in such countries as Ukraine, Japan and the US, the court decided the case at hand by recognizing the surrogate mother as the natural mother of the children. As the woman is Indian, the children were granted Indian citizenship under the law, irrespective of the father’s nationality. The High Court observed that, “...a lot of legal, moral and ethical issues arise for our consideration in this case which has no precedents in this country,” and it also directed the Central Government to immediately frame the necessary laws.
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What does the future hold? Health experts expect to see an increasing demand for commercial surrogacy in India in the coming years. Dr. Indira Hinduja, a prominent fertility specialist who was behind India’s first test-tube baby, receives several inquiries a month from couples overseas. “Today people accept this. Formerly they used to be ashamed but now they are becoming broad-minded.”
However, if the practice of commercial surrogacy keeps expanding, some fear it could evolve from a medical necessity for infertile women into a convenience for the rich. Indian clinics report that the incidence of surrogacy has more than doubled in the last seven years, with the demand driven by fertility requests from abroad and the decision by some professional women to delay trying for a family until their late thirties.
A recent BBC News report estimates the country’s booming surrogacy industry to be worth more than 500 million USD a year – and growing. Though commercial surrogacy for infertile couples seems to be a practical approach, we should think about the future, because surrogacy has deep social implications.
Unsurprisingly, with such ambiguous regulations in place surrogacy in India has become a dangerous playing field for middlemen who try pushing uneducated and poor women into surrogate motherhood. It is still very much a grey area from an ethical point of view. Quite apart from the purely ethical questions, the most obvious hazards relate to the risks involved for the surrogate mother. Indian women may well have agreed to rent out their wombs, but most of them prefer to hide the bulge because of the stigma attached to the idea of carrying someone else’s baby. A
surrogate mother stated that, “When the child is born we will tell friends that we have given it away to someone or that I had a miscarriage. It is difficult to tell the truth because people will think that I had a relation with someone.” Not to mention the risk to the surrogate mother’s and the offspring’s health. In order to boost pregnancy rates, some physicians tranfer several embryos at a time, thus raising the risk of multiple births.
The emotional concerns should not be underestimated either. Childbearing is not just like any other activity. There is a strong possibility that the expectant mother can develop emotions that make giving the child away extremely difficult and that emotional damage may be caused by having to part with the child.
The Fertility Clinic at Victoria Hospital, London Health Sciences Centre, is internationally known for its excellence in fertility treatment. For more than 35 years, the physicians, nurses, laboratory technologists, counselors and administrative support staff at The Fertility Clinic have been providing state-of-the-art fertility treatment in a compassionate, caring and safe environment. The Fertility Clinic offers a full range of fertility services for both male and female patients as well as gynecological care, including: Minimally Invasive Surgery Early Pregnancy Assessment Unit Ovulation Induction/Ovarian Stimulation Sperm Banking Microsurgical Sperm Extraction
Embryo Cryopreservation Preparation Counseling/Stress Management Intrauterine Insemination Donor Insemination In Vitro Fertilization
Intracytoplasmic Sperm Injection Laser Assisted Hatching Gestational Surrogacy Egg Donation
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Créons des familles • SUMMER/ÉTÉ 2014
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Some questions need
Unanswered questions
urgent answers,
Many sensitive, surrogacy related issues need to be tackled on a priority basis. Moreover, some questions need urgent answers, such as:
such as: • What can the surrogate do if the couple refuses to
• What happens if the surrogate dies during child birth? • What can the surrogate do if the couple refuses to take the child?
take the child?
• What can the couple do
child?
Desai, Pankaj(2007) “Insight into the business of health care,” Indian Express Newspaper, Mumbai. Ghosh, Jayati(2006) “Rent-a-womb: The latest Indian Export” Macroscan. retrieved on 30 April, 2008. Niazi, Shuriah (2007) “Surrogacy Boom” Niazi.html retrieved on 10 may 2008. Sharma, Abhinav (2008) “Centre drafting surrogacy legislation,” The Times Of India, August 9, 2008. “Can adoption be a way out for surrogate twins?” Times Nation, The Times of India, January 19, 2010.
• What can the couple do if the surrogate mother refuses to handover the child?
The Associated Press (2007) “India’s surrogate mother business raises questions of global ethics, ” Daily News, retrieved on July 14, 2007
• How much should the surrogate be paid?
Kanan, Shilpa(2009) ”Regulators eye India’s surrogacy sector,” India business Report, BBC
• Who will bear the medical bills if the surrogate falls ill as a result of the pregnancy?
The Hindu, New Delhi (2013) “Surrogacy on the rise in north India.” Daily News, retrieved on November 3, 2013
if the surrogate mother refuses to handover the
Society,Boloji.com retrieved on 26 April, 2008
The Asian Age (2014)
• What happens to unused eggs or embryos and who supervises their fate?
www.surrogacyindia.com www.india surrogacy.com www.surromomsonline.com
•
Should the surrogacy arrangements be disclosed to the child? If so, when?
• What happens if the child is handicapped or abnormal and is unwanted by the couple and the surrogate mother as well? It is time the government take serious actions and consider enacting a law to regulate surrogacy and related IVF/ART technologies in India so as to protect and guide couples turning to such an option. Without a foolproof legal framework, patients will invariably be misled and surrogates exploited. A national policy is needed to check the criminalization of all forms of commercial surrogacy. References The Tribune, Magazine Section- Sunday Extra, 23 Feb., 2007 Lal, Neeta (2007) “Regulating the Surrogacy Boom”
www.delhi.ivf.com
About the Author
Dr.Vinita Lavania is Associate Professor of Sociology at the Government Post Graduate College in Nathdwara, Rajasthan, India. She has authored the book Childless Couples: Infertility and Sterility in India, published research papers in renowned journals and presented research papers at national and international conferences. She visited the Netherlands in 2011 in the context of research on “Surrogacy and Society” under the Scholar Exchange Scheme of ICSSRNOW. She writes regularly in many magazines and newspapers about medical-social issues in India.
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Patient’s Perspective
My Infertility and My Siblings by Charmaine Graham The past couple of days have been big days for my family. My younger sister and my sister-in-law gave birth to their sons only 14 hours apart. As I have been surfing Facebook the past 24 hours, and watching the onslaught of photos of these beautiful two newborns filling up my news feed, I am overwhelmed with the exquisiteness of their new lives, and the joy my family is experiencing as a result of their births. I am also very touched to witness the happiness my siblings are experiencing at the birth of their children; children none of us ever expected them to have.
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Now, let’s be clear; my family has never been exceptionally close. We are a composite family, separated by five provinces, divorce, different sexualities, financial and social classes and family discourse. There is a 21-year age gap between my first born and last born sibling. We are each incredibly different human beings. But we do love each other very much. And today, as I watch my family engage in a unified conversation over the birth of these two new babies, I thought back to my infertility days and how each of my siblings responded to them. I have three siblings. An older sister, Angela,
six years my senior, who lives in Alberta. She has a Masters in Counselling and works for Catholic Social Services. She is gay and she is in a long-term relationship with her wonderful partner Karen. She is brilliant, a computer genius, cerebral, and introverted. Angela was always clear she had no interest in utilizing her reproductive organs – ever. I also have a brother named Chad. Chad is thirteen months my junior and lives in British Columbia. Chad works in construction and is a man’s man, if you catch my drift. He is very smart, very realistic, and he always carries a chain saw, auger or wrench the size of a cocker spaniel in his pocket. Chad was always clear he did not believe in the institution of
Patient’s Perspective I was the only child interested in having kids and to find out it wasn’t going to happen like we all suspected was a bit of a hard pill to swallow.
marriage and never considered that he would want to settle down or have children. And finally, I have another sister, Amanda, 16 years my junior, who lives in Manitoba. Amanda is soft and considerate, kind and vulnerable too. I have been touched by Amanda’s spiritual beliefs in spite of a very challenging start in life. Even in the roughest teenage years when she battled addiction (and won) she stated to me many times she probably would not have children. I suspected this was because she hadn’t yet found that life could be bountiful and happy.
entire family was rather shocked at this news as well. I was the only child interested in having kids and to find out it wasn’t going to happen like we all suspected was a bit of a hard pill to swallow. Two days after finding out I was infertile I remember my older sister Angela calling. She expressed a deep and profound sadness for me. It was heart-breaking for her to hear my unfortunate news as she knew how much I wanted children, and she wanted to help. Angela actually called to offer to donate her fallopian tubes to me. Angela had a step-daughter and was a fantastic mother to her, but she was always very clear she would never reproduce directly. She had no use for her fallopian tubes and would go through a surgery if donating them would help me. Sadly, transplants of that sort are not really a viable option. But I was overwhelmed with her support, her sadness for what was happening to me, and her kind and genuine offer.
See, I have heard on many fronts of siblings of my infertile friends offering to donate eggs, or be a gestational surrogate, but there have been very few situations where this actually happens. It is so gracious to offer, but most people, I believe, are not fully aware at the time of the seriousness of such an offer, and how complicated it can be. At first it sounds kind and wonderful, but then the realities set in and they back away. Take egg donation for example. How many out there reading this have had a sister or female relative offer to donate their eggs? The truth is that once this offer settles the true complications of stimulating to donate eggs, the medical invasiveness of such a procedure, as well as the emotional ramifications of giving one’s sibling an actual biological child are just too much for many people to process and follow through with. The same goes for surrogacy. Pregnancy can be dangerous, and giving birth to a sibling’s
For many reasons it seemed, as we were all coming of age, that my life was the only one to fit the classic “go to university, get married, buy a house, have a baby, be a stay-at-home mom” platform. In fact, it was perceived for almost a decade that I would be the only sibling who would have a child. I was the only one of my siblings to really want a child... When I was 30, and after 18 months of trying to get pregnant, I finally found out I had bilateral tubal blockage with hydrosalpinx complications, I felt defeated and empty. My
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Patient’s Perspective Angela actually called to offer to donate her fallopian tubes to me. I was overwhelmed with her kind and genuine offer.
child can just be a bit too overwhelming to consider as a viable solution. However, I had no doubt in my mind that Angela’s offer to donate her fallopian tubes to me was anything other than absolutely genuine. Offering tubes is a lot different than eggs or to an offer to be a surrogate. I still think of that phone call and it warms my heart. My brother Chad at the time was still unattached and living in Ontario for a brief period of time. I don’t remember talking to him very deeply about my infertility, but I know he felt bad for me. What I do remember though is one day coming home
from work enraged because a friend of mine had become pregnant and was avoiding me. I was so upset and hurt and when I walked into my garage where he was fixing our ATV I started sobbing and ranting about the whole situation. What he did surprised me; he put his tools down, cracked open a beer and sat down on the ATV and started telling me about a relationship break-up he had gone through and how his friends had treated him and how much it had hurt him. He listened to me, he agreed with me on the stupidity of my situation, and he shared a reflective story that let me know I was not alone in feeling ostracized. This man, my brother, sat down
and shared my grief with me. I will never forget that feeling of acceptance and support from him. Chad is not the emotionally giving type, so for him to open up and care about me on this day was profoundly supportive and important to me. My younger sister was still too young to really be of help at this time, as she was only 14. She had her own stuff to deal with and I have always been against having our younger family members taking on the troubles of the adults. When she found out I was infertile she offered to carry a child for us, but while it was an offer made with a good heart, it was made without true understanding of what that meant. And I would never take advantage of that. But I loved her for caring about me, and I made sure she knew she didn’t need to worry. I was old enough to do that on my own, and I had the resources to manage my own problems. Infertility is probably the most isolating experience a woman can go through. To be separated from the rest of the society because of an inability to procreate is horrifying. I felt damaged, ignored, disregarded, dismissed and
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Patient’s Perspective alone. And while there were hurtful things I am sure so many of my friends and family might have said during these years, I also remember the times that they really helped. Usually that help merely involved sitting down, listening to me cry, and giving me a hug, even if it was over the phone. I wonder if the fact that my family is so dispersed also offered me some relief because there were fewer times and family events at which they could say something insensitive or hurtful. And I am sure it was easier for me to accept their support when none of them were even close to having their own children or pregnancies at the time. I believe it would be easy for me to look at the things I didn’t get from my family during my infertility, but instead I try to remember the times they actually stepped up and made a difference.
It took a few years of self-abuse in the infertility arena before I one day realized I was only hurting myself and moved forward with private domestic adoption. I adopted two newborns 19 months apart in my home town of London, Ontario. I am so in love with these
children and feel such a deep gratitude for their lives that I look at them a hundred times a day in wonder and joy. I ponder sometimes if I would have felt that way if I had gotten pregnant and given birth as I had initially planned. I swear, their adoption has made me know how lucky, grateful, blessed and delighted I am to be their parent. And my siblings have accepted my children as full members of our family and love them completely. Now obviously since I just became an aunt twice in 14 hours, my two younger siblings did end up having children as well (remember my older sister was already a co-parent). My brother later met a fantastic woman who changed his life with her strong and clear approach to the world. While he stuck to his anti-marriage creed, they have built the most beautiful family having his first child at age 40, and adding a second son to their lives just yesterday. They live in British Columbia on a farm where he works in construction and she owns an virtual assistant business, raises their boys like the earth mother she is, herds her goats and tends to her gardens. They are a beautiful family!
My younger sister got her life together and married a few years ago. She too married a strong man who works in farming equipment sales. They make a good team together and have just had their first born son, Dexter, early this morning. To see photos of her holding her newborn son brought tears to my eyes. To see her child sleeping peacefully away on his father’s chest is incredible. In spite of challenges in her youth I know my sister will be an excellent mother. There is a peace there for all of them I am so grateful she found. My older sister raised her amazing stepdaughter to be a stunning, intelligent and brilliant young woman herself. I feel proud that my sister has dedicated so much of her life to helping children in serious need of intervention and help. Sure I had times during my infertility that were painful and filled me with hurt. But as a few years have passed I have trained myself to let a lot of that go and to remember what was good, and what was given to me as a result of that struggle. I remember the kind things my siblings did for me during that time. I am
This man, my brother, sat down and shared my grief with me. I will never forget that feeling of acceptance and support from him.
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all our lives. There was a time when I was sure that this family would never continue at all, that no children would enter our lives... But here we are, six children between myself and my three siblings. And I am amazed at the directions life can take when I once believed there was no hope.
About the Author
My siblings have accepted my children as full members of our family and love them completely. grateful I had them when I needed them. And today, as I sit here after becoming an aunt two more times in 14 hours, I am grateful for my family and this slew of kids who are part of
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.
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hannamfertility.com (416) 595-1521
The LGBTQ Column
QUEER SPAWN: THE CHILDREN OF LGBTQ PARENTS by Rachel Epstein
and Ken McNeilly
This issue’s column takes a look at what it’s like to grow up with LGBTQ parents. I am joined by guest Dr. Ken McNeilly, who recently completed a doctorate at the Ontario Institute for Studies in Education in Toronto. As part of his research, Ken interviewed young people with LGBTQ parents, including asking them about what they viewed as advantages of growing up in their families. We start by providing some important LGBTQ parenting history and looking at some research, old and new, and then we hear from some of the young people Ken spoke to.
Of course, the experience of growing up with LGBTQ parents it is not the same for everyone; LGBTQ parents and their children are as diverse as any other group. However, recent research does point to some interesting potential advantages of having LGBTQ parents. But first, a look at an historical context that saw LGBTQ people being denied the right to have children and, at times, losing their children.
Some LGBTQ Parenting History
Children with LGBQT parents sometimes refer to themselves as “queer spawn,” or as “culturally queer kids,” both terms coined by Stefan Lynch of COLAGE (a support group for children and young people with LGBTQ parents: www.colage.org). Like all terms, they are not universally embraced, so I use the terms recognizing that not all the young people referred to here would identify in that way.
Thirty years ago, queer parents were, for the most part, invisible. It was in the 1970s that lesbian mothers, a previously unrecognizable category, gained a degree of visibility. Women who had become parents in heterosexual relationships and then “came out” were fighting for custody of their children in courtrooms that were, to say the least, unfriendly places for them. In 1977, Francie Wyland wrote, “Only once in Canada, and fewer than a dozen times in the United States, has a known lesbian mother been granted
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The LGBTQ Column
LGBTQ parents and their children are as diverse as any other group. However, recent research does point to some interesting potential advantages of having LGBTQ parents. unconditional custody of her children” (cited in Mackay, 1982: 16).
In these court battles, which involved enormous loss and heartbreak, lesbian and gay parents were pushed to present themselves and their children as “just the same as” and “just as good as” the heterosexual nuclear family – itself an artificial construction that never in reality looked or worked like it was supposed to. Court decisions that denied lesbians and gay men custody of their children were based on a series of arguments that found lesbians and gay men
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to be “unfit parents” (Pollack, 1990).
These arguments, originating in the custody battles of the 1970s/80s, have demonized lesbian/gay parents in popular culture and are now deeply embedded in mainstream consciousness. LGBTQ parents and their allies have spent decades rebutting them. Such arguments focus on how detrimental it is to children to grow up in LGBTQ families, and include assumptions that: lesbian/gay sexuality is immoral and that lesbians/gay men are promiscuous, sexually maladjusted and likely to sexually harm children; children raised in lesbian/gay homes will develop
The LGBTQ Column Countless studies show that there is virtually no difference between the children of lesbians and those of heterosexual mothers with regard to gender identity, gender role behaviour, psychopathology or homosexual orientation. inappropriate gender identities and gender role concepts and behaviours, and may themselves develop a homosexual orientation; healthy child development requires the presence and availability of biological fathers as “male role models” (or in the case of gay fathers, “female role models”); and children raised in lesbian/gay homes will be socially stigmatized and subjected to ridicule, teasing, and hostility from their peers.
When lesbian and gay parents (and their lawyers) were in court rebutting these arguments, they had to respond within the given framework. They had to prove that they were
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“fit” to be parents – that their kids would be “just like” kids growing up in heterosexual families. The research carried out during this period helped to bolster these arguments. (For a summary of this research, see Patterson, 2005.) There are now countless studies that prove that sexual abusers are not, for the most part, lesbians or gay men but are, in fact, heterosexually identified; that there is virtually no difference between the children of lesbians and those of heterosexual mothers with regard to gender identity, gender role behaviour, psychopathology or homosexual orientation; that lesbians mothers are actually more concerned than heterosexual single mothers with providing opportunities for their children to develop
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ongoing relationships with men, not to mention more complex arguments about the assumptions embedded in “male/female role model” arguments; and that it is a dangerous, bigotry-fueled argument to suggest that any group that experiences systemic oppression should not have children because of the potential emotional damage to the children.
Much as we would like to leave behind this framework that puts us on the defensive by requiring that we prove both our “fitness to parent” and our likeness to a non-existent heterosexual norm, the political and social context within which we parent does not fully allow us to do so. However, as we achieve more visibility and social recognition, the framework is slowly shifting.
Shifting Landscapes Queer parents, and researchers of queer parenting, are starting to address some of the complexities of our lives, including the ways that LGBTQ families may differ in interesting (and, perhaps, not so interesting) ways
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The LGBTQ Column
from mainstream heterosexual experience. Stacey and Biblarz in their landmark 2001 article “(How) Does the Sexual Orientation of Parents Matter?” refuse the “we are the same” conversation and insist on exploring differences, drawing on fifteen years of research on children with lesbian moms. The differences they highlight in children growing up with lesbian/gay parents include less traditional gender-typing;
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higher self-esteem and better mental health; more egalitarian, shared parenting; more closeness and communication between parents and children; and increased awareness and empathy in children towards social diversity. The most recently released study (Gartrell, Bos, Goldberg, 2010) found that adolescents reared in lesbian families are less likely than their peers to be abused by a parent or caregiver, and that daughters of lesbian mothers are more likely to engage in same-sex behaviour and to identify as bisexual – a finding that will likely be used by some to promote the idea that LGBTQ parents “recruit” their children. And while research exploring trans parenting is scant, trans parents and their children are beginning to articulate the possibilities of benefits to children, a recurring theme being the benefits of a happier, healthier parent. Other benefits echo those articulated by children of lesbian and gay parents, including: open-mindedness and social awareness, understanding of oppression, and pride in their families (Hines, 2006; Garner, 2004; Canfield-Lenfest, 2008). While the differences these studies point out are fascinating, the most exciting contribution they make is the shift from a limiting framework of comparative
The LGBTQ Column “My mom always was a really good role model not even because she
However, the queer spawn in McNeilly’s study did talk about the advantages they experience in having LGBTQ-identified parents, including: viewing their parents as role models of strength; open-mindedness on issues of sexuality; heightened awareness of social justice issues.
was a lesbian, but because she’s such a feminist […]. She’s a really strong person. defensiveness to one of exploration, curiosity, and possibility. This shift is made possible by the social and legal recognition and security that LGBTQ parents, in some places, have now achieved. All this brings us to Ken McNeilly’s study of Canadian youth who have grown up within social and legal frameworks that have become increasingly secure for LGBTQ-led families. The young people McNeilly interviewed were very clear that they did not view their families as significantly different from other families, and if there were differences, they intuitively recognized that “differences” do not imply “deficits.” In fact, the youth in Ken’s study readily articulated some perceived advantages of having an LGBTQ-identified parent. Victoria (all names have been changed to protect participant anonymity), a 19-year-old female, had very positive things to say about growing up in a lesbian-led home, but was careful not to generalize her experiences: “I always have to acknowledge that I’m speaking about my parents and not all gay and lesbian parents. It’s been great growing up in my lesbian family.” Her words serve as a reminder that it is not a good idea to generalize about any group.
Openness about Sexuality Many of the queer spawn interviewed in McNeilly’s study maintained that having LGBTQ-identified parents had allowed them to be more open in their conversations about sexuality and in the discovery of their own sexual identities. Denise comments: “I feel like [having a bisexual mother and a bisexual
Role Modelling Strength Three participants used the word “strength” to describe their lesbian mothers. When asked to consider the advantages of growing up in an LGBTQ-led home, Victoria exclaimed, “Oh, my gosh, so many good things! […] From my parents, I’ve taken a lot of courage and strength because they’ve had to come out, you know?” She alluded to the transmission of that strength from one generation to the next. “There’s things about being gay that don’t even add up, they surpass, you know, because [LGBTQ people] have to be radical and amazing and so strong, that I think, it’s like, they’ve definitely passed that on to me.” Ellie remarks that she too benefited from the strength she saw in her mother: “For me, my mom always was a really good role model,” she explained. “Not even because she was a lesbian, but because she’s such a feminist […]. She’s a really strong person. Like, she outed herself in a really small town that’s really gossipy and told her parents who were really old-fashioned.” Similarly, Anna describes her mother as a role model: “She is very much a role model for me because she’s very strong and I’ve seen her go through her family getting very upset with her because they’re so religious… And so I view her as a very strong role model because I strive to be strong just like her.” Participants in McNeilly’s study valued their parents’ honesty and their willingness to take the risk of ‘coming out,’ and they were proud of their parents’ genuineness.
Growing up in an atmosphere where you have to fight for your rights, you become more of an open person towards human rights issues and social justice issues.
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The LGBTQ Column the resolution of her confusion, and was certainly not its cause. Essentially, her own identity configuration was facilitated by having parental role models who made her aware of alternatives to heterosexuality.
Social Justice
father] has made me a lot more openminded… I also feel more comfortable to approach my parents about sexual orientation issues, LGBTQ issues, than some of my friends do, things that my friends wouldn’t want to talk to their parents about.” Julia echoes the same sentiment: “It definitely has affected my life as in, I’m very open. I’m a lot more open to explorations of, you know, sexuality.” Victoria, who voluntarily disclosed her own non-heterosexuality during the interview, believes that having lesbian moms made her “more open-minded to my own sexuality and to other people’s sexuality.” She adds, “I’m not saying that my parents made me gay, but I think it might have taken me a lot longer to realize that I wasn’t just typically straight.” Of course, some would cite Victoria’s nonheterosexuality as evidence that LGBTQparenting causes confusion about sexual orientation. Victoria’s experience, however, was that having LGBTQ parents assisted in
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The queer spawn in McNeilly’s study believed that having an LGBTQ-identified parent, and witnessing discriminatory behaviour directed at their parents, heightened their awareness of issues of social justice. As Nick puts it: “I really understand the inequalities. You really notice how [your LGBTQ parents] are treated, you know what I mean? Denise speculates that: “The population of queer spawn as a whole are more socially aware. Which is not to say there are some queer spawn who are not socially aware. And, of course, there are lots of kids who are not from queer families who are very socially aware as well. So it’s a give-and-take, but I think as a per capita sort of measure – I would say that [youth with queer parents] are probably more socially [aware]. Just because of the close involvement.”
Her response echoes Saffron’s (1998) suggestion that close proximity to LGBTQ communities puts queer spawn in a position to more intuitively understand social injustice, to know the effects of marginalization that come from belonging to a social minority. Julia suggests that growing up with the sense of being a minority helped shape her understanding of social justice issues: “I think when you are a minority of some type you’re very much more focused on that. So I think growing up in an atmosphere where there’s, like, you have to fight for your rights, you notice more, and you get more involved, and you become more of an open person towards human rights issues and social justice issues. As opposed to someone who didn’t grow up with any problems, any types of things they had to fight for.”
Victoria adds that having lesbian mothers made her “more open-minded to other differences and to oppressed or magnizalied voices.” She wonders aloud: “I don’t know if that’s because my parents are political or because they’re queer, or a mix of both.” In a sense her words are a reminder of the ways that all our lives are influenced by the intersection of multiple identities, experiences and narratives. Victoria recognizes that some LGBTQidentified adults considering parenthood might have reservations and she expresses her desire to encourage them to pursue their intentions to parent. “I love talking to [potential LGBTQ-identified parents], because I hear this fear, this, ‘Oh gosh, am I fucking up my child?’ And I’m always, like, ‘Do you know the amazing things I’ve gotten from having a queer family? Like, if anything, you’re giving them a gift, you know?’” Of course, McNeilly's research participants
Queer Spawn: The Musical To ensure that the inspiring stories of his research participants reach a wider audience, McNeilly has written a 60-minute musical comedy entitled The Common Ground: A Musical Dissertation. The Common Ground will have seven performances at the Toronto Fringe Festival from July 2-13, 2014. Tickets will be available in mid-June through fringetoronto.com. Feel free to contact Rachel (parentingnetwork@sherbourne.on.ca) or Ken (kenneth.mcneilly@hotmail.com) for more information about the musical.
La communauté LGBT also acknowledge the difficulties they face as queer spawn. They are sometimes frustrated by their peers' unsubstantiated assumptions, and they feel a sense of, in Victoria's words, having to “always prove our family's legitimacy.” They face difficult interactions in school (see Epstein, Idems, Schwartz, 2013; Canfield-Lenfest, 2008; Garner, 2004), including moments when they are asked about their “real parents” or when they feel the burden of being an ambassador for queer and/or trans communities. On the whole, however, the queer spawn in McNeilly’s study are proud of their parents and keenly aware of the advantages of having LGBTQ people as parents. They see themselves as having grown up with role models of strength, able to talk with their parents about sexuality and other concerns, and with an expanded awareness of social inequality and social justice. Perhaps their experiences contain lessons for all parents, regardless of sexual orientation or gender identity.
References: Canfield-Lenfest, M. Kids of Trans Resource Guide, San Fransisco: COLAGE, 2008.
Epstein, R., B. Idems, & A. Schwartz. “Queer Spawn on School.” Confero: Essays on Education, Philosophy and Politics 1 (2), 2013: 173-208. Garner, A. Families Like Mine: Children of Gay Parents Tell It Like It Is. New York: Harper Collins, 2004. Gartrell, N, H. Bos, & N. Goldberg. “Adolescents of the U.S. National Longitudinal Lesbian Family Study: Sexual Orientation, Sexual Behavior, and Sexual Risk Exposure.” Archives of Sexual Behavior, 2010. Hines, S. “Intimate transitions: Transgender practices of partnering and parenting.” Sociology 40 (2), 2006: 353-371.
Press, 1990. Saffron, L. (1998). Raising children in an age of diversity: Advantages of having a lesbian mother. Journal of Lesbian Studies, 2(4), pp. 35-47. Stacey, J., and T.J. Biblarz. “(How) Does the Sexual Orientation of Parents Matter?” American Sociological Review 66, 2001: 159–183. Wyland, F. Motherhood, Lesbianism and Child Custody. Toronto: Wages Due Lesbians, 1977.
MacKay, L. Children and Feminism. Vancouver: The Lesbian and Feminist Mothers Political Action Group, 1982. Patterson, C. “Lesbian and Gay Parents and Their Children: Summary of Research Findings.” In Lesbian and Gay Parenting: A Resource for Psychologists, 2nd ed. Washington, DC: American Psychological Association, 2005. Pollack, S. “Lesbian Parents: Claiming Our Visibility” In J.P. Knowles and E. Cole, eds., Woman-Defined Motherhood. New York: Haworth
About the Authors Rachel Epstein has been an LGBTQ parenting activist, educator and researcher for over 20 years and coordinates the LGBTQ Parenting Network at the Sherbourne Health Centre in Toronto. She is the author of the Best Start Resource Centre's new resource: Welcoming and Celebrating Sexual Orientation and Gender Diversity in Families: From Preconception to Preschool, and editor of the 2009 anthology Who's Your Daddy? And Other Writings on Queer Parenting (Sumach Press). Rachel recently completed her PhD in the Faculty of Education at York University. Ken McNeilly has been a teacher for over 20 years, working in elementary, middle, and secondary schools in Canada, Belgium, and Korea. He is also an adjunct lecturer at the University of Toronto in the Initial Teacher Education program. In 2012, Ken received his PhD from the Ontario Institute for Studies in Education at the University of Toronto. Ken is excited to bring his doctoral research paper to life on the stage of the 2014 Toronto Fringe Festival in the form of a one-hour musical comedy entitled The Common Ground: A Musical Dissertation.
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Le texte qui suit est extrait d’un chapitre de l’ouvrage Vivre avec l’infertilité.
Qui informer dans son entourage ?
Que faire avec son entourage par Susan Bermingham
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Lorsqu’un homme et une femme apprennent qu’ils ont de la difficulté à concevoir, c’est un choc. Les projets qu’ils avaient pour l’avenir sont profondément bousculés. Les questions qui les assaillent, au début, vont impliquer seulement la sphère très intime du couple luimême. « Qu’est-ce qu’on fait? » « Est-ce qu’on reste ensemble? » Mais très vite, ils vont se rendre compte que les conséquences d’une telle nouvelle vont venir toucher l’ensemble beaucoup plus large de leurs relations. En effet, découvrir un problème d’infertilité signifie souvent qu’on va vivre une profonde détresse psychologique. Le comportement des personnes peut alors se transformer brutalement et l’entourage ne manquera pas, plus souvent qu’autrement, de le remarquer. Ensuite, cela annonce aussi la batterie de traitements qu’il faudra essayer ainsi que les décisions à prendre quant aux procédures
Trop souvent, l’entourage familial verbalise un peu vite sa déception et son chagrin.
qu’on accepte et celles qu’on refuse. Il s’agit enfin d’un sujet important dans la vie d’un couple, car le fait d’avoir une famille ou non est un facteur non négligeable quand il s’agit de se définir et de définir les relations qu’on a avec ses proches. C’est pourquoi il peut s’avérer judicieux de réfléchir à ce que l’on va partager ou non avec son entourage. Qu’est-ce que l’entourage ? Il s’agit de la famille bien sûr, des amis, évidemment, mais il faudra aussi considérer le cercle plus large du milieu de travail.
La famille Ce sont, sans aucun doute, les membres de la famille qui sont le plus susceptibles d’aborder la question de la conception d’un enfant. La plupart des parents souhaitent ardemment devenir grands-parents, c’est dans l’ordre des choses, et les frères et sœurs espèrent voir quelques neveux et nièces prendre place dans leur vie et celle de leurs propres enfants. Le couple vit alors le déchirement d’être porteur d’une si triste nouvelle, et un sentiment vague et embarrassé impose un frein au désir de se confier. Quand on évoque la famille, on inclut les personnes communément les plus proches du couple mais, paradoxalement, c’est la raison la plus fréquemment mentionnée pour ne pas leur en parler. Alors qu’ils sont frappés de plein fouet par une déception qui n’avait jamais été envisagée, des paroles irréfléchies et imprudentes de leur part, déplacées parfois, risquent d’être dites. « Donc je ne serai jamais grand-mère ? » dit l’une. « Mais avec un donneur, le bébé ne sera pas vraiment de la famille » dit un autre… On s’agite. On parle sans réfléchir. On dit n’importe quoi. Trop souvent, en effet, l’entourage familial verbalise un peu vite sa déception et son chagrin. Je ne dis pas, ici, que ces émotions n’ont pas lieu d’être. Elles sont au contraire fort légitimes. Ce que je dis cependant, c’est que, en laissant s’exprimer toutes les réactions négatives qui
Les non-grands-parents souffrent beaucoup du risque de ne pas avoir de petits-enfants, mais ils ont parfois l’air d’oublier que la première personne touchée par ce drame est leur fille ou leur fils. viennent à l’esprit, on en vient à rendre plus lourd le fardeau déjà écrasant de l’infertilité porté par le couple. On voit alors la personne infertile consoler les non-grands-parents, alors que c’est plutôt elle qui a besoin de soutien. Cela a pour résultat d’accentuer le sentiment de malaise qu’elle éprouvait déjà confusément. Cette idée trouble qu’il y a faute est d’ailleurs sans doute une des raisons (non avouée) qui pousse la famille à s’immiscer de façon parfois excessive dans le déroulement des traitements. Chacun a envie de donner son avis. Telle cousine a lu dans un journal que. Tel grand-oncle a entendu dire que. Et puis, la sempiternelle question : « Alors, quand est-ce qu’on aura enfin des petitsenfants ? » La personne infertile subit alors une
pression accrue s’exprimant par une intrusion abusive avec harcèlement de questions et exigence de détails. L’expression d’un désir raisonnable de la part de la famille peut donner lieu à des comportements déraisonnables. Ne laissez pas ces remarques inconsidérées accentuer un sentiment d’impuissance que, déjà, votre problème d’infertilité a peut-être provoqué en vous. Si votre intuition vous fait craindre des réactions de ce genre, au sein de votre famille, peut-être que le mieux serait de rester discret. On a beau dire, même dans notre monde occidental et moderne, qui se veut si individualiste, la question de la descendance demeure un sujet délicat. Sans doute aussi est-ce en raison de ce mythe individualiste
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Le 12 septembre 2014 Québec, QC
Joignez-vous à nous pour la 2ième édition de
la marche Défi Affaire de Famille
INSCRIVEZ-VOUS DÈS MAINTENANT www.iaac.ca/fr/event/61 60
Créons des familles • SUMMER/ÉTÉ 2014
CINQ PETITES PHRASES BLESSANTES • Les traitements de fertilité, c’est jouer avec la nature. C’est peut-être un message de Dieu ou du destin si vous ne pouvez pas avoir d’enfant… • Au moins, vous n’êtes pas malades ! • Je te donnerais bien un de mes gamins : ils me rendent complètement folle ! • Pourquoi ne pas simplement adopter ? Il y a tant d’enfants sur terre qui ont besoin d’une famille ! • Si tu te concentrais un peu moins sur ta carrière, ce serait peut-être plus facile pour toi de tomber enceinte ?
on ne revienne jamais à ce qui a été annoncé. Ce silence est d’une grande violence pour la personne infertile. Elle se retrouve égarée dans une zone d’ombre, floue et équivoque. A-t-elle réellement parlé ? A-telle manqué de clarté ? Et en même temps, elle sent confusément qu’il lui faut continuer à se taire. Elle se sent abandonnée. Il ne faut donc pas hésiter à faire preuve de circonspection quand se pose la question du dévoilement de son infertilité. Souvenez-vous que la première personne blessée, c’est vous. Souvenez-vous que vous avez droit à votre chagrin, tout comme vous avez le droit du respect de vos choix, peu importe ce qu’ils seront. La route au-devant de vous peut s’annoncer compliquée et longue. Inutile de vous la rendre plus tortueuse… Il n’existe pas de bonne réponse à la question de savoir s’il faut informer sa famille de son problème de fertilité. Tout dépend de la personnalité des gens qui la composent, du lien que l’on entretient avec chacun d’eux, et du soutien que l’on espère. Il est nécessaire que les conjoints parlent entre eux et s’échangent leurs points de vue à ce sujet. Aucune famille n’est identique. Le choix de se taire ou de parler va dépendre de la relation de chaque conjoint avec sa famille respective. Il est nécessaire qu’ils expriment mutuellement ce qu’ils attendent des différents membres de leur famille.
Les amis qu’il est d’autant plus trouble à aborder. C’est ainsi qu’il arrive que les grands-parents se tournent exclusivement vers les petits-enfants qu’ils ont déjà, auxquels ils portent un intérêt tel qu’ils se détournent de leur enfant sans enfant. Ce dernier éprouve alors le sentiment que sa famille ne s’intéresse pas à son histoire ou que celle-ci est devenue taboue. Il souffre alors de rejet et d’isolement. Les grands-parents le font sans doute sans s’en rendre compte. Mais le mal sournoisement est fait. S’il est on ne peut plus normal que les non-grands-parents souffrent beaucoup du risque de ne pas avoir de petits-enfants, ils ont parfois l’air d’oublier que la première personne touchée par ce drame est leur fille ou leur fils. Ils ne se rendent pas compte que leur comportement peut être profondément blessant – si ce n’est humiliant. La personne infertile a besoin de soutien. Si vous pressentez que les réactions de votre famille risquent de compliquer votre relation avec eux, ou encore si vous craignez qu’elles soient défavorables ou douloureuses au point de vous blesser, il peut être prudent de vous abstenir de leur annoncer la nouvelle. Une autre réaction est le contraire exact de ce que nous avons évoqué plus haut. Après la nouvelle, la famille se tait. Pas de déclarations inappropriées, pas de questions oppressantes, mais un grand silence. Il se peut aussi que l’on change de sujet, sans transition aucune, et sans que, plus tard dans la conversation, alors qu’on se dit que le choc est passé,
En ce qui concerne les amis, la situation est similaire à celle de la famille. La décision de les avertir dépend des caractères des uns et des autres, et des relations nouées avec chacun d’entre eux. Il peut être préférable d’éviter d’en parler à ceux qui risquent de devenir trop curieux ou même indiscrets et, au contraire, fort sage de se confier à ceux qui semblent aptes à offrir une oreille attentive. Tout est question d’équilibre. Et une douce amitié peut être le baume dont on a cruellement besoin, surtout si, par exemple, on a jugé opportun de ne pas ouvrir son cœur à sa famille. Comme les membres de la famille, certains amis peuvent faire des allusions qu’ils croient spirituelles, mais qui font en réalité de la peine : « Si tu ne sais pas comment faire, je peux te le montrer, tu sais ! » dit l’un. Ou d’autres peuvent avoir envie de donner toutes sortes de conseils insolites qui ne font qu’irriter parce qu’ils sont perçus comme insultants car absurdes. « Peut-être que c’est parce que tu ne te nourris pas bien ? » dit une autre. C’est à vous de prendre en compte les personnalités de chacun pour décider de la conduite à prendre, celle qui vous protègera le mieux. Et puis, si certains couples infertiles prennent un grand plaisir à côtoyer des familles avec des enfants, d’autres au contraire souffrent de la présence de ces enfants qui ne seront jamais les leurs. Il peut être pénible de suivre la grossesse d’une amie ou d’assister à un shower de
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faire… » entend-t-on parfois. C’est sûr que vous ne pourrez pas vous prémunir contre tout. Le savoir et le prévoir, c’est déjà prendre des précautions et prendre soin de soi. Admettre qu’on est particulièrement sensible à certains sujets, apprécier le fait qu’on est parfois susceptible, c’est aussi se montrer bien avisé. Il faut savoir reconnaître que les relations qu’on noue avec les autres sont un échange où chacun a un rôle et une responsabilité. Telle amie enceinte, qui se plaint de ses nausées et de ses maux de dos, a le droit, elle aussi, à ses émotions. Tel couple d’amis, qui n’en peut plus du comportement turbulent de son enfant de trois ans et se lamente, a besoin, tout comme vous, d’un espace de parole. À vous de voir comment gérer ce que de telles remarques vous font vivre et à quel point elles vous sont supportables ou non.
On a le droit de dire à sa mère : « Quand tu me dis que c’est parce que je travaille trop, que je ne peux pas avoir d’enfant, cela me fait de la peine, tu sais… »
Il faut faire attention cependant à un excès de précaution car cela risquerait de conduire le couple à réduire son cercle de façon drastique et donc à s’isoler. Entre voir trop de familles avec enfants et pas du tout, à chacun de trouver sa mesure, mais il est primordial de tenter de trouver un équilibre sain qui fait conserver ses amis tout en respectant ses limites et ses sensibilités.
Éduquer son entourage
Il faut aussi savoir se préparer à recevoir parfois des commentaires désobligeants parce qu’irréfléchis. Malheureusement, même les gens qui vous aiment parlent sans réfléchir et peuvent vous blesser. Ils oublient de se mettre à votre place. « Au moins, vous, vous avez de la chance, vous n’avez pas à vous lever chaque fois que le bébé pleure la nuit ! » Ils oublient que ces enfants dont, devant vous, ils se plaignent si aisément sont pour vous une aspiration si dévorante qu’elle fait mal. Vous avez bien compris que ce n’était qu’une boutade. Mais ils ne se sont pas rendu compte que c’est le genre d’humour dont vous n’avez pas le luxe…
Une fois que le couple a déterminé quelles sont les personnes de son entourage qu’il souhaite informer de son infertilité, il devra les « éduquer » car les gens sont trop souvent victimes de mythes et d’idées reçues. Le mot choisi – éduquer – n’a rien de péjoratif. Cela signifie simplement que l’expérience de l’infertilité et de ses traitements est difficile à appréhender pour le néophyte et qu’il est naturel que les proches se sentent un peu perdus. Plus encore, il est bon de prévenir les remarques maladroites en allant au-devant des questions qui taraudent et en établissant, sur une base claire, ce qui est acceptable de dire ou non, et ce qui est bienveillant ou non. On a le droit de dire à sa mère : « Quand tu me dis que c’est parce que je travaille trop, que je ne peux pas avoir d’enfant, cela me fait de la peine, tu sais… » Vous sentant en détresse, les gens croient souvent que vous avez besoin de conseils. En réalité, vos émotions les mettent mal à l’aise. Pour avoir une sensation de contrôle sur cette impuissance qu’ils ont à ne pouvoir vous consoler, ils recommandent, sermonnent, exhortent. On veut alors vous remonter le moral ! On veut vous faire part de ce qu’on a lu, l’autre jour, dans un article de journal, et qui semblait être une recette miracle ! On veut vous gronder devant votre incapacité à vous changer les idées ! Or, rien n’est plus faux. Vous avez simplement besoin d’un accueil généreux de votre chagrin et de vos doutes. Et c’est souvent tout.
« Attention avec le bébé ! Tu n’en n’as pas, tu ne sais pas comment
S’il est important d’en parler ouvertement et sans gêne, il ne s’agit pas
bébé lorsqu’on est soi-même en train de faire son deuil d’une naissance naturelle. Vous êtes libres de décider de la fréquence des rencontres, si chacune d’elles vous laisse meurtris, libres aussi d’expliquer ou non la raison de l’espacement des visites. Tout dépend de la confiance que vous avez d’être entendus et respectés dans vos besoins.
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éprouvant. Il faut qu’ils réalisent que leurs mots ou leurs actes peuvent être blessants, et leurs questions malvenues. Le couple doit pouvoir leur expliquer de quel soutien il a besoin, dire s’il préfère ne pas être interrogé et garder le choix d’annoncer les événements, ou au contraire si cela lui fait plaisir d’être invité à en parler. En outre, il est important de donner les informations relatives aux effets secondaires sur l’humeur que provoquent les médicaments pour la fertilité, car ils expliquent en partie la sensibilité exacerbée de la personne qui les prend, ce qui permettra de
CONSEIL À L’ENTOURAGE La meilleure question à poser aux conjoints dont on vient d’apprendre l’infertilité est : « Que puis-je faire pour vous ? »
non plus de donner des informations techniques relatives aux traitements et ce qu’on peut en attendre, mais bien plutôt d’expliquer à ses proches les sentiments que provoquent l’infertilité et ses conséquences. Ceux-ci doivent comprendre que l’infertilité est un deuil, que les traitements sont pénibles à vivre et demandent une véritable volonté. Ils doivent savoir à quel point leur échec est
dédramatiser certaines réactions qui semblent déroutantes. Quant à vous, qui êtes un proche d’une personne qui vit l’infertilité, que vous soyez de la famille ou un ami, ou même une simple connaissance à qui on s’est confié, si vous ne deviez retenir qu’une seule chose, ce serait celle-ci : n’hésitez pas à lui demander ce que vous pouvez faire pour l’aider. Vous découvrirez bien vite qu’elle n’a pas besoin de grand-chose, si ce n’est de votre écoute et de votre patience.
À propos de l’auteure
Susan Bermingham, M.Ps., est psychologue clinicienne et travaille depuis 1992 auprès des couples ayant des difficultés à concevoir, à des cliniques de fertilité à Montréal. Elle a participé aux divers groupes d’études et aux comités d’éthique concernant la procréation assistée mis en place par les gouvernements provincial et fédéral. Elle est l’auteure du livre Vivre avec l’infertilité (disponible à susanbermingham.com), qui a pour objectif de donner des clés pour comprendre l’infertilité et les difficultés psychologiques vécues par les couples qui s’engagent corps et âme dans une démarche pour fonder une famille lorsque l’enfant tarde à venir.
25/4/14 2:18:07 PM
Ma Famille.... UN bébé à la fois Centre de la Reproduction
Reproductive Centre
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The Naturopathic View
MYO-INOSITOL and PCOS
by Judith Fiore, ND
Anna and Steven, a couple in their late 30s, came to see me as they had gone through two IVF cycles without success. Anna was 36 years old and had received a diagnosis of Polycystic Ovarian Syndrome or PCOS as it is typically referred to.1 Before beginning medical fertility treatment, her cycles were anywhere between 45 to 60 days in length, and she was struggling with the wide range of symptoms associated with PCOS: weight gain, acne and facial hair.2 Anna was taking Metformin, a medication that helped to regulate her cycles. With IVF treatment, she had achieved pregnancy twice, once with each fresh embryo transfer. Sadly she had miscarried both times, the first time at six weeks, and then again at seven weeks. Before embarking on a third IVF cycle, she and her husband came to see me with the hope of improving her PCOS and increasing her odds of carrying a successful pregnancy.
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Studies from Europe were presenting evidence that myo-inositol could improve egg quality in women with PCOS and result in higher rates of IVF success.
The Naturopathic View For PCOS patients who are showing signs of insulin resistance, myo-inositol appears to
improve insulin sensitivity. Like many fertility patients, Anna was exercising regularly, eating a healthy diet, and had lost nearly 30 lbs. She was also taking a number of nutritional supplements that she had read about and which showed promise of enhancing her fertility. She had improved her lifestyle and diet, and had begun taking the supplements several months before her second IVF attempt, so it was a huge disappointment that all her efforts still did not result in a baby.
Encouraging studies I had been hearing about the positive effect that myo-inositol could have on women with PCOS undergoing IVF treatment. It appeared that myo-inositol is a nutrient particularly that increases insulin sensitivity,
in the ovaries – PCOS is often associated with resistance to insulin. Studies from Europe were presenting evidence that myoinositol could improve egg quality in women with PCOS and result in higher rates of IVF success.3,4,5
I counselled Anna that I wasn’t 100% sure that myo-inositol would help improve her chances, but since there didn’t appear to be any harm in trying, I recommended that she begin taking powdered myo-inositol at the dosage used in the studies. The research indicated that women would need to be on myo-inositol for at least four months, with a dosage of 2000 mg taken twice daily.
The wonderful thing is that Anna’s next cycle resulted in a twin pregnancy that IVF
she carried to 37 weeks. Her twin daughters are now two years old, and are the joy of Anna’s and Steven’s world.
Since observing Anna’s success, I have been recommending myo-inositol to all of the women I see who are dealing with PCOS. Overall, there have been improved outcomes for many, although not all. I don’t believe that myo-inositol alone will guarantee babies for everyone, but the research and my patients’ experiences are encouraging.
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What is myo-inositol, and how does it help with insulin sensitivity? Myo-inositol is a carbohydrate that is found primarily in
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The Naturopathic View fruits, especially cantaloupes and oranges. It can also be found in beans, nuts and seeds.6 Myo-inositol is thought to be important for insulin sensitivity as it plays a role in cell signalling. Cell signalling is how a cell knows what to do in different situations. For PCOS patients who are showing signs of insulin resistance, myo-inositol appears to improve insulin sensitivity. In PCOS, insulin resistance and the resulting increased levels of insulin in the body are thought to be the primary reason why the syndrome develops. With increased insulin, the ovaries will produce too much testosterone. The combination of high insulin and high testosterone interferes with the normal development of ovarian follicles, and leads to problems with ovulation and poor quality eggs.7 It has been postulated that the concentration of myo-inositol in the follicular fluid of PCOS patients and the resulting egg quality may be connected, as it’s been found that low levels of inositol correlate with poor quality eggs.8 This may be why daily supplementation of myo-inositol for at least four months prior to IVF treatment shows improved egg quality.9,10 More research needs to be done, and there may certainly be other nutrients required to help
increase IVF success for women diagnosed with PCOS. In the meantime, it is easy to incorporate myo-inositol as part of a healthy lifestyle. I recommend to my patients that they pur-
chase myo-inositol (usually just referred to as inositol) in powdered form. It is available in health food stores and it is easy to add powdered inositol to a glass of water. It has a mildly sweet taste and to date none of my patients have experienced any negative effects from taking inositol daily.
There has also been research indicating that myo-inositol could help with improving egg quality in women who do not have PCOS.11 This is relatively new information, and it will be important that further studies are conducted to determine whether myo-inositol is a supplement that all women with egg quality issues should consider taking.
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The Naturopathic View Nutrition 33 (9): 1954–1967. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility Sterility 2004;81:19–25.
2.
I don’t believe that myo-inositol alone
Genazzani AD, Lanzoni C, Ricchieri F, Jasonni VM: Myo-inositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndrome. Gynecol Endocrinology 2008;24:139–144.
Diamanti-Kandarakis E: Insulin resistance in PCOS. Endocrine 2006 Aug;30(1):13-17.
7.
3.
will guarantee babies for everyone, but the research and my patients’ experiences are encouraging.
Costantino D, Minozzi G, Minozzi E, Guaraldi C: Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial. Eur Rev Med Pharmacol Sci 2009;13:105–110.
Chiu TT, Rogers MS, Law EL, BritonJones CM, Cheung LP, Haines CJ: Follicular fluid and serum concentrations of myo-inositol in patients undergoing IVF: relationship with oocyte quality. Human Reproduction 2002, 17:1591-1596 8.
4.
Papaleo E, Unfer V, Baillargeon JP, Fusi F, Occhi F, De Santis L: Myo-inositol may improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial. Fertil Steril 2009, 91:1750-1754.
Ciotta L, Stracquadanio M, Pagano I, Carbonaro A, Palumbo M, Gulino F. Effects of myo-inositol supplementation on oocyte's quality in PCOS patients: a double blind trial. Eur Rev Med Pharmacol Sci. 2011 May;15(5):509-514.
9.
5.
References:
Papaleo E, Unfer V, Baillargeon JP, Chiu TT: Contribution of myo-inositol to reproduction. Eur J Obstet Gynecol Reprod Biol 2009, 147:120-123.
10.
Lisi F et al: Pretreatment with myo inositol in non polycystic ovary syndrome patients undergoing multiple follicular stimulation for IVF: a pilot study. Reproductive Biology and Endocrinology 2012, 10:52.
11.
Homburg R: Polycystic ovary syndrome from gynaecological curiosity to multisystem endocrinopathy. Human Reproduction 1996;11:29–39.
1.
Clements RS Jr, Darnell B (1980). Myoinositol content of common foods: development of a high-myo-inositol diet (PDF). American Journal of Clinical
6.
About the Author Dr. Judith Fiore, ND, is a naturopathic doctor who has been dedicated to helping individuals and couples with fertility issues since 2000. For more information on her naturopathic fertility practice, please visit her website at: www.naturalfertility.ca
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Dr. Kirk Lo
Q:
I am a 30-year-old man. I have never paid much attention to my lifestyle, but now that my wife and I would like to start a family, and with all the talk about male infertility on the rise, I would like to enhance my fertility as best I can through a healthy lifestyle. What do you recommend?
Dr. Kirk Lo: In general, anything that is good for your health will have a positive effect on your fertility. Exercise, for example, is good for your health in the long term, and in the short term it improves the quality of sperm because physical activity relieves stress and raises testosterone levels. However, don’t take a hot bath after you exercise! Heat destroys sperm. Therefore, it is also best to also avoid saunas, heated car seats or placing your laptop…on your lap.
A
:
Smoking is highly damaging to sperm as it generates in the body, among other toxic compounds, harmful by-products called free radicals. Also known as oxidants, free
The Doctor’s Column radicals play a role in ageing and several diseases. While they occur naturally as a result of organic processes, they can also form through exposure to solar radiation, pollutants or industrial chemicals, and smoking of course. If you are a smoker, my first advice would be to stop. It is difficult to believe that men trying to conceive would not give up smoking, but for some people it is extremely difficult, and going through infertility tests and treatment raises one’s level of stress, which makes quitting smoking even more daunting. For everyone, and especially for smoking males trying to conceive, an adequate intake of antioxidants (such as Vitamins C and E) and other nutrients (CoQ10, folic acid, Vitamin B12 among other things) can help neutralize to a certain extent the negative impact of pollutants on the body’s cells, including sperm. The most efficient way to ensure a proper intake of antioxidants and other recommended nutrients is to eat large amounts of fruits and
vegetables, and it is a well known fact that men tend not to eat sufficient amounts of these antioxidant-packed foods – don’t forget tomatoes, which are especially beneficial thanks to an antioxidant compound called lycopen. If you are incapable of increasing your intake of fruits and veggies, you may consider taking a vitamin supplement. Improvement in sperm quality has also been noted after supplementation with the enzyme CoQ 10. Some supplements are specially formulated so as to enhance fertility (in men and/or women). Some of them, for example, contain L-carnitine (an amino acid which has been shown to have positive effects of sperm quality in some individuals). Multivitamin supplements will likely not do much for people who have a balanced diet to begin with, but they may help those who do not. A multivitamin supplement should not be too expensive, and you should aim for one that you take once a day – people tend not to comply with ... continued on page 70
Dr. Kirk C. Lo, MD, CM, FRCSC graduated in medicine and completed his urology residency at McGill University, in Montreal, before specializing in male reproductive surgery and medicine at the Baylor College of Medicine in Houston, Texas. A Urologist and Surgeon Investigator at Toronto’s Mount Sinai Hospital since 2004, he is currently Associate Professor at the University of Toronto. In addition to patient care, he is involved in clinical and basic science research focusing on the preservation of fertility in cancer patients. Dr. Lo currently serves on the Executive Council of the American Society of Andrology. He is also the Secretary and President-elect of the Society for the Study of Male Reproduction.
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La chronique du médecin Q:
Je suis un homme de 30 ans. Je n’ai jamais porté une grande attention à mon mode de vie, mais maintenant que ma femme et moi aimerions fonder une famille, et avec l’infertilité masculine en hausse, je souhaite optimiser ma fertilité grâce à un mode de vie sain. Que recommandezvous ?
En général, tout ce qui est bon pour votre santé aura un effet positif sur votre fertilité. L’exercice, par exemple, est bon pour la santé à long terme, et à court terme il améliore la qualité du sperme parce que l’activité physique réduit le stress et augmente le taux de testostérone. Toutefois, gardez-vous bien de prendre un bain chaud après votre séance d’exercice ! La chaleur détruit les spermatozoïdes. Il vaut donc mieux éviter les saunas, les sièges chauffants des voitures ou encore de placer votre portable sur vos genoux.
A
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Fumer est très dommageable pour le sperme parce que le tabagisme génère
dans l’organisme, entre autres composés toxiques, des sous-produits nocifs appelés radicaux libres. Ces oxydants jouent un rôle dans le vieillissement et l’apparition de plusieurs maladies. Bien qu’ils résultent naturellement de processus organiques, ils peuvent aussi se former par suite de l’exposition au rayonnement solaire, aux polluants ou produits chimiques industriels, et bien sûr à la fumée du tabac. Si vous êtes un fumeur, je vous conseillerais avant tout de cesser de fumer. Il est difficile de croire que des hommes cherchant à concevoir continuent de fumer, mais renoncer à la cigarette est extrêmement difficile pour certaines personnes, et subir des tests et traitements de fertilité augmente le niveau de stress, ce qui rend cesser de fumer encore plus ardu.
Pour tout le monde, et surtout pour les hommes qui tentent de concevoir, un apport suffisant d’antioxydants (par exemple les vitamines C et E) et d’autres nutriments (la CoQ10,
l’acide folique, la vitamine B12, notamment) peuvent aider à neutraliser jusqu’à un certain point l’effet nocif des polluants sur les cellules de l’organisme, y compris les spermatozoïdes. La façon la plus efficace d’obtenir un apport adéquat d’antioxydants et d’autres nutriments recommandés est de consommer de grandes quantités de fruits et de légumes, et il est bien connu que les hommes ont tendance à bouder ces aliments très riches en antioxydants – n’oubliez pas les tomates, particulièrement bénéfiques grâce à un antioxydant appelé lycopène. Si vous êtes incapable d’augmenter votre consommation de fruits et de légumes, vous pourriez envisager de prendre un supplément vitaminique. On a noté une amélioration de la qualité du sperme après une supplémentation avec l’enzyme CoQ10. Certains suppléments sont formulés spécialement pour améliorer la fertilité (chez les hommes ... suite à la page 70
Le Dr Kirk C. Lo, MD, CM, FRCSC, a obtenu son diplôme en médecine et fait sa résidence en urologie à l’Université McGill, à Montréal, avant de se spécialiser en chirurgie et médecine de la reproduction masculine au Baylor College of Medicine de Houston, au Texas. Urologue et spécialiste en chirurgie exploratoire à l’Hôpital Mount Sinai de Toronto depuis 2004, il est actuellement
DOCTOR IS IN
Professeur agrégé à l’Université de Toronto. En plus des soins qu’il prodigue aux patients, il participe à des projets de recherche clinique et fondamentale axés sur la préservation de la fertilité chez les patients atteints de cancer. Le Dr Lo siège actuellement au Conseil exécutif de l’American Society of Andrology. Il est également secrétaire et président désigné de la Society for the Study of Male
LE MÉDECIN VOUS ATTEND
Reproduction.
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The Doctor’s Column
La chronique du médecin
... continued from page 68
... suite de la page 68
products they have to take four or five times a day. Also note that no supplement should be taken for extended periods of time, as some vitamins are stored in fat rather than excreted by the body; too much of certain vitamins may be dangerous, as it was found out when some people prescribed large doses of Vitamin E ended up having heart problems. Make sure as well that you avoid any hormonal products, such as body builders, since any supplement containing estrogen or testosterone may actually decrease the sperm count.
et/ou les femmes). Certains d’entre eux, par exemple, contiennent de la L-Carnitine (acide aminé dont on a démontré les bienfaits pour la qualité du sperme chez certains individus). Les suppléments vitaminiques ne feront probablement pas grand-chose pour les hommes dont la diète est équilibrée, mais ils pourraient aider ceux dont ce n’est pas le cas.
After all, Happy life, Happy sperm.
Pour résumer : vie heureuse, spermatozoïdes heureux.
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Un supplément vitaminique ne devrait pas être trop coûteux, et vous devriez en choisir un qui se prend une fois par jour – on a tendance à se lasser des produits qu’il faut prendre quatre ou cinq fois par jour. Notez aussi qu’aucun supplément ne devrait être pris pour de longues périodes, car certaines vitamines s’accumulent dans les tissus graisseux au lieu d’être éliminées par l’organisme. Plusieurs vitamines peuvent être dangereuses en excès, comme on l’a constaté lorsque des individus à qui on avait prescrit des doses élevées de vitamine E ont développé des problèmes cardiaques. Prenez soin également d’éviter les produits hormonaux tels que les stéroïdes que prennent les culturistes, puisque tout supplément contenant des œstrogènes ou de la testostérone peut diminuer la numération des spermatozoïdes.
INFERTILITÉ FÉMININE :
QUE PEUT FAIRE LA CHIRURGIE ?
par Dre Louise Lapensée Les progrès réalisés dans le domaine de la chirurgie au cours des dernières décennies permettent aujourd’hui de remédier à un plus grand nombre de problèmes médicaux à l’origine de l’infertilité féminine. Deux techniques en particulier ont élargi l’éventail des chirurgies qu’il est maintenant possible d’effectuer : la laparoscopie et l’hystéroscopie. Elles s’ajoutent à la chirurgie classique consistant à ouvrir l’abdomen, appelée laparotomie.
niveau du nombril. D’autres incisions, souvent effectuées dans la région du pubis, servent à introduire des instruments chirurgicaux. La laparoscopie exige beaucoup de dextérité de la part du chirurgien, puisque ce dernier doit procéder en se guidant sur l’image projetée sur un écran. En évitant les larges incisions abdominales caractéristiques des chirurgies ouvertes, la laparoscopie réduit de beaucoup la durée de l’hospitalisation et de la convalescence.
La laparoscopie La laparoscopie est une intervention réalisée sous anesthésie générale à l’aide d’un laparoscope, téléscope chirurgical que l’on introduit dans la cavité abdominale, habituellement au
L’hystéroscopie L’hystéroscopie, réalisée à l’aide d’un appareil optique appelé hystéroscope, vise à permettre l’observation de l’intérieur de la cavité utérine
en passant par les voies naturelles. Cette intervention peut être utilisée soit pour établir un diagnostic, soit à des fins opératoires.
Problèmes susceptibles d’être améliorés ou réglés par la chirurgie Trompes de Fallope bloquées ou malades Les problèmes aux trompes de Fallope liés à des troubles de la fertilité peuvent être causés par la maladie pelvienne inflammatoire (MPI), qui résulte dans de nombreux cas d’infections sexuellement transmissibles (ITS)
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Les problèmes aux trompes de Fallope liés à des troubles de la fertilité peuvent être causés par la maladie pelvienne inflammatoire (MPI), qui résulte dans de nombreux cas d’infections sexuellement transmissibles (ITS) non traitées. non traitées. Les ITS les plus courantes sont la chlamydia et la gonorrhée. Les trompes peuvent également être bloquées ou endommagées par suite d’infections subséquentes à une fausse-couche, à un avortement ou, dans de rares cas, à un accouchement, ou de troubles tels que l’endométriose ou l’appendicite associée à une péritonite. Des chirurgies pelviennes antérieures peuvent également causer un problème d’adhérences pouvant affecter les trompes. Si les trompes sont bloquées, notamment par des adhérences (tissu cicatriciel laissé par une infection, par exemple) ou de l’endométriose, les chances de grossesse sont limitées ou nulles, puisque l’ovule et le sperme ne peuvent se rencontrer dans la trompe.
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Parallèlement, les risques de grossesse ectopique sont augmentés.
Endométriose L’endométriose désigne une maladie qui fait en sorte que des cellules de l’endomètre se développent à l’extérieur de l’utérus. Le pelvis est la région la plus couramment affectée, mais des cellules endométriales peuvent être présentes ailleurs. L’endométriose peut gêner la qualité des ovules, leur fécondation par le sperme, la motilité des trompes de Fallope (permettant la descente de l’ovule) ainsi que l’implantation de l’embryon. On découvre parfois à l’examen laparoscopique que l’endométriose joue un rôle dans certains cas d’infertilité inexpliquée.
Fibromes Les fibromes utérins sont des tumeurs bénignes qui s’installent sur la paroi de l’utérus, de façon isolée ou en groupe. Leur incidence est élevée – ils affectent de 20 % à 40 % des femmes caucasiennes et jusqu’à 50 % des femmes afro-américaines. Ils apparaissent normalement après l’âge de 30 ans. Leur taille peut varier de la grosseur d’un pois à celle d’un pamplemousse, voire davantage. Les fibromes n’entraînent généralement aucun symptôme et ce n’est que très rarement qu’ils deviennent cancéreux. Cependant, outre qu’ils peuvent provoquer des saignements menstruels abondants, de la douleur et des envies fréquentes d’uriner, ils peuvent occasionner des problèmes de fertilité.
Synéchies Polypes Les polypes sont des excroissances généralement bénignes sur une muqueuse (par exemple le côlon ou la paroi de l’utérus). Ils peuvent nuire à la fertilité, surtout s’ils sont volumineux. Ils peuvent diminuer les chances d’implantation d’un embryon lorsqu’ils sont situés dans la cavité utérine.
Les synéchies sont des adhérences, c’est-à-dire du tissu cicatriciel. Lorsque ces cicatrices sont situées dans l’utérus, on parle de syndrome d’Asherman. Ce syndrome entraîne des symptômes tels que des changements dans le cycle menstruel, des douleurs pelviennes cycliques, des troubles de la fertilité ou des fausses couches à répétition. Dans les cas bénins, les cicatrices peuvent n’affecter qu’une petite
On découvre parfois à l’examen laparoscopique que l’endométriose joue un rôle dans certains cas d’infertilité inexpliquée.
taille, leur aspect ou les symptômes associés. Les kystes endométriotiques sont associés à l’endométriose sévère et nécessitent souvent une chirurgie s’ils font plus de 5 cm, s’ils occasionnent des douleurs sévères ou si l’on veut traiter l’infertilité.
Le traitement chirurgical par laparoscopie Trompes de Fallope bloquées ou malades. Avant que la fécondation in vitro (FIV) ne devienne populaire, la laparoscopie était le seul moyen à la disposition des médecins pour réparer les trompes de Fallope. Or, nous savons depuis plusieurs années que la FIV a des résultats de loin supérieurs à la chirurgie pour ce qui est d’obtenir une grossesse chez une femme dont les trompes sont abîmées. La FIV ne guérit pas les trompes, bien sûr, mais elle contourne le problème puisqu’on prélève les ovules de la patiente qui sont ensuite fécondés en laboratoire.
portion de l’utérus, ce qui ne nuit généralement pas à la fertilité. Cependant, dans les cas graves, les parois antérieure et postérieure de l’utérus peuvent adhérer l’une à l’autre de manière à obturer la cavité utérine. Le syndrome d’Asherman est en cause dans 1.5 % des cas d’infertilité féminine. Les cicatrices peuvent résulter d’une dilatation-curettage après une fausse couche, du retrait de fragments de placenta après un accouchement, d’une IVG, d’une intervention chirurgicale ou encore d’une infection.
Kystes aux ovaires
Septum
Le syndrome des ovaires polykystiques (SOPK) est un trouble relativement fréquent dont les symptômes sont de multiples kystes aux ovaires entraînant souvent un déséquilibre hormonal associé à des signes de masculinisation (pilosité abondante, acné, etc.) et/ou à des symptômes de diabète ou de résistance à l’insuline. Le SOPK peut aussi causer des troubles de la fertilité. La chirurgie est cependant rarement indiquée pour le SOPK, que l’on traite habituellement par la médication, et la plupart des femmes atteintes réussissent à devenir enceintes.
Un septum est une cloison à l’intérieur de l’utérus. Il s’agit de la malformation congénitale de l’utérus la plus fréquente. Elle peut entraîner des fausses couches à répétition du fait qu’elle est habituellement mal irriguée par le sang, ce qui gêne l’implantation et l’alimentation du fœtus.
Il existe d’autres types de kystes ovariens, notamment les kystes dits organiques, pour lesquels la chirurgie peut être indiquée. La plupart des kystes ovariens ne sont pas associés à l’infertilité mais peuvent quand même à l’occasion nécessiter une chirurgie selon leur
Un septum est une cloison à l’intérieur de l’utérus. Il s’agit de la malformation congénitale de l’utérus la plus fréquente. Elle peut entraîner des fausses couches à répétition. SUMMER/ÉTÉ 2014 • Creating Families
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Le syndrome d’Asherman est en cause dans 1.5 % des cas d’infertilité féminine. Les cicatrices peuvent résulter d’une dilatationcurettage après une fausse couche, du retrait de fragments de placenta après un accouchement, d’une IVG, d’une intervention chirurgicale ou encore d’une infection. Depuis août 2010, les résidents du Québec peuvent accéder sans frais aux traitements de fertilité, dont la FIV, puisqu’ils sont couverts par le Programme québécois de procréation assistée. C’est pourquoi il se pratique beaucoup moins de chirurgies tubaires – chirurgies visant à réparer les trompes de Fallope – au Québec depuis l’implantation de ce programme. Nous sommes désormais en mesure d’offrir à la patiente le traitement le plus adéquat sans être obligés de tenir compte de ses moyens financiers. Ailleurs au Canada, les chirurgies tubaires sont encore nombreuses étant donné que la FIV n’est pas couverte et n’est pas à la portée de toutes les patientes. À noter que l’Ontario offre la FIV sans frais aux patientes dont les trompes sont bloquées.
Endométriose, synéchies et kystes. La laparoscopie rend également service lorsque l’examen laparoscopique détecte de l’endométriose ou des adhérences dans les trompes de Fallope, sur les ovaires ou ailleurs, ou encore pour retirer des kystes, notamment aux ovaires. Le chirurgien peut alors procéder immédiatement à l’exérèse ou à la réparation des tissus malades ou endommagés. On recourt aussi à la laparoscopie pour effectuer des réanastomoses tubaires, nom désignant
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l’intervention qui vise à débloquer les trompes pour rendre de nouveau fertile une femme ayant subi une ligature des trompes.
Le traitement chirurgical par hystéroscopie Étant donné que l’hystéroscopie consiste à insérer un appareil optique dans l’utérus par les voies naturelles pour visualiser l’intérieur de la cavité utérine et opérer selon ce que révèle l’examen, cette technique est idéale pour éliminer les polypes, les synéchies, un septum utérin ou certains fibromes. Cependant, il pourra être nécessaire de procéder à une laparotomie – large incision dans l’abdomen, comme pour une césarienne – dans le cas d’un ou de plusieurs fibromes très volumineux. En résumé, la chirurgie aura toujours une place pour le traitement de l’infertilité malgré un accès beaucoup plus facile à la fécondation in vitro. De nombreuses femmes réussissent encore de nos jours à concevoir naturellement après une chirurgie laparoscopique ou hystéroscopique pour divers problèmes comme les fibromes et l’endométriose, entre autres. La chirurgie sera parfois nécessaire alors que,
dans d’autres circonstances, différentes options s’offriront à vous. Le plus important est que votre médecin discute avec vous de tous les choix possibles, incluant les avantages et les inconvénients.
À propos de l’auteure
Depuis 1996, la Dre Louise Lapensée est obstétricienne gynécologue à l’Hôpital SaintLuc du Centre hospitalier de l'Université de Montréal (CHUM) et professeure adjointe de clinique au département d'obstétrique gynécologie de l’Université de Montréal. Elle a effectué une spécialisation en endocrinologie de la reproduction et infertilité au Massachusetts General Hospital, affilié à l'Université Harvard à Boston, et elle a fait une deuxième année de spécialisation en recherche fondamentale dans le domaine de la reproduction à l'Université de Montréal. Très active dans le domaine de la recherche en obstétrique gynécologie depuis 1997, elle a publié de nombreux articles et prononcé une cinquantaine de conférences au Canada et aux États-Unis. Elle exerce au Centre de Procréation assistée du CHUM et à la clinique de fertilité OVO.