Is There an eXXception for Those without the Double XX?

/in /by

You’re not seeing things…we at Truly, MD, are turning our pens and paper towards the guys. While everything up to this point has been girl (or what you need to know about your plus one if he’s a guy)-related, we are breaking the mold and making this piece about men. Specifically, what happens when you have double the sperm and no eggs (a.k.a. same-sex male couples). And while the options may seem limited or even impossible without two key baby-making ingredients (eggs and uterus), there are ways to work around this.

Where do you find an egg(s)?

Close your eyes, and take a trip back to your childhood—specifically an Easter egg hunt. And while it may be a bit hazy at first, you can probably remember searching and collecting dozens and dozens of eggs. And although your brother, sister, or BFF may have come in at a slightly higher egg count at the end of the day, everyone made out pretty well (and consumed lots of chocolate). Finding an egg donor that is healthy and fertile while also possessing the characteristics (e.g., ethnicity, race) and traits (e.g., artistic, athletic) that you and your partner desire in a donor is just the opposite.

The screening process is intense—physical exam, personal and family history, blood testing, ultrasound, and genetics. Bottom line, there are many hurdles that must be cleared before an egg donor is cleared to give her eggs. Egg donors can be anonymous or directed (a.k.a. known). While most couples opt to go the anonymous route, whom you select is up to you and your partner. However, whomever you pick will need to go through IVF to extract her eggs.

Where do you find a uterus?

Finding a uterus (that is, a gestational carrier or a surrogate) can be laborious (no pun intended)! It is a big decision for any woman to make, and therefore, finding a woman who is willing and able can take a lot of time and a lot of resources. Just as there are for egg donors, there are agencies and attorneys who focus on identifying gestational carriers. Getting hooked up with one shortly after you get hooked up with your plus one is a good way to start the process.

Where do you find sperm?

While this question might seem somewhat misplaced (are they kidding me?), deciding whose sperm to use and when can be a bit complicated. If both partners want to provide a sperm, then you must decide whose embryo(s) will be transferred and when….

Today, parenthood is possible no matter who your partner is and what you are “lacking.” And although you may be missing one or two of the core “necessities” (eggs, uterus, or sperm), you already have the most important core necessity for parenthood—a major desire to be a parent. So don’t worry about the rest. That, we can help take care of!

No Y, No Way? How to Achieve a Pregnancy in a Same-Sex Relationship

/in /by

Long gone are the days of June Cleaver, her dress and pearls, and her white picket fence. Nowadays, the face of families has had a major facelift. Two mothers, two fathers, working mom with a stay-at-home dad…it has all changed. Kudos to choice and change! But while you can mold your family to take whatever shape you want without an egg and sperm source, you will need some outside help manipulating the “clay.” Cue your friend, the fertility doctor.

While all pregnancies require an egg, a sperm, and a uterus, how these three sources meet and where they come from can be quite variable. It is our job (a.k.a. that of the fertility specialist) to help make these necessary introductions and ensure that, from this meeting, comes a baby!

The first order of business when we meet with a same-sex female couple is to figure out preferences and timing. Simply stated, do both partners want to give an egg, do both partners want to give a uterus (a.k.a. carry), and if so, when? And taking it one step further, do both partners want to carry their own genetic child or their partner’s genetic child? (Don’t worry if this sounds confusing; we will explain!) We then use this information to formulate your fertility plan. Here’s how.

Timing is not only everything in relationships but also in family planning. Which partner should go first (#getPREGNANT) is not only based on personal preference but also on medical factors (egg quality, egg quantity, and uterine receptivity). Therefore, before any final decisions are made, it’s a good idea for both partners to visit a fertility specialist and get checked out.

What your MD finds might have a major impact on what fertility options are available and in what order. For example, if you are 35 and your partner is 38 but your ovarian reserve is approaching that cliff (a.k.a. about to take a sharp decline), we may recommend that you go first in the pregnancy process. On the flip side, if your partner is 40 and you are 30 and you were hoping to have your little one before 31, we will probably recommend that you put your baby button on pause and let your partner go first. Nuances like this are not apparent unless you get down to the nitty gritty (blood work, ultrasounds, and a full exam) with a fertility doctor.

After you have been checked out, there are a few options for you to check out. Unbeknownst to most, there are a couple of ways (other than the obvious) to get egg and sperm to meet. These include inseminations (IUI) or IVF.

And the variety doesn’t stop there. When it comes to IUI, you can do it as bare bones as possible (a.k.a. time the inseminations to when you are ovulating) or add medications to boost your fertility (e.g., Clomid, letrozole, gonadotropins). Which route you choose to take is often made after recommendations from your doctor. If IUI isn’t working out, we might recommend that you amp it up a bit (#IVF). If other medical issues exist (low egg reserve, advanced maternal age), we may suggest skipping IUI altogether and going right to IVF.

In many ways, same-sex female couples have the most options on how to make and carry children. Let’s face it: although you may be at a loss for sperm, you have double the eggs and double the uterus. This doubling will come in very handy when mapping out how you want to enter motherhood. The reason is that, if you want, you can switch things up. You can carry the embryo created with your partner’s egg and donor sperm, and she can carry the embryo created with your egg and donor sperm. It’s a unique way to build a family, though it requires IVF, creativity, and cash. (We too believe the lattermost is unfair. We have added our voices to the fight against insurance inequities!).

Think about a cake. While the core ingredients are always the same (think flour, sugar, and butter), there is more than one way to mix it up (add cinnamon, nutmeg, or chocolate chips). The same goes for building a family—although you need those core ingredients (an egg, a sperm, and a uterus), how you combine these three can vary. Today’s family should have the flavor and flair of you and your partner—rigid guidelines are “rotten.” Anyone who tells you otherwise has way passed his or her expiration date.

Am I Ready to Be a Parent? Single Parenthood

/in /by

Of all the questions we ask ourselves, “Am I ready to be a parent?” is probably the biggest one (followed by “What should I wear on that first date?” and “Should we go for dinner or drinks?”). But all kidding aside, knowing when the time is right to become a parent can be downright difficult. Even us non-lawyer types can convincingly argue both sides and sway even the toughest of juries (ourselves, our besties, and our family) to see it our way. Add to that deciding to go at this on your own, and the decision can be even more difficult. When embarking on single parenthood, you need to think about things like sperm source, fertility medications, inseminations, and ultrasounds. Sorting this stuff out can make even the most level-headed among us a little loopy.

But just like any legal battle, evidence is needed before a decision can be made. And to get to that decision, it takes time, research, and a whole lot of effort! Deciding if, when, and even how to have a baby without a partner is no different. It takes a lot of thought and evidence before you can reach your decision. And although it is unlikely that we will be sitting with you when your personal verdict is delivered, we can offer some advice on how to craft your argument about if single parenthood is right for you (#PROSandCONS).

PROS

  • You are ready to be a mother. You don’t want to freeze your eggs and think about becoming a parent in the future but are ready to become a parent (without a plus one) today.
  • You no longer want to wait for someone else to do this with—you are pretty sure that you can do this on your own.
  • You spoke with a fertility specialist, reviewed all options, and are cleared for pregnancy (a.k.a. you are in good health, your reproductive organs ready, and you have selected a sperm source).
  • You have thought about your decision for a while; it was not made in haste.

CONS

  • You are not physically your best you. While most of us can tolerate pregnancy (aside from the back pain, the constant urge to pee, and the swollen hands and feet), there are some medical conditions that preclude us from getting pregnant. Although most of them can be fixed (blood pressure can be controlled, diabetes can be regulated, and seizure medications, changed), it is super important that you deal with all of this before you get pregnant.
  • You are not financially stable. Kids cost money! And while you certainly don’t need to be a billionaire before you bring a baby into this world, you do want to make sure that your financials are in order before you start a family.
  • You are not emotionally ready. Children require A LOT of attention and time. They are pretty much all-consuming all of the time. Make sure you are ready to give of yourself to someone else before you go all in.
  • While you want to be a parent, you don’t want to be a single parent by choice.

Odds are that, although our list may not match your list, there is probably a good amount of overlap. Minus the few additions or subtractions, at the heart of it lies the big question: “Are you ready to do this on your own?” And while we as physicians can’t tell you which way your “jury” will go (a.k.a. are you ready to do this?) we can tell you if your uterus, your ovaries, and your body are ready do this.

Furthermore, no matter how long that list is, we can assure you that while you may be thinking of this as single parenthood or as “having a baby on your own,” you are really never alone. You have friends, you have family, you have your fertility team, and you have an entire community of individuals who have also become single parents (many who are eager to share their experiences and offer advice). Go and speak to your OB/GYN and/or a fertility doctor—they can not only provide you with the information about the process but also help you make this baby thing happen.

We will make this closing argument brief. If you want to be a parent, you can become a parent. The modern family has many different faces. Find out what you want yours to be, and shape it. In this courtroom, you write your own verdict. While the process of becoming a parent may take a slightly circuitous path, with a knowledgeable physician and a good support system, you can certainly do this—case closed!  

My Vote Doesn’t Matter, Anyway: Why Not Caring About Your Reproductive Health Is The Worst Thing You Can Do!

/in /by

Apathy stinks. No matter what you are apathetic about: your job, your partner, your country’s politics, or your body, it is a major bummer. And while it may seem a long way away, you should not only care about things that affect your world but also things that affect your womb. Unprotected sex can lead to some pretty unpleasant things (a.k.a. sexually transmitted infections—think gonorrhea, chlamydia, syphilis, HIV, and herpes), which can cause some pretty serious damage to your fertility (specifically, your fallopian tubes) down the road.

So, here’s why your vote matters.

Sexually transmitted infections are no fun. But unfortunately, they are sort of frequent. Approximately one in four women will be diagnosed with an STD during their lifetime—and given that many who contract an STD never seek treatment, this number is likely a lot larger. In fact, there are about 19 million new cases reported every year in the United States.

The problem with STDs is not only the possible itching, burning, and oh-so unpleasant discharge but also the long-term effects like chronic pelvic pain, scar tissue, and infertility. Infections like gonorrhea and chlamydia can leave a mark that even the best of treatments can’t erase. However, the earlier you seek treatment, the less the negative impact will be. Therefore, don’t be shy about sharing your secrets with your doctor. We never judge!

While prevention is the key (think condoms), sometimes the door has already been opened—think sex without condoms. In this case, curtailing what could potentially happen next is the goal.

Lesson 1, share everything with your doctor. Make sure we know what you are doing and whom you are doing it with.

Lesson 2, if it is a new partner or one that you are not in a monogamous relationship with, you should undergo STD testing.

Lesson 3, while many sexually transmitted infections don’t announce themselves: “Hello, my name is Chlamydia, and I am here to annoy you,” if you are experiencing atypical symptoms (abnormal vaginal discharge, abdominal/pelvic pain, vaginal itching, or burning and fever), you need to go and get things checked out.

Lesson 4, use your voice to effect change. If you test positive for an STD, make sure to share this with your partner(s). They too will need treatment; you don’t want go into the ballot box on this decision alone. Be vocal about what’s going on with anyone who too is at risk.

Lesson 5, don’t take shortcuts when it comes to your course of treatment. Some antibiotic regimens can be lengthy and can require commitment in the form of a couple of weeks. Finishing what you started in terms of medication is mandatory to make sure you have rid yourself of these unwanted guests.

Lesson 6, while STDs come and go, even those that are treated can leave their mark in the form of scar tissue and tubal damage. Therefore, while we don’t recommend you wake up each day remembering the STD you contracted five years ago, when you start thinking about starting a family, you should consider seeking fertility assistance early in your fertility journey. Making the acquaintance of a fertility doctor early can make the path from potential parent to parent much shorter and smoother.

Not caring about what happens is a bad thing. Your voice and your vagina matter (spoken like true gynecologists!). The decision you make today can affect your health and your fertility in the future. While you may not walk out of the GYN’s office with a sticker that says, “I got tested for STDs,” you will get a clean bill of health.

And although this does not ensure that when you are ready to have a baby it’s smooth sailing, it does increase the chances that things get off to a good start. Giving up on yourself, particularly your health, is not an option. So, get out, and vote for your future. In this election, it’s a victory either way!

WHO’s Infertile? Why it May No Longer Take a Year of Unprotected Intercourse to Make the Diagnosis.

/in /by

Before you reflexively nod yes or no and start to sing the lyrics to the Madonna song “Who’s That Girl,” take a minute to consider what we are asking and why. We are not asking because we want to rub salt in a wound for those with infertility or remind those who are going through fertility treatments how painful it can be. We want WHOever to know that the WHO (better known as the World Health Organization) has changed the definition of infertility. And while it may not make the cover of the New York Times, it is a testament to our times, and it’s about time everyone knew about it. So, take some time to hear what WHO has to say.

The times, they are a changing. Single men and single women as well as same-sex male and same-sex female couples have traditionally been barred from using their insurance’s fertility benefits because, by definition, they were not infertile (a.k.a. they had not failed to conceive a pregnancy after 12 months of regular unprotected intercourse). No matter how difficult it was to “do the deed” to declare them fertile (or infertile), they were repeatedly denied coverage for fertility treatments. Lack of monthly “exposure” to the opposite gamete, that is, an egg or sperm, put them at a lack for “access” to what they had paid for month after month in their premiums: unfair (to say the least). But you know, WHO was listening and is doing something to change it.

In early October (2016), the World Health Organization suggested that infertility be amended in a major way. Rooted in a desire to give every individual the “right to reproduce,” the WHO has changed the diagnosis from a straight-up medical one (one year of unprotected intercourse without a pregnancy) to a social one as well (no partner or a partner without the necessary gametes). Those without access to eggs or sperm (single men, single women, or same-sex partnered couples) are also infertile and deserve every opportunity to become a parent.

And while you may not know or care to know who the WHO is, it is WHAT they have to say that can be world changing. We take our hats off to those WHO have pushed the notion of fertility equality forward. Recognizing that no access to the opposite gamete is no different from repeated unsuccessful attempts with the opposite gamete, would expand who can be parents and who can’t. WHO can argue with that?

Pot and Pregnancy: Is It Okay to Puff When Pregnant?

/in /by

Marijuana use has become fairly widespread. Pot, hashish, ganja, dope: it’s all over. The legalization of marijuana in many states across the country has made lighting up as acceptable as having a drink; people can routinely be seen puffing in public in places like Colorado and Washington. In fact, to date, 23 states and the District of Columbia have legalized marijuana in some form (medicinal and or recreational use). Many more states have decriminalized the possession of small amounts of marijuana; taken together, pot is now fairly prevalent. It’s no longer something sold surreptitiously on a street corner. Given this, use during pregnancy and the postpartum period (specifically while breastfeeding) has become a more commonly asked question. So we are here to answer the question: can you toke during any trimester?

As you probably predicted (sorry to be a buzzkill for those who are fans), put your lighter down. Marijuana use in pregnancy is not kosher. Legal or not, it’s most definitely not legit in pregnant women. Cannabis sativa (Latin for marijuana) is the most common illegal drug used during pregnancy. About 2–5% of pregnant women report using it during pregnancy. (And if this is the number of patients admitting to it, think about how many more people are not copping to it!) In fact, about 50–60% of marijuana users continue to use during pregnancy. Whether you think of marijuana as the gateway drug to evil or the contrary and celebrate its legalization, you should realize it’s not okay in pregnancy or while breastfeeding (even when being used for medicinal reasons).

Animal models designed to test the impact of marijuana use in pregnancy have shown that the active ingredient in marijuana (tetrahydrocannabional, THC) does cross the placenta. Studies show that use during pregnancy can disrupt normal brain development. Children who were exposed to marijuana in utero had lower cognitive function, impaired visual-motor coordination, and lower scores on tests of visual problem solving. Furthermore, prenatal marijuana exposure was associated with decreased attention span and behavioral problems.

While brain development, behavioral problems, and attention span may be affected, the impact of “smoking up” during pregnancy has not been linked to structural anatomic defects (birth defects and other abnormalities in organ development). Additionally, there does not appear to be an increased risk of infant mortality among mothers who used marijuana during pregnancy. Lastly, the data do not demonstrate a consistently higher risk of preterm delivery or growth-restricted babies (medical term for small babies).

It is also important to remember that, while pot can be ingested (a.k.a. pot brownies), it is most commonly smoked. Smoking, whether it is marijuana or cigarettes, results in the release of really bad toxins. Newsflash: the levels of such toxins in joints is actually several times greater than in tobacco smoke. While this is not meant to be a prescription for eating rather than smoking your marijuana, it is important to remember that you are doing double negative duty to your baby on board when you smoke pot.

The data on breastfeeding and marijuana use are sparse. While THC has been observed in breast milk, the effect of its use on breastfeeding babies is limited. Given this, we recommend abstaining until nursing is fully completed. Simply stated, TLC does not equal THC! In addition, while marijuana is prescribed for select medical reasons, it should not be used for such purposes during pregnancy. According to the FDA, there are “no approved indications” for marijuana use during pregnancy and lactation.

If you happened to puff while pregnant but you didn’t know you were pregnant, it is not an indication for termination. Be honest with your OB/GYN about what happened so that the appropriate assessment can be taken. Whether it’s legal in your state or not, we are not here to lecture or lionize you for your personal practices when you’re NOT pregnant. However, when you’re pregnant or breastfeeding, we are here to say you should most certainly lay off the pipe. No matter how chill it makes you, it is not cool in pregnancy!

Sleepless Nights, Sleepless Days

/in /by

There is probably nothing more exhausting than taking care of a baby (and this is from two girls who completed OB/GYN residency, working 80+ hour weeks!). A newborn trumps everything. There are no shifts, no sign out, and often no relief, which means there are many days with NO sleep. The fatigue you are feeling is like nothing else. And while we don’t have a degree in sleep therapy, or sleep training, or even come close to being baby whisperers, we do know what it feels like to be a new mom. Here, we offer a few tips on how to tackle your tiredness.

  1. Get Out of the House
    When all you want to do is lay down and close your eyes, it may seem somewhat odd that we are suggesting you do just the opposite. Take a shower, get dressed, get out and move. Getting some fresh air and boosting your heart rate a bit can make a big difference in your energy level and your mood. A short, brisk walk not only will help clear your mind but it also might help your baby go to sleep—now that’s efficiency!
  2. Remember to Eat AND Drink
    Food and drink are your friends. While you may not have time to whip up anything fancy, you do have time to chow down on a bowl of cereal or a PB&J sandwich. Additionally, invest in a water bottle, and every time you prepare to feed the baby, fill your bottle. This will help you keep your body in tip-top shape to deal with the fatigue, and for those of you who are breastfeeding, it will help keep the milk flowing.
  3. Cool it with the Caffeine
    When you can barely keep your eyes open, you might reach for liquid help. If you are a coffee, tea, or espresso girl, you go with something that is loaded with caffeine. While we certainly are cool with your ~ 2 cups of caffeine per day, anything more will most likely make you sick. Think jittery, anxious, and nauseous. Additionally, if you are breastfeeding, too much caffeine can dehydrate you, which is not good, especially when you are trying to make milk for your little one.
  4. Phone a Friend
    Ask for help from someone. Anyone. Your partner, a family member, a friend, or even a babysitter, they are there to help. Everyone needs some time off. Be it an hour, a night, or a day, we all need to walk away and take a breather for a bit. Extreme fatigue can seriously cloud your judgment, leading to accidents, injuries, or worse. Even Superwoman had buddies—ask yours for a break.
  5. Nothing is Forever
    Even the worst infant sleepers will one day catch some Z’s. While everyone talks about those babies that sleep through the night the moment they come home from the hospital, most take at least a few months to get into their slumber groove. That said, if several months have passed and you still are staying up all night, it’s probably a good idea to speak to your pediatrician. Something might be preventing your little one from lying down peacefully—your pediatrician should definitely be your go-to on this one.There are tons of books, blogs, and sleep experts out there who have made a living out of providing advice on sleep and sleep training. We certainly are not sleep experts, but we are women who have been there before and who, as doctors, know what you need to stay healthy. The words we offer come from a mixture of those two perspectives. Now, go find yourself a place to lay your head and get some rest!

How to Stop a Drought: Vaginal Dryness in Post-Menopausal Women

/in /by

When it’s dry as the Sahara Desert down there, you are in need of some major water. In the case of the vagina, water doesn’t come from a bucket or a well but from estrogen. Think of estrogen as a hose. Without a hose, you have no water, and without water, you are going to face a drought. And as we have all seen on the news or lived through in real life, droughts are not fun. As a result, vaginal dryness is not just a pesky problem but rather a major pet peeve. It can cause pain, bleeding, itching, daily discomfort, and urinary symptoms (infections and incontinence). Here’s how to get the water flowing again.

Vaginal dryness is best treated with vaginal estrogen…seems intuitive, right? If you have a fire, pouring water on it is the best way to put it out. Vaginal estrogen comes in creams, rings, and tablets. They are placed, in one of these three forms, into the vagina and deliver a low dose of estrogen directly to the vaginal tissue. While the doses and composition may vary, most of the vaginal estrogens function in a similar way. Going back to our fire reference, when you pour water on a fire, the water doesn’t typically spread. It does its job on those flames only. Vaginal estrogen is not absorbed into the bloodstream (like oral estrogen); therefore, the hormonal effects on other parts of the body (think breast, ovarian, uterus, etc.) are very small. The limited spread of vaginal estrogen makes it appealing too many.

On the flip side, if you are experiencing both vaginal dryness and hot flashes you should start searching for a wider and bigger hose. Vaginal estrogen can’t put out those fires, and they can be hot! In these cases, oral estrogen or an estrogen patch is the better way to go.

While vaginal dryness is no joke, it’s particularly unfunny in women who have or have had a history of an estrogen-sensitive cancer. In such situations, using estrogen, be it oral or vaginal, can be risky and somewhat taboo. Therefore, OB/GYNs usually like to start twisting the faucet by using non-hormonal approaches. Some of these include vaginal moisturizers, vaginal lubricants, and topical anesthetics. And while they are not estrogen, they are pretty good at temporizing the torrid situation. When they don’t and the dryness is debilitating, we must look for other options. In select cases, even in women with estrogen-sensitive cancers, we will give vaginal estrogen a go for a short period of time.

Anything that impacts your quality of life should sound the sirens. You shouldn’t live in pain. We may not put the fire out on the first try, but we have many other firehouses and engines that we can call for back up. If you sound the sirens, we will find a way to put it out!