Two weeks ago I was staring at what must be my hundredth pregnancy test, willing the second line to appear. “Please God, this time, let me be pregnant. I can’t take another failure.” I had been muttering these words for the last two weeks. When that one lonely line appeared on the test, I told myself it was ok. I’d make it through this, again.

My husband and I were on our way back from a conference on polycystic ovarian syndrome (PCOS). PCOS is one of the reasons I am in this infertility boat. I started driving north out of Arizona. About 20 miles of highway flew under our wheels before I was forced to pull over when the road started floating in my tears. My husband drove for the next three hours as I cried myself to sleep, woke and cried some more. My brain said we could, and would, try again. My heart felt as exposed and desolate as the wind-sculpted red cliffs around us. The twisted sagebrush desperately sought moisture from the desert soil. I wondered if my womb was as desolate as the sun baked clay. Did a fertilized egg seek that frantically to find sustenance within my body—and fail?

By nightfall the sight of red blood silenced any fantasies that the test might be wrong. It was more than just menstrual hormones that kept me in tears over the next week. Just days before the insemination we learned that we would never have a baby without help—and expensive donor sperm. I know that our financial and emotional stamina is limited, so each attempt feels like my only chance—even though I know it isn’t. I know that even if we run out of fertility options that we will someday have enough saved for an adoption and we’ll probably even find an agency that will give us a baby despite my husband’s health. Knowing this doesn’t help much. My heart still feels like an empty piñata. I wonder if the next swing will bust it wide open.

I’d already taken an emotional beating long before I started the infertility treatments. Nearly five years ago, while I was still single and living in Virginia, a social worker at a Washington, DC, foster adoption agency told me she was looking for permanent homes for four babies. She promised me that if my file was complete in the next 30 days one of those babies would be placed with me. I needed one signature from one person to complete that file. When that person finally followed through and signed that paper after five months, it was too late.

Red tape started to fly between the various agencies and the state border was closed to children from DC. I begged the state of Virginia to place a child with me. I offered to take older children, sibling groups, children of any race, pored over web sites asking about child after child. After 18 months I sold my house. The handpainted clouds still floated over the wild animal border in an unused nursery. I’m not ready to go the public adoption road again and we don’t have the money for a private infant adoption right now.

I’m an active griever. Since I closed the door to that unused nursery I have lived in 5 states, changed careers, written two books, and found a million reasons to smile. No matter how busy I keep myself, my arms stay empty.

I believe we will be parents someday, but each day I struggle to maintain that hope and faith as I see and hear of children who are neglected or abused. When I hear of murdered children or hear a parent explain why they left three small children alone in a car while they ran into a store, I think of the hundreds of infertile women I have talked to over the years I have worked with women who suffer with PCOS. Each time, I pray that these women will each find the peace and healing they need and, if possible, someone to call them “Mommy” next year.

* Consider skipping family events and doing something else that day. For some, attending a family event with seemingly endlessly fertile family members can be really hard. If these events ae really hard for you, consider letting your mom (or mom-in-law) know that even though you love them, it is just too painful for you to participate so you will see them at another time.

* If you do decide to do your own thing on Mother’s day, consider whether a good walk, a movie, or some other simple event will give you a chance to put your mind on other things. If you are experiencing severe grief or depression, you may not feel like doing much of anything, but you will feel better if you go somewhere and do something. I often spent hard days at a coffee shop or bookstore with my journal. If this is too personal for you to experience in public, consider doing some journal time at home with a treat such as a favorite movie.

* If you must participate in a family event, try to spend some time alone before hand so you can regroup and work through your feelings. If the family always had brunch on Sunday with mom, plan a quiet journal session the night before so you can work through your feelings before you are facing a lot of people.

* Holidays can also be a good time to paint the bathroom or clear the weeds out of the garden. Activities can help lift your spirit and give you a constructive outlet for our stress.

Whatever you choose, keep in mind that while your arms may be empty today, there is always hope for tomorrow. This year will be my first Mother’s day with a child of my own. However, the year before I got pregnant was one of the worst Mother’s days I have had as I was just about to divorce and wondering if I would ever have a baby. Life is unpredictable and this may be your last Mother’s day without a baby.

It is important to have at least 2 – 3 semen tests done. You need at least two tests done to determine whether your results are “normal.” If your doctor accepts only one result and does not request a second test, change doctors. The results on any one day can be very different from other days and can lead to believe there is a problem when there isn’t one – or can lead to a false assurance that everything is fine.

A man’s testes produce sperm continuously. The number and health of the sperm can be affected by nutrition, stress, and other health factors. It takes about 74 days for sperm to mature, so if you do find that there are problems you will need to improve your nutrition and overall health for at least 2-3 months to see if that improves sperm count and sperm health. A man’s sperm count may vary so it is a good idea to have more than one sperm analysis done to make sure that the results are accurate.

Mature sperm look a bit like microscopic tadpoles. The enzyme-coated head contains the genetic material for fertilizing the egg. The tail moves back and forth to propel the sperm forward and through the woman’s reproductive system. An average ejaculate contains 40-150 million sperm. Only a tiny percentage of these – a few hundred – will get close to the egg.

The analysis will be looking for several different things:

Sperm Count. Not everyone agrees on the right number for healthy sperm. Generally over 20 million sperm per milliliter is said to be fertile. Some labs consider over 40 million to be necessary for fertility. Again, more than one test is necessary as your count can change with temperature, medications, infections, colds or viruses and other factors. Numbers below 20 million are usually considered low, although they may still result in pregnancy.

Motility. More than 50 percent of your sperm need to be motile (able to move quickly) for normal fertility. At least 65 percent of them must be alive. Their ability to move well is very important in their ability to reach the egg and fertilize it. Being sick or exposure to drugs and tobacco can reduce motility.

Morphology. They will be looking for high numbers of malformed sperm. Those with misshapen heads, broken or poorly shaped tails, and other unusual shapes can not swim well or penetrate the egg. At least 50 percent of your sperm must be properly shaped to ensure fertility.

White and red blood cell count. Infections can cause high levels of white or red blood cells in the semen. This is usually treated with antibiotics.

Clumping. Sperm that clump together may be a sign of antisperm antibodies caused by your body mistaking sperm for an invader. This can also be the result of an infection.

If any or all of these factors are below the norm you may be considered “subfertile.” This simply means that your results are lower than normal. It is not the same thing as being completely infertile. As long as you have some healthy sperm there is a possibility of a healthy pregnancy. It may simply take longer or it may require some medical intervention.

See the vitamins for fertility page for tips on vitamins and supplements that may increase sperm count, morphology and motility. Clearing up any underlying infections with antibiotics can improve sperm counts as well.

If all else fails there are a number of medical procedures that can help even those with very low sperm count or poor motility to conceive.

First, 5-10% of women of childbearing age have PCOS. If their symptoms are mild they are often undiagnosed. If they have even one child, many physicians will say they can not have PCOS. This is ridiculous if you look at the diagnostic criteria. The most common criteria for diagnosis include a failure to ovulate regularly. However, for many women this means they have long cycles (35 days or longer in many cases) but they DO ovulate.

Some women with PCOS have unhealthy eggs because their periods are too far apart, in many cases this is correctable with herbs, diet or drugs. Many women with PCOS also have a thyroid condition. Frequently, if this is treated they begin to ovulate. Many women with PCOS have frequent miscarriages, but they eventually have a healthy baby—often with the help of progesterone cream or suppositories. Some women find that losing weight, taking vitex or other herbs, or reducing stress cause them to begin ovulating (for me it was all three!). Some learn to detect ovulation through cervical mucus and basal body temperatures (BBT or temperature charting). Again, these women often have healthy babies without medical intervention.

It is hard to know how many women with PCOS become pregnant without help since many women are first diagnosed with PCOS because they are having trouble getting pregnant. Often metformin or other insulin-sensitizing drugs work wonders and they are able to get pregnant and carry a baby to term.

The fact is, only a small percentage of women with PCOS ever make it to the stage of trying fertility drugs. Clomid (clomiphene citrate) is often the first drug of choice since it is cheap and easy to take. I did find studies indicating that Clomid alone works for 70% of women with PCOS. Other women find that they need Clomid and metformin or stronger fertility drugs. The success rate tends to drop a bit as time passes and stronger methods are tried, but the bottom line is that most women who have PCOS and want children have them.

Even for those who are told they will never succeed at getting and staying pregnant, there is much reason to hope. Several close friends of mine have surprised themselves and their doctors by getting pregnant after years of infertility. “Lisa” adopted three children and then found herself pregnant in her late 30’s. It seems that for many women their PCOS symptoms mellow out as they get older. “Anne” went to the doctor to find out why she was infertile after several years of marriage—she was 3 already months pregnant and boy number two followed just 15 months later. “Susan” had three miscarriages and was told she would never carry a baby to term. Four months later she was pregnant with her daughter and her son is two years younger. “Barb” got pregnant when she was not even thinking of fertility and now counts herself extremely blessed to have two healthy boys.

I know many women who have done everything possible to get pregnant, even IVF, and have not succeeded. But the majority of women with PCOS DO get pregnant. There is even more reason to hope for the young women who are just now learning they have PCOS. First, they are more likely to be diagnosed at all. This means many women will be diagnosed who would have been overlooked ten or fifteen years ago when my generation was first beginning the march from doctor to doctor looking for answers. We know so much more than we did then. Treatments, both natural and medical, are much, much better than ever. In addition, being diagnosed now means they have the chance to prevent much of the physical and emotional trauma older women have experienced because our doctors just didn’t know how to help us.

My advice to any particular woman is to do all you can to increase your fertility (see my other articles and my books for more information about this). Then do your best to relax and let your body work. The odds are with you in the long run.

Male fertility starts with large quantities of healthy, well-formed sperm. About 90% of male infertility is caused by low sperm counts. Low sperm count can be caused by pollution, diet, genetics and many other factors. Other causes of male infertility can include sperm that die too quickly or are not formed properly, and physical problems such as enlarged scrotal veins (varicocele) or fluid accumulation in the scrotum (hydrocele). Correcting circulation to the testes with exercise or surgery may restore fertility.

Under current guidelines from the World Health Organization a sperm sample is considered to be normal if there are at least 20 million sperm per milliliter and at least 50% of those sperm are moving. If there are less than 20 million sperm or fewer of them are mobile, then it is considered to be abnormal. However, the National Cooperative Reproductive Medicine Network proposed new guidelines in 2001 that suggest a sperm count of greater than 48 million per milliliter and more than 63% mobility is normal. Anything between 13.5 million and 48 million would be considered to be in a “grey area” according to the proposed guidelines. Those with fewer than 13.5 million sperm and fewer than 32% mobility would be considered infertile.

There are many simple things you can do to improve sperm quality and sperm count. Nutrition is one of the most important steps to better sperm, although there are also a number of herbs proven to improve your odds of fertility. It is important to note that men also need proper levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone. There are a number of herbs that will help to make sure your hormones are properly balanced.

Start with a thorough health workup and sperm analysis. Talk to your doctor about any concerns that arise. Thyroid problems or diabetes can also interfere with proper hormone levels so it is important to discuss these issues with your doctor.

Between 28% and 71% of men with low sperm count are in fact suffering from an infection in the reproductive organs. Infections of the prostate and epididymis (a tubular structure secretion collectors on top of each testis) can interfere with sperm production or block the path of sperm. Infections can lead to anti-sperm antibodies. Some infections, such as Chlamydia, are sexually transmitted. Many infections have no outward symptoms, they just silently cause inflammation that can block the flow of sperm. They may also cause sperm anti-bodies to form, causing the immune system to kill sperm. Treating the infection with antibiotics can often restore fertility.

Some infections, such as an inflammation of the testicles following the mumps can result in permanent infertility. Chromosomal abnormalities such as Klinefelter’s syndrome may be associated with permanent infertility.

There are natural treatments for many causes of male infertility. Many natural remedies have astoundingly high success rates in scientific studies.

The nutrition industry alone is estimated to be worth $25.7 billion dollars a year. Clearly there is big money to be made from even poorly studied herbs and supplements—and even from substances we know have no effect or are even dangerous. In some cases (particularly in weight loss and body building) very dubious substances are marketed as health building. Not only are some of these substances unlikely to help you, some of them can kill you. Never take a supplement until you know what its history is.

When choosing a practitioner of any kind there are several things to keep in mind. The same rules apply to choosing a medical doctor, a naturopath, a massage therapist, or an acupuncturist.

*Do you feel comfortable with this person? If you get bad vibes, find someone else.

*What are their credentials? You want someone who has been properly educated and knows the risks of treatment as well as the potential benefits.

*How long have they been practicing? If they are new, is there an experienced practitioner keeping tabs on them? One of the best doctors I have had looked like he had just finished Junior High School. He knew his stuff, talked to me like I was a real person, and listened to my concerns. The fact that he was new meant that he was up-to-date on recent research and willing to try new things.

*Can you ask them anything and get a complete answer?

*Do they understand your health needs? You are unique and PCOS is complicated. If they don’t know at least as much as you do, are they willing to learn?

*Do they practice good cleanliness rules for patient interaction? Whether a doctor or an acupuncturist, you need to know that they are washing their hands, wearing gloves, and using clean needles!

*Do they offer references? Find out if they are for real or if they just talk a good talk.

In the end, the person you choose as your guide in the infertility journey as key to your success as well as your emotional health throughout the process. Studies show that your trust in the practitioner is sometimes even more important to successful treatment than the actual treatment.

Includes recipes, a gentle exercise program, and loads of references to the studies on which he bases his conclusions. Reducing inflammation is the key to treating the diseases we are all interested in preventing. Inflammation may also be at the root of many cases of infertility. Chronic inflammation can interfere with hormone production, cause swelling and circulation problems for the ovaries and other organs, and lead to auto-immune diseases such as celiac disease and thyroid problems.

Well-written in an easy to understand manner as are his other books, this one seems to have worked out some of the kinks in his earlier systems. Eating an anti-inflammatory diet makes it much, much easier to lose weight and restore your health. It seems so simple couldn’t be true, but the science is there to back it up. Eating this way can reduce cholesterol, reduce your risk of heart disease and diabetes, and improve your overall health. The healthier you are the better your fertility. Many studies have linked PCOS to chronic inflammation. Future studies will undoubtedly prove that inflammation is at the root of many other cases of infertility. Highly recommended!

Expecting Miracles

This reads like a cross between a memoir and a fertility guidebook. I learned a lot and had fun reading the success stories of the many couples treated by this amazing fertility doctor. His caring and concern for the couples he treats is obvious on every page. A great overview of infertility treatments as well as an entertaining read.

The Conception Chronicles

An amusing look at what it is really like to try to get pregnant when the stork doesn’t come calling at the expected time. A personal look at infertility with a lot of good technical stuff explained along the way.

What to Do When You Can’t Get Pregnant

A thorough, if not particularly well-written, look at modern techniques to treat infertility.

Getting pregnant is hard for one couple out of 6. If you need extra help in getting pregnant, having a good guide book along the way makes a world of difference. Be sure to check out the many book reviews and articles on this site. Knowing the terminology and understanding the mechanics (and chemistry) of fertility can make it much easier to choose the right fertility path for you and your family. You are not alone – and a few great fertility books can really help.

One fertility clinic in Mumbai, India, offers a single round of IVF for a mere $3,000. Even adding in the cost of drugs ($800 versus $1500 for the exact same drugs in the US) a $1,200 plan ticket, 10-14 days of hotel accomodations and freezing of any excess embryos, the total cost would be less than $7,000 for the same treatment offered in the US. Don’t want to travel to India for the procedure? Consider Australia, Canada or the United Kingdom where government health care keeps costs down.

While the procedures are exactly the same, the costs vary widely due to many factors. Malpractice insurance in the US is very expensive. Doctors in the US are also free to charge what the market will bear without government interference. Finally, drugs are often offered much less expensively in other countries – even when they are produced by the same manufacturer.

Here are some things to consider if you are thinking about fertility tourism:

* Ask a lot of questions. Be sure you understand exactly what you are paying for and what the doctor or clinic’s success rate is.

* Talk to others who have used the same clinic. Ask for references.

* Understand how treatments may differ. For instance, in the US, Australia, Canada and the UK, doctors are limited in the number of embryos they can transfer in one procedure. This limits the risk of multple births and the attendant risks to mother and babies when more than two babies are carried. Doctors in India are free to use their own judegement about the number of embryos they transfer. This can increase the cance of pregnancy in difficult cases, but it can also lead to the heartbreaking need to selectively reduce the number of embryos if more than two implant.

* Consider whether you are comfortable with foreign travel or travel to a particular destination. While the idea of a vacation is appealing, it can be really unpleasant to be far from home and possibly alone while you go through the emotional roller coaster of fertility drugs(you can bring frozen sperm with your for the procedure if your spouse can’t travel).

There are approximately 500,000 children in foster care in the US at any given time. Many of those children will never be able to return to their birth families. Some will be available for adoption, others will stay in the system until they are 18 – when they will be left to their own devices without the supports that a family traditionally offers.

Single foster parenting is challenging. You have no one else to lean on when times get tough – and they will get tough. Children who have been abused or neglected, the vast majority of those in foster care, are often difficult. They may be angry, scared, depressed or numbed out. They may do anything from the typical “kid stuff” to actually hurting people or destroying things. Being a foster parent requires huge wells of patience and love. The rewards can be powerful and unexpected.

If you choose to be a foster parent, be sure to do your research. If there is more than one agency in your area, talk to parents who work with both agencies so you can get a feel for how they handle things. Connect with other foster parents online and in your area as soon as possible. Experience can be vital and when you can learn from those with more experience you will be more likely to have a successful foster care experience.

Be prepared for the agency to question you thoroughly about your marital status and your reasons for being a foster parent. While many agencies welcome single foster parents, they do need to protect themselves and the kids in their care by making sure that you have the right motivations and a good understanding of what you are getting into.

Foster care can be risky, so knowing what you are getting into and how to protect yourself is important. False accusations have harmed many well intentioned foster parents and there are things you can do to reduce your risks.