The Hemp Connection:
infertility

One of the most difficult parts of working with PCOS is how hard it is to help cysters understand the widespread effects of their diagnosis. The tendency is to focus on the symptom causing the most distress in the moment, and to look for relief from that distress, even if it isn't helping the core issue.

So, for example, women who are focused on infertility, tend to be caught up in ways to have a child, and to not think about what it's going to take to keep that pregnancy, how to nurse the child, and how to stay healthy until that child grows up to produce grandchildren.

One very nice woman I worked with who had PCOS was only willing to work with me for one appointment. It seemed, as we worked through my assessment questions, that she was realizing that what was going to result from our time together, was that she would need to address her binge eating behavior in order to reduce her carbohydrate intake and manage her blood glucose. She politely told me that she had decided that she would be better off pursuing in vitro fertilization (IVF), and if she developed gestational diabetes, she would call me to schedule another appointment.

I felt very sad about this, because this woman was not young, and fertility was not something to take for granted. And it seemed to me that the bigger picture here was that if the binge eating was not addressed, she may never get to the point where she was pregnant and in need of my help! But I couldn't tell her that. My job is to accept my clients where they are at and maybe plant a seed or two that encourages seeing things in new and different ways.

Which brings me to my topic for today.

Serum C-reactive protein (CRP) is a blood marker of inflammation, a degenerative process that has been identified in women with PCOS.

In a study of 63 women receiving IVF, it was found that CRP increased in conjunction with this treatment. Even if the women were taking metformin.

There is such a mentality in our country that we are entitled to have access to medical treatments for whatever ails us, and that we should expect that these treatments are risk free. That simply isn't the case. IVF produces many beautiful babies, but that doesn't mean it isn't without its issues.

What isn't even considered here…is the effect of an active inflammatory process on the developing fetus who has no choice but to live in that environment for nine months?

Is it just me…or doesn't it seem that if you want a baby that badly, that this baby deserves the absolute best possible environment in which to live and thrive from day one in utero? Which means taking a serious inventory of all of the nutritional and lifestyle choices we make that interfere with that on behalf of the new life that we want to create? And making some sacrifices in that department?

Just a little something to think about.

Kjøtrød SB, Romundstad P, von Düring V, Sunde A, Carlsen SM. C-reactive protein levels are unaffected by metformin during pretreatment and an IVF cycle in women with polycystic ovary syndrome. Fertil Steril. 2008 Mar;89(3):635-41. Epub 2007 Jun 4.

Our Chicago network member Lesli Bitel-Koskela sent me this great article about myoinositol, a nutrition supplement that was recently studied in comparison to metformin for its effect on anovulation and infertility.

In a study with 120 women who were required to have both a PCOS diagnosis and confirmed 14 to 16 months infertility prior to starting the research protocol, half were randomly assigned to a regimen of 1,500 mg metformin daily, while the rest were assigned a combination regimen of 4 grams myoinositol and 400 mcg folic acid. Here's how their stories played out.

Metformin 50% restored spontaneous ovulation, and 18.3% of those who did, achieved pregnancy. Total pregnancies for the 60 women: 5.

Myoinositol 65% restored spontaneous ovulation, and 30% of those who did, achieved pregnancy. Total pregnancies for the 60 women: 12.

My thoughts:

1. Myoinositol is a metabolic intermediate, and it's relatively inexpensive (looks like about 78 cents per 4 g dose as described above).

2. It certainly makes sense to try this first before moving into metformin.

3. If it doesn't succeed in achieving ovulation and pregnancy on its own, it certainly wouldn't hurt to use it in conjunction with metformin, hopefully achieving more effects with metformin on lower doses less likely to cause the horrible side effects our readers consistently complain about.

4. If you choose to try this regimen, be sure to include both the myoinositol and the folic acid, as it was not clarified which of the two is the most active one, or whether they work in conjunction.

5. This is a different compound from d-chiro-inositol, a popular supplement with women who have PCOS. Both appear to have benefit, as research evolves, we'll understand the particulars.

Lesli, I can guarantee you made a lot of readers happy by sharing this!

Readers, if you do experience success with this, please come back and share with us so those coming along behind you can benefit.

If you're REALLY interested in this, over the weekend I'll talk about where you can find myoinositol in food.

Raffone E, Rizzo P, Benedetto V. Insulin sensitiser agents alone and in co-treatment with r-FSH for ovulation induction in PCOS women. Gynecol Endocrinol. 2010;26(4)275-280.

First of all…it's great to be back! I was traveling, and while it's kind of fun to say I saw both the Atlantic and Pacific oceans in the period of a week, I do like my base camp and I really missed reading research. I'm looking forward to getting back into my daily groove.

Last week, I read an article in the New York Times about insurance companies, and how they are starting to ask consumers to absorb the cost of medications by asking that these medications be paid for not by flat copayment, but proportionate to the cost of the medication.

Nice. First we're convinced that we absolutely need all these drugs, and that we can get them for cheap, then once we're dependent on them…we're thrown under the financial bus.

Right now, the medications that are being sold under this new proportionate plan are not any of the medications that I focus on with this blog. However…since several of the medications you readers are on, are some of the most popular medications out there, I suspect it won't be long before these insurance companies start to see dollar signs in terms of the quantity of people they can expect to help finance this venture. Categories of medications like antidepressants…and insulin sensitizers and statins, which are commonly prescribed when the antidepressants start to mess with hormone balance.

That's the bad news.

The GOOD news is, I finally felt vindicated for having sat through this scenario for the last 25 years, wishing people would see what I have always seen…that when you take responsibility for your own health, and don't depend on people who make money off of you to help you, you have a good chance of getting better results. Think about it. Why would a drug company spend millions and millions of dollars to develop a product that you eventually wouldn't need once you started using it?

My goal, ever since I started what I do, is to put myself out of business. I started learning to play golf last year and it has been very frustrating to have to put it aside to attend to the demands of my growing business. I have a children's story I'd like to publish. And there are a couple of screenplays roaming around in my head that I'd love to get into theaters.

But the drug and insurance industries don't have that goal. Their goal, as is the goal of most corporations, is to increase market share and return on investment. Which means you can (1) increase the dosages of medications you sell to already existing customers, (2) find new customers for your medications by either creating new diagnoses or finding off-label uses for your already developed products, and/or (3) increase the price you charge for the product. Hmmmmm…nowhere in there do I see"helping the patient feel better".

Of course, I'm not naive. I know some medications are entirely necessary and even life-saving. But I also see so many conditions that could drastically improve with a few judicious lifestyle choices.

Last week I listened to the husband of a friend tell me what it was like to go through an in-vitro fertilization (IVF) procedure with his wife. He was near tears as he spoke about the trauma, the callousness of the providers, the emotional stress…the expense, and the feeling of failure as a human being when the entire investment of time, emotions and money did not produce the desired result.

He drove me to the bus stop, and I headed to the airport. As I was standing in line to board my plane, a colleague phoned me. She'd gone through my professional training and had been using my protocol on women with infertility. And she told me, that with just a few nutritional tweaks, these women were getting pregnant! Not only that, their depression was responding with equal profundity. Even the women who'd failed with the same IVF procedure as my other friend and who had given up on ever having children, were seeing results.

There's something very wrong with a system that promotes a $20,000 emotional and financial (mis)adventure over a $12 bottle of Coscto fish oil…but we as consumers need to shift our expectations for help from those who stand to make money off of our misfortunes and invest in choices, behaviors, and financial purchases that are empowering and affirming. You'll never get a company making money off of you to change how they do things if it means less money. But we can certainly get their attention if, collectively, we start to say"no" to some of their answers to our problems and"yes" to options that make more sense.

You bet the power of where you pull out your wallet is tremendous. And when groups of thousands of wallets get together…well, that's the vision I have that will finally get these screenplays out of my head!

Eating well. Physical activity. Adequate sleep. Less stress. It's that simple. It's incredible what prioritizing these four areas can do to your overall health. Not to mention your budget.

http://www.nytimes.com/2008/04/15/opinion/15tues1.html?hp

This just came across the Twitter feed, it is very encouraging and I wanted to share it.

http://www.newscientist.com/article/mg20126973.700-youthful-infertility-balanced-by-lateblooming-ovaries.html

I have had a handful of inquiries in the last week about an inCYST fertility consultation. I thought I would lay out, honestly, what it is we do and what we do not do, in order that you know exactly what it is you are contacting us for when you do, and to prevent disappointment by hoping we might be something we are not.

1. We do not make babies. We are not fertility clinics. If what you are looking for, is someone to give you a baby, a fertility clinic is where you should be asking for help.

2. We DO, if there is anything about your lifestyle that has the potential to interfere with fertility…be it sleep, nutrition, activity, stress management…have a strong ability to identify what it is and to help you replace the behavior in question with a more fertility-friendly option.

3. We DO assume that you are willing to make changes in your behavior and that this is an active partnership. We cannot live those lifestyle changes for you. We cannot become pregnant for you.

4. We DO NOT consider ourselves to be an"either — or" issue, in competition with the fertility industry. In fact, I am quite surprised at how few of our fans do not invest in a proactive inCYST consultation on deciding to go with IVF. If anything, we can help to be sure you are in the absolute best physical and mental condition to be in upon engaging in a physically and mentally challenging procedure. Just as an Olympic athlete would want to be nutritionally and physically ready for the big event, we believe partnering with us is good insurance that all of the money and stress you are about to encounter is worth the investment.

5. We DO NOT believe that there is a high success rate among women who do have lifestyle issues interfering with their fertility, who believe they can bypass the effort and inconvenience of changing that lifestyle with a medical procedure. You cannot fool Mother Nature.

6. We DO NOT provide false hope. That would be cruel.

7. We DO NOT pressure potential clients. Women with infertility are stressed enough as it is.

8. We DO NOT hang our celebrity clients out on a shingle as marketing tools. Celebrities need their privacy too.

9. We DO believe enough in what we do to be willing to work to create a research foundation to pursue our findings in a scientific fashion.

10. We have seen miracles, but we do not promise them.

We'd like to think we have a whole lot to offer you, but we won't chase it down. That is because the clients most likely to succeed with our program are not the ones we have to chase down and convince of our value. It's the ones who already believe in us.

We hope that this describes you, but if it is not, we respect the differences and truly wish you the best.

OK, I watched the interview. I've also been talking to women seeking infertility treatment for going on 10 years. I've heard the same story coming from Atlanta, Columbus, and Sacramento. In that time, I've also worked to create a program that serves as an alternative for those who could benefit. I think I've got enough observations under my belt to contribute an informed opinion about what goes on in the incredibly emotional, expensive, and at times, dangerous, world of reproductive endocrinology.

First and foremost, the fact that we can create babies in so many ways other than the one Mother Nature originally designed…is pretty much a miracle. It is a gift that we as medical professionals can provide this help. That's right, it's a gift. We should accept it with humility and treat it with respect. I never forget that. Every single time I have a new appointment, in person or on the phone, I pause to say a prayer,"God, your will, not mine." I take this work that seriously.

There are some incredible practitioners out there who do their work with respect and humility. However, because infertility treatment is, much of the time, not a medical issue that insurance will pay for…it is a huge money maker for those who practice it. Which means it also attracts individuals with reasons other than altruism for being in the business.

And it is those practitioners who, unfortunately, have pushed the science of reproductive endocrinology ahead much more quickly than those with a conscience have been able to formulate and communicate appropriate codes of ethics by which that science would best be used.

Let's look at how the dynamic develops.

1. You've got a woman who believes she's 100% normal in the reproductive department, who assumes that when the time comes, she'll marry, have children, and happily continue the cycle of life. She may go to the doctor for a routine physical or go because she's not been able to conceive after 6 months of trying. She's told she may have trouble having children. She may be told that she may not be able to have children. Or…as many of my own clients have shared, she may be told that there is no way she will have children without paying thousands of dollars to the man in front of her to make it happen. She has been told that, instead of creating a life with her significant other, in a loving and intimate environment, she must consent to an expensive, invasive, very sterile, and potentially humiliating procedure which can leave her feeling more like a laboratory rat than a beautiful woman and loving-mother-in-the-works. And the person who will be making this happen is not only not someone who loves her, but someone who's going to hand her a huge invoice at the end of the encounter.

2. The combination of desperation on one side of the room and greed on the other…is highly likely to not play out in a way that prioritizes honesty and integrity.

3. A very high percentage of the women I encounter in this work are intelligent and high achieving; everything they've ever wanted in life, from an education, a career, a home of their own, has been attainable with focus and hard work. So being told that one of life's most basic functions, fertility, may not be yours for the taking, becomes one of the most frustrating, confining, maddening, esteem-assaulting things they've ever been forced to ask to accept. The only thing left to throw at the situation is…you guessed it…money.

4. And because this population is so high-achieving and intelligent, they often have that money. Money that can pay for procedures they may not necessarily need. But that they are highly likely to spend because their desperation is being viewed as a profit center for the person sitting on the stool next to their examination table.

5. It just goes downhill from there. On almost a daily basis at this point, I have a conversation with someone who's been through this wringer who finds this blog, who wants help and has been so brainwashed into believing that her problem is so bad that only tens of thousands of dollars and a person with a certain diploma on the wall can fix it. Even when we put solutions and testimonials and support on this blog, completely for free, the sales job these women have been given is so complete and so convincing, dozens and dozens and dozens of women do not even give any other kindler, gentler, less invasive and dangerous option an iota of consideration. So they empty out their bank accounts. Sometimes they get a baby. Sometimes they don't.

When I do my PCOS trainings, I always invite women with the syndrome to come in and share their stories to those who want to help women who have this diagnosis. I do it because I want those who have no experience with the infertility world to understand just how much anxiety and depression their future clients have. They need to understand just how much compassion we owe them when they come to us for help.

Sometimes I sit and listen to the spiels these women have been given about what they must do (which invariably includes making a monthly payment on their physician's mountain home) in order to have a family. And I wonder why this guy bothered spending all the money to get a medical degree when he could simply have left high school and made much bigger fortune selling used cars at the parking lot down the street.

I reiterate, I have had the good fortune of meeting and working with many kind, compassionate, intelligent, and ethical reproductive endocrinologists. I am happy to support their work and the miracles they have been given the talents and power to create.

But I also have a lot of trouble with physicians who forget that they are not God. They are not even one step away from God. They're preying on insecurity and desperation that risks the lives of the women asking for help and the babies who didn't even ask to be part of the situation.

I'm not at all happy to hear this story coming out of California. But…maybe the fact that this happened will encourage more scrutiny of the entire reproductive industry as a whole. Maybe we'll finally work on a code of ethics to protect all of the lives involved. Those who do this work for the right reason deserve to shine and be rewarded. And those who would be better off selling Yugos…can be nudged into the polyester suits and those dusty, moldy offices on America's seediest of car lots.

If you have PCOS, and you’ve tried to get pregnant, you may have already discovered that you can add infertility to the list of “what’s wrong with my body.” Infertility often feels like one more failure of your body to perform as expected, and one more thing that feels out of control. There are actions you can pursue to shift your mind and shift your body, however:

Get out of denial – know the timeframes for diagnosing infertility (generally six months of trying without a successful pregnancy if you’re over 40; one year if you’re under 40). Know that infertility isn’t just a matter of stress or bad timing – although those can be contributing factors. Know that infertility is a treatable condition, but it takes finding the right medical team, and that may include some highly specialized people, like a reproductive endocrinologist.

Have your anger – infertility is definitely something to be angry about. You’re mad, you’re frustrated, you’re irritable, you feel deprived, you want what you want – something other people manage to have without even trying – and you are entitled to rant and rave about it. But don’t let anger become your primary way of experiencing your infertility. Take the energy that powers that anger and turn it towards a more productive experience.

Fully experience your regrets – as much as you can understand them in the moment, experience your regrets. These might include the fact that the romance and private experience of love and sexuality are separated from the process of reproduction. Perhaps it means acknowledging that you won’t have a biological child. Or it might even mean deciding that children are not part of your future, at least not right now.

Grieve what you need to grieve – this might include some of the regrets mentioned above, or whatever else you feel or define – loss of womanhood, loss of health, loss of a specific type of relationship. Get support for this grieving if you need it, from other women in the same situation, or from a professional counselor.

Refocus your dreams – now that you’ve moved out of the hope or fantasy of “accidental” or sort-of-planned pregnancy, cried, had your rage, and gathered some support, decide what’s next – assisted reproductive technology, adoption, surrogacy, or a child-free life.

Take action to achieve that dream – make sure you’re on the same page with your spouse or partner, if you have one. Do the research to find a great reproductive endocrinologist, a supportive counselor, a knowledgeable dietician, and any other resources you need. Join online support communities that are specific to infertility, just as you joined this PCOS-specific community. Make a plan – give yourself some general timeframes and budgets for what you are willing to do.

With luck, planning, focus, and support, you may well be able to achieve the family you’ve been dreaming of, in spite of infertility.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

One of the more frequent searches bringing readers to our blog is"vegetarian" and"fertility"…and"vegetarian" and"pcos". I've also noticed when doing Fertility Friendly Food Tours at Whole Foods, that a disproportionate percentage of women attending these classes, are vegetarian. And, in my individual counseling, it's not uncommon to learn during an assessment that if a client is not currently vegetarian, she was at some point in her life.

So I wasn't surprised to find this study reporting that women with PCOS tend to be deficient in vitamin B12.

I often teach that PCOS is a counterintuitive illness. By that, I mean that what often needs to be done is the opposite of what you might think. In this case, rather than immediately assuming that the most important strategy is to restrict food choices because your appearance suggests overnutrition, it may actually be to add foods back into your diet to correct underlying deficiencies.

This B vitamin is found almost exclusively in animal products, including fish, meat, poultry, eggs, milk, and milk products. It is also found in some fortified breakfast cereals, but if you're avoiding carbohydrates as well as trying to be vegetarian, you're likely not getting enough vitamin B12 in your diet.

Some fermented soy products, namely tofu, tempeh, miso, and tamari, may contain vitamin B12, if the bacteria, molds, and fungi used to produce them were vitamin B12 producing. This is a project I'll look into and blog about in a later post.

Finally, some nutritional yeast products also contain vitamin B12. Lucky for you Aussies reading this blog, that means Vegemite and Marmite, made from yeast extracts, can be excellent choices to include in your diet!

It is possible to obtain vitamin B12 by taking a vitamin supplement, but the amount of the vitamin that is actually absorbed through the digestive tract may be very low. For this reason, physicians who note a low vitamin B12 level may recommend an injection, to bypass the digestive tract.

Women over 14 years of age, if not pregnant, should be consuming 2.4 mcg of vitamin B12 per day. They should aim for 2.6 mcg per day when pregnant, and 2.6 mcg per day when breastfeeding.

It's clear, if you don't do vegetarian eating in a thoughtful, proactive way, it carries considerable health risks. As you've seen before in this blog, inCYST believes that healthy vegetarian eating is about what you DO choose to eat, more than what you DON'T choose to eat.

It is a good idea, if you're vegetarian, or ever have been, to ask your physician to check your vitamin B12 levels. A low status is easy to correct and that can be part of your strong foundation for managing your PCOS and improving your mood, insulin function, and fertility.

Kaya C, Cengiz SD, Satiroğlu H. Obesity and insulin resistance associated with lower plasma vitamin B12 in PCOS. Reprod Biomed Online. 2009 Nov;19(5):721-6.

It's not uncommon to read blog posts, tweets, and chat room conversations in which women with PCOS describe their depression, and attribute it to the weight gain and appearance that their PCOS has promoted. It can be easy to blame the discomfort, fatigue, restless, and anxiety that depression provokes, on tangible and unwanted physical changes

A recent study helps to verify what I've believed all along…that depression, like hirsutism, weight gain, and infertility, is another condition that PCOS has potential to create. It is not the result of other symptoms associated with PCOS.

Here's the study.

Thirty women with PCOS and thirty women without PCOS participated in this study. All subjects had similar BMI's/weights. Only women who were not on any psychotropic medication were included. Women with PCOS scored higher on an anxiety scale than women without PCOS. They also slept less, worried more, and experienced more phobias than women without PCOS. Weight was not associated with any of the symptoms, except for sleep.

In other words, regardless of your weight, you can be depressed if you have PCOS.

If you attach or blame your depression on your weight, your appearance, or your infertility:

--you can set yourself up for an eating disorder…if you actually lose weight and discover it didn't change how you feel.
--you can feel even worse if you spend time and money on cosmetic surgery, only to realize you don't feel as good as you hoped you would.
--you can put yourself through the tremendous stress of infertility treatment, and get the baby, only to discover that you still feel depressed, and now you've got a baby who isn't sleeping through the night who is dependent on you.

That's the bad news. The good news is that the inCYST program is very helpful at reducing anxiety and depression. So in addition to helping you normalize your weight, reducing the progression of testosterone-related programs, and increasing your fertility, it helps you to feel better. It literally rebuilds your nervous system so it can reduce the influence depression can have. And in rebuilding the nervous system, it helps to balance hormones so that symptoms can lessen.

We like to focus on feeling better, since we know that in women who do, the other problems tend to fall into place. That's not to say that being anxious about your PCOS doesn't worsen when you focus on your symptoms, and that when you learn better coping skills you won't feel even better. Gretchen Kubacky has done a great job of discussing that here, on her blog, and on PCOS Challenge.

It's just that you want to be sure you're tackling the core cause of the problem, and not simply putting band-aids on the symptoms. Nothing can be more frustrating than investing all your time, resources, and money into diets and medical procedures, only to feel the same or even worse once you've done so.

Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index

REFERENCE
E. Jedel1, M. Waern2, D. Gustafson2,3, M. Landén4, E. Eriksson5, G. Holm6, L. Nilsson7, A.-K. Lind7, P.O. Janson7 and E. Stener-Victorin8,9 Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index

1 Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden 2 Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 3 Rush University Medical Center, Chicago, IL, USA 4 Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden 5 Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 6 Department of Metabolism and Cardiovascular Disease, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 7 Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 8 Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 434, 40530 Gothenburg, Sweden

I can tell by looking at this blog's visitation statistics that a very high percentage of its visitors are looking for help with an immediate problem that has"hit them where it hurts", so to speak. You may have acne. Or want a child. Or be looking for a successful weight loss plan.

The fact is, however, that sitting in my seat, it is equally important to offer insight and solutions for those problems as it is to educate about the big picture.

The fact is, 10% of women with PCOS will be diabetic by age 40.

The fact is, PCOS increases your risk of heart disease and high blood pressure.

And…since diabetes is increasingly being associated with Alzheimer's disease, the fact is, you may end up being at risk for that as well if you're on this blog looking for help with your acne.

Fortunately, you don't have to do one thing for your fertility, another for your acne, and another to prevent Alzheimer's. All the suggestions you see here work to help all organ systems function better.

And the fact is, there is a whole lot you can do to decrease your risk of having any of the problems mentioned above.

The fact is, you can't decrease your risk if you don't take action. That part of the solution is totally in your control.

In this particular study, the alpha-linolenic acid (ALA)concentrations in fat tissue were evaluated in 1819 people. (ALA is a type of omega-3 fatty acid found in flaxseed, flaxseed oil, soybeans, canola oil, and nuts, to name a few.)

Individuals with higher levels of ALA had a lower risk of heart attack.

The fact is…if you cook more often with canola oil, eat more nuts, put some edamame on your next salad, and/or add some ground flaxseed to your next bowl of oatmeal, you just might experience the same benefits as the people in this study.

If it can't hurt and it might help, there doesn't seem to be a reason not to try at least one of those things!

Campos H, Baylin A, Willett WC. Alpha-linolenic acid and risk of nonfatal acute myocardial infarction. Circulation. 2008 Jul 22;118(4):339-45. Epub 2008 Jul 7.

As always, quality time spent with Cysters and inCYSTers humbles and inspires. Marie Mariano, RD, LDN, CDE, just shared a poignant life story about PCOS, infertility, miscarriage, pregnancy, and purposeful living that I encourage anyone who can relate to those words, to take the time to listen to. Thanks, Marie, for your gr ace, strength, and dedication. Hugs and love to you!

http://www.blogtalkradio.com/incystforhormones/2010/10/18/meet-marie-mariano-rd-ldn-cde-cyster-incyster-pcos-activist

Marie has been gracious enough to share her personal story to colleagues and women with PCOS, in an outreach that has supported many women with the same diagnosis. Having suffered with PCOS herself, Marie has made it her life’s mission to help women who are affected by this disease.

Marie Mariano has been a registered dietitian for 11 years. Youngstown State University in Youngstown, OH is her alma mater where she earned her B.S.A.S in Dietetics. Licensed in both OH and PA, she currently works as a clinical dietitian and outpatient nutrition counselor for Heritage Valley Health System in Beaver, PA. As a Certified Diabetes Educator, she specializes in Diabetes, Gestational Diabetes and Polycystic Ovary Syndrome.

In addition to her clinical work, Marie is the founder of Hannah's Heart Ministries, an organization dedicated to serving those grieving through infertility and pregnancy loss.

We'll be chatting with Marie about her personal story, as well as the work she does through Hannah's Heart. It is sure to be an inspiring hour of conversation!

This show will air on Monday, October 18, 2010, at noon Eastern, 11:00 am Central, 10:00 Mountain, and 9:00 Pacific times. It will also be available for listening in our archives after the live session, at the same link listed above.

For some reason, I have been placed on the mailing list for a fertility researcher in the UK who is doing some interesting work looking at how fertility doctors conduct their treatments around the world. I actually tried to answer his survey, but since none of the choices available to me had anything to do with changing diet and lifestyle, I was not allowed to complete it.

That is something I find very interesting, that it would not even occur to a fertility specialist to consider the nutritional status of the client and the nutritional interventions provided clients as important variables to consider. Dr. Balen, if you ever wish to consider those factors, now you know where I am.: )

Anyway, I thought the readers of this blog would find some of the results of this study to be interesting. I'll put my commentaries in italics.

This is a summary of 179,300 IVF treatments conducted in 262 fertility centers on every continent where there is a fertility center…meaning Antarctica was not on the list.

1. 73.3% of these cases were assessed for impaired glucose tolerance. That means that 26.67%, or 47,694 women, were not.
--I would be interested to see the geographic distribution of these answers. Several years ago, I moderated a listserve in Spanish for women with PCOS and it was rare in that group to hear of women being treated for insulin resistance. I actually had to go on strike and refuse to give out any more information until the women in the group who had not been evaluated, got the evaluation. About three months later, we had about 6 pregnant women amongst us.: )
--Not sure why, since PCOS has such a strong connection to insulin resistance and it is the number one cause of infertility, this assessment simply is not a universal precaution?

2. 61.3% of the physicians who chose to assess for impaired glucose intolerance were only doing so in obese patients.
--Here we go again, the invisible lean cyster. If up to 70% of women with PCOS are NOT obese, consider the number of infertility cases that are made more complicated than they need to be, simply because of a misperception of what PCOS has to"look like" in order to be taken seriously.

3. 69% of the physicians surveyed, in their PCOS patients, considered clomiphene citrate to be the first line of treatment.
--I would love to know how they would have answered this if they had been given the option of nutrition/lifestyle/sleep hygiene consultation had been an option to answer.

4. Cutoffs for treatment based on BMI:
30% would not treat if BMI was greater than 30
33% would not treat if BMI was greater than 35
20% would not treat if BMI was greater than 40
6% would not treat if BMI was greater than 45
--Which has me wondering, again, why nutrition/lifestyle/sleep hygiene consultations are not considered the absolute essential first line of treatment.

So lean women, apparently, even though their BMI's would be considered appropriate by these practitioners, would not be given the assessment that would help them get the proper treatment.

And obese women, apparently, are not given any direction regarding what to do to bring their BMI into a workable range.

If you're still wondering why your patients with PCOS can be so angry, skeptical, and emotional, maybe you would have better success with an accounting career.

Imagine how much more successful my colleagues in these 262 treatment centers would be if they partnered with professionals who know how to do something about those quandaries.

We'd love to help you improve on those statistics.

The invitation is open.

Source: PCOS – Definition, Diagnosis and Treatment, a survey compiled by Prof. Adam Balen, Leeds Centre for Reproductive Medicine, Seacroft Hospital, Leeds, U.K

I was just on a website for a local naturopathic physician who specializes in women's health and reproduction. She is well known in our area for her success with challenging conception situations. I love to refer to this particular naturopath because she is so skilled and compassionate.

I'm pasting some excerpts from her testimonials page.

"It was hard to hear from the MD's that I would not have a baby unless it was in-vitro…"

"I was told I was facing early menopause and may need an egg donor to conceive a child. When faced with paying more than $14,000 out of pocket per IVF attempt, which offered a 20% success rate and no guarantees, enough was enough."

"My reproductive endocrinologist told me I had little or no chance of conceiving a child. He told me if I wanted to try to conceive with my eggs, we should do IVF immediately, even though we had less than 10% chance of success."

These are all women who became pregnant when they decided to not listen to that advice and seek help elsewhere.

I hear these stories too. Sometimes I have a very hard time with the reproductive industry, despite the miracles they've created, because they often seem to prey on the desperation that can develop when a baby isn't easily created. They can make you feel like the problem is that something is wrong with YOU.

In many cases, the real problem to the doctor is that you're not giving him/her your money quickly enough!

What other service would you be willing to spend so much money for with so little guarantee of success?

I am so excited about what inCYST is learning and the success stories we've been able to be a part of. But what I'm still trying to understand is the psychology of the infertile woman. I offer classes for $15 apiece. That's about the cost of a copayment. That's a smoking deal compared to an in vitro procedure. Sometimes I even do them free of charge. But women I invite, often politely tell me, thanks but no thanks, I've made an appointment with my fertility doctor. I'll try that first.

One woman recently shared that even though she paid for the class and didn't show, she decided to go through in vitro. She ended up having to quit her job, because she could not manage the stress of the treatment along with her work responsibilities. She's pregnant, now, which is the good news. But she's financially challenged, to the point where she's asking me for free help. I'm not sure if that is success or not? And at that point, whose responsibility it should be that a $15 resource has become too expensive?

If you have two choices for earning money, one being interest in a bank account and the other being money won playing blackjack in Las Vegas…and you politely tell the banker thanks but no thanks, I'll bring you my Vegas winnings and I'll earn interest on that…and you lose your shirt in Vegas…do you think the bank is going to give you money to put in a savings account? Probably not. You have to make good decisions in advance.

It seems to me that the most important time a nutritional tuneup should be considered is precisely WHEN you've decided to invest in IVF. If it were me, I'd want to be absolutely sure that the environment I am giving my physician to work with when being paid to help me, is the healthiest, most balanced, most receptive to successful conception and pregnancy. What better preparation for success could you offer your reproductive system than nutritional health?

I know there is a huge difference between what you'll get in an inCYST consultation vs. what a physician provides. We're definitely going to ask you to make some changes. We're here to support, to encourage, and to point you to ways to make the new changes livable. Unlike a physician's visit, where most of the hard work is done by the doctor, we will ask YOU to do some things. We don't believe anything is wrong with you. We believe that life on planet Earth has its stresses, but if you learn how to manage them, hormones cooperate. Very simple.

We're not an"either-or" kind of choice, at all. We are not the only answer out there, and we are not ever going to eliminate the reproductive endocrinology industry. In fact, I think there are a lot of opportunities, when working together, for us to help increase some of those dismal percentages I quoted so the doctors have higher success rates as well!

Just a note, a friend just e-mailed me to tell me that this very topic was featured on the Today Show today. I Googled the website for the Fertile Soul, the program featured in their segment. Even their fees are high--as much as $12,500 for a couple to attend. I want to reassure anyone coming to this blog looking for help, I want to help people, and I do need to pay my bills, too, but our program is not about depleting anyone financially. Our one day couples spa program is only $350.

It just seems to me like when you have a choice between paying several hundred dollars and several thousand dollars, and you're seeing indications that the least expensive option may actually work, that you'd start low and work up the pay scale, if and only if needed.

I'd love it if this post inspires you to think differently. Sometimes medicine works and sometimes it creates miracles. But sometimes medicine has its limits. Why not try an inCYST provider or class or retreat and see if it gets you going in the right direction?

FOR IMMEDIATE RELEASE:

New Infertility Program Puts Mother Nature Back Into The Equation

Phoenix, AZ and Marina del Rey, CA (August 19, 2008). Monika M. Woolsey, a registered dietitian, knows the story well. “Can you please help me? I failed fertility treatment, and I’m desperate for a baby, but I’m emotionally and financially exhausted.” She finally decided to do something about it. During ten years of specializing in infertility, she used her training in nutrition and exercise physiology to create a lifestyle program that naturally balances hormones. She’s trained a few dozen colleagues in the concept, and they’re confirming her findings—a few simple tweaks in diet and lifestyle can greatly enhance fertility.

Michele Gorman, MS, RD, LD, of Twin City Nutrition in Minneapolis, trained with Monika. “My client who was trying for over 2 1/2 years, tried in-vitro fertilization, and was working with one of the best reproductive medicine clinics in the city. She was sophisticated and well educated on treatments for fertility, however after 2 1/2 years she found herself depressed, exhausted and believing that she would never conceive. She never had any expectation that she would leave my office with a plan to promote ovulation, but that day we did exactly that and at her 5-week visit, she shared in tears that she was PREGNANT!”

The results from this program have been so profound that Gorman and Woolsey, along with dietitian Susan Dopart of Santa Monica, are now setting up their first research study to officially document their findings.

In the meantime, Woolsey has created a day spa, Fertile Intentions, for couples who would like to learn more about a natural option to try either as a first step or as an adjunct to traditional medical treatment. The first event will be Saturday, October 25, 2008, at Creative Chakra Spa in Marina del Rey. In addition to teaching the science and application of this program, this day spa will focus on emotionally supporting couples whose pursuit of familyhood has started to erode their relationship.

“The entire day is filled with information and experiences completely devoted to the COUPLE. And how that couple can live, relax, and communicate in ways that promote better balance all around. If the goal is to bring children into this world, as much as possible, I want those parents to be happy and excited, not completely exhausted when it finally comes to be,” says Woolsey.
For further information on Fertile Intentions Couples Day Spas, visit www.afterthediet.com/fertileintentions.htm

Contact:
Monika Woolsey, MS, RD
Fertile Intentions Couples Day Spas
www.afterthediet.com/fertileintentions.htm
marika@google.com
623-486-0737
###

I'm going to be a little less active for about a week here, but it's for an important reason that will hopefully serve at least a few of you who regularly visit my blog!

For the past few years I've been training colleagues around the country in some of the practical aspects of using nutrition to help with fertility. The colleagues I've been working with, as we've gained an understanding of how it all fits together, have been reporting some wonderful success stories in clients who had been told they might never have a child of their own.

As we've grown as a network, we've gained the attention of sponsors, and one of those sponsors, Nutrabella, approached me about collaborating with them to contribute to a fertility report that will be appearing in East Coast newspapers this coming Friday--the Washington Post, Wall Street Journal, and Boston Globe, to name a few. Another sponsor, SGJ Consulting, contributed to the project as well. It's been a great team to work with from start to finish!

That kind of opportunity has the potential to reach quite a few people (2.1 million is what has been projected)! So I've been busy making sure we're ready to handle the traffic and that everyone who's been going through my training is ready to take referrals.

If you know of anyone who is struggling with infertility, please tell them we have several resources:
(1) this blog, of course!
(2) individual consultations. Many of the professionals listed on this page do contribute to this blog.
(3) Fertile Intentions (TM), our new couples infertility spa day experience, in Marina del Rey, California.

This is such a great audience with whom to share the message that there are many options outside of medication for helping with fertility.

I'll be back in about a week, hopefully with some exciting updates, and definitely with more comments on nutrition and mental health. In the meantime, I'm hoping other contributors have some helpful hints and interesting notes!

Have a wonderful rest of August in the meantime!

When working with women who desire very much to conceive, it can be challenging to help them understand the big picture. They want a baby…they want it NOW…and if that's not something you can promise…well, there are a gazillion other people out there who will gladly take their money if they say what these women want to hear.

We're establishing a pretty good track record when it comes to fertility help, but what I want to be sure everyone understands, who comes to this blog, is that we're equally concerned about your long term health, and preventing infertility in the babies you might have.

One of the patterns I'm seeing when evaluating clients, is that they were either formula fed, or breast fed for a short time before being switched to formula. Yes, what happened to you as a child can definitely affect your fertility. We can do a pretty good job of playing catch up, but if you only play catch up long enough to become pregnant, then go back to your former way of eating, you're setting up your babies to have similar problems in THEIR adulthood. Knowing what you've likely gone through yourselves…why would you wish that on anyone? Especially your own child?

So even though you may not really be thinking about the fertility prospects of the baby you may not even have yet, I'm encouraging you to think long-term and big picture. Here's an example of research that tells you why I'd do that.

Seventy-seven healthy babies born to term were compared to each other based on the following: (1) breast fed longer than 6 months, (2) breast fed between 3 and 5 months, and (3) exclusively formula fed.

Baby's DHA levels (that's the omega-3 found primarily in fish oil and marine algae) did not differ much at birth, but DHA significantly decreased between birth and the first year of age in babies who were not breast fed. The researchers concluded that breast feeding for at least months is what is required to prevent this decline.

Because every milligram of DHA a baby gets in breast milk comes from mama's personal supply, it is crucial that mama's diet be adequate in DHA throughout nursing. Fortunately, the very diet we've been encouraging you to consume to become pregnant and stay pregnant…is the diet that facilitates this process. It wasn't that you were healthy and just needed a little push to become pregnant. You were out of balance, and the way you chose to eat restored that balance. Once you get there, the goal is to maintain balance, not go back to being out of balance because you've achieved your important goal and want to get back to the easier way of doing things.

It's about your pregnancy, your baby's health, your brain and baby's brain. And it's not really that hard. Hopefully we're helping you to see that.

Sanjurjo Crespo P, Trebolazabala Quirante N, Aldámiz-Echevarría Azuara L, Castaño González L, Prieto Perera JA, Andrade Lodeiro F. [n-3 and n-6 fatty acids in plasma at birth and one year of age and relationship with feeding.] An Pediatr (Barc). 2008 Jun;68(6):570-5.

If you've been thinking about coming to our getaway, August and September are your chances to take advantage of the low season rates.

Informational classes, massages, rooftop yoga, healthy eating, meet and greet with local fertility-friendly companies…it's a great chance to step off of the infertility treadmill and regain perspective.

Many couples DO conceive with what we teach them. For those who don't…a jumpstart into healthy living that can ready you for more intensive treatments is definitely a good investment into yourselves.

If you're interested in seeing the full-size version of this brochure, write me at marika@google.com, and I will forward it.

We hope you can come!

Registration information can be found at www.afterthediet.com/fertileintentions.html.

I hope I got your attention! Because, yes, algae can be a very important part of a diet for PCOS.

It's becoming increasingly clear, as our baby counter ticks up and up and up, that omega-3 fatty acids ARE the answer for a lot of women out there who may not have found fertility success.

But I also know, from being in this business for over two decades, that there are some people, no matter how much you tell them that fish is good for you, simply aren't going to eat it. Whether it's because of taste, allergies, or vegetarian practices.

That's where algae comes in. The innovative people at Martek Biosciences have been culturing a species of algae, Crypthecodinium cohnii, that is naturally high in DHA, one of the omega-3 fatty acids. Don't worry, I stink at Latin, too. Just remember,"omega-3 algae" and you have all you need to know.

Martek has figured out how to take this algae, extract the DHA, and put it into a form that can be incorporated into foods that you and I actually eat. The examples I found today on Martek's website include (in alphabetical order):

Beech-Nut® Stage 2® DHA plus+™ Jars — a product of Beech-Nut
Beech-Nut® Stage 2® DHA plus+™ Cereals — a product of Beech-Nut
Bellybar™ Nutrition bars — for pregnant and nursing women from NutraBella Challenge Dairy Spreadable Butter — a product of Challenge Dairy
DHA plus+™ Yogurt Blends with Juice — a product of Beech-Nut
Crisco® Puritan Canola Oil with Omega-3 DHA — a product of the J.M Smucker Company
Fujisan Sushi — a product of Fuji Foods Products, Inc.
Glucoburst™ Diabetic Drink — a product of PBM Nutritionals Gold Circle Farms® Eggs — a product of Hidden Villa
Horizon Organic® Milk — a product of WhiteWave Foods
Kids-Pro Nutrition Drink — a product of British Biologicals
Little Einstein's Disney Milk — a product of Stremick's Heritage Foods
Minute Maid® Enhanced Pomegranate Blueberry Juice — a product of the Coca-Cola Company
NuGo Organic Nutrition Bar — a product of NuGo Nutrition
Odwalla's Soy Smart™
Oh Mama!™ Nutrition bars — for pregnant and nursing women from Vincent Foods, LLC Oroweat Whole Grain 9 Grain Bread — a product of Bimbo Bakeries USA, Inc.
ProSource NutriPure Supreme — a product of ProSource
Rachel's® brand, Rachel's® Wickedly Delicious Yogurt — a product of WhiteWave Foods
Rico's® Cheese Sauce — a product of Ricos Products Company
Silk® Soymilk — a product of Whitewave
So Good™ Omega DHA Milk — a product of Soyaworld
Stremicks Heritage Foods™ Organic Milk — a product of Stremicks Heritage Foods
Vitasoy® Soymilk — a product of National Foods
Yoplait Kids™ — a product of General Mills
ZenSoy Soy on the Go™ — a product of ZenSoy
Yo on the Go® — a product of Whitney's Foods, Inc.

Bottom line, if you can't or don't do fish, you can still do omega-3's.

One note, it's still important to have a diet that overall, is balanced in fat, carbohydrate, and protein. So if you're loading up on one option here that is sweetened, you may not get the optimal effect of the DHA. It might be worth downloading this list and showing it to your dietitian so the two of you can work out a game plan that incorporates these foods with the best chance of benefitting from them.

I am expecting:) Love that fish oil! I am only about 6 weeks but am ecstatic — --Thank you so much I really appreciate your help.

--I am sky high right now

---the non-ovulating mother of soon to be 3:) Love those miracles --or in this case fish oil

Note from Monika: When I count back, this success story apparently happened within 10 days/2 weeks of our consultation.