How many times have I heard, "Dr. Kristiansen -- I hate that term! Can't we use something different to refer to my age?" Sorry -- it's a rather tacky-sounding medical terminology shortcut that means "chronologically older than average for optimal fertility".

Here's a message that needs to be heard during this National Infertility Awareness Week:

The fact: Without intervention, most women in their 40's (and many in their 30's) would not get pregnant.

Another fact: Yes, IVF is incredible technology worth marveling at, and one of the reasons is its ability to facilitate conception in women who otherwise would not get pregnant.

The Big Myth: IVF is so effective, you can wait until you're of "advanced maternal age" to try and get pregnant -- and have a high likelihood of succeeding by way of fertility treatment.

That myth IS a fact for some women. But only for some women. Are you one of them? There's a good chance that a thorough diagnostic workup by a reproductive endocrinologist can provide clues to answer that question. Can we guarantee it? No.

I don't think either the media or fertility experts intend to confuse women about the question of age and pregnancy. But the confusion among women is apparently prevalent and ongoing.

Just as it would be overkill to suggest that all women in their teens or early 20's run out and get fertility testing to prepare for the future, it is unreasonable to recommend women put all their eggs into that future basket by expecting ART to be their surefire answer to pregnancy. (There is the option of freezing your eggs, a different but related story...)

So, the simple truth: If you're delaying conception until your late 30's or older with the intention of simply walking into any fertility center and getting pregnant easily on the first try, you're automatically decreasing your odds.

If you're like many of my patients and have delayed pregnancy for lifestyle reasons like not finding Mr. Right, wanting to give your all to your career before parenthood, or because your finances aren't in order yet, you can take heart in knowing that virtually any safe and effective technique will be made available to you here at Houston Fertility Center. Not only that, but the treatment will be delivered by a team of experienced, compassionate women.

We know how much you want a baby. We applaud your courage and tenacity in the pursuit of parenthood. We'll educate you about every treatment option. We'll be your cheerleaders in the journey. And we'll be honest with you, too.

~ Dr. Sonja Kristiansen M.D.

 Is it possible we sometimes actually don't help things with our "more is better" attitude toward information?

It's quite common in my office to hear, "Dr. Kristiansen, we want a baby so badly, we'll submit to any test that exists to find out the problem." I applaud their desire to get to the root of the situation and make it better. For many patients, the "not knowing" is nearly as difficult as not having a baby.

Ironically, even when I have strong reasons to suspect a particular cause of a patient's infertility, some may feel very unsettled if I order only those tests that I know will hone in on that cause. I understand -- they want to cover every single realm of possibility, right up front, leave no stone unturned (so to speak), even if it means performing tests that have a low chance of being applicable in their situation.

Recently, an organization published fact sheets called "Five Things Physicians and Patients Should Question," authored by nine medical specialty societies such as the American Academy of Family Physicians and others. The point of this public information campaign: to encourage patient-doctor communication about eliminating unnecessary tests and procedures. The campaign was first started by the National Physicians Alliance and then further supported by the ABIM Foundation with a focus on evidence-based medicine.

There are two recommendations that are pertinent to gynecology:

However, there are no similar recommendations specific to fertility treatment.

If you're trying to get pregnant and are worried there may be a problem, here are the tests that I recommend for virtually any fertility patient:

• Medical history: Not exactly a "test" but a good review of your health and even a little about your immediate family's health history can give us a lot of clues.

• Semen analysis: It really does take two, so there's almost no point in only looking for infertility causes in half of a couple.

• Pelvic exam: Even if you've had annual well-woman exams for years, it's possible that something's been missed or that things have changed in terms of your reproductive structure.

• HSG, unless you're using IVF: Hysterosalpingogram is the best way to determine tubal patency. If there's not a definite plan for in vitro fertilization (which is a very successful workaround for tubal factor infertility), then we need to know the pathway for your eggs is clear.

• AMH & Day 3 FSH: Simple blood tests, testing these two hormones give us a wealth of information about the quantity and quality of your eggs, for patients of all ages, and enables us to start your treatment plan most appropriately. There's no point being caught by surprise later down the line by an ovarian reserve that was in decline all along.

Of course, there are more diagnostic tools at our disposable if necessary. And that's my point: Simply having a wider array of tests and procedures does not make them all necessary. So why go through the expense of both time and money, not to mention additional anxiety, by submitting to every test -- unless we find, one step at a time, that your initial tests aren't revealing enough information to optimize your treatment path.

Can we have too much information? Not really, especially when it comes to our comfort level. We've all become very accustomed to the sense of control over our lives that comes from having all that data. But there are costs to being inundated with data, both financially and emotionally. Part of my job as a fertility specialist is helping patients find what's necessary and truly helpful from among the abundant but sometimes confusing options.

Cancer patients' fertility is in the hands of cooperating physicians.

More women are surviving cancer. We know that some of the cancer treatments will leave them less fertile or even completely sterile. Fortunately, the assisted reproductive technology exists to help young women preserve their fertility for later use, post-cancer. But a new study in the journal Cancer says very few of these women take the steps to save their eggs or embryos before infertility-causing cancer treatment.

Of the 1,041 women sampled from the California Cancer Registry, ages 18 to 40 at time of diagnosis between the years 1991 and 2007, and who participated in the survey, only 4 percent underwent fertility preservation techniques.

One of the study's authors, Dr. Mitchell Rosen of California, cites a couple of reasons. One is cost. Another is the limited amount of related counseling that oncologists are providing to these frightened patients.

The good news is that more cancer doctors are informing their patients of the connections between cancer treatment and future infertility, partly due to guidelines instituted by the American Society of Clinical Oncology back in 2006. But just what constitutes adequate information is in question.

According to Rosen in this Huffington Post article, an oncologist may refer vaguely to the problem ('The treatment might affect your fertility, but let's figure out how we're going to go ahead and save your life') and "That brief sentence might be considered counseling..."

Another issue this study brings to light: it appears not every woman is equally informed, based on demographics like age, race, and even educational level. The article says:

"Those who had gone to college were 20 percent more likely to be counseled than those who had not.
Women who were childless, younger, white and heterosexual were also more likely to be told about the possible effects of cancer treatments on their ability to conceive."

In 2008, Houston Fertility Center published a website called BabyLater.com to inform the public that we offer a number of techniques for deferring conception by way of preserving fertility. The purpose of our website and my related outreach activities is to educate not only patients, but the abundance of professionals in the cancer care field here in Houston.

This Huffington Post article says a panel of recommendation experts is revising guidelines now, but they won't be made public for another year or more. The article also quotes Dr. Kutluk Oktay, co-chair of that expert panel, commenting on the current state of that crucial information pipeline:  "On the cancer side, there's no official training for this."

Physicians on the front line of cancer treatment are holding the cards in terms of letting women know that they have choices, that they can save their ability to have children in the future. I will continue to do what I can to spread the good news, that not only is there very often life after cancer, but parenthood, too.

~ Dr. Sonja Kristiansen M.D.

A new report commissioned by UK-based medical tourism site, Treatment Abroad, reveals where people are going and why. Traveling to other countries for fertility treatment has become more popular in the UK because of tight government restrictions on who can access varying types of fertility treatment. Among the more than 1,000 European patients who took part in the study, 4 percent were seeking treatment for infertility. The most popular destinations for those patients were Spain, Cyprus, and the Czech Republic. The biggest reason cited? To avoid waiting lists for treatment in their home countries.

The U.S. gets bonus points for leaving questions about treatment access up to physicians and patients, not government agencies. Still, patients from America are also finding reasons to bundle up their vacation time and fertility treatment cycles, sometimes flying to the other side of the world to try and achieve pregnancy. But as this article in the International Medical Travel Journal reported in 2009, more and more Americans are traveling to... other states in the U.S.

We often have patients from other states and regions of the world, including Mexico, South America, and even Scandinavia. Their reasons? When they combine all the factors -- sophistication of medical care available and all costs involved in fertility treatment -- coming to us makes the most sense.

Houston is a great place to visit, and here's why:

• Two large airports and a central U.S. location make flying here relatively inexpensive.

• Big city culture and amenities -- thriving arts community, world-renowned restaurants and shopping -- yet neighborly friendliness abounds.

• It's just a quick drive to the Gulf Coast for fun on the beach.

• Our weather is usually moderate (maybe not so much in summer, but every place you go has great air conditioning!)

• The cost of living is lower than in nearly every other big city in the States, so visitors find savings in accommodations and travel around town.

When you match all of Houston's benefits with our locations on Memorial Road and Sugar Land TX, highly experienced staff, state-of-the-art laboratory, and variety of patient discounts, it makes a lot of sense to come this way for fertility treatment. And you won't even need to learn a new language.

~ Dr. Sonja Kristiansen M.D.

But you don't have to be an exercise physiologist or a registered dietitian to understand a few simple points amid the building database of knowledge about fertility's connections to weight and physical activity.

And here's the latest: Moderate activity wins the game. Again.

A just-released study (from Fertility & Sterility) of more than 3,000 Danish and U.S. women ages 18 to 40 found that moderate levels of physical activity resulted in "small decreases in time to pregnancy" for women of all body mass index (BMI) levels.

If you're struggling to get pregnant, that finding may not seem so exciting. But factor in the rest of the story and fertility patients may feel a little uplifted by this study.

Importantly, the subjects in this study were drawn from the general population, not from among fertility patients. Requirements of participation included:

• being in a stable relationship with a male partner
• planning to get pregnant
• not receiving fertility treatment

In this study, vigorous activity included running, fast cycling, aerobics, gymnastics, and swimming.

The "winners" -- in this case, those who took the shortest amount of time to pregnancy -- were women who engaged in 20 to 39 MET hours (total metabolic equivalents assigned to different kinds of activity) per week of physical activity. And moderate activity was key.

Though the authors concede more data is warranted to investigate different types of physical activity in relation to fertility, their study suggests that overweight or obese women might benefit from any physical activity and lean women will likely enhance their fertility by switching to moderate, rather than vigorous, activity.

So what's moderate?

Brisk walking, leisurely cycling, golfing and gardening.

Source: A prospective cohort study of physical activity and time to pregnancy

L. A. Wise et al., Fertil Steril 2012

Location: 3525 Town Center Blvd., South Sugar Land, TX 77479

A common question in my office: "Dr. Kristiansen, should I continue taking my depression medication while we're going through fertility treatment?"

My general answer: If it works, keep it up, but there are a few exceptions.

This is a really tough decision for most patients, because they've often done enough of their own research to be confused by the data, even from well-done scientific studies. You can find large-scale, carefully conducted research that says depression, itself, seems to decrease fertility, even with fertility treatment. You'll also see studies that say women who are using depression medication have higher rates of fertility treatment cycles canceled.

Men, too, may have something to worry about if they're trying to become a dad and need to treat their depression. A small 2009 study demonstrated that men using paroxetine (Paxil) had significantly higher rates of sperm DNA fragmentation, which can lower their fertile potential.

Until we know more about links between fertility and depression and depression medication, physicians and patients are instituting choices based on the more established data about impact during pregnancy. Here, fertility treatment provides an advantage over conceiving without fertility assistance. The benefit has to do with timing.

Women using fertility treatment virtually know the moment conception takes place. There are far fewer mysteries when you're inseminated or you've had embryos transferred. And since we know some depression medications when taken during pregnancy are closely linked to congenital defects, essentially scheduling conception allows the woman to make choices in advance. She may choose to stick with her current medication, or she may talk to her prescribing practitioner about using an alternative treatment.

I and my staff at Houston Fertility Center encourage our patients to speak frankly with the health care professional who prescribes their depression treatment. Tell them you are trying to get pregnant, even before you make the choice to use fertility treatment. In no case do I ever recommend that you simply avoid making a choice.

The hormonal fluctuations that every woman undergoes through both fertility treatment and pregnancy can have a tremendous impact on  your emotional well-being. If you already know you experience depression, or if you start to experience mood swings or emotional dullness that are worrisome, keep all of your health care providers in the loop. That way we can work together as a team for the benefit of you and your hoped-for baby.

~ Dr. Sonja Kristiansen M.D.

Location: 3525 Town Center Blvd., South Sugar Land, TX 77479

And now, he'll be able to test his sperm count at home. It's not the first product of its kind, but starting in April, it could be the only one on shelves of big drugstores like Walgreens and CVS, and it appears to be simpler to use. According to this article on Bloomberg.com, the makers are counting on "women dropping an extra $40 for the test when they buy ovulation and pregnancy kits for themselves."

Great idea, since it's true that most men aren't eager to jump with both feet into the fertility diagnostic effort. It's hard to blame them. But proceeding with fertility treatment having only searched for causes in the woman is like, well, getting a half-filled box of chocolates.

Still, $40 seems like a lot to drop on something that only gives you part of the picture anyway. Like its predecessors, SpermCheck Fertility tells you whether or not the sperm count is 20 million or more per millileter of semen, which is considered normal. That's all.

The test doesn't give users any information on the extremely important factors of morphology (sperm cell shape) or motility (movement), both of which can make or break a guy's capacity to play Cupid to your Valentine.

For just a slightly higher fee, you can get the whole big picture -- count, shape, and movement of the sperm cells -- and have a laboratory professional do the reading. (Do I get patient calls like this: "Dr. Kristiansen, I can't tell if I see a line on this OPK..."? Yes, I do.)

So, I can't advise you on whether or not to spend your money on this product, but if you do and find out that he's "normal" -- but you still don't get pregnant -- I *can* tell you that your continuing infertility is not necessarily, therefore, all on your shoulders. It's not uncommon to have a great sperm count but with a high percentage of cells that don't function well.

Fortunately, reproductive endocrinologists (like me) have plenty of ways around those issues. Please note: you won't find the most advanced treatments, like ICSI or TESE, available through OB/Gyns who aren't Board Certified in REI. In fact, just like shelling out the bucks for at-home tests that don't give you a full diagnostic result, trying to achieve pregnancy with male factor infertility through your OB/Gyn can be a money drain.

Besides, if the at-home sperm count test comes back "abnormal" your next step is heading to a physician anyway. I bet your sweetheart would far rather lob all of those arrows in one appointment. If he's sweet enough to participate in helping you have a baby, maybe you should bundle all of his related tasks into one romantic, hopeful day. The Houston Fertility Center staff is happy to help make your dreams real.

~ Dr. Sonja Kristiansen MD

The Wall Street Journal says that "dragon babies" -- those born from now until February 9, 2013 -- are supposed to be strong, smart, and lucky. Quite a combination! What parent wouldn't want those things for their child? Even if you think astrology is nothing more than silly fun...

But here's the modern twist on an ancient tale: Couples are actually taking advantage of assisted reproductive technology to boost their chances of getting pregnant with a Dragon Baby. In the article, one egg donation agency reports they've increased the number of donors with Chinese ancestry to prepare for an expected rise in intended parents.

What we're talking about here is a new kind of family planning, people taking full advantage of the availability and increasing reliability of fertility treatment success, even if there are no fertility problems. "But Dr. Kristiansen," you're wondering, "isn't IVF for fertile people going to extremes?" IVF is the most direct means of assisted conception for many people, but artificial insemination can work as well for some.

So if you want to have a Dragon Baby, you need to institute a plan and aim for conceiving by mid-May of this year. My staff at Houston Fertility Center will be happy to assist -- even if you think astrology is just for fun.

~ Dr. Sonja Kristiansen M.D.

Quick red flag: If the words "cure" or "miracle" appear on a treatment website, be very wary. (I won't credit the site by linking to it in this post.)

Fortunately, there are many other reputable websites that educate and support patients with PCOS. But what I found especially disturbing about this one (and there are others out there) is their tactic of making money from the dissemination of medical information that's already available to consumers for free. That's the miracle of the Internet.

Before you're tempted to spend your money on e-books, email "programs" or newsletters, or even virtual face-to-face counselors who claim to have cures for PCOS -- or any other cause of infertility -- stop and do your research first. Investigate the authors, as well as the company marketing the products and services. Even more importantly, connect with the many available patient groups (like PCOS Challenge) who can tell you what you need to know and offer you support and tested resources, too.

But have we? It turns out there's an underground, online market for sperm, where women can access prospective biological fathers for their children without the intervention (and guidance, and screening, and medical and legal protections) of reproductive professionals.

Newsweek's Tony Dokoupil called one related website "a weird blend of Facebook, Match.com and a traditional sperm bank" in this article for ABC News.

"What's wrong with the DIY approach to getting pregnant, Dr. Kristiansen?"

Here's a quick list of why I think you and, more importantly, your potential children are far better off going the more conventional routes to accessing sperm for getting pregnant:

Without standard controls by the Food & Drug Administration and the policies and procedures of reputable clinics like the Houston Fertility Center, you risk transmission of infectious diseases and genetic conditions, to both the mother and child.

Engaging in activity within this level of intimacy, even if sexual intercourse isn't on the agenda, with people whom you've only "met" online is simply not as safe as using professional services.

Agreements made between individuals about level of parental responsibility and involvement in the child's life may not be binding without proper legal representation and execution.

If you've found the whole process of getting pregnant stressful, just imagine the additional burden that comes with using what amounts to be an unknown substance to conceive. Worry about the cost of artificial insemination? It just doesn't compare to worrying about your personal safety and your child's health and future.

In this blogpost for Huffington Post, author Leslie Goldman sums up the thoughts that run through so many patients' minds: "Why not me?!" Just as Leslie found out when she dared reveal her struggles with getting pregnant, there is in fact a huge number of people who are going through the same or similar. She finishes up her post with experienced advice for those who are still trying to conceive: "Drink wine. Lots and lots of wine. And enjoy it while you can."

For this holiday season, I encourage you to let things go a bit. If you're in the middle of an IVF cycle or other treatment, follow doctors' orders, of course, but also take advantage of every single opportunity allowed to enjoy yourself. Any questions about whether it's okay to do this or that in mid-cycle? Just ask. If you're not in the middle of treatment, then try your best to shelve the sense of urgency. Breathe as much as you can, both literally and figuratively. After the holidays, you can get right back on the path (if you want) or start thinking about new roads to travel.

But for now, I wish you all peace.

~ Dr. Sonja Kristiansen M.D.

 ~ Dr. Sonja Kristiansen M.D.

Here's whatHuffington Postblogger Naomi Cahn had to say about the new law and its potential repercussions: The Biological Clock -- for Donor-Conceived Offspring?

Have a great weekend, knowing you're free to choose fertility treatment and make other decisions that are right for your life.

~Sonja Kristiansen, M.D.