ASRM: Books reviews about infertility from the MHPG Newsletter

“Waiting For Daisy" by Peggy Orenstein (Reviewed by Kim Kluger-Bell, M.F.T.)

"Waiting for Daisy" is a delightful personal memoir of the author's journey through infertility to parenthood by means of an unexpected natural conception after years of fertility treatments. Funny, provocative, intelligent and above all, honest, the book follows the author's initial ambivalence about
motherhood through three miscarriages (including one partial molar pregnancy); several unsuccessful IVF cycles (including one with donor eggs from a young woman who had read one of the author's books and started an email correspondence with her); and a failed attempt at adopting a Japanese infant due to bureaucratic problems. The author's sense of humor and her keen observational powers make this account of a struggle through infertility both memorable and entertaining. The book is about more than simply infertility. It includes interesting chapters on a visit to an old boyfriend who has become an orthodox Jew and has 15 children, and an interesting chapter on a visit to a Buddhist temple in Japan where she pays homage to her recently miscarried child by bringing offerings to Jizo (a Buddhist enlightened being who looks after miscarried and aborted fetuses or "water children").

Patients who are struggling with the intrusiveness of fertility treatments, the difficulty of maintaining a vibrant sex life, and a strong relationship with their partners will find this book both interesting and affirming. However, for people who have reached the end of their medical treatments and are moving seriously towards adoption, this particular story may not be what they need. This is because the book tends to reinforce the idea that if you keep trying long enough you will eventually have a successful pregnancy even if the odds are stacked against you. So, if you recommend the book to patients, be forewarned that those who are ending medical treatments and grieving the loss of their biological children may not find the book reassuring.

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Confessions of a Serial Egg Donor by Julia Derek (Reviewed by Kim Kluger-Bell, M.F.T.)

Confessions Of a Serial Egg Donor is the kind of book you have to force yourself to read if you are a professional in the field of assisted reproductive technology. But if you can get past the sensationalized title and the odd tone it is written in, it is a cautionary tale of the utmost importance.

The author, Julia Derek, is a Swedish student going to school in the U.S. on limited funds, for whom the lure of what seems to be easy money through egg donation is impossible to resist. Although turned down by one clinic on the east coast (due to the fact that she was not planning to be in the area long enough to complete the screening process and be matched with a recipient), upon arrival in L.A., she responds to an ad in BackStage Magazine and is quickly recruited by a sweet talking egg broker who befriends and guides her "career" as a professional egg donor through 5 cycles with one clinic, and then (after one doctor at that clinic objects to her donating again), the broker guides her through an additional five cycles at several other clinics, advising her to with-hold the information about exactly how many cycles she has been through. Along the way, Julia is advised by the egg broker to ignore her discomfort, and not be a "whiner". At one point she is even told that the egg broker knows a woman who donated 16 times, had no problems, and now has kids of her own. Eventually, however, on her last cycle, her ovaries fail to respond to the fertility drugs and she
becomes severely depressed for months on end. It is not her egg broker "friend" or the clinic where she last donated who finally helps her. It is an OB unrelated to the whole ART business who prescribes Serafem (a form of Prozac usually prescribed for Premenstrual Dysmorphic Disorder) which she takes for several months until her hormones return to normal.

Oh, and did I mention that she wasn't required to see a psychotherapist for an assessment until after her fifth cycle, and that when she did, she was sent to a psychologist who was making pottery in her home and who only asked her three or four questions (to which Julia gave hostile, uncaring answers) before "passing her" with flying colors?

Assuming that this autobiographical account is true (and I really have no reason to believe that it is not) the only thing you can do is shake your head and sigh. Julia herself does not minimize the role that her own desire for financial gain plays in her decision to keep donating her eggs, but the fact that so many people enabled her in this process (either actively or passively) is extremely disturbing and points to how much work still needs to be done to counteract the fallout from the business of ART.

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The Genius Factory - The Curious History of the Nobel Prize Sperm Bank by David Plotz (Reviewed by Kris Bevilacqua, Ph.D.)

There are infertile men and women who want children and those who want perfect children. We see those prospective parents in our offices on a regular basis. The Genius Factory is the illuminating story of a uniquely narcissistic idea by a man who didn't think his own children were special but
thought he could improve the quality of the United States population by giving away sperm from the smartest men he knew. Whether that was eugenics, misguided marketing, or a unique idea undone by Mother Nature will be up to the reader to decide. Whatever your conclusion about David Plotz' book, the story is both informative and entertaining.

For mental health professionals, The Genius Factory provides a fascinating look at Robert Graham, the eccentric millionaire who was convinced that this country was facing a crisis of intellectual mediocrity. He set out to improve the genetic stock of the country by providing exceptional sperm, gratis, to couples who were worthy of the task of raising exceptional children. How Robert Graham wooed the donors without providing compensation to them and without the intense medical screening we are familiar with today makes fascinating reading. David Plotz, editor at the online magazine Slate, researched Mr. Graham's history by talking to donors, recipients, offspring, and employees linked to The Repository for Germinal Choice - nicknamed in the popular press at the time as the Nobel Prize Sperm Bank. The sperm bank was controversial from the time it opened until it ceased operations after the death of its founder.

In one chapter, David Plotz describes his own experience when he tries to become a sperm donor in today's more demanding climate. His self-deprecation about the process as well as concerns about his own manliness based upon the quality of his sperm make for humorous reading as well as shedding light on the process that ends up as a number in a catalogue. As the saying goes, it's a tough job but somebody's gotta do it. Although David Plotz' history of sperm donation in general may be underdeveloped in the book, the place of the Repository for Germinal Choice in the evolution of contemporary sperm banking with numerous options for information about the donors is evident. As we currently review the catalogues of available donors from sperm banks and visit with the sperm bank representatives at ASRM, it is clear that the sperm banks are trying to promote their donors by providing unique services such as conference calls with the donor, numerous photos, audio recordings, and enhanced educational levels, all for a price. Interviews with offspring from the donors in The Genius Factory remind us that Mother Nature and mothers still have a whole lot to do with who the child becomes in spite of specialized marketing plans to help provide prospective parents with the child of their dreams.

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Mommies, Daddies, Donors, Surrogates: Answering Tough Questions and Building Strong Families by Diane Ehrensaft, Ph.D. (Reviewed by Mary P. Riddle, Ph.D.)

Last October, I had the pleasure of meeting Diane Ehrensaft at the annual conference of IPTAR (Institute for Psychoanalytic Training and Research). I was just as impressed with her in person as I was with her book, Mommies, Daddies, Donors, Surrogates: Answering Tough Questions and Building Strong Families.

As mental health professionals, we are often faced with the anxieties and fears of patients struggling with issues that would have been unheard of in a previous generation. We are privy to the secret fears and struggles inherent in family building that utilizes advanced reproductive technology. Given the complexity of the medical aspects of treatment, it is no wonder that the emotional component can be just as complex. This book is amazingly comprehensive in capturing the experience of the patient. Dr. Ehrensaft states that her intent was not to set out to write a comprehensive volume on the issues inherent in reproductive medicine. She says the book grew out of her work with an increasing number of patients seeking help in raising healthy children. There was a realization that a growing number of these patients had conceived their children using advanced reproductive technology. The author states that this book was written in defense of and as a support to parents who are contemplating or have already embarked on the process of having a baby with the aid of assisted reproductive technology (p.10). Mommies, Daddies, Donors, Surrogates is an in-depth detailed analysis of the unconscious processes that we, as mental health professionals, are hoping to illuminate for our patients. Dr. Ehrensaft uses a developmental model of contemporary psychoanalysis to explore the fantasies and fears of couples who have conceived with the help of the "birth other". Much of the book explores the issues that arise when someone outside the couple contributes to the conception of a baby. She coins the term "birth other" stating that she typed it accidentally one day when she meant to write "birth mother". It is a concept that is woven into the fabric of this book and explored as an entity that significantly impacts these families created in ever evolving ways. The book details many of Dr. Ehrensaft's own clinical experiences, which serve as poignant examples of the challenges that families created by non-traditional means struggle to resolve.

As I mentioned, the book covers a wide range of topics. There is a chapter entitled "The Power to Create, the Fear of Creation" which discusses the internal conflict between power and fear; the power over procreation versus fear of harming the creation due to "unnatural" intervention. She comments on the challenge of finding mental health professionals with the expertise to help. She explores the fantasies that can arise from "someone else" contributing to the making of babies. There are chapters entitled "Should I Tell" and "When to Tell" as well as one entitled "How do the Children Fare".

In particular, I want to mention the portion of the book that Dr. Ehrensaft refers to as the "triptych” - three chapters that focus on many of the issues she feels are unique to families with children born with the help of a "birth other". This section of the book covers many of the primary issues my patients bring to me. These three chapters (the "triptych") are devoted to the issues of bonding and family building, issues surrounding disclosure (including the decision making process of whether or not to disclose), and what Dr. Ehrensaft calls a "developmental map" for telling the child if the
couple is so inclined.

I like the formatting. Each chapter/section starts off with a list of questions that are then addressed/illuminated in the text. When the topic of bonding is explored, the questions that most couples ask and worry about are first stated in the text, then examined in-depth. There are many questions discussed that will be familiar to you if you work with these families. Will there be a competition for the love of the child; will a child love a parent less if they find out there is no genetic connection, or will the child feel different and therefore suffer?

The portion of the book I would most like to focus on is the section about disclosure. Part of the consultation work that I do is to meet with recipient couples primarily in a psychoeducational role. For those of you who do this type of work, you know that there can be a lot of ground to cover. I find many couples have not even thought about it, much less had a conversation. It is understandable that a couple who has struggled with infertility might have difficulty thinking about the reality of an actual child to whom they might need to disclose anything. However, there is often not a lot of time to help them work through the issues they may encounter.

Dr. Ehrensaft acknowledges that although there are strong opinions in the field as to whether or not disclosure should take place, there is a paucity of research to help us know with any empirical certainty the longterm benefits (or harm) of disclosure. She lays out the important questions to be asked and she stresses that all parents should have a plan in place (whether they choose to disclose or not to disclose) in order to be able to communicate with their children with regards to their origins.

Dr. Ehrensaft stresses that there is not a "one size fits all approach" in the chapter "Should I Tell" where she discusses the growing acceptance for disclosure as compared to the secrecy of the past. She is comprehensive in her discussion of all aspects of this issue and argues both disclosure and non-disclosure. She speaks of circumstances when it would not be in the child's best interest to tell. I find this entire section particularly helpful and regularly recommend it to recipient couples considering egg donation as a means of family building.

Obviously I cannot speak for the entire mental health community, but I imagine that many of us would advocate for disclosure. I know that I am often faced with couples who have no intention of disclosing. I see my role as educational and strive not to present a biased view, but rather to help my patients consider all sides of the issue. For anyone who has been faced with this dilemma, here is an extremely well-written, comprehensive presentation of the issues that should be considered and discussed by parents who are thinking of the use of a "birth other".

Lastly this section of the book explores the question of when to share the means of conception to a child. The book presents three schools of thought: to share the information from the time of infancy (before the child has the language to understand), waiting for the child to ask questions, or to wait until the child has reached school age. She includes a section of disclosure during adolescence and includes all the reasons why this should not be a consideration. All of these schools of thought are presented in a thoughtful manner, with an emphasis on the developmental tasks at hand during each of these stages, as well as testimonials from parents. Finally, the book asks the question "How Do the Children Fare?" This chapter overviews the empirical literature (both medical and psychosocial), but more importantly seeks to explore the world of the children themselves. This chapter is full of stories of children conceived in various ways, and Dr. Ehrensaft asks the reader to step into the shoes of these children who may be asking "Who am I?" and "Who do I belong to?" Life stories are shared and illuminate the many ways in which children define themselves when conceived with a "birth other". This chapter is most useful for both the parents wanting to raise well-adjusted children and for the professionals who share their journey.

It is difficult in a short review to cover the many strengths of this book. I know that I have gone back to it many times and it has helped me in my clinical work. It is rich in its content and appropriate for parents and professionals alike. I highly recommend this important new work, both as a resource for professionals and patients, and as a major contribution to the field.

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Unsung Lullabies: Understanding and Coping with Infertility by Janet Jaffe, PhD, Martha Ourieff Diamond, PhD, and David J. Diamond, PhD (Reviewed by Mary P. Riddle, PhD)

If you are looking for a good book to recommend to both patients and colleagues, then I suggest Unsung Lullabies: Understanding and Coping with Infertility written by Janet Jaffe, Ph.D., Martha O. Diamond, Ph.D., and David J. Diamond, Ph.D. It is a thoughtful and compassionate integration of both the authors' personal insights from their own infertility experiences and the stories of their patients.

The book begins by stating that its evolution was a personal mission of sorts, given that the authors all endured their own struggles with infertility. These three clinical psychologists are the founders of the Center for Reproductive Psychology in San Diego. They have collaborated on a book that explores the tremendous sense of loss experienced by those struggling with infertility, as well as a wide range of coping strategies. The authors utilize the format of introducing many personal stories and insights from both patients and professionals alike.

At the core of the book is the concept of the "Reproductive Story". The writers use this explanation to illustrate the deeply ingrained conscious (and unconscious) ways in which we think about what parenthood will be like. They have written about the many factors that contribute to one's reproductive story, and what the fallout can be when the story does not turn out the way it was intended to. It is through the use of this concept that the authors introduce different styles of intervention. Coping strategies are all aimed at being able to recognize and acknowledge the importance of the reproductive story as it relates to one's self-concept. Additionally, the book fully explores the emotional fallout many couples experience when they are faced with the possibility that they will need to consider a different outcome than the one on which they were depending. The authors share their own reproductive stories and how these stories shaped their own personal struggles with infertility. It is a useful concept for mental health professionals to incorporate into their discussions with patients, as well as helpful for patients struggling to find a framework in which to process their pain.

The authors also seek to examine the many painful feelings and questions that arise when patients attempt to move forward towards a resolution. The primary theme of the second part of the book is loss. Although this can be a common theme for mental health professionals who work with infertility patients, the book provides a very broad overview of the many ways in which loss can be experienced and the profound impact it can have on one's core sense of self. The book specifically addresses men's issues with a chapter entitled, "Men Have Feelings, Too" which will be helpful to couples who are struggling with ways to communicate and/or share their pain. The section addresses the strain often felt by couples in relationships where infertility threatens the well-being of the couple. Again, there are personal testimonies, as well as a discussion of coping strategies.

One section of the book is devoted to the theme of grief. It is this particular section that led me to initially recommend the book to a patient of mine. I have found that it is sometimes surprising to patients to have what they are experiencing framed as a grieving process, but that it offers a new way to conceptualize the pain. It can also allow an opportunity to give oneself permission both to grieve and not feel guilty for doing so. This section of the book does a great job of introducing the ways in which grief manifests itself and also the ways with which it can be dealt. Again, there are a lot of personal narratives that give a larger perspective to the range of experiences that people can have.

Lastly, the book addresses the idea of "rewriting" the reproductive story. The authors acknowledge that there can be many different endings to one's story and many forks in the road. The book addresses the wide range of emotional and spiritual considerations involved in the decisions that couples often must make. The ultimate goal of this section is to highlight the idea that there are many potential outcomes and that it is possible to move past the pain.

One aspect of this book that I think is terrific is that it is written by mental health professionals who clearly have used their personal experiences to enrich their clinical expertise rather than to stand in the way of it. I think it is a particularly good model of how any personal experience can be processed and channeled in ways that make one a more effective clinician. This goes for any personal experience, not just that of infertility.

I have already recommended this book to several patients. I often see patients in consultation where it is unlikely that I will have an opportunity to work with them for an extended period of time. Sometimes, there are things left unsaid, given the nature of this particular type of therapeutic relationship. I have felt like this book allows me to continue the conversation, in that I may have introduced the idea of loss and grief, but may not have the opportunity to help the patient process these emotions.

I also recommend this book for mental health professionals. I have personally found it helpful and have received positive feedback from some of my patients. The book is well organized and comprehensive in its approach. Very often I encourage patients to seek out others who have experienced infertility so that the journey might be less lonely. It is nice to have a resource that gives a voice to many personal experiences for those patients unable or unwilling to seek out support in other ways. In my opinion, this book offers real life advice and coping strategies from a number of people who know first hand what the pain of infertility can be.

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Hope and Will Have a Baby: The Gift of Surrogacy, The Gift of Egg Donation, The Gift of Embryo Donation, The Gift of Sperm Donation, The Gift of Adoption, Written by Irene Celcer and Illustrated by Horacio Gatto (Reviewed by: Elaine R. Gordon, PhD)

The Hope and Will Have a Baby series is a welcomed addition to the children's books genre of non-traditional family building. What stands out when reading these stories is that the subject matter never veers from the over-riding message that children born into our world through reproductive efforts are loved and truly cherished. Celcer takes five reproductive options and tells a story about a couple's struggle to have a child. Each story's theme describes Hope and Will's desire to become parents in clear terms using descriptive language that children can understand.

Using the same initial and final storylines, the five reproductive options are inserted midway through the book: surrogacy, egg donaton, embryo donation, sperm donation, and adoption. Needless to say, each story has a happy ending with Hope and Will achieving their dream of having a baby and becoming parents.

The illustrations are delightful which will appeal to children of many ages. Celcer uses language that is delivered in a straightforward fashion but in a soft and gentle tone that exudes warmth and comfort. This sweet and endearing series of books are recommended additions to all home libraries in an effort to best appreciate the various ways families come to be and to welcome all children born through these means.

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Having Your Baby Through Egg Donation, by Ellen Sarasohn Glazer and Evelina Weidman Sterling (Reviewed by Ellen Speyer, MFT)

The good news is that this is a wonderful book for all of us to read and to share. The bad news is that if your patients read it before you do, they may cancel their appointment with you, feeling like they now know everything about this subject!

I have been reading and referring to this book since I received my copy. It is very comprehensive and covers most every topic any of my patients has brought up in session. Ellen S. Glazer and Evelina W. Sterling have brought together in one place the information we have been sharing with our patients since we as professionals were first asked to meet with recipient couples.

The book is written in short, subject discussion style. The authors have made it easy for anyone to browse the book, pick out the topics they are interested in and turn to that information. The book has addressed the issue of egg donation from beginning to end. Starting with the subjects of decision making regarding egg donation, choosing a donor program and choosing a donor, the book continues to walk the reader through the entire scope of issues including legal, moral and ethical questions, grief and loss as part of this and special family situations such as gay and lesbian couples. Pregnancy with donated eggs and parenthood after egg donation are also included as subjects for review. The scope of this book is all-encompassing and serves as a great comfort to those who are eager to learn all they can about this family-building option.

The amount of information presented is a wonderful beginning in anticipation of meeting with the trained professional. If the couple would read this book in preparation for their visit, they would have a good foundation to begin an in-depth discussion of their decision-making choices. The authors have shared early in the book that their bias is towards “the importance of truth telling.” Even the word “disclosure,” they write, implies that there is a secret at the outset of the process that may or not be shared. Honesty
about this decision comes from the confidence gained regarding this choice for their family, and that is a good thing to be shared and spoken about with children. For those individuals or couples that may not agree with this, my hunch is that the encouraging tone of the book and the couples presented in the cases who are happy with this choice for themselves, will help the unsure couples consider egg donation as a positive choice and embrace it openly and honestly as one way to build their family.

When egg donation is first presented as an option to an individual or couple, the questions, the fears and the fantasies flood one’s being. Having this book to read can serve as a great comfort to someone wanting to sort out and understand this new, maybe previously unheard of, reproductive technology.

One of my favorite chapters was “What You Can Do to Prepare Emotionally.” Ambivalence is the first line item in this chapter. How might it ease a woman’s or a man’s mind to be reassured that this feeling, along with the many others, is normal and need not mean that egg donation is out of the question for them because of these feelings? I think that as individuals and couples are struggling to create their family and deal with their fertility challenges, they will refer to this book over and over to clarify the issues and help them stay on the task of moving forward with their plans to have their family.

I can picture one family member presenting this book to other family members in hopes of raising awareness of the issues. If family members are considering coming together as donors and couples, this would be important to read and discuss.

Similarly, reproductive professionals such as physicians, nurses and administrators of the paperwork would be wise to read this along with mental health professionals to increase their knowledge and understanding of all the issues that need to be addressed before one can move ahead with egg donation from a position of informed consent. It is a grand achievement to address the entire range of psychological, legal, practical, financial and relational nuances of egg donation as a family-building choice. Because there
are so many topics and sub-headings, one must not expect to have a totally in depth discussion of all of the issues. For example, grief, loss and mourning receive only limited attention. Do we say that’s inadequate? I would say that what is most important is that the significance of these feelings has been addressed and acknowledged to the reader. We would hope they could use this to further their work and discussion around these core issues.

I am thankful for this book and refer it often to prospective parents before or during consultations. It has been well received, and I expect it to be an important part of our shared literature on this subject. It is valuable in the concrete, comprehensive way it outlines and addresses the collective knowledge about egg donation that we have to this point. I expect it to pave the way for many individuals and couples to experience creating their families with confidence and joy.

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Sometimes It Takes Three to Make a Baby (Explaining egg donor conception to young children) by Kate Bourne, Published by Melbourne IVF (Reviewed by: Carole Lieber Wilkins, M.F.T.)

This sweet little book is designed for three-nine year olds who were conceived by two parents using donor ova. It may be a little to simplistic for any child over six or seven but is an excellent book for younger children. The illustrations are colorful and engaging and the story very simple. There are three parts of this book-- the story to be read to a child, the fill-in part where a child can put in family photos and details of his or her own story, and a section for parents. That this is all done effectively in 24 simple pages of a children’s paperbound book is quite a feat.

The book starts out telling the story of Mum and Dad who loved each other a lot, had good jobs and lived in a nice house. But of course something was missing and that something was a baby. The illustration shows a dark-haired man who coincidentally looks just like Harry Potter, blonde woman, and a dog in front of a house with a picket fence. In every way this is a traditional family who used non-tradition-al means to become parents.

Mum and Dad go to the doctor to see why they could not make a baby. The doctor explains that to make a baby, one needs an egg from a woman, sperm from a man, and a uterus which is the part of the “Mum’s tummy where the baby grows.” The doctor did some tests and told the couple that mum’s eggs could not start a baby, but that another woman might “give them some of her eggs to start a baby. This is called donating eggs.”

They found a “kind lady” who offered her eggs and when the eggs were ready, they went to the hospital where the eggs were collected and put them together with Dad’s sperm, which joined together and started to make an embryo which is the beginning of a baby.

A note here about language. Parents and children are unanimously resonating with the word “helper”, rather than “donor” or “kind lady”. Thanks to Patty Mahlstedt for offering this simple language change with which patients are so comfortable. It is a word children understand much better than “donor”, and seems to roll off parent’ tongues more easily as well as frames the entire conception in the spirit of giving and helping, both words kids can easily relate to.

The baby grows and grows and when it finally arrives it is one of the “happiest days of their lives.” “The egg donor was happy too because she had helped Mum and Dad start the baby.” The illustration shows a brown-haired woman holding bouquets of flowers and a thank you card.

Then the story shows the Mum, Dad, and Donor at the top of the page and a child observing himself in the mirror. The text explains that when there are three people who help to make a baby, the child will probably be a little bit like all of them. Perhaps the child will get Mum’s sense of humor, Dad’s hair color, and the donor’s eye color. This part of the book finishes by encouraging the child to ask his parents to tell him how he began. It’s a special story but the main thing to remember is that “you were made with so much love.”

The next section of the book is called “My very own book about me”. This section has pages where the parent or child can fill in sections such as “I live with my family. Their names are:…” or “draw a picture of the woman who donated her eggs. You can use your imagination if you haven’t met the donor.”

The last pages of the book contain a very helpful letter from a couple who writes about their experience talking to their daughter about her conception. It is reassuring and quite concrete. They explain the importance of using any relevant time to talk to the daughter about conception, using opportunities to build on prior information with new information, and how they have responded to the child’s questions about her hair.

The parents’ section consists of two pages from the author, Kate Bourne, on How to Use this Book (sic). The highlights of disclosure are in bullet points:

Start early when kids are young. They will need to be retold often as questions become more complex.
Encourage discussion. The importance of the relaxed and comfortable tone parents use versus just the correct language.
She suggests that it might be helpful to talk to a counselor, especially if one is feeling uncomfortable talking with their children, explaining what red flags to watch for that this may be necessary. One such red flag is delaying talking to one’s child and fearing rejection from the child.

This book fills a very big need for parents looking for help in beginning the process of storytelling with their child. It starts at the beginning and tells the basic information that a helper and a doctor were needed to help Mum and Dad become parents. The fill-in section allows the child and parent to fill in whatever details may be known, primarily focusing on the child’s family. Like most children’s books this one can serve as a “prop”, a starter point for non-readers with engaging illustrations, which parents can adapt and change the words or the story to match their own.

The Publisher, Melbourne IVF can be reached at 320 Victoria Parade, East Melbourne, 3002 Victoria, Australia; Telephone: +61 3 9473 4444; Web site is www.mivf.com.au

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Overcoming Male Infertility: Understanding Its Causes And Treatments by Leslie R. Schover, Ph.D., Anthony J. Thomas Jr., M.D. (Reviewed by: Ellen Speyer, M.F.T., Education Committee Co-Chair)

Have you ever read a book and reviewed in your mind all the times you could have and should have had a book like this to read and refer to? That was precisely my experience and it could very well be yours.

As a clinician I wish I had been able to refer my patients to this book for an informative, comprehensive and sensitive handling of this subject. Some of us know one of the authors, Leslie Schover, Ph.D. from earlier Mental Health Professional Group courses and meetings. I remember enjoying her presentations for the scope of information she shared. Fortunately, Dr. Schover will be a faculty member for our upcoming MHPG postgraduate course in Seattle.

This book is written to cover an extensive amount of information, which can help the reader from the point at which infertility is diagnosed all the way through treatment, alternative options, and conclusion of this developmental life crisis. The medical realities of the diagnosis and treatment are referenced clearly and simply. I feel patients will appreciate the complex medical facts and treatments that are put forth in an easy to understand way. For men and women who may not have a clear understanding of the workings of male anatomy, this book can clarify so much and give the reader a basic understanding with which to take to doctor’s appointments as well as form a foundation for discussions with partners and family.

I can imagine that it was a huge task to cover the range of pertinent medical information and blend it with the emotional aspects of male infertility in order to facilitate the decision making that is often the most difficult part of resolving infertility issues.

The book presents itself as “hope and strategies for couples dealing with infertility.” It definitely offers both. The text offers clear strategies to use in order for individuals and couples to deal with the information they are given and the choices they may have. The authors’ style and the few brief case reports offer hope to the couples. The short case reports are used to help couples relate to the information. Clinicians will find them somewhat dispensable.

The authors have used a topic and discussion style, which is very effective. It works to present a tremendous amount of information in a very readable and accessible style. Anyone can turn to the part that applies to them and receive clear information.

The authors have included references to spiritual guidelines. Because so many of our patients struggle with the meaning of their infertility and the messages they feel they need to figure out, it can be helpful to read a concise chart of what the Judaic, Catholic, Protestant and Islamic response to a certain treatment has been.

Difficult medical issues such as genetic abnormalities and terminal illnesses such as cancer and HIV as the basis of the infertility are addressed in addition to the more common requests for information regarding donor insemination and issues of disclosure.

I think what readers will appreciate most is that the authors do not “vote” on which plan is best or even best for the couple but they present all sides of the issue and encourage them to consult with physicians and mental health professionals.

Drs. Schover and Thomas have successfully introduced the reader to difficult and painful subjects with respect and professional guidance. A good dose of compassionate humor embedded in the title headings such as “I gave at the office” or “when the crew can’t respond to orders” serves to keep the book moving as well as appropriately lightening up difficult subject matter.

Stylistically, the book has a tremendous amount of information organized into twenty-six chapters each with an average of eight sub-topics.

The glossary and reference sections are easy to read as well as understand. The chapter references are described in a way to facilitate access to original sources by non-academic readers as well.

Mental health professionals, urologists, reproductive endocrinologists and newly diagnosed as well as ongoing patients can all benefit from reading this book and understanding the complexity of how these issues all dovetail together medically, emotionally and spiritually. They cannot be separated out which was probably a great challenged for the writers in terms of presenting the material clearly.

Overcoming Male Infertility is a book I will definitely keep on the table closest to my office chair along with my other favorite references to recommend to patients. I also feel it is mandatory reading for mental health professionals who need a strong foundation in the medical as well as emotional issues specific to male infertility. So many professionals are predominantly better versed in the female anatomy and reproductive loss issues. The information offered to the reader does indeed present strategies for dealing with these issues along with hope for positive resolution and moving on.

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Choosing to be Open about Donor Conception: The Experiences of Parents by Sharon Pettle and Jan Burns [can be ordered from the DC Network for ~$10] (Reviewed by: Jean Benward, L.C.S.W.)

Choosing to be open… is a booklet published by the Donor Conception Network of the UK. Responding to the need for understanding the experience of parents who disclose, the UK Department of Health provided a small grant to develop reading material. Sharon Pettle and Jan Burns, two clinical psychologists, met with parents in discussion groups in various locations in England. Most of the 52 parents who participated were recruited through the Donor Conception Network. DC Network, a UK support organization for donor conceived families, supports openness and most of its members are parents who have decided to tell their children about their donor conception.

Since so little is known about the parents who disclose, this booklet, which shares their stories, is a welcome addition. Recording the discussion groups the two psychologists identified the major themes that emerge and provide us direct quotes as we learn about the parents' issues and feelings.

The book begins with a look at the influences on their decision to be open, including the role of their own childhood experience. It moves to how they handle telling friends, families and professionals and then telling their children. The book closes with the parents concern about the future and the importance of proving a peer group for themselves and their children. The children range in age from babies to teens and many of their comments are included.

In all, this small book is a gem and I recommend it for professionals and parents.

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Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth and Infant Loss by Ann Douglas and John R. Sussman, M.D. (Reviewed by: Jan Elman Stout, Psy.D.)

“Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth and Infant Loss” is a thorough, rich, easy-to-read, and engrossing book aimed at preparing women and their partners for subsequent pregnancies following pregnancy loss or the death of a baby. Ann Douglas is a childcare and parenting book author who personally experienced both miscarriage and stillbirth prior to giving birth to a healthy baby.

At the time of publication, Dr. Sussman was Chief of Obstetrics and Gynecology at New Milford Hospital in Connecticut, as well as an Assistant Clinical Professor of Obstetrics and Gynecology at the University of Connecticut Health Center.

The book focuses on couples’ decision making regarding subsequent pregnancies and the emotions and coping mechanisms that have an impact on their decision making. While these authors share their own perspectives, knowledge and/or expertise with their readers, each chapter of their book is also infused with numerous vignettes from some of more than 100 parents who answered a number of the authors’ questionnaires about their losses during a three-month period of time. These questionnaires addressed a variety of issues relating to pregnancy after a loss, and in particular how these parents: knew they were ready to try to become pregnant again; coped when one partner’s timeline regarding readiness differed from the other’s; coped when they did not become pregnant again quickly; decided whether or not to change caregivers; decided about prenatal testing; and coped with their fears and prepared for their subsequent upcoming births.

The chapters of this book are laid out in chronological order, and move from addressing couples’ need for information about their losses and their need to make sense of them (e.g., emotionally, spiritually, etc.), to providing medical information about miscarriage, stillbirth, and infant death, then helping couples assess their readiness to try to become pregnant again and identifying methods for preparing them to do so, to identifying emotional issues relating to trying again and specifically assessing whether a fertility problem exists, then enumerating a host of emotions and coping mechanisms involved in subsequent pregnancy, and finally to decision making regarding prenatal testing, ways to cope with high risk pregnancy, and methods of preparing for the next baby’s birth. Many chapters of this book include very useful medical facts and statistics, figures, charts or graphs, and benefits versus risks analyses which are clear and easy to understand. Chapters which address emotional issues and methods of coping identify a wide range of normal responses, many of which are illustrated through quotes or vignettes from the authors’ research subjects.

I highly recommend this book to women and couples who have experienced pregnancy and/or infant loss, as well as to the medical, mental health, and allied professionals who treat and/or counsel these couples. The book provides an excellent window into these couples’ medical, emotional, social, and spiritual experiences. It is a virtual encyclopedia of facts and statistics that can help couples — and those who care for them — understand their losses and how they are negotiated emotionally, and can aid in couples’ decision making regarding subsequent pregnancies. It helps couples and their caretakers appreciate the wide array of normal emotional responses involved in their loss, as well as the broad range of coping methods they employ in trying to grieve and resolve their losses and move on in their lives. The overall format of the book makes it very readable, and the many subtitles and charts make it easy to locate specific types of information. One particularly useful appendix of the book includes an extensive directory of organizations and Internet resources in the United States and Canada that provide information and support to couples, and is invaluable to couples and the professionals who serve them.

In my view, this book has only a few minor shortcomings. The authors provide only a very brief description of the research protocol, methodology, subject pool, and methods of recruitment they used in relation to the parents whose experiences they share throughout the book, therein providing very little context for their remarks. While the authors identify a wide range of normal emotional reactions and methods of coping with parenting losses and subsequent family building efforts, they provide virtually no information to help couples assess normal versus atypical emotions and coping mechanisms or guidance regarding when to seek professional help in negotiating them. While informative, the chapter that addresses infertility issues does not appear to have the same depth and breadth of information as the rest of the book. In particular, the information on assisted reproductive technologies is sparse, and the success rates and treatment costs that are listed are outdated. Nonetheless, I highly recommend that couples who have experienced pregnancy or infant loss read this book and share it with the professionals who provide services to them.

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Reaching Out: The Guide to Writing a Terrific Dear Birthmother Letter by Nelson Handel (Reviewed by Carole Lieber Wilkins, M.A., M.F.T.)

Up until now, potential adoptive parents began their domestic adoption process being thrown to the metaphoric wolves. After carefully selecting an adoption professional, they were almost immediately sent forth to battle their own internal demons and return with a calling card—a Dear Birthmother letter upon which the success and timeliness of their adoption often rested. For many, the pressure and anxiety is intense when writing about yourself, intimately and truly? Most find this an overwhelming task.

Nelson Handel’s new book, “Reaching Out: The Guide to Writing a Terrific Dear Birthmother Letter,” fills this crucial gap in the educational process for domestic adoptions. It comprehensively details the process of creating a strong and effective outreach letter and it does so in an entertaining, delightful, and pressure-reducing way.

The book begins with an orientation to the birthparent’s perspective toward adoption, and proceeds methodically to discuss all the component parts that make up the typical outreach letter. It looks at the various letter forms commonly employed, investigates each subject area thoroughly, and provides plenty of step-by-step techniques for writing and revising (this last is a procedure that should make it much easier for those prospective adoptive parents not accustomed to extensive writing). Throughout, Mr. Handel projects the philosophy that authenticity, honesty, and heartfelt speech give prospective parents the best chance of connecting with like-minded birthparents and thus completing a successful open adoption.

This is the second book most prospective parents should read after whatever “adoption process” self-education they complete and the first that begins to grapple with their personal experience of the journey to forming an adoptive family. Most will find Mr. Handel’s knowledge and approach immensely useful. But the real value of the text perhaps may lay in the positive mental approach to adoption it projects. In the guise of orienting almost parents to the letter-writing task ahead, Reaching Out stealthily challenges and corrects many of the negative preconceptions, stereotypes, fears, and self-consciousness they often bring to the adoption table.

An adoptive parent himself, Mr. Handel also brings his skills as a professional journalist to the task. He shows equanimity in areas where adoption professionals disagree but doesn¹t shy away from taking stands on certain subjects, from birthmother infantilization to the overuse of exclamation points (don¹t you just hate that!!) found in many birthmother letters. Overall, he establishes a friendly relationship with the reader, maintains a jovial and supportive tone, and injects a good measure of light humor that keep things moving and makes for an enjoyable read.

Reaching Out accomplishes all it sets out to do, and a good measure more. It should quickly find its way into the established canon of domestic adoption literature, and on to the bookshelves of most adoption professionals.

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What to Expect When You're Experiencing Infertility, How to Cope with the Emotional Crisis and Survive by Debby Peoples & Harriette Rovner Ferguson. (Reviewed by Jan Silverman, M.S.W.)

Recently, one of my clients gave me a gift of "What to Expect When You're Experiencing Infertility" by Debby Peoples and Harriette Rovner Ferguson, C.S.W., proclaiming she had finally read the perfect book. She wanted me to have a copy to add to our Resource Centre to have it available for every infertile woman/man/couple to read.

She was right!

No anatomy lessons, no details of the various procedures, no "how-to's". This book is for those who have been there, who are there, who have very specific issues and concerns and need them addressed with depth and respect.

The book is divided into four sections for clients utilizing the C.A.R.E. (Crisis, Acceptance, Resolution, and Epilogue) model. Within each section, the wide-ranging chapters speak to essential dimensions of the psycho-social crisis of infertility while exploring different paths and new directions. The format is one of a short discourse on a topic followed by questions and answers. The questions represent real concerns. The answers to the provocative and often emotionally laden questions are substantive and relevant. In addition, they serve as a resource to other reference material allowing the reader to further explore a specific area. The fifth section of the book is a "Guide for Professionals." Addressing both the fertile and infertile therapist, this section probes theories, interventions and techniques for dealing with the infertile client/patient. Issues such as the use of alternative therapies and the impact of sexual abuse are also respectfully addressed.

The appendix includes a self-help guide and an extensive resource guide which references many health-related issues. Some acknowledgment to non-American sources would have been appreciated, for this outstanding book deserves to be read by clients and therapists world-wide.

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Talking with Young Children about Adoption by Mary Watkins and Susan Fisher. (Reviewed by Ellen Speyer, MFCC)

As an educator and mental health professional, I highly recommend this book. The main point of the book is that listening sensitively to the struggles of our children will enable us to know them and guide them. The beauty of the book is that it gives concrete examples of how to respond to a child emotionally. It goes on to validate the parallel struggles of the parent in dealing with these issues. Through real dialogue between parents and children, the issues become manageable and much more comfortable. Written in a narrative, case example style, the book is easy to read and relate to. Theory is interspersed in an understandable fashion which gives a great deal of substance to the book.

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Helping the Stork: The Choices and Challenges of Donor Insemination by Carol Frost Vercollone, Heidi Moss, and Robert Moss. (Reviewed by Susan Cooper, Ed.D.)

This book is a must-read for anyone considering building his or her family via donor insemination. It is also a book that will benefit physicians, nurses, and mental health clinicians involved in their care. Carol Vercollone and Heidi and Robert Moss, with their knowledge and experience - supplemented by an abundance of vignettes from those who have been there - guide readers through the decision-making process of donor insemination. This comprehensive book begins with the initial diagnosis of male infertility. It then takes the reader through the myriad decisions facing prospective DI parents, the process of attempting pregnancy, the different challenges involved for non-traditional families, and most importantly (to this reviewer) the process of talking to children - throughout their lifetime - about donor insemination.

While respecting some parents' decision to maintain secrecy regarding their children's origins, the authors make no secret about their bias towards disclosure. In fact, one of the poignant touches of Helping the Stork is that the Mosses, who built their family via donor insemination, model openness by sharing their personal experiences throughout the book. DI parents who would like to be open but are uncertain about how and when to do so, can turn to Chapter Seven, "Growing with DI." This lengthy chapter offers excellent advice about discussing donor conception with children.

The strength and uniqueness of this book, in addition to the quotes and stories by DI parents, is the breath of material covered. By virtue of this comprehensiveness, the authors (all staunch supporters of donor insemination) make clear that DI is not a simple solution to male infertility, but rather a complicated, yet potentially rewarding method of building one's family. The wisdom and guidance offered will surely help prospective DI parents make careful choices that will benefit their family throughout its lifetime.

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The Complete Single Mother: Reassuring Answers to Your Most Challenging Concerns by Andrea Engber and Leah Klungness. (Reviewed by Ellen Speyer, MA, MFCC)

I would recommend this book to someone just beginning to consider single motherhood as an introduction to the serious issues that one can expect. It is comprehensive, concise and it works from a positive and supportive point of view. In addition it offers real life advice to real life problems that all single moms will inevitably face. It is a helpful follow-up to one of my favorites, Single Mothers by Choice. Fortunately, The Complete Single Mother addresses the issues for all women, including those who would not have chosen to be single parents.

The concise outline format of this book allows it to be easy to use and perfect for hassled moms. After 402 pages I was wishing for more! What this book offers in scope of topics necessarily means it cannot go into narrative depth on every subject. The outline form allows a tremendous amount of information to be covered in a direct way. Therefore it is the perfect book to read or have on hand for an extensive reference. I would highly suggest seeking a qualified counselor to help address the most sensitive and difficult issues that this book cannot cover to the greatest degree. I do wish that the book would have more frequently included recommendations to their readers to seek experienced counselors to help deal with the most difficult issues.

The range of topics includes, "Are you ready for single motherhood?" to "Letting go of the daddy fantasies". "The practical aspects of your pregnancy" is informative but so is "The do's and don'ts of combining personhood with parenthood". One of my favorite headings is "If your kids hate your boyfriend".

The extensive list of references in the back of the book is an important addition. It includes references for adoption, donor insemination and psychological referrals.

The first chapter of the book finishes with a paragraph that illuminates the spirit of the book and it's authors. "Don't confuse the challenges of single parenting with hard luck or unfortunate circumstances. You might be blessed...you can not only raise happy, healthy, and productive children, but you will also be able to become the person you were meant to be--strong, decisive, independent, courageous and, above all--a joyful woman."

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Adoption and Assisted Reproduction, by Madelyn Freundlich. Published by Child Welfare League of America Press, 2001 (Review by Anne Malavé, Ph.D., private practice, New York City)

In an age when clinical and ethical boundaries are increasingly blurred, as technological achievements threaten to outpace our human capacity for conceptualization and integration, a book like Adoption and Assisted Reproduction provides a welcome advancement to our field. This book illustrates the well-known dictum of how our increasingly separate areas of specialization often leave us ignorant of important contributions from related fields and how we can all benefit from cross-fertilization (pardon the pun!) among disciplines. Written by a lawyer who is also a social worker, from an ethics-based perspective, this book uses a simple yet powerful method of comparative analysis to identify key issues in the interface between adoption and assisted reproduction and generate a series of conclusions for professionals to consider.

The author, Madelyn Freundlich, Policy Director for Children’s Rights, Inc., New York City, former Executive Director of the Evan B. Donaldson Adoption Institute, NYC, and General Counsel for the Child Welfare League of America, developed this book under the auspices of the Evan B. Donaldson Adoption Institute as fourth in a series of books on ethical issues in adoption. Other titles in this series include on the role of race, culture, and national origin in adoption; market forces in adoption; and the impact of adoption on members of the adoption triad. These ethical topics were identified by a multidisciplinary Ethics Advisory Committee with representatives from a wide diversity of disciplines, including the social sciences, the judiciary, and bioethics. The series was developed for the purpose of providing a synthesis of the current knowledge base on key adoption policy and practice issues to guide future policy and practice. This book was developed to investigate whether this knowledge base is applicable in the context of reproductive technology.

Freundlich conducts a systematic and comprehensive examination of the issues and existing tensions in adoption and assisted reproduction (including sperm donation, egg donation, embryo transfer, and surrogacy). The book considers questions such as the meaning of parenthood, the parties served, disclosure and information access, market forces, and the law, using existing research, as well as practice-based knowledge in an ethics-based framework. The writing style and organization is clear and methodical, with the result that this analytical and scholarly book is also refreshingly direct and unassuming. The result is that complex and embedded material which might otherwise remain invisible or opaque is gradually revealed as the book progresses toward its conclusions, which are framed as a series of similarities and differences. Similarities include the common point of origin (infertility), the involvement of multiple parties, lack of genetic connection, social stigma, a history of treating information as confidential, and the business aspects in each service. Differences include the greater complexity in the nature of the relationships in assisted reproduction, differences in the roles of the parties who make the services possible (birth parents and donors), differing perspectives on disclosure of information and differing levels of support societally for disclosure, differing service environments and views of the roles of the professionals involved, and differing laws and legal implications. Freundlich suggests that this identification of key issues may provide a platform to further the discussion of issues that professionals face in policy and practice. Interestingly, in March 2004 (and 3 years after this book was published), the Ethics Committee of the American Society for Reproductive Medicine published guidelines regarding disclosure in assisted reproduction, making reference to parallels to adoption.

Reading this book as a clinician, I found myself longing for the kind of realization and clarity that I find usually only comes from supplementing ideas with clinical material. Obviously, providing a purely clinical approach was neither the orientation nor the intent of the author. I believe, however, that this book lends itself extremely well to providing a welcome starting point from which clinicians can begin to have clinical conversations about these crucial issues. At a time when technology provides an exponentially increasing array of family-building options and the people we serve are feeling increasingly overwhelmed, lost, and confused, we can all use guidance to inform our policies and clinical practice. This book makes some important, and yet often neglected, points having to do with power relations, such as the fact that in infertility treatment, the client is the adult patient, whereas in adoption, it is the child who is traditionally the focus of consideration. The discussion of the market forces that are at play within each system provides a heightened awareness of the complexity of the competing interests in each system. I believe that this approach also provides us with a potential framework from within which to reflect upon and evaluate our own power roles within the system in which we too participate.

This book fills a central gap in the field of infertility, as not all mental health professionals working in this area have a knowledge base of adoption, and many of us struggle to gain clarity and consensus about these powerfully laden issues. This book’s simplicity and clarity make questions and concepts which are charged with emotion and controversy accessible to inquiry. Mental health professionals are only too aware of the powerful press for repetition we human beings are vulnerable to, individually, societally, and globally. It behooves us all, where possible, to learn from history and to try to apply our understanding to help people live their lives. Because there is so much at stake, we need to be open to points of view from multiple perspectives and knowledge bases to inform our work. Adoption and Assisted Reproduction is an invaluable resource for information and for furthering our discussion and work towards consensus-building in the critical work we engage in of helping people. I highly recommend this illuminating book.

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Infertility: Psychological Issues and Counseling Strategies edited by Sandra Leiblum. (Reviewed by Francine Dell, ACSW, BCD)

Infertility has an excellent selection of authors, who have years of clinical experience in this exciting and ever-changing field of infertility. There are 13 authors contributing current information, all of whom have expertise in the field of infertility. The editor, Sandra Leiblum, Ph.D. is an authority in the field of sex therapy and the psychosomatic aspects of women's reproductive health. In addition to editing this book she has contributed a chapter entitled, "Love, Sex and Infertility: The Impact of Infertility on Couples". This book is very comprehensive, covering a broad spectrum of topics. Consideration is given to gender differences in coping with infertility. Strategies are provided for helping individuals deal with anxieties, feelings of inadequacy and low self-esteem. There are sections devoted to specific issues such as privacy and disclosure in third party reproduction, reproduction among single women and same sex couples. A review of currently available ART options is also included. This book is an excellent reference for all mental health professionals working with clients grappling with the multiple issues of infertility. It is very comprehensive, covering a wide variety of topics such as: medical, ethical, and psychological perspectives; clinical considerations and treatment; and alternatives for when medical treatments fail.

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Infertility Counseling: A Comprehensive Handbook for Clinicians
Edited by: Linda Hammer Burns, Ph.D. and Sharon Covington, M.S.W.
Published by: The Parthenon Publishing Group, 1999
(Reviewed by: Francine Dell, A.C.S.W., B.C.D.)

This book is a must for anyone working with infertility patients. It clearly addresses the gamut of issues that infertile individuals face. It offers a comprehensive and multi-disciplinary look at all aspects of the psychological components in the world of infertility. Both seasoned and novice infertility counselors would benefit from reading this book. It offers a great resource as a handbook to refresh oneself on pertinent issues surrounding infertility.

It covers a wide variety of topics on psychosocial assessments and treatment modalities, as well as medical counseling issues and dealing with special populations. Additional information regarding third-party reproduction and alternative family building are covered, as well as "post-infertility" counseling issues. There are also issues surrounding the role of the physician and nurse as counselors and legal and ethical issues which are addressed.

This book is recommended for professionals; however, I think that patients would also benefit from the information in several chapters such as "Medical Aspects of Infertility for the Counselor" by William R. Keye, M.D., which provides a comprehensive historical overview of infertility diagnosis and treatment.

Several of our MHPG members have contributed outstanding chapters with valuable information based on their clinical experiences.

The book features an extensive appendix which in and of itself makes it a worthwhile purchase for any clinician. It includes resources, bibliographies, relevant organizations, guidelines for screening and counseling, as well as a grief scale. There are several clinical protocols in specific areas such as perinatal loss, embryo donation and informed psychological consent forms.

Personally knowing both Linda and Sharon, I feel that they are both excellent clinicians in this field and I applaud their efforts in recruiting contributors with vast experience and expertise. This book is a definitive handbook for all practitioners of infertility counseling and essential reading for mental health professionals.

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