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Tuesday, February 10, 2009

Barren Advice: Twenty-Eight

This is the 28th installment of Barren Advice. You can ask questions that are fertility or non-fertility related.

Barren Advice is posted each Tuesday-ish. If you have your own question for Barren Advice, click here to learn how to submit. Please weigh in with your own thoughts in the comment section and indicate which question you're addressing if there are multiple questions in the post.

Dear Mel:

Hi, I have looked at INCIID and RESOLVE sites for information on cancer survivors and their experiences with domestic adoption. I also bought a book about adoption and the information on this topic is insufficient (Godwin & Godwin Complete Adoption Guide). Can you talk about this issue?


The core idea in this question is what are the tipping points for adoption agencies and expectant parents seeking placement--what sorts of things are skeletons you shouldn't have in your closet or conditions you wish you didn't have to list when it comes to adoption.

The best advice I've ever read on this topic came from Elizabeth Swire Falker's book, The Ultimate Insider's Guide to Adoption. The over riding idea when she covers the homestudy is that social workers know that you're human and you're going to have problems, but it's how you deal with those problems that makes a difference.

The big red flags for social workers (and by extension, expectant parents too) are lying, felony or child-abuse arrests, and recent addiction issues. With lying, it's better to disclose everything than to have it discovered later. And with addiction, "recent" is a general term. Showing that you've taken steps to treat the condition and that you've logged a substantial amount of sobriety time prior to starting the adoption process makes a difference.

But there was nothing in the book specifically about cancer, so I wrote Swire Falker (who is an attorney in the area of adoption in addition to being a writer) this question. Her thoughts on the matter follow idea above--that there are few skeletons in anyone's closet that are going to wholly keep them from becoming an adoptive parent.
Starting an adoption plan isn’t easy stuff for anyone. Most prospective adoptive parents come to the process carrying a hefty amount of baggage. Whether it is from infertility treatment, or being an “older” adoptive parent, or our marital status, most of us are really scared about what a birth family, adoption agency, or even a foreign country may think about us and who we are. There is no doubt that the fear of rejection is daunting. It’s amazing what we do to ourselves through this process. How we compartmentalize our personalities and our features and try to “predict” what it is that might make us more appealing to a birth family or what might make us less “pickable” to another country. It has gotten so out-of-control in some respects that I now lovingly call it the “Pickable-Factor” or the “Pickable List.”

The Pickable Factor is anything that we think might disqualify us or make us less attractive to a birth family, an adoption agency, or another country; ultimately causing her/it to choose another adoptive parent(s) over us or rejecting our application to adopt. Every one of us has our own list of “pickables” that we think will make our wait take longer or stop it altogether.

The reality is that some of your “pickables” may play a role or even prevent you from pursuing some type of adoptions. For example, China has new regulations (don’t get me started!) that require that applicants be married for a specified period of time, not be obese, and not have taken antidepressants. China probably wouldn’t look so favorably on an application from someone with disabilities and/or who is a cancer survivor. I would check with your adoption agency if you have any of the “pickable factors” I just listed before you submit your application. I didn’t say this was fair, I just said these were some of the new regulations that went into effect in 2007.

However, these same “pickable factors” may not play any role in your adoption process if you were open to consider other types of adoption. If you chose a domestic newborn or infant adoption, a foster-care adoption, much if not all of what China disqualifies might not raise an eyebrow for your attorney or your adoption agency. A history of cancer or a history of depression, or any significant item on your “pickable list” should all be thoroughly addressed in your home study, but as long as you are healthy today and have the ability to care for a child, your social worker should be able to navigate successfully around what might have been a huge stumbling block in another adoption program.

I think the bottom line is to be educated about the criteria that various countries and agencies have for accepting applications from prospective adoptive parents, and then see if your list of “pickables” precludes or limits your participation in certain programs. Domestic adoption, and especially foster-care adoption tend to be more flexible avenues than international or some agency-assisted adoptions. But every prospective adoptive parent should – armed with a good home study – have a program or avenue to become a parent. No single criteria whether it be sexual orientation or a history of cancer should ever preclude you from becoming an adoptive parent. Your individual Pickable Factors may mean you have to do more research and be more creative, but unless you’ve got a felony child abuse arrest on your Pickable List, and as long as you’re honest with yourself and your social worker, then you shouldn’t encounter too many problems on your path to parenthood (I mean, other than the 1,001 you’ve already had to endure).

So it would appear that being a cancer survivor shouldn't affect adoption as long as your disclose this information to your social worker.

Dear Mel:

My RE suspects I have endometriosis, which explains A LOT of things that have been happening to me the past couple of years. The hubs and I are going on 4 years of TTC with one miscarriage 3 years ago and a whole bloody trail of BFN's. We are currently scheduled to do 2 more IUI cycles, before having a laparoscopy and moving on to IVF in June.
I have been reading about endo quite a bit,trying to understand how it works, if there is anything we can do to ease the symptoms, etc, and I stumbled on some blogs and forums where it was stated that there is sometimes a connection between endo, infertility and gluten.

I saw that there are quite a few books written about the
gluten free diet increasing fertility. That, and, shazam, I got an email from a dear friend this morning, who has been trying to conceive with her husband for EIGHT years now. She's pregnant, from real live sex with a man, and believes that going gluten free, combined with acupuncture is what helped her. She had only been gluten free for two months when she got her BFP, so we could say it was a coincidence, but seriously... after eight years of BFN's? I have a sneaking suspicion that she might be onto something. I'd love to have your take on this. Thank you so much.


First I started in books and when I couldn't find a lot on gluten-free diets in regard to endometriosis, I took to the Internets (yes, plural, because there are so many of them). I found many forums, but no formal studies. This speaks nothing to how factual it is and more to what avenues researchers are interested in pursuing and what they can get funding to study.

What I did find were books that spoke about that general diet that is used to treat everything from endometriosis to human African trypanosomiasis. While I'm being sarcastic, there is no harm in a diet that is low in refined sugar and carbs, alcohol, caffeine, preservatives, and fried foods--which is the basic rundown of most fertility diets.

You could ask your doctor what she thinks about gluten-free diets and their effect on endometriosis, but she's likely to tell you that it's of the "can't hurt" category along with drinking green tea or chowing down on whole milk ice cream. If endometriosis is your problem, is not eating gluten likely to stop the spread of endometrial cells? Well, no, I can't really think of any situation where the omission of a food cures a condition (with the exception of food-related illnesses). Removing a food may be helpful in not exasperating a condition, but it won't cure it.

So what should you do? If sticking to a gluten-free diet isn't going to make you feel like you are giving up one more thing as a sacrifice to infertility, I say go for it. The only problem I can see arising is not knowing enough about substitutions which could create a deficiency in your diet. But if you look into it carefully and pay attention to your overall diet, I think it's a great idea. My concern is only if it doesn't work. Will you feel like it was still worth a shot and a worthwhile investment? Then yes, you should go ahead with the diet. But if you fear that you're going to look back on this time period and say, "I made myself give up everything I like to eat and it still didn't do anything; all it made me was miserable," then I'd forgo it. To be honest, I like my gluten so much that unless a study was unearthed strongly proving a connection between gluten consumption and premature ovarian failure (my diagnosis), I probably wouldn't try it out just in case. I feel like I've denied myself too much as is from events to food. I'd rather be happy in the places I can be happy. But that's me and my unnatural love of gluten.

No really, the beauty of a blog advice column is that you get to weigh in with your two cents too. Let the questioner know if you support the advice, add to the response, or dispute it completely.

Leave a comment in the reaction box below--only keep in mind that conflicting advice is embraced and rudeness is not. Want to ask your own question? Click here to see what you need to send in order to be included in a future Tuesday's installment of Barren Advice


Anonymous said...

With regard to the first question, one of my "pickables" was chronic medical conditions with my sinuses and lungs that necessitate my pulmonolgist basically being my PCP.

We were kicked out of international adoption because of this, but it wasn't an issue at all with our domestic adoption.

I think that it's all in how it's presented. On a form submitted to another country they are looking at things like "married 5 years" and "recovered from cancer of the ...." all listed on the same form and perhaps giving each thing more of an equal weight. On the other hand, with domestic adoption, our SW would have presented it as "these are wonderful people and here are all of the wonderful things about them and then yes, the wife has some chronic medical conditions but I have a letter from her doctor that they will not impact her lifespan or her ability to be a great mother." When presented that way it's much less likely to freak out the potential birth parents. Being a cancer survivor is (pardon me here if I'm being inappropriate) kinda "in" right now with Livestrong bracelets and Breast Cancer Awareness month, etc. So perhaps the cancer survivor factor might be a *helpful* thing if the potential birth parents think of you as one of those inspirational cancer survivors who go on Oprah because they climbed a mountain or swam across the English channel....or adopted a baby.

Anonymous: hope your adoption journey is short and sweet.

Courtney said...

Interesting info...I wish I could remember the book title, but I did read a book in a chain bookstore about endo and a sensitivty/allergy to yeast. The book talked about a gluten free diet as well. I thought about it, but I just couldn't put myself through more stuff. I would suggest that she has the surgery before her IUIs. Surgery does improve pregnancy rates for endo so I would do the surgery first to have the best chances with the IUIs. The best book I've read about endo was "Endometriosis for Dummies" is amazing...a must read for anyone with endo.

Erin said...

Anonymous, a family at my synagogue finished treatments for the wife's leukemia and was home with their newborn baby boy less than two months later. They were picked by a birthmom for whom it wasn't an issue after she'd seen the wife's prognosis. So it can happen and hopefully yours will happen quickly.

Alexicographer said...

On gluten -- celiac disease is an auto-immune disease, and I believe endometriosis is or can be or is suspected of being. People who have one auto-immune disease are more likely than average to develop others, so ... well, you can do the math. Also, celiac disease (an auto-immune response to gluten that resolves when the exposure is eliminated but not -- note, not -- necessarily just when it's reduced) is definitely linked to infertility.

If you think you may have celiac disease, it is is something you can and should be tested for. My understanding is that the testing can take 3 forms ... gene tests can identify a gene that is essential to having celiac; if you don't have the gene, you don't have the disease (the reverse is not true -- you can have the gene but not the disease). Blood tests may (I am not sure) be able to rule celiac in or out, but they are not the definitive diagnosis. That is done by conducting a biopsy of some part of your gut (stomach or small intestine, I think, but I forget which).

Eliminating gluten for awhile is reasonably straightforward, but the thing is, at least if you do have celiac disease (diagnosed or otherwise), you absolutely positively have to cut out all gluten, and this is hard to do (feasible, though) as it's pretty pervasive and shows up places you wouldn't expect (soy sauce, for instance).

If you want more information about celiac disease, I'd recommend the book Celiac Disease: A Hidden Epidemic by Peter Green, and/or the site, including the message boards there. People who have untreated celiac disease, even without the usual gastrointestinal symptoms associated with the disease, are at risk of a wide range of health problems like lymphoma, so it's worth finding out if you have it, if you think you might, and acting appropriately (i.e. eliminating gluten) if you need to.

Melissa, sadly, some causes of DOR are thought to be auto-immune, so it's at least possible that we, too (I'm a fellow DORer) should be tested ...

sassy said...

Hmmm, thank you Melissa for your response as to the gluten question. I'm still up in the air. (I cut gluten out last eek, but m baking bread as we speak, and, well, you know what that smell does...) I guess the jury is still out on this one.

I did, howevevr, truly appreciate your point of view when you talked about the fact that we, ther Inferts, have already given up so much. One more thing, unless knowing it will work, does seem like a lot.

Then I read some of the comments...

Courtney : I'll have to get a hold of that Endo for Dummies book. Unfortunately though, the laproscopic surgery isn't an option BEFORE the IUI's but my RE will do it before my IVF in June (assuming I'm not pregnant by then.) I live in France, which means (sorry) that fertility treatments are 100% covered by government health insurance but on the other hand the patients are (even by the best, most human RE's) treated a bit like children and not given much choice on the matter. The protocol basically imposes having 3 IUI's before moving on to other orocedures, whatever the diagnosis may be. Pretty stupid, I know, but I guess it's the governments way of thinking that they're 'saving money' by avoiding going straight to IVF. It's actually only because I have endo that my RE could justify me doing 2 IUI's before the surgery and IVF.

Pretty stupid, eh? I try to look at the bright side and tell myself that at least we're not having to dole out thousands of dollars for the treatments like so many of you are in the US. My heart really goes out to you guys.

Alexicographer : Interesting info but I'm not sure what the connection between Celiac and Endo is...

Thalia said...

As mel said, there is really no evidence to support a gluten-free diet for endo. Anecdotally, I tried it and my endo got WORSE while iwas on the diet, so I gave up. And then a year later, after 2 laps and zoladex to clear up the endo, I got pregnant spontaneously. I certainly wouldn't put myself through that diet again.