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Life can only be understood backwards but must be lived forwards. chana_mag viii_final.indd 2

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Female Section

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Contents

Personal Experience

Poetic Thoughts

Regular Feature

Life’s Perspectives

Chana News

Medical Focus

Personal Experiences:

Poetic Thoughts

11 12 20 26 34 40 44 46 49 60 63

16 23 25 32 37 45 52 59 65 67

Who would ever believe? Finding my strength within So... Is she your eldest? Those were the days Pieces of a puzzle Waiting for a grandchild Does anyone feel the same? Only Yossi’s mummy Dearest Children A burning issue Just make that call

68 Of babies and benches

Regular Feature: 5 7 74 77 78

Editor’s letter Dear Chana letters List of Chana publications & CDs Chana services Bulletin board

Chana News 6 10 39 58 66 71 72 73 76 82

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From the desk of the support workers Chana calendar A Chana volunteer speaks out A busy Chana volunteer Wellwoman meets Kallah teachers The Fertility show Chana Brunch The Chana fertility helpline Wellwoman helpline Chana online

View from the “other side” Master puppeteer My heart aches My grip Viewpoint A woman’s prayer Just one question Loss Candle Today

Life’s Perspectives 17 29 30 36 42 53 64 70

Pushing the rock Among the blessed When one’s faith wavers Law of the dustbin lorry A tiny bit of light Answered prayers Not good enough The bamboo and the fern

Medical Focus 18 24 28 33 38 50 54 62 80

Eye of the needle The end of IVF Diagnostic surgery High fibre, low expectations Innate health Blastocyst transfer Medical advisory panel What is hypnosis? Medical terms explained

News & Views VIII

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Editor’s Letter

Spring 2010/5770

Dear Friends, We actually sat down to work on this Magazine about six months ago. Many of you were, understandably, getting concerned about this issue ever seeing the light of day. So, here it is, Boruch Hashem we proudly present you with the eighth edition of Chana News and Views, a bumper issue, bigger than ever. Compiling a magazine such as this one is a very lengthy process. Continuous efforts go into contacting and convincing people to share a very private side of their life and put pen to paper so you can benefit and learn from their experiences. Literally hours on end are spent sorting, sourcing, scanning and finding the best articles which touch on various different aspects of the challenges that our readers face. Chana, (possibly because of its name) is often mistakenly perceived as a predominantly women’s organisation. Infertility affects one in six couples who are trying to conceive. In at least a third of the cases the male factor is a major contributor. In order for all to feel more comfortable, we now have a qualified male therapist who joined the Chana Team. Have a look at “Subfertility issues explained“ written by Mr. Anthony Hirsh, giving you a better insight on the male fertility issues. We are also happy to present you with our first male section, so, to our male readership, do keep your suggestions and letters coming. We have included articles from the husbands’ perspective of how they coped with infertility dealing with their own anguish and watching their wives’ pain. Rabbi Malcolm Herman aptly portrays this in his article “At her Side”. The world of infertility is a very lonely one. Yet, times have changed and there is much wider awareness of the issue. There is no need to feel so alone and isolated in your loneliness. Human beings crave to have some sort of connection with each other, but natural barriers and circumstances can prevent this from happening. Each of us have our independent thoughts and our own emotional baggage, which defines who we are, and makes us unique beings. No two people experience the same challenge in the same way, but since they do go through the same experience it creates a special bond. With Chana there is no need to be alone, as you will learn when reading about our new buddy service. We can put you in touch with someone who has gone or is going through a similar situation as you to help alleviate that lonenliness.

Looking at Chana’s achievements to date, we feel humbled and encouraged by the support received from the community. We strive to guide and assist the couples who turn to us and your feedback keeps us going. Just last week while I was compiling this letter I received in the post an envelope addressed to Chana which read the following: “Mazel Tov, our Simcha is really yours and so we want to share it with you. We are delighted to announce the arrival of a lovely precious little girl. Without you at Chana, we would not have been able to enjoy our beautiful family. We are forever grateful for what Chana did and continues to do for us. May you continue to be a help to many, with heartfelt thanks from family ...…”

Just like Moshe we too are not able to see things in the future and comprehend reasons for any struggles or difficulties that happen in the world. By Hashem showing him His tefillin on the back of His head it symbolized His love for Moshe and that He wished to remain attached to Klal Yisroel always, even if He could not reveal the fullness of His essence. However, when we look back at what has happened, analysing past events, sometimes we are able to understand how things do fall into place. Difficulties, when brought upon us, do have a reason and a purpose even if we do not see it that way. Our hishtadlus and emunah go a long way and Hashem does not want to reveal to us the future enabling us to continue davening and doing hishtadlus in the best way possible.

I am mentioning the above only to bring home the point which we, at Chana constantly are trying to get across – there is someone here for you when you feel that the burden is too heavy to carry on your own.

I cannot end this letter without a quick thank you to all of those who helped make this magazine such a bumper issue. To the writers, the copy typists, the proof readers, the office staff and last but not least my contributing editor without whom none of this would have happened. Thank you to the whole Chana team who continue to strive to keep the efficient and expert running of the office and all our services as smooth as possible throughout the year. To our team of volunteers we are indebted to you for your time, devotion and passion for the cause.

The Chasam Sofer comments on the episode of the – golden calf which is mentioned in Parsha that after the B’nei Yisroel sinned and served the golden calf. Moshe found an opportune moment to ask G-d how he was ruling the world. and Moshe said to G-d “show me Your glory” Moshe found it difficult to understand the reason for tragedies and unexplained challenges that befell Klal Yisroel so he wanted G-d to reveal to him the answers. Hashem replied saying the following, – then I shall remove my hand and you will see My back but My face may not be seen.

It is my hope that by assisting those of you who are doing tremendous hishtadlus we can help make your journey easier to navigate. So, now I do not want to take up any more of your time as you have a lot to read. I love it that I have heard from so many of you already but would like you to continue to let me have your suggestions, tips and stories for the next issue. Please stay in touch.

G-d, told Moshe you or no other human being will ever see My face. Rashi explains that Hashem showed Moshe the knot of His tefillin. What was Hashem trying to illustrate here? The Chasam Sofer explains that Hashems’ reply alludes to the fact that Hashem was not intending to reveal the full essence of how He runs the world. He showed Moshe – only His - His back and not the front – not the future.

News & Views VIII

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Chana News

FROM THE DESK OF THE SUPPORT WORKERS

Dear Friend, It has been an exciting time to be part of the dynamic team that makes up Chana. Here at the Chana offices there have been many exciting new developments since the publication of the last News & Views Magazine. The office is buzzing and busy with different projects, many of which are highlighted in this magazine. Under the guidance of its esteemed Patrons, Rabbonim, Dayan Ch. Ehrentreu and Rabbi Chaim Halpern, and with the leadership and support of its valued trustees, Chana continues to try to expand its services to meet the needs of the many people in the community who need it. We are constantly looking at how to get the message out in a sensitive way that we are here to help. Some recent highlights include: Being recognized – Chana is increasingly being seen as an important player in the field of fertility, by attending conferences, and through our involvement with the National Infertility Network and the HFEA. Setting up a Buddy Programme which will be able to link men and women who have had personal experience of fertility issues with a partner, in confidence, to ease some of the isolation associated with infertility. Outreach to the Community we need to know what the community wants, and we need to offer assistance in different ways. We have begun meeting with groups of Rebbetzins, Kalloh and Chosson teachers to offer informal education and back up under our Well woman and Well man banner. Setting up a website which will be further developed, but is up and running and offering information and alternative means of contact with Chana. Adding a male support worker to our team, making it easier for those who wish to speak to a man about Well man or infertility issues.

Continuing to offer Chana support across the UK and Europe by reaching out to different Communities. Launching a Nurses Programme. This programme will enable Chana to offer support and advice in administering injections during treatments, as well as Well woman issues. Continuing to offer a series of events geared both to specialist infertility issues, as well as a range of Well woman topics. Continuing to receive calls from near and far on our helpline numbers, including our new Stamford Hill number. Building up an amazing team of volunteers who, whilst not dealing with confidential information manage to bring a huge range of talents, interests and energy to our Chana office and beyond. (If you have time to offer, we would love to hear from you!) Finally, building up a team of support workers and office staff who are excited about the work they do and feel privileged to be helping Chana to ensure it continues to meet the Communities and your needs.

We are happy to hear from you, and hope you will find the magazine relevant, moving, informative and uplifting. Rae Adler & Carolyn Cohen

Where appropriate, author’s credit is given. Where authors prefer to remain anonymous, no credit is given.

Chief Editor: Shelley Groszman Contributing Editor: Efrat Schimmel Copy Typists / Proof Readers: Chaya Dunner Chaya Suri Hus

Rachel Romer Michal Wittenberg

Graphic Design: Create Services www.createservices.co.uk CHANA is a non-profitable charitable organisation.

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All expenses towards the cost of this publication have been sponsored. Anyone wishing to make a donation to help benefit the work of CHANA please send to 23 Ravenshurst Avenue, NW4 4EE. Charity No.1070196. The views expressed in any articles or correspondences included in this magazine are those of the individual writers and not necessarily of CHANA or the CHANA editor. Their inclusion does not necessarily imply endorsement by CHANA. CHANA is in no way linked to any clinic/ company, nor do we recommend or endorse any one clinic/company.

to CHANA – no part of this publication may be reproduced or used in any form without the prior written permission from the editors. The purpose of this publication is not to give specific or individual advice in any one case. Persons who require advice for their individual situation must contact their professional advisors. CHANA welcomes your letters, articles and poems. All suggestions and comments are welcome. CHANA reserves the right to edit all articles. Please send all correspondence to: CHANA News & Views 23 Ravenshurst Avenue London NW4 4EE

The editors do not accept liability for any printer’s errors, although every care is taken to avoid mistakes. All material in this magazine is copyright

News & Views VIII

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Letters

Dear Chana

May Hakodosh Boruch Hu give you strength to continue your wonderful work. Kol Tuv, JA

Dear Chana, I just wanted to take the time write to let you know how much impact your magazine had on me. I recently visited the Mikvah and whilst waiting, I picked up a copy of your recent magazine and started reading it.

To all at Chana, I would like to use your magazine as a tool to make my voice heard and my innermost feeling understood. I have been married several years and unfortunately have not yet been blessed with children. All the neighbours around me have a few young children who play together and the mothers chat to each other in the streets on a daily basis. I notice how they’re not interested to involve me in their conversations and can only assume they’re not interested to be friendly with me as I don’t have my own children for them to play with. Don’t they realise how painful this is for me to see, do they think it’s my choice that I’m in this situation? Obviously not. Please, spare a thought for your neighbour who isn’t as fortunate as you are and make the effort to not ignore her when you see her. From your lonely Neighbour.

advice and support. From that day on, I felt more positive and calm. Happily I did get pregnant and am now expecting my baby in May. Thank you A grateful Mother

Dear Chana, We have recently undergone an IVF treatment cycle kindly financed by Chana and we are delighted to inform you that we are expecting a baby please G-d. We are extremely grateful to Chana not just for the financial assistance but also for the sensitivity with which our case was handled and for all the help we have received over the years. We will do our best to reimburse at least some of the payment when it is possible for us to do so.

Yours sincerely, H & M. R

Dear Chana,

With fondest good wishes, to every one of you and continuous Hatzlachah. Shalom, Shalom, Lady Jakobovits

Dear Chana, I just wanted to write a quick thank you for the support I received from Chana when I needed it most. I already had three children but could not seem to get pregnant again. I was feeling really low and devastated and thought nobody understood. When I phoned your confidential line, I received such warm

Hopefully this will also help me and others like me to be more sensitive and considerate to those not yet blessed with children of their own so as not to make their burden even harder to bear. Thank you for all your hard work and may Hashem answer each and everyone’s Tefillos Letoivah. In admiration J.S.

To my Chana Support Worker, Meanwhile we wish you much Hatzlocho in your wonderful work.

Dear Chana, Just a short note, but full of admiration, which grows day by day for the incredible love and care Chana gives to too many of our precious young couples who need its help.

I want to say even though I Boruch Hashem have my own children, I have friends who unfortunately don’t have yet and never truly realised quite what they go through on a daily basis. It has made me realise both how thankful we must be for what we have. It has highlighted to me how truly courageous these women are for the very hard test they endure, the pain and suffering which they obviously hide from us.

Please find enclosed a cheque in support of your wonderful work. I was extremely impressed with your latest magazine it has really turned into a professional and impressive publication. If you ever have people passing through our part of the world who need somewhere to rest or eat then please feel free to put them in contact. With best wishes, Rabbi Y Pink Chairman Birmingham Rabbinical Board

Every time I receive a Chana magazine, I decide to write in for next time. I am no good at writing and can never sit down to put pen to paper. This time, I decided it doesn’t matter how well I can write I wanted to at least just let you know how I really feel. Right from the beginning when we contacted Chana for a grant, we felt unbelievably accepted. No questions asked, no digging – just giving in the most respectful way. It’s not easy to ask for help but you at Chana made it a wonderful experience. Each time I talk to my support worker, I come away feeling better. Besides the medical side which she understood so well, she was amazing at keeping me going emotionally. She never lectured me yet she really, really taught me to appreciate what I have got – never condemning me for complaining.

Dear Chana, Whilst having my wig styled, I chanced upon the Chana magazine. Many of its articles moved me to tears. On the whole I found what I read very informative.

I received the new magazine in time for the second day of Yom Tov. I couldn’t put it down! It was quite informative regarding PGD – the subject I was interested in - and it had a list of professionals which was

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amazing. I always do feel better after reading the magazine realising that I am not alone and there are others going through the same trials and struggles that we are. May all of us be Zoche to see only Brochos in our lives. With deepest gratitude, B.S.

Then I look the other way and see friends not yet blessed with their first child, and I feel guilty for asking for more – when I DO have so much Boruch Hashem.

From an Admirer in Manchester Sheyimeleh Hashem Kol Mishalos Libenu Letova – may we all be blessed with that which we all daven for – Doros Yeshorim Umevorachim. Thank you Chana, for providing me with an outlet to express my feelings, which sometimes nobody else understands.

Dear Chana, Thanks for your informative magazine. We would have benefitted from explanations of scientific terminology used throughout the magazine. It has been a real eye opener! PK

To the Chana Charitable Trust, Please find enclosed a cheque for £140.00. This money has been donated by the ladies who use the Central London Mikvah. We have had a lot of feedback from the ladies about how they have personally benefitted from your organisation and the amazing services you provide. They have also said how much Chizuk and enjoyment they receive from the Chana magazine. We all think your organization is fantastic and we look forward to reading the next edition, and to continuing to raise money for you. Yours sincerely, Mikvah Manager

Yours, A friend of Chana

Dear Chana, This morning I received your gorgeous baby card wishing me Mazel Tov on the birth of my baby daughter. Please accept my donation for your wonderful cause. I was really inspired with your recent magazine that gave me a clearer insight of the struggles of infertility and a renewed appreciation for my blessings. Yours sincerely M.W.

Dear Chana, I was totally enthralled by your last magazine which I read from cover to cover, and if I had not exercised extreme selfcontrol, I would have been the lady (in your Letters to the Editor) whose husband came home in the evening to find the house in a terrible mess, because his wife had been sitting on the couch glued to the Chana magazine since 2.00pm!

Dear Chana, I just re-read a copy of your last magazine. Thank you for your excellent publication. Thank you for reminding me that I am not alone in my situation. I identify so strongly with the author who wrote her feelings on secondary infertility – Where do we belong? Boruch Hashem I have one child. For that I am eternally grateful to Hashem. And yet, there is an ache inside me that doesn’t go away. I so much long to have a BIG family. I look at all those who conceive so easily, so naturally, and I think, will that ever happen to me one day? Will I have to wait again and again before each child? These are the questions to which only Hashem knows the answer. Only Hashem knows my innermost feelings which are sometimes so difficult to express. So, I continue to daven and try my best to be happy for each new friend who shares her news with me. I want to keep up my friendships and not become bitter. Yet each time it hurts anew as I feel the sting of another blow.

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may all your subscribers be able to do so as “Chana Parents” instead of waiting for it to become a reality.

I only wish that your publication would circulate among the world of fertile couples, who are able to conceive easily, so as to give them some kind of insight into your deep pain and bitter struggles and all that you endure and suffer in the hope of having one healthy child. I think it would give them a true appreciation of their ability to have a family without any invasive, gruelling, painful and astronomically expensive treatment, often culminating in failure and most bitter disappointment. It would also give them a deeper sensitivity for couples still struggling to conceive and prevent them from making comments, possibly well-meaning but nevertheless extremely hurtful and adding salt to the open wounds. I think it would be wonderful to have your magazine on sale for the wider public at whatever locations you decide to use. I myself have told a number of people what an amazing publication it is and have strongly recommended that they read it. Keep up your terrific work, Chana, and

Dear Chana, I just wanted to thank you for helping us to focus and bring back the spark in our marriage. Although we don’t have children yet, we have managed to recreate some of the fun that we first had in our marriage. We have been married for five years and have gone through endless hours of investigations, treatment and a cocktail of drugs. This took a tremendous toll on our relationship and we were beginning to find it even hard spending an evening together without bickering. Fortunately my husband was wise and called the Chana helpline and arranged for us to meet with two of your therapists, a male and female support worker. After seeing them a few times and dealing with our issues, namely anger and frustration, things began to improve at home. Our problems are still there and we are desperate to have a child but we can now at least enjoy each other’s company again. Thank you A Grateful Couple

Dear Chana, Having a miscarriage even after just a few years of fertility treatment is such a painful experience. One can’t share it with anyone, not the terrible physical pain and humiliating experience that I went through in the hospital and not the emotional trauma that my husband and I experienced. Our Chana support worker held our hand during this horrible time reminding us to try and clarify the reasons for the miscarriage, helping us to come to terms with our loss which no one else knew about and accompanying us on our journey to recover from the miscarriage and heal and try again. We hope that other people are aware of the work that you do because this isn’t something that is talked about at the Shabbos table. Keep up the good work. Yours gratefully B.R.

Dear Chana, We finally got pregnant and told our Chana support worker that we were now in the

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Letters

care of our antenatal hospital and felt secure there.

made to feel like a number in the process makes it even harder.

Two weeks before our baby was due I went into labour and was extremely frightened. The baby was in distress and within a short time the baby was born but did not breathe. Nothing or no-one could have prepared me for the fear I experienced when I didn’t hear my baby cry. My husband and I felt that we were in some sort of hellish place where we couldn’t find a way out. After weeks of me crying my husband got in contact again with the support worker that we had known previously and asked whether there was anything she could do to help me. We met on several occasions and the talking, reminiscing, reliving and making concrete facts about that event gave us some relief from our terrible pain. She helped us to look at the medical and spiritual issues so that we were eventually after some time able to move forward.

I cannot recommend highly enough to all who have to face these issues how helpful it was to have a Chana support worker. Having been able to open up and air our out my feelings with an understanding support worker made the world of a difference to me.

It was hard enough dealing with our own grief but what was also difficult and what we needed help with was how to respond to well meaning family and friends. Chana put us in contact with other people who had been through such similar tragic experiences. Thank you E.S.

Dear Chana, I want to thank your support workers for helping us to cope with our clinic. Our fertility clinic was highly recommended by various specialists and by some of our friends who underwent treatment there. We juggled to get to our appointment on time having taken time off work. The clinic receptionist had called in the morning to confirm our appointment. We sat in the waiting room for ten minutes waiting our turn. The receptionist assured us that it would not take much longer. Eventually the Consultant called us in one hour late! The first visit left us with a bitter aftertaste. We were soon to find out that punctuality was not something our chosen clinic believed in. After many more such late appointments, I contacted my Chana Support worker. She understood my frustration when I wondered if those consultants did not realise that in order to pay for their expensive treatments we did need to keep both our jobs. I was aggravated by the fact that hanging around in the waiting room for hours simply jeopardised those jobs. All those long waits made me very angry. My support worker suggested ways of discussing my frustration with our Consultant at our next visit which I did as I felt that I was helping out future parents as well. Fertility treatment is hard and being

Yours sincerely A.M.

Dear Chana, It is hard enough in day to day life to be assertive. When you go through infertility treatment it is even harder. During my recent IVF treatment I was lying on the operating table being injected with sedatives when the anaesthetist was offhand, abrupt and cold about his failure to sedate me. He tried at least three times to insert the IV into my right hand to no avail. He was getting very frustrated that it wasn’t working. I could find no strength in my voice to tell him how awful it was to be the patient who was being prodded and pricked whilst having to hear his comments and hear his disappointment at not succeeding. Eventually it worked. When I woke up from the sedation, I noticed that he had inserted the IV in my left hand. My hand was so sore, impossible to lift, infected and very painful and I was extremely sedated after having so much sedation pumped into me. All I wanted to do was to go home. Unfortunately, that treatment cycle failed and I didn’t go back to the clinic so I never got the chance to tell them about my experience with the anaesthetist. The whole experience for me was a horrific nightmare with two bruised hands. The only thing that pulled me through was my friend who having experienced her own issues similar to my own could relate to me at this time. It is so comforting to talk to someone who is going through or has been through a similar experience to you. I was lucky I had a friend to talk to, but for those who don’t please don’t bottle it up and suffer on your own. I have subsequently learnt about Chana’s Buddies programme whereby they can buddy you up with someone who can empathise and understand you as they may have been through something similar themselves. For those of you who don’t have anyone to talk to at the time when you may need it, this could be a great support and help for you. Thank you S.N.

To all at Chana, Time ticked by – weeks turned into months and months became years. After years of moving from one Consultant to another they all uttered the same sentence namely: Lose weight and then things will be ok – you are still young, stop worrying. But for us Jewish women this was not good enough to hear that I was still young. Of course I was young but I had been married a number of years already and it was long enough. Eventually my only option was IVF. I was entering the unknown. I knew very little about IVF except for a few facts and the medical procedure it entailed. I had no idea what it involved mentally and emotionally. I had no one to ask – I didn’t want to look like a fool asking stupid questions. My fertility clinic were not very forthcoming with information – I was groping in the dark and felt very scared and alone. I saw the weekly Chana advert in the Jewish Tribune and decided it was time to pick up the phone to call them. If they would not be able to help me, who would. From the first phone call I was at ease. The Chana Support worker explained to me step by step all that I could expect from the treatment. It was an immense relief, she gave me the reassurance that I could deal with this difficult challenge ahead of me. Boruch Hashem we saw positive results and we now have a healthy baby boy! Chana – I could not have done it without your support. May you continue to give support to many others out there who need it. Kind regards A grateful Mother.

WE CANNOT DIRECT THE WIND BUT WE CAN ADJUST THE SAILS. News & Views VIII

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Chana News

Chana Calendar Date

Event

Speaker

Feb, 2008

How Do you Feel Inside & Out?

Dr Marilyn Glenville, Nutritionist.

Finding the right nutritional path for you and your family

at all stages. Including Adolescence, Pre-Pregnancy, Menopause

and later stages in life.

Mar, 2008

The Low GI Diet - Can it Really Help me?

Dealing with PCOS, Diabetes, Pre-menopause,

Prof Nadir Farid, Consultant Endocrinologist.

Hormonal Irregularity.

May, 2008

PCOS ( Polycystic Ovarian Syndrome) – Impact on Fertility

Dr Davinia White, Specialist in Reproductive Its

Medicine, St Mary’s Hospital

- Insulin Resistance

-         FSH Injections

-         The Role of Metformin

-         Clomid

-         Ovulation Induction

-         Surgical Procedures

-         Dietary Therapy

June, 2008

A Spot of Bother?

Dr Malcolm Rustin, Consultant Dermatologist,

Expert Guidance on when Acne, Excess Hair, Irregularities

Royal Free Hospital.

Dr Judith Tobin, GP.

and Excess Weight cannot be ignored.

June, 2008

Medical Panel Meeting

Sept, 2008

Information Update on Surgery Relating to Fertility Issues

-         Endometriosis

-         Blocked Tubes

Mr Arjun Jeyarajah, Consultant Gynaecologist, St Bartholomew’s Hospital

-         Fibroids

-         Ovarian Cancer

Sept, 2008

Medical Panel Meeting

Dec, 2008

Medical Panel Meeting

Feb, 2009

Rebetzens & Kallah Teachers Meeting

March, 2009

Medical Panel Meeting

Jackie Vittori, Clinical Hypnotherapy

Apr- Nov, 2009

Evenings Dedicated to Relaxation

Sessions of relaxation exercises & techniques helpful in everyday life.

May, 2009

Miscarriage

Prof Lesley Regan, Head of Obstetrics & Gynaecology,

St Mary’s Hospital.

-         Overview of the Main Causes

-         New Advances in Research & Treatment

-         Progesterone in Treatment of Recurrent Miscarriage

-         The Role of Natural Killer Cells in Causing Miscarriage

June, 2009

Cancer and Fertility

Dr Alison Jones, Consultant Oncologist & Senior

-         Breast and other cancers affecting women with

Lecturer, Royal Free Hospital

emphasis on protecting future fertility. Mr Arjun Jeyarajah,

Consultant Gynaecologist, St Bartholomew’s Hospital

-         Information on the gynaecological and surgical aspects

of preserving fertility in women with cancer.

June, 2009

Medical Panel Meeting

July, 2009

Rebetzens & Kallah Teachers Meeting

July, 2009

-         Emotional & practical issues relating to infertility and pregnancy

-         Expectations during pregnancy

-         Maternal – infant attachment

Sept, 2009

Chana Annual Brunch

Sept, 2009

Unexplained Infertility

Dr Andy Glew, Embryologist, Herts & Essex Fertility Clinic

-         Why using Blastocysts is the preferred method of treatment

The Challenges of Pregnancy and Motherhood

Julie Cohn, MSC Health Psychology

after Fertility Treatment

Suzie Weisz, Midwife

Dr Michael Ah-Moye, Medical Director

-         Up to date information on investigations & treatment

Sept, 2009

Medical Panel Meeting

Dec, 2009

Medical Panel Meeting

March, 2010

Medical Panel Meeting

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Personal Experiences

WHO WOULD EVER BELIEVE? A small family with big blessings A family. The hopes and dreams of many young couples as they stand under the Chupa in earnest prayer and anticipation of the bright future awaiting them. I too davened hard under the Chupa for life to flow smoothly and joyously. Indeed, Boruch Hashem, it did. Our first anniversary brought a precious newborn son, giving us the title of parents. What followed was something completely unexpected and foreign, and quite shocking to us. For the first couple of months, I nursed the baby full time, but by the time he was fifteen months and my cycle had not returned, we grew concerned. We visited the GP who said that it must be a second pregnancy. We waited patiently but nothing seemed to be happening. Another visit to the GP, nobody was too concerned. A temporary irregular cycle after a pregnancy sometimes happens, we were told. Blood tests, medication and more intervention yielded no results. No pregnancy, no cycles, fluctuating test results. We were thrown into the deep end of trying to find the right specialist. Of course, we weren’t comfortable discussing the issues with anyone else, even our parents, so we groped around feeling very vulnerable, lonely, and so, so young. Eventually we did get a diagnosis which we eagerly awaited as we realised that once we had that, we would be able to come up with some solution to the problem. Deep down inside we were aware that my problem might be quite a serious one, yet we were both very young and felt that we would find the right treatment and would be able to start hoping for a brighter future. The specialist gently informed us that the various tests indicated that ours was a case of POF, premature ovarian failure. This meant that although everything inside me seemed to be functioning properly, my ovaries were not functioning and therefore no eggs were being produced at all. This is what usually happens to a woman’s body during menopause, when the ovaries finish producing eggs and childbearing years are over.The specialist went on to shatter the delicate lifeline we were holding onto by explaining that the only solution available to us was egg donation. Since stimulation of my ovaries would not work at all, he handed

us a brochure about egg donation where people, themselves undergoing treatment of ovary stimulation, donate spare eggs to others who could benefit from it. It took all of our combined energy to remain impassive and friendly towards our doctor. The entire way home, on the underground, I avoided making eye contact with my husband for fear of bursting into tears. I will never forget my husband’s reaction when we got home. The first thing he did was convince me to say some Tehillim with him. After that came the tears, the anger, and the overriding feeling of pain, strong, strong, deep pain. What I am about to describe should not be taken as an offence towards our wonderful, warm and caring community – but the bold fact is that we belong to a community whose entire way of life revolves around raising large families. Everywhere I went, I would feel people’s eyes move straight towards my stomach. Only after that did they greet me. Casual conversations when meeting friends would be stilted. Wasn’t there anything else to talk about? All they would say was, “Oh, you are a lady of leisure!”

‘We eagerly awaited that diagnosis as we realised that once we had that, we would be able to come up with some solution to the problem’ No, I wasn’t. I was running absolutely everywhere in search of a doctor who could help us. I was crying and davening. Is that “leisure”? I no longer enjoyed shopping anywhere. Then there were the comments from people who felt “close” enough to tell us what they thought – “You’re having a nice long break!”, “What, you can’t cope already after one?”, “So when are you going to stop taking the pill?”... All we wanted was more children! I know they didn’t mean anything bad – but the pain was searing and the comments acted like salt on an open wound. I really began to feel like an outcast. We have lots of family and Boruch Hashem everyone was having babies. I would attend all the Simchos and family gatherings – trying so hard to smile and feel happy and hope that everyone would

act naturally towards me – but I could see their eyes, so full of pity, and catch snatches of conversation with the word “Nebach” sprinkled in very liberally. Some wider family members asked for our full names so that they could daven for us. So nice of them, but it felt like a knife cutting through our hearts. I felt humiliated – as though I couldn’t hold my head up in public – but really what had I done wrong? And along with all the pain came the strong sense of guilt! Why couldn’t I be grateful? At least I had one child. So round and round went our thoughts and our emotions. After a while we were put in touch with a Choshuve Rav who became our lifeline. It was there that we could ask any halachic or medical questions, and vent our frustrations. We felt so validated – finally someone understood us. The doctors had basically given up on us having any more children. We went for a last-ditch attempt. We begged the director of a large fertility clinic to let us try one more IVF cycle, but he refused, showing us how our other cycles had failed. With his letter of refusal in our hands, we once again went to our Rav. He read the letter and looked at us and said: “It is time to stop running around. It is time for acceptance.” We tried. We really did. We tried to remind each other how fortunate we were, and to move on with our lives. I tried to keep really busy – but I won’t pretend that the stares at my middle, the pitying looks, or the comments, disappeared. They didn’t, and they still hurt. Boy, did they hurt! There were days when I felt completely miserable and the pain threatened to engulf me. Still we made a conscious effort to move on and have a more positive outlook on life. Boruch Hashem our story has a happy ending. One fine day, whilst trying to get rid of an “internal infection”, we discovered that I was pregnant – just like that, naturally and without any medical intervention! The excitement we felt was simply indescribable! We still don’t have a big family but we are so extremely grateful for what we do have – it certainly overrides all other feelings. We have learnt to feel positive towards other people and to try to judge them favourably, but above all to simply enjoy our precious family.

News & Views VIII

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12/5/10 10:36:05


Personal Experience

FINDING MY STRENGTH WITHIN A woman discovers her inner strength

When I look back to that blissfully happy woman who got married nine years ago, I cannot believe I am the same person who has gone through so much in such a relatively short time. My move to London took a lot of getting used to. Adjusting to a foreign country as a newlywed, starting a new job, having no friends or family to lean on, were all challenges which I faced. Yet, little did I know this was just the beginning of what lay ahead of me. I surprised myself and came to realise, over the years, that I had immeasurable strengths which I previously was unaware of. After six months I found myself feeling very homesick and arranged to visit my parents on my own as my husband could not take time off work. Whilst I was there I noticed that my period was late in coming so I took a pregnancy test confirming that I was indeed pregnant. I immediately called my husband to share the happy news with him but I remember feeling upset about us not being together for that joyous occasion. My excitement was shortlived when a few days later I started bleeding. I was shocked and unsettled, not really coping with this new turn of events. There I was, blissfully happy for a few days, adapting to a new reality and suddenly my joy was a thing of the past. My parents consoled and comforted me to the best of their ability. They tried to convince me that I had not really been pregnant as the pregnancy had never been confirmed by a doctor. I was very distressed as the bleeding was very heavy and I did not know what to do. A close friend told me about a local gynaecologist whom I went to see and he confirmed that he was actually going through a miscarriage. The time came to go back to London and I could sense that, to my parents as well, the geographical distance between us was very difficult to manage. Even though it was hard to leave my parents behind, once back home, my husband was most supportive and caring. I knew that it is not unusual to miscarry a first pregnancy, particularly at such an early stage. So, I just decided to move on and put it behind me, hoping that I would fall pregnant again soon. I felt that Hashem would not have sent me a trial which I could not handle. Yes, there were days when I did not feel like facing the world but I put on my smile and just got on with it. Thankfully I had a job that needed my full attention. My husband, sensitive to my every need, arranged a delayed, two week long, honeymoon. It was a welcome balm which soothed

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News & Views VIII

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Personal Experience

my pain and gave us the opportunity to strengthen our relationship. It was four months after the first miscarriage when I realised that my period was overdue. Excitedly I took a pregnancy test which proved to be positive. Once again we were overjoyed but not for long. Our joy was temporary as, unfortunately a few days later, just like the time before, I started bleeding. I was in a panic so went to my GP and a blood test indeed confirmed the pregnancy. My GP at the time was not the right person to comfort me. I was so devastated that in such a short time I had been through two miscarriages, both in exactly the same manner. We were both older and desperate to start a family.

‘I surprised myself and came to realise over the years, that I had immeasurable strengths of which I previously was unaware’ We felt so alone and isolated. My parents, with whom I am extremely close, despite the distance, just couldn’t cope with the fact that I was going through this experience without them near me. I think that since they couldn’t be with me it was easier for them to block out my sadness whilst reassuring me not to worry. I, from my part did not want to trouble them unnecessarily. This time we felt the need to explore further why I was miscarrying. So, after consulting with a friend, we were recommended to see a renowned gynaecologist. I underwent a whole battery of tests for a few months costing us a small fortune. The results came back and the doctor detected a hormonal irregularity that was causing me to miscarry. Each time I fell pregnant my hormone levels dropped significantly so I could not contain the pregnancy. His advice to me was that I should take some suppositories next time I got pregnant to help maintain the pregnancy On hearing the diagnosis I felt inadequate as a woman and wife. I felt guilty that it was all my fault that I couldn’t hold a pregnancy. My husband wouldn’t hear any of this and totally supported me that we were in this together and we would do everything to have a baby no matter what it would take. With my husband’s positive outlook and encouragement I

was ready to continue no matter how difficult, messy, painful, invasive, or uncomfortable it would be. I would do everything to have a child naturally, and the rest is Min Hashamayim – determined from above. Hashem knows what is best for us and how much we can endure. I felt strengthened by that knowledge.

a laparoscopy to remove my right tube and stop the bleeding. I had to stay in hospital for Shabbos, my husband slept on the floor next to me and didn’t leave my side with only a short break to go and put together all the Shabbos necessities. It was one of the most difficult Shabboses I can remember.

Our dream to have a child took on a whole new meaning. We explored all avenues. We spoke to Rabonim got brochos - blessing, gave tzedaka - charity, took on numerous segulos and really worked on ourselves spiritually. We felt confident to try to continue to conceive naturally with all the brochos and segulos we were given. My profession is child based and I was willing to devote myself fully to the children in my care whilst waiting to be given a gift of my own.

Once back home, my parents came to visit me -it was the first time since I was married that they had come. I had always thought that my parents’ first visit would be when I would have presented them with a grandchild. I sensed how difficult it was for my mum to see me looking so helpless, yet she was very comforted by how we were dealing with our loss and trying to continue with our lives as normal as possible. It was a great comfort for me to have their support at this time. I was very grateful that my husband was so supportive, caring and understanding and I really felt that we were in this together. This was one of the main things that got me through as it must be very hard to go through this without the support of a caring husband.

Several months later I fell pregnant again. We were ecstatic and believed that this time it was for real, this time, we would be on top of things and this pregnancy would go full term. Shortly after I found out that I was pregnant. For the third time, I attended a family Simcha abroad. Even though it was still quite early on, it was already visible that I was pregnant and we were so excited to share our news with our family, accepting all their good wishes. This time due to my medical history I had been having early check ups and was being closely monitored. As instructed I was taking the progesterone suppositories – a rather messy business – but I was prepared to do anything to hold onto this pregnancy. We were infused with excitement from the simcha and the love we had received from all the family. We arrived home Thursday night happy and impatient to see our baby on the ultrasound scan at our appointment the next day. But, unfortunately once again our excitement was short lived. There was no heartbeat - the sac was in the fallopian tube with no heartbeat – it was an ectopic pregnancy. I had started bleeding internally. Just a few minutes earlier I was feeling so good, alive and happy – with the blink of an eye I felt as if a balloon had deflated inside of me – I was numb, frozen, shocked, I couldn’t believe this was happening to me. If I hadn’t been scanned so early on in my pregnancy I could have died within 48 hours. I was hysterical – there was so much information to grasp within a space of a few minutes. My whole world was turned upside down. I was rushed into the emergency room for

I had always thought that my parents first visit would be when I would have presented them with a grandchild To the outside world we continued to put on a good show even if it was hard at times. When I arrived home from hospital carrying a suitcase, my newlywed neighbours asked if we had been away for Shabbos hoping we had had a good time. With a bit of smiling and nodding we acknowledged we had. We never felt we needed to say anything different because after all the surgery went well, we were home together and had each other. They never knew any different. Life goes on… that is I how I tried to cope. I went back to work, threw myself into chesed projects and continued to be a dutiful housewife. Etched in my mind were my mothers parting words to me when I left my native country. She said she believed in me and knew that I was strong and able to face challenges head on with my immense inner strength. Yes, I was sad, felt lonely and hollow –and I loved the idea that Hashem’s creation had been growing inside me. To lose that was devastating. It took me time but once I admitted to myself how devastating

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Personal Experience

it was, only then could I accept it. I understood that Hashem had his reasons and was grateful that Boruch Hashem I had my health, my husband and at least I knew that I could get pregnant. My Mum’s mantra kept me going. I felt confident that I had the strength to overcome those challenges. I was grateful that I had the strength to deal with what came my way – I am aware that not everyone can adopt this attitude. It is always hard when your friends and siblings around you are getting pregnant and don’t know how to deal with your pain. What made it easier for me was that I would tell them to share their joy with me - it made me so happy that they wouldn’t have to experience all that we had to. With time they realised how much I meant it and I was the first person they would call with their news.

‘I just stood there all the blood drained my face frozen to the floor with shock and embarrassement but not wanting to create a scene’ The months were passing when we began to realise that not only could I not hold a pregnancy I could not fall pregnant either. This was probably due to the fact that my right most active tube had been removed. This created a whole new dimension to the problem. We didn’t know where to turn and just as we were deliberating what avenue to take, Boruch Hashem I couldn’t believe it, I fell pregnant naturally. We were so excited with each week that passed and I was still pregnant. Yet, at the same time I was nervous and holding my breath till my three months check up. One month, six weeks, two months passed and my three months check up was approaching. The following Friday night I started spotting – I was scared. The whole Shabbos I was a nervous wreck and I had to wait till after Shabbos to call my specialist to arrange an emergency ultrasound. My specialist could not see me in person which distressed me even more. The scan confirmed that there was no heartbeat and the baby had probably died two weeks earlier without me knowing. I was in total shock. Everything seemed to be going so well. I couldn’t sleep all night until I met my doctor the next day. He suggested that I could either have a D&C immediately or wait to miscarry naturally. I had such difficulty accepting I was carrying a dead foetus inside me

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compared to the last ten weeks when I was so excited being pregnant. I couldn’t wait any longer so I opted for a D&C. After the operation, I was extremely emotional and vulnerable. My weight fluctuated from the pregnancy and I could have even been mistaken for still looking pregnant. A story that is etched in my mind that hit me the hardest was once when I was in a local shop. An acquaintance of mine shouted across the shop in front of everyone “I’m so happy for you – when are you due it’s so nice!!!” I just stood there all the blood drained from my face frozen to the floor with shock and embarrassment but not wanting to create a scene – I softly replied that I was no longer pregnant. She was embarrassed and apologised over and over again. I bit my lip and pretended to be fine all the way back home until I walked through the front door and burst into tears and thank G-d was comforted by my husband. When I next met my doctor I was greeted with the news he told me that I was quite unique in having had two miscarriages, one ectopic pregnancy and being the carrier of a defective chromosome. He informed me that the reason for my miscarrying was due to a chromosome problem that only occurs in females. This was quite a lot to deal with. He then asked if I wanted to proceed to try to get pregnant. I responded that my whole goal in life was to be a good wife and become a good mother. He reassured me that he would do everything to help me achieve this. To help us survive this difficult time, we went to visit my family abroad. Once there we were recommended, by a local Rabbi, to see a specialist fertility clinic. Desperate to try anything I agreed to go to the clinic. I underwent another whole battery of more invasive painful tests. Instead of finding an answer to my recent miscarrying they discovered I had an added problem. It seemed to be extremely serious, requiring major surgery and incurring a costly fee. We were so confused and shocked. How could it be that the specialist in London had simply overlooked this problem? We didn’t know what to think. As soon as I got back to London I went to see my Specialist who did more tests to see if he could confirm this diagnosis. Unbelievably all the results came back negative. It seemed that back home, I had been misdiagnosed. What a rollercoaster ride it had been and I was just relieved and grateful to have been spared painful and unnecessary surgery.

It took me a while to get back to myself after all that we had been through the last few months. Once I felt physically and emotionally ready, after investigating all our options we realised IVF was the only way we may be able to achieve a pregnancy. We put together all our savings and prepared ourselves to undergo our first IVF cycle. We eventually found the right clinic where we felt comfortable. At first my cycle was monitored for a short while to determine when would be the optimum time to start with the medication. Once that was established I was fully immersed in the treatment swallowing pills, having daily injections, regular blood tests and scans. Boruch Hashem all seemed to go smoothly and I was producing many follicles. It didn’t seem to be as difficult as I had imagined. I was ready for egg collection and many eggs were removed but much to our dismay only one fertilised.

‘I was too nervous to get excited so refused to allow myself to get emotional or attached to this pregnancy’ Once implantation had taken place, the waiting time was endless. I had only one single embryo. After all we would be grateful for one healthy baby, so we prayed and hoped it would embed to achieve a pregnancy. Throughout my treatment I had the support of some very close friends which was a great help. I remember telling one of my closest friends that if this didn’t work I would need a very long break to gather my strength again mentally and physically for the next step. Boruch Hashem that one single embryo embedded and I was indeed pregnant. It was a miracle – we couldn’t believe it had worked. That was only the first positive step -I still had to maintain the pregnancy. I was too nervous to get excited so refused to allow myself to get emotional or attached to this pregnancy. I had to take a double dosage of progesterone every morning and evening for four months. I counted every passing day. I counted every passing week until I reached the three months mark. I was constantly monitored with blood tests and had more scans than anyone else I knew. The IVF treatment had worked but I was so tense throughout my pregnancy. People would encourage me to enjoy this special pregnancy. They warned me that once

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Personal Experience

the baby will be born life would take on a totally different dimension. Little did people know just HOW nervous I was 24 hours a day and how much I just couldn’t wait nor even imagine holding a baby in my arms. I prayed and begged to merit a healthy child after all we had been through. The months dragged by slowly, each month felt like a year. I went into labour on my due date. Having been through countless treatments and lots of medication I insisted on a completely natural birth to savour every second of it. After being in labour for many long and difficult hours our beautiful baby boy arrived. We were numb, in shock and it took us a while to register that all this was actually happening to us. We had been yearning for this little being for so long and here he was. We would sit and just stare at him for hours in amazement. We were elated and so grateful that after eight years of pain, yearning and hoping, at last we were Parents. Looking back at the past eight years of my life, I feel that at times, the trials sent to me were difficult to bear. Sometimes the pain and helplessness felt like I had fallen into a deep dark hole with no escape in sight. I know that many face similar challenges or will do so in the future. These nisyonos-trials are sent to us and there is no way of explaining why. There is a reason but we do not always understand. I am happy to be writing this article for the Chana magazine as I hope that it will give some chizuk –hope- to those who need it. We are fortunate to be living in times when there are so many medical advances to help achieve a pregnancy. We are lucky to have an organisation like Chana. At Chana you will find a non judgemental friend, holding your hand and guiding you through any facet of this difficult journey. Having been through eight years of hardship we realise that Hashem has given us tremendous strength, courage and determination to deal with any future challenges. Each test, treatment or discomfort created a stepping stone which elevated us to the status of parenthood. I now recognise the inner strength which I have been given to overcome any challenges and nisyonos brought on my loved ones or me in the future.

News & Views VIII

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Poetic Thoughts

View from the “Other Side” By Leah Reich I pulled aside the curtain

The new ripples in my lake

And screamed, as I fell into your

Are from your tears.

Nightmare

We are so close.

Just for an instant.

But we are separated by the

It was so close that I touched it –

Vast

The pain where you live, always

Plunging

Without escape.

Divide Of anguish.

But I live in safety,

I stretch out my arms,

Except for one burn

But yours are empty.

From the fire that consumes your days. How can it be that we both live in the How can it be that we both live in the

Same world?

Same world?

How can you live at all?

And how can it be that we look so alike?

I have been brushed by your pain and

I float on a placid lake,

Changed forever.

With just a ripple, now and then.

I want to rescue you from the agony.

But you thrash and struggle in angry

But all I can do is

Waters,

Call out

Gasping and choking,

From across the ocean,

Searching frantically for the sunshine

Wishing that you could hear me

That I receive anew each day.

Over the cry of the wind. Reprinted with kind permission from Binah Magazine. Copyright 2010

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News & Views VIII

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Life’s Perspectives

Pushing the Rock Shira Gutskind

Desperate for a job, Yisrael hunted the newspaper. He hit upon a classified ad with an interesting opportunity. “Looking for a stong man to assist mover. Job well paying.” That sounded great – he felt strong and wanted a well-paying job. After a short interview, Yisrael received a call informing him of his acceptance to the position. But the acceptance included a stipulation, that there would be a one month preparation period, during which he would be paid, but not moving furniture. Arriving at work the next day, the boss showed Yisrael a small room. The concrete walls were white and bare, save one small wooden window, which provided a bit of air. An immense boulder waited near the right wall. The boss instructed Yisrael to push the boulder with all his might. Obligingly, he pushed. Then, to his surprise, his boss said, “That was great. Do this for the next three hours, until work is over.” Intrigued, Yisrael pondered this puzzle; there had to be more beneath the surface. Can it be that the boss would pay him to push a stone? He searched the room for an explanation or a clue. Nothing. A completely empty room, save himself, the stone, and a trace of air. But being a paid worker, he had to do his job. So he pushed. And pushed. At the day’s end, the boss came to check on him. Yisrael questioned the absurdity of the job. “Is there some reason for it? I worked so hard. I’m just wasting my time. Why would you pay me to waste my time?” The boss simply replied that this is the way he hires his workers. Mystified, Yisrael left work. The next day, to his

surprise, his boss informed him that he would be doing the same work as the day before. “Seriously? You want me to spend a whole day just pushing the enormous boulder? I can’t. It’ll drive me crazy!” “Anyone who works for me has to follow my protocol. You can take short breaks to rest and to drink, but for the rest of the time you are to do just that, push.” Yisrael went to the stifling room and began pushing the large rock. He pushed for an hour, and then two. With time, Yisrael could go on no longer. Drenched in sweat, and feeling utterly ludicrous, he thought he’d lose his mind. But a job is a job, so he continued.

large boulder. His boulder is a bit different than yours, but he has to push all the same. You cannot go into his room, everyone doing this must be alone, but you can take a peek into someone else’s room, so that you can know that you are not the only one struggling.”

The days slowly trudged by. From morning until evening, Yisrael did that wearisome labour. It was lonely in the little white room, and Yisrael felt like collapsing. His whole body heaved in pain, and the monotony threatened his sanity. What does he want from me? Why is he leaving me in this utterly desolate place? I must be the only one in the world doing such ridiculousness?

Every muscle of his body protested from strain, his nerves stretched taut, and his strength waned. The only that kept him going was his trust in boss, in spite of the monotony and gruelling work.

Determined to preserve his sanity, Yisrael begged his boss to explain. “Please, help me to understand, even just a little bit. It’ll make the job so much easier for me if I know the reason for this strenuous work. And why am I the only one doing it? Why don’t other people have to go through the preparation that I do?” With that, Yisrael burst into tears. The boss listened quietly as Yisrael cried. “The reason I cannot explain, that you will only find out at the end. But for now, I can tell you that you are not the only one. Anyone hired has to go through this. Come to the window over here, you can see another worker also pushing a really

Yisrael felt satisfied. Clearly the boss had his reasons. He wasn’t the only one doing this. Somehow just that knowledge made it easier. But as the days progressed, so did his exhaustion. A full day of just pushing the boulder wore him down. A discouraged Yisrael wondered how he would ever manage the next two weeks.

Through much difficulty, Yisrael managed the next two weeks. They were agonizing ones, full of self-doubt, and at times, despair. But he made it, a complete month. Gratified, he presented himself to his boss. “I did it. Though many times I felt like giving up, I pushed through, and I made it. Now please, I beg of you, tell me what happened when I pushed the stone.” A moment’s silence, and then the Boss replied. “Yisrael, lift up your sleeves. Do you see those muscles? They weren’t there before. Only now you are ready to move. Worlds”. Reprinted with kind permission from The Butterfly Magazine

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Medical Focus

Eye of the needle Acupuncture not only relieves pain, it can also relieve the symptoms of many physical and psychological conditions, and as Dr Jeremy Nathan explains, the procedure can be an effective adjunct to conventional medicine

Acupuncture is the procedure of inserting and manipulating needles into various points on the body to relieve pain or for other therapeutic purposes. Acupuncture can relieve the symptoms of many physical and psychological conditions and may encourage the patient’s body to heal and repair itself, if it is able to do so. The word acupuncture comes from the Latin acus meaning “needle”, and pungere meaning “to prick”. The earliest written record of acupuncture is the Chinese text Shiji written in 100 BCE although acupuncture is known to predate written history. Indeed, a wellpreserved natural mummy of a man dated from about 34th century BCE, named by scientists as Ötzi the Iceman, was found in September 1991 in the glacier on the border between Austria and Italy. Ötzi had approximately 57 carbon tattoos consisting of simple dots and lines on his lower spine, behind his left knee, and on his right ankle. It has been speculated that these points were most likely to be acupuncture points used to treat osteoarthritis of the corresponding joints.

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Interest in Acupuncture in the west really began in earnest when Richard Nixon visited China in the 1960s. One of the journalists who accompanied him, James Reston of the New York Times, underwent an emergency appendectomy during his visit. While standard anaesthesia was used for the actual surgery, Mr Reston was treated with acupuncture for postoperative discomfort. He subsequently wrote about his experiences on his return and interest in the west really took off.

‘Acupuncture does much more than reduce pain and modern research has shown that acupuncture can affect most of the body’s systems’

Western medicine understands acupuncture to stimulate the nerves in skin and muscle producing a variety of effects. It is known to increase the body’s release of natural painkillers – endorphin and serotonin – in the pain pathways of both the spinal cord and the brain, modifying the way pain signals are received by the brain. But acupuncture does much more than reduce pain and modern research has shown that acupuncture can affect most of the body’s systems – the nervous system, muscle tone, hormone outputs, circulation, antibody production and allergic responses, as well as the respiratory, digestive, urinary, and reproductive systems.

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Medical Focus

Infertility and Acupuncture Acupuncture is known to help regulate the hypothalamus and pituitary glands which produce the hormones that control the reproductive organs in both men and women. This finely-tuned system is very sensitive to stress and other environmental factors that can inhibit its ability to function properly. In women, acupuncture is beneficial in promoting follicle production, enhancing uterine blood flow, and improving thickness of the lining of the womb (thought to be directly proportional to the success in maintaining the developing foetus). Furthermore, by helping to regulate stress hormones it is thought to have a positive influence on this delicate balance of hormone production. Acupuncture may assist with treating some of the following fertility imbalances: Anovulation – is the lack of ovulation. Ovulation, which is the release of an egg from the ovary, must happen in order to achieve pregnancy. Research shows that acupuncture can promote the induction of ovulation. Hormonal Imbalances - acupuncture treatments can be especially beneficial for women faced with luteal phase defects, high FSH levels, low oestrogen levels, or polycystic ovarian disease. Acupuncture influences the hormonal regulation centres in the brain and autonomic nervous system, helping to restore a balance of these hormones by mechanisms yet to be fully understood. Male-Factor Infertility – low sperm count, low motility, movement, morphology –shape can reduce chances of conception. Acupuncture can increase blood flow to the male reproductive organs and has a positive influence on sperm production again by mechanisms still not fully understood, although helping to relieve symptoms of stress may play an important part in this.

‘In women, acupuncture is beneficial in promoting follicle production, enhancing uterine blood flow, and improving thickness of the lining of the womb’ At the moment, anybody in the UK is allowed to call themselves an acupuncturist and can start advertising and practising acupuncture immediately, regardless of qualifications or experience. This is not ideal within a healthcare setting, so patients must check the credentials of their practitioner. The author of this article, Dr Jeremy Nathan, is an accredited member of the British Medical Acupuncture Society an organisation formed in 1980 as an association of medical practitioners interested in acupuncture. It is now a nationwide group of registered doctors and allied health professionals who practise acupuncture alongside more conventional techniques. The BMAS encourages the use and scientific understanding of acupuncture within medicine for the public benefit. It seeks to enhance the education and training of suitably qualified practitioners, and to promote high standards of working practices in acupuncture. The BMAS believes that acupuncture has an important role to play in health care today and promotes the use of acupuncture as a therapy following orthodox medical diagnosis by suitably trained practitioners. Members are all regulated healthcare professionals who practise acupuncture within the scope of their professional practice.

DR JEREMY NATHAN General Practitioner, Clinical Teaching Fellow, Academic Centre for Medical Education, UCL Medical School, BMAS Accredited Medical Acupuncturist and Chana Medical Advisory Panel member. email: drjnathan@live.com www.privateacupuncturegp.co.uk

Despite its longevity, acupuncture has become increasingly popular in very recent years. Whilst it is exciting that the range of medical applications of acupuncture is increasing, it does mean that the responsible practitioner of acupuncture has a duty to educate the general public about the strengths and weaknesses of the technique. It is not an eternal panacea, but in the right hands can be a very effective adjunct to conventional medicine.

News & Views VIII

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Personal Experiences

“So... Is she your eldest?” “Yes... And my youngest” Leah Cohen ponders where acceptance begins and ends All names are fictitious to protect anonymity.

The Intro... I debated a long time over whether to write this article. I asked myself whether it was presumptuous to write an article about the struggle I had in the area of secondary infertility whilst being aware that couples suffering from primary infertility were going through a far greater struggle. I also knew that others going through secondary infertility have faced difficulties far harsher than mine.

‘If you haven’t become pregnant by now, you won’t become pregnant naturally’ Thus who was I to help anyone and what chizuk could I give anybody which would help them in any way at all? However, my experience in the area of SIF was that the taboo surrounding discussing fertility is so huge and the silence enveloping is so deep and difficult to penetrate that any nugget of empathy, or chizuk or shared experience from a fellow “SIF-er” meant a huge amount to me at the time. I very much hope that this article could do the same for some readers. I feel that if anyone reading it can feel even the smallest bit more validated in the feelings they have or more supported, it is worth writing. I hope that no one reading it will think it presumptuous. Please believe that I know that there are many more people suffering far more than I can know and that I am humbled by what they go through and how they deal with the challenges they face.

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Personal Experiences

Personal Experience

The flight for SIF is about to take off... When and where does the journey of SIF start? In my case, I have often wondered. Was it when my daughter, Sara, was 11 months old and mildly concerned, I asked my GP whether she thought I should already be pregnant again? Or was it when I came back again slightly more concerned, when Sara was 18 months to ask the same question again? Or perhaps it was when I collapsed with a gynaecological condition when Sara was two years old to discover that I had a condition which had been undiagnosed for years. I think that our realisation that we had a problem really started when despairing of any help from my GP and by now seriously concerned, I went to see my husband’s GP who said, “If you haven’t become pregnant by now, you won’t become pregnant naturally”. I walked out of the surgery in a daze and reality really began to hit home. Medical Matters... Many trying months went by in cycles of pain from my condition which at times was very difficult to bear. The nature of having a gynaecological issue is that it is never discussed socially. There were many times while we were socialising when I was in terrible pain, yet of course not wishing to mention it. I just pasted a smile onto my face and tried to suffer in silence. The strain of the pain and the outward denial of it were huge. And the appointments of course: visits and phone calls to GPs, gynaecologists, hospitals, complementary therapists carrying on month in and month out with no end in sight. One operation was followed by another a few months later... and another. Throughout it all was the chorus coming from every medical practitioner of “Its...unexplained secondary infertility”...that twilight zone that offers glimmers of hope and frustrations of wishing for a diagnosis and nothing concrete at all to focus on. Crazy Comments... Comments... comments... comments... I am convinced that no one ever means to hurt anyone’s feelings with their remarks which are just often ill thought out. And of course reactions to comments are very subjective. What might hurt someone’s feelings may not even affect another’s – indeed they might even appreciate the comment. Equally, I am sure that I myself have

made many hurtful comments to people without realising the impact of my words. However the logic of all of these never helped me when I was feeling sensitive about having “only” one child and was at the receiving end of a careless remark. The one that stands out the most in my mind was at Sara’s birthday party. I prepared a beautiful party for her with many friends and relatives attending and enjoying. As the room was full, one of my friends arrived and came shrieking into the room, “Leah! You don’t have a baby anymore!” I wanted to sit down and cry on the spot. Another time I met a friend who was here from Israel with her five children. We were both in the shoe shop chatting and comparing notes about our lives. After she had ascertained that I had “just” one child she said laughing incredulously, “so what do you do all day?” – similar, I suppose, to the people I used to meet, who would say patronisingly, “So, how are you?”.... “Keeping busy?”... “Lady of leisure!?” – as if without a large family no one ever has anything to do to keep them busy.

‘So what do you do all day?... “Lady of leisure?!?!?’ Added to this was the care and concern of our parents, grandparents and siblings who were often consumed with worry about us but didn’t want to be intrusive. All their efforts to remain discreet were appreciated but it was inevitable that from time to time their worry would erupt with comments, wanting to know ‘what was happening’, or rather wasn’t happening, and why. I came to dread every Erev Rosh Hashana and Erev Yom Kippur with the tears and brochos for ‘many more children’ to come iyH.

I would ask David to do the rota for me. Much as I tried to just enjoy Sara and be grateful for the enormous blessing which we had in her, I often dreaded school events, where I felt that my situation was obvious for all to see. I recall one mother-daughter activity in school which I attended. The mothers and daughters were seated together to do an arts and crafts activity. As I sat down and tried to focus on Sara and enjoy my time with her, I couldn’t fail to notice that the classroom was crowded with buggies of younger siblings in every shape and size. I was the only one without a baby to fuss over and look after. At that moment I felt so exposed and upset that I just froze. I felt so overwhelmed that I just felt incapable of uttering one word. I went home alone and in tears that day. Most devastating of all was when David and I were called into school for a meeting. We were told in no uncertain terms that as parents of an only child the staff were concerned that we were being overprotective of Sara and over-involved in her education. We were told that we should treat Sara ‘as if she was part of a normal family’. The hurt that this caused us is impossible to put into words to this day. My constant companion... guilt

My darling daughter...

I felt often that guilt was like a shadow, always present, sometimes looming large and at other times nearly (but never quite) invisible. I felt terribly guilty towards Sara. I felt that not being able to provide her with a sibling was failing her in a major and life-changing way. I often imagined (and I do think that I was just imagining it) that she felt alone and lonely. I felt awful that she was different to all her friends that that when she asked when we’d have a baby, I had no answer to give her. Every time a friend came to play and and asked her where the baby was, my heart ached.

Throughout this challenging time of course Sara was the highlight of our life. David and I were crazy about her and enjoyed all the time which we spent with her. We had many happy times together and derived huge nachas from her, rejoicing at her every milestone. Taking Sara to playgroup and then to school where she was the only “only child”, and where I used to always meet other mothers with younger children in tow became very painful for me. I felt so self-conscious, as if everyone was looking at me and pitying me, and my self-confidence plummeted. Many times

I felt guilty towards David, feeling as if I was the cause of us not being able to have a large family. His assurances that he loved me irrespective of how many children we had and his continual reminders that all was in Hashem’s hands made me feel calmer, but the guilt was continually eating away at me. I felt guilty that I wasn’t davening more, doing more mitzvas, doing more to be deserving of having another child. When my husband tentatively mentioned fostering a child I felt even guiltier that this wasn’t something which I felt I wanted to do. My doctor warned

News & Views VIII

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Personal Experiences

me that the guilt and anxiety was really harmful and was affecting my whole persona, and I knew that she was right. I was becoming a changed person full of worry and anxiety almost all of the time. CHANA and Chizuk Rightly or wrongly, being a very private person and suffering from a very personal medical condition, I did not discuss what I was going through with anyone other than David. I knew I needed some help with dealing with the feelings I was having. I often thought of calling Chana, however I would say that it took me about a year to muster the courage to do so. When I finally did place the call and the support worker answered, I surprised myself by starting to cry unstoppably as all the pent-up emotions I had been keeping to myself started to surface. The support worker just waited patiently and from that call on, I felt that my life had become easier. I now had a refuge which was always non-judgemental, confidential and encouraging. It was a huge support for me to be able to share my feelings in this manner and to receive practical help too, and I cannot overstate the strength that this gave me during this time. I also spent time on the A T.I.M.E. website and forum for SIF. I found that sharing my feelings and receiving feedback from people in similar situations gave me enormous chizuk and helped me recharge my batteries many times. On one visit to my gynaecologist, when I was feeling particularly despondent, he said to me some words which I will always remember. “Leah,” he said. “You have to learn to step out of your community. Not to step away from them but just to step out of the community. Stop looking around at everyone else and trying to have a large family like them. Give yourself a break, be individual, and be grateful for what you have.” This wise advice actually rang a strong bell with me and from that time on I did consciously try to stop noticing how many children other people had, who was pregnant and who wasn’t, and I began to try to focus more on the positive in my life and not think about if and when I would be pregnant again.

and other projects which I wished to accomplish. We had wonderful holidays and beautiful Yamim Tovim together, and I really felt blessed in countless ways.

‘When I did finally place the call.. I surprised myself by starting to cry unstoppably as all the pent-up emotions started to surface’ Our Yeshua For some time we had been on a waiting list to start a new fertility treatment. The treatment actually had to be postponed as the letter from the hospital had gone to my old address where the new owner had not passed it onto me. At the time I felt very upset with her that she was the cause of us missing our appointment and having to wait months to reschedule it. As I should have reasoned though, Hashem has a reason for everything and there was certainly a reason for the treatment being postponed. We were scheduled to start treatment in March. In February, to our great amazement, I fell pregnant. The unexplained infertility had changed into unexplained fertility, proving to us that explained or unexplained, “Hakol Biyedei Shamayim”. Our gratitude to Hashem and joy had no bounds when I gave birth to another baby.

Looking Back... I often think back to this period in my life to try to see what I can learn from what we went through. It is obviously difficult to openly support people who are going through something as private as fertility issues. I try extremely hard to be sensitive and particularly aware of other people’s feelings who may be suffering ‘behind the scenes’. I try to realise that friends who may seem fine might be experiencing intense physical and emotional pain, all with a smile pasted onto their faces, as I was. I try to remember for myself that no Tefilla goes to waste and that even though conventional wisdom and logic may tell you one thing, Hashem works over and above common sense and logic and statistics and that truly, ‘Yeshuas Hashem Keheref Ayin’. I daven every single day that this Yeshua will come to everyone and that no one should have to wait for it or suffer any pain while doing so. Postscript When my baby was just a few days old a friend of the family came to visit. “So...”, he asked. “How many children do you have now?” “Two”, I answered proudly. “Only two???” he answered, visibly shocked. So, I wondered... at which stage does the journey of SIF actually end?

And of course there was so much positive to look at. I know that I was blessed with a hugely supportive and loving husband and a fantastic daughter. I had ample time for myself to concentrate on my studies and my work

22 News News&&Views ViewsVVIII

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Poetic Thoughts

Master Puppeteer By Chani Figall Reprinted with kind permission from Binah Magazine. Copyright 2010

For too long I forgot The Master Puppeteer Of the largest Most famous theatre. Who pulls The strings And the puppets Do his bidding. March across stage To his rhythm, His tune, Each performing Its act On stage. I was The foolish puppet Who tried to break free. Forgot The strings that bind And danced across the stage Alone. Yet hard as I strained, The strings Remained In the puppeteer’s Guiding hands. I strained to the right, Pulled to the left. Felt Bereft Yet the Puppeteer Held his strings. The straining Was painful. Breaking free Devastating, Impossible. So dear Puppeteer, Dear Father, I return To Your loving Hands, Constantly pulling The strings On the stage That is Life.

News & Views VIII

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Medical Fucus

The end of IVF? Review of a new book that takes a simpler approach to the treatment of infertility: The Fertility Plan by Dr Sami David and Jill Blakeway (Book review published in Style Magazine the Sunday Times 26 July 2009)

It is a sad fact of life that one in six couples will have difficulty conceiving. Those praying for a miracle will often try anything, from the estimated 75 per cent who experiment with alternative therapies, to the one in 80 women who will eventually give birth to an IVF baby in the UK each year.

IVF at less than 35 years of age are still only a 47 per cent success rate. The duo present a range of factors including yo-yo dieting or excessive exercising as being common inhibitors to fertility as well as reduced pelvic blood flow or infections which can be cleared with simple antibiotics.

Now two leading fertility specialists have decided to bridge the gap between conventional and complementary medicine, to offer an alternative to rushing to the IVF clinic. Dr Sami David estimates that 50 per cent of women on IVF treatments don’t need it and would probably get pregnant naturally. Although Dr David, who was involved in the first successful IVF baby in New York, has a vested interest in the multimillion pound industry, he believes that too many doctors are very quick to rush their patients onto expensive, invasive treatments instead of taking the time and trouble to investigate why these couples are failing to conceive. He has teamed up with Jill Blakeway, an alternative health practitioner to write The Fertility Plan, a three month scheme to help women overcome common blocks to pregnancy.

What is your fertility type? These questions apply to men and women and you might find that you fall into more than one category. Tired, Dry, Pale, Stuck or Waterlogged. - Tired: Often cold and have poor circulation. Need a lot of sleep, prone to aches, often have pale or sallow skin, get out of breath and may have trouble concentrating. Tired people can experience a range of digestive complaints. They are prone to loose stools first thing in the morning, bloating and flatulence, and are sensitive to sugar. This group puts on weight easily, particularly when fatigued or stressed, and tend to retain water but many urinate frequently. Tired people often have low libido. - Dry: types have dry skin, eyes and hair. They tend to feel dehydrated and usually hot flush easily and have rosy cheeks. They can be constipated, are generally thin and have low tolerance to stress, and may get restless, fidgety or anxious. Many dry people have trouble sleeping. Symptoms tend to worsen with age. Dry women are often prescribed fertility drugs to which they do not respond very well and may be put even more severely out of balance. In rare cases fertility drugs can bring on premature menopause. - Stuck: These people often complain of tension headaches or a nervous stomach. They are prone to high blood pressure and tight muscles. The stuck cycle of bottling up stress and then exploding sometimes translates into alternating constipation and diarrhoea. Other symptoms are premenstrual

This book offers targeted advice to five different “types” of women, these are loosely based on Chinese medicine but every effort has been made to simplify the esoteric aspects of this eastern philosophy. The book has quizzes and guidelines to help identify your “type” and what to do in each case, refreshingly simple. This book also explores areas that most clinics avoid discussing. The quick fix attitude to society has in part contributed to the increase in IVF - “I will go for IVF when the time comes to have a baby but for now I will concentrate on other things”. They point out that in the best USA clinics, the results for women having

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mood swings, breast tenderness, fibroids and endometriosis. Many experience the effect of oestrogen dominance or too much oestrogen in relation to progesterone. Most Stuck women’s symptoms are expressions of hormonal patterns disrupted by stress, with alcohol, poor diet and environmental toxins potentially exacerbating the problem. - Pale: You can tell the pale type by their face, but also their lips where it is most obvious; it’s also evident in the nail beds. They have vision problems and experience hair loss: women have low menstrual flow. Pale people have trouble falling asleep and many complain of fatigue. They can feel “shaky”, experience a rapid heartbeat and dizziness when they stand up. They are prone to muscle injury. Some are malnourished ; vegetarians, vegans and those who limit the amount of meat they eat are often pale and may be diagnosed with anaemia and tend to be anxious and prone to weepiness. - Waterlogged: Many such women retain water or put on weight easily: they are prone to polycystic ovarian syndrome and yeast infections. This type complains of painful joints, heavy aching legs and headaches and may have poor insulin metabolism which could lead to further hormone imbalances. Waterlogged people tend to have a weak immune system and sinus infections, congestion and drainage problems are common, as are allergies and asthma. Waterlogged people suffer from cystic acne, fibrocystic breasts, fatty nodules or tumours and chronic swollen lymph nodes. Heart disease and diabetes are common in this group. Now you know your type, boost your chances with the simple diet and lifestyle changes recommended by Jill blakeway and Dr Sami David. To find out more contact the Chana office.

News & Views VIII

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M


Poetic Thoughts

Personal Experience

My Heart Aches

My heart aches to have to write this sensitive letter But, it is only to help everyone – to make the world better Lots of us have problems – everyone has their share Yet people must know the pain they cause – it’s really not fair.

Why aren’t people sensitive and realise my deep pain? Why at every Simcha must they gaze down at me again? I’m not a fool – I can’t stand their looks anymore Hashem, please, to my Tefillos – open already the door.

You don’t know who I am – you’ll never guess I’m a smiling, popular woman – who always says yes Always busy – accepts all problems – never unhappy However, now I’ll reveal my true feelings and identity.

I’ve davened so hard – my tears have run dry But the stabbing pain is so strong, it just makes me cry. Hashem, I know it’s for the best – to be brave and happy l will try But people make comments that cause me to deeply sigh.

All I want in life, is a child of my very own I’ve waited so long – the pain has really grown How long will I have to wait – I worry and wonder? How long can I last out – no one has an answer

“How long have you been married?” they ‘casually’ ask And to give a ‘casual’ answer, is no easy task But with a determined smile on my face, I reply... Hashem should help Bekarov, they wish me – and say goodbye.

Dearest ladies who are suffering with me You’re not alone – Hashem is with us constantly We are the lucky ones – chosen to be tested And in the next world, our rewards will be collected. To all the rest of the fortunate mothers Never complain about your kids – to me or similar others Treat me like normal – but questions don’t ask Don’t stare at me – remember my smile is a mask. In the merit of us all trying together Not to hurt the feelings of one another Hashem will bring to us the much needed Geula Of Moshiach Tzidkenu – when we will all have a Yeshua.

Anonymous News & Views VIII

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Personal Experience

come from abroad for Yom Tov. Sitting down to the Seder I remembered fondly the various stories and notes I used to bring home from School and enjoyed listening to everyone round the table say their Divrei Torah. On Chol Hamoed ,the weather was great – spring was in the air and we had a lovely few days. On Motzei Yom Tov we joined in helping with all the cleaning up and we were the first to go and buy bread for everyone. Those were the days…

Those were the days Navigating the Yomim Tovim without children

Unfortunately, Pesach now is very different. The newlywed stage is over and even though we don’t have children yet, we can’t rely on our mothers to make Pesach for us any longer. So, for the last few years we have made Pesach at home just for the two of us. Some meals we do spend with our respective families, but when our parents’ homes are filled with grandchildren, mess, chaos, laughter and noise it is just too painful. Being surrounded by all the children and not having any of our own is unbearable. Different situations create different difficulties and Seder Night brings with it enormous challenges. When will we have a child of our own to say How many more years will we have to hear everyone else’s children say it? On Chol Hamoed we try to avoid family outings if we can, as it just highlights that we have no kids of our own to entertain. These are all constant reminders of the loneliness, suffering and anguish we are going through. Shavuos - Our first Shavuos was an enjoyable Yom Tov spent with both our families, dividing the meals between them. The second year we ate at my parents in-law first night and I slept there so I wouldn’t be alone when my husband went to learn in Shul all night. Those were the days...

As I sit here contemplating how to start writing this article for the Chana magazine, I think back and compare the person I was seven and a half years ago to the person I am today. With Purim just around the corner memories come back to me of that first Purim as a newly married couple. Purim - We were married for two months and had a great time on our first Purim with our siblings and their children. We dressed up and had fun visiting friends and popping into family, delivering our small Mishloach Manot which we created ourselves. It truly was a happy

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day getting to know all the family. Allow me to take you on a journey. Follow me on a road which compares my Yomim Tovim all those years back to what Yom Tov is like for us today. Pesach - Our first Pesach together was obviously very exciting. We knew we did not have all the weeks and months of preparation like our mothers did because we would be going to them for all the meals. We looked forward to the wonderful opportunity to spend time with our siblings and their children who had

This year the first night of Shavuos, when my husband went to learn I decided to be brave and stayed at home alone. I couldn’t bear to be with either my parents or in-laws and catch their pitying looks and comments. After all, I am married for seven years – I have matured and do not want to feel like my parents need to babysit me. For the meals I worked really hard cooking and baking and invited just one family with their young children so we could be feel some of the Yom Tov atmosphere. It was still quite tense for us as we are on our guard all the time

News & Views VIII

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Personal Experience

Rosh Hashanah - I was so excited for my first Rosh Hashanah. I expressed my gratitude to Hashem as I felt that all my Tefillos had been answered when I married my wonderful husband. It was such a different davening and feeling for me. We enjoyed being with both our families relaxed and happy. I was so proud when I waited outside Shul for my husband to come out – everyone was making such a fuss about us being the newly married couple in the family.

Sukkos - Our first Sukkos together was very enjoyable. We had no need to build our own Sukkah as we had plenty of invitations and were happy to accept them all. We took interest in all the special Sukkah decorations that all our nephews and nieces had produced and looked forward to our children decorating our own Sukkah in the future. During Chol Hamoed outings, we would hang out every day with another member of our family and their kids. We were like kids ourselves, having fun, enjoying everyone’s company. Simchas Torah was the highlight. My husband danced the night away amongst all the young boys and men in our Shul while I looked on happily, chatting with my friends.

Those were the days...

Those were the days...

Elul arrived and it sent shivers down my spine. The pressure and the fear of the forthcoming weeks hung like a heavy cloud over me. It was my seventh Rosh Hashanah as a married woman and I was still standing and davening, waiting for my Tefillos to be answered. Never would I have imagined that seven years later I would still be so emotional in when saying – how many will be created? Will it be my child that will be created this year? Nowadays we find it easier to eat most of our meals alone at home rather than with all the family. Now, instead of waiting for my husband outside Shul, I slip out through the back door without anyone giving me pitying looks.

We got plenty of invitations for Sukkos. It was becoming too difficult for us to have to sit in other peoples Sukkas watching their growing families. However, Boruch Hashem we built our own Sukkah – our walls were not so bare. We are grateful that we have nieces and nephews who contributed with their artwork. But we are still waiting for our own children’s arts and crafts to hang up one day soon. Chol Hamoed hardly existed for us. We had to spend our time at work as we had no excuse to take off to entertain our children. Simchas Torah, which was once the highlight of my Yom Tov and I would never miss one minute of it has turned into a “stay at home day”. My husband though had no choice as he had to be in Shul. He just sat quietly in the corner learning on his own whilst trying to ignore his friends carrying their children under the Tallis for Kol Hanaorim. He found it so difficult to be Besimcha as he had other things on his mind. The day after Yom Tov he was going to have surgery - a very delicate and difficult procedure.

praying and hoping that none of the little children would ask us “Where are your children?” or “Why aren’t you a mummy and daddy yet?” as they have innocently asked in the past.

Yom Kippur - My first Yom Kippur, I spent the whole day in Shul assuming this would be my last Yom Kippur without commitment. I felt on a spiritual high by Neilah, I sensed I had davened well imagining that please G-d next year I would be home davening with my baby on my lap. Those were the days... Once again for the seventh year running, I spent the whole Yom Kippur in shul. I was surrounded only by women older than me, young girls or newlyweds. I had no reason to go home, I had no commitments yet – my main purpose for this day was to stay in Shul and daven as hard as I could. My thoughts and prayers were so focussed on only one thing as we were about to embark on our first ICSI cycle and did not know what lay ahead of us. By the time it came to Neilah, I was so drained, mentally and physically just hoping that maybe our Tefillos had been answered and we would not need to do the treatment at all.

Chanukah - Our first Chanukah together was extra special as my husband used his new silver Menorah that I bought him. He was so proud to show off my culinary skills with my homemade doughnuts and latkes. My mother in law was really impressed and delighted with her newest daughter-in-law. Playing games each night added to the Chanukah spirit. Those were the days... Chanukah this past year felt like a true disaster – unfortunately the procedure my husband went through after Sukkos did not have the outcome we had hoped for. We were not in the mood for any Chanukah celebrations. We had to light

the Menorah but that was about it. There was no baking doughnuts frying latkes or partying. We still did try to play some Chanuka games together even though it was just the two of us so as to give the moment its deserved importance. Those were the days... Purim - is just around the corner and eight years later how things have changed – I am dreading Purim. Purim is one of the worst days of the year for me. I am not looking forward to spending the Purim Seuda with all my nieces and nephews, as there have been many more since last year and more on the way please G-d. Purim is a day when we are meant to be Besimcha - a difficult task for us. We definitely won’t be dressing up this year as we did the first few years of our marriage. I keep thinking that I wish I would be arranging Purim costumes for my kids. We will only be giving Mishloach Manot to the minimum amount of people we have to as I hate going round the streets seeing children of all ages dressed up and having fun. I feel so sad inside. Even going to Shul for Megilla is stressful. This year I think I will try to find a womens’ only Megilla leining so I don’t have to hear all the kids banging for Haman. I am so saddened by my constant bad mood -although to the outside world I put on my “Mrs happy mask”. I think I have given you a slight taste of my life around the year, taking you through the Yomim Tovim, but things do not start or end with that – every day, every Shabbos, brings more challenges to us as it forces us to face our current reality. The Jewish community celebrates its joyous moments surrounded by their families sitting at their dinner tables. To us, those usually precious moments are difficult to bear and so we sometimes try to avoid them. It is understandable that family and friends do not always know how to react to our mood swings. At times, we may seem distant, stuck in our own world and complaining a lot, we do not mean it badly as each situation brings up different emotions in us, emotions we sometimes find difficult to cover up. Please do not judge us, continue being there for us no matter how we behave. We tend to turn down invitations at times, other times we may turn down an outstretched, well-meaning arm. Yet, remember that deep down we are always grateful and appreciative of our dear extended family and friends who care for us in our time of need.

News & Views VIII

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Medical Focus

DIAGNOSTIC SURGERY – A VIEW FROM INSIDE Adrian Lower presents a keyhole to understanding minimal access techniques

Minimal access surgery, or “keyhole” surgery as it is popularly known, has provided important new methods for the investigation, diagnosis and treatment of many conditions affecting fertility. Minimal access techniques offer significant advantages over standard surgical procedures including reduction in risk and generally a much faster recovery time. An inspection of the pelvic organs is an important part of any fertility investigation. This can be done either by a laparoscopy and dye hydrotubation (lap & dye) or by using X-ray and ultrasound imaging. The ‘lap & dye’ is generally the ‘Gold Standard’ investigation and this allows the doctor to check your pelvic organs, in particular the fallopian tubes. It allows him to diagnose conditions such as endometriosis, pelvic adhesions which would be missed on X-ray or ultrasound scans. Fibroids or ovarian cysts, which can be seen on ultrasounds, can be more closely and comprehensively assessed and treatment or surgery planned. Many gynaecologists will also perform a hysteroscopy at the same time as a laparoscopy. This is a relatively low risk procedure used to check that there are no fibroids, polyps or congenital abnormalities of the uterus. The fallopian tubes and uterus will be examined using an X-ray examination called hysterosalpingogram (HSG) or a special ultrasound called hysterosalpingocontrast sonography (HyCoSy). These are less invasive procedures which tell if the fallopian tubes are blocked, however they will miss some types of adhesions or endometriosis. These investigations will often be offered in the early stages of investigation, especially if the medical history suggests a low risk of abnormality. Laparoscopy would be more likely to be offered to patients suffering from pelvic pain, heavy periods, painful intercourse, previous pelvic surgery or infection such as Chlamydia.

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What does a laparoscopy involve? This is usually performed under general anaesthetic. A fine needle about 1.5mm diameter is inserted through the navel to deliver carbon dioxide gas into the cavity; this will distend the abdominal wall away from the bowel. A small incision 5-10mm in length will then be made to insert a port through or just below the navel. This allows the laparoscope (telescope) to be inserted to view the pelvic organs. The view is improved by gas as well as tilting the operating table to 30 degrees headdown position. A second port is placed low down in the abdomen through which a probe or forceps can be inserted. The tubes and ovaries will be moved as part of a thorough investigation to be sure there is no evidence of endometriosis. Finally the uterus is filled with a blue dye which will – so long as the fallopian tubes are healthy – with gentle pressure will send the dye flowing rapidly through.

‘You are unlikely to suffer any long term ill effects but expect to feel tired or washed out for a few days’ What does hysteroscopy involve? This is an inspection of the inside of the womb. It is done using a fine telescope called a hysteroscope. Fluid such as saline or gas such as carbon dioxide will be used to distend the uterus so that the hysteroscope can be inserted through the cervix and the cavity inspected.

Risk of diagnostic surgery There are risks attached to any operation, which is why doctors try to restrict them to cases where they feel abnormalities will be found. There is also a very small but measurable risk associated with general anaesthetic. The most hazardous part of

the laparoscopy is the insertion of the first port and the carbon dioxide gas; there are risks of intestine, bladder or blood vessel damage. Complications are estimated to occur in seven of every 1000 procedures. How will I feel after the laparoscopy? Most are performed as day procedures. You are unlikely to suffer any long term ill effects but expect to feel tired or washed out for a few days. You will also feel rather tender and bruised around the lower abdomen, you may experience some light vaginal bleeding, but this should not last for more than a couple of days. A particular pain associated with laparoscopy is shoulder tip pain; this is referred pain from the diaphragmdue to the gas, but it should settle in 24 hours or so and you may need to take an aspirin or ibuprofen. Some people complain of sore throat – this is from the tubes the anaesthetist will have used and again should not last too long after the event. You will have to stay in hospital for a few hours after the procedure to be sure you can empty your bladder but then you will be free to go home and rest. You will be able to remove your dressing 48 hours after your return home and stitches should be removed four or five days later.

Infection If your temperature goes up or there is abnormal swelling or redness around the wounds you should contact your doctor. Increased frequency or pain urinating might indicate a urinary tract infection. Vomiting or a rigid abdomen would be indications of bowel injury, and urgent medical attention should be sought, particularly if this accompanied by raised temperature. Taken from Pathways to Pregnancy, December 2007

News & Views VIII

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Life’s Perspectives

Personal Experience

Among the Blessed As the vernal breezes and budding bushes of April and May change to the sultry heat of June, it becomes clear that summer has arrived. And the beginning of summer heralds the end of the school year. Most students simply dream of casting aside books and pens and plunging into pools, but some have a milestone to cross in between the two. They dream of the ceremony which will commemorate the last time they will step through the doors of their school. Graduation is a poignant mix of hope for the future and memories of the past. Anticipation of a new chapter in life mingles with tendrils of fear of leaving the familiar. For parents of the graduates, graduating signifies yet another giant step their child is taking upon the path to adulthood.

And every year, as they sing the words about their Ima, the touching rhymes thanking mothers for all they are and do, I cry. As I rummage through my purse for a tissue, I think of another woman – one I’ve never met, but with whom I feel a genuine connection.

I’ve a number of years ahead of me before I will watch my child in gown and mortarboard march across a stage to accept a rolled and beribboned diploma. I’ve been to a fair share of minigraduations, those ubiquitous little end-ofthe-year parties that every kindergarten teacher feels it is her sacred duty to hold. The children practice for weeks, bring home brightly-coloured invitations, and invite Bubby as well. On the big day, they dress in white shirts and blue pants and skirts – the classic Israeli outfit for important occasions, and sing their hearts out. They sing about becoming big, about learning and growing, they sing thanks to their teachers and mothers. Half the words are beyond their vocabulary, but that doesn’t prevent them from belting them out with childish enthusiasm.

I was young when I read the book, just out of my teens. I had only recently started to date and dreamed of a rosy future surrounded by a devoted husband and cherubic children. A friend lent me the slender volume when I complained of nothing to read. It was the story of one woman’s journey through infertility. With searing honesty, the author chronicles her trials and tests, her disappointments and near despair. It takes years, and much heartache, but she is finally blessed with two children. Their births leave her ill, but that doesn’t diminish the overwhelmingly powerful love she had for the souls she has managed to bring into the world.

With nursery and kindergarten stretched out over four years here in Israel, and several children close in age, every June finds me shifting uncomfortably in a hard plastic seat as I listen to one of my progeny serenade me and exult in her passage to the future.

‘They sing about becoming big, about learning and growing, they sing thanks to their teachers and mothers’

One of the very last pages of the book describes the kindergarten graduation of her oldest child, her personal miracle. She writes of the other mothers yawning, looking at their watches, snapping a few dutiful pictures while they mentally compose shopping lists for the grocery next door. She, on the other hand, is engulfed with emotion. She is sitting with other mothers, watching her very own child as he leaves kindergarten

forever. She has emerged from a tunnel of darkness. She is among the blessed. When her little boy sings a thank you to Ima, she unabashedly weeps with joy. Although I had yet to find my husband, much less have children, I was deeply struck by this scene. Why, I couldn’t help but wonder, does a woman have to struggle with years of infertility to be able to truly appreciate a milestone in her child’s life? Must we first be denied a gift in order to feel gratitude upon receiving it? With the righteous indignation of the young, I found myself angry with the other mothers at the graduation. Simply because the blessings had flowed down upon them naturally, did they not realise how blessed they were? Years passed, I married and just several weeks after our first anniversary our first son was born. The next child was not long in coming. Infertility was not among my personal tests; my challenge was keeping my head above water as I awoke three times a night and changed more diapers than I could count. The days seemed endless, but the months flew by, and before I knew it I was sitting at a kindergarten graduation. I watched for a while, took a few pictures, held back a yawn, and snuck a look at my watch. It was then that I remembered her. I thought of the scene – of the previously barren woman rejoicing in her child, awash in euphoria of meriting to sit at a kindergarten graduation. And I wrested my eyes away from my wrist. I focused fully and unreservedly upon my daughter. I gazed at her delicate features, took note of her effervescence, revelled in her exuberance. And when she reached the song about Ima, I wept. I am a mother, and I too have my own little miracles. Thanks to the One Above, I am among the blessed.

News & Views VIII

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Life’s Perspectives

When one’s faith wavers by Rebbetzin Feige Twerski

Rebbetzin Feige Twerski shows us how to find strength in times of despair

Dear Rebbetzin Twerski, My wife and I have been trying to conceive for the last six years. We have had numerous IVF treatments and IUI treatments. During this time, I became observant and tried hard to maintain my faith. After this past Rosh Hashana, my wife and I finally conceived. We were pregnant with triplets. Sad to say, we lost two of them within the first two weeks, and then we lost the third at 17 weeks. We just completed a fourth fresh IVF cycle and found out that once again we have had a failure to conceive. Everything is “unexplained infertility”. I have to say that my faith is wavering. I prayed, I learned, I received a blessing from a very important rabbi, and I put all of my faith that G-d would help us, and He hasn’t. I am not sure where to go from here.

Rebbetzin Feige responds: My Dear Reader, The pain and feelings of disappointment that you describe resulting from your, thus far, failed attempts to conceive are totally understandable and the concurrent crisis of faith that you are experiencing is likewise a normal and reasonable response to dashed hopes and dreams. Personally, I have found that on the occasions when I have importuned the Almighty for Divine Assistance, it was helpful for me to frame the requests in the context of first giving thanks for the blessings that He has, in His infinite kindness, already conferred upon me. The tendency that all humans have, especially in needful moments, is to focus

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exclusively on what is missing in our life, irrespective of so much that we should be grateful for. This is significant because gratitude, appreciation and a positive perspective create a healthy energy that becomes a virtual magnet for abundance and good things in the universe to be drawn to us.

‘The tendency that all humans have, especially in needful moments, is to focus exclusively on what is missing in our life’ A second observation is that when we move away from the intense preoccupation that accompanies so

consuming an effort, we, in a sense, make room for God to step in and play His role. Consider, Gail, a young woman, whose every waking moment was devoted to exploring options and interventions to conceive. It all came to a halt when she, quite suddenly began to suffer terrible tooth pain and was diagnosed with a serious case of impacted and abscessed wisdom teeth that required immediate attention. In this state of extreme agony, she was distracted and could think of nothing else but getting relief from her excruciating pain. In a sense, when she temporarily let go of her obsession with infertility, to her amazement, she found herself pregnant. Clearly, I am not suggesting that medical interventions and protocols be ignored, but there are amazing stories and anecdotal evidence out there that defy conventional explanation, pointing to the intangible mysteries in life that transcend

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Life’s Perspectives

our ability to reduce them to cause and effect. Opening ourselves up to those possibilities require invoking the maxim of “I do my best and let G-d do the rest.” G-d runs the world from a vantage point of knowing the broader picture and, hence, what ultimately is in our best interest. Relinquishing the illusion of control and placing ourselves in G-d’s hands speaks to our understanding that He alone runs the world. Implicit in that understanding is that He does so from a vantage point of knowing the broader picture and, hence, what ultimately is in our best interest. The human perspective, informed and knowledgeable as it might be, is at best, limited in its scope.

‘G-d runs the world from a vantage point of knowing the broader picture and, hence what ultimately is in our best interest’ This posture of faith can provide a sense of inner peace which gives us the wherewithal to embrace and celebrate the existing opportunities for joy in our life. The absence of perspective robs us of the present, the here and now. We become so preoccupied with what we desire for our future and what has eluded us in the past that the opportunities for the ‘now’ are missed and forfeited. It is truly sad that with so much to enjoy in our lives we become totally oblivious to the myriad of blessing that surround us, a loving spouse, parents, health, the beauty of the world around us and the gift of friendships. Clearly, this is not intended to marginalise the admirable desire and effort to have children. G-d willing, you and your wife will yet be successful in your attempts, but life must be fully embraced in the moment, quite apart from what tomorrow will bring. Abby, a young woman, married for five years and grappling with her infertility issues, sought my counsel. I advised

her to relish this season in life, where husband and wife have only each other and no distracting responsibilities. While children are certainly a blessing, when such happens, this particular season comes to a close, the dynamic in the relationship changes and a new chapter ensues. Many years later, with two babies in tow, she thanked me for that advice, grateful that she hadn’t missed out on the uniqueness of that particular time in her life. Rita had undergone many conventional interventions without success. Discouraged, and after much research, she turned to a natural approach that focused on building up the health of the woman through a combination of diet, exercise, acupuncture, Chinese medicine, etc. She worked with a health professional who coordinated all of these various disciplines. After a period of about a year, Rita, to her great delight, found that she had conceived. Annie tried for many years and finally chose to adopt. Her life was enriched by two beautiful children, to whom she devoted all her attention. She was quite shocked by the unexpected pregnancy that came when she had, in effect, given up on that possibility. Dr. Heather, a recent guest in my home, shared that in her practice as an OBGYN, she advised patients who had experienced many miscarriages that theirs might be a unique mission. They alone, she advised them, were in the position of understanding and giving counsel and strength to others who had suffered similar losses. Their contribution could be invaluable. We need to pray for the recognition that no matter what, our Heavenly parent is holding our hand and will see us through our life’s journey. Shirley was determined that her contribution and investment in the life of others would not be denied to her simply because biological children didn’t appear to be an option. She became the ‘aunt’ of many of the neighborhood children who found her home to be an oasis for nurturing, caring, counsel and fun. She had many ‘children’ who loved her and whom she loved. She chose to become an integral part of so many lives. At the end of the day, her contribution to this

world will certainly be no less than that of a biological parent. Prayers to the Master of the World, consisting of both our fondest dreams and expressions of our greatest frustrations, should never be abandoned. Ideally, we would want our wished granted as stated. But simultaneously, there needs to be a humility, a deference to His will. We need to pray for strength, for the recognition that no matter what, our Heavenly parent is holding our hand and will see us through our life’s journey.

‘We need to pray for the recognition that no matter what, our Heavenly parent is holding our hand and will see us through our life’s journey’ In the final analysis, we don’t write the script for our lives. There will be the inevitable bumps and potholes along the road we travel. We need to remind ourselves constantly that our mental and psychological well being cannot be dependent on external circumstances. The only variable for well being comes from the inside out - from the thoughts and the attitudes that we choose to embrace.

WE ARE THE CHOOSERS AND THE THINKERS AND, ULTIMATELY, WE ARE THE ONES THAT COLOR THE IMAGES THAT APPEAR ON THE SCREENS OF OUR LIVES. Reprinted with kind permission from Aish.com

News & Views VIII

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Poetic Thoughts

P I R G Y M by

dm y Zel F rad

an

Today I’ve learned An important lesson How to let go. It’s hard. I’m holding the Top of the sack so tight, My knuckles Have turned white. I’m scared That if I loosen my grip The bag will slip And all will Come tumbling out. But when I finally take The time To look closely I see A string tied tight Around its neck. 32

How Ludicrous It was for My hand To be holding the top so tightly Whoosh. Whew! That feels good, Bye-bye Sack You’re in good hands now; A string tied in A dependable knot – The string Of the One Above. Ahhhh! Reprinted with kind permission from Binah Magazine. Copyright 2010

News & Views VIII

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Medical Focus

High fibre, low expectations? Could women who are trying to conceive benefit from lowering their fibre intake?

Women who eat too much fibre may ovulate less and have lower oestrogen levels, according to a recent study. The researchers examined the link between fibre consumption and hormone concentrations in 250 women aged 18 to 44 and found that those who reported eating the recommended 20g to 35g of fibre a day had the lowest blood concentrations of oestrogen and other reproductive hormones. A roughly 10times higher risk of having ‘anovulatory’ menstrual cycles (where the ovaries fail to release an egg) was also linked to high fibre intake, especially fibre from fruit. The researchers, led by Audrey Gaskins from the National Institute of Child Health and Human Development (NICHD), Rockville, Maryland, US, published their findings in the American Journal of Clinical Nutrition, making sure to point out that their results do not mean that high-fibre diets are a bad thing - after all, they have been linked to many health benefits such as lower risks of diabetes, heart disease, breast cancer and colon cancer. However, the team do believe their findings ‘call into question’ whether the current regulations are best for those women who are trying to become pregnant.

over two months, as measured by the low levels of oestrogen and other reproductive hormones in their blood over two menstrual periods. Some 22 per cent of menstrual cycles in this high-fibre group were anovulatory as opposed to only seven per cent in the low-fibre group. However, there are many causes for anovulation, including extreme anxiety or stress, having too little or too much body fat, taking too much exercise, thyroid gland dysfunction and polycystic ovarian syndrome – a common female endocrine disorder that affects approximately five per cent to 10 per cent of women of reproductive age. It was only once the researchers took into account these factors, along with others such as race and calorie intake, that they arrived at the corrected estimate of high fibre intake causing a roughly tentimes higher risk of anovulation.

Ms Gaskins emphasised that, while the results were consistent with fibre disrupting some women’s ovulation, they did not prove that this was the case. However, there is a biologically plausible mechanism that could explain the findings. Quite simply, high-fibre diets are known to decrease the activity of particular intestinal enzymes, in turn causing more oestrogen to be excreted from the body in faeces because less oestrogen is being reabsorbed in the colon. Whilst more studies are needed before any solid conclusions can be drawn and recommendations made, Ms Gaskins and her team believe that their results suggest that women who are trying to conceive may benefit from lowering their fibre intake. From www.bionews.org.uk

All of the 250 women in this study were healthy, and having regular menstrual periods. But the women who reported the highest fibre intake (22g a day or more) were found to be more likely to have at least one anovulatory cycle

News & Views VIII

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Personal Experiences

Pieces of a Puz There are different ways of building a family jigsaw

Many a time people mention the fact that anything happening to us is just part of a greater plan, a brushstroke on a large canvas. When faced with draining infertility issues somehow it gets tiresome hearing this being said over and over again. I know and am aware of that “Plan” yet find living it quite hard to imagine. Our road to achieving a family – something that for many – is just a natural given, was one with many bumps and several dead ends. The difficulties were many but the joy of having a family by far outweighs all the troubles we had to go through. Today we Boruch Hashem have three beautiful children. I like to tell you this from the start, as there are two things which I dislike most and these are surprises and excessive paperwork. I am the type of person who always reads the last pages of a book before the beginning as I do not like to be in suspense. I am not sure if I used to be that way long ago, or if the fertility journey lead me to become like this. To be honest I can’t really remember much about us before we embarked on this journey. If I had the time, my story could fill many pages but due to space constraints (and possibly your patience!) I am going to give you a precis of a puzzle that Boruch Hashem just seemed to fit! We were trying to start our family for a while without any sign of success, so we decided to have some investigations done. We underwent the numerous initial tests, and procedures, which eventually lead to finding where the problem lay. We

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thought we now knew what interventions were needed to achieve a pregnancy. And so began our journey of endless fertility treatments. Unfortunately things were not as simple as they originally seemed and we spent years trying to conceive. We started off each cycle with the usual scans, and spent huge amounts on medication. I would get injected to stimulate the production of several follicles when after a number of days I would be told things weren’t going in the right direction and the treatment cycle had to be stopped. I cannot recall how many times this scenario repeated itself, but I am sure that you can understand my recurring feelings of shattered dreams and destroyed hopes.

‘We looked into various options suggested to us and kept on coming back to adoption’ Eventually one treatment cycle reached as far as egg collection. Amazingly, to our astonishment implantation succeeded and I was able to keep the pregnancy going till full term. My pregnancy was not one without scares or hiccups. I even ended up bleeding and being rushed to hospital but thank G-d my pregnancy continued to progress nicely. After a very long, complicated delivery – bang in the middle of the hottest week in British history our daughter arrived into the world. She is a true gift, delightful and full of joy, and she continues to fill our home with her lively personality and constant dancing and singing.

As our princess grew from baby to toddler, we started thinking of expanding our family and plucked up the courage to contact the doctors once more. Once again we were met with failed hopes and cancelled cycles. We questioned Hashem’s plan and looking inwards we wondered if we were being greedy. Having spoken to several doctors some of them felt that the amounts of medication being pumped into me was becoming dangerous. We discussed at length whether maybe one child should be enough for us, or whether we should continue doing the treatments despite the doctors’ warnings. After all they did not say we must stop treatment altogether. We even started exploring other options such as adoption. At this point I could not see it clearly yet, but our puzzle was really starting to take shape. We looked into various options suggested to us and kept on coming back to adoption. If you knew us as a couple you would understand that adoption is the right thing for us. Of course adopting may not be right for everyone, and it does not come without its challenges. However, I do feel that within the field of infertility, the process (and I don’t use the word process lightly) of adopting is one which is infused with hope. When embarking on this path you know that despite the mounds of paperwork, the intrusion into your life by social workers you will end up bringing home a child (or maybe even two). So we braved and contacted Norwood to set up an initial appointment. I could write a book of a few volumes to describe the lengthy route of bureaucracy, paperwork and administration involved in the adoption process. Suffice to say that

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Personal Experiences

Personal Experience

Puzzle from the initial appointment to discuss adoption options until actually bringing home your child takes on average three years. At least they were assuring us that in the end we would embrace a much longed for child. We attended the first preparation course leading to the process. After the initial course, one of the formalities that needs to take place is for our GP to fill in a medical form of both parents. We were not worried about this at all. We were both young, healthy and fit, ate well and led a generally healthy lifestyle (despite the occasional kugel here and there) so we were confident that all would go well. The GP started to check me up and listened to my chest. I was 32 years of age and had several professionals listening to my chest in the past. Over the last few years I had numerous procedural surgeries, gone through childbirth and had even been taken to A&E complaining of chest pains. Yet, here I was at the surgery of a random NHS GP being told that my heartbeat was irregular. He enquired about it and wondered if I was aware of the problem. I was astonished and had no idea what he was talking about, he arranged for me to have an echo-cardiogram. The consultant immediately noticed the very large (3cm) hole in my heart. I had been born with this defect yet nobody had ever noticed it. The professionals were amazed that this had never been picked up. They wanted to know if, I had been monitored during pregnancy. Honestly, would I, a Jewish woman having faced infertility issues neglect being tested during pregnancy?

The doctors could not believe that even during delivery nobody had picked up my irregular heartbeat whilst my heart must surely have been under stress at that time. Hashem works in amazing ways! This problem obviously needed to be dealt with and with relative simplicity I underwent surgery to rectify the hole in my heart. The adoption was a very positive process, although lengthy with heaps of administration nevertheless an amazing adventure filled with struggles and triumphs. We found the adoption community to be very warm and supportive.

‘For me, my life now is certainly not what I envisaged ten years ago however retrospectively today I would not wish to change my life at all’ Boruch Hashem after all the hurdles and nearly three years later, we adopted two gorgeous, lovely lively sons – who fill our home with joy, mess, and constant fun! Sometimes during hectic dinner time when the decibel level is extreme, I wonder if my neighbours miss the teenagers who lived here before us with their all-night parties noise. I wonder whilst thanking Hashem for our most amazing fortune. My clan can be loud, messy and stroppy, but I love them dearly and would not swap them for anything in the world. There were so many pieces in our puzzle

that just fitted to create what we really needed. Had we not opted to adopt who knows what would have happened, I may never have found out that I had a heart defect. Eighteen months earlier, a hole in my heart, the size I had would have needed open heart surgery. Today, as medicine is constantly advancing, the stent method I underwent to repair the hole had been perfected being only a 24-hour procedure as opposed to surgery of a few hours with many weeks recuperation. I do not know you nor do I know your journey. I do not know what your plan will look like, it may not turn out the way you imagined it. For me, my life now is certainly not what I envisaged ten years ago. However retrospectively I would not wish to change my life at all. I believe that Hashem has a plan for each and every one of us – else the suffering and pain is worth nothing. Please G-d may you see joy and triumphs as you move through the process and the pieces of your puzzle somehow fit together.

TOO MANY PEOPLE MISS THE SILVER LINING BECAUSE THEY ARE EXPECTING GOLD. News & Views VIII

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Life’s Perspectives

Law of the dustbin lorry One day I hopped in a taxi and we took off for the airport. We were driving in the right lane when suddenly a black car jumped out of a parking space right in front of us. My taxi driver slammed on his brakes, skidded, and missed the other car by just inches! The driver of the other car whipped his head around and started yelling at us. My taxi driver just smiled and waved at the guy. And I mean he was really friendly. So I asked, “Why did you just do that? This guy almost ruined your car and sent us to the hospital!” This is when my taxi driver taught me what I now call, ‘The Law of the Dustbin Lorry.’

He explained that many people are like dustbin lorries. They run around full of rubbish, full of frustration, full of anger, and full of disappointment. As their rubbish piles up, they need a place to dump it and sometimes they’ll dump it on you. Don’t take it personally. Just smile, wave, wish them well, and move on. Don’t take their rubbish and spread it to other people at work, at home, or on the streets. The bottom line is that successful people do not let dustbin lorries take over their day. Life’s too short to wake up in the morning with regrets. So... Love the people who treat you right. Pray for the ones who don’t. Life is 10 per cent what you make it and 90 percent how you take it! Have a blessed, dustbin lorry day!

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News & Views VIII

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Poetic Thoughts

VIE

T N I O P W

oiten by Y. R

b a rg

If there would always be light,

If fruits were always on the trees,

We tremble when thunder crashes,

The bright sun would never part,

They would never be barren or bare,

Bringing heavy sheets of rain,

Day would not change to night,

We would all delight happily

We’re afraid when lightning flashes;

We would not struggle in the dark.

With abundance everywhere.

Must we battle strong winds again?

Of course we must surmise

In fall we could not catch a glimpse

Hashem displays a colored rainbow

There would also never be,

Of leaves, orange, red and gold,

After He has soaked the ground,

The splendor of the sunrise,

Sweet scented blossoms would not exist,

Like little seeds, we too will grow,

Nor a magnificent sunset to see.

Seasons would not unfold.

He has promised we will not drown.

If life’s paths would be smooth

If we could skip life’s thorny parts

When the road winds steeply uphill,

With no rocky cliffs to climb,

What good do thistles bring?

When our paths are not well lit,

No obstacles to block our view

They tear and pierce our sensitive hearts

When of stormy nights we’ve had our fill

Our lives would be sublime.

They scratch, scrape, hurt and sting.

We struggle and want to quit;

Imagine the world without its heights;

Yet delicate petals of a rose can grow

Look at the trees and rise upwards too,

No mountains, crags or peaks,

With thorns right at their side;

Like the bright sun we can shine

Spectacular views and wondrous sights

They prick the colorful petals we know

For pure souls into us He blew,

We would never chance to meet.

To spread their sweet scent far and wide.

We can ascend to levels sublime.

With ditches we could do away,

If we did not have to venture out

Don’t give up and don’t despair

They only make us fall,

On cold wet wintry days,

When there are challenges to face,

It is so tough to rise each day

If we only had to know about

Remember, every trial that’s there

When we know we may well stall.

Bright light warm sunrays;

Is Hashem’s warm loving embrace.

But in the shady valleys below,

Our world would never be dressed

He places us where it will sting

Grass and flowers sprout there,

In fresh white glistening snow

To beautify our lofty souls,

Clear streams of water flow

Nor would we ever be blessed

Inducing us to pray, soar and sing;

In a serene calm atmosphere.

With a sparkling new tomorrow.

And thus fulfill our roles.

A world without heartache or pain,

The world is full of changes

To live without a tear,

Which catch us by surprise,

No need to fight oncoming waves

The many wonders Hashem arranges

Life would be easier to bear.

Contain lessons to internalize.

There would be no vast deep sea,

Gentle messages, lovingly sent our way,

Or waves to roll on golden sand,

For us to see, observe and hear;

Fresh sea air we could not breathe,

Encouraging us day by day

No waterfalls to spray the land.

Reminding us that He is near.

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Medical Focus

Innate Health Reacting to what you feel in a positive way Rabbi Shaul Rosenblatt explains the principles of innate health

Let me share with you some of the insights that are gained through innate health and its understanding of the 3 principles of human nature.

make life into whatever we wish for it to be. The world becomes ours to shape and create for ourselves. Koheles tells us that:

Why is it that you can have two people in exactly the same circumstance who respond to it in such different ways? There are, for example, people who are diagnosed with terminal illness and respond with bitterness, resentment and anger. And yet, surprisingly, there are others who are diagnosed with the exact same disease and, whilst deeply upset by it, nevertheless view it as an opportunity to reflect on life and make changes in themselves. There are those who even feel grateful for this opportunity for change. These are the extremes but there is a whole range of possible experiences in between. The same is true with infertility. The scope of possibility for how a person will go through the experience is very broad. One of Innate health’s primary messages is that we usually see life as ‘outside-in’ – that which happens on the outside affects our inner experience. If life is painful, it might make me feel sad. If a person is ill, they may feel scared. If someone’s life is very busy, they may feel stressed. In truth life is the opposite. It is an ‘inside-out’ experience. How we experience the outside is entirely dependent on what’s going on inside. Someone who sees life through a lens of stress will feel stressed whilst lying on a beach in the Caribbean. And someone who has found a sense of peace within will not be overwhelmed even if his life seems to be falling apart. All of life is how we choose to see it and, as such, we have the ability to

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God made man straight, but he made many calculations. Human beings are straight. The path to God and Godliness is a natural and obvious one. But we spend so much time thinking and thinking and thinking and forget to live in the moment. God is not in the past, He is not in the future. He is simply in every precious moment of our existence. Letting go of our thoughts and allowing ourselves to fully experience the present moment, will guide us to true bitachon – to trusting in Hashem and allowing Him to hold our hands and lead us wherever He wills us to go. When we recognize the freedom that is an integral part of the human being, we are liberated from playing the game of predictable reactions. Instead, we become aware of having an infinite number of possible reactions to the given situation. And by drawing on the inspiration of the moment, we connect to the innate wellspring of serenity and peace that is already in us. Some more on Innate Health: Innate health is an understanding of 3 simple principles that seem able to guide people to a more spiritual experience of life. In the short period of time I have been involved in teaching these principles, I have seen people go through amazing transformations. I have seen people gaining confidence, wisdom, independence, self-understanding and a sense of healthy spiritual connection.

These lead in no direction other than one of Godliness, so the range of possibilities they open for a person is almost infinite. Armed with an understanding of these principles, a person will walk through life with more grace, more humility and more calm. Put another way, these principles are a guide to one’s spiritual self. They help a person experience life as a soul. The reason we find this to be so helpful for people in almost every area of their lives is because it provides perspective. Innate Health helps orient people in a direction of perspective that leaves them experiencing life more philosophically and less personally. Life, and its experiences, seems lighter and more manageable. The Innate Health approach is incredibly versatile. In the US, it is used in therapy, drug and alcohol addiction, marriage counseling, business consulting, schools and the criminal justice system. One of the wonderful things about it is that it is non invasive and impersonal. As opposed to solving mental illness, innate health focuses on creating mental health and robustness. Mental illness does not disappear it just becomes less and less relevant for the person. It is not a panacea. It is simply awakening a human soul that is full of love, wisdom and joy. For a soul that is created in God’s image, life can never be anything less than thrilling and uplifting.

Innate Health is taught in the UK by Tikun. We work with individuals and groups, as well as teaching regular classes in our centre on Finchley Road.

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Chana News

A CHANA VOLUNTEER SPEAKS OUT How volunteering for Chana makes my day

Sitting at the exquisite Chana Fundraising Brunch one year, I was quite literally moved to tears by the real-life story given by one of Chana’s members, and judging by the faces of the ladies around me, I was not the only one. That night as I read the Chana magazine, I saw a notice asking for volunteers so I decided to go along to the meeting to see if I would be able to do something for this amazing organisation. There were various options and one project in particular captured my interest and since it only involved one morning a week, I decided to take it on. About 3 years ago, just before I began, I felt a little like a good samaritan, about to volunteer in a worthy cause, and a warm feeling spread over me when I arrived at the office for the first time, as I felt really good about having an opportunity to help out. As the weeks progressed though, I began to realise that Chana was actually giving me many many times more than I was able to give it. Being surrounded by notices and phone numbers and files of doctors and medical specialists and names of clinics and hospitals, I began to realise how real all this is to so many people and how much a part of their life medical intervention is. I began to appreciate my children so much and a few months later when I became pregnant with my fourth child, the pregnancy was totally different to the previous three. I don’t think I complained once, the whole way through - much to the delight of my

long-suffering husband! Every twinge, every bout of morning sickness, every ache and pain became a milestone and a gift to treasure. Every week when I left the Chana office, I wanted to sing and dance and thank Hashem for this growing miracle inside of me that is denied to so many. I was much more aware of the pain of those around me who are not yet parents and davened for them so much more earnestly.

‘Without hesitation I jumped on the band wagon and began working as a part time volunteer at the Chana office and loving every minute of it’ When this baby was born it was so much easier to get up for him when he cried. The motto “it’s hard when they cry at night - it’s harder when they don’t” stuck firmly in my head and accompanied me to the babys’ room at all hours of the night. The feelings of frustration and impatience when the baby cried at 3am and then at half-hourly intervals until 6am, were replaced by a sense of pride and delight and I revelled over his beautiful little being, who was simply calling out to his mother. I was much calmer even when extremely sleep-deprived and I enjoyed his babyhood tremendously. I also had more patience with my other children and though I am far from the perfect mother,

I tried to keep the big picture in mind and to distinguish between what was really important and what was not. So THANK YOU CHANA for giving me this priceless gift of being able to truly appreciate my family, and face the challenges of bringing up my young children with constant feelings of gratitude. THANK YOU for changing my perspective, for showing me what miracles I have experienced in becoming pregnant naturally and easily without any of the hassle, aggravation, and emotional roller-coasters involving medical intervention which others experience. THANK YOU for teaching me greater sensitivity and instilling in me a heightened awareness of the indescribable pain so many not-yet-parents are going through. THANK YOU CHANA for giving me far more than I will ever be able to give you. Bas Chava P.S. Do any of you reading this have any free time on your hands to volunteer for CHANA? Maybe it will change your life as it has changed mine! For more information call the Chana office on: 0208-203-8455

News & Views VIII

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Personal Experience

Waiting for a grandchild A grandmother describes the pain of watching and waiting My Story… My daughter Shifra was blessed to have been one of the first in her class to get married. She was just 18 years old. We were so thankful to Hashem and the prospect of being a young grandmother excited me no end! However, it was to be 11 years later that Hashem granted me my wish. We are all unique with our own individual feelings and wishes. Each of us reacts differently to the same situation. I humbly share my thoughts on being a “childless” grandmother for those many years. “Bird leaving the Nest”… At the beginning there was so much to adjust to. I experienced the famous “bird leaving the nest” syndrome with the normal consequence of my newly married daughter drifting away from me as she left home to share her life with her new husband. My best friend, who’d already married off a number of children, reassured me that once Shifra would have a child, our close mother-daughter relationship would again return. Boruch Hashem today we have a very close relationship, however there are so many lessons I have learnt along the way. Mum “can’t” fix it… When I look back and reminisce about their first two years of marriage, I remember feeling totally baffled as to why Shifra hadn’t yet become pregnant. My next dilemma was that I couldn’t do the “mum will fix it” remedy that had often worked before! After she had been married for about two years, Shifra mentioned to me that someone had given her the name and phone number of a CHANA counselor. This was so very helpful and constructive, and I felt so relieved that she had a professional and caring person onto whom she could offload… Just a little peep… I remember Shifra telling me that after she’d been married a short time she felt very self-conscious, for instance when she’d arrive somewhere she would feel people would be looking at her stomach for any tell-tale “bump”… Well, that really shook me up, because deep down, if I was really honest with myself, until then

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I too had done much of the same. It was never done out of curiosity, but out of simple concern - just a quick glance hoping I’d see good news that would quell my anxiety. (I too was very aware of the women around me who were in the same situation as my daughter). When Shifra shared this with me I realised how very hurtful just a little peep can be. The Silence… Throughout those years, Shifra did not share with us what sort of procedures they were going through. I believe that couples find it very important to guard their privacy while undergoing the intrusive treatments. However, I found this very hard as I wanted to be there for Shifra and her husband, to support them; be it with a ready hot meal; or a shoulder to lean on. Once, my daughter told me “Mummy, you just don’t want to know, believe me - why should you have the heart ache too”. I didn’t always understand their secrecy, and thought they may have felt quite isolated at times. I noticed that sometimes Shifra would disappear, probably for appointments, and at times she looked un-relaxed and tense… but I kept silent. Feeling left out… Meanwhile, over the years, I sensed my friends distancing themselves and reluctant to share their nachas with me. They wouldn’t speak about their grandchildren in front of me (or could it be that I forgot to ask about them)? I felt they did not feel comfortable when I came to their grandchild’s Bris or Kiddush. Perhaps this was just my imagination, but it made me feel sad. I can honestly say that I did feel genuine happiness at my friends’ Simchos. In my heart it was never “IF my daughter will have a child” it was just the “WHEN”...After my daughter gave birth 11 years after her marriage, I was quite overwhelmed when the comments came in...”WHAT a miracle!” The way they said those words, I felt many had envisioned my daughter never conceiving, and that truly shocked me. The Pity… The most moving and heartbreaking thought my daughter once shared with me was the self-consciousness she would feel when she’d see the look of pity on people’s

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Personal Experience

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faces. Shifra and her husband chose to be positive and hopeful, both were busy at work, they had an active social life; they were not locking themselves up in their home… so why were people feeling sorry for them? In fact, I believe all those who are struggling with a challenging situation will agree that the last thing they want are people feeling sorry for them. Perhaps this is THE most important message I wish to share. Our thoughts and Tefillos should indeed continue but our pity should NEVER be visible. On the other hand, a degree of sensitivity and empathy is so important to give a couple if one feels it would be welcome. It’s so hard to get it “right”… What’s “normal”… I went through so many feelings and emotions. Some of them rational feelings and some totally irrational! I realise there is no right or wrong reaction - like with anyone going through a hard time, we get all types of reactions and that is “normal”. I remember when my other children married and were each Boruch Hashem blessed with their first baby arriving shortly after, it was hard for me to fully enjoy their Simcha, as Shifra was always on my mind. It was heartwarming to watch Shifra and her husband play with their nieces and nephews with such genuine love and joy, but at the same moment it gave me such a pang. When would they merit to have children of their own? Each and every month, imagining her disappointment, I would worry how the treatments were affecting her, but at the same time respecting their privacy and sensitivity which made me feel so restricted. Insights… However, Shifra and her husband have taught me so much. I’ve watched my couple grow together forging a very special and close unit. I have observed this to be true of many other couples who have had to wait awhile before they were blessed with children. Their relationships seem to take on a different dimension as they have had the “time” to nurture their marriage. To my amazement I’ve watched Shifra and her husband open up their home and host and entertain with such joy. As I have often been at their Shabos table, I have been so inspired by their ability to simply be themselves, with much laughter and fun creating a most welcome and relaxing atmosphere. I have watched Shifra’s self-confidence grow as a result of her success at work, and her faith in Hashem has always

been so strong. She projected outwardly a genuinely positive and optimistic disposition and outlook on life. All those years Shabbos and Yom Tov were the best times, without babies to tend to, that we could talk, share and have challenging discussions. We developed a very honest, caring and close relationship, I have an exceptionally special contact with my son-in-law too, which I cherish deeply. My couple’s sensitivity and thoughtfulness touched me greatly - how they did not wish to burden us with their hardships, disappointments and heartache, in fact protecting us from their challenges. In addition, there is my total admiration to my husband, as I have watched his complete and devout confidence and inner trust and faith in Hashem that Shifra would one day be blessed with a child. He never wavered and it gave me added strength. It was so moving to observe how Shifra and her husband readily listened to the many Segulos people heartily suggested to them, and how they listened intently to the words of the Rabbis they went to see, adhering to the suggestions that were requested of them. I feel such love, appreciation and thanks to my family and closest friends for their unspoken support, for their Tefillos and wishes, for their phone calls the night before their own children’s weddings requesting the names of our couple so that their Choson and Kalla would pray for them under the Chupa; and finally for their excitement, joy and generosity when Shifra gave birth. My thoughts… These years have most importantly given me a tiny inkling into the world of infertility, understanding that I will NEVER understand couples’ heartache or pain, yet I do empathise and accept their wishes not to share, and do not take it personally when they are uncommunicative or seem distant. My wishes…. To all the Shifras out there, with a standing ovation, I applaud your courage, your belief, your determination and your strength… on a good day, AND I silently offer you my friendship, my loyal support, my empathy and my devoted prayers… on a difficult day. May you have more of the former, less of the latter, AND may you ultimately, please G-d, be shortly blessed with a precious bundle of your very own. Amen. By a proud grandmother

News & Views VIII

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Life’s Perspectives

A TINY BIT OF LIGHT CAN BANISH A GREAT DEAL OF DARKNESS By R Avrohom Twerski

Several years ago, there was a popular book, “Don’t Sweat the Small Stuff,” with a subtitle “And it’s all small stuff.” I could not agree. There are adversities that happen to people that are not “small stuff” at all. In fact, they may be very big things. Getting laid off from one’s job is not small stuff. I then wrote two books entitled, “It’s Not as Tough as You Think,” indicating that even big stuff, while certainly significant, may appear to be greater than it actually is. But even this title is inaccurate. Some adverse happenings can be every bit as tough as we think, and what we need is the strength and courage to survive and cope with these challenges. We are told that Hashem never gives a person a greater challenge than he can withstand, but the Rebbe of Apt did not consider this much of a consolation, saying, “We have the strength to withstand so much.” The Talmud (end of Makkos) relates that when the sages saw the ruins of the Holy

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Temple, they wept, while Rabbi Akiva smiled and explained, “The Scripture approximates the prophesies on the destruction of Jerusalem with its rebuilding.

‘Why should I thank Hashem in advance for the kindness He will do with me in the future?’ Since the first prophesy was fulfilled, we can be sure that the prophesy of its rebuilding will be fulfilled.” The sages responded, “Akiva, you have consoled us. Akiva, you have consoled us.” Why the repetition? Because it was not so much what Rabbi Akiva said that comforted them, but rather it was who he was that comforted them. It was his unshakeable faith that the second prophesy would be fulfilled that was the consolation. We must read it as “ Akiva, you have consoled us.” Alas! We lack the likes of Rabbi Akiva that

can provide us with this quality of chizuk (reinforcement). We can only try our best. Rebbe Baruch of Medziboz, a grandson of the Baal Shem Tov, was reciting the prayer before Kiddush Friday night, and as he said, “I gratefully thank You, Hashem, for all the kindness You have done with me, and which You will do with me,” he paused and reflected, “Why should I thank Hashem in advance for the kindness He will do with me in the future? I can thank Him then, when the kindness occurs.” Then he said, “Ah! I understand. I may not recognize what Hashem will do for me as a kindness, and so I will not thank Him then. That is why I must do so in advance.” Then he began to cry. “How tragic it is! Hashem will be doing a kindness for me and I may not appreciate it.” Our great tzaddikim had true emunah, faith and trust in Hashem, that He is a loving father, and that everything He does with his children is for the good, but

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Life’s Perspectives

this is a level of spirituality which is so difficult to reach. At least, that is what I always thought, and I consoled myself that inasmuch as I was nowhere near being a tzaddik, I could complain when things did not go my way. But one day I attended a meeting of recovering alcoholics. The speaker was a young woman of thirty-five. She had started drinking at twelve and drugging at fifteen. This led to delinquent, decadent behavior. In spite of suffering the consequences of living on the street, she was a slave to her drug addiction. At twenty-six she found her way into Alcoholics Anonymous and at the present was nine years clean and sober. I had heard similar stories countless times, and this one did little for me. But I have never been to a meeting that I didn’t take away something of help. What I took away from this meeting has served me well, because toward the end of her talk, the woman said, “I must tell you something else before I finish.

‘Ever since I turned my life over to G-d, I no longer get uptight when things dont go my way’ “I am a football fan, a rabid Jets fan. I’ll never miss watching a Jets game. One weekend I had to be away, so I asked a friend to record the game on her VCR. When I returned, she handed me the tape and said, ‘By the way, the Jets won.’ “I started watching the tape, and it was just horrible! The Jets were being mauled. At half-time they were behind by twenty points. Under other circumstances, I would have been a nervous wreck. I would have been pacing the floor and hitting the refrigerator. But I was perfectly calm, because I knew they were going to win. “Ever since I turned my life over to G-d, I no longer get uptight when things don’t go my way. I may be twenty points behind at half-time, but I know it’s going to turn out o.k. in the end.” This woman may not have qualified as a tzaddik, and I envied her emunah. Even if we try hard, it may be difficult for the average person like you and me to maintain a constant state of intense emunah. Indeed, the Talmud states that a person is not held culpable for expressing anger toward Hashem when one is in agony (Bava Basra 16b). However, it

is extremely important to muster up emunah, even for a brief period of time, because if it relieves our suffering and enables us to have even momentary simchah, it has achieved a great deal. Just a tiny bit of light can banish a great deal of darkness. Chassidic writings stress the importance of simchah. Recently, there has been much interest in “Positive Imagery,” whose proponents say that by imagining positive experiences, one can actually cause them to happen. I was skeptical about this, until I came across a comment by the Rebbe of Apt, who points out that emunah means not only faith, but also “to bring up,” and that intense belief in something can bring it into reality. If so, then we should indeed use “Positive Imagery” and focus on things we would like to see happen. Is it possible to have simchah when one is distressed? Of course! Among the millions of people who watched the Superbowl, there were many who had lost their jobs and/or their life’s savings, yet when their team scored a touchdown, they were elated and cheered wildly. But isn’t fulfilling a mitzvah as good a reason for elation as a touchdown? When one gives tzedakah or recites a berachah or lights the Shabbos candles or does any other mitzvah, one should be elated, even though one may be experiencing adversity. In spite of the various explanations given, we cannot fully understand all suffering. The Talmud says that Moses asked Hashem why righteous people suffer, and Hashem told him that as long as he inhabits a physical body, he cannot understand this (Berachos 7a) The Talmud says that Moses wrote the Book of Job, where all arguments to explain why the righteous suffer are presented and refuted. It is crucial that we find ways to generate simchah. The Talmud states that the prophet Elijah indicated two men who were certain to be rewarded in Gan Eden. Why? Because they circulated in the market place, and when they saw a person who was depressed because he suffered a loss of money, they would say things to cheer him up (Taanis 22a). But what if one cannot generate feeling simchah? Although it is generally assumed that our emotions determine how we act, the sefer HaChinuch says that the converse is true: our behavior determines our emotions (Mitzvah 16). Smile, sing and dance as if you were happy, and this will generate simchah.

I had a friend who had a serious illness. I made up with him that I would fax him a funny story every day, and he would fax one to me. There is clinical proof that a cheerful disposition enhances recovery. Listen to the words of King Solomon. “A merry heart keeps the spirit up, but a depressed spirit desiccates the limbs” (Proverbs 17:22). Rabbi Samson Raphael Hirsch says, “A cheerful disposition is an estimable treasure. It preserves health, promotes convalescence and helps us cope with adversity” (From the Wisdom of Mishle p. 220). Obtain videos of comedians and get yourself a healthy belly-laugh every day. I visited Israel immediately after the Yom Kippur war. The country was in deep despondency over the many casualties it had suffered. On the way home, I stopped in Italy to share in a friend’s Bar-Mitzvah, and I visited Rome. I walked over the ruins of the Roman forum, the residuae of the once mighty Roman Empire.

‘Smile, Sing and dance as if you were happy, and this will generate Simchah’ I saw the Arch of Titus, with the sculptured image of the Romans carrying off the Menorah when they sacked Jerusalem and destroyed the Temple. The caption reads, “Judea capta.” At the time of the Roman triumph, what would anyone have predicted? Why, of course, that the mighty Roman Empire would endure forever, but the tiny country of Judea would be off the world map. 2000 years later, I was walking on the ruins of Rome, whereas tiny Judea was alive and thriving. Yes, hurting badly, but alive and growing. Someone had written graffiti on the Arch of Titus, Am Yisrael Chai, the nation of Israel lives! What is true of the nation as a whole, is true of every Jew! No adversity can destroy us, because we cling to Hashem. Am Yisrael Chai! FROM THE EDITORS: We are delighted that Rabbi Dr Twerski has shared his thoughts on achieving happiness through difficult times. We are confident that his inspiring words on living for now, seizing the moment and finding ways to be positive when facing challenges will resound with our readers.

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Personal Experience

?

Does anyone feel the same way as me?

Do you also...

always find out that you’re not pregnant just the day your sister-in-law tells you that she’s having another one, or on the day that everyone you meet in the grocery seems to have just put on maternity clothes. How hard it is to smile and be in a good mood that day...

Do you also...

cringe inwardly when people go on and on about how special so-and-so is because she’s pregnant again or because she’s having her eighth child, and you have to smile and nod, agreeing with them. When really as far as you’re concerned they’re just accepting the gifts that they’re being given. How you wish for a large family with toddlers, babies and pregnancies! Of course you know it’s not always easy for them, but how you wish you could have that Nisayon instead of your own!

Do you also...

wish you could stay in bed, go to a luxurious mother and baby home; have people fussing over you and sending food and presents in, all for the one reason that you have the Brocha of a new baby...

Do you also...

feel desperate for a break from your job, even if you love it, but you have no reason to leave? All around you people are going on maternity leave, but you plod on year after year with no break in sight...

Do you also...

look through the Hamodia or Tribune, until you find the Chana advert, reminding you that you’re not totally alone and that people do care?

Do you also...

feel that anyone not in the “Parsha” can’t really understand the term “roller coaster of emotions”? How for two weeks you’re so sure that you’re pregnant, you feel it physically and emotionally, only to get that terrible slap in the face when the test is negative and you become a Niddah again...

And for those with secondary infertility: Do you also...

wonder how people, even friends, can be so insensitive with their comments? “I’m so happy i had a girl so my daughter has a sister now” when your daughter would love to have any baby, boy or girl. Or how about, “You’re so lucky to be free all day and to go shopping without the kids!” Does she really think I am lucky? Is this what she would want?

Do you also...

feel lost in the maze of treatments and doctors, not knowing what to do next or whose opinion to follow. You can’t even speak to people because as someone wrote before in this magazine, secondary infertility is very lonely. Officially you’re fertile: you’ve had kids, but you feel so isolated because you got left behind somewhere. You don’t even feel comfortable speaking to people in the same situation as you.

Do you also...

cry for your daughter, when she constantly asks you why we have no baby? So you tell her to daven but when you still don’t become pregnant, you stop telling her to daven. After all, it is a hard lesson to learn that sometimes the answer is “no” or even “not yet” when she’s still so young? I want my kids to know that if they want something, they turn to Hashem, and not to lose hope already in their childhood. I doubt this has given Chizuk or inspiration to anyone, but if even one person can identify with some of these points, then I’ll know that I’m not so alone and you’ll know that you’re not so alone in your feelings either...

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News & Views VIII

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Poetic Thoughts

A Woman’s Prayer

by S.R.

A child. A dream? A hope. An illusion? Am I fooling myself? Can I really have a child?? I menstruate Again Dual feelings surface I cry At the lost opportunity At the lost child Even at the rejection Of not being chosen To mother a Jewish soul I cry For the new month ahead Going through the same procedure. Again Hope And then maybe Disappointment Why? And I cry Dual feelings Menstruation A new month begins New life emerges Perhaps forever! Maybe yes But I fear I fear to dream

To lift my tongue above the waters To lick up a breath of life I know Hashem it is Your will It is the greatest gift to me What’s wrong then with my eyes? Why are they tearing? My sister in law asks my spouse ‘Is Mali expecting?’ I cringe as I hear So insensitive My in-laws are looking my way Placing their hopes Where I fear to hope So a new month begins Maybe for the good Maybe not A depressing dread overtakes my mind Hashem, please help me see the gift Please help me through this maze I am trying to get to the centre I want to be centered In your kindness In your presence Please help me see the gift Please grant me the gift Speedily

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Personal Experiences

Only Yossi’s Mom Explaining why Yossi doesn’t have any siblings is proving to be very difficult

Hi. I’m Yossi’s mommy. Of course, that’s not my real name, any more than Ahuva is my real name, but those are the names I’ll use for now. I’ll change every detail that I can, too, but the situation my story’s based on – that, unfortunately, I can’t change. Yossi’s our only child. Actually, that’s my whole story. I want to tell you about a perfectly ordinary and normal couple who find themselves in a situation rather strange in our community: they’re not a couple who are blessed with many children, and not a childless couple either, but something in between. I’m not complaining. No one means us any harm. But since I’m sure there are others in a similar position, I’ve decided to tell my story, to focus some attention on a subject not often discussed.

‘After a wonderful first year, a tiny cloud appeared on our horizon: we hadn’t yet merited children’ We settled down, like any young couple, accompanied by thousands of blessings, and with a myriad of hopes. The future was clear. I already had a teaching job. My husband would start Kollel the day after Sheva Brochos. Our families had managed to provide us with an apartment. There was nothing to mar our happiness, and that’s how we went to the Chupa. I discovered very soon that my husband was everything I’d been told he was: a true Ben Torah with wonderful character traits, who learned well and fulfilled what he learned, exactly the person with whom I wanted to raise my children. He, too, wasn’t disappointed. As one of the oldest girls in my large family, I was well prepared to run a home, to manage everything, even with limited time and energy. I knew how to cook, loved to clean, and nothing was difficult for me. I wasn’t overly young, overly fearful, or with unrealistic visions about life. I had

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my two feet firmly planted in reality. After a wonderful first year, a tiny cloud appeared on our horizon: we hadn’t yet merited children. My prayers for this became more fervent. When I was a Kallah, parenthood had seemed such an ordinary development that it hadn’t occurred to me to daven for it. I assumed it was automatically included in my prayers to be happy and to live a life of Jewish nachas. I never imagined I’d have to shed a tear over this prayer, any more than over a prayer for good health, for example, when health had never been an issue. After that first year, however, I understood that becoming a mother might not be something I could take for granted. I was already feeling a twinge in my heart when I thought about this topic. Because clearly, what would make our marriage complete was a baby, and that central item was still lacking. Meanwhile, my younger sister married. We’d always been very close, and I thought it would be so nice if we could share the experience of becoming mothers. But the months passed, and I discovered that what remained a dream for me would soon become my sister’s reality. I’m not jealous by nature, but the truth is that this stabbed deep into my heart. I wished my sister only the best, but I was in deep pain. If until then I’d thought that life was all I wished it to be, I could no longer deny that something very basic was missing. If until then, children were important and I wanted them very much, this was the point when that desire intensified to a new degree and became a painful, tense and anxious longing. My life wasn’t anything like it had been the year before, when I hadn’t yet begun to worry, when I’d still thought that everything would straighten out soon. Now I knew that it hadn’t. It got worse each year. I got sadder and more anxious and less happy, though, Baruch Hashem, I had many reasons

to be happy. My husband and I enjoyed good health and no financial problems. As a couple, we exemplified the beauty of a Torah marriage. Things couldn’t have been better, but...we couldn’t enjoy anything. We wanted children! Now! Many of them! Immediately! And it didn’t look like that was going to happen. I knew that “Hashem’s help comes in the blink of an eye”. But three years later, my younger brother was married and already the father of a son, my younger sister was expecting her second child, my parents were davening tearfully, and I had taken on many extra resolutions. My husband, of course, also longed for children, but he’s much less emotional than I am. He tried to calm me with his own strong faith, saying that with Hashem’s help, everything would work out. He didn’t really succeed; as time passed my future seemed less and less bright.

‘True, we were no longer childless, but now that we’d tasted parenthood we wanted more’ Naturally, nobody witnessed this. Outside, I kept a smile on my face. At home, I fell apart. I couldn’t forget even for a second that “I don’t have”. And so many things reminded me. At work, during coffee breaks in the teachers’ room, all the talk was about children. On the way home each day, I passed a playground. My mother made a Sheva Brochos for one of my cousins. All the cousins were there, each with her baby. They talked about which stroller was better, which pacifier, and other topics about which I knew nothing. Of course, I listened and even laughed – I didn’t want a room to go quiet whenever I walked in; I want to be part of my family in every way. I’m only human, though. Where’s my stroller? I thought. Where’s my baby? I don’t know whether you’ve ever noticed,

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Personal Experiences

ommy but our world revolves entirely around children. Whoever doesn’t have seems to be irrelevant. There are a number of subjects that they can still talk about – the weather, for instance – but to a large extent, they don’t have anything to share. What can he talk about? His son’s new cheder? The Rebbi? He’s never prepared a son for a Bar Mitzvah or helped a son study for a yeshiva entrance exam. And what can she talk about? She’s never bought girls’ clothes, never made a cake for a siddur party, never had to get a daughter into seminary. And of course, neither he nor she has ever dealt with any of the myriad other parenting issues; Shabbos tables, Chinuch and sibling rivalry. We both tried not to let anyone know how different we felt, but it didn’t stop us from being different. We were a minority, an exception. We had nothing to say. Well, actually, we had a lot to say – about doctors, counsellors, tears of despair into our pillows, but these weren’t the kind of things you talk about. In public, we always had a smile on our faces and plenty of empathy for everyone’s problems. Inside our hearts? A storm of emotions. I’m sure it wasn’t easy for our family and friends, either. They didn’t want to make things hard for us, but they knew better than to stop talking whenever we entered a room, because that would hurt even more. We went through almost ten years of prayers and hopes, efforts and disappointments, trying to stand up to these life-tests, failing again and again. Ten years of Gehinom. The change came totally by surprise. Simply a present from Heaven – it’s a cliché, but that’s what he was. When we held Yossi in our arms, our gratitude was beyond words and boundaries. In that moment, I became part of things; the conversation about baby products, the new nursery school that was opening or the old one that was closing.

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Personal Experiences

Yossi was sweet and bright and we’ve always had much joy and nachas from him. He went to nursery school and to cheder and, without us even noticing, he was soon learning all day long. That was when I again started feeling difficulty. True, we were no longer childless, but now that we’d tasted parenthood, we wanted more than ever to fill our home, again and again and again, with all that we’d experienced from Yossi. The house was too quiet. Again, there wasn’t much to talk about with others. I couldn’t say that I was tired. (What does she have to do, with just one child?) I had no excuse not to help make sheva brochos. (What else does she have to do, with just one child?) I had no excuse not to go to my mother-in-law’s house for Shabbos. (How difficult can it be to organise a visit, with only one child?) So we have this one child, and he’s our whole world, and maybe that’s part of the problem. He’s our whole world and we have to be careful not to love him too much, not to be overprotective, not to stifle him, not to be jealous of people who have boys in his class with four younger siblings. The world can be divided into groups. Large groups such as Jews and nonJews. Ethnic groups such as Sephardim and Ashkenazim. And subdivisions such as the various Chassidic groups. Social status groups; rich, poor, nobility, or personal status groups, of which the biggest is family members. They’re the decisive majority, the norm, the way things should be. In the minority are various other groups marked as belonging, yet not belonging: those who have no spouse (subdivided into single, widowed or divorced), those who have a major hardship at home – an illness, or a serious financial situation; childless couples. And the relatively small group of parents of one child. This is a unique group, with its own special joys and sorrows that no outsider can understand. With deep fears (what if, Heaven forbid, any harm befalls my one and only child, on whom my whole world is built?), with deep anxiety about whether things are good for him, whether anyone’s planning to harm him, whether he will find the right girl to marry, and whether he will be happy – because parents of an only child can’t bear to see their one child suffering. It’s not that parents of large families don’t care about their children. They just have

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so much going on that it distracts them from concentrating solely on any one child’s happiness or lack of happiness. For parents of an only child, all of their happiness and pain, and their hopes and fears, are embedded in the person of that child. Their heads, their hearts, and their entire being centred on him. And at the same time, they have to be careful that this won’t have a negative effect on his upbringing, because the first thing that destroys a child is a lack of boundaries, pampering, and his parents’ over protectiveness. You have to be careful all the time – so careful, there’s no energy left for anything else.

Sure”, says Yossi. “But you’re not really alone. You have your brothers and sisters. I’m completely, completely alone.” “So what are you so busy with?” asks a neighbour, who no longer has to be careful not to talk about children in front of me. “So why didn’t you come yesterday?” asks my sister, not adding the rest of the question that’s begging to be asked. “So what if he didn’t do well in the Gemara test?” says my brother. “At his age, I wasn’t first in my class either. Baruch Hashem I straightened out in Yeshiva.” I want to scream, “But you were one of five brothers! Your parents were able to move onto something else. For me, we’re talking about the whole world!” Every single minute, I thank Hashem for Yossi, and at the same time, I daven for him and for us. Every child is a precious diamond to his parents. For us, Yossi is equal in value to all their diamonds put together. And we put a lot of work into him. A 12-year-old doesn’t need a babysitter, true, but he doesn’t like to be left all alone at home, either, when his parents want to go somewhere. “What’s the big deal?” his cousin of the same age asks him. “I stay home by myself lots of times”. “Sure”, Yossi says. “But you’re not really alone. You have your brothers and your sisters. I’m completely, completely alone.” I hear this and my heart is torn. That’s what our only son feels, every moment when we’re not with him, because he doesn’t have anyone else. I remember babysitting for my seven-year-old

sister, when I was a teenager, when my parents went to a wedding. She was afraid of something happening to them. She was having nightmares because a neighbour of ours had been killed in an accident. “If anything happens to them, you’ll take care of me, right?” she asked. I promised her that I would. When I think of that today, I ask myself who would take care of Yossi if anything happened to us. He has a whole extended family, but everyone’s so busy with their own huge crew. You’ll say that this is a lack of faith. You’ll say that maybe I need to see a psychologist. Believe me, I’ve considered these things. But I don’t need any help. I just need more children. It’s as simple as that. I just need to have no time to think so much. I need to have more and more and more of this taste, because now that I’ve tasted it, I can’t be satisfied with only one bite. Yes, for couples who have no children, it’s infinitely more of a hardship. You don’t have to tell me; I was there. But in their case, everyone understands how hard it is. Everyone knows that you’re not allowed to ask them for explanations, because who knows why they didn’t come to whatever event it was, or what difficult experimental tests they’re involved in, or which doctor’s appointment they were keeping. But with parents of a single child, it seems, there are no acceptable excuses. They’re not childless, so why isn’t she in a good mood? I just want you to know that there may well be many things that are bothering them, that are preventing them from attending or helping. They have an only child – and maybe precisely because of that – their burden is greater than that of a home filled with many. Reprinted with kind permission from Family First @ Mishpacha

IF YOU CAN FIND A PATH WITH NO OBSTACLES, IT PROBABLY DOESN’T LEAD ANYWHERE.

News & Views VIII

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Personal Experiences

News & Views VIII

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Medical Focus

BLASTOCYST TRANS Moving towards an effective single embryo transfer

Since IVF began, embryos have traditionally been cultured in the laboratory for just two to three days before transfer into the uterus. At this stage the embryos consist of a few cells, and as it is difficult to predict which embryo is more likely to develop into a healthy baby a number of embryos are transferred in the hope that at least one will result in a successful pregnancy. This approach is widely accepted in order to achieve pregnancy rates that make IVF treatment a viable option for couples and healthcare providers.

Often the embryologist has to select from a group of very similar looking embryos all at the same stage of development: not a good position to be in when very little information is available to support the selection process. Under standard IVF conditions only 25% – 60% of embryos will progress to the blastocyst stage, and this is because until fairly recently culturing embryos successfully in the laboratory to blastocyst stage, and at the same time achieving a good pregnancy rate, was extremely difficult. Research has shown that an embryo has different needs during various stages of its development. In response to these needs, scientific progress has led to the production of innovative, sequential culture media which enable embryos to grow and survive under laboratory conditions to the blastocyst stage. So what is a Blastocyst? A blastocyst is an embryo that has developed for five to six days after fertilisation, with 2 distinct cell types and a central fluid filled cavity (blastocoel cavity). The cells in a blastocyst have just started to differentiate and form two distinct cell types. The surface cells surrounding the cavity are called the trophectoderm which will later develop into the placenta. The more centrally located group of cells called the inner cell mass will become the fetus. The whole embryo rests inside a shell called the zona pellucida and this shell breaks as the blastocyst expands in size allowing the blastocyst to hatch. Hatching is usually completed by the end of Day 6, and the hatched blastocyst hopefully goes on to implant and form the pregnancy. Worldwide statistics show that of all 2-4 cell embryos replaced within the uterus, only 15-20% actually implant. Blastocysts on the other hand, are up to three times more likely to implant than Day 2 or Day 3 embryos. Implantation rates in excess of 40-60% per blastocyst are regularly achieved. It is now possible to transfer a single blastocyst in patients and still achieve success rates comparable to the transfer of two embryos on Day 2-3.

Inner cell mass

Fluid filled cavity

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Zona Pellucida

Trophectoderm

Why is Blastocyst Transfer so successful? There are a number of possible reasons for its success. The most likely reason is that embryos developing successfully to blastocyst stage are undoubtedly fitter and stronger, and therefore have a greater potential to implant. We know that a very high proportion of embryos cultured in the laboratory are not viable, and their development is arrested before reaching the blastocyst stage. It is therefore reasonable to assume that Blastocyst culture acts as a perfect screening process to select the few embryos that do not have extreme chromosome or genetic defects. Blastocyst transfer is also more physiological as it mimics natural conception, whereby the embryo travels down the fallopian tube and reaches the uterine cavity five days after fertilisation. This ensures correct synchronisation between embryo and uterine lining development. In standard

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Medical Focus

ANSFE R

IVF, embryos are often replaced on Day 2/3 into the uterus, whilst in the natural course of events an embryo would normally be still half way down the fallopian tube, and this early introduction into the uterus may well be part of the cause for historically poorer results with IVF. Unfortunately not many embryos survive to five days in the laboratory, and if not carefully selected and monitored, some patients may not make it to the blastocyst transfer stage. It is important therefore that we select patients who on Day 3 have at least three good quality embryos. If the number of embryos is low there may be no significant advantage to leaving the embryos outside the uterus, as we already know which embryos are to be selected for transfer. Our experience Our centre has been the pioneer of the Blastocyst Culture Programme in the UK since the year 2000. In those days we concentrated on patients with a history of repeated failed attempts through standard IVF, but who always generated a good number of embryos. The results were very encouraging and our first blastocyst babies were delivered in June 2001. We are delighted that currently 55% of our patients are undergoing a blastocyst transfer. Nowadays we offer Blastocyst culture to any patient who has a sufficient number of good quality embryos on Day 3. The embryos are assessed daily after egg collection and the patients are informed accordingly of their progress also daily. If the embryo quality is poor or if there are less than three good quality embryos, the embryos will be transferred on Day 2 or Day 3 as there is no real benefit in leaving them in the incubator. Culturing embryos to blastocyst stage will be suggested if by Day 3 there are at least two or three good quality embryos. Are there disadvantages associated with blastocyst transfer? There is a possibility that none of the embryos may survive to Day 5. As there is no guarantee that the embryos will survive to the blastocyst stage, we monitor the embryos stringently, and recall patients on Day 3 for embryo transfer if we have the slightest doubt as to the further developmental potential of the embryos in vitro. Herts and Essex Fertility Centre – Blastocyst Results Our very latest clinical pregnancy rates for Blastocyst Transfer for 2009

Per embryo transfer

<35 years

35-37 years

38-39 years

58.%

33.3%

20.0%

Blastocyst Transfer for Patients under 38 years No. of treatments

Clinical Pregnancy Rate / Embryo transfer Implantation Rate

Single Embryo Transfer SET (Blastocyst) Clinical pregnancy Rate

87

48.3%

42.0%

30 cases

43.3%

Double Embryo Transfer (Blastocyst)

56 Cases

Clinical pregnancy Rate

51.8%

Blastocyst Transfer and elective Single Embryo Transfer One of the more difficult areas to contend with in IVF is when modifications are made to treatments in order to reduce risk, the most recent change in practice being the need to reduce the risk of high rates of multiple births as a result of assisted reproduction. Undoubtedly reducing the number of embryos will reduce the multiple birth rate, but the fear is that this will lead to a reduction in the overall success of treatments. However, we believe that Blastocyst transfer is the perfect model to use in any multiple birth reduction strategy as we are more likely to select the “best” single embryo from a group of embryos. The chances of that one highly selected embryo implanting are in the order of 35 -60%. At our Centre, we have recently carried out single embryo replacement in the from of a single blastocyst in 92 patients under the age of 38 years and currently the ongoing pregnancy rate for this group is 46%, which is exceptional as >95% of these patients will proceed to have a healthy single live birth. There is no doubt that the Blastocyst Culture Programme is proving very popular in IVF laboratories world wide. We are still learning about the requirements of these late stage embryos, and indeed we need to find improved ways of consistently choosing the best blastocyst from a cohort of embryos. This may come from still more advanced technologies, but may be a simple matter of fine tuning the process of assessment and selection based on their morphological appearance itself. Mr Andy Glew, The Herts and Essex Fertility Centre, Bishops’ College, Churchgate, Cheshunt EN8 9XP

News & Views VIII

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Poetic Thoughts

JUST ONE QUESTION By Y.P.

He enters the shul, with self assuredness and stride here’s the only place where anxiety’s cast aside. Back home there will be talk of treatment and medication but with these few hours of learning call it a mini vacation! As he leans over the reading words so pure, somebody taps on his shoulder and with a voice so confident and sure “I’ve just one question, really don’t mean to pry but here’s a with a ‘well known’ care to give it a try?” There she sat alone, amidst all the hearty chatter as the ladies on her table were passing platter after platter. The topic of conversation was how “the babies are up all night! and boy! The kids can’t do anything, without breaking into a fight!!” She sits and listens with a smile perched on her face about her deep inner struggle one wouldn’t see a trace. and then the lady two seats away with a voice that chirped like a bird turns to her direction making her self quite heard. “Hi, I’m so and so and who are you? I’ve got ‘Just one question’ to pose… left your kids with a babysitter, I suppose???”

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They’re glancing through their wedding album scenes and faces of the past on that joyful day it had seemed that their dreams would forever last… But had another plan for them one that’s considered a difficult test on how they wished they could build their very own nest… Suddenly the shrill of the phone sounds interrupting their reverie ‘Oh this time’, he cheerfully announces the call is meant for me. booms the voice down the line I’ve just had a boy and this is number nine! Now there’s ‘Just one question’ hope by asking you wont matter, How would you and your wife like the honour Of being our Kvatter??? we know you’ve put us to test oh how we all daven to build our own nest But though life might be a challenge And not everything seems as it should everything you do is precisely for our good, and that every krectzh and sigh should not accompany the most common word ‘Why’? But ‘Just one question’ we ask without begrudging friends, relatives or brothers did you give us this for us to learn how to be sensitive to others???

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Life’s Perspectives

Answered Prayers A voyaging ship was wrecked during a storm at sea and only two of the men on it were able to swim to a small, desert like island. The two survivors, not knowing what else to do, agreed that they had no other recourse but to pray to G-d. However, to find out whose prayer was more powerful, they agreed to divide the territory between them and to stay on opposite sides of the island. The first thing they prayed for was food. The next morning, the first man saw a fruit-bearing tree on his side of the land, and he was able to eat its fruit. The other man’s portion of land remained barren. After a week, the first man was lonely and decided to pray for a wife. The next day, there was a woman who swam to his side of the land. On the other side of the island there was still nothing. Soon the first man prayed for a house, clothes and more food. The next day, like magic, all of these things were given to him. Meanwhile, the second man still had nothing.

Finally the first man prayed for a ship, so that he and his wife could leave the island. In the morning, he found a ship docked at his side of the island. The first man boarded the ship with his wife and decided to leave the second man on the island. He considered the other man unworthy of receiving G-d’s blessings, since none of his prayers had been answered. As the ship was about to leave, the first man heard a voice from heaven booming, “Why are you leaving your companion on the island?” “My blessings are mine alone, since I was the one who prayed for them,” the first man answered. “His prayers all went unanswered and so he does not deserve anything.” “You are mistaken!” The voice rebuked him. “He had only one prayer, which I answered. If not for his prayer, you would not have received any of my blessings.” The first man then asked the voice, “Tell me please, what he prayed for that I should owe him anything?”

“He prayed that all your prayers be answered.” For all we know, our blessings are not the fruit of our prayers alone, but those of another praying for us.

My prayer for you today is that all your prayers should be answered. What you do for others is more important than what you do for yourself.

News & Views VIII

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Medical Focus

CHANA MEDICAL ADVISORY PANEL Meet the experts.

Since its inception in 2003, Chana’s Medical Advisory Panel has grown from a small group and expanding to consist of renowned specialists in the field of male infertility, endocrinology, miscarriage, genetics, ultrasound scanning, gynaecology and infertility. The panel also includes GP’s who are particularly sensitive to the needs of the Orthodox Jewish community in North West London and Stamford Hill as well as a paediatrician and medical liaison who are able to offer specialised input. The panel has expanded and we are delighted to welcome our two new members Dr Andy Glew and Mr Gidon Lieberman to our medical panel. The aims of the panel include: being a source of advice and support to CHANA regarding medical information for members and support workers, being available as a source of referrals; helping CHANA establish links with a range of medical specialists, and raising the profile of CHANA, so that individuals and couples can utilise CHANA’s services. Members of the public can access specialised information through the Chana helpline who have direct contact to the Medical Panel with up to date medical breakthroughs. The Medical Advisory Panel meets four times a year and they are instrumental in helping us at Chana to develop our policies regarding medical issues as CHANA grows and develops. This enables CHANA to offer an outstanding and high calibre service to the community. Many of our panel members kindly support us by speaking at our Well Woman and CHANA specialist infertility events. 54

Dr. Miranda Abraham (Glick) Dr Abraham is a General Practitioner in practice for 13 years with a special interest in gynaecology. Practices under the NHS in West Hampstead and privately in Golders Green and has experience working with the Stamford Hill Jewish Community.

Dr. Yossi Adler Dr Adler is a General Practitioner who practises in N.W. London with a large percentage of Orthodox patients. Involved with helping patients with a range of infertility treatments.

Dr. Veronique Berman Dr Berman Formerly was the senior scientist in the Molecular Diagnostics Laboratory in Haematology at the Hammersmith Hospital, providing the full range of molecular diagnostics and molecular monitoring for malignancies, chimerism for transplants as well as diagnosis of clotting disorders and Thalassemias both for the Hammersmith Hospital and the West London region. Doctorate in molecular endocrinology with a particular interest in hypogonadism and infertility.

News & Views VIII

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Medical Focus

Dr. Anthony Cohn

Mr. Andy Glew

Dr Cohn is a Consultant paediatrician at the Watford and Hemel Hampstead Hospital. Had his children through treatments and is aware of issues resulting from treatments as they relate to premature and multiple births.

Mr Andy Glew is currently celebrating his 22nd year working in the field of clinical embryology. His first position was a joint venture with Professor Ian Craft, Wellington Humana Hospital, London and Dr Robert Moor at the Institute of Animal Physiology and Genetic Research, Cambridge. This joint role gave Mr Glew a good insight into both animal and human embryology and at the time the Humana IVF unit was the UK’s largest, performing several thousand cases a year. In 1989 Mr Glew co-established the Essex Fertility Centre, now the Herts and Essex Fertility Centre along with the Medical Director, Mr Michael Ah-Moye, where he currently manages a successful team undertaking 700 cycles per annum.

Dr. Gerard Conway Dr Conway is a lead clinician in endocrinology at UCLH and maintains a clinical research interest in pituitary, ovary and adrenal disorders as well as developmental conditions. Much of this work comes under the heading of reproductive endocrinology which is a specialist interest in the department. Dr Conway has pioneered the development of multidisciplinary clinics for Turner Syndrome and Congenital Adrenal Hyperplasia, which have become a model for care of these conditions applied throughout the world. In the area of reproduction Dr Conway undertook research into the Polycystic Ovary Syndrome under Professor Howard Jacobs and has developed this interest over the last 20 years. He runs a clinic specialising in PCOS in the Reproductive Medicine Unit at UCH where he is the physician overseeing hormone aspects of infertility.

Dr. Simon Fishel (associate member) Dr Simon Fishel is Managing Director of the CARE Fertility Group. He is recognised for his pioneering work in IVF, especially in the fields of microinjection for male infertility and preservation of fertility in children with cancer. He has been active in the field for over 30 years, researching at Cambridge with Professor Robert Edwards before the birth of the first IVF baby. He has written over 200 scientific articles and edited 3 books on the subject. He was awarded a personal Professorial Chair in Human Reproduction in recognition of his work and is also an Inspector for the Human Fertilisation and Embryology Authority (HFEA). CARE Fertility have been associated with the introduction of many of the advanced and specialised technologies in IVF, and their patient Bulletin Board has been described as “one of the best patientpatient resources in the field” www.carefertility.com

Mr Glew was a founder executive member of the Association of Clinical Embryologists, and is currently an external inspector for the Human Fertilisation and Embryology Authority. His interests encompass all aspects of embryology with particular interest in blastocyst transfer and the promotion of collaboration and sharing of information within the field. Also Mr Glew is actively involved in developing electronic systems for witnessing to enhance the manual witnessing systems that currently are in place in all our labs at present. Mr Glew has been involved in setting up and advising assisted reproductive centres in Serbia, Ghana, Durban and Nigeria and is currently acting as a consultant to Xytex International who supply donor sperm throughout the world.

Dr. David Goldmeier Dr Goldmeier is a Consultant physician in Sexual Medicine at Imperial College NHS Trust at St. Mary’s Hospital. Clinical lead for the Jane Wadsworth Sexual Function Clinic. Involved in clinical research. Sits on editorial boards for a number of academic journals and on the board of directors/councils of a number of national and international sexual function organizations.

Dr. Lyann Gross Dr L Gross is a Family Planning Doctor and GP who has special interest in gynaecology, fertility and family planning. She also works as a Family Planning doctor for Barnet Primary Care Trust and has lectured to other doctors and health

professionals on gynaecological issues in Orthodox Judaism.

Mr. Anthony Hirsh MB, DRCOG, FRCS Andrological Surgeon Mr Hirsh is a surgeon specialising in male subfertility and male sexual dysfunction. His principle interests involve the management of infertile men by conservative, medical and surgical methods, including surgical sperm recovery techniques and assisted reproduction. A graduate of Westminster Medical School, he is Consultant in Andrology to Whipps Cross Hospital, London, Bourn Hall Clinic Cambridge, Guy’s Hospital Assisted Conception Unitwhere he is Honorary Senior Lecturer, and The Fertility Unit, Homerton Hospital, London. He served on the Development Group for The NICE Fertility Guidelines (2002-2004). He has regularly lectured on the British Fertility Society special skills courses, King’s, Guy’s and St Thomas’s Medical School, The Bourn Hall academic programme, and various clinical meetings. He has also contributed several papers and chapters on the investigation and management of infertile men in the assisted conception unit, and introduced reproductive medicine specialists in several units in the UK and abroad to the skills needed to manage infertile men, including surgical sperm recovery.

Mr. Arjun Jeryarajah Mr Jeyarajah was appointed Consultant Gynaecologist and Gynaecological Oncologist at St Bartholomew’s Hospital in 1999. He has sessions at Queen’s Hospital Romford in his role as Gynaecological Oncologist in the North East London Gynaecological Oncology Network. Mr Jeyarajah qualified at Cambridge University and Kings College Hospital London. He trained in Obstetrics and Gynaecology at Beth Israel Medical Centre in New York City, USA. On his return to the UK he completed his membership of the Royal College of Obstetrician and Gynaecologists and carried out a further sub-specialisation in Gynaecological Oncology between St Bartholomew’s Hospital and The Royal Marsden Hospital. He was awarded the Fellowship of the Royal College of Obstetrics and Gynaecologist in 2007. His research interests include screening for ovarian cancer and laparoscopic pelvic surgery.

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Medical Focus

In addition he is Chairman of the North East London Gynae Oncology Tumour Advisory Group and his specific areas of expertise include laparoscopic surgery and colposcopy. He has extensive experience in radical pelvic surgery. In the private sector he consults in Wimpole Street, London and has operating sessions at the Princess Grace and The BUPA Roding Hospital.

Mr. Eli Kernkraut Mr. Kernkraut has for many years familiarised himself with information about clinics, specialists and treatment procedures. In a voluntary capacity, Mr. Kernkraut helps prospective patients in the Jewish community to find out particular information specific to their own interest as well as help them liaise with appropriate specialists in the field.

Ms Sara Levene Ms Levene is a Genetic Counsellor based in the Clinical Genetics department at Guy’s Hospital. Aside from a broad genetics caseload of general and cancer genetics, Sara has previously managed the long-term follow-up of families with chromosomal re-arrangements, and has more recently taken on the management of long-term follow-up of Fragile X families. Sara is also works in a team running a local multi-disciplinary clinic for women with disorders of sexual development. Sara’s special interest is in genetic conditions which are more common in the Jewish population, and as well as running the Tay Sachs screening clinic at Guy’s she has more recently completed a Dept of Health funded ‘Visiting Fellowship’ to visit Jewish Genetic screening programmes in the USA, Canada, Australia and Israel. The UK National Screening Committee has now funded further work to review the current Tay Sachs screening service around the UK. In addition, the Guy’s Genetics department where Sara is based, in conjunction with the local Assisted Conception Unit, run one of the most active Pre-implantation Genetic Diagnosis (PGD) services in the NHS.

Mr Gidon Lieberman Mr Lieberman is an experienced consultant gynaecologist practicing in both the NHS and private sectors with a special interest in fertility. Mr Lieberman is a Consultant Gynaecologist at The Whittington Hospital and is the clinical lead responsible for Fertility Services and the Early Pregnancy Unit.

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Mr Lieberman undertook his undergraduate studies at St Andrews University and Manchester Medical School, qualifying in 1993. Since then he has worked at University College Hospital, The Royal Free Hospital and St Bartholomew’s & the Royal London Hospital. Mr Lieberman is accredited by the Royal College of Obstetricians in both laparoscopic and hysteroscopic surgery, gynaecological ultrasound and management of the menopause. Mr Lieberman has published peer reviewed articles in gynaecology including gynaecological cancer and reproductive medicine.

Mrs. Geeta Nargund Mrs Nargund is the Consultant and Head of Reproductive Medicine services at St George’s Hospital, London. She is also the Medical Director of Create Health Clinic, London. She was awarded a “Visiting Professorship and Gold Medal for her contribution in infertility by the University of St Marco, Lima, Peru (oldest university in Latin America) in September 2007. She has been a Senior Governor of primary and secondary schools in south London. She has published extensively on the use of Advanced Ultrasound Technology in Reproductive Medicine. She pioneered the use of follicular Doppler for assessment of egg quality in infertile women and “One-Stop Fertility Diagnosis” using advanced ultrasound technology. She has also published the first scientific paper of cumulative live birth rates with Natural Cycle IVF (IVF without ovarian stimulation).She is the President of the International Society for Mild Approaches in Assisted Reproduction (ISMAAR) She is passionate about prevention of infertility & making Assisted Conception Treatments (ART) more natural, safer and affordable globally. She is the Chief Executive of the UK national women’s health charity, Health Education Research TRUST (www. hertrust.org). Through this charity she is committed to raising public awareness about women’s health and funds for scientific research.

Dr. Jeremy Nathan Dr. Nathan is primarily a General Practitioner working in North-West

London. His particular interests include Medical Acupuncture and Medical Education. He is a fully accredited member of the British Medical Acupuncture Society, holding their Diploma in Medical Acupuncture and is the official Acupuncturist for CHAI Cancer Care. He is also a Clinical Teaching Fellow in the Academic Centre for Medical Education at the Royal Free and University College Medical School, UCL. He lectures undergraduates in Health Promotion, tutors 1st and 3rd year medical students, and is a finals year examiner. His website can be found at www.privateacupuncturegp.co.uk.

Mr. Nick Panay BSc MBBS MRCOG MFFP Mr Panay is a Consultant Gynaecologist with a special interest in reproductive medicine and surgery, menopause and menstrual disorders. As director of the West London Menopause & PMS Centre at Queen Charlotte’s & Chelsea and Chelsea & Westminster Hospitals, he heads a busy clinical and research team which publishes widely, presents at scientific meetings and trains health professionals at all levels. Much of his team’s research has focused on improving the understanding and management of premature menopause, PMS, new HRT preparations and complementary therapies. Nick is currently the Editor-in-chief of Climacteric (The Journal of the International Menopause Society) and is on the editorial boards of the Journal of Obstetrics and Gynaecology and Journal of Family Planning and Reproductive Healthcare. He has a particular interest in minimal access surgery, both laparoscopic and hysteroscopic. He heads the operative outpatient hysteroscopy centre at Queen Charlotte’s Hospital, which facilitates the one stop investigation and treatment of women with bleeding disorders. As council member of The British Menopause Society and The British Society for Gynaecological Endoscopy, Vice President of The Royal Society of Medicine, Chairman of The National Association for Premenstrual Syndrome and Patron of Daisy Network, he campaigns actively for women’s health issues both nationally and internationally.

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Medical Focus

Professor Lesley Regan MD FRCOG Professor Regan is Head of Obstetrics and Gynaecology, Imperial College, St. Mary’s, London. Her specialist interests are in recurrent pregnancy loss, subfertility, non-invasive therapies for the management of uterine fibroids and general gynaecology and obstetrics. She recently received a Woman of Achievement Award for services to Reproductive Medicine.

Mr. Bill Smith Mr Smith is a Technical Director of Clinical Diagnostic Services. Ultrasound practitioner with extensive expertise in women’s healthcare issues including obstetrics, gynaecology and reproductive medicine. Recognised internationally for his pioneering work in developing ultrasound technology in many aspects of gynaecological scanning. Has been involved in setting up several fertility/IVF units within the UK over the past two decades.

Dr Davina White MBChB, FRACP - Associate Specialist in Reproductive Endocrinology. Dr White is a specialist in reproductive endocrinology based at St Mary¹s Hospital. Imperial College Healthcare Trust.

Mrs. Carolyn Cohen Mrs Cohen is the Principal Social worker of CHANA, responsible for help line and counselling services and member of management committee. Mrs Cohen has experience in marital and family social work.

Mrs. Rae Adler Mrs Adler is the Community Development officer, responsible for helping CHANA widening its links in the community and help potential members access CHANA’s services more easily. Member of the senior social work team.

Mrs. Devorah Gelley Mrs Gelley is a Support worker for the CHANA helpline. Mrs Gelley has broad experience in the community, having worked with adolescents in school setting and been involved for many years as Rebbetzen and Kallo teacher. Also works for other Jewish charity as support group facilitator. Fluent English, French, German, Yiddish, Ivrit.

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12/5/10 10:42:36


Chana News

A BUSY CHANA VOLUNTEER Why this volunteer enjoys her involvement at Chana

My involvement with Chana was limited. All I knew was that my husband had taken part in a number of the fundraising car rallies which he enjoyed immensely. This was a fantastic fundraising initiative for this most unique organisation. Two years ago, I attended my first Chana brunch. Besides being impressed with the beautiful presentation and huge turnout, what moved me most was the emotional impact the speakers had on their audience. Both of them founders of this wonderful organisation bravely stood on the podium sharing their own personal struggles of their infertility challenges whilst giving us an insight as to why Chana was founded. Throughout their speech you could hear a pin drop. Everyone was focused intrigued and deeply stirred by the powerful words. For me it hit a raw nerve. Towards the end of the brunch, leaflets were handed out requesting the need for volunteers. I had been living in England just over two years and was looking to do some volunteer work. I took this opportunity and offered my services.    A few days later I met with one of the many devoted employees at the Chana office. My first impression was one of real admiration. Just standing in the office I understood even more the need for an organization such as Chana. I had experienced the trials and tribulations of infertility and knew all too well how important and necessary it was to have Chana there to guide individuals and couples medically, emotionally as well as financially.    

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Without hesitation I jumped on the bandwagon and began working as a part-time volunteer at the Chana office and am loving every minute of it. The office and staff are extremely efficient and very skilled but at the same time even if you are a volunteer you are made to feel a part of one big happy family. There is really no time for twiddling thumbs or playing a game of solitaire as there is always some ongoing or new project to work on. Although I do not know the full extent of all the incredible work that Chana does for the Jewish community of Great Britain and abroad, I am compelled to mention but a few. 

‘Without hesitation I jumped on the band wagon and began working as a part time volunteer at the Chana office and loving every minute of it’ The extremely qualified support workers at Chana are constantly busy developing new ideas and ways to reach out and provide support and information to those couples that need it. The telephone Helpline is professionally manned with many new callers each week. At the moment, the exciting new project being set up is the Buddy system. Individuals (men and women) who have faced or are still going through infertility issues can be paired up with a buddy who has their own

similar experience and be there for them as an informal support. Chana’s amazing magazine with its heart-rending as well as informative articles (like this one!) can be spotted at your local surgeries or even your favourite wig salon and mikvah. The fundraising volunteer committee are continuously working on their various projects throughout the year. There are many volunteers who come in and out of the office throughout the week. We are all assigned different tasks. One of my many jobs is to source GPs’ details throughout the country in order to update and enter them onto the vast database so that we can introduce them and make them aware of Chana. With so many people involved both as employees and as volunteers one can only wonder how an organisation that deals with such emotional and private matters can keep things so confidential. Well the answer is they do. The volunteers are never privy to any private details and do not have any involvement with confidential information.    So, for anyone who has some spare time on their hands and would like to do something purposeful, which will give them tremendous satisfaction please don’t hesitate and give Chana a call!  For me Chana has really enriched my life – it has shown me that there is a part of this community which was unknown to me. I am so privileged to assist and be part of this organisation although my involvement is only a drop in the ocean of what actually takes place at Chana.

News & Views VIII

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Poetic Thoughts

Loss by L.N.

Some may ask how one can lose

The strain of pretending to the world

Strength and trust in Hashem

what one has never had

that all is fine

often seem beyond grasp

To not have is to know the answer

To ask for privacy from the world

When davening sometimes one feels,

is a privilege

how many more times can I ask?

Happy occasions,

not always granted to a case like mine.

a mixture of emotions,

Bitochon means trusting

ever so aware of others looking

The pain may be held

that Hashem is great,

How can one describe

behind a strong dam,

He has a plan tailor-made to you

what is going on inside,

supported by a very special select few

As painful as it might be He knows best

Looking on as months and years go by

and for that I am eternally grateful

why you have been chosen

It becomes ever so difficult to hide.

to those of you

as one of the select special few,

A small crack may be caused

Take hold of His hand, continue to ask,

Often one might feel

by one small thoughtless remark

focus on the good

having reached the end

But please do realise the painful

that He has bestowed upon you

of this difficult journey

emotions you might spark

This is the essence of a Faithful Torah Jew

Only to be thrown to the start again

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12/5/10 10:42:47


Personal Experience

A Burning Issue Recognising a message and acting on it It all happened on what seemed a very ordinary Wednesday evening. I was sitting in the study opposite my husband when a tissue touched a burning candle and caught fire in his hand. I stood up and stared motionless at my husband who was desperately trying to stamp out the tissue which had transformed into a blazing flame. Not thinking quite straight, I ran out of the study to grab whatever I might find to extinguish the fire. By the time I returned, my husband had dropped the tissue onto the carpet, not really caring about the damage to the furnishings. I was surprised to see that the flame had miraculously died down and that, besides a strong smell, there was no mark nor stain on the green coloured carpet. There was absolutely no remnant of the flames – it was unbelievable. Looking at each other in shock, all we could feel was immense gratitude to the Ribono Shel Olam for having spared us from what could have turned into a fullblown disaster. A potentially harmful fire which caused no damage whatsoever was to us a clear sign that we were meant to take this incident, recognise its message, and act on it. You might - understandably - wonder why a candle should be burning in the lounge on a regular Wednesday evening, and why we chose to share this episode with you. So let me tell you our story... When we got married, over twenty years ago, we were young and optimistic, blissfully content and looking forward to a fulfilling family life. As one year of marriage passed and then another, we were in a routine of sorts, and our home became a bustling household, yet the gurgling sound of a much longed for baby were not heard. About two years after our marriage, we embarked on a long and painful journey of fertility tests and treatments, which went on for many years. More years went by and my husband was guided by a leading Posek who is considered to be one of the leading Gedolei Hador – great leaders of our generation - to seriously consider adoption, adopting a Jewish child from abroad. My husband was more enthusiastic about the idea whilst I only listened half-heartedly and the

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concept did not really sink in. This was surely not how we had mapped out our life whilst undergoing all those treatments. All we ever wanted was OUR OWN child. We yearned to fulfil the mitzva of Peru Urevu, we wanted Doros generations of our own, to continue the link in the chain that connects us to the future. At the same time, people around us also started mentioning the adoption option regularly. Yet, the more I heard about it, the more reasons I had to reject the idea. The more time elapsed, the more my need to actually physically bring a child into the world intensified. We adore children and our home was constantly filled with nieces, nephews and friends’ children visiting. I did not say no to adoption but I wanted our family to start off with a child of our own, a baby that was genetically ours.

“The more time elapsed, the more my need to actually physically bring a child into the world intensified” About three years ago our Posek spoke to my husband again and convinced him that the right time had come for us to look into adoption seriously. Slowly I somehow started to warm to the idea. I came to realise that adoption did not necessarily mean “I give up.” My attitude started changing as I mentally prepared myself to become a vessel which could receive blessings in a number of different ways. Surely, I figured, I could start the adoption process whilst still continuing to daven and hope for the blessing of our own child? I kept thinking I could adopt and then hopefully go on to have a child naturally. My husband started looking into the options after having been advised to look for a child born to a Jewish mother, a very difficult task indeed. In England, applying for adoption once you have reached age

forty is basically impossible and we were nearing forty. In the U.S.A, on the other hand, many parents who end up adopting are aged between 40 and 50, and so our search to bring home our little bundle of joy started there. It took me a few months to actually pluck up my courage and pick up the phone to begin the slow legal process required which leads to adoption. From the moment that I started the legal proceedings till our papers were accepted took two long, drawn out, very difficult years. Having been through endless gruelling fertility treatments, I was convinced that I could not encounter anything more painful - ever. I did not imagine that once again, we would face shattered hopes and unfulfilled dreams. Several times we almost managed to obtain a baby from abroad. However, each time we were about to achieve our goal to bring home a baby, out of the blue the birth mother changed her mind at the very last moment, and our dream just vanished in front of our eyes. Take it from me, the ALMOST being there and then realising that the cradle will have to remain empty for a while longer, is a different sort of pain to the hurt of infertility - Yet the pain is incredible. It was at this time that we read in the Hamodia about a certain Segula to help couples struggling with infertility, which consisted of lighting a daily Yahrzeit candle in the zechus of whilst at the same time giving Tzedaka. Although we were legally not yet eligible to adopt, my husband decided to take on that Segula and to continue lighting the candle daily until we would succeed in bringing our baby home. We also undertook to publicise our story once we received our Yeshua, with the intention to help and guide others. To be considered as adoptive parents we needed to sit in front of a panel of about fifteen professionals for an assessment. We went through a gruelling session of questions and interrogations to prove that we would be suited to become good parents. The very first panel meeting took

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Personal Experience

place during Yom Tov so we could not attend. The following panel meeting took place two months later and by then we were getting really impatient as things were not moving at all in the right direction. When we finally sat in front of the adoption panel, it was during the two weeks when our name was being put forward on the Chana baby Mishmeres* group and wonder of wonders – in that zechus, we passed. Amazingly enough, our daughter was born during the same week as my friend’s child who kept the same hours as us on the Baby Mishmeres. All along the way we saw clear examples of Hashgacha Pratis. Our local MP was instrumental in helping us obtain all the necessary paperwork on time. In fact, the forms arrived in the U.S.A on the same day as we did. Had we not been in the possession of those important papers, we would not have been able to adopt our daughter Bruchi. We experienced another example of divine providence when, we became very friendly with a jewish orthodox woman who worked at our adoption centre. She herself had two adopted children and was very familiar with the ins and outs of adoption. She ended up being a tremendous support to us and to the birth mother. Her internship with the adoption agency was to last a year and it was on exactly her last day at work that she witnessed the birth mother signing the necessary forms which enabled us to travel home with our baby. I took all those little signs as a clear message from above, a voice telling me that I had done all the necessary Hishtadlus and that now was the right time to move on. My whole outlook towards adoption was slowly changing. The most unbelievable example of Hashgacha for us was when we realised that it was exactly nine months from when we began lighting the candle that we were told we were allowed to adopt our daughter. With all the hardship that the adoption process brought with it, we definitely merited to see many Nissim miracles along the way, and we witnessed our own little victories. I could go on endlessly stating examples of how we saw Yad Hashem constantly guiding us and carrying us throughout our trials. We now see our daughter’s arrival into our home as a true Nes - miracle. Hashem clearly has different ways of granting people their wish. It was I who did not realise nor understand that my goal WOULD be achieved and my dream

would come true, just not through the route which I had envisaged. Hashem had a different route for me and now I could clearly see it. As we write these words, we look at our precious daughter and are enveloped by an immense feeling of warmth. We stare at her and realise that she is OURS, she is part of us - how could we have loved someone any more than we love her? It was for her that we cried, davened and waited. We feel we got much more than we could ever have imagined when we began our adoption journey. We are still waiting for the day Hashem will answer our tefillos and grant us the zechus to physically give birth to a natural child. When that happens, please G-d, Bruchi will always remain our eldest child, and the one who brought us immeasurable joy by enabling us to become parents. We did not adopt instead of giving birth or because we gave up hope of ever giving birth. We opted for adoption because, for now, that was the suggested and suitable route which would lead us to parenthood.

“My whole outlook towards adoption was slowly changing” Bruchi physically looks like us, something that cannot be explained but which tends to happen to adopted children. Hashem has predestined who are the real parents of an adopted child and we were predestined to be Bruchi’s. A renowned Godol Hador assured us that we were fulfilling the mitzva of Peru Urevu through Bruchi, and that through her we would merit to see Doros, future generations. I once heard it said that some special Neshomos are chosen to achieve big tasks here on earth. The Mekatregim try to stop them from being born and so they have to reach their parents in a roundabout manner- this is exactly how we see our Bruchi. I consider it to be my zechus to say Modeh Ani with my daughter and to tuck her into bed at night with a meaningful Shema. We take it as a privilege to be handing over our Mesora, our tradition, to the next generation. Reading through what I have written so far, I realise that I am painting my present life in a very rosy tint. I must admit that things are not always straightforward. We have been through many difficult hurdles on the way. At times, people make painful or insensitive remarks, but

on the whole Bruchi has been accepted by our community with open arms and a warm embrace. She has become quite a celebrity and I am actually looking forward to the excitement about her dying down and her being able to grow up as any other child on the block. Whilst I was going through my various challenges over the years, I was supported for some of the time by a Chana support worker, a precious woman who helped me immeasurably. A few months ago I was contacted by someone at Chana, who enquired if I would be willing to tell my story to the Chana readership. Initially, I said no. However, when we had the fire, I realised that Hashem was sending us a message and a reminder that we had promised to light a daily candle and then publicise our Yeshua – the Yeshua had come, but we had not yet done anything about it. We had been meaning to share our journey with others but just could not decide in what form we should do it. After our “reminder”, we realised that there would be no more appropriate place to write down our experiences, and publicise our Nes than the Chana Magazine. For it is only you, the little minority group who has visited “infertilityland”, that would understand where we have been to and where we have returned from. That is probably what gave us the confidence to publicise our Yeshua in the Chana magazine. We felt we would be writing to people we are connected to, who understand our situation. The same day that we decided to publicise our story, we got an email from America apologising that their computer systems had been down for a while so they could not deal with our case. They promised that from now on, our paperwork would be moving at a faster speed and all legal formalities would be sorted out. For obvious reasons, we strongly believe in the segula of lighting a daily candle in the zechus of . May you too, soon experience your own Yeshua and may the endless waiting be a thing of the past. * The baby Mishmeres was set up by CHANA in 2001 for couples who have not yet been blessed with a child to join a group and undertake to refrain from speaking Loshon Hora for a two-hour slot each day in the zechus of a certain couple’s Yeshua. Every two weeks, then names would rotate to focus on another couple. If you would like to join the Mishmeres Initiative please call Debbie on 020 8458 6458.

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Medical Focus

WHAT IS HYPNOSIS / CLINICAL HYPNOTHERAPY? Jackie Vittori explains how hypnotherapy can help fertility

Many people find it hard to understand what hypnotherapy really means and what it does. So I would like to explain. Hypnotherapy works on the subconscious mind. The subconscious mind is responsible not only for running our automatic body systems,but for holding our beliefs about life, love, ourselves, other people. It takes care of everything we ever learned consciously. We’ve had to learn everything since we were born how to eat, how to walk, how to brush our teeth. All of this began at a conscious level, until it became automatic and was taken over by the subconscious part of the mind The subconscious mind is like a big stew pot of carrots, celery, potatoes, peas, etc. In that stew is anything that’s ever happened to us, everything ever said to us, everything we ever learned everything that was done to us, whether real, imagined, or even misunderstood.

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It houses our emotions and the various parts of our personality. By using Clinical Hypnotherapy and reaching into that “stew-pot” filled with all our memories and beliefs, change can be brought about by how we perceive and do things. It can even help our bodies work better, thereby helping us become healthier. Hypnotherapy induces a deep focused relaxation. We can achieve this by visualisation, imagery, and colour. When relaxed our inner thoughts are calm, which in turn calms our bodies, giving a feeling of complete well being and harmony, leaving our subconscious minds ready to work on absorbing good positive suggestions. Many people who are dealing with either primary or secondary fertility issues find the relaxation exercises particularly helpful in reducing stress levels and anxiety.

JACKIE VITTORI Clinical Hypnotherapist Member of the National Council of Hypnotherapy Jackievittori@googlemail.com Tel: 0790 896 7548

EVERY DAY MAY NOT BE GOOD BUT THERE IS SOMETHING GOOD IN EVERY DAY.

News & Views VIII

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Personal Experience

Just make that call

Dear Chana, Every woman’s dream is to become a mother to healthy, well balanced children. What happens when you are a carrier of a genetic disorder – which means there is a 50% chance of you passing on the faulty gene to your child who will be disabled for life? Fortunately due to the advance of medicine today there is a solution, albeit a difficult one. That was the situation we faced as a new young married couple. I was 19 – my husband was 21 – we were children ourselves and did not realise the enormity of what lay ahead of us. Having been healthy Boruch Hashem all my life – I would now have to embark on a very difficult journey of IVF and PGD treatment. My first year of marriage revolved around my monthly cycles, doctors, injections, scans, blood tests and hospitals. It was quite a feat for such a young couple as us. It was even harder as we did not have a fertility problem as such – but in order to eliminate the faulty gene we needed to go down this route. We went through our first cycle of IVF and PGD and even though we managed to collect a few healthy eggs, they did not develop after implantation. Soon after, we started with our next cycle. This time we did not even produce any healthy eggs at all. By now all our spirits were slightly dampened. What was meant to be a time of getting to know each other and just enjoy being married and keeping a home, had become a time of pressure, stress and exhaustion. On top of it, by now our financial resources had run out. We had nowhere to turn. We ourselves were not earning enough money to pay for these expensive treatments and we could not turn to our parents. We were stuck! We had heard about the Chana organisation by now, but for us the mere thought of calling and having to share our personal details with anyone – never mind having to ask for financial assistance seemed too frightening and overwhelming. However, the weeks were passing and the time was due to start our next cycle so we had no choice but to call. What we thought would be a dreaded phone call could not have turned out better – all our fears and anxieties vanished as soon as we heard the warm friendly voice on the other end of the phone. We were made to feel so at ease. We were treated with the utmost respect and dignity with minor intrusion into our personal details. Within a short time our request was granted and our hospital bill was settled in full so we could once again start with our treatment. Boruch Hashem this time we were successful and are now the proud parents of healthy twins. We are forever grateful for the enormous support and help that Chana gave us on our journey enabling us to make our dream come true. In admiration for the wonderful work you do, may you be able to help many more couples achieve their dream. THANK YOU Family S.

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12/5/10 10:43:43


Life’s Perspectives

Not Good Enough Don’t let negativity get the better of you By Sarah Chana Radcliffe

I move so slowly. Eventually I get it done, but my friends get more done so much faster and better. I don’t know what’s wrong with me. Why is it so hard? My sister and I are opposites. She’s so organised that she starts getting ready for Shabbos on Sunday, while I scramble frantically in lastminute hysteria. I can only do one thing at a time. Everyone else seems to be able to manage so much better. My best friend holds down a full-time job, has eight kids (including twins), and gives so much time to the community. It’s all I can do to keep my house running smoothly. I feel so inadequate next to her.

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The inner critic

But it’s all true

The personality is made up of many parts. Only one part is in the “driver’s seat” at any given moment, while the rest are passengers. A competent, mature adult part may be making an executive decision at work. Later, on the home front, a toddler part may be stamping her feet because someone forgot to put away the meat that was defrosting on the counter. A person is neither mature nor childish. She’s both, with each state appearing at different times.

Although people don’t enjoy listening to their Inner Critic, they allow it to press on, because they feel that everything it says is accurate. “Others are better cooks than I am. Should I pretend that I’m something I’m not? Lashon Hara is also true – and it’s among the most destructive forces in the universe. We’re not allowed to speak Lashon Hara about anyone, including ourselves. The question is not “Is it true?” but rather, “Is it helpful?” Is it helpful to point out someone’s failings all day? Should parents “help” their children this way? Should spouses “help” each other this way? By all accounts, the answer is no – unless we want to destroy the one being “helped”.

We know we have different parts; it’s clear from how we act (so differently in different situations) and how we think. It’s possible, for instance, to judge ourselves. That process, however, requires two parts: the judge and the judged. You’re such a loser, says the Inner Critic. The Self, in response, feels awful. In fact, the Self can get downright depressed by the Inner Critic’s nonstop put-downs: You’re not smart enough, quick enough, beautiful enough, good enough. You’ll never measure up. It’s hopeless. No one likes you. You have nothing to contribute. Don’t bother trying, because you’ll just fail. No one wants to hear what you have to say... Quietly or loudly, the voice of disapproval natters away, sapping the life energy of the rest of the personality. Like an emotionally abusive parent, it tries to “help” by offering a steady diet of dire warnings, negative feedback and critical complaints. It never stops to examine the effects of its efforts: an exhausted defeated, anxious and/or saddened Self collapsing under a barrage of insults.

In the inner world, the same dynamic occurs. A heartless, critical accuser beats up other parts of the personality, eventually replacing the person’s natural joy and optimism with misery and pessimism. These dark energies produce openings for the Yetzer Hara. Soon, the internal conflict is reflected in poor functioning and interpersonal conflict as well. Negativity poisons both the inner and outer environments. Reprinted with kind permission from Family First @ Mishpacha

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Poetic Thoughts

Candle by Leah Mizrachi

NER HASHEM NISHMAS ADAM (Mishlei 20, 27) THE SOUL OF A MAN IS LIKENED TO A CANDLE OF HASHEM.

If my soul Is yet bound, To the material, As a candle’s flame To its wick, May the fire of My suffering Melt the wax Of earthliness Within me. Reprinted from kind permission from Binah Magazine. Copyright 2010”

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Chana News

WELL WOMAN MEETS KALLAH TEACHERS & REBBETZINS FACE TO FACE

CHOSSON TEACHING

Many Rebbetzins and Kallah teachers are the first port of call when a young woman has questions or concerns about family life and gynaecological health, so it makes sense for Well woman to open up an ongoing dialogue with this key group in the community.

Chana has established links with a group and individuals who are teaching young men - Chassanim, before they get married.

Chana Well woman is delighted to be offering a series of educational sessions on many key areas of concern for women, which can affect their reproduction health. Presentations have been made on a variety of topics by a Support Worker and a member of our Medical Panel, and have been hosted both in Stamford Hill and North West London. In return, Chana Well woman has been receptive to requests and suggestions made by these groups of committed women, eg regarding future events, developing news leaflets for young women.

Many of those in that role continue to informally support the young men they teach for some time after the wedding, and have expressed an interest in receiving training on practical as well as emotional issues relating to young couples.

Outreach to Rebbetzins and Kallah teachers is but one of the Chana Well womanâ&#x20AC;&#x2122;s exciting ways to link up with different parts of our community and ensure not only that those who need us knows of our services, but also to develop further services by hearing what the community wants.

A Chana male support worker is liaising with this group of men in the Community who play such an important role, and is available on the phone for both the newly-married men, as well as their teachers for consultation.

For further information about this programme, please contact our office.

For more information, please call 020 8457 1415 or 020 82015774 on Wed 7:30pm â&#x20AC;&#x201C; 10:00pm or Friday 8:30-10:00am

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News & Views VIII

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Poetic Thoughts

LINGO GUIDE FOR BEGINNERS

TODAY

2ww = Two week wait after ovulation AF = Aunt Flo (flow) A.K.A., your period AI = Artificial Insemination AO = Anovulation ART = Assisted Reproductive Technology ASA = Anti-Sperm Antibody BB = Bulletin Board BBT = Basal Body Temperature B/W = Bloodwork CD = Cycle day

So much to do So little time.... But it’s great to be busy And great to feel fine

CM = Cervical Mucus DPO = Days Post-Ovulation Dx = Diagnosis E2 = Estradiol (Estrogen) EPT = Early Pregnancy Test ET = Embryo Transfer (IVF)

Those who are ill Have no lists at all Nor errands to run Not even one call

FET = Frozen Embryo Transfer FSH = Follicle Stimulating Hormone HPT = Home Pregnancy Test IF = Infertility IUI = Intrauterine Insemination IVF = In Vitro Fertilization LAP = Laparoscopy

I guess I am lucky My life’s all that I’ve so much to do I can’t even chat.

LH = Luteinizing Hormone LP = Luteal Phase LPD = Luteal Phase Defect

Reprinted with kind permsission from The Butterfly Magazine

MC or m/c = Miscarriage O or OV = Ovulation OPT = Ovulation Predictor Test OTC = Over the Counter PCOS = Polycystic Ovary Syndrome PCT = Postcoital Test PI = Primary Infertility RE = Reproductive Endocrinologist SA = Semen Analysis SI = Secondary Infertility UR = Urologist US or u/s = Ultrasound

News & Views VIII

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Of babies And benches

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by Malka Forster

12/5/10 10:44:17


Personal Experience

r The park bench, I mused. I was sitting, rocking my infant daughter’s carriage in the local park one afternoon, when I began to stare at the bench, pondering its significance. It was one of those rare, peaceful moments conducive to thinking about things beyond diapers, supper and laundry. The park bench, I mused. What a central player in the lives of thousands of Jewish women worldwide. On these wooden slats, I considered, over the raucous kvetching of cranky toddlers and the incessant cries of colicky infants, how many secrets are confided, frustrations shared, questions aired, gossips revealed, and pieces of advice exchanged. “...they all got the chicken pox at once! It was the craziest week of my life”. “My two oldest don’t stop bickering. What do you do?” “...my boss is a doll. She gave me off Erev Yom Tov.” It’s a cheerful place, a distraction from life’s challenges, a forum for troubles, a support group of sorts. But I wasn’t always welcome on this bench. In fact, just some time ago, it would taunt me as I walked by, jeering, a stark reminder that “I had not yet arrived.” I had no carriage to push and no baby to soothe. No toddler to chase and no child to watch. The park bench was not for me. “How long are you married?” We must have been on the receiving end of this question a million times. At first, we would blush and proudly answer “two months” or “almost half a year”. We were in the newlywed state of bliss, and it oozed out of every remark that we made. But then the question turned irritating, annoying. “Why is it their business?” “Did we miss a deadline?” “Are we not keeping to the schedule?” I know they meant no harm when they asked it. They saw a cute young couple and wanted to show interest. So I tried hard to smile politely to the taxi drivers, the classmates, the new neighbours,

as I said “a year and a half” or “almost two years,” but I couldn’t help feeling bitter. And my response would invariably be followed by a knowing glance, eyes looking away, or a hearty Brocha. It would’ve been funny had the pain and longing not been so deep. I tried to assuage the pain with facts I knew to be true. “You have more time to work on your marriage”, “You can finish your schooling with ease”, “You can settle yourselves before the family comes”, “Some people have been dealing with this a lot longer than you”. But after a while, the mantras rang hollow. My heart yearned too much to heed such cold logic. I tried to work on myself. When my sisters had to interrupt our weekly conversations every few minutes to wipe this one’s tears and pack this one’s lunch, I swallowed hard and garnered every ounce of strength that I had to fargin them their bundles of joy. When I took up my coworker’s slack at the office because her daughter had the flu, I told myself to be thankful for the chesed that I could do in my situation. And when my friends hardly called because they were too busy with their kids, I reminded myself that they were simply doing what they were supposed to be doing. The constant worry was the worst part. I knew that many couples went through this – some for years or even decades – and most were eventually blessed with children. But the unspoken question was always there. What if... What if I wasn’t that “most”? The visions would pop up, of me and my husband ten, twenty years down the line... a deathly quiet house, empty chairs at the Shabbos table. I’d desperately try to banish those awful images from my mind, but every misplaced comment or awkward incident brought them back to haunt me. If only I knew, I’d plead with Hashem, that I would have a baby in even ten years, I’d

be okay. But I didn’t know. The relentless worry gnawed at my heart and fragile peace of mind. I attended the weekly shiur, but almost every topic developed into a child-related discussion. I didn’t want to hear about how hard it was to stay home on Rosh Hashanah and Yom Kippur. I didn’t want to hear about today’s chinuch challenges. I talked to Hashem a lot. I told Him I was trying to grow from this life test, to develop my compassion and sensitivity towards others, to empathise more with them and enhance my appreciation for all He has given me. Just please, I’d implore, didn’t I grow enough already? How long must I be “outside the camp”? My daughter’s cries break my reverie. “Thank G-d”, I murmur, tears forming in my eyes. Thank G-d for the nausea, for the weight gain, for the labour pains. Thank G-d for the colic, for the sleepless nights, for the utter exhaustion. My heart bursts with the deepest gratitude I’ve ever known. I see a woman from our kehillah. She’s been married eighteen months and doesn’t yet have kids. “Sarah, how are you?” I invite her to sit down and tell me about her master’s programme, her tutoring, her gourmet dinners. She’s computer savvy, and I ask her advice about a technical problem. After several minutes of animated conversation, she walks away with a lightness in her step and a brightness in her face that wasn’t there before. I’m only one person, but I’m determined. I want to teach the park bench to make room for the ones who are still waiting. Reprinted with kind permission from Family First @ Mishpacha.

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Life’s Prspectives

THE BAMBOO AND THE FERN How high should I rise? One day I decided to quit.... I quit my job, my relationship, my spirituality..... I wanted to quit my life. So, I went to the woods to have one last talk with G-d. “G-d”, I asked, “Can you give me one good reason not to quit?”

It had spent the five years growing roots. Those roots made it strong and gave it what it needed to survive. I would not give any of my creations a challenge it could not handle.” He said to me. “Did you know, my child, that all this time you have been struggling, you have actually been growing roots?

His answer surprised me... “Look around”, He said. “Do you see the fern and the bamboo?” “Yes”, I replied. “When I planted the fern and the bamboo seeds, I took very good care of them. I gave them light. I gave them water. The fern quickly grew from the earth. Its brilliant green covered the floor. Yet nothing came from the bamboo seed. But I did not quit on the bamboo.

I would not quit on the bamboo and I will never quit on you. Don’t compare yourself to others.” He said. “The bamboo had a different purpose than the fern, yet, they both make the forest beautiful.” “Your time will come, “G-d said to me.” You will rise high!” “How high should I rise?” I asked. “How high will the bamboo rise?” He asked in return. “As high as it can?” I questioned.

In the second year the fern grew more vibrant and plentiful. And again, nothing came from the bamboo seed. But I did not quit on the bamboo”. He said. “In the third year there was still nothing from the bamboo seed. But I would not quit.

“Yes.” He said, “Give me glory by rising as high as you can.” I left the forest and brought back this story. I hope these words can help you see that G-d will never give up on you. Never, never, never give up!

In the fourth year, again, there was nothing from the bamboo seed. I would not quit.”

Never regret a day in your life. Good days give you Happiness. Bad days give you Experiences. Both are essential to life.

“Then in the fifth year a tiny sprout emerged from the earth. Compared to the fern it was seemingly small and insignificant. But just 6 months later the bamboo rose to over 100 feet tall.

Keep going... Happiness keeps you Sweet, Trials keep you Strong, Sorrows keep you Human, Failures keep you Humble, Success keeps You Glowing, But Only G-d keeps You Going!

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Chana News

The Fertility Show One wintry Friday a group of Chana support workers went off together to the Fertility Show in Olympia, in London. This was a 2 day show, starting on Friday and it was part of National Infertility Day. There were 80 exhibitors and 45 talks. On arriving 80 exhibitions were displayed in the large arena and there were also cordoned off areas with chairs laid out prepared for the numerous talks and presentations by fertility experts. As we were short of time we split the hall between us. The exhibitions were fascinating. There were clinics represented from as far afield as Las Vegas, Barbados and South Africa to Spain, Copenhagen, Cheshunt and Harley Street! Some of the clinics had medical experts present, either embryologists or gynaecologists and others had nurse practitioners and marketing people. Each clinic gave as much time and attention as we needed to talk about different scenarios and different needs. Anyone who was present at the exhibition could have used this opportunity to investigate further a clinic they had had some information about, at no charge. Some of the medical experts spent

quite a decent amount of time talking through matters with people who visited their stands. Each of the clinics that we visited at the exhibition were keen to understand further the needs of Jewish patients and some already catered for Jewish patients and went as far as knowing the names of hotels and kosher food suppliers in case the patient needed to be in on Shabbos for a treatment and asked whether there was anything else that they could do to service our community. The presentations were given by renowned lecturers like Dr Simon Fishel, Professor Richard Fleming & Stuart Lavery. It was also possible at the show to get a taster of alternative & complimentary therapies. By visiting Marilyn Glenville’s stand and going to her presentation one could understand more about nutrition and its ability to boost fertility and prevent miscarriage or if one visited Zeta West’s stand one could learn how to combine the latest medical thinking with practical advice on nutrition, emotional & psychological management and complementary therapies.

booklets about fertility matters. We purchased a couple of books that were newly issued and we met representatives from national support groups. Some of the support groups were very specialised in their focus, for example, Asherman’s Syndrome where we’d heard about the work that they do but had never met the people running the organisation. We would highly recommend a visit to the Fertility Show next year for anyone who is on the journey to resolve their fertility issues as it is a unique opportunity to meet Doctors in the field, to broaden ones horizons and knowledge about clinics and to hear lectures on a variety of subjects that could be very useful to the individual. It was an exhausting day but armed with freshly baked chocolate yeast cake from one of our colleagues we managed to cram everything in before rushing home to complete the finishing touches of our Shabbos.

Rae Adler, Carolyn Cohen, Nomy Cohen & Devorah Gelley

Whilst walking around we picked up many goody bags with leaflets and

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Chana News

CHANA’S BRUNCH Chana’s annual summer fundraising event was a huge success

Over four hundred women from across the entire spectrum of the Jewish community attended the fifth annual fundraising brunch last week presented by Chana, the organisation set up to deal with fertility issues within the community. Apples, was the topical theme underlining the approach of Rosh Hashana and a bright New Year in the pastoral setting in a marquee erected in Princes Park. The immaculate presentation and delicious food beautifully prepared were all greatly appreciated by Chana’s many supporters who hope will bring to its members the result they yearn for. The event featured a married couple who eloquently presented both sides of their fifteen year long and traumatic journey in dealing with fertility issues in an incredibly moving way. Their words brought home to everyone present the heartache experienced by couples without children. Since as many as one in six couples endure s the pain and loss of infertility, it is vital for people in the community to react sensitively to a situation which, although private and personal, is present all around them. Chana’s public events are held not only to raise funds and acquaint people with the most up-to-date medical

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information but, equally to increase awareness of this widespread problem while preserving confidentiality.

infertility, in the case of couples who already have a child but encounter problems in increasing their family.

In our community, where so much emphasis is placed on the future generation, the anguish of infertility is magnified. The family is central to everything in Jewish life as reflected in the Jewish calendar; the Yomim Tovim revolve around it, making the period of the Yomim Noraim particularly difficult for childless couples.

Chana offers support to many of the members of the Jewish community at various stages of the tortuous road out of infertility. It may hearten them to know that medical knowledge is increasing its boundaries all the time, revealing breakthroughs that could benefit them. Within the last few weeks, for example, the Care Fertility at Nottingham under the directorship of Dr Simon Fishel reported a new and successful technique that could help a large number of women. Chana is up to date in its awareness of medical research and has access to the consultants concerned.

Chana undertakes a great deal of work in discussing all halachic issues with Rabbonim. Dayan Ehrentreu shlit’a and Rabbi Chaim Halpern shlit’a, experts in this challenging field, who are Chana’s devoted Rabbinical advisors. Chana also offers an array of services including a strictly confidential helpline, male and female support workers who speak a variety of languages including Yiddish, Hebrew, French and German. Chana has a team of female and male support workers, a large medical advisory panel, as well as offering financial help towards the costs of treatment. Chana is also available to assist with secondary

Chana’s unobtrusiveness and its insistence on strict confidentiality must not be allowed to lessen its significance. Its comprehensive and highly professional approach to a problem that now appears to be more widespread than ever before is fundamental to the health and wellbeing of our community. Written by Rachel Rogoznitsky for the Jewish Tribune, Sept 09

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Chana News

THE CHANA FERTILITY HELPLINE A gateway to Chanaâ&#x20AC;&#x2122;s services Chanaâ&#x20AC;&#x2122;s helpline is staffed by qualified and experienced councellors who give emotional and practical support on a wide range of issues. Men and women from the UK and abroad can talk in confidence about their concerns, medical queries and emotional turmoil. In addition to English, Yiddish, Hebrew, French and German are also spoken. Through the Helpline, callers can receive information about lectures, specialist clinics, books and financial assistance for treatment in order to feel better equipped to handle their situation. Callers can request to be linked to a Buddy, for informal support in confidence. The Helpline is also open to family and friends who may wish to understand aspects of fertility treatments and discuss ways to support a couple. Topics that callers enquire about include PCOS, endometriosis, nutrition, new treatments available privately or through the NHS. The CHANA Helpline is backed by members of our Medical Advisory Panel, who offer their specialised medical expertise. You may telephone the Helpline on a one-off basis or arrange an appointment to speak to a counsellor on the telephone or in person. If you prefer to speak anonymously, our counsellors will be happy to advise you as well.

At others times you may leave a meassage, and a counsellor will get back to you.

The CHANA Fertility Helpline number is

020 8201 5774 News & Views VIII

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Publications

Publications available from the Chana office

AUTHOR

YEAR

TITLE

Anton, Linda Hunt

1992

Never To Be A Mother

Beer, A.E. MD

2006

Is Your Body Baby-Friendly?

“Unexplained” infertility, mascarriage & IVF failure explained

2005

The Low Gi. Guide to managing PCOS

1980

Feeling Good. The new mood therapy

Cooper, S.L. & Glazer, E.S.

1994

Beyond Infertility. The new paths to parenthood

Finkelstein, Rabbi B.

2005

The Third Key. The Jewish couple’s guide to Fertility

Brand-Miller, Dr J. & Farid, Prof N.R. & Marsh, K. Burns, D.D.

& Finkelstein, M Furse, A.

2001

Your Essential Infertility Companion. A user’s guide to tests, technology and therapies

Glenville, M. PHD

2000

Natural Solutions to Infertility. How to increase your chances

of conceiving and preventing miscarriage

Glenville, M. PHD

2001

Nutritional Health Handbook for Women

Glenville, M. PHD

2008

Getting Pregnant Faster

Grazi, R.V. MD

2005

Overcoming Infertility - A guide for Jewish couples

Haynes, J. & Miller, J.

2003

Inconceivable Conceptions. Psychological aspects of infertility

and reproductive technology

Hillel, Rabbi Yaakov

2005

Roni Akara. A guide for the childless

Houghton, D. & P.

1987

Coping with Childlessness

Indichova, J.

2001

Inconceivable. A woman’s triumph over despair and statistics

Kohner, N. & Henley, A.

2002

When a Baby Dies. The experiences of late miscarriage, stillbirth and neonatal death

Lauersen, N.H

1991

Getting Pregnant. What you need to know right now

1996

Counselling in Male Infertility

Lewis, R. PHD

2004

The Infertility Cure. The ancient Chinese wellness program for getting pregnant

and having healthy babies

Moulder, C.

2001

Miscarriage. Women’s Experiences and Needs

Regan, Prof. L

2004

Miscarriage. What every woman needs to know.

A positive new approach

2005

Your Pregnancy Week by Week

Rosenberg & Epstein

2001

Getting Pregnant When You Thought You Couldn’t

Bryan,E & Higgins,

1995

Infertility - New Choices and New Dilemmas

Uyterlinde, J

2006

The Baby Void - My Quest for Motherhood

& Bouchez, C. Lee, S.

Regan, Prof. L

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CDs

CDs of Chana events CDs are £5.

CDs

DATE

SPEAKER

Mothers of Teenage Daughters

Feb-06

Dr. Miranda Glick (GP) & Rebbetzin Via Kimche

Recent Research into Miscarriage

Jun-06

Professor Lesley Regan (Head of Obstetrics

and Gynaecology Imperial College, St. Mary’s)

Concerned about… Pelvic Pain

May-06

Mr. Lindsay MacMillan (Consultant Gynaecologist, Deceased)

Thyroid & Hormonal Issues

May-06

Professor Nadir Farid (Consultant Endocrinologist & General

Physician, Deceased)

Is it my Hormones or is it Me?

Oct-06

Mr. Nick Panay (Consultant Gynaecologist)

Stress Relief

Nov-06

Mrs Donna Abraham (Cranial Therapist); Mrs Carolyn Cohen

(Social Worker); Mr David Uri (Hypnotherapist); Nadine Fox

(Therapeutic Massage) .

The Low G I Diet

Feb-07

Professor Nadir Farid (Consultant Endocrinologist & General

Physician, Deceased) & Ms. Leanne Green (Registered Dietician)

Natural/Minimal Stimulation IVF

May-07

Mrs. Geeta Nargund (Consultant and Head of Reproductive

Medicine at St George’s Hospital and Medical Director of the

Centre of Reproduction and Advanced Technology (CREATE)).

Is it my Hormones or is it Me?

Jul-07

Mr Nick Panay (Consultant Gynaecologist)

You & Your Daughter (Hormones)

Dec-07

Ms. Amma Kyei-Mensah (Consultant Gynaecologist)

Your Fertility Questions Answered

Feb-08

Mr. A Gadir (Consultant Gynaecologist & Fertility Specialist

at the Highgate Clinic)

How Do You Feel inside & Out? Partial recording

Feb-08

Dr Marilyn Glenville (Nutritional Therapist)

PCOS – Its Impact on Infertility

May-08

Dr Davinia White (Specialist in Reproductive Medicine,

St Mary’s Hospital, Paddington)

A Spot of Bother?

June-08

Dr Malcolm Rustin (Consultant Dermatologist)

& Dr Judith Tobin (GP)

Cancer & Fertility

June-09

Dr Alison Jones (Consultant Oncologist) & Mr Arjun Jeyarajah

(Consultant Gynaecologist and Gynaecological Oncologist)

Medical Treatment Options

Nov-09

Mr Michael Ah-Moye (Medical Director)

& Mr Andy Glew (Embryologist) Herts & Essex Clinic.

News & Views VIII

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Chana News

WELL WOMAN HELPLINE Do you have a question about your reproductive health and wellbeing? The Well Woman Helpline offers you the opportunity to telephone in confidence to seek and receive answers to your questions and clarify your concerns. You may discuss a medical procedure or just want to find out when to go for a second opinion. A sensitive and discrete professional counsellor will answer your query and offer support on a range of issues including irregular cycles, miscarriage, hormone imbalance, early menopause, PMS, fibroids and general gynaecological well-being. Through the Well Woman helpline you can access specialist medical information via the consultants and medical professionals of CHANAâ&#x20AC;&#x2122;s Medical Advisory Panel.

The CHANA Well Woman Helpline number is 020 8201 7101.

At others times you may leave a message and a counsellor will get back to you.

CHANA BUDDIES A Buddy is someone who will be there for you.

Would you like to talk to: Someone who has also personally experienced fertility issues? Someone who can understand your feelings, pain and isolation? Someone who is going through or may have been through something similar to you? Someone who can identify with the ups and downs of investigations and treatments? Someone who can empathise with your successes or failures? Chana can link you with someone for informal support, in confidence who has personally experienced fertility issues. We can connect you with someone who can be available for you at the other end of the telephone, or with someone you can meet in person.

NEW CHANA SERVICE

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For more information, please call Chana 020 8201 5774 / 020 8800 0018 or email chanact@chana.org.uk

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Regular Features

CHANA SERVICES CHANA Medical Advisory Panel CHANA is supported by a team of specialists and GP’s who are sensitive to the impact of Jewish Law on all aspects of gynaecology, infertility and reproductive health.

Chana Website

Books and Audio Libraryl

Chana Website is a useful resource to access information about a range of issues. People can also contact Chana by email via the website if they wish.

Chana Fertility T: 020 8201 5774

CHANA Fertility Help Line & Professional Support A team of qualified counsellors offers the opportunity to talk about the issues and concerns that you as a couple are experiencing. Support is available on a one-off basis or via on-going counselling by telephone or in person in NW London and Stamford Hill, in a confidential setting.

Especially for men CHANA recognizes that men in the community may feel particularly isolated. CHANA provides male support workers for individual consultation which can be accessed through our Help Line.

A wide range of materials are available to borrow or buy.

Chana Well Woman T: 020 8201 7101

CHANA Well Woman Help Linel Through the Help Line you can access information on a range of gynaecological and reproductive wellbeing issues. The Help Line is available for discussing a variety of medical treatments and concerns and is supported by CHANA’s Medical Advisory Panel as well as CHANA’s Nursing team.

CHANA Well Womanl Medical Information Eveningsl A series of lectures by renowned medical specialists held across Greater London offers members of the community information on a wide range of topics related to gynaecology and reproductive health.

Specialist Information Sessions CHANA invites infertility specialists to address men & women with fertility issues on current research and treatment options.

Shiuriml CHANA organises a series of shiurim which offers insight on tackling life challenges as well as chizuk for difficult circumstances.

Financial Assistance Grants are available to assist in meeting the cost of investigations, fertility treatments and counselling.

CHANA Well Manl Through the Helpline you may access information on a range of male reproductive well being issues.

Buddies Chana can link you with someone who has personally experienced fertility issues for informal support, in confidence. Please call: 0208 201 5774 or 0208 800 0018.

The Helpline can be used to discuss a variety of medical treatments and concerns and is supported by Chana’s Medical Advisory Panel. Chana Well Man helpline: 020 8457 1415.

Nurses Teaml Chana’s team of volunteer nurses and midwives are all highly trained, qualified and experienced practitioners. They have a variety of roles within Chana – lecturing and supporting members in the self administering of drugs. Midwives are available to help support women through any difficult issues they may have in their pregnancy following fertility treatments.

News & Views VIII

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Bulletin Board

CHANA BULLETIN BOARD

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Bulletin Board

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Medical Focus

MEDICAL

TERMS

EXPLAINED

Anovulation - The lack of ovulation Azoospermia - Deficiency or absence of sperm. D&C (Dilation and Curettage) - When miscarriage takes place after 10 weeks of pregnancy, a surgical procedure ensures that the contents of the uterus is removed. Echo cardiogram - Painless procedure using ultrasound to provide a moving image of the inside of the heart to see how well it is functioning. Ectopic pregnancy - An abnormal pregnancy that occurs outside the womb Endometriosis - A condition in which tissue perfectly resembling the uterine mucous membrane occurs in various locations in the pelvic cavity. Epididymis - The glandular tube where sperm is stored. FSH – Follicle Stimulating Hormone ICSI- Intracytoplasmic Sperm Injection - Used in conjunction with I.V.F, a procedure where the embryologist directly injects a single sperm into the egg. IUI - Intra Uterine Insemination, a relatively simple infertility treatment where a small tube is used to place washed sperm directly into the uterus.

IVF - In Vitro Fertilisation- A procedure that involves retrieving eggs from the woman’s ovaries and fertilising them with a mans’ sperm in the laboratory. The resulting embryo is then returned to the woman’s uterus in the hope of achieving a pregnancy. Laparoscopy - Operation performed in the abdomen through small incisions with the aid of a camera.It is used to inspect and diagnose a condition. P.G.D treatment - Pre implantation genetic diagnosis used to identify an unaffected embryo for implantation. P.O.F - Premature Ovarian Failure - A condition whereby ovarian failure leads to an early menopause (ovulation stops) P.C.O. - Polycystic Ovarian Disease - A condition in which there are small cysts in the ovaries which can affect a woman’s ability to conceive. Progesterone suppositories - Suppositories used to support the endometrium (lining of the womb) SIF - Secondary Infertility - The inability to conceive again after having conceived naturally. Subfertility - Diminished reproductive capacity. Testicular biopsy - A procedure involving a small portion of testicle being removed for examination. Tubal Patency test - A test required before a patient begins any treatment which requires unblocked fallopian tubes. Varicocele - Enlarged veins in the scrotum that causes abnormalities in the temperature regulation of the testis.

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Adverts

WWW.BUY.AT/CHANA Welcome to the Chana Web Shop. Here’s a great way to get some fantastic online bargains, find cheaper gas and electricity services and even book a holiday. Remember, anything you buy through our web shop will help towards our fundraising targets. So go on, top up your CD/DVD collection, or, if you’re making business purchases, why not make them from our web shop? For example, you can buy computer equipment, great value broadband or stationery from Euroffice or any of your clothing from Marks and Spencer. There are also plenty of offers on DIY products, electricals and lots more from big high street names.

SO WHAT EASIER WAY TO SUPPORT CHANA WHILST DOING ONLINE SHOPPING. YOU LOSE NOTHING AND CHANA ONLY GAINS – SO START SHOPPING TODAY AT WWW.BUY.AT/CHANA These are some of the retailers supporting your fundraising:

WE WANT

TO HEAR

FROM

YOU! If you have any: questions

thoughts

ideas

comments

news

stories

views

poems

suggestions Send them our way to Chana News & Views 23 Ravenshurst Avenue, London NW4 4EE Fax: 020 8202 8635 Email: info@chana.org.uk

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Chana News

Chana online Check out our new website! The website is easy to navigate and offers information from the comfort of your own home, wherever you are in the world. We are very proud of the services that CHANA offers, full details of which can be found on the website. You can also read a “Who’s Who” in CHANA so you can make sure that you are contacting the right person. Our medical panel consists of renowned specialists across many fields and they are instrumental in enabling CHANA to offer the highest quality service. Queries can now be emailed to the medical panel through the website and will be answered as soon as possible. CHANA is a non-for-profit charity that receives no Government funding and relies on the generosity of our donors. The website can now take donations, 24 hours a day.

from: Sarah C, London subject: thank you! to: Chana Thank you CHANA. I regularly use your website to find out about your upcoming events. You provide such a good service to the community – thank you.

from: Miriam, Antwerp subject: Chana website to: Chana I had never heard of CHANA until I did an Internet search. By using the website one evening, I knew exactly whom I had to call and was able to make contact with a support worker the next morning. Little did it matter that I was calling from Belgium!

from: Mr & Mrs Z, Manchester subject: a wonderful service to: Chana What a wonderful service. We had a medical query which we submitted to the panel. It was answered in an efficient, professional yet caring way.

from: Abigail, London subject: donating to Chana to: Chana

The website is constantly being updated – please visit us regularly at

www.chana.org.uk so you can keep in touch with us.

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Instead of asking for gifts for my 40th birthday, I asked for guests to donate to CHANA. It was so easy to set up and simple for my friends to donate.

News & Views VIII

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Clinical Diagnostic Ultrasound Services “A more personalised approach to women’s healthcare issues and ultrasound scanning” Clinical Diagnostic Services is a very well-known ultrasound practice based in St John’s Wood, North West London. It is recognised for its expertise and pioneering work carried out particularly in areas of fertility and women’s healthcare issues. Patients benefit from the state of the art ultrasound facilities that CDS is able to provide. CDS offers a gentle approach to patient care and scanning techniques and is committed to the emotional and clinical needs of every patient referred to its clinic. We co-operate very closely with all referring clinicians to ensure a safe and clinically effective environment for the patient. Our experienced team of ultrasound practitioners are recognised internationally for aspects of their work, not only in infertility but also in general obstetrics, pregnancy screening and assessment of gynaecological problems. CDS works very closely with gynaecologists and complimentary therapists as part of an integrated approach to women’s healthcare.

We also have extensive experience in general medical assessments and male screening. A comprehensive range of clinical applications include:

• Fertility assessment and ovulation monitoring • General gynaecological assessments and ovarian screening • Breast screening • General medical • Male screening – prostate etc • Pregnancy screening – detailed fetal assessments • Early pregnancy problems • Recurrent miscarriage • Paediatrics • Musculo-skeletal problems

For more information please contact Mrs Ruth Carr, Practice Manager on 020 7483 3611/1717 Clinical Diagnostic Services, 27a Queens Terrace, St John’s Wood, London NW8 6EA Also at 37 Manchester Street, London W1U 7LJ

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In the book of life, the answers arenâ&#x20AC;&#x2122;t in the back.

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Male Section

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Contents

Regular Feature

Medical Focus

Chana News

Poetic Thoughts

Personal Experience

Regular Feature:

Medical Focus:

87 88 107

95 99 104

Letters from a Support Worker Letters Membership form

Sub-fertility issues explained The A-Z of male health Fact or fable

Chana news:

Poetic Thoughts:

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Emunah and Bitochon

Darkness & Light

Personal Experience: 92 96 100 103

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At her side Needle in a haystack Extracts from our journey Reaching a greater understanding

News & Views VIII

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Letters

Historically infertility has been associated with women and not men. Anecdotal literature from couples struggling with infertility is filled with questions from distraught women hoping to conceive of ‘Why I do not get pregnant? What is wrong with me?’ Men have been quoted to relate that ‘I hope they find out what my wife’s problem is so that they can fix it and we can start our family.’ Even doctors would often assume that in childless couples the wife would need to undergo thorough, even invasive investigations before even considering the husband’s medical history. In reality though women and men bear nearly equal responsibility. About one-third of infertility cases can be ascribed to male factors and another one-third to factors that affect women. For remaining couples, infertility is caused by a combination of problems in both partners (about 13%) or is unexplained (about 10%). So what does this statistic mean? On the one hand it informs society in general and couples and infertility professionals in particular that during the investigation process, earlier and more careful attention needs to be paid to husbands. More careful attention seems even more pertinent than ever, since recent research studies show that male infertility is increasing. On the other hand, any kind of statistic on whose medical ‘problem’ it is at best immaterial and at worst damaging for the couple. Why? Because infertility is never the wife’s or the husband’s problem. Infertility is a joint problem! No matter whether one is a perfectly healthy husband standing by his wife undergoing medical investigations or the patient himself, infertility affects both members of the couple. Whilst several support structures exist for women, support for men had been very scarce. Taking a genuinely holistic approach to the treatment of infertility, Chana decided to develop support services and programmes for men. Chana liaises with specialized services and professionals on the subjects of male infertility also offering counselling support via our helpline or one to one counselling with a male therapist. Following this Chana is now happy to announce that a male section is being added to the existing Chana magazine. Its aim is to reach out to men within the community who are undergoing fertility challenges and give them a forum to explore the possibilities available to them. We await your feedback to enable us to continue to support you on whichever part of the infertility journey you are travelling.

Chana Support Worker

News & Views VIII

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Letters

Rabbi Chaim Halpern Rav Beis Hamedrash Divrei Chaim 71 Bridge Lane London NW11 0EE

BS’D Adar 5770 To all those who are involved in this important organisation “Chana”, I would like to pen a few words of admiration for this most valuable institution, founded some years ago, that helps those in need of assistance and moral support in upholding this first Mitzvah of the Torah “Peru Urevu – You shall go forth and multiply”. There is no way of measuring or describing the support that is offered, whether by way of counselling, direction or financial assistance when deemed necessary. I can personally testify regarding several families whom are known to me whose benefit from Chana has given them a new lease on life. These families have merited through the organisation to have children in a respectful and sensitive manner. I therefore convey my Brocha to the entire team that they merit much success and blessing. May we all merit toreceive the countenance of Moshiach Tzidkeinu as is recorded in the writings of Chazal “The son of David will not come until all the souls of the Source have descended”. I sign in the honour of this Mitzvah as it is immense. Rabbi Chaim Halpern. Chana Patron

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News & Views VIII

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Letters

Dayan Ch. Ehrentreu Rosh Beth Din

55 Shirehall Park London NW4 2QN Tel: +44 (0) 20 8202 2364 Fax: +44 (0) 20 8203 8942 Email: dayan@ehrentreu.com

24.3.2010

When people find themselves in trying and agonising situations such as infertility, when they donâ&#x20AC;&#x2122;t see light at the end of the tunnel, how refreshing it is for them to know that the wonderful organisation Chana is only a phone call away, ready to connect with them, give courage to continue, which they so sorely require. I salute with admiration and highly laud, the exemplary sterling work being achieved by Chana. Their devotion to the cause and their unstinting efforts to alleviate suffering is very greatly appreciated. I fervently pray that the Almighty should continue the shower his blessings on all their efforts and that their endeavours should be crowned with success.

Dayan Ch. Ehrentreu Chana Patron

News & Views VIII

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Chana News

BELIEF AND TRUST

Adapted by Mr Y. Wiesenfeld from the transcript of a public shiur given by Rabbi Chaim Halp

1 Introduction: (Belief), (Trust). Familiar words, easily said and oft repeated. But what do they really mean, and how do they impact on our daily lives?

2 Definitions: The Rambam defines Emunah as the obligation to believe that H-shem created the universe and He directs and enables the minutiae of the world’s continuing existence. H-shem is everything, therefore no human can claim credit for any achievement. Rabbeinu Yonah states that the mitzvah of Bitochon is to believe that H-shem will rescue me from every adverse situation. The Chazon Ish explains Emunah as the theory, and Bitochon as the practical application to daily events. The test of

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your Emunah is in your Bitochon. When in trouble, where do you – deep down – place your reliance? On the doctor, the lawyer, the accountant, - or exclusively on H-shem? Do you trust H-shem to the extent that you are calm and confident? If you really trust in H-shem, you will not worry about the future. You feel secure, content with your lot, and have no reservations when spending money on tzedaka, or mitzvos, or even tax when legally due. You will not lose sleep over what might go wrong tomorrow, be it finances, health, shidduchim etc. You trust that H-shem will care for you like the responsible shepherd for his helpless sheep, constantly checking the fences, and driving away any predator who attacks.

3 Common Misconceptions: 3.1 Maybe i am being punished? Q. “Maybe this is a punishment I deserve; so H-shem wont save me?” A. Wrong! H-shem helps even sinners who brought the misfortune upon themselves. H-shem saved the Israelites from Amalek even though they were responsible for his attack. Chazal tell us that H-shem’s middah of mercy is there both before and after the sin. If a person has sinned against H-shem, it is simple logic that what he needs to do is motivate H-shem to feel for him and help him. This is achieved in two simple ways: 1. Do His will to the best of your ability. When He sees you performing Torah and Mitzvos, that pleases Him and generates warmth and

News & Views VIII

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Chana News

Chaim Halpern Shlit”a

willingness to help you. 2. Feel and express Bitochon, daven to H-shem to help you. The very fact that you trust Him implicitly motivates Him to help you. You trust Me, you rely on Me, you believe only I can help you – I will not fail you. 3.2 Why do

(repentance)?

Q. “If H-shem helps even sinners, why repent, why be a tzaddik?” A. A bank robber needn’t daven to Hshem for a successful raid. Only when H-shem sees that a sinner regrets his actions and wants to improve, will Hshem be motivated to forgive, help and grant him new opportunities.

person to person?” A. There is so much we can do to become believers. As H-shem gave us this mitzvah, it must by definition be achievable – for everybody. We have to do our best to please H-shem through our actions. We have to learn about Bitochon and express it. We have to daven to H-shem to bless us with the gift of Bitochon. The reward for Bitochon in H-shem is the inspiration of Bitochon. And once we truly trust in H-shem we dare not take Bitochon for granted, we must daven daily to H-shem that the security, calm and peace of Bitochon should never leave us. 3.4 So why can’t i just pray and do nothing?

3.3 I either believe or i don’t Q. “How can it be a mitzvah, an obligation, to believe? Isn’t belief a natural state of mind that varies from

Q. “Why seek intervention and help, just trust H-shem” A. H-shem placed us in a physical world and expects us to eat, sleep,

work, take professional advice. We may not rely on miracles. We are obliged to make very normal human effort, whilst simultaneously believing that it is H-shem alone who directs and guides me and all the intermediaries all the way. Pharaoh admired Joseph for his brilliance in interpreting dreams and predicting and preparing for a seven-year famine, but Joseph replied, “ ” – I am simply H-shem’s representative. Every ability, talent and result is solely Divinely inspired and achieved.

4 Conclusion True believers enjoy true inner peace and serenity, secure in the knowledge that H-shem is caring for them. We can all achieve that level. Just trust and pray to H-shem, and He will surely respond. The reward of Bitochon is Bitochon.

News & Views VIII

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Personal Experience

AT HER SIDE Coping with infertility - A husbandsâ&#x20AC;&#x2122; perspective by Rabbi Malcolm Herman of Seed UK

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News & Views VIII

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Personal Experience

E

This is an unusual request. “Please write an article on 13 years of infertility from the perspective of the husband”. It is unusual because those years are behind us and yet I would say they have never left us. No day goes by without a flash-back to the difficulties of those years. I am not unused to writing articles or presenting in public. That is my job. Normally words are carefully chosen and constructed, yet this article is free flowing, cascading thoughts as they come to mind… I am revisiting a world, not as a stranger but as a previous inhabitant – not to recreate but to relive. Those who inhabit that world will recognise its landmarks and its rocky contours… The purpose of this article is to give words to emotions that I once found difficult to articulate, in the hope that this will give expression to others... Infertility is a strange life-challenge. On the one hand it is intensively private and yet it is painfully public. Eighteen months after the Chasuna band have packed up their belongings for the night, the querying looks begin. At first there are well-meaning enquiries, “Is everything alright?” “Yes, fine Baruch Hashem”. The offers of “Kvatter” are touching, auspicious and encouraging. Then it becomes painful, even embarrassing. At one stage we joked ironically that we ought to have business cards printed, “Professional Kvatters”. Eventually we declined the offers, quelling the gnawing doubt that “perhaps this is the one” in favour of self-preservation – “also an important segulah” we reasoned. To be honest the hardest occasion was the “Shalom Zachor”. To hoist oneself out on a Friday night to go and wish Mazal Tov to a new father probably ten years younger and married just last week…(or so it seemed…) And then there are those guilt feelings about the resentment itself ... It is not that I begrudged others their Simcha, it was just their Simcha accentuated our worry, our anxiety and in all probability there was always that unease about what others would say at the occasion…I had not realised that words could be so difficult and so painful.. I remember once at a Shalom Zachor where a very well meaning individual grabbed my hand in front of others and showered me with reassurance and Berachos. I was desperate to extricate myself and run home, his bonhomie was like acid. It seemed to trivialise the enormity of the pain. Instead of empathy I felt rejection. He had dispensed his responsibility with platitudes that were

meaningless. I learnt so much. I learnt that you could never know the pain of another human being until you are they. Is it any wonder that the phrase for nechama in bereavement is “Hamokom Yenachem..” Only Hashem who is “Hamokom – the place” the totality of all that there is, encompassing life in its entirety, can really offer comfort. Anyone else is an outsider. As a husband I felt an enormous responsibility to try and look after my wife as much as possible and to understand the process - both physiological and medical. I had no science background at all. Most of the consultants spoke a different language “the jargon” of infertility…hormones, motility, fallopian, genetics, sperm count, (was 10 million good or bad? Sounded plenty to me, after all we only needed one..). New terminology, confusing procedures and intrusive investigations for both of us… Then there is the plethora of halachic issues, hilchos Niddah, sperm tests, hilchos Shabbos. I saw it as my role to lift that burden.

“I am revisiting a world, not as a stranger but as a previous inhabitant – not to recreate but to relive” In truth, the pain of infertility is much different for a man than for a woman. I would go so far as to say that it is not simply a question of “more pain” or less pain, it is quintessentially distinct – different at the core of being. For a man the process of child-rearing is external. For a woman it is internal. Every cell in her body is poised from adolescence to nurture and carry a child. For a man, it is a question of “what he has”. For a woman it is a question of “who she is”. That is not to minimise the anguish of husband living through infertility, not at all. The very purpose of this article is a candid account of that anxiety. It is simply to highlight the reality of standing “at her side..” . Some specialists were sensitive and patient. Others were distant and clinical. It was curious how as a husband I was sometimes “persona non grata”. We would sit in the waiting room until “Mrs Herman” was called in. I almost felt that I had to ask permission to come with! It was strange in this “egalitarian” world.. Over all, the most difficult equation to handle, was to strike the balance between

News & Views VIII

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Personal Experience

encouraging hope and managing disappointment… “Do you think Hashem will bless us?” How much I wanted to say “yes I’m sure”. “I don’t know darling – we have to keep davening”. And yet in all honesty, sometimes the Siddur was the heaviest item in the house. Another Yom Kippur and last year’s pages were still moist. I learnt that “Emunah” does not mean that we must have no questions. I learnt that we have to believe that there are answers, despite the questions, the raw, unanswerable questions. “Were we being punished?” “No” I was reassured by the greatest of Torah minds, tested… In fact I graduated yet a stage further in my understanding of Emunah. I learnt that it is only if one has Emunah, that one does ask questions. It is testimony to conviction that Hashem runs the world, otherwise why question Him? A close friend persuaded me to see a great Rebbe. In fact he very kindly booked the appointment. I queued for two hours in line, deeply apprehensive. For a start I could not speak Yiddish and the Rebbe did not speak English. I was ushered in clutching my kvittel and presented it to him trembling. He looked at it and then shook his head from side to side, I did not understand his words and before I could find out more I was told that that was it. My encounter had finished. All I had understood was the gesture. A negative. I came home after my wife had fallen asleep. Sat in the chair and cried. What did it mean? What should I tell her the next morning? Had I received a Beracha or the reverse? Was it a movement of empathy or a sign of hopelessness? It took some unravelling. My well-meaning friend made contact with the Rebbe’s Gabba. That wasn’t easy. The Rebbe had already left the UK and was travelling. No it was not a curse. It was an expression of sadness on his part. The Rebbe gave his Beracha.

pain’..namely in pain more so than in his serenity, then he should know that it will not be via excessive or unusual activity that he achieves solution. If Hashem wants resolution, He is not short of means. Instead, our obligation is to do that which appears logical and sensible and not more…ultimately we must rely on Hashem..especially if our efforts will disturb our regular Avodah…” (Shiurei Da’as page 127 Yissurim Shel Ahavah ) Along the way we learnt the critical importance of “not putting life on hold” by defining ourselves only by what we were waiting for, remaining in a state of permanent limbo. There has to be self-definition beyond infertility. We understood too that the outsider can never fully understand. That has taught us more sensitivity to life’s many other painful situations.

I learnt that Emunah does not mean that we must have no questions. I learnt that we have to believe that there are answers” And then we realised the need to “allow ourselves” other “compensations” – an extra break, house decorated, a special gift. These do not resolve the problem but they create breathing space. Emotions are a resource just like finances. They too can run dry and need replenishing.

And then when do you stop pursuing every last segulah, every speculative medical lead (a revolutionary clinic in Europe…a specialist in Chinese medicine) the list was endless. What is reasonable Hishtadlus and what is ridiculous? We took an approach with the advice of our Rabbonim, which I have subsequently found expressed in the words of Rav Eliyahu Meir Bloch of Telz…in a ma’amar on “suffering”

I get asked now and again if “in retrospect” I understand why Hashem put us through this?” I think that we understand more than that… The question is both legitimate and presumptuous. Legitimate because it comes from a realistic appreciation of the emotional pain of infertility, yet presumptuous because perhaps the most difficult “limmud” of all was that of “acceptance”. Acceptance that Hashem has His plans and it is only within that framework that we exercise our choices. I feel that to “second guess” His plans now, would be to undermine this ultimate Shiur. I cannot say that this comes easy, far from it, but it is the “response” beyond all answers. We cannot box life neatly into symmetrical patterns. Sometimes in our efforts to understand Hashem, we risk trivialising Him. In the end, when we reflect back, we find that we still question and grapple with the enormity of infertility.

“Indeed a person must work for solution, but if he feels that Hashem is close to him in his pain as it says, ‘I am with him in

That is the dynamic of a relationship. And then we try and accept – that is the dynamic of humility.

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News & Views VIII

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Medical Focus

Observing Sub-Fertility Explained by Dr Anthony Hirsh

Strictly observant Jewish couples have special problems and issues, which charitable organizations such as Chana understand and which their information articles address. It is only Rabbis who have the authority to interpret and advise on the most appropriate tests or treatments for a couple. Sub-fertility is a highly stressful and sensitive topic for any couple, and where there is anxiety or a misunderstanding it is invaluable to have an expert counsellor to explain the tests or treatment, so that higher guidance is followed. It is well known that in couples who do not conceive within a year or two of marriage there may be a ‘female factor’. Also, that in a third of subfertile couples all tests reveal no abnormality of wife or husband, or in medical terms ‘unexplained infertility’. Presenting soon after this time scale to arrive at an early clinical diagnosis may improve the result of any treatment, because the fertility of both partners declines gradually with age. In many cases simple medication for the

woman results in a natural pregnancy, and this is the best result, with job satisfaction for their fertility specialist. What is not so well known is that there may be a ‘male factor’ in up to 40% of infertile couples. Yes….but ‘he’ is just slightly sub-fertile in most cases. Working with glycol ether, found in solvents used for paints, has recently been implicated as a cause, but there is little evidence for other lifestyle risk factors. It is quite unusual to find a patient who could never have children - about 1 in 1000 men… favourable odds if we look at risk factors in any situation. There are some treatments for men with severe infertility, such as medication, hormones or microsurgery, that can cure, but such cases are rare. However, whatever the ‘male factor’ there is usually a treatment which offers the couple the chance of a child, that usually involves ICSI. Today, subfertile couples, with female or male factors, both factors, or unexplained subfertility, are truly fortunate, since, if

simple treatment does not work, most can take advantage of the rapid progress of assisted reproduction treatments involving IUI, IVF or ICSI, with excellent results. And they are available via the GP in the NHS. Fertility units, whether NHS or private, are set up to preserve the confidentiality of clients. Even their GPs cannot receive clinical information about them unless both partners give consent. It is important for all women and men to keep healthy, eating sensibly by avoiding fatty foods, keeping the correct weight, taking exercise (I’m a poor example), not overeating, drinking too much alcohol or smoking. This may also help to preserve fertility, improve the outcome of fertility treatment, and gain a healthy, longer life in which to enjoy family - as well as potentially avoiding the need for any treatment at all! The religious aspects of lifestyle may also help, as a scientific study has shown that organized committed prayer improves the outcome of fertility treatment. Mr. Anthony Hirsch FRCS Andrological Surgeon

News & Views VIII

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Personal Experience

NEEDLE IN A HAYSTACK A husband speaks out

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News & Views VIII

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Personal Experience

Another phone call, another relative calling to say that they are Boruch Hashem pregnant. I have lost count of the number of siblings, cousins and friends who have called us since my wife and I have embarked on our difficult infertility journey. This will probably evoke differing emotions in those reading this. Of course I am happy for the person telling me the ‘news’ and of course I am grateful that they ‘didn’t want me to hear it from anyone else’, but each time I hear it, it chips away at another little part of me. Is this a familiar story? Probably so for many of you, but here’s the difference, I am a man and I had not given it much thought until I heard the word *‘azoospermia’ a simple sounding word and yet, one that has changed my life. For the inexperienced this means that in our situation, I am the one with the fertility problem. Every time I see my wife shattered by yet more good news, or some insensitive question or comment at a Simcha, I know that in a way, I am responsible for her suffering – not in an intentional way but I am none the less the cause. Much less is known about male than female fertility problems particularly in the Jewish community. Until we were fully up to date about all the medical information we had to struggle with much disinformation as to various options for procedures both in England and abroad. As with all problems, a competent Rabbi needs to be involved along each step of the process as numerous sheilos always arise. For the first part of our journey my wife had to undergo all the usual preliminary tests and ultrasound scans to see if she was fertile before the doctors could begin to investigate me. I underwent many blood tests and an ultrasound to ascertain if there

was any obvious cause for the problem. Once our investigations were done we started to embark on the best course of treatment available to us. It was decided that I had to undergo a testicular biopsy. After a number of failed attempts using all the samples that were retrieved during the four hour testicular biopsy, today we are back to square one. For those who may need to consider having a testicular biopsy, the biopsy is not major surgery and the recovery time is not long.

“Every time I see my wife shattered by yet more good news or some insensitive question or comment at a simcha, I know that in a way I am responsible for her suffering” In the case of ‘azoospermia’ where the surgery is needed to try to locate even one sperm there is not much choice but to go through the whole IVF stimulation procedure first. This is in case one sperm is found to use to fertilise the follicles. There is however an added concern with the surgery that one’s wife will have to undergo the entire cycle of IVF drugs, injections blood tests and scans only to discover that the surgery could not produce any viable sperm for the IVF treatment. In my case after four hours of surgery the doctor found nothing not even one single sperm. Even in my still drugged state immediately after the biopsy whilst still in recovery when he came to tell me the news - this was the biggest shock of all. This was not the outcome we had expected. My wife had undergone the

whole IVF procedure, taken many drugs produced follicles and now it was all for nothing. This is extremely difficult to deal with even more than a regular failed IVF cycle. I was devastated and felt so inadequate. I realised at this point that this probably meant the end of the line for us. The days that followed the operation were the worst I have ever experienced – the shock of what the doctor had told us just did not sink in. Unbelievably, a few days later the doctor called to say that whilst checking the pathology reports of the frozen samples they had found enough sperm for a couple of ICSI cycles. This was unbelievable. We couldn’t quite grasp what we had heard. The last few days we had been so low and now with this news our hopes were once again lifted. It was like finding a needle in a haystack – the odds for this to happen were so rare. Unfortunately, the ICSI cycle did not have a positive outcome – our emotions were once again in turmoil. As the Chofetz Chaim once said, “for those with faith there are no questions & for those who lack faith there are no answers” or to put it another way, “ours is not to question why”. Ours is, for the moment a story with no ending. We are trying, hoping and praying for a Yeshua. I just felt compelled to write to create an awareness that infertility is a constant pain felt every day by those experiencing it. It is particularly difficult on the woman, who on the outside might look relaxed and without a care in the world, yet inside is feeling empty and vulnerable to insensitive remarks from onlookers. You may ask... “How do we manage to carry on and blend in to regular society?..” With difficulty we try but it isn’t always easy some days are much more difficult than others and we pray to Hashem that soon our trials should come to an end.

News & Views VIII

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Poetic Thoughts

DARKNESS & LIGHT by L. Paris

Darkness Its darkness envelopes me. There are no shadows, no shades of grey, It is black in the absolute. My head begins to spin, My eyes blur and become heavy, A sense of biliousness provokes my every sense, My stomach churns and butterflies attack my insides. I become unsteady on my feet. Perched high above such a bottomless void, No horizon on which to focus, No hand rail for which to grab, I am alone.

Light It was 4 a.m.

I am alone with my senses, Clutching for something solid, For something stable on which to steady myself. There is nothing. The sensation continues, The fear intensifies, On a bad day I will break into a sweat and a sense of panic will attempt to overwhelm me. But I haven’t lost it yet. I haven’t lost it yet. My final line of defence is the knowledge that if I lose it, There may be no way back. The panic subsides, Black turns to grey, A glimmer of shadow appears, And a flicker of sunlight creeps through the density of darkness. My darkness returns from where it came, Inevitably to show itself again at some unplanned time in my future. I return to normality, The sunlight enters my world, The abyss no longer below me. I continue my journey…

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I was stirred from my slumber as I heard my little girl cry. Would she return to sleep or was she in need of a cuddle? “Dada” she cried, “Dada”, I sat up, reached for my dressing gown and went to her room. “Dada” she cried again, And her arms reached for me as I looked into her cot. I collected her in my arms, sat in her bedroom chair and she snuggled up to me. It was 4 a.m., the sun had not yet stirred, I was tired but this was one of those precious moments, I am her daddy and she is my beautiful little girl. The time was an irrelevance as we cuddled and she dropped back to sleep. I was aware of the gift I had been given, Such a beautiful moment, Such a privilege, As I gently laid her back in her cot and returned to my slumber.

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Medical Focus

A-Z OF MALE

HEALTH

reaction to a transplanted organ. It is advisable to ask your GP or consultant how the medication may affect sperm development. Heat: Skip the tub. To maximize the quality and quantity of your sperm, avoid hot tubs and baths. Spending more than 30 minutes in water 102 F (40 C) or above may lower your sperm count. Saunas and steam rooms may have a similar effect. Illicit drugs: Stay clear. Marijuana can decrease sperm density and motility and increase the number of abnormal sperm. Cocaine and opiates can contribute to erectile dysfunction, and amphetamines can decrease sex drive. Lubricants during intercourse: Take care of what you use! Personal lubricants, lotions and even saliva can interfere with sperm motility. However, vegetable-oil-based lubricants are okay.

Antioxidant: Antioxidants are molecules capable of slowing or preventing the oxidation of other molecules. Some of these antioxidants are vitamin C and E, beta-carotine (vitamin A), selenium and folic acid. By eating lots of fresh foods rich in these nutrients, you are giving your body plenty of antioxidants to fight damage. Examples include oranges, raw carrots, strawberries, raspberries and even some fortified breakfast cereals and grains. Studies carried out at two fertility clinics in Spain have found that men who had a low antioxidant intake had poor quality sperm. Those men who ate more fruit and vegetables had better quality sperm with improved sperm count and better mobility and morphology (the shape of the sperm and how it moves). Bicycling: Take more breaks if you need to cycle for a long distance, since cycling increases the heat in the scrotum and thus affects sperm quality. Stay cool: Increased scrotal temperature can hurt sperm production. Experts know that hot work environments, tight underpants, prolonged sitting and use of laptop computers can all increase scrotal temperature. They are still studying how these activities affect fertility. Drinking: Heavy consumption of alcoholic beverages may reduce the quality and quantity of sperm. Limit alcohol to no more than one or two drinks a day. The combination of tobacco and alcohol is particularly harmful. Environmental hazards: Avoid them If your work or hobby brings you into contact with environmental dangers such as pesticides, solvents, organic fumes, secondhand smoke, or radiation exposure, you may be unknowingly affecting your fertility by impairing sperm production. Flaxseed oil: helps to produce healthy sperm Gout: high blood pressure or inflammatory bowel disease are often controlled by medications that suppress your immune

Medication: Anti-depressant, antiandrogens (used to treat cancer) interfere with sperm production and decrease sperm count and quality. Nutrition: The importance of a healthy diet cannot be overstated. To function properly, the reproductive system requires the proper vitamins and minerals. Nutritional deficiencies can impair hormone function, inhibit sperm production, and contribute to the production of abnormal sperm. Oatmeal: Oats contain soluble fiber that is known to reduce the bad cholesterol level. Oatmeal is also a great source of protein, vitamin E, zinc, iron, magnesium and other nutrients important for male fertility. Also whole grain foods like oat are rich in Bvitamins, like folic acid, which is important not only for female but for male fertility too. Pollution of the air: Car exhaust hurts sperm. A recent study ledy by Health Canada found that mice who were exposed to pollutants had 60 percent more sperm mutations after 10 weeks than mice who were breathing in HEPA-filtered air. Human studies also suggest that exhaust affects sperm quality and motility. So drive with the windows closed, walk on side streets instead of main roads and stop idling the car engine. Quit Smoking! The sperm of men who smoke may be misshapen and may move more slowly than those of nonsmokers. Smoking can also damage your sperm’s DNA. Experts suspect such damage could even affect a baby’s growth and development and increase a child’s chance of having certain health problems, including cancer. And chewing tobacco isn’t safe either — it also may cause low sperm counts and damage. As if that weren’t enough, tobacco use can increase erectile dysfunction. Research shows men who both smoke and drink alcohol have lower sperm counts and motility than do men with either habit alone.

Radiation: Beware. Research results from research studies in Cleveland (2009) and Poland (2007) showed that there is a significant correlation between mobile phone use and decreased sperm count, motility, viability and morphology. It has been suggested that placing mobile phones in jacket pockets is better than in one’s trousers or clipped onto the belt. Stress reduction: Stress might interfere with certain hormones needed to produce sperm. Stress can also decrease sexual function. Toxins: Watch out!. Experts think certain workplace and household substances might have an effect on sperm quantity and quality. These include heavy metals used in industrial workplaces, pesticides and chemicals in solvents. Use protective clothing, proper ventilation and face masks to reduce the risk of absorbing such toxins. Underwear: wear loose as not to increase scrotal temperature, since that can hurt sperm production. Vitamins: A daily multivitamin can help provide essential nutrients that are important for optimal sperm production and function. E.G. Vitamin C (2,000 to 6,000 milligrams daily) helps prevent sperm from clumping or sticking together, thus improving the chances for fertility. Weight: Watch it. Too much or too little body fat may disrupt production of reproductive hormones, which can reduce your sperm count and increase your percentage of abnormal sperm. You’re most likely to produce lots of high-quality sperm if you maintain a healthy weight. Regular Xercise: Physical activity is good for reproductive health as well as your overall health. But don’t overdo it. Men who exercise to exhaustion show a temporary change in hormone levels and a drop in sperm quality. Yam: Wild yam also known as Dioscorea villosa, is a species of a twining tuberous vine which has been used by herbalists in treating treat menstrual cramps and problems related to childbirth as well as stomach upset. Herbalists also say that wild yam contains certain substances that help to reduce levels of triglycerides in the blood stream, resulting in lessening the risks of hardening arterial wall and high blood pressure and increasing the blood flow to the reproductive region, leading to improving of quality sperm production. Get Plenty of Zinc: According to several studies, zinc deficiency decreases male fertility, resulting in low sperm count, ejaculate volume, and sex drive. Improve male fertility by eating food sources rich in zinc, such as oysters, nuts, and lean meats. Men may also take zinc supplements. Zinc supplementation (100 to 200 mg daily) has been shown to increase testosterone levels, sperm count and sperm motility. High zinc sources include oysters, organ meats, lean beef, turkey, lamb, herring, wheat germ, legumes and nuts.

News & Views VIII

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Personal Experience

Extracts from our journey Bringing home our daughter proved to be an emotional roller coaster by L. Paris

It had been a long journey. We celebrated our 17th wedding anniversary this July, but it wasn’t always a celebration. Our anniversaries, birthdays, and simchos would all serve as a reminder that we were childless. I think it fair to say I wasn’t overly concerned in the first few years of our marriage. I had travelled, I wanted to travel with my wife, there would be time. Children would come. Time passed, we were ready, but the children didn’t come; my wife took the initiative and started the process of enquiring why. To a great extent I was just the passenger, she would be prodded and poked and I would be nearby, helpless. Over the years we saw a collection of doctors and consultants. We followed conventional and alternative routes, tried kinesiology, reflexology, acupuncture, osteopathy, eaten fig jam from Israel because it was suggested!; Visited various Rabbonim and Rebbe’s graves took on segulos and more. It was a long and difficult journey. In the beginning, after a host of initial tests and procedures on my wife, we were referred to our first ‘assisted conception unit’ at UCH. We sat in the waiting room,

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full of hope and expectation that this place would sort out whatever problem we had and we would start our family. We had some more tests, my wife a small op, and then a few treatments there whilst we were both working, and although that wasn’t ideal, our work probably helped us maintain our sanity. The routine and responsibility provided a stability that helped us keep going. Paradoxically, it also added to the stress when at a moment’s notice we would both down tools and speed to the hospital as my wife’s body moved into the correct phase!

“I would find myself arguing with G-d. Trying to understand what He’s doing. It made no sense to me, my wife was such a good girl, why torment and hurt her in this way?” I don’t think I took it that seriously at the time but it was clear that we needed to move on from the UCH. We decided to change hospitals, to the Hammersmith. We had renewed hope. This place would solve our problem… whatever it was. We would dutifully arrive there at 7am

most mornings for blood tests and scans and then travel on to our workplace. It was this phase of our treatment that started to gnaw at me. I would speak to G-d and ask him what He was doing. I would ask why He was taking us along this journey, why He was inflicting such pain on us and why He was not allowing a treatment to work. I would look on and see my wife prodded, poked, scanned, injected with a cocktail of drugs to stop her ovaries, start her ovaries, promote the egg production, stimulate the egg release in time for a doctor to harvest them and so much more, all in pursuit of starting our family. We would then endure the two week wait to see if she was pregnant. We would analyse every twinge, I would monitor her every mood, we would be cautiously optimistic until our hopes were bludgeoned to pieces as her period came and we knew we had failed. On one occasion the hospital phoned to tell us that she was pregnant - but her period had already started. A week later they phoned to confirm from the blood test that we had failed. The highs and lows are intense and volatile. The financial cost is not at all as expensive as the emotional expense, as each cycle would drain you that much further, leaving you that much weaker. We would survive on holidays, recharge our batteries and make a further push in our hopes for a family.

News & Views VIII

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Personal Experience

after her and here I was unable to do a thing. My anger with G-d intensified and I regarded Him as indifferent to our pain and indifferent to how we felt as we tried to fulfil what he had created us for! When our specialist at the Lister gave us a moment of honesty we knew it was time to draw a line on the fertility world, I remember leaving the clinic, looking up to the skies and saying to Hashem, “We’ve done as much as we can, it’s over to you now”. But I also knew it was bigger than me. My wife was so prepared to move on but I had some serious issues. I was upset with G-d. I had been for a number of years and when she started taking me to Adoption Meetings, my anger started to show. More than one person recommended I speak to a Rabbi. I had other issues as well. Could I be an adoptive father? Could I father a child that was not biologically mine?

I would find myself arguing with G-d. Trying to understand what He was doing. It made no sense to me. My wife was such a good girl, why torment and hurt her in this way? My davening would range from compliant to intense to indifferent, but He never answered me. I became bitter; my relationship with Him became stretched and difficult. I davened but with hostility. At times I would try to trade with Him. “If not for me, for my wife?” but He wasn’t dealing. We moved on from the Hammersmith. It was a choice between the ARGC and the Lister. We met with both of them and it was clear to us that we were a better fit with the Lister. My wife was more comfortable with the specialist there, who connected with her and made her feel at ease. Bedside manner was to be more important than any other factors and the Lister offered it.

“Another very close friend and Rabbi delicately suggested to me that I was lucky. To be angry with G-d demonstrated that I had a relationship with Him” I remember thinking, “This is bigger than me, I need help”. I had no shortage of Rabbis to turn to. One very special friend and Rabbi met my wife one day and enquired after us and, on hearing our despair, wanted to start learning with me. We started learning on the subject of “Why bad things happen to good people”. So many theories as to what lies behind G-d’s actions. In truth, we haven’t a clue. Another very close friend and Rabbi delicately suggested to me that I was lucky. To be angry with G-d demonstrated that I had a relationship with Him.

I had been writing about our journey for some time as it was cathartic for me. I wrote a letter to the child that I longed for. It was an interesting day. Our Norwood Adoption Induction Course made me realise how much closer we were to having you. Your story won’t have begun when we received you. As your parents, it started so long ago when we dreamed of you as our child, when we planned to start our family with you as our first. How life can twist and turn! How fate can play cruel tricks with us and how G-d could hold back and look on allowing our volatile roller coaster of a journey, I will never understand. Suffice to say that this story, your story, encompasses our issues with the Man Above but also tells more. Hopefully I will find the ability to tell you where your Mum and I journeyed, the depths, the hopeful periods, the pain and despair. The voyage of discovery through the World of Fertility which was perhaps more akin to a North Sea Crossing, but more of that later! You may have recognised that it was a difficult journey; one filled with pain and frequent periods of emptiness, leaving both of us, in our own way, to question our beliefs and faith. On so many occasions I would ask “Why”? Sometimes a fool would amble by and offer me a moshel or a performer would embrace me for all to see as I broke down in tears, never to hear from him again. Then again, the world has its people of quality and integrity and it was these people who would restore my faith in mankind. As for my faith in G-d, I have struggled. There have been times when I would blindly go to shul with an empty heart, when I would stare blankly at the prayers and let the service pass me by. On other occasions I would wrap myself in my Tallis and engage in my prayer, connect with G-d and await a reply. It never came.

My wife endured yet more tests as the Lister climbed on board. Now she was taking a low dose steroid and Heperin along with all the other cocktails. On occasion she would be returned from egg collection in such pain that they would give her morphine to ease the pain. I hurt in a different way. I would look on and feel absolutely helpless. I had always looked

As for becoming an adoptive dad – this was huge. Could I do it? There was no margin of error here, I needed help. I am not a person that naturally turns to counselling but I had no choice. We contacted CHANA and embarked on working through my issues of pain, my anger and my need to be a Daddy.

I struggled so much. Your mum would hold herself as I fell and, on the reverse, I would gather myself to provide support for her. I would joke that we both had PMT – Mum was pre and I was post! Fortunately, we rarely fell together and this was perhaps our method of survival.

News & Views VIII

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Personal Experience

We closed our relationship with the fertility and medical world in May 2004. Mum had been ready to move on so long ago, but held on for me to catch up with her. Having caught up with her, I was a resentful passenger. My dreams of being a Daddy had faltered. I so wanted to be a “normal” person, for Mum to fall pregnant and you to be born but this wasn’t to be and caused me great difficulty in reconciling to alternative options. How could I be sure that I could meet my responsibilities as a parent to a child I had not fathered? Mum would do fine but could I fulfil my role? The burden weighed heavily on me despite advice from so many well meaning people. This was an issue I needed to resolve within myself. I have long known that I can be a father even if I don’t father the child, but were these merely words? Having worked through my issues and embarked upon a new journey towards an adoptive child, we had the misfortune to suffer an abortive adoption. We had chosen to adopt a newborn from the US but there is always the risk of a birth mother deciding to parent. After two years we were matched with a 4month pregnant woman who constantly checked our commitment with the plan! With a week to go, having met her and journeyed almost two trimesters with her, she decided to parent and we were left bereft. We had never sunk as low as we scavenged what reserves we had simply to survive. It was a torrid time as we shut out the world and attempted to recover from our grief. It was January 2008 and our mood was as grey as the sky above us. We crashed and burnt out a month ago and we found ourselves on holiday running from our failed adoption. We needed to escape – my wife badly needed space, and so we hurriedly put together a trip to be as far away as possible. For obvious reasons, even though we were away, our emotions, grief and pain simply followed. But the opportunity of being away allowed us some solitude and a chance to explore the depth of emotions that we had plummeted to. It had been some 15 years. I could make no sense of it; I looked to the heavens for my answers only to find myself in a vestibule with closed doors. I had tried so many

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ways to open one of those doors and find a way through, but without success. I had been broigus with G-d for a number of years but, after much introspection and thought, recognised the futility of my anger. I have now made peace with Him, or should I say submitted to His will? I cannot argue any more, I accept I am merely a pawn on his chessboard and it is He who controls the moves. Whilst I look forward and fear a future with no children, I find it difficult to believe that He could deprive us of the joy, the thrills and responsibilities of parenthood. The skies remained grey, my wife so fragile and I not knowing what to do for the better. January came and went. There was no activity at our adoption agency. February arrived. What little activity taking place at the agency was not to our benefit.

It really can happen like that! From the depths of despair, from our abyss of emotion to this new, strange reality. Our little girl of 1 day was 4,800 miles away and she would be confirmed as ours after another 24 hours. It took four days to get to her and another three weeks to get home but what a time! We will never understand why we had to wait 15 years to have our adorable little girl. Why we were put through so much? Only HE knows. HE chose her for us after all. She is our Purim night miracle. But I can tell you that when we hear her say Mama and Dada, we just melt. We still go in to her room now at nearly 21 months and look on at her sleeping. We shake our heads and talk about how fortunate we are every night and all of the new things she’s up to. We never thought we could be this happy.

“From the depths of despair from our abyss of emotion to this new strange reality. Our little girl of one day was 4800 miles away and she would be confirmed as ours after another 24 hours”

It was March, Taanis Esther neared its end, another Purim beckoned. Purim and Simchas Torah were positively the worst days of the year for us. So many children, so much joy - and for us, so much loneliness. I davened Maariv in a compliant fashion. I feared another Rosh Hashanah and another recital of Chana’s prayer in the first day Haftorah. It had been mine for too long. The Megillah came and went whilst I mustered the energy to challenge Haman’s name. At least I would be escaping to friends in Gateshead. We could hide a little there. The plan was to rush home, break the fast and leave almost immediately. We returned home and my mobile rang. “Hi Daddy, you have a beautiful little girl”

I ASK NOT FOR A LIGHTER BURDEN BUT FOR BROADER SHOULDERS.

News & Views VIII

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Personal Experience

Reaching a Greater Understanding of Male Infertility Infertility effects one in every six couples who are trying to conceive. In at least half of all cases of infertility a male factor is a major contributor. Historically, infertility has been considered a women’s disease. It is only within the last fifteen years that the importance of the male factor contribution to infertility has been recognized. The good news is that the rapidly advancing research in the area of male reproduction, has brought about dramatic changes in the ability to both diagnose and treat male infertility. The most common identifiable cause of infertility in men is Varicocele. This is a condition of enlarged veins in the scrotum that causes abnormalities in the temperature regulation of the testis. Testicular temperature should be maintained at 2.0 degrees below core body temperature. This temperature differential is necessary for normal sperm production. Surgery to remove varicocele may improve sperm production but can cause other problems and there is no proof that it will increase pregnancy rates in this group of patients. The second major cause of infertility in men is blockages or obstructions of the male reproductive tract. This is particularly true for men with zero sperm count, a condition called “azoospermia.” Many with azoospermia can be divided into two broad groups: 1. Men who have an obstruction problem or blockage, meaning they are making sperm, but the sperm can’t be released 2. Men who have a production problem, meaning they are not making sperm, a condition called “non-obstructive “ azoospermia.” One can determine which group an infertile male is in by doing a testicular biopsy. Approximately 1% of all infertile men are born with the congenital absence of the vas deferens. Unfortunately, there are no artificial tubes strong enough to replace the vas deferens. However, doctors are now able to help such men and others with obstructive azoospermia conceive using an operating microscope to retrieve sperm from the tiny ducts of the epididymis, freeze them and use them later for in-vitro fertilization (IVF). The most exciting new development in the field of male infertility is the ability to treat men with severe sperm production problems called non-obstructive azoospermia. Even though these men may have no sperm in their semen, we can now find sperm between the cells of the testicles in almost half of these cases. Artificial techniques of reproduction have advanced to the point where a single sperm can be physically injected into an egg. This procedure, called intracytoplasmic sperm injection-ICSI has dramatically changed the treatment available for even the most severe male factor infertility. Medical ability to combat male infertility has never been stronger and with new research evolving all the time the future looks more and more optimistic.

News & Views VIII

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Medical Focus

Fact or F Approximately 15% of couples trying to have a baby have difficulty. Fact - Studies have shown that 15 to 20% of couples trying to have a baby have difficulty conceiving. Having been able to have children in the past guarantees that a couple will be able to conceive. Fable - Although the majority of infertile couples have never had children before (primary infertility), many couples being evaluated and treated for infertility have been able to have children in the past (secondary infertility). It is estimated that 25 to 30% of couples with infertility have been able to have children in the past. Most causes of male infertility are treatable. Fact - The causes of male infertility include reversible problems, irreversible problems and problems that cannot be identified. Reversible problems include varicoceles, obstruction, ejaculation disorders and hormonal imbalance. Irreversible problems include chromosomal and genetic disorders

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as well as many problems with sperm production. Approximately 25% of men with abnormal semen studies do not have an identifiable cause of their infertility. All of these causes can be potentially treated by either correcting the underlying abnormality or utilizing advanced reproductive techniques. Men who were previously labelled ‘sterile’ now have the potential to father children. Fact - Many infertile men have irreversible abnormalities in sperm production. These men were labelled “sterile” in the past and had to utilize insemination with donor sperm or adoption to have children. Modern technology allows these men to have children that are genetically related to them since many of these men have low but sufficient numbers of sperm in the testes despite the complete absence of sperm in the semen. Genetic, environmental and hormonal factors can cause male infertility. Fact - There are many causes of male infertility. Recent studies have shown that there are important genes for sperm

production on the Y chromosome that are sometimes absent in infertile men. Likewise, many environmental factors can affect fertility. A common one is temperature. Use of a hot tub can depress sperm counts. Moreover, there are many known and unknown toxins in the environment that adversely effect male fertility. Finally, sperm production and normal sexual function are dependent on the presence of a normal amount of male hormones. Tight fitting underwear (Jockey Shorts) causes male infertility. Inconclusive – There are conflicting studies. Some studies have shown that the type of underwear worn has no effect upon male infertility. In fact one study looked at the potential use of bicycle shorts as a male contraceptive agent and did not observe any change in semen quality. In contrast, other factors that raise testicular temperature such as regular hot tub use can cause infertility. Varicocele, abnormal veins around the testis, is the most common identifiable and reversible cause of male infertility.

News & Views VIII

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Medical Focus

or Fable?

Fact - Varicoceles, defined as the presence of enlarged or varicose veins of the scrotum, are present in 15% of all men and approximately 30% of infertile men. Repair of a varicocele results in an improvement in sperm count in two thirds of infertile men. Testosterone therapy will improve the fertility of infertile men. Fable - Testosterone is the major sex steroid hormone in men. It is critical for the production of sperm and the concentration is normally very high in the testis because that is where it is made. Administration of testosterone, or similar anabolic steroids, fools the body into thinking that enough is being made and the testis shuts down. This actually results in a reduction in sperm count rather than an increase. Testosterone should never be administered to improve fertility and is actually being studied as a male contraceptive. Testicular cancer is a rare but important to recognize cause of male infertility.

Your questions on male infertility answered

Fact - Testicular cancer occurs in approximately 4 of every 100,000 men annually. The peak incidence is in men in their third and fourth decades. Although most men with testis cancer feel a lump in their testicle, infertility is sometimes the presenting problem for a man with testicular cancer. Moreover, there are other serious medical disorders that can present with male infertility. Therefore, it is very important that all infertile men undergo a complete physical examination by a trained specialist. As men age, the amount of testosterone in their blood goes down. Fact - Longitudinal studies have shown that testosterone levels in the blood decrease with age. Moreover, the amount of testosterone available to interact with other organs decreases with age. This is because the protein that binds testosterone within the blood stream increases with age. However, men do not undergo an abrupt change as they get older, in the same way that women do.

Smoking can cause impotence. Fact - Men who smoke have been shown to have abnormalities in sperm production. Both sperm quality and quantity are affected by cigarette smoking. These abnormalities translate into higher rates of infertility. Fecundability refers to the reproductive potential of giving birth during a particular menstrual cycle. It is dependent on the reproductive potential of both partners. Cigarette smoking decreases fecundability, which can be assessed through a semen analysis; normal sperm morphology should be greater than 50% and sperm count should be above 20 million/ml. These values are drastically reduced in men who smoke. Smoking can also lead to impotence by causing damage to blood vessels. The mechanism of developing an erection is dependent on healthy veins. In diseased veins, as in the case with chronic cigarette use, blood flow is decreased, and thus causes weak and ineffective erections.

News & Views VIII

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Chana News & Views VIII  

Chana News & Views VIII

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