Fertility, #85

Anne Belden:

There's a real element of shame around that not being able to conceive. I mean, if it's such a given, it's such an expectation, it's such a part of our womanhood and now we're not able to meet that expectation and produce that what does it say about me as a woman?

Dr. Benjamin Lannon:

I spent some time in the biotech world trying to explore just the pure science of things, but ultimately it's that human connection that was important to me. And being able to use a wealth of knowledge that physicians acquire, but being able to use that in ways that can really help and benefit individual people, that's what gets me through every day right now.

Dr. Lisa Belisle:

this is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and podcast show number 85 fertility, airing for the first time on Sunday, April 28, 2013. With the spring comes the promise of growth and new life. This week on the Dr. Lisa Radio Hour, we discuss what happens when creating new life presents a challenge to couples. Our guests, fertility and adoption coach Ann Belden and reproductive endocrinologist Dr. Benjamin Lannan, offer hopeful perspectives on an emotionally charged topic. I come from an unusually large family. My parents had 10 children in 16 years, including one set of twins. I was the oldest. Raised in a suburban Maine town, mine was not an experience shared by many. That my parents were so obviously fertile caused me no end of embarrassment as a youngster. Another one my schoolmates would ask, how many kids do your parents plan on having anyway? I could not answer that question until after my youngest brother was born during the autumn of my senior year in high school. 10. That was the final number. Though I had often suggested that I would never have children myself, having helped raise enough of them already, I became pregnant with my son at the tender age of 21. As a first year medical student living two states away from my then husband who visited only on weekends, I was surprised by this turn of Events surprised, and again, slightly embarrassed, I cannot explain why I would have felt shame over so normal a human function. Now a mother of three and proud big sister and aunt to many, I have greatly benefited from fortuitous biology. Others are not so lucky. As our guests on the Dr. Lisa Radio Hour remind us this week, fertility does not naturally come to all. Fertility and adoption counselor Ann Belden and reproductive endocrinologist Dr. Benjamin Lannan have worked with countless couples for whom having a baby becomes a challenging ordeal. They describe the shame felt by men and women who cannot accomplish what they are told should occur naturally. Fertility issues, for some strange reason, remain one of Madison's dirty little secrets. I come from an unusually large family. My parents fertility status was no secret. The early embarrassment I felt over this and my own discomfort following the surprise pregnancy with my son in no way matches what couples who struggle with fertility must feel. But I have great compassion for those who experience embarrassment over something they cannot control. I hope that fertility, whether abundant, inadvertent, or lacking, will someday be treated for exactly what it is, a human function about which nobody should feel shame. Whether you are part of a couple

Dr. Lisa Belisle:

challenged by fertility or somebody who knows

Dr. Lisa Belisle:

somebody challenged by fertility, or simply a compassionate human being. We're very glad that you've joined us

Dr. Lisa Belisle:

here on the Dr. Lisa Radio Hour this week and are willing to listen

Dr. Lisa Belisle:

to what Ann Belden and Dr. Benjamin

Dr. Lisa Belisle:

Lannan have to say on this topic. Last year on the Dr. Lisa Radio Hour and Podcast, we were fortunate to have a group of women come in and talk to us about hearty girls, healthy women, and enjoyed the company of my guest who has returned here again today, Ann Belden. Today's conversation is going to be about actually being a Hardy girl and a healthy woman, but in a very different way. So I'm happy to have with me in the studio today Ann Belden, who is a fertility and adoption coach and is also organizing an important event coming up at the end of April. Thanks for joining us today.

Anne Belden:

Thanks, Lisa. It's so nice to be here with you.

Dr. Lisa Belisle:

This is a free fertility seminar, and fertility is something that, as you and I were talking, it's something that a lot of people deal with and yet not a lot of people discuss. So the fact that you're putting this seminar out there and for the first time, it's.

Anne Belden:

It says a lot, right? Yeah, it does affect a lot of couples. One in eight couples experience infertility, which is defined as trying to conceive for a year, deliberately trying to get pregnant without success. So one in eight couples is a lot of people. And you're also right that it's really not talked about very much. I like to say that it's really one of the last social issues to kind of come out of the closet.

Dr. Lisa Belisle:

Why do you think that's true?

Anne Belden:

I think that fertility and infertility

Dr. Lisa Belisle:

tap

Anne Belden:

into such a personal part of ourselves. It says so much about who we are as women in this society, the expectations that our culture puts on us as women. It helps us to sort of think about who we want to become. It taps into our sexuality. So very, very personal issues. Our intimate relationship is involved, and I just think it carries with it a lot. A lot of privacy and sensitivity.

Dr. Lisa Belisle:

Do you think that women have felt pressure to kind of be all things to all people, go out and work and also simultaneously get pregnant and be fertile and give birth and parent? And do you think that this contributes to a level of stress that perhaps makes it difficult to get pregnant in the first place?

Anne Belden:

Well, that's such a. You know, it's an interesting question. The whole question as of, does stress create fertility problems or do fertility problems create stress? You know, it's like a chicken and an egg, and I think it's probably a little bit of both. I think it's hard for everyone today in our society to do so many things that, you know, that we're wanting to do for women in particular, building their families, having careers that are fulfilling and meaningful. We all want to, you know, many of us want to do both of those things. And so where's the balance? How do you do that? I think that the question of stress is a good one, though, because what happens is the longer women try to conceive and are not able to, it does definitely build stress. And we do know that chronic and ongoing stress can at the same time impact on our state of health over an extended period of time.

Dr. Lisa Belisle:

Did this stress become an issue in your own journey? Because I know that you have two children now. They didn't come easily, right?

Anne Belden:

That's right. And so I can certainly relate to this stress as it relates to fertility. You know, we spent, my husband and I spent 10 years trying to build our family. And although that was quite a long time ago, my kids are now 18 and 23. I can completely understand what women are going through because the emotional aspects of infertility are the same as they were 25 years ago. And one of the things that contributes to that is there are so many people who are trying to be helpful by telling you or inviting you what to do how to, you know, how to get pregnant, how to feel better, how to just relax, how to do these things, as well as the medical community, which are, you know, wonderful and trying to direct you down the right path. But it can be really confusing. You can feel like you're kind of pushed and pulled in so many directions that you don't really. You lose touch with what is really best for you, which might not be best for the next patient or for your friend who's having trouble conceiving. And so that does create some, you know, some stress. And it's important to be able to begin to untangle that. It's kind of like those, I don't know, just those mangled roots that get all gnarled up. What feeling is really coming from, what.

Dr. Lisa Belisle:

One of the things that you do as part of your work with women and families with fertility and adoption issues is that you offer them mind, body methods of dealing with their own stress. And I have in front of me this breathe pamphlet that you've given me. So talk to me about why breathing is so important for your patients or your clients.

Anne Belden:

I should say, yeah, it's important because whenever we begin to feel stress, our bodies have a physiological response, no matter what it's in response to. And so we start breathing more shallowly, our heart starts to beat more rapidly, we start to get sweaty. And one of the most. The easiest, most fundamental techniques is to try and breathe more diaphragmatically. So breathe really deeply. I speak with my. I talk to my kids about this, and I talk with my clients as they're maybe going into a difficult medical procedure that they're stressed about. Maybe they've just had their embryo transfer for ivf. If they can really begin to just start breathing much more deeply and really thinking about it, mindfully breathing, it can help them to calm down. But there are a lot of other simple things that I have here on this card. You know, emotional expression, which sounds so simple, but is actually a lot harder to do. So that can come in the way of, you know, certainly talking with friends in an honest, authentic way. But also writing can really help to sort of move emotions out of us. Another thing that I talk with people about is what I call thought massaging. Just looking at. Also kind of call cognitive restructuring, a more clinical term, but really looking at those sort of those negative thoughts that start to play over and over again in our heads, such as, I'm never going to be a mom. I'm not getting pregnant because I won't be any Good at it. And so helping them to really get up on a sort of on a stool and look down at those thoughts and begin to sort of take them apart and think about, is this really true? How is this helping me? What can I do to sort of intersect those thoughts when I start to realize they're playing over and over again

Dr. Lisa Belisle:

in a newsletter that you sent me recently, talking about the impact, the physiologic impact of smiling.

Anne Belden:

Right. Yeah, that was a great study that I put in there. And, you know, we don't think about it, but if you really, the more you smile, people smile back at you. And so when people are smiling at you, you feel better. And if you feel better, it's going to change the whole way that you sort of move through that day. And the more you do those kinds of things, it lifts us up in terms of our spirits. It can really change how we enter into any kind of situation if we do that. So those are the little kinds of things that I talk with clients about.

Dr. Lisa Belisle:

And you also offer what you call back pocket comebacks.

Anne Belden:

Yeah, I came up with those because it's the things that people say to you when you're trying to get pregnant. Not in a way that's intended to be hurtful or harmful, but they do come across like that. So one of the things I have on here, one of the most common things that people get are, are you ever going to have kids? I mean, you're 30 now. It's about time you got ready. Talking to your. Getting ready to have children. And so what I've got on here is I've got two different kinds of responses. One I call sort of that same snarky response, which is the thing that you're probably not going to say, but what you'd really like to say. So what I have on here is, well, hold on, let me grab my Ouija board. You know, of course, like, if we only knew, if we had that Ouija board, that crystal ball, wouldn't that be nice? But the more sort of thoughtful, gracious kind of response that is actually helpful to have in your back pocket might be something like, we'd really love to have kids, but it's a lot harder than we expected. So. So people are bombarded all the time with really hurtful kinds of things. Again, not intentionally, but we lose our focus when we're in a place of struggle or even emotional pain, and we can't come up with something to say. And so this is intended to help people come up with that. Another one, if I could just go through another one that people get all the time is why don't you just adopt? There's so many kids out there that need good homes. And so that sort of that initial snarky kind of response, you know what sometimes you think about saying is if there's so many kids out there, why didn't you just adopt? You could have adopted. But of course a more gracious kind of thing to say might be something like, you know, we may consider adopting, but right now we're trying to have a biological child like most people want to have.

Dr. Lisa Belisle:

And this is something that you had to deal with in your own life. I mean, you had questions probably just like this because you ended up having one biological child and one adopted child.

Anne Belden:

I did. Right. It took us 10 years to have those kids. Our son was conceived through art, artificial reproductive technology. And that was about a three and a half year process to conceive him. We considered ourselves really lucky and we didn't have major medical issues. It was mostly unexplained infertility. And then as soon as he was born, about a year afterwards, we started trying pretty much right again to try and conce. We tried for about five years. I had surgeries in there. I had a 12 week miscarriage. I did it all that was available at that time. I did more perganal cycles than they would ever consider allowing. I think I did around 17. I did gift. I did several IVF cycles. So that took about 10 years. And at the end of that, one of the hardest things is deciding when to stop. How much farther do you go? There's always, always that next carrot dangling in front of you, that next new medical drug or procedure. And so we, I finally, you know, decided that I didn't want to do that anymore. And we then opened ourselves up to adoption. But it was a really, really tough time. And one of the things that got me through, of course, was that my husband and I were on the same page about what we wanted. I'm a real extrovert. So I sort of enlisted the support of my friends to, you know, to help me get through it. I also connected with Resolve, which is a great national organization that's been around for about 40 years supporting, supporting this issue through advocacy and education. And that's really what this event is sort of tied into is the National Resolve.

Dr. Lisa Belisle:

The goal of the Dr. Lisa Radio Hour is to help make connections between

Dr. Lisa Belisle:

the health of the individual and the health of the community.

Dr. Lisa Belisle:

The goal of Ted Carter Inspired Landscapes

Dr. Lisa Belisle:

is to deepen our appreciation for the natural world. Here to speak with us today is Ted Carter.

[Unidentified voice]:

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Dr. Lisa Belisle:

Why is it that even pregnancy, something that is deeply personal, becomes a topic of conversation that everybody feels that they have a part of, whether it's pregnancy, whether it's fertility. Why is it that women's reproductive cycles, why are they something that we all seem to have a stake in, unlike any other topic?

Anne Belden:

Yeah, because I think it's so fundamental to who we are as women and as human beings. It's also such a cultural expectation. I'm not sure people even think about it that much in terms of they just have the expectation that it's part of the life cycle to go on. And, you know, you move into adulthood, you start to build your family. And women, it's a very integral part of how we see ourselves as women is that, you know, when we get our periods when we're, when we're teenagers, that is something that, you know, everybody starts talking about. And so it's, I think it grows from there.

Dr. Lisa Belisle:

And I see that. I still also see that, you know, you wouldn't, you wouldn't necessarily openly have a discussion about somebody's alcoholism, per se, or, you know, somebody else's. You wouldn't always talk about somebody's cancer or you would know. I don't know. It's interesting to me that fertility and infertility and pregnancy and all the things around reproduction just seem like such a public access thing.

Anne Belden:

Yeah. Well, so I think what's interesting about that is that fertility maybe and pregnancy you know, I mean, there's just. You see books and all that stuff everywhere, but people in public will. Strangers might touch a pregnant woman's belly who. They don't even know them. But yet at the same time. So what's interesting is that infertility is not. So you have this huge public access, as you said, to pregnancy and fertility and childbearing, putting videos of giving birth online, that kind of stuff. And yet when it comes to infertility, all of a sudden the door sort of slams shut. And I think that there's a real element of shame around that not being able to conceive. I mean, if it's such a given, it's such an expectation, it's such a part of our womanhood, and now we're not able to meet that expectation and produce that. What does it say about me as a woman? I think it goes with. Part and parcel with. People feel that that is in the realm of the public, and they don't think about the fact that someone may not be able to. To achieve that. They're just not tuned into that because it's such a cultural expectation.

Dr. Lisa Belisle:

I wonder if we will see the same thing happen to infertility that we actually saw happen with pregnancy and birth. I mean, it wasn't that long ago that women were sort of sent into the twilight sleep and then they magically reappeared with a baby. So it wasn't that long ago that men weren't really involved. It wasn't. I mean, I'm thinking the 60s. So maybe resolve has been around 40 years. Maybe we are finally heading into a time where this doesn't have to be quite so shameful or quite so hidden.

Anne Belden:

Yeah, I think that organizations like Resolve, mainly Resolve, are really working at that. If you look at just the language around it, you know, infertility versus fertility, people have a hard time talking about that. But I do think that people are speaking out a little bit more about their experiences of not being able to get pregnant. IVF is. It's kind of in the news all the time now. I mean, it really hasn't been all that long that we've had, you know, IVF. I think the first IVF baby, Louise Brown, was in 78. And since then there have been over 5 million babies born through IVF. So we see it in the papers, it's being talked about, it's becoming much more acceptable. But yet. So I think that that will begin to happen. It will begin to move into that more public realm.

Dr. Benjamin Lannon:

But.

Anne Belden:

But I think it's a much Slower grow.

Dr. Lisa Belisle:

One of the ways that you're helping this to move into the public realm is to offer a free fertility seminar coming up in honor of National Infertility Awareness Week. And I know you have thoughts on the term Infertility Awareness Week, but this seminar is coming up on April 30th from 5:30 to 8:00 clock at the Maine Medical center. And it's featuring some pretty, some pretty high level guests. Dr. Lannan from Boston IVF, who is also on the show, Dr. Michael Drouin, Dr. Carolyn Hodson, who has been a guest of ours before, Dr. Ann Rainville and Dr. Dan Spratt. I mean, these are some heavy hitters.

Anne Belden:

Yeah, it's really fabulous that all of these people are willing and able to come out on this evening to speak on this panel because what people want to see is a range of approaches and a range of practices. And it gives people an opportunity to meet these different physicians, get a sense for what they might be like. But it's a wonderful contribution that they're making. It's the first time we've ever had an event in honor of what Resolve calls National Infertility Awareness Week. But as you pointed out, I'm calling this a free fertility seminar because I think coming at it from a positive approach, calling it fertility, it just plain feels better to people than coming saying it's infertility. And along with those five physicians who are going to be speaking, there are eight alternative practitioners who will then be not speaking on the panel, but will be available to speak with. Some of them will be doing demonstrations, giving little mini talks, meeting with people afterwards. So. So it's an opportunity to meet a wide range of practitioners who really focus on and specialize in fertility issues in Portland.

Dr. Lisa Belisle:

I like the fact that you're calling it a fertility seminar. And I'm sure that you are going to have a fertile or at least large group eventually, hopefully fertile group of people coming to the seminar.

Anne Belden:

Yeah, we hope that they don't. It's sort of, I feel like sort of planned, planned obsolescence where, you know, you want them to come, but then I don't want them to have to come back next year. It's sort of like the support group that I do. I do a monthly support group through Resolve. I do that. I'm here in Portland. I donate that. And we have now around 10 or 12 people who come every month to this, both men and women. It's held the last Tuesday of each month at Maine Med. And it is my hope that people don't come back to it because we all want them, of course, to get pregnant in between meetings.

Dr. Lisa Belisle:

How can people find out about the fertility seminar that's coming up on April 30th or about the work that you do as a fertility and adoption coach?

Anne Belden:

Yeah, I have a website which is annbelden.com I can also be reached on my business Number which is 233-5939. But my website is a really good place to get a sense of who I am and how I work. I have this event on there and if there are other events, I'm right now I'm doing a four week Mind Body program with women who are trying to conceive and I have an office right here in Portland where I work individually one to one with women or couples who are going through infertility and adoption.

Dr. Lisa Belisle:

Well, Ann, it's been a pleasure to have you back in the studio after going from Hardy Girls Healthy Women to ongoing Hearty Girls Healthy Women in a different way as you bring fertility to women and families in the Portland and Main area. And I hope that people take advantage of the seminar. We've been talking to Ann Belden, who is a fertility and adoption coach and an organizer of the fertility seminar coming up at Maine Medical center on April 30th. We really appreciate your coming in and talking with us again.

Anne Belden:

Thanks so much for having me. I appreciate it.

Dr. Lisa Belisle:

We'll return to our program in a Moment on the Dr. Lisa Radio Hour I'm podcast.

Dr. Lisa Belisle:

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Dr. Lisa Belisle:

Spring is the time of year when

Dr. Lisa Belisle:

things are growing, plants and flowers and

Dr. Lisa Belisle:

little animals, and we're thinking about fertility and growth.

Dr. Lisa Belisle:

So we're talking today with Dr. Benjamin Lannan. He's a reproductive endocrinologist with the main center of Boston, ivf. Thanks for coming in and talking to us today.

Dr. Benjamin Lannon:

Thanks for having me.

Dr. Lisa Belisle:

Ben, you grew up in New Hampshire and you have a presence here in Maine, and you have a presence in Boston. What was it about growing up in New Hampshire that caused you to kind of decide, you know what? I want to come back here, I want to raise my kids. I like this part of the world.

Dr. Benjamin Lannon:

My wife and I both grew up near the ocean, and it was a really important formative part of our childhoods. And I really appreciated just being able to get to the beach easily. And the beauty of the coast of New Hampshire and also the coast of Maine and even Massachusetts were really part of my formative years. And so for both of us, it was important to include that in our, in our ongoing lives and also the lives of our children. So being in touch with that aspect of nature is really important for us.

Dr. Lisa Belisle:

And you also received your education largely in New England. You have a very extensive education.

Dr. Benjamin Lannon:

Yeah. So I've been mostly around New England, either in northern New Hampshire or down in Rhode island and also in Boston, but haven't really strayed too far from the New England region, which, again, is, I think, part of my identity.

Dr. Lisa Belisle:

So did you always want to be a doctor?

Dr. Benjamin Lannon:

I think I was in fourth grade and went to career day as a doctor, and my father was a doctor and my grandfather was a doctor, and I think probably that had a major impact, although my father was very much encouraging me to explore things outside of medicine, knowing that many children sort of follow in the path of their parents without fully thinking of where they want to go. So I think I went through a long period of time planning to go into medicine and then later in college tried to find other things besides medicine to do, but ended up coming back. So it's always been sort of another part of my, part of my identity.

Dr. Lisa Belisle:

And what, what makes it part of your identity? What drew you back?

Dr. Benjamin Lannon:

I think there's the interaction with, using aspects of science and technology, but really being able to apply them directly to humans and individuals. And I spent some time in the biotech world trying to explore just the pure science of things, but ultimately it's a human connection that was, was important to me. And being able to use a really wealth of knowledge that physicians acquire, but being able to use that in ways that can really help and benefit individual people. And so even I spent some time in the, in the public health world as well, and it just, it really didn't speak to me as much as just that one on one interaction with people. And that's what gets me through every day right now.

Dr. Lisa Belisle:

You do have an extensive education. You have an undergraduate degree from Dartmouth, a medical degree from Brown, Masters in Value of Clinical sciences again from Dartmouth. You did a residency in obstetrics and gynecology at Beth Israel and Harvard, and

Dr. Lisa Belisle:

then a fellowship in reproductive and endocrinology

Dr. Lisa Belisle:

and infertility at Beth Israel Deaconess. That's a lot of investment of time and energy and resources likely to come back around to do something that ends up impacting your life in a big way. Has it been worth it?

Dr. Benjamin Lannon:

I think it's been worth it so far. I am just coming off of the final phase of my training, which has been board certification and reproductive endocrinology. And it's been a time to reflect back on, at times an exhausting education process. And my wife, who started in business school when I started in medical school, many of her friends are contemplating down, stepping down in their careers. And I feel like I just got my first job, so. But the process along the way is part of the journey and I think you can't just wait to get through training to start things. So it's been a really rewarding process so far and I'm looking forward to the next phase, which is more of the independent part as opposed to the training. But I think most doctors are always in the process of learning or training, so I think it's what you sign up for when you enter this career.

Dr. Lisa Belisle:

When you look at your education, you

Dr. Lisa Belisle:

kept narrowing it down and narrowing it down, narrowing it down and now your focus really is helping bring life into the world. That is absolutely your focus at this point. And it's a challenging focus because people who come to see you are challenged. Talk to me about why you would go into such a field.

Dr. Benjamin Lannon:

When I was in medical school and trying to figure out what I wanted to do, I really found myself drawn to this profession. And I think I ultimately went into my residency anticipating going into further training in infertility medicine. And I think there's a really, again, it's. And it's that nice interplay with. There's a lot of basic science and a very detailed understanding of the molecular aspects of reproduction. But the people that are sitting in the room across from me don't necessarily care about that. They just want to have a baby. And being able to use those, use the skill and the knowledge that I've acquired, and really being able to help people and probably one of the most valuable aspects of their life is really. It's a privilege and it's rewarding every day, Whether it works or it not. Helping people get through the processes has been the thing that when I looked at what, you know, with every doctor, they have to figure out what they're going to. What's going to get them up every day. And in many professions, that's true, but particularly in medicine, what's the thing that's going to get you through the whole process? And for me, it's the reward of that interaction and the satisfaction when the patients are successful or even if they're not successful, that they come through the process with a feeling of some closure.

Dr. Lisa Belisle:

Fertility has become a really important field. It's grown leaps and bounds. I mean, Boston IVF has a lot of different locations, including this one in Maine that you work for. Why is that true? Why are we having issues with fertility in our culture today? And I guess, conversely, what's been. How have we been able to come to a place where we can now help this problem more?

Dr. Benjamin Lannon:

I think there's been. There's been a. Not necessarily an explosion, but a really constant improvement in the technology of the technologies that exist to help couples that are trying to get pregnant. When we look back roughly 35 years ago, the first IVF procedure was performed, and the amount of progress that's occurred in the 35 years since then has been incredible. And it's been made available to a much wider group of people. So I think anytime you have more technology that's available to help people, more and more people are. And more and more people get access to that treatment, I think you'll start to see it become more prevalent in the society. I think there's a lot of different things that occur that are occurring in our society that we don't really know how they're impacting our fertility. A lot of chemical substances and things called endocrine disruptors that may or may not be having an impact in all of our lives. And not just reproduction, but lots of studies looking at changes in the time of menarche or the first signs of puberty that girls are having, whether there are changes in semen or sperm parameters that men have over the last 30, 50 years, it's unclear exactly what impact those are having and whether it. Whether we're sort of experiencing a mild epidemic of infertility. But I think a lot of it has to do with just changes in our society. People are really much more comfortable talking about these things, whereas the previous generation or two really suffered in silence around a lot of these issues. So I think that's one of the biggest factors. And then also just the changing dynamics socially of when people are having children. So as more and more couples, and particularly women, are making more proactive decisions about reproduction, we see a difference in the time that people are having children compared to one or two generations ago. And so there are many more women. About 20% of women are having children after 35 for their first child, which one or two generations ago would have been much less common.

Dr. Lisa Belisle:

What are some of the actual causes of infertility? I mean, you're talking more of a sort of a global reason for global reasons for infertility. What are some of the more common diagnosis gut diagnoses that occur?

Dr. Benjamin Lannon:

I think one of the things to appreciate is that infertility really affects couples, and it can affect both men and women. So it's not always just. Even though our specialty comes from women's health and obstetrics and gynecology, roughly half of the time there is a known factor. It's either male or female. And so there are things that can impact sperm production or the release of sperm that may impact a couple's fertility. For women, there are a host of problems that can impact ovulation. So either something called polycystic ovarian syndrome, where women have an imbalance in the hormonal relationship between their brain and their ovaries and ovulate on a less frequent basis, or maybe not at all, as well as other hormone interactions, again, between the brain and the ovary and those signals that are important in regular ovulation cycles that can reduce the likelihood that women ovulate. That's in addition to some of the more structural issues, such as having blockage in the fallopian tubes, which is the passage that the egg has to travel as well as the sperm in order to meet each other. And those can be results of either infection or inflammation that's occurred much before somebody has tried to get pregnant. One of the differences with fertility or infertility and many other diseases is that it's mostly asymptomatic. So people don't necessarily know that they have a problem. And the definition of infertility itself is really based on the lack of ability to get pregnant over a certain amount of time of trying. And so, so it's different than having a bladder infection where you feel a symptom and you know that something is different and therefore you go in and have a specific test here. It's really based on what is normal within a population and where you're deviating.

Dr. Lisa Belisle:

So what are some of the technologies you've talked about? Ivf, in vitro fertilization? What are some of the other things that have recently come about that are helping couples to conceive?

Dr. Benjamin Lannon:

The range of treatments can be very simple to being more focused on the timing of intercourse and when couples are trying to get pregnant, increasing the number of eggs that are produced in a given cycle, maybe increase the likelihood of success, as well as procedure called insemination or intrauterine insemination, where sperm is placed rather than in the vagina, directly into the cervix and into the upper part of the reproductive tract. Those are technologies that have been around for a long time and are the more simple end of things. The more advanced aspects involving in vitro fertilization, as well as something called intracytoplasmic sperm injection or icsi, where a very small amount of sperm can be used to fertilize eggs. And some of the newer technologies that are emerging are our ability to do genetic testing or chromosomal screening on embryos before they go back into the uterine cavity. So that for couples that have either a known genetic disorder or are trying to screen for chromosomal imbalances such as down syndrome, that testing can be done on an embryo even before it has implanted in the uterus. And that's made a lot of improvement for couples that are facing some of the not necessarily fertility related issues, but just the genetic complications that come along with reproduction.

Dr. Lisa Belisle:

We'll return to our interview in a moment.

Dr. Lisa Belisle:

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Dr. Lisa Belisle:

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Dr. Lisa Belisle:

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Dr. Lisa Belisle:

Judging by the fact that there are now requirements in some states that insurance companies actually pay for fertility treatments, it seems as though we are finally accepting the fact that this is an important medical diagnosis trying to help people conceive. It's not an optional thing. It's not as though some people just because they're fortunate enough to have everything in place, they have the right to have children and for everybody else, it's too bad for them.

Dr. Lisa Belisle:

Has that helped in some way to

Dr. Lisa Belisle:

kind of move this field along?

Dr. Benjamin Lannon:

It has helped and I think it's the great underlying question in our society is whether infertility is a medical condition or really a misfortune. As you said that we say, well, we're sorry that you can't get pregnant, but we don't deem it worthy of other medical conditions that insurance will treat. And it's very interesting on a state by state basis how this is decided. But in several states, I won't say many, maybe 10 or 11 states, there is some coverage for infertility diagnosis and treatment, while in other states there really isn't any treatment coverage. And it makes a major difference for many couples because as we said, this can be quite an expensive process. And when you're paying for it out of pocket, it comes at a significant expense to the rest of your life. Massachusetts has a very comprehensive insurance coverage for infertility, whereas Maine is quite limited. And that in many senses dictates what treatment people do, if at all, or how far they can they can get. Price ranges for treatment might range from on the low end, could be in the 500 to $1,000 range, but can get upwards of 15 to $20,000, depending on how complicated things get. And for a process that theoretically should be free for most people, it's a significant amount of money.

Dr. Lisa Belisle:

And that, I guess, goes back to the idea of what medicine truly is for. I mean, is it for curing an individual's, cleaning out their arteries so that they won't have another heart attack, or is it for looking at things from sort of an eagle eye view? I mean, we're looking at the continuation of a species. So if we're saying that the only people who can reproduce are the people who can do it, quote, unquote, naturally, then we're not really looking at the health of the population at large.

Dr. Benjamin Lannon:

Yeah, and I think it's a very. There are a lot of conditions that are associated with infertility, depression, anxiety, as well as other gynecologic or medical conditions that, that get treated. But somehow the infertility diagnosis itself for many people is not considered a medical necessity. And I respect people's opinion that our society should in some way determine what is considered a medical issue versus not. But I think anybody who's struggled with infertility or known somebody who struggled with infertility, recognizes that this is the same, meets all the criteria of any disease that we consider in the rest of our population. And so it's really unfortunate that many states are not. Many insurance companies or many states don't require coverage for this.

Dr. Lisa Belisle:

Ben, you and your wife Jane, have

Dr. Lisa Belisle:

two children, Oliver and Gretchen.

Dr. Lisa Belisle:

How has the work that you've done in the field of infertility changed the way that you've looked at your own ability to have a family or vice versa.

Dr. Benjamin Lannon:

I have a picture of my family in my office and I put it off to the side. I think many times you go to a doctor's office and there are lots of pictures of their family and their children. And I want it to be there for me to know and for my patients to know that I understand what they're working towards. But I think it's important not to have it be too much in the face of my patients who are having all these other consequences and reminders of people's families. But I think anybody who had a family without much difficulty maybe should recognize the challenges that some people have and that anytime that we can successfully form our own families, that it's a blessing for all of us. And I think many times we take our own families or children for granted sometimes. And many people, when they're talking to somebody who is trying to get pregnant and they say, I just want to have children, and people will say, oh, you can have mine, they're driving me crazy. But that's, you know, I think that sort of speaks to this imbalance of perspective that we all have where it's a great fortune to be able to have children and whether it was. Whether your children were created with minimal amount of complication or significant amount there. I think everybody has the right to be able to do that if they want.

Dr. Lisa Belisle:

The type of work that you do requires not only the high tech and

Dr. Lisa Belisle:

the knowledge and all the education that

Dr. Lisa Belisle:

we spoke of when we first began the interview, but also a significant sensitivity and compassion and empathy. Do you feel as though medical education today is heading us in the direction of being able to marry those two, the high tech and the high touch?

Dr. Benjamin Lannon:

I think it's very person specific. I think there are always going to be people that are gravitate to the high tech and there are always going to be people that gravitate to the high touch. And some of it you can teach, but a lot of it is inherent in the personalities of the people that ultimately decide to go into medicine or any of the really the healthcare professions. There are many doctors who. The last thing they would want to do is deal with my patient population. And I think that's part of the selection process of all of us when we choose a profession. You know, there are big differences between radiologists and internal medicine doctors and my profession, for example. But I think it's always important for all of us, as in whatever we do, but particularly in medicine, to figure out which things that you like and are good at and how you can apply those to whatever specialty you end up going into.

Dr. Lisa Belisle:

And you think that doctors might not want to deal with your patient population because it does require the high touch and the sensitivity and the compassion. And that's not always easy.

Dr. Benjamin Lannon:

Yeah, it's a very, I think needy has a connotation, but it's a very demanding population in terms of the amount of time and energy that goes into this process. It's not a I'll see you once for your annual exam and come back in a year or I'll see you for, you know, this broken arm or whatever process that you're dealing with. It evolves over for many of my patients, months to years, but before we achieve the goal. And so that's a very unique aspect of this type of medicine that you have to be able to, you have to prepare for.

Dr. Lisa Belisle:

And there is also the possibility that the goal that you achieve is finally realizing that you may not be able to carry a biological child and that you may need to explore or other options.

Dr. Benjamin Lannon:

Yeah, that's one of the hardest things that we all face in this profession is helping couples find closure or transition to a different pathway than they had originally intended, such as going through adoption or moving on without children, or even for many people, using donated gametes, either sperm or eggs, to help assist in their goal. And I think that's again, one of the challenges that we all work towards is helping throughout the journey is really helping people kind of get perspective on where they are now and where things are going or may be going. Because there are always going to be people that don't that aren't achieving their exact goal. But it doesn't mean that they aren't successful.

Dr. Lisa Belisle:

Ben, you'll be speaking at the Free Fertility Seminar, which is coming up on April 30th from 5:30 to 8:00 clock at the Maine Medical center. So people can hear more about what you've been talking about there at this seminar. Also, people can find out about you through the website for the Main center of Boston ivf. So tell us what that website is

Dr. Benjamin Lannon:

so you can look us up if you go to Boston IVF or BostonIVF.com that would be the easiest access point. There are a number of fertility groups that are available and we're certainly one option for many people. But I think our goal is to make sure that people are aware of this issue and can get access to somebody to provide help. But as I said, we're always happy to tell people or help people make that next step into the process.

Dr. Lisa Belisle:

We've been speaking with Dr. Benjamin Lannan, who is a reproductive endocrinologist with the Main center of Boston ivf. We're quite privileged to have you in here today and thank you for the work that you're doing to bring life into the world.

Dr. Benjamin Lannon:

Thanks very much.

Dr. Lisa Belisle:

You have been listening to the Dr. Lisa Radio Hour and podcast show number 85Fertility. Our guests have included Ann Belden and Dr. Benjamin Lannan. For more information on our guests, visit drlisabelisle.com the Dr. Lisa Radio Hour and Podcast is downloadable for free on itunes. For a preview of each week's show, sign up for our E newsletter and like our Dr. Lisa Facebook page. You can also follow me on Twitter and Pinterest Dr. Lisa and read my take on health and well being on The Bountiful Blog bountifulpath.com We'd love to hear from you. So please let us know what you think of the Dr. Lisa Radio Hour. We welcome your suggestions for future shows. Also, please let our sponsors know that you have heard about them here. I am privileged that they enable us to bring the Dr. Lisa Radio Hour to you each week. We hope that our conversations with Ann Belden and Dr. Benjamin Lannan may add a chance for you to think about

Dr. Lisa Belisle:

life in a slightly different way and perhaps change the way that you approach it.

Dr. Lisa Belisle:

Thank you for allowing me to be a part of your day. May you have a bountiful life.

Anne Belden:

It.

Dr. Lisa Belisle:

Sa.