I appreciate all your emails. It’s obviously more fun to keep writing when I find out that others are being educated, enlightened and inspired by the fruits of my labor (or labour, as many of you readers appear to be from the UK and Australia).

Many of you are sending me your specific stories, asking for comment. Bear in mind that I am not permitted to give you specific medical advice. I am board-certified only in the USA and more specifically, I’m only licensed to practice in the state of California. Even if you were to pay me, as some of you have kindly offered, I can’t tell you to increase your dose of Clomid to 100mg. I can’t order lab tests on you. I can’t prescribe you drugs. Even if you do live in California, the only way I can give you specific medical advice is if you officially become my patient, so that I have the chance to fully speak with you and evaluate you and there is no way to do that through a website.

I have heard of other doctors, especially psychiatrists, who have perfected a way of taking on new patients over the internet, even across state and country lines. It does, however, require an great deal of documentation and therefore consume huge amounts of time. That’s something I might look into in the future, but as for now, this blog is something I do solely out of passion, not as any sort of business venture. Having said that, just because I can’t use this site to help you in any role as a doctor, I can certainly offer you help as a journalist, directing you to the latest medical news, as an entertainer, amusing you with cute stories, as an educator, trying to explain scientific concepts, as a motivational coach, giving you strength and encouragement to seek help from your own doctors and perhaps as a consumer advisor, giving you my opinion on how best to select an RE and get the most out of your interaction with them.

See? Doctors are by no means the only professionals who can accompany you in your journey towards having a happy healthy baby.

Before technology gave us the option of doing IVF-ICSI, the only choice for couples with severe sperm problems was to use a sperm donor. Even today, there are times when donor sperm is used. These cases happen with couples who have absolutely zero sperm available (even with high-tech methods) or for whom IVF-ICSI is not feasible within the constraints of their budget. There are also women without any source of sperm who choose to get pregnant by donor sperm. One of the first questions facing patients who are ready to use donor sperm is “Where do we get the sperm?”

There are some who choose to go through a well-screened anonymous sperm bank and there are some who want to get sperm from someone they know. In general, my recommendations go more often towards the option of the anonymous sperm bank. There are three main reasons for this: Privacy. Medical safety. Legal safety.

PRIVACY: So after two years of unsuccessfully trying, you and your husband finally get around to having his sperm tested. Surprise! The results show that he has almost zero sperm. After eventually settling down from the devastating news, you start thinking about your options. You absolutely do not want to do In-Vitro Fertilization. What now? You two agree to get pregnant through donor sperm. He suggests his brother could donate, or maybe his uncle Ted. You two think about this for a minute and decide NO. By instead going with an anonymous donor, you can keep your privacy. At family gatherings, there will be no awkward situations related to running into any sperm donor relatives. What if you use sperm from a friend or family member and repeated cycles are unsuccessful? There is now the subconscious blaming of someone who was just trying to be nice and help out. Again, the privacy afforded by using totally a well-screened, but totally anonymous donor definitely warrants consideration.

MEDICAL SAFETY: Reputable sperm banks have a rigorous protocol for screening the donors. When you put your family member or friend on the spot and ask them if they will donate sperm, they may be less that honest on the screening questionnaires regarding any risky lifestyle habits they may have. This is a principle learned from the concept of directed BLOOD donors. If you put a family member on the spot and ask for a blood donation, the extreme pressure can lead them to be less than honest when replying to screening questions regarding intimate questions of sexual behavior or even drug use behavior. This results in even riskier conditions as compared to using standard banked sperm or blood. Professional sperm banks also practice quarantine, so that the sperm that you can get today has already been frozen for a year. The original donors have already been retested and found to be negative for infectious diseases. This prevents the scenario of a someone contracting HIV on Monday, testing negative on Tuesday and then donating sperm on Friday.

LEGAL SAFETY: People often advise other to avoid doing business with friends. Well, the principle applies even more strongly when it comes to having offspring. Friendships and relationships are always susceptible to change. There was a recent case this week of a woman who asked an ex-boyfriend to donate sperm for her. She promised him that of course he would not need to pay child support. He made the mistake of believing her. She changed her mind and successfully got the courts to put him on the hook for support. The decision was recently overturned. Fortunately, in the case of anonymous donation, this type of problem is not an issue.

Having said all this, there are still times when I have agreed to help patients get pregnant using sperm from known donors. When I do, I ALWAYS involve skilled family law attorneys who draw up contracts, stating as clearly as possible, the agreements of both parties. I also strongly encourage prolonged quarantine similar to that which is done by the sperm banks.

It’s a lot nicer for all involved, especially for the child, if things are not messy.

OK, so maybe it’s not exactly like this, but you get the idea. It’s not all that easy for a sperm to find an egg.

Do you want a baby this year? I am convinced of the usefulness of setting goals in life. I don’t mean just sort of having some vague idea in your mind of what you want. I mean concretely thinking things over and converting these thoughts into words. Each year, I take time not only to come up with goals, but to committ them to writing. In fact, I don’t limit this activity to just each January 1. I update my goals on a regular basis. Time and time again, I’ve shared this habit with friends who later told me that the more they got into the habit of writing down clear goals, the more that their lives gravitated towards their getting what they wanted.

The principles of goal-setting also apply when it comes to achieving pregnancy. There are two common ways of thinking I’ve seen among infertile couples. Both ways of thinking are common and normal, but I challenge you to ask yourself which type of thinking will do you more good in getting what you want? And then you can ask yourself which type of thinking is YOUR style?

Two common types of people are whom I call obstacle-focused thinkers vs. goal-focused thinkers. One type is always thinking about the unfortunate and negative aspects of their situation. The other type is always asking themselves “what do I want” and “what will I need to do to get closer to what I want”. The contrast goes something like this:

• OBSTACLE-FOCUSED THINKING: It is so frustrating. My best friend just got pregnant with her third and I try to be happy for her, but it’s hard. It seems so easy for everybody else, but as for us, we’ve been trying for two years now. I’m beginning to think it’s never going to happen and I feel ready to just give up. Some people have told me that my weight might have something to do with it, but it’s not easy to lose weight for me. I try my best to eat healthy and I try my best to be more active, but each month, I end up actually gaining more. I can’t even bear to step on the scale. Yesterday, my period came for the first time in three months and I cried myself to sleep. Having a big home makes things worse when it is empty no kids. My co-workers tell me to just relax and it will happen, but that just adds to the stress. We tried going to Hawaii last winter and this summer we spent a week in Europe, hoping the change of scene would do the trick. Well, it really wasn’t all that relaxing and it obviously didn’t work. I wonder if my husband’s smoking is messing up his fertility as well. He keeps saying he’s going to quit but we both have stressful jobs and that makes it more difficult. I really wish someone would give me an answer of what I can do. I really don’t want to see any doctors or do anything unnatural. Besides, I already checked and my insurance doesn’t cover infertility. I’ve heard that in-vitro is expensive and there’s no way we can afford it…
• GOAL-FOCUSED THINKING: We were hoping to get pregnant by now, but it’s been over two years and nothing, so it’s time to try something different. I really wanted a baby without help, but I am not going to wait any longer. I’ve invested a great deal of time reading books, finding information on the internet and asking some people I trust. I realize that it would help me if I were to get in better shape. I will agree to make some sacrifices of eating slightly smaller portions and gradually, but consistently increasing my exercise level, because I know it will get me closer to having a baby and living a healthier life. If it becomes necessary, I have explored ways in which I can advance in my job or even take on an additional part time position so that I can save up what it will take to pursue some of the more costly treatment options. I am going to forego my daily Starbucks and we will pass on that cruise this year. My husband was thinking of changing jobs anyway, but now he’ll be attentive to what insurance plans his next employer offers. Hopefully, we won’t need to spend a lot, as our budget is tight, but we will keep trying things until we reach our dream of having a baby in our home…

You get the idea. Personally, my heart is more saddened by people with the first mindset, and I feel a stronger longing to help them, but honestly, the people with the second mindset seem to get pregnant faster and more often.

Now ask yourself. Which one are you? Would it be worthwhile to try thinking the OTHER way in 2008?