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Subject: Infertility FAQ (part 3/4)

This article was archived around: Mon, 03 Apr 2006 12:42:58 -0400

All FAQs in Directory: medicine/infertility-faq
All FAQs posted in: alt.infertility, misc.health.infertility
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Archive-name: medicine/infertility-faq/part3 Posting-frequency: weekly Last Modified: May 14, 2001 URL: http://www.fertilityplus.org/faq/infertility.html
This FAQ is maintained and updated by Rebecca Smith Waddell. Copyright (c) 1997, 1998, 1999, 2000 by Rebecca Smith Waddell, Meg Fiegenschue, Lynn Diana Gazis-Sax, William F. Panak, Rachel Browne, Jennifer Clabaugh, Kate MacKenzie, and Ian Scott Speirs. All rights reserved. Information in this FAQ may be distributed as long as full copyright information is attached, including URL, and use is strictly not for profit. ______________________________________________________________________ ______________________________________________________________________ SECTION 9 - TREATING INFERTILITY Please note, information on drugs mentioned appears after the male and female sections, as does methods of impregnation (IUI, IVF). ------------------------------------------------------------------------ 9.1 - TREATING MALE FACTOR Varicocele: The options are either surgery to close it off, or balloon insertion to block the blood flow. ICSI: Done in conjunction with IVF. After the eggs are retrieved, a single sperm is injected into each mature egg. Stats on ICSI vary _widely_ from clinic to clinic. It is a good idea to check out the clinic and the embryologist for their ICSI statistics before doing ICSI. A fertilization rate of at least 50-60% should be expected with a good clinic and currently the better clinics have a 35-45% ongoing pregnancy rate. (needle aspiration of sperm, inject in egg, implant egg again, supposed to work even with quite low sperm counts). For retrograde ejaculation: antihistamines and alpha-sympathomimetics. For idiopathic oligospermia: Antiestrogens, such as clomiphene citrate (Clomid and Serophene) and tamoxifen can increase sperm density and motility. Sporadic success has been reported with testoractone. hCG has had some positive results, but they aren't solidly reproducible. GnRH (in early stages of investigation). Of questionable benefit or outmoded: testosterone, arginine, bromocryptine (other than for hyperprolactemia), corticosteroids, thyroxin, oxytocin. (This list from "Male Infertility," by Larry Lipshultz, MD, and Serono Syposium. There seems to be a lot of controversy about which infertility treatments are worthwhile, so some of these may still be being debated.) Note: Larry Lipshultz is a highly regarded urologist who specializes in male infertility. He is located at the Baylor College of Medicine in Houston, Texas. Coffee and vitamin C are claimed to improve sperm motility. There is conflicting evidence on whether caffeine is good or bad for sperm counts. Caffeine added to washed sperm does help motility, but whether caffeine taken internally will help is questionable. Vitamin C does have a tendency to help other vitamins absorb. Vitamin E: May help sperm attach better to the egg. Recommended dose is 600 mg per day. An improvement was shown in sperm function on the zona binding test, which may help increases chances of pregnancy. Vitamins and herbs: Rachel Browne has suggested the following formula which seems to have helped her husband: multi vitamin (without iron but with zinc), 1 mg C, 1000 mg l-arginine, 200 IU E, Bee Pollen and Siberian Ginseng in 500 mg pills, 100 mcg selenium, high potency B-complex, and 250 mg l-carnitine. His multi vitamins have: 10000IU beta carotene, 400 IU D, 150 mg C, 100 IU E, 25 mg B1, 25 mg B2, 25 mg B6, 100 mcg B12, 100 mcg niacinamide, 50 mg pantothenic acid, 300 mcg biotin, 400 mcg folic acid, 25 mg PABA, 25 mg choline bitartate, 25 mg inositol, 25 mg calcium, 7.2 mg magnesium, 5 mg potassium, and 15 mg zinc. Microsurgical epididymal sperm aspiration (MESA), testicular sperm aspiration or extraction (TESA, TESE) and percutaneous epididymal sperm aspiration (PESA): MESA, TESA,PESA and other forms of retrieving sperm are used when there is no sperm in the ejaculate are used in conjunction with IVF and often with ICSI. Depending on where this is done, it can be done with a needle, a microscopic needle, or surgery. See http://www.ihr.com/bafertil/articles/azoosper.htm or http://www.maleinfertility.org/new-retrieval2.html Other treatments include surgery to remove blockage, vasectomy reversal (of course), and some kind of gadget which men wear to cool the scrotum area. ------------------------------------------------------------------------ 9.2 - TREATING FEMALE FACTOR INFERTILITY Anovulation, irregular ovulation, and weak ovulation: All are treated with clomiphene citrate, menotropins (Pergonal, Humegon), and urofollitropins (Metrodin, Fertinex) to enhance follicle production. Some women also treat this problem with accupuncture or herbs. Check http://www.healthy.net/clinic/therapy/chinmed/specifics/fertility.htm for more information. Endometriosis: Some can be removed with laser during laparoscopy. Also treated with Danazol, Lupron or birth control pills. Polycystic ovaries (PCO): Can be treated by using superovulation drugs, steroids, and ovarian surgeries mentioned below. Current studies are looking into the use of GnRH. Immune problems: Some autoimmune problems are treated with low-dose aspirin and Heparin. Alloimmune problems are treated with paternal white blood cell immunization and IVIg. See http://www.inciid.org for more information. Adhesions and scarring: Treated with laparoscopy and hysteroscopy for laser removal of scar tissue. Infectious: STDs and PID are treated with antibiotics when possible. May also require surgery for adhesions and scarring. Recurrent miscarriage/pregnancy loss: If a cause can be found, it usually lies within one of the above-mentioned fertility problems, such as an immune problem or infectious disease. See http://www.fertilityplus.org/faq/miscarriage/rpl.html for testing information. ------------------------------------------------------------------------ 9.2a - Corrective Surgeries for Wowen Laparoscopy: Often used to laser out endometriosis. Brief description and personal experiences are posted at http://www.fertilityplus.org/faq/itests.html#lap1 Hysteroscopy: used to remove fibroids and correct septums. Brief description and personal experiences are posted at http://www.fertilityplus.org/faq/itests.html#hyst1 Tuboplasty: Plastic or reconstructive surgery to correct abnormalities in the fallopian tube. Fimbrioplasty: Plastic surgery on the fimbria, finger-like projections at the end of the fallopian tube that capture the egg from the ovary and deliver it into the tube. Ovarian drilling: Process of putting several holes in polycystic ovaries to increase chances of ovulation. Ovarian wedge resection: surgical removal of a portion of a polycystic ovary to increase the chance of ovulation. ------------------------------------------------------------------------ 9.3 Drugs Commonly Used in Infertility Treatment Aspirin (low-dose or "baby" -- usually 81-82 mg): Used in treatment of immune problems such as presence of anti-phospholipid antibodies or the lupus anticoagulant -- mostly in conjunction with Heparin. Also used by some to increase thickness of the uterine lining. Basically to prevent clotting in the lining. Very few side effects are observed with low-dose aspirin. Full-strength aspirin and NSAIDs such as Advil and Aleve should not be used as they may interfere with ovulation and reduce the chance or pregnancy. Check http://www.ivf.com/immune.html for information on aspirin therapy in pregnancy. Check http://www.fertilityplus.org/faq/nsaids.html for more information on ovulatory problems related to these drugs. Birth control pills: Commonly used for suppression of the ovaries prior to a stimulated cycles. Common side effects include headaches, weight gain, light periods, mid-cycle spotting, and elevated blood pressure. Bromocriptine, brand Parlodel: Used for reduction of prolactin levels in both men and women. Side effects include dizziness and drowsiness, as well as more serious ones such as convulsions, black stool, nervousness, shortness of breath, and more. Clomiphene citrate, brands Clomid and Serophene: Used to induce or enhance ovulation in women by stimulating the hypothalamus to release more GnRH and the pituitary to produce more LH and FSH. Common side effects include drying of cervical mucus, headaches, dizziness, cramping, hot flashes, moodiness, sore breasts, stomach upset, bloating, vision problems, skin rash thinning of uterine lining and formation of cysts. For men, it is used to lower estrogen and to increase LH and FSH to increase sperm counts. See http://www.fertilitext.org/clomid.htm and http://www.serono-usa.com/fertility/serophene.html. Conjugated estrogens, brands, Premarin, Premaril and many others: Given mostly as hormone replacement. Side effects for men include muscle spasms, weakness, numbness, shortness of breath, change in vision, and headache. In women it can cause profuse bleeding. In both sexes it may cause increased chance of yeast infection, hair loss, acne or rashes, gastrointestinal problems, nausea and vomiting. Premarin info http://www.premarin.com/. Danazol, brand Danocrine: Synthetic androgen used to treat endometriosis. side effects include acne and oily skin, muscle cramps, weight gain, swelling of feet or lower legs, tiredness and weakness. Estradiol: Given often after IVF to keep E2 levels up. Side effects include nausea and bloating. Follitropins, alpha and beta,(recominant FSH, R-FSH, R-hFSH) brands Follistim, Gonal-F, Puregon: Recombinant FSH (lab made, rather than made from urine of post menopausal women), most often used for superovulation. Received through subcutaneous injection, though Follistim is approved for intramuscular injection in obese women. side effects include hyperstimulation, abdominal and pelvic pain and bloating. Follistim info http://www.organoninc.com/products/consumer/follistim/follistim_c.html, Gonal-F info http://www.serono-usa.com/fertility/gonal_f.html. GnRH-antagonist, ganirelix acetate, brand Antagon: Used to inhibit premature luteinizing horomone (LH) surges in women undergoing controlled ovarian hyperstimulation (COH). It's use is similar to Lupron, but it is newer on the market and has the added benefit of shortening up the IVF cycle. Side effects include abdominal pain, headache, ovarian hyperstimulation, vaginal bleeding, injection site reaction, nausea, and gastrointestinal discomfort. More info: http://www.organoninc.com/pi/antagon/antagon.html. Glitazones, brands Actos (pioglitzone) and Avandia (rosiglitazone): These are insulin-sensitizing meds used primarily for diabetics, but gaining popularity in the treatment of insulin resistance in women with PCOS. These medications are usually tolerated better than metformin, and may be more effective in improving glucose tolerance. The downside is that they are less likely to assist weight reduction (if desired) and they are both Pregnancy Category C medications and most doctors will want to take patients off the medication once a pregnancy is achieved. Liver function should be monitored quarterly while on these meds, and patients should be aware of signs of liver troubles such as jaundice, dark urine, vomiting and stomach pain. The most common side effect is headaches. Check http://www.actos.com, http://www.avandia.com and http://www.inciid.org/faq/pcos.html for more information. Gonadotropin releasing hormone (GnRH): Used in treating PCO and low sperm count. Guaifenesin, brand Robitussin (many generics available): Used to thin cervical mucus. Recommended dose is 2 teaspoons three times per day with a full glass of water. Should be taken starting 5 days prior to ovulation and continued until ovulation has occurred. Side effects include nausea and gastrointestinal problems. Check http://www.fertilityplus.org/faq/cm.html. Heparin: Used in treatment of immune problems -- to prevent blood clotting in the uterine lining. This is an anticoagulant which may have side effects such as nosebleeds, blood in urine or stool, and bruising. Recommended that you take calcium supplements in addition to pre-natal vitamins since Heparin depletes the supply. Human chorionic gonadotropin (hCG), brands A.P.L, Profasi, Pregnyl, Chorigon, Novarel, and recombinant brand Ovidrel: For women hCG is used to induce ovulation, usually after taking clomiphene citrate, menotropins or urofollitropins. Also used to support the corpus luteum and keep progesterone levels elevated. Side effects include pregnancy symptoms such as nausea and breast swelling. Interferes with the ability to take a pregnancy test. Used to help a man's sperm count if the FSH, LH, and testosterone levels are low. Sometimes used in conjunction with menotropins. Only for men with the rare condition of hypogonadotropic hypogonadism. Side effects include moodiness and tiredness. The new recominant hCG, Ovidrel, is supposed to cause less localized reaction, and may help with empty follicle syndrome. Profasi info http://www.serono-usa.com/fertility/profasi.html, Pregnyl info http://www.organoninc.com/products/consumer/pregnyl/pregnyl_c.html. Intravenous immunoglobulin (IVIg): Treatment for immune disorders. Side effects are fast or pounding heart and trouble breathing. Leuprolide acetate, brands Lupron and Decapeptil: used to treat Endometriosis, uterine fibroid tumors, and to suppress women prior to IVF. Side effects include moodiness, hot flashes, and irregular vaginal bleeding. Lupron info http://www.lupron.com/. LHRH antagonist, cetrorelix, brand Cetrotide: used to block LH surge/premature ovulation. It blocks the effects of gonadotropin-releasing hormone (GnRH). The GnRH controls the secretion of LH, the hormone that triggers ovulation. Like Antagon, it allows for a shorter stimulation cycle for IVF or IUI. Side effects include, reddening, itching, or swelling at injection site, nausea, and headache. Menotropins, brands Pergonal, Humegon, Repronex: FSH and LH, commonly used for superovulation. Side effects in women may include hyperstimulation, soreness around ovaries, bloating and rash. For men, side effects include dizziness, loss of appetite, headache, irregular heartbeat, nosebleeds, and shortness of breath. Pergonal info http://www.serono-usa.com/fertility/pergonal.html, Humegon info http://www.organoninc.com/products/consumer/humegon/humegon_c.html, Repronex/Menogon info http://www.ferringusa.com/rephome.htm. Metformin, brands Glucophage and Glucophage XR: Metformin is a diabetes medication used to to improve insulin utilization. For several years it has also been used to treat insulin resistance that often accompanies PCOS. For some women it will restore ovulation or improve response to ovulation stimulation medications. Side effects are mostly gastroinstestinal and usually lessen with continued use.It is a Pregnancy Category B medication that is sometimes continued in all or part of pregnancy. For more info, check http://www.glucophage.com, http://www.inciid.org/faq/pcos.html and http://www.fertilityplus.org/faq/metformin.html. Paternal white blood cell immunization: White blood cells from the father are injected into the mother as a way of fighting certain immune problems. Commonly given when partners are very similar genetically because the woman's body may fail to recognize the pregnancy and fight it. Progestins, brand Provera: Used to induce a period when there is no natural cycle. Side-effects, bloating, headaches, mood swings, swelling of face and extremities, increased blood pressure, and weight gain. Progesterone, brands Crinone, Prometrium, or compounded at pharmacy: Can be given as suppositories, vaginal capsules, oral capsules/pills, lozenges/troches, Crinone gel applicator, and injections. Used to keep progesterone levels elevated in the luteal phase. Side effects include bloating, cramps, constipation or diarrhea, dizziness, drowsiness, headache, effects that warrant doctor consultation include pain, swelling or redness of an arm or leg, one-sided muscle weakness, vision problems, trouble breathing, fainting, itching, or skin rash. Crinone info http://www.serono-usa.com/fertility/crinone.html. Progynon C (Ethinylestradiol 0.02mg): used to increase thin uterine lining. Steroids such as dexamethasone and prednisone: used to suppress androgens in women with PCO and for certain immune problems. Side effects include weight gain, blurred vision, and increased thirst. Tamoxifen citrate, brand Nolvadex: Used to treat men with elevated estrogen levels. It is also used for women who fail to ovulate. The typical starting dose is 20mg on days 2-5 of the cycle. Women with irregular cycles can start it any time, and the dose may be increased as needed. It is used in a similar manner as clomiphene citrate, but may have less damaging effect on cervical mucus and uterine lining. Side effects include nausea, hot flashes, weight gain, and headache. Any vision changes, vomiting or skin rash require doctor consultation This medication is used primarily for breast cancer. Nolvadex info http://www.nolvadex.com/. Urofollitropins, brands Metrodin and Fertinorm (discontinued): Pure FSH, most often used for superovulation. Received through intra-muscular injection. Side effects include hyperstimulation, abdominal and pelvic pain and bloating. Urofollitropins, highly purified, brands Fertinex, Fertinorm HP and Metrodin HP: Pure FSH, most often used for superovulation. Received through subcutaneous injection. Side effects include hyperstimulation, abdominal and pelvic pain and bloating. May not be as effective in those with a body mass index over 26 (meaning higher dose may be needed). Fertinex info http://www.serono-usa.com/fertility/fertinex.html. ------------------------------------------------------------------------ 9.4 - ASSISTED REPRODUCTION TECHNIQUES Timed intercourse: As the name implies, this involves timing intercourse for ovulation. The use of ovulation predictor kits may make this more exact. The greatest pregnancy rate is achieved in those who have sex the 5 days leading up to ovulation and perhaps ovulation day (though some feel that is too late). Couples with low sperm counts should have sex every other day, while daily intercourse should be fine for those with normal and high counts. Artificial insemination (AI): The insertion of sperm into the female reproductive tract. Includes insemination at the cervix and intra-uterine insemination (IUI). At-home insemination (AHI): This can be done with donated sperm (though proper testing is suggested before doing this) or with the husband/significant other's sperm. Rather than using a turkey-baster, as some jokingly suggest, this is best done with an oral medicine syringe. Semen is collected in a cup (or thawed from donor), sucked into the syringe, and slowly injected into the woman's vagina as close to the cervix as possible. For more information, check http://www.fertilityplus.org/faq/homeinsem.html Intra-uterine insemination (IUI): Semen is collected and "washed" or "spun." The sperm is then injected through the cervix, into the uterus using a small catheter. Check the IUI FAQ at http://www.fertilityplus.org/faq/iui.html. Intra-tubal insemination (ITI): This is similar to IUI, but the catheter goes beyond the cervical opening and deposits sperm in the fallopian tube. This is a more uncomfortable procedure and may not greatly improve chances of success. In vitro fertilization (IVF): Eggs and sperm are combined in a lab to fertilize eggs outside the body. Embryos are transferred back 2-3 days after egg retrieval. Intra-cytoplasmic sperm injection (ICSI): Basically one sperm injected into one egg. Used for men with very low sperm counts to try to increase the chance of fertilization. Assisted hatching (AZH): Assisted hatching is putting a small opening in the embryo's outer layer called the zona pellucida. The embryo must break free of the zona to hatch out prior to implantation in the uterine lining. AH is often used for older women (38 or over), who often have more rigid zonas. Non-surgical embryonic selective thinning (NEST): Similar to assisted hatching, only the embryo is slightly shaved prior to implantation to thin the zona pellucida rather than put a hole in it. Gamete intra-fallopian transfer (GIFT): Combining eggs and sperm outside of the body and immediately placing them into the fallopian tubes to achieve fertilization. Immature oocyte retrieval: Immature eggs are collected and grown in the lab using fertility drugs. When mature, they are fertilized and replaced in the same manner as IVF. Zygote intra-fallopian transfer (ZIFT): IVF with the transfer of the zygote into the fallopian tube -- a combination of IVF and GIFT. Stimulated cycle oocyte retrieval in (office) fertilization (SCORIF): This is a stimulated cycle, like IVF, where the eggs are retrieved and placed in a capsule with sperm. The capsule is then inserted into the vaginal so that fertilization takes place within the woman's body. After fertilization (2-3 days), the embryos are transferred into the woman's uterus. Non-stimulated (cycle) oocyte retrieval in (office) fertilization (NORIF): Natural cycle where eggs are retrieved, placed in a capsule with sperm, and the capsule is inserted into the woman's vagina for fertilization. In 2-3 days the embryos are transferred in the uterus. Donor egg: Use of another woman's egg to achieve pregnancy through IVF. Donor sperm: Use of donated sperm for artificial insemination or IVF. List of online cryobanks can be found at http://www.fertilityplus.org/faq/donor.html. ________________________________________________________________________ ________________________________________________________________________ SECTION 10 - INFERTILITY INSURANCE The best way to determine what kind of infertility insurance you have is to check the details of your policy and/or call the company (and get any details in writing if necessary). One often sees questions on the infertility newsgroups about whether or not this or that insurance company covers infertility treatment -- it isn't that easy a question to answer because the same company in the same state can sell different policies to employers. If you have coverage for prescriptions, you may need to check separately to see what is covered. When calling about drugs, use specific names. Drugs that have multiple purposes are usually covered (such as progesterone and estrogen). There are cases where treatment is not covered, but medications are -- and vice versa. There are also policies that cover testing but not treatment, and many cover treatment at a different percentage than other services. These are just some common sense suggestions . . . you can check the following sites for more information: State Infertility Insurance Laws at http://www.asrm.org/patient/insur.html; Infertility Insurance FAQ at http://www.fertilethoughts.net/infertility/faq.html; and Insurance Coverage for Infertility article at http://www.inciid.org/legal.html. The latter two sites also have bulletin boards for discussion of insurance issues. ________________________________________________________________________ ________________________________________________________________________ SECTION 11 - RECOMMENDED READING ------------------------------------------------------------------------ 11.1 - BOOKS The Ache for a Child by Debra Bridwell Victor Chariot Books, 1994, ISBN: 1564762483 And Hannah Wept: Infertility, Adoption, and the Jewish Couple by Michael Gold paper: Jewish Pubns Society, 1994, ISBN: 0827604424 cloth: Jewish Pubns Society, 1988, ISBN: 0827603061 The Couples Guide to Fertility: Techniques to Help You Have a Baby by Gary Berger, Marc Goldstein, Mark Fuerst Main Street Books (Doubleday), 1995, ISBN: 0385471246 Getting Pregnant and Staying Pregnant: Overcoming Infertility and Managing Your High-Risk Pregnancy by Diana Raab Hunter House, 1991, ISBN: 0897930800 Getting Pregnant When You Thought You Couldn't: The Interactive Guide That Helps You Up the Odds by Helane S. Rosenberg, Yakov M. Epstein Warner Books, 1993, ISBN: 0446393886 Having Your Baby by Donor Insemination: A Complete Resource Guide by Elizabeth Noble Houghton Mifflin, 1987, ISBN: 039545395X Healing Mind, Healthy Woman: Using the Mind-Body Connection to Manage Stress and Take Control of Your Life by Alice D. Domar, Henry Dreher Henry Holt, 1996, ISBN: 0805041346 (hardcover) Audio cassette available, ISBN: 0694516988 Paperback to be released soon. How to Be a Successful Fertility Patient: Your Guide to Getting the Best Possible Medical Help to Have a Baby by Peggy Robin Quill, 1993, ISBN: 0688117325 How to Get Pregnant with the New Technology by Sherman J. Silber Warner Books, 1991, ISBN: 0446393223 Infertility: Your Questions Answered by S. L. Tan, Howard S. Jacobs, MacHelle M. Seibel Birch Lane Press, 1995, ISBN: 1559722940 In Pursuit of Fertility: A Fertility Expert Tells You How to Get Pregnant by Robert R. Franklin, Dorothy Brockman Henry Holt, 1996, ISBN: 0805041818 Listen to Your Body by Eileen Stukane, Niels H. Lauersen Berkley Pub Group, 1993, ISBN: 0425104931 Longing for a Child: Coping with Infertility by Bobbie Reed Augsburg Fortress Pub., 1994, ISBN: 0806626720 Miscarriage: A Man's Book by Rick Wheat Centering Corp., 1995, ISBN: 1561230820 Miscarriage: Women Sharing from the Heart by Marie Allen, Shell Marks John Wiley & Sons, 1993, ISBN: 0471548340 Overcoming Infertility Naturally by Karen Bradstreet Woodland Pub., 1994, ISBN: 0913923869 Preventing Miscarriage: The Good News by Jonathan Scher, HarperPerennial, 1990, ISBN: 0060920564 A Silent Sorrow: Pregnancy Loss Guidance and Support for You and Your Family by Ingrid Kohn, Perry-Lynn Moffitt Dell, 1992, ISBN: 0440507138 Sweet Grapes: How to Stop Being Infertile and Start Living Again by Jean W. Carter Perspectives Press, 1991, ISBN: 0944934013 Taking Charge of Infertility by Patricia Irwin Johnston Perspectives Press, 1994, ISBN: 0944934072 Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control and Pregnancy Achievement by Toni Weschler Harperperennial Library, 1995, ISBN: 0060950536 Wanting Another Child: Coping With Secondary Infertility by Harriet Fishman Simons Lexington Books, 1995, ISBN: 0029289386 There is also a book section in the Fertility Information Resource List at http://www.vais.net/~travis/firl.html. More recommended reading regarding miscarriage is posted at http://www.fertilityplus.org/faq/miscarriage/resources.html. ------------------------------------------------------------------------ 11.1a - ONLINE SOURCES FOR ORDERING INFERTILITY BOOKS Perspectives Press is a publisher specializing only in adoption and infertility titles, for adults and children. Go to http://www.perspectivespress.com/ourbooks.html for a listing of titles. Purchasing information is included as well as an online order form for direct sales. There is also a discount book page where you can get some deals. Amazon books at http://www.amazon.com has a huge selection of infertility and miscarriage books available for mail order at a small discount. It takes 2-3 days for most titles to be sent out, then add transport time. This resource also allows you to sign up for notification whenever new books in your selected subject area become available. Most books sold at a 20-30% discount off the cover price, some at 40%. Tapestry books at http://www.tapestrybooks.com has a large selection of infertility and adoption titles. Amazon may have more available, but tapestry offers a printed catalog of titles as well as its web site. Barnes & Noble is now online at http://www.BarnesandNoble.com. In-stock titles are sold at 20-30% discount off the cover price. ------------------------------------------------------------------------ 11.2 - PERIODICALS Used with permission of Travis Low, Fertility Information Resource List (FIRL), http://www.vais.net/~travis/firl.html FerreFax, by the Ferre Institute, Inc. 258 Genesee Street, #302, Utica NY 13502 USA Telephone: 315-724-4348 (vox), 315-724-1360 (fax) http://members.aol.com/ferreinf/ferre.html mailto:ferreinfo@aol.com Fertility and Sterility American Society of Reproductive Medicine 1209 Montgomery Highway, Birmingham, Alabama 35216-2809 USA Telephone: 205-978-5000 (vox), 205-978-5005 (fax) http://www.asrm.com/profession/fertility/fspage.html mailto:asrm@asrm.com A cutting-edge medical journal. A bit pricey, but it may be worth it for you. Fertility Weekly P.O. Box 43054, Atlanta, Georgia 30336 USA Telephone: 800-705-7185 (vox) 770-949-2066 (fax) http://www.homepage.holowww.com/1f.htm mailto:kkey@hendersonnet.atl.ga.us A weekly digest on fertility and human reproduction. Expensive, but sample issues are available (and you get what you pay for). Hannah to Hannah P.O. Box 5016, Auburn, CA 95604-5016 USA Telephone: 916-444-4253 (24 hour voice mail) http://www.hannah.org mailto:hannahs@hannah.org Published by Hannah's Prayer, a Christian infertility and pregnancy loss support organization with a small but growing number of local support group chapters in the US. The Infertility Experience (T.I.E.) P.O. Box 10, St. John, IN 47373 mailto:inferex@aol.com Bimonthly newsletter offering support and guidance to those going through the infertility process. Includes reader response and book reviews. The cost is $18.00 for a one year subscription. INCIID Insights P.O. Box 91363, Tucson, AZ 85752-1363 USA Telephone: 520-544-9548 (vox), 520-509-5251 (fax) http://www.inciid.org mailto:INCIIDinfo@aol.com Infertility Awareness A membership benefit from Infertility Awareness Association of Canada (IAAC) 396 Cooper Street #201, Ottawa, ON K2P 2H7 Canada. National office: 613-234-8585 or 800-263-2929 (vox), 613-234-7718 (fax) mailto:iaac@fox.nstn.ca The Infertility Experience (T.I.E.) P.O. Box 10, St. John, IN 47373 mailto:inferex@aol.com Bimonthly newsletter offering support and guidance to those going through the infertility process. Includes reader response and book reviews. The cost is $18.00 for a one year subscription. Infertility Helper 36 Norwood Road, Toronto, Ontario M4E 2S2 Canada. Telephone: 416-690-9593 (vox). http://www.helping.com/family/iy/iy.html mailto:helper@helping.com They also publish the Adoption Helper. Newsletter of Resolve National 1310 Broadway, Somerville MA 02144-1731 USA Telephone: 617-623-0744 (vox), 617-623-0252 (fax) http://www.resolve.org mailto:resolveinc@aol.com Roots & Wings Adoption Magazine PO Box 577, Hackettstown, NJ 07840 USA http://www.adopting.org/rw.html mailto:76262.354@compuserve.com TASCFORCE A free email newsletter concerning surrogacy issues. http://www.surrogacy.com mailto:TASC@surrogacy.com ______________________________________________________________________ ______________________________________________________________________ continued in Infertility FAQ (part 4/4) ~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~ mailto:bec@fertilityplus.org Fertility FAQs and Info - by patients, for patients http://www.fertilityplus.org/toc.html