#1. The conception/pregnancy/birth was planned and not accidental

[meat-loving-meat]

furiously typing a vaguepost about how my sperm donor post isn’t about jod and also cannot be about jod. JOD IS NOT A SPERM DONOR!! He is A DAD who didn’t know he was a dad. The instant he found out he had a kid he stepped the fuck up and made her an evil colonialism prince. Now Wake, on the other hand—

[callioope]

I’ve been vague about what has been going on in my life intentionally, both because I needed to tell some people offline first and because it’s a lot to process. 

But here is what happened: I am in the process of miscarrying.

I thought it might help to share my story. Miscarriage is more common than people realize and rarely talked about. If someone can benefit from my story, all the better, but mostly this is to help my grieving and coping process.

This is pretty detailed, so trigger warnings and all that.

Exactly one month ago, I read the results I had longed for: pregnant.

Today, I’m sprawled out on the couch in the most excruciating pain I’ve ever experienced. 

They don’t tell you that miscarriage is a process.

We’ve been trying to conceive since the end of last June. It was taking so long, I was convinced I’d be scheduling a fertility consultation this coming June. They tell you if you’re under 35, to give it a year. Before we started trying to conceive, I’d tell anyone about how time speeds up the older you get. It makes sense logically, of course, when a year is 1/5 of your life, it sure seems long, but went its 1/32, well... 

But this has been the longest eleven months of my life. The first month we started trying, I had an unusually long cycle. 39 days. I was so sure I was pregnant. My breasts had been hurting for two weeks. Husband and I were vacationing in Minnesota to see Aston Villa play. I bought a pregnancy test, beaming, excited, and was puzzled by the negative result. A week later, when my period came, I cried to my mother, and she said something about the universe saying I wasn’t ready or something. Whatever it was sounded bleak and ominous to my ears. It sounded like it meant I’d never be ready. 

The fall was busy and stressful, and despite all the tedious ovulation test strips, nothing happened except somehow, my period got lighter month by month. I was pretty sure something was wrong with me. I thought I had a UTI. (I was actually stressed and dehydrated, which I eventually remedied.) While I cried at a Sara Bareilles concert in November, my mother told me that her OBGYN said it can take as much at 9 months for the body to recalibrate after being on the pill.

Speaking of which. I’ve been taking the pill for over a decade. For the most part, I took it correctly. There is some leeway to taking it incorrectly, for the record. You can miss two pills in a row and it still has instructions for what to do (while cautioning to be safe and use extra protection). Maybe only once did I ever have to throw out a pack for missing too many in a row. 

(This is maybe neither here nor there, but rebelcaptain accidental pregnancy fics have become a bit of a pet peeve for me. Jyn and Cassian are far too careful and intentional to let that happen, and it is so easy to be responsible since there are so many birth control alternatives these days that don’t even require reliance on routine or memory.)

So, of course, the concern lately is that clearly 10+  years on birth control has messed me up. I do not know this objectively (what I do know is that I have OCD and anxiety and obsess over Everything That Can Go Wrong), but the point is that birth control really can have consequences that I don’t think are necessarily fully understood or studied. DO NOT GET ME WRONG, USE BIRTH CONTROL. My only regret is what I didn’t know.

I learned too late, but a lot of conception advice articles tell you to quit the BC as soon as possible. Even if my mom’s OBGYN is wrong, the general advice does seem to be that it can take up to 3 months for your body to recalibrate. So, if by any chance someone reading this is thinking about conceiving soon, if you take nothing else away from this rant, take this. I wish I had stopped taking the pill a few months before we actually intended to start trying.

After ten months of all this worrying, I finally got what I’d longed for. The moment I saw that positive result, it felt so surreal. There had been little things leading up to that moment, strange hints and signs, like I knew subconsciously even before a test would have been positive. I wrote that Howl’s Moving Castle pregnancy fic before I knew. I started learning “Here Comes the Sun” on my ukulele before I knew (it’s... silly, but I decided I wanted to learn the ukulele because I wanted to be able to play that song for my kids some day). It involves finger picking, so I’d been putting off learning it, but one day I just decided it was time. And finally, I decided to watch the latest season of Brooklyn 99. I’d avoided it because I knew Amy & Jake were also trying to conceive, and it was too emotional for me to watch that when I was so frustrated for how long I was taking. (Of course I didn’t realize they also had trouble, and watching it actually felt cathartic for me.) I got that positive result literally the next morning. 

I spent Monday, April 20, making checklists and spreadsheets. I set my first prenatal appointment for May 8. Those two and a half weeks were the slowest of my life. They stretched out like a rubber band. I couldn’t really focus on anything except this pregnancy I’d waited so long for. That’s probably why time moved so slowly. I wasn’t filling it with the hobbies I enjoyed, writing and playing my ukulele. All my overwhelmed brain could handle was the hilarious distraction of Community. Yeah, this is also around the time I disappeared from fandom. It was originally for a happy reason, I was just too excited to focus!

I know many women who have miscarried. The data seems to vary from source to source, but anywhere between 10% to 20% of pregnancies end in miscarriage. I couldn’t wait to get to the doctor to confirm everything was okay. I wondered if they would do an ultrasound; I dreamed of seeing a fetus on that screen.

We started talking about how we were going to tell our family. We wrote a pretend promotion letter for my sister, promoting her from “sister” to “aunt” (she’s a badass at her job and we had recently been talking about her promotions so it was thematically relevant). We planned to do a video call with my parents where we played Quiplash and created custom answers related to the pregnancy. 

But we never got that chance. On May 8, I went in for my first appointment. I’d spent the last three days sewing a mask because the ones we ordered still haven’t arrived yet. So all the time I would have spent preparing myself for the worst (as is my way) was spent instead distracted by sewing and finishing up Community. 

They took me to an office first and went over medical history questions. “Any morning sickness?” the nurse asked. “Not at all,” I said. “Should I be worried?” “No,” she answered. “Consider yourself lucky!” 

(For the record, many women who carry to term do not ever get morning sickness.)

(It was just one of those unfortunate exchanges.)

Then the exam with the doctor. All in all, it’d probably been 30 or 40 minutes by this point, all of this excited talk. I was going to tell my parents on Mother’s Day. My due date was Christmas.

I video call my husband just in time for the ultrasound. 

There was no embryo. 

The doctor said a lot of women are ovulating later in their cycles due to the stress of the pandemic. At the time, I thought maybe. Hope is funny like that, in the face of logic. It started to grow like a weed in the cracks of my breaking heart. 

But the thing is, even with that stubborn hopeweed, I knew. I’d been doing this for ten months. I knew when my last period was, I knew when I ovulated. I was 7 weeks and 1 day, and there was no embryo, and that was it.

The beginning of the process of miscarriage. 

Technically, it’d started a few days before that appointment, but I was distracted at that time. I’d noticed one morning that there seemed to be more hair in the shower floor than there should be. 

Dots started to connect. My breasts had stopped aching. Now, they started to shrink back to their original size. 

This happened over several days. I felt certain I would miscarry on Mother’s Day; fortunately, that did not happen. No, enough days had to pass for that hopeweed to prosper. Only then, when it whispered maybe would I start spotting and cramping. 

On Tuesday, the second ultrasound confirmed what I already knew. Not viable. Missed miscarriage. Technically, the prescription the doctor hands me reads “missed abortion.” “It’s just the technical term,” the doctor explains, acknowledging that many women might find this triggering. 

I don’t cry as much as I did. I only cry when I tell people. It seems important for people to know, just in case. Just one person in the relevant circles of my life. I had to tell my boss to explain the sudden uptick in unexpected doctor appointments. (I’m Rh negative, so I needed to go to the hospital to get bloodwork and a Rhogam shot -- and being in a hospital these days in anxiety-inducing enough without this trauma.)

It still feels surreal. All of this happened in one month. Somehow my life has changed completely and then reverted back. This is just a blip in my life, relatively, and yet it seems the longest month of my life.

In movies, in stories, miscarriage seems to go the same way: a flash of bloody sheets, a shout of shock and pain, and then grief. I never knew how it really goes: that it would stretch out for weeks, from the moment I saw that first ultrasound to now, twelve days later, just starting to bleed. I’ll have to go back for another ultrasound to confirm it’s done, and if it’s not, then I’ll need surgery. 

This speaks nothing of the grief. 

And then it’s back to square one, a whole year later: ovulation tests and endless waiting. 

It’s been a whole month; it’s been only a month, and miscarriage is a process. 

[batmanisagatewaydrug]

Hi there! I know “never have unprotected sex!” is a generally good guideline, but there are obviously some people who have unprotected sex, because…here we all are, existing. So…I was wondering if you could clarify the kinds of situations where it’s responsible to not use protection? What if you and your partner are monogamous and have tested negative for STIs? What if you have recently sanitized a sex toy? 1/2

Wearing gloves makes sense since hands go so many places, but then should I also be wearing gloves when I masturbate?? How is the intimacy of oral different from the intimacy of kissing?? I am all confusion. Thank you!! 2/2

hi friend,

if you and your partner want to make the decision to have sex without protection - a concept that some people call “fluid bonding,” although I’ll say up front I’m not crazy about the term - that’s up to you. obviously, as you alluded to in your ask, for some couples that will require a discussion about the potential of pregnancy, and whether or not they want to take other measures to avoid it without using barrier protection during sex; in that case, hormonal birth control or more permanent measures such as a vasectomy or hysterectomy would be necessary. 

if you’ve recently sanitized a sex toy, that’s awesome! cleaning your toys is important for keeping them safe to use. so is putting a condom on them if you plan on sharing them with a partner; if it’s going to go in more than one person’s orifices, it needs to be covered with a fresh condom for each use and washed frequently to prevent the accidental spread of any bodily fluids.

wearing gloves when you masturbate isn’t necessary (but if you like it, knock your socks off) because your own bodily fluids aren’t going to hurt you. I’d definitely recommend keeping your hands and nails clean, especially before touching yourself, but gloves are really only necessary for hands and fingers going inside of somebody else. 

I don’t quite understand your last question about oral sex and kissing. they involve different parts of the body, and therefore each will be a slightly different experience, the way that eating an apple is different than eating an orange. both are physically intimate experiences, and I don’t think either supersedes the other.    

[christinaroseandrews]

Randomization and You: How to ask the right questions, know when to roll the dice, and decide when to invoke the word of God

One of the problems that writers often run into is when they’re world-building, plotting, and character-creating, is finding the answers to every foreseeable question ever.  Which is your main character’s dominant hand?  When were they born?  Did someone get pregnant from unprotected sex? Who dies in this horrific event that didn’t happen in canon? What race is this random side character? You get the picture.  

You can answer all of these questions on your own, and if they’re important, you absolutely should.  But when it doesn’t matter, when you don’t care, or if you’re unsure, sometimes randomization can help.  Randomization takes out bias. Or, conversely, a roll of the dice can clarify the direction that you actually want to go. 

The two of us use randomization a lot.  Not just in our fanfiction, but in our original works as well.  We do it for everything from character birthdays to ethnicity to who a background character might end up with to who lives and who dies.  Randomization is a nifty tool if you know how to use it.

In this meta, we’re going to go over when and how to randomize.

A note: there are major spoilers for some of our fanfic and minor spoilers for some of our original fiction.  If you want to know what those spoilers are, please feel free to message us.

oOo

When is it a good time to randomize?

Randomization is best done in the planning stages.  It’s not something you want to do halfway through the story (although you can, if you discover you need to -- we certainly have!), but it’s best done early on, when you’re still world-building, plotting, and creating your characters.  

Say you’re creating a fantasy world.  You know you have three countries that are going to be your primary focus.  But does the world have more nations?  You might not know the answer to that.  In which case, it might be time to randomize.  

It can also be used in character creation.  Sure, you’ve got your main characters and you know what their main traits are, but do you know when their birthdays are?  Or other seemingly unimportant details that may end up being important later, like religion, physical characteristics, or taste in entertainment.  This is especially important when you’re dealing with secondary characters who may not be as fully fleshed in your mind when you’re in the character creation phase. Because seriously, unconscious bias will come into play here. The number of books and stories we read where the only characters are the ethnicity of the author is staggering. This is especially problematic when it comes to creating accurate representation. Randomization can solve this. Want to write a story about 5 friends who kick ass and take names? You can literally randomize every major trait -- age, gender, sexuality, race, religion, skillset… you name it. You don’t have to randomize everything if you have a vision, but you should randomize things that “don’t matter” like the doctor or the secretary or the janitor. Randomization can remove stereotypes and bias. It’s colorblind casting but for the author. 

You also can choose ranges within which to randomize -- for example, if said story is about 5 teenagers, your range can be 14-18.  You are definitely not required to use all possible options while randomizing.

Then there’s randomization when you develop your plot.  Say you’re writing a romance.  You know your main characters will end up together.  But what about your secondary characters?  Your main characters’ best friends/siblings are going to end up meeting.  Do they hook up?  Are they interested?  Believe it or not, Prim and Bing getting together in Floriography was entirely randomized.  (Floriography has since been turned into an original work, The Language of Flowers -- but we kept said randomized relationship.)

Another thing -- in a romance, you know your main characters will end up together and you may know how they get there.  But what if you don’t?  You can randomize where they have their dates (using both typical and atypical choices such as a restaurant or a monster truck rally), other events that might interfere, and various other beats in your plotting.

Or the biggie... who dies in a major event? Plot Armor is lovely. The trio in Let Me Fly has Plot Armor. (We are not killing our trio, stop asking!) But everyone else… nope… no Plot Armor. That meant when Johanna Mason failed her rolls to survive the flu, she died. We love Johanna. Love her. She’s a blast to write. But she wasn’t crucial to the story we wanted to tell, so she died. The same is true for a lot of other people in our stories. Some deaths we’ve planned. But some that happened ended up changing the story… we’re looking at you, Third Quarter Quell deaths in Let Me Fly. Don’t think we don’t see you. Justice for Justus, indeed!

So yeah. Randomization can completely change your plot and understanding of the characters. It can even help you out of an “I don’t know what to do!” slump.

You want to go wild with the randomization?  Go to TV Tropes and pick a list of tropes that would make up a main character.  Pick a list of villain tropes.  Pick a list of plot tropes, romance tropes, whatever.  Number them all, shove them into a list, use a randomizer, and pick ten of them.  Congratulations, you now have the outline for a short story.  Think this doesn’t work?

Well… here goes.

We went to TV Tropes Character pages first to get our protagonists and antagonist. And this is what we picked.

  Sounds fun, right? I bet you can start imagining stories that could fit these tropes already. 

We ran these through the randomizer and got the following:

A Gentleman Thief and a Big Beautiful Woman Wake Up in a Room on a spaceship wearing matching rings. The door opens to reveal a notorious Space Pirate who congratulates them on their Accidental Marriage. Unfortunately they won’t be able to enjoy the honeymoon Mwah-ha-ha-ha! While they are making their escape, they end up someplace where they have to truly pretend to be newlyweds and they realize that somehow along the way they’ve Become the Mask and are truly in love. YAY! 

Sure it’s pretty rough and there are some parts missing, but it’s an absolutely viable plot… and I’m fairly certain I’ve seen something like this before. This is a great way to get out of a writing slump or even your comfort zone.

It’s all about asking questions and deciding if you know the answer, if the answer is necessary, and what the possible answers can be.

oOo

How do you randomize?

Randomization isn’t always as easy as rolling a die or flipping a coin.  Sometimes it takes creating spreadsheets or lists, while other times it involves understanding probability and percentages.

For example, say you’re writing a fantasy novel that features swordplay.  Knowing if someone is left or right handed is actually plot-relevant.  However, fifty percent of the population isn’t left handed.  Here, Wikipedia is your friend.  Knowing the percentages will help you know what numbers to use.

Another common time to do randomization is pregnancy.  Depending on what method of birth control and/or pregnancy prevention your characters are using, you can research the failure rates.  For example, when figuring out if Katniss was going to get pregnant during the arc of Brand New Breeze (second arc of Let Me Fly), we looked up the failure rate for the rhythm method and applied it to each menstrual cycle she had -- which, by the way, the length and duration of her menstrual cycle was also randomized.  She did okay for the first few months, and then all of a sudden, right around the time that the three of them got married (which was not randomized), she got pregnant.  

That opened up a whole slew of other randomizations, including: did the egg implant?  Did she have a miscarriage?  Was she carrying twins?  Who was the father?  Was the baby a boy or a girl?  What were its eye color, skin color, and hair color (based off of the parents and what was genetically possible)?  How difficult was the pregnancy?  When exactly did she give birth?  How long was the labor?  How difficult was the labor?  What time was the child born?  What were its length and weight?

You notice that was a lot of questions.  But they came in order.  The first question that got asked was: did she get pregnant?  The rhythm method is one of the least reliable forms of birth control.  Without proper medical data, Katniss was guessing, which increased her chances.  According to the Mayo Clinic, thirteen out of every one hundred women get pregnant.  Because of other reasons, we upped it to twenty percent for Katniss.

Using random.org, we rolled on a 1 to 100 scale for each menstrual cycle, with a roll of 81 or higher being a pregnancy.  Katniss did not get pregnant on her first two; she did on her third.

After conception, there are two primary hurdles to a pregnancy.  The first is implantation.  Many fertilized embryos never implant.  The numbers change based off of the age of the mother, the health of the mother, and other environmental conditions, but it’s estimated that at least 30% of fertilized embryos never implant.  So Katniss got randomized on that with a roll of 30 or below being a failed implantation.  She rolled higher.

Then there’s the risk of miscarriage, which, considering Katniss’s environment, health, and activity levels, we gave her a flat 30% chance of miscarriage.  Again, she did not miscarry.

Then it was just answering a lot of yes/no questions and looking up pregnancy-related details.  Did you know that the chance of twins is about 10%?  Identical twins is 1%, so the other 9% are fraternal.  If there are fraternal twins, they can have different fathers.  

We didn’t roll for anything higher than twins because the chances of Katniss surviving a pregnancy with triplets or more with no medicine are extremely low, and that’s if she even got pregnant with more than two babies at once -- which is highly unlikely.  We did not roll for Katniss dying in pregnancy.  That was us invoking the word of God.  

But wait, you ask.  Didn’t Katniss have a chance of dying?  

And you would be correct if this were the real world and not words on a page, Katniss would absolutely have a chance of dying in pregnancy.  However, that was a direction we were not interested in exploring, and that’s when invoking the word of God becomes necessary.  You have to know what you are comfortable writing as an author.  Not everyone wants to write a pregnancy, so they might say, “Nope! This unprotected sex did not result in a pregnancy!”  While others, like us, will occasionally roll for this -- while other times we’re like “Nope!” Trust us, we’ve totally noped Katniss getting pregnant… random.org has it in for her, I swear!

Some people might’ve said “oh hell no, I’m not dealing with a pregnancy in this story” and that’s perfectly fine.  They wouldn’t even have rolled for it.  It depends on what you’re willing to do as a writer.  But often that’s something that randomization can help you with… knowing your own mind. Because oftentimes people don’t know where to go next because they have choice paralysis… randomization can help solve that problem. 

oOo

So when do you invoke the word of God?

Well, here’s a secret.  The two of us invoked the word of God when it came to both of the Hunger Games in Let Me Fly.  

For the 74th Games, the original randomized winner was the girl from Three.  Unfortunately, that did not work with our plot.  Three was too far from our group for Cressida and her group to flee from there and conceivably make it to our characters, which was a plot point we wanted to happen.  So we rerolled with an eye toward what would work, and Taylor, the girl from District Eight, won.

For the 75th Games, the initial randomized winner was the woman from Eight, and -- having plotted the 74th Games -- we realized that the Capitol really wouldn’t be okay with back-to-back winners from an outlying semi-rebellious district.  So we rerolled and got Chaff.  (By the way, some of the side characters -- the infant for instance -- had zero chance of making it out of the bloodbath alive, and each other character had a percentage for what their chances of winning were based on their age, skill, and other factors, and we used a 1-100 scale for randomization.)  

However, there was another thing that happened that basically has colored our plot from the moment that it happened.  

Justus came in second.

The six-year-old kid only had a two percent chance of being picked at any specific time.  But he came in second.  And we took that and ran with it.

That is how randomization can end up creating plot for your story, and also why you want to do it fairly early on.  If your outline changes, you may need to do it later.  Or if you’re a pantser.  But if you’re a plotter, you’ll want all your ducks in a row before you get started.

In reality, randomization is all about asking questions and figuring out probabilities.  And sometimes the questions can tell you which way you want to go -- and you end up answering the question itself without randomization ever coming into play.  Or the randomization tells you which choice you wanted… something you often know by your reaction to the choice you rolled.  (If you groan at something you roll, it is probably a choice you’ll want to override.)

Remember that you are not bound by your randomization.  If you absolutely hate something that randomized and can’t figure out how to make it work, throw it out!  It’s still giving you valuable information, because it’s telling you something about where you don’t want the story to go.  

Sometimes it’s even fun to work with the hard things, the complicated things, the stuff you never expected to roll.  Making something surprising work is a challenge -- and a way to grow as an author.  But if you can’t or don’t want to, you can always toss your randomization. 

oOo

So why would you want to randomize?

One of the downfalls of being a writer is that you know everything about your story.  Where it’s going, the relationships, everything.  Randomization creates that feeling of wonder that you experience when doing something new.  It allows you to brainstorm, and it can force you down paths you might not otherwise have chosen to take.

The two of us were very hesitant about pairing up Prim and Bing in Floriography (later The Language of Flowers).  They were the siblings of our main characters, they were seven or eight years apart in age, they lived a good four, five hour drive away from each other, they’d just met… and would they even want to be together?  We asked the question on a whim.  And then we rolled it.  And then we ran with it.  And it’s become one of our favorite pairings ever.

We would’ve never paired the two together if it weren’t for the randomization.

We’ve even done this when writing whole fics… like we didn’t know what we wanted to write, just that we wanted to play in a particular fandom. So we rolled what characters we were going to play with.  This is how we ended up with a Darcy/Tony/Sif threesome because Why Not? 

We also do this with original fiction all the time. As stated above, it deals with the unconscious bias that we carry in regards to racism, sexism, and a whole slew of other -isms/-phobias. It can also help shape directions where you might take a story. Like our Adeniyi Siblings Series… we initially had all of the siblings paired with white characters… but then (thankfully) we realized the serious Unfortunate Implications… so we broke out the randomizer. Other than Paige (who we’d already written her story). All three of the other siblings’ significant others changed, and it made our series better in the long run. 

In addition to removing bias and answering questions, randomization can be fun.  Even if you never incorporate what you’ve randomized, you’ve got these little details, special things that you know about the character or the plot or the world.  We can tell you EVERYTHING that Katniss and Prim hunted and gathered in Damaged, Broken, and Unhinged. We can tell you every single character who got sick from the flu in Let Me Fly. This is information that none of you need, but gosh darn it it was fun to find out, and it colored how we wrote the story even if the specifics never made it on the page.

As we’ve hopefully explained, randomization can be a powerful tool in the writer’s toolbox.  But like any tool, it’s about knowing when and how to use it. We recommend using it to answer questions. Develop plots and even plot twists. And most importantly, remove unconscious bias. 

Now if you’ll excuse us, we have a Gentleman Thief and a Big Beautiful Woman demanding that their story be written.

Until next time!

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[ouraidengray4]

When Do You Ovulate? Here’s How to Track Your Cycle

Menstrual cycles have been tracked for a long time to pinpoint your period. But what’s the best way to track when you’re ovulating?

These days, many prefer the ease of an app over the traditional calendar, but it’s the same idea: Knowing roughly when your ovary releases an egg can be pretty useful.   

Whether you’re trying to boost your odds of pregnancy or lower them, let’s break down eggsactly how to pinpoint when you’re ovulating.

Getty Images

What is ovulation, anyway?

Ovulation happens when one of your ovaries releases a lil’ egg that travels from your fallopian tube to your uterus.

Around days 6 to 14 of your menstrual cycle, follicles in one of your ovaries begin to mature. By day 10 or 14, an egg develops from one of your follicles. The egg then continues on its mission around day 14.

When does ovulation happen?

Ovulation happens typically once a month if you have a uterus and are of childbearing age — usually around day 14 to 16 of a 28-day menstrual cycle (AKA, about 2 weeks after your period). In rarer cases, some people might release multiple eggs within 24 hours of each other.

Once an egg is released, your mature egg (aw, so grown up!) is ready to be fertilized. If sperm fertilize your egg, surprise, next comes conception and pregnancy.

Otherwise, your egg will dissolve within 12 to 24 hours. When fertilization doesn’t happen, Aunt Flo comes-a-marching: Your egg and uterine lining will shed in about 2 weeks.

Then, much like Groundhog Day, the whole thing starts over. And over.

When do you ovulate on birth control?

The pill typically prevents ovulation. For instance, combination birth control pills contain estrogen and progesterone, stopping your egg-formation process. These hormones also thicken up your cervical mucus, making it harder for sperm to wriggle into your uterus.

The progesterone-only pill, AKA the mini pill, also thickens your cervical mucus, thins your uterine lining, and suppresses ovulation. For maximum effectiveness, the pill should be taken at the same time every day.

According to the National Health Service, about 9 in 100 women on either pill have an accidental pregnancy each year. The pill’s effectiveness can vary based on the time you take it, other medications or supplements, and certain medical conditions.

If you’re concerned about an unplanned pregnancy, talk to your OB-GYN about how to play it as safe as possible.

In general, it’s best to use a backup barrier-form of birth control (condoms FTW!) for at least the first week on the pill. Ovulation can still happen until your bod acclimates to hormones.  

How long does ovulation last?

Ovulation only lasts for about 12 to 24 hours, but peak fertility lasts for quite a bit longer.

According to the University of California San Francisco, sperm can survive for up to 5 days in the female reproductive tract. So, there’s a pretty big window for fertilization to occur. This means that there’s about a 5 to 6-day window you can get pregnant (and you don’t even have to do the deed during ovulation).

Signs and symptoms of ovulation

Not everyone experiences symptoms of ovulation. Sometimes, though, people may notice some or all of the following signs:      

1. Ovulation bleeding

Bleeding doesn’t exclusively happen during your period — it can also occur during ovulation. Unlike most periods, though, ovulation bleeding is typically super light. Basically, some people notice some faint spotting that might require an underwear liner at the most.

The spotting is usually light pink or red in color, which is a sign that the blood’s mixed with cervical fluid. It should only last for 1 or 2 days or about 11 to 21 days after the first day of your last period.

Only about 3 percent of people have mid-cycle spotting, though. So, it’s not a super reliable way to check for ovulation.

2. Ovulation cramps

Chances are, you know a thing or two about period cramps. While much less discussed, ovulation pain can be a thing too. In fact, German speakers even have a name for it: mittelschmerz, which translates to “middle pain.”

Some describe these sensations like a ”twinge” or a ”pop” in either ovary, a mild burning sensation, or a feeling of heaviness in the lower abdomen. The discomfort is often quite subtle and short-lived.

3. Basal body temperature

Checking your temperature each morning when you wake up may lend clues to when you ovulate.

Your basal body temperature (BBT) is the temp you have when you first wake up — before you even check your emails or trudge your way to the French press. During ovulation, your BBT rises by about 1°F or less and stays that way until menstruation.

This slight increase happens due to the hormone progesterone, which helps your uterine lining become thick and spongy to prep for implantation.

4. Revved-up sex drive

If you’re more than ready to get down and dirty, you might be ovulating. No one’s sure exactly why some people get horny before their periods, but it could be due to a rise in estrogen and testosterone levels during ovulation.

5. Soft cervix

Your cervix (essentially the lower portion of your uterus) gets a little softer than usual, sits a little higher, and becomes more moist during ovulation. 

Earlier in your cycle, your cervix is firmer and closed. When you keep tabs on your cervix, you’ll start to notice the changes.

6. Egg-white discharge

Wait, what’s that stuff in your undies right now? If you notice an influx of different-looking discharge, ovulation may be the culprit.

Cervical mucus consists mostly of water. When estrogen levels surge during ovulation, this fluid becomes more voluminous, stretchy, and clear — almost like egg whites. Basically, it’s the wave that sperm ride to the egg.

During peak fertility, you might notice a lot more than usual. When it looks stringy and sticky, it could be a clue that you’re ovulating or close to it.

So, how do you know you’re ovulating? 

1. Track on an app or calendar

Since ovulation typically occurs around 10 to 16 days before your period starts, an app can be a helpful way to track when it happens. If you prefer the old-fashioned way, a calendar totally works too.

Here’s how to track it with regular-old pen and paper:

Record the start date and duration of your period for 8 to 12 months.

Take note of your longest and shortest cycle.

Subtract 18 days from your shortest cycle — that’s the first day of your fertile window.

Subtract 11 days for the duration of your longest cycle.

Your fertile window = the time between the 2 days you wrote down.

For best results, your menstrual cycle should be roughly regular each month. You can also improve your estimates by coupling it with other methods like checking your temperature and cervical mucus.  

2. Check your temp

Check your basal body temperature in the morning right when you wake up. Remember to check it while you’re still in bed, before you move around to ensure the reading’s as accurate as possible. If it’s about a degree higher than normal for several days, you might be ovulating.

You should use a thermometer specifically designed to measure BBT. These thermometers have extra features, like temp recall and accuracy of up to 1/100th of a degree.

This method might not be completely reliable, and a research review even concluded that the method is only 22 percent accurate in detecting ovulation. Make sure to combine taking your BBT with other methods for best results.

And, take note: A late night of drinking, traveling, or illness can also get your BBT out of whack.

3. Survey your cervical fluid

Keep your eyes on your cervical fluid for clues about ovulation. If it looks thick and clear like egg whites, you might be ovulating.

To check your fluid, simply check the residue in your undies or use a clean finger to survey the liquid. A stringy texture is a decent indicator that ovulation’s going on.

4. Scope out your cervix

To see if you’re ovulating, you can use clean fingers to reach inside your vagina and feel your cervix. If it feels firm (kind of like your nose cartilage), you’re prob not ovulating. If it feels soft and moist (more like your lips), then you might be ovulating.

This is obvs not an objective test, but it can lend a helpful hint.  

5. Use an ovulation predictor test

During ovulation, your bod starts making more luteinizing hormone (LH), causing the egg to be released. An ovulation predictor test can help detect the levels of LH in your body, which can help predict when ovulation goes down.

Also known as a luteinizing hormone (LH) test, the pee strip or digital test measures the amount of LH in your urine. You can pick one up at any drug store.

According to the American Association for Clinical Chemistry, these tests have varying accuracy levels and should not be used to definitively predict when ovulation occurs. Again, using a few methods can help you pinpoint ovulation with more accuracy.

How to prevent pregnancy during ovulation

Not on birth control, but want to prevent pregnancy during ovulation? Natural birth control tracking methods like fertility awareness methods (FAMs) can help you keep tabs on your menstrual cycle so you can predict ovulation and avoid pregnancy.

According to Planned Parenthood, when used correctly, FAMs are about 76 to 88 percent effective when used as birth control, meaning that about 12 to 24 out of 100 couples who rely on FAMs will become pregnant each year.

To use FAMs to predict ovulation, here’s what to do for the best results:

Combine several FAM methods. According to Planned Parenthood, you can track ovulation with the temperature method, the cervical mucus method, and the calendar method for best results. A fertility app and regular LH tests can also help you keep tabs on ovulation.

Use a barrier method or abstain during ovulation. During your estimated ovulation window + 3 days before and after, abstain from sex or use a barrier-form of birth control (like a condom) to prevent pregnancy.

Talk to a nurse, doctor, or counselor. Tracking your fertility takes a lot of time, patience, and expertise. If you’re committed to this method, you can also chat with a nurse, doctor, or counselor familiar with FAMs to help guide you through the process.    

How to get pregs during ovulation

Tracking ovulation is a tool to help increase the odds of pregnancy. If you’re hoping to have a baby, these tips might help:

Use several methods to track ovulation. Combining multiple predictive methods, like the calendar method, LH test, and BBT method, will help increase the accuracy of your ovulation window prediction. Being consistent definitely helps too.

Have sex before and after ovulation. You’re most likely to get pregnant 2 or 3 days before your ovary releases an egg, so be sure to hit the sack around this estimated time period.

Talk to a professional. Tracking your fertility can be exciting — it can also be overwhelming. For best results, talk to a doctor who specializes in fertility. They can offer the guidance you need.

The takeaway

Tracking when ovulation occurs is tricky and notoriously unreliable, but you can take steps to improve accuracy. Combining several methods (like the calendar, temperature, and cervical mucus methods) and chatting with a medical professional may improve results.

from Greatist Health RSS Feed https://ift.tt/3ltIaUA When Do You Ovulate? Here’s How to Track Your Cycle Greatist Health RSS Feed from HEALTH BUZZ https://ift.tt/3ptFGIo

[shankss-magnificent-ass]

Unadulterated Crack part 11

Pairing: Thorin Oakenshield x Reader

Word Count: 1,855

warnings: Anxiety, slight angst?

--- Part 1 --- Part 2 --- Part 3 --- Part 4 --- Part 5 --- Part 6 --- Part 7 --- Part 8 --- Part 9--- Part 10 --- Part 11--- Part 12 ---

  That night, you asked Bilbo to help you with the dishes, while the others retreated to their rooms. When you were in the kitchen you seized his arm and dragged him into the freezer, and shut and locked the door. Bilbo exclaimed, “What are you doing!”

     “I need to talk to you, and this is the only soundproof room in the house I can speak to you with that won’t arouse suspicion.” You hissed, “Please, it is very important, and I’m freaking the fuck out, which really is not good.”

     “By the green lady, you need to calm down, it’s not like you’re pregnant.” He huffed. 

    You squeaked, “Well actually that’s the thing…I am pregnant I haven’t the slightest clue about pregnancies of my own kind let alone those of a mixed species child.” avoiding eye contact.

    Bilbo gawked at you for a good three minutes before shrieking, “You’re actually pregnant!” To which you nodded your head in response. The hobbit started pacing back and forth, he said, “I was under the impression that Thorin bedded you for the first time in Rivendell. That was a little over a month ago, there is no way you could be absolutely certain you are with a child this soon.”

     “Well I missed my period this month, and I am ninety percent sure I am. You see my people developed a cheap and easy yet reliable test that can tell that you are carrying within a week of conception. And I have taken three tests a day everyday for the last week. Eighteen say I am, two were inconclusive, and only one came back as negative.” You explained.

     “Well if that is true why are you telling me about it? Should you not be telling Thorin he’s going to be a father.” Bilbo asked. After you explained your reasoning, and told Bilbo of the fate that would befall the line of Durin, Bilbo said, “I would tell all of the Dwarves excluding Thorin. Alone each of them might not be very helpful, but their combine knowledge and experience might prove useful. Also it would mean all of them would be looking out for you, and not just Balin, Gloin, Oin, and Bombur.”

     You shifted uncomfortably, and muttered, “I don’t know if I’m comfortable with that. That would increase the chance of Thorin finding out.”

     “It would also mean if they agree to keep it from Thorin the others can stop someone from letting your secret slip.” Bilbo reasoned, “You don’t have to tell them by yourself, I would be more than willing to stand beside you as you do it.”

    Bilbo managed to convince Thorin to go help him with his swordsmanship to give you an excuse to talk to the rest of the company. You asked them to gather in the sitting room of your floor, you stood there fidgeting nervously for a good minute after everyone had gathered. Everyone patiently sat and waited for you to speak. Eventually Dwalin barked, “surely ye didn’t bring us here just to watch you squirm.”

     You reluctantly sighed, “Um, before I tell you anything, I need you to swear to on your axe, your honor, to me, and Mahal that you will not tell Thorin what I am about to tell you even if your life, his life, or my life depends on it.”

     All of them looked at each other for a second, before looking at you suspiciously. Balin grumbled, “What is this about, Lass?”

     “Promise me!” You nearly shouted.

     Sensing the panic and anxiety in your body language and voice, they all agreed to keep Thorin from finding out. Once this was done you explained everything, they quietly listened to you, staring at you with unmoving, and blank expressions.

    When you finished, you sat down in an empty arm chair, and curled up in a ball. It took a minute for anyone to say or do anything. It was Dwalin who reacted first, he jumped to his feet, stormed over to you, and took you into his arms, and gently butted his forehead against yours. You looked up at him in confusion, he laughed, “Lass, ye will make Thorin the happiest Dwarf alive.” while weeping tears of joy. The others started to laugh, and excitedly chatter amongst themselves, and hug and shake hands. Fili and Kili grabbed each other and started to sing, “We’re going to have a cousin!” and then barged over to you, and hugged you. You started to thank them as best as you could through your blubbering.

   Oin, Gloin, Balin, Dwalin, and Bombur kicked everyone out, and started to explain in great detail what you should expect to happen over what would apparently be a two year pregnancy. They said they’d provide medicine, and a proper diet for you while trying to keep Thorin from finding out. Who they assured you would be over the moon when you allowed him to find out about the baby. Bombur started planning meals for you that Thorin would not think twice about . Gloin was going to make sure you were comfortable as possible. Balin would misdirect and distract Thorin, and teach you typical Dwarvish traditions about child rearing, and birthing. Dwalin would make sure no one accidentally told Thorin, and protect you from harm. While Oin would make sure that you and the child in proper health, while using herbs to lessen the symptoms of the pregnancy. 

    As you traipsed through the Misty mountains, Gloin and Ori made sure you had enough clothing on to keep you and the baby warm in the knee deep snow. Dwalin told you to stay between him and Thorin in the line, so you did not have to overexert yourself by wading through the snow. You were not used to the high altitude, and the having to waddle through the snow for so long. Around noon, you really needed a break, you were out of breath, and your muscles were screaming at you to take a break. You stopped and leaned down on your knees, sucking in the cold, crisp, and sharp air. Balin must have had had a talk with everyone else about not fussing over you too much in front of Thorin. Because you could feel them watching you nervously and restraining themselves from rushing over to you. Thorin turned to you, placed his hand on your back, and announced, “We’re stopping for lunch.” to everyone.  Thorin led you inside the house after you manifested it, and helped you over to the couch in the living room. The older Dwarves silently ordered the others to be careful about with what they say and do by shooting them a cautionary look. 

    Thorin rubbed your back as he held you to his chest and rocked you back and forth gently as he softly hummed to you. Oin toddled over and examined you, and made sure your vitals were normal. After a minute Thorin asked, “how is she?”

     “She is just not used to the altitude, she’ll get used to it in a few days. Until then, she should not be over working herself for prolonged periods of time. So possibly we should move her to the back of the group so the snow won’t be quite a cumbersome.”  Oin suggested.

     You objected, “No, I can use snow shoes, it’ll let me walk over the snow with relative ease.” only slightly out of breath now. Bombur came in the room with a bowl of thick and meaty soup with lots of veggies for you. You wolfed it down and insisted that the company keep moving. 

    As you walked along the narrow ledge through the storm, you clung to Thorin to stop yourself from being dragged off the outcropping by the winds. Turns out it was the day of the Thunder battle, and when the stone giant hit the cliff side over your heads, Thorin shielded your head with his oak branch. When half of the company was bashed into the rock wall by the stone giant they were unknowingly standing on, you moved quickly to help everyone, Bilbo in particular. However when you attempted to even get near the ledge Bofur grabbed you, pulled you away, and gently pushed you to Thorin.

    As you rested in the cave you made sure to sleep near where Bofur was sitting because you knew he’d be the last to fall into Goblin Town. When the floors of the cavern did indeed cave in you, and you all landed in that cage thing, you landed on top. Bofur, who was the first to realize the Goblins were almost on you, he wrapped his arm around you and caged you under his body as he supported himself on his elbows and knees to stop the goblins from stepping on you. Unfortunately he was dragged to his feet, and thrown to another goblin. You quickly followed him, and were dragged in front of the Goblin King. When he spotted you, he crooned, “Oh, such a pretty thing you are…” then announced you would be the first to go through the bone breaker, sending the entire company into an up roar. You just calmly stood there internally grumbling at Gandalf to hurry the hell up.

          After the wizard did come, all of you escaped, the wargs chased you up the trees, and Azog showed up. You snapped, “Don’t you dare do what you’re thinking about doing Thorin Oakenshield!” from beside Nori.

      Thorin looked at Nori and said, “Keep her safe,” getting to his feet. You lunged at Thorin, only to have Nori wrap an arm around your ribs and pull you against his chest. You shrieked in protest and struggled against Nori. You hit, slapped, and scratched his arms and hands to try and get him to let you go. He only buried his face in your shoulder and whispered his apologies hoarsely into your coat.

    The Eagles, having heard your rabid curses and threats at not only Thorin, but Azog, dropped you off at the rock last. You set foot on the ground as Thorin stumbled to his feet, by this time you’d had enough time to stew in your own juices. You silently and unmovingly watched the exchange between Thorin and Bilbo, and then Thorin laying eyes on the Lonely mountain. After Thorin announced you’d all be resting a the bank of the near by river. As Thorin started to embark on the decent from the rock, Dwalin approached you to make sure you were alright. No one else, besides Gandalf moved an inch, all of them had their eyes locked on you. Thorin only noticed halfway down to the bank that the only one that was following him was Gandalf. He yelled, “Is something wrong?”   Kili snarled, “Are you not forgetting something, Uncle?!" 

    Thorin hollered, "What are you talking about?”

     “Guys don’t, when he realizes that he forgot I existed he’ll feel even worse about it than he would if you called him out on it.” You hum, “Just follow, I am more than capable of putting your uncle in his place on my own.”

--- Part 1 --- Part 2 --- Part 3 --- Part 4 --- Part 5 --- Part 6 --- Part 7 --- Part 8 --- Part 9--- Part 10 --- Part 11 (here) --- Part 12 ---

TAG LIST: @fictionalquintessence @life-is-righteous @wowjustwow002 @17baldwinn@jumpingmanatee @savvythedork @savvym0use @tschrist1@imaginesreblogged @dracsgirl   @lady-of-fandoms @jotink78@enkelin

[juniperpublishers-gjorm]

Medical Images of Adenomyosis and Hypofertility: About Two Clinical Cases at Jean Paul Hospital 2 in Conakry, Guinea

Authored by:  Camara Mk* 

 Abstract

The authors report, through images of 2 clinical observations, a particular cause of hypo fertility, the implantation of pregnancy on uterine adenomyosis and the reciprocal influence with a review of the literature.Keywords: Pregnancy; Adenomyosis; Ultrasound; PrognosisGo toIntroductionAdenomyosis occupies an important place in uterine pathology. It continues to raise many questions concerning its pathogenesis, but also its diagnosis and its methods oftherapeutic management [1]. 

The thickened myometrium deviates unevenly and the uterus loses its former elasticity. A problem can occur at the beginning of pregnancy or conception in women and in the evolution of pregnancy. The discovery of a uterine adenomyoma during the confirmation of an involuntary pregnancy, motivated the pictorial description of 2 clinical cases with a review of the literature on the reciprocal influence of this association.

Observation 1Mrs. CS, 30 years old, hairdresser, having in her history, 2 gestures, 1 parity with a 3-year-old living child and secondary dysmenorrhea, consults for an Ultrasonographic confirmation for the suspicion of fetal death with unspecified gestational age, date of last menstruation is unknown. The pelvic ultrasound examination performed on 13th /03/17, visualized intrauterine an inactive fetus with a 37mm LCC corresponding to 10 SA, a posterior placenta inserted into a posterior wall with regard to a heterogeneous mass with hypocritical foci. 50mm x 25mm x 11mm echogenic. The diagnosis of pregnancy with egg death retention estimated age >16 SA, associated with uterine adenomyosis. The management was an Intra Uterine Manual Aspiration and a progestational hormonal family planning post abortum. In Figure 1, death in utero: placenta inserted on adenomyosis.Observation 2Mrs DAB, 33 years old, 4th gesture, and 4 living children, accountant, consults on 18/02/2018 for metrorrhagia on an amenorrhea of 3 months without precision of the date of the last period, with a history of dysmenorrhea, the last childbirth going back to 3 years without contraception. Upon gynecological examination, the cervix is intermediate, long and open to the finger pulp at the external orifice on a soft uterus, the size of 12 weeks-amenorrhea (AW) and a good general condition. The pelvic ultrasound performed with the trans-abdominal probe of 3.5Mhz, reveals, in intrauterine, a sluggish ovular sac having within it an inactive embryo whose value of the biometry is lower than the age of amenorrhea; and at the level of the posterior wall of the uterus, a heterogeneous, echoic image of 41 x16 x 35 mm The diagnosis of unevolutive pregnancy, associated with a uterine adenomyosis is confirmed. The patient preferred ambulatory observation. She completely delivered the contain of uterus at 9am in the ward, on 20-08-2017, with an empty uterine cavity on post abortum ultrasound (Figure 2 & 3). Post-abortion contraception counseling for 6 months was done with a consent choice of combined oral contraception and obtaining consent from the couple for publication as a clinical case. In Figure 2 Uterine sac and uterine adenomyosis (from 18-02-2018) and Figure 3 Uterus with adenomyosis in immediate post abortum (from 20-02-2018)Go toCommentsAdenomyosis was accidentally detected on pelvic ultrasound at the trans-abdominal catheter of 3.5Mhz, during pregnancy involution (case1) or pregnancy metrorrhagia (case 2) by the diagnostic criteria retained, the presence in the uterus of an ovum sac containing or not an embryo/fetus and appendages, at the level of the myometrium, heterogeneous hyopoechoic foci with or without cystic images [2]. Numerous authors have shown the superiority of transvaginal ultrasound with sensitivity and specificity of 86% [3]. Adenomyosis occurs during a period of great activity and initially affects women over 35 years of age with multipara [4]. On the contrary, it has been observed in young women under 35 years and in multiparas in the second case. The association of adenomyosis with a normal pregnancy is possible. It seems that adenomyosis is improved by pregnancy in some cases [5]. Adenomyosis is responsible for pathophysiological disturbances that decrease the chances of pregnancy. In infertile women with adenomyosis, there is a decrease in implantation rate. Adenomyosis is responsible for a 30% decrease in the chances of pregnancy and an increase in spontaneous miscarriage rate [6]. Pregnancy can evolve to its end with the birth of a live child, if its implantation is far from adenomyomatous tissue, hence its discovery in multiparous women (case 2).However, there is also an increase in spontaneous miscarriages, probably related to a particular myometrial activity. We attribute spontaneous abortion (case1) and in utero death (cases 1 and 2) to inadequate uterine placental blood flow related to trophoblast insertion into the posterior wall of the uterus or adenomyosis. According to Tremellen K, has an impact rather on embryo implantation than its fertilization (OR: 0.79 (0.67-0.93)) (OR: 1.01 (0.93-1.10) [7]. For Benaglia, the asymptomatic adenomyosis did not affect implantation and pregnancy rates in FIV Routine transvaginal ultrasound will allow early detection and follow-up until the end of placentation to assess the prognosis of pregnancy [8].Go toConclusionThe authors report, through images of 2 clinical observations, a particular cause of subfertility, implantation of pregnancy on uterine adenomyosis with a review of the literature.Camara Mk

[truffledmadness]

Warning: Grouchy Truffles Ahoy

All right, it was inevitable I write something about this. I usually quite like @slatestarscratchpad, but THIS THING. As a genuine Humanities Person (I am literally going for a PhD in history--women’s history at that, sacre bleu), I HAD to weigh in on this.

1.) The groups you describe as having “great gender balance” .... don’t, for a lot of them. You’ll never find a Wiccan circle or gender studies class that accidentally ended up 100% male... you’ll find ones that ended up 100% female instead. “Great gender balance” is roughly 50/50, not “has lots of women.”

(and the reason religious groups tend to have fairly even gender balance, even/especially the extreme ones, is that they’re self-replicating and hard to leave. When you get new members by giving birth to them, gender rations tend to even out, and when there are huge social/physchological (and sometimes physical) consequences for leaving, people don’t. Conservative Christianity is an example I know a lot about, because they often deliberately lock women out of educational opportunities from a really young age--of course they don’t leave; where would they go?)

2.) Honestly, you write about hard-line humanities geeks as if you’ve never met one. You do a fairly apt job of describing a certain kind of undergraduate humanities major, but that’s a wildly different thing, as things like English and political science have become go-to majors for people who want a degree, any degree, and/or are planning to go to law school afterwards. Given that we’re currently building a STEM Bubble, I give it about ten years before That Person is a stereotypical CompSci major--you can already see it starting.

As a Humanities who hangs around other Humanities, generally once you get past undergrad, where there’s tremendous variance, what you get is people, myself included, who just desperately love a book/era/historical figure, and they can’t even really articulate WHY, but THEY JUST THINK THIS THING IS BEAUTIFUL AND IMPORTANT AND THEY REALLY WANT TO TALK ABOUT IT. Nerds is nerds.

3.) Women aren’t more likely to support social safety nets and conservative sexual norms out of a Pure Holy Compassion and Empathy Which Men Lack-- it’s because historically, we benefit the most from them. When your sex has had greater odds of poverty, unwanted pregnancy/children, and so on, for a few hundred years, that leaves a mark. Pornography is a fine example-- most porn is not produced with women in mind (the lack of material that panders to the female id is a huge economic idiocy to my mind), and there are more female porn actors than male, so you’re more likely to hear horror stories about the porn industry from the mouth of a woman, just because probability. If something has little benefit and high potential harm for you/people like you, why wouldn’t you be against it? I’m not against pornography myself, but it certainly makes more sense that anti-porn attitudes stem from that, rather than some vague concept of empathy.

4.) I actually agree that “sexist attitudes” aren’t responsible for gender imbalances. At least not on the micro level people talk about. I also don’t think gender imbalances are necessarily bad, so long as outliers are welcomed.

[studycell]

Hello everyone! Haven’t posted a masterpost in a long time! Hopefully this will be helpful to all of you in the following semester! I’m posting this now and not in the middle of finals week because some of these tips actually require of you to plan ahead so don’t be lazy, start the summer semester right!

The tips are organised more or less chronologically through the progression of the semester.

Disclaimer: This masterpost is aimed mostly at college students, seeing as we sometimes take big exams with 1000+ pages of study material, but I believe these tips could be helpful for anyone else! So let’s get started!

[check out my other masterposts here]

1. Start on time

Starting with a big one. Start. On. Time. The earlier you start with revising and going through the material, the more time you’ll have to do practice test which are one of the most important aspects of your revision (more on practice tests below!)

What this includes:

Going to lectures - this is an important step in gaining passive knowledge about the subject, by paying attention to what your professor says, you are already saving some of the concepts in your short-term memory [find about more about short-term vs. long-term memory here]

Taking notes during the lecture - doesn’t have to be anything fancy, just follow the main concepts of the lecture and write down main points - do not write down every single word you hear!!! this has no effect and you just become a human tape recorder. [this makes you pay attention and has your brain actually process information it’s hearing instead of just recording it]

Make your notes such as they are editable, meaning either use a computer or binder paper so you can insert additional pages and add content from different sources (textbooks, past papers, etc.)

Revise your notes after lecture - this takes just up to 30 minutes every day and for me it would be colour coding the notes I made in class. [colour coding your notes during the class simply takes too much time and imo takes a lot of time, at home you can take time to colour code and sort the material so your brain doesn’t only remember recording the information, but now sees it as an organised unit]

2. Have a life outside of school

Make friends, join a sport club, join the chapel choir, go jogging every weekend, go clubbing on Fridays, whatever you like!

Personally I like learning Swedish, going to dance parties whenever I can and taking long walks along the river. I study Microbiology and Genetics so learning a language is a nice way to “stimulate other parts of my brain”, so to speak. The different the hobby from your major, the better!

I am very aware that during the finals week, you’ll probably have to cut some time on some of these activities, but keep in mind that just because you’re at Uni, you don’t have to abandon every other aspect of your personality.

This also includes:

Taking breaks

Treating yourself with some nice things whenever you reach a goal

Dating!! (if you want, of course)

3. Take care of your (mental) health

This is a tricky topic, but I am fully aware that a lot, and I mean A LOT of students struggle with mental health issues, some of us have had this struggle even before starting college/uni.

After having a horrible first semester mental health-wise as a student abroad AND a queer female student in the STEM field that already had a life long history of depression, this January I’ve realised how much of my potential is wasted on horrible panic attacks when I should be studying and dreading existential depression when I should be going out and exploring the city. I reached out to my Uni therapist and asked for help. I’ve been visiting the organisation for two months now and it is completely FREE. I am still struggling but just ASKING FOR HELP has helped me so so much. I thought there are no free options for me and I’d have to waste a ton of money on just getting help, but if you use that magical lil thing called google, I’m sure you’ll find many options for students in your area.

This also includes:

Taking care of your physical health - no school subject should make you get sick because you sleep too little or make you loose a ton of weight because you think you don’t have the time to eat healthy

Taking care of your reproductive health!!! - if you are sexually active and live in a college campus/alone away from your parents, chances are, you are in great risk of getting an STI or unwanted pregnancy. I think this isn’t mentioned enough but check in with your insurance company about the coverage for things such as IUD, birth control pills, nuva ring, etc. as well as other contraceptives that prevent STI’s (female and male condoms, etc.)! If you don’t practice heterosexual intercourse, here’s an important link, also here. When in doubt, talk to your doctor!

What does this have to do with big exams?

Well, many students I know seem to ignore their health and sacrifice their sanity, just to get “a good grade”. Emotional, as well as physical health is crucial for being happy and satisfied with yourself. I also mention reproductive health because it is often overlooked as something “people should know already”, but people often overlook the consequences of getting an STI or getting accidentally pregnant. Having a panic attack over a weird growth on your genitalia or missing your period and wondering whether it’s from stressing about exams or getting pregnant is the LAST thing that should be happening to you when you need to thinking about your education. Also letting your mental issues building up and then having a nervous breakdown the day before your big exam probably isn’t a good idea.

4. You are probably not a night owl

Before I get bombarded with hate for this one, I do think that, YES, some people are night owls! But I also believe that some people, SOME people simply have little to no self-control and/or organisational skills and therefore end up staying late at night finishing that last-minute assignment or studying the night before the test. I AM this person, I do this. But when I do manage to get my ass out of bed at an appropriate time and get a good nights sleep beforehand, my productivity is OUTSTANDING. Try rebooting your sleeping schedule and actually getting stuff done in the morning, you might be surprised in realising you are, in fact, a morning person! If you truly try and again fail, then congratulations, you are indeed a creature of the night!

By actually getting myself to be productive in the morning, I managed to have 0 allnighters for my last exam and pass it as well!

Here are some interesting links on the topic:

The AsapSCIENCE video

Sleep and good grades

5. To coffee or not to coffee?

This is also a complicated topic but IF you feel like you are well rested, fairly focused and you usually do not need to drink coffee! If you are like me, the additional caffeine will just send you into anxiety mode and for the rest of the day you’ll feel like someone spiked your drink with DMT. Not joking!! It is also important to remember that drinking too much coffee too early in the morning can indeed affect you negatively in the long run so be careful! The last thing you need during your finals week is to have painful stomach ulcers, yikes.

While there are negative sides to drinking too much coffee, there are also findings that show coffee helps with your memory!

If you find yourself literally OD-ing on coffee and not getting any results, try drinking tea instead. Fun fact: tea leaves actually contain more caffeine than coffee, but by diluting them while prepping your beverage, the effects are weaker.

All things in moderation, especially when preparing for a big exam!

Here are some links:

20 Harmful Effects of Caffeine

Perk Up Your Memory with Caffeine! 

Caffeine and anxiety

6. Practice tests!!!!

Do. Practice. Tests. It doesn’t only prepare your brain for the exam environment, but it also makes you actively learn things.

My usual practice for big tests is 1 month of hardcore studying (going over the materials) and 1 week of going through past papers or practice tests as some call them. You can also do 5 days of going through the material and then 1 day of doing exam questions, but this is mostly up to you, as everyone is different and no person can study the exact same way as you! The uni usually has an entire server of these and a good tip is to join some facebook groups of older students and politely ask them to send you some old questions/give you tips on the exam you are taking! Most of them are usually happy to help.

An interesting study about practice tests

And lastly, don’t forget that your grades aren’t everything and as a college student, you probably won’t be able to get through all of those 1000+ pages of study material and that is okay! Usually the main thing you will be graded on is understanding the concept and applying it to a real-life situation in the field. Focus on the big picture and don’t stress too much over small details! I tried to be as general as possible, as to have this masterpost applicable for anyone and I am fully aware that your studying strategy will differ depending whether you study linguistics, history, computer science, or something completely different!

If you think that I forgot anything or have any questions, feel free to message me and I’ll make sure to answer to you as soon as possible!

Have a lovely Monday!

[leosecret0661]

16 Myths About Getting Pregnant and Ovulation

The Truth About Ovulating, Sex, and Conception

There are tons of half-truths (and full-on-falsehoods!) on ovulation and getting pregnant out there. Believing misinformation on conception could make it harder for you to urge pregnant. does one know your myth from fact?

 Myth: If You Don’t Get Pregnant After a few Months of Trying, Something Is Wrong

You may have gotten the impression in your high school sex education class that getting pregnant is nearly too easy. just one occasion in bed and that’s it—you’ll expect. Years of using contraception also can put you into this mindset. once you spend such a lot of time worrying that you simply might accidentally get pregnant, you'll be surprised once you don’t conceive instantly.

The truth is that few couples get pregnant in the primary month they struggle. It’s completely normal to require up to 6 months to urge pregnant. Some couples take up to a year to conceive, and that’s also within the realm of normal.1

How quickly are you able to expect to urge pregnant? One study found that after three months of trying, 68% of the couples were pregnant. After a year, 92% conceived.2 These women were using fertility tracking techniques, however. It wasn’t hit-or-miss intercourse that got them pregnant.

What if you’re not pregnant after a year? Go see your doctor. If you’re age 35 or older, go see your doctor after six months

Myth: Ovulation Occurs on Day 14 of Your Cycle

Ovulation might occur on day 14 of your cycle. But…it also won't. Ovulating as early as day 6 or 7 or as late as day 19 or 20 isn’t uncommon or abnormal.

When learning about female reproduction, most of the people are taught that a woman’s cycle is 28 days on the average which ovulation occurs at the mid-point, on day 14. The key phrase here is on the average. A healthy woman with good fertility can have a cycle as short as 21 days or as long as 35 days, and every one be considered fine. The day of ovulation shifts earlier or later, counting on how long a woman’s cycle is.

Myth: Your Ovaries alternate Ovulating an Egg

This isn't true. Your body doesn't systematically "schedule" ovulation to alternate ovaries from month to month. Ovulation can switch from side to side, but it doesn't need to.

It's common for ladies to tend to ovulate more often on one side than the opposite. that would be your left ovary or your right ovary; it depends on a variety of things . this is often also why you'll notice you get ovulation pain on one side more frequently than the opposite.

Which ovary releases the egg has more to try to to with which ovary features a follicle (which contains the developing egg, or oocyte) that reaches the ultimate stage of maturity. At the beginning of your cycle, several follicles in each ovary begin to develop. just one (or two) will make it through the stages of development and ovulate. When quite one follicle releases an egg, that's how you'll conceive non-identical twins!

Myth: You Can’t Get Pregnant If you've got Sex on Your Period

You can get pregnant if you've got sex during your period. Your ability to urge pregnant depends on once you ovulate, and indirectly related to menstruation.

Some women mistakenly believe that if they're still on their period, they aren’t yet within the “fertile window.” (That’s the period of 5 to 6 days when it’s possible to urge pregnant.) But if your cycle is brief, and you ovulate on day 7 or 8, you'll conceive from sex on your period.

Another misconception people have is that menstruation will “wash out” any sperm alongside period blood. But that’s not true. Your period won’t stop sperm from swimming up to your genital system.

Myth: to urge Pregnant, you would like to possess Sex After You Ovulate

If you would like to urge pregnant, you would like to possess sex before you ovulate. Ideally, sex within the two days before ovulation is presumably to assist you conceive.1

This is a standard misunderstanding, and it’s easy to ascertain how people come to the present conclusion. It seems to form sense that the egg must be present first, before you send the (sperm) swimmers. However, that’s not how it works.

First of all, sperm can survive within the female reproductive tract for up to 6 days. The sperm will die out because the days pass, therefore the closer to ovulation you've got sex, the higher. But they don’t got to get there “at the moment” of ovulation.

Secondly, and maybe most significantly, the egg becomes nonviable very quickly. If a sperm doesn’t fertilize the egg within 12 to 24 hours of being released from the ovary, pregnancy can’t occur.1

When you take into consideration this short viability window, sex after ovulation might be too late. (There are, however, other good reasons to possess sex after ovulation.)

Myth: you ought to roll in the hay Every Day—Or Even Twice a Day!—to Get Pregnant Faster

You certainty could roll in the hay a day, if you wanted to. But there’s no evidence that it'll assist you to get pregnant faster. It’s far more likely to steer to blow out and frustration, especially if (or when) you don’t get pregnant within the first month.

Sex every other day, or sex during your most fertile days, is all you would like to conceive. If you had sex 3 times every week, you’d even be likely to hit your most fertile time.1

The reason why more sex doesn’t necessarily mean you’ll get pregnant faster is because conception is about far more than timing. There is a spread of physiological factors that impact whether you get pregnant in any given month. If timing were all it took, people would conceive the primary month they tried whenever.

Myth: The Signs of Ovulation Are Always Obvious

There are some ways you'll track or plan to detect ovulation, from basal blood heat charting to cervical mucus observations, to ovulation predictor tests and more. for a few women, one or a couple of those methods are perfect, and that they haven't any difficulty using them. That’s not always the case.

For some women, basal blood heat charting won’t work, either because their sleep schedule is just too complicated, or they can’t remember to require and record their temperature consistently every morning.3 for a few women, cervical mucus tracking is straightforward, and for others, they question whether or not they even have “fertile-quality” cervical mucus.

Even ovulation test kits, which you’d think should be fool-proof, are often complicated. Determining whether the test line is darker than the control line isn't always simple.

With all that said, if you’re concerned about a few lack of ovulation signs, ask your doctor. You may be having difficulty detecting ovulation because you’re not ovulating. Ovulation problems (anovulation) are a possible explanation for female infertility.

Myth: If You’re Ovulating, You Won’t Have Trouble Getting Pregnant

Ovulation is important to getting pregnant—but it takes quite just an egg to conceive. for instance, the pathway to the egg must be clear. If the fallopian tubes are blocked, pregnancy can’t occur. Also, you would like sperm. Getting pregnant isn’t only about the woman’s fertility.

It’s also important to understand that infertility doesn’t always have obvious symptoms. Some fertility problems (in both men and women) aren't detectable without fertility testing. It’s impossible to inform without lab testing if a man’s ejaculate has enough sperm cells to be fertile. There could also be no obvious signs if a woman’s fallopian tubes are blocked. Ovulation is simply one piece of the fertility puzzle.

Myth: 40 is that the New 30, Even for Getting Pregnant

Unfortunately, regardless of how good you look, and the way healthy you're, your fertility declines with age. Your odds of getting pregnant at 40 aren't nearly as good as they're at 30. Female fertility begins a steep downward path around age 35.4

This is why women over age 35 should seek help for getting pregnant before younger ladies. If you’re younger than 35, you ought to attempt to get pregnant for a year before you ask a doctor. If you’re 35 or older, you ought to seek help after six months.

Myth: You Can’t Get Pregnant After 40

All that said, getting pregnant after 40 is entirely possible. many women have babies after 40 and even 41. Your risk of infertility increases at 40, alongside your risk of miscarriage. it's going to also take a touch longer for you to urge pregnant. But you’re not sterile simply because you celebrated your 40th birthday. albeit you’ve started perimenopause, until you’ve completed menopause, if you would like to avoid pregnancy, use contraception.

Myth: Age Doesn’t Matter for Men

You’ve likely seen stories of male celebrities fathering children past age 60. this might have given you the impression that male fertility has no regulation, but that’s not entirely true. While men don’t undergo an organic process like menopause, with a particular ending to their fertile years, male fertility does decline with age.

Besides an increased risk of infertility, pregnancy's conceived with men over 40 are more likely to finish in miscarriage or stillbirth. there's also a rising risk of certain disease and conditions, including autism, manic depression, schizophrenia, and childhood leukemia.5

One study found that combining female age with a man's age can create fertility problems. They found that when a lady was age 35 to 39, if her partner was five or more years older than she was, their odds of conception dropped from 29% (on their most fertile day) to only 15%.6

Myth: contraception Causes Infertility

Birth control does prevent pregnancy when you’re using it, which is strictly how you would like it to work! But once you stop taking it, your fertility returns. Research has found that contraception doesn't increase your risk of infertility.7

Sometimes, a lady will have regular periods while taking contraception, and then, after she stops, they become irregular. She might imagine that this suggests the contraception caused her cycles to be irregular, especially if she had regular cycles before taking contraception. This isn’t accurate, however.

Most hormonal contraception drugs cause a man-made regular cycle. Once you stop taking it, the body takes over. It’s not that the contraception caused your cycles to become irregular, it’s that the contraception was creating a man-made regular cycle.

Sometimes, it happens that a lady conceives easily her first or second child, goes on contraception for a while, then when she tries to possess another, experiences infertility. It’s easy responsible the contraception for this, but secondary infertility isn’t caused by contraception use.

There is one sort of contraception which will impact your fertility longer than a month approximately after discontinuation: the contraception shot, or Depo-Provera. Depo-Provera doesn't cause infertility—your fertility will return. However, the consequences of the medication can last for much longer than a month approximately after you stop using it. While most girls are going to be ready to conceive within 10 months of stopping the injections, it can take others up to 2 years for his or her fertility to return.8 ask your doctor if you're concerned

Myth: If you would like to urge Pregnant, you would like to possess Sex within the “Missionary Position"

Any sexual position that leads to ejaculate getting near the cervix can cause pregnancy. For that matter, albeit ejaculate gets near the vaginal opening, pregnancy can occur.

The so-called “missionary position” of man on top, woman on bottom, is assumed to be the simplest position for conception. However, there’s no evidence that you’re more likely to urge pregnant having sex this manner .4

Myth: You Don’t get to Worry About Your Health Habits Before You Get Pregnant.

You know you shouldn’t smoke or drink when you’re pregnant, which you ought to make certain to eat a nutritious diet. But does it matter before you conceive? Yes, it does!

Smoking negatively impacts both male and feminine fertility.9 It’s also really difficult to quit overnight. Better to quit before you conceive.

While an occasional drink is probably going okay, heavy drinking when you’re trying to urge pregnant could harm your fertility.9 Also, you would possibly accidentally drink when you’re in early pregnancy. Remember that you’re already four weeks pregnant by the time you'll get a positive bioassay result.

As for your diet, what you eat matters when you’re trying to conceive. It’s especially important to urge enough folate in your diet. Low vitamin Bc intake is related to an increased risk of birth defects.

Myth: you've got to Drop Your Starbucks Habit if You’re Trying to Conceive

It’s debatable whether you would like to completely quit caffeine when you’re trying to urge pregnant. The research hasn’t been clear. for instance, a study in Denmark found that tea drinkers were slightly more likely to urge pregnant, that soda drinkers were slightly less likely to conceive, which coffee appeared to haven't any impact on fertility.

What does all that mean? We don’t know. For now, though, most agree that but 300 mg of caffeine each day should be fine. One cup of coffee is a smaller amount than 300 mg.

Myth: “Trying Too Hard” Makes It Harder to urge Pregnant

“You’re trying too hard to urge pregnant,” someone may say, “If you stop trying so hard, you’ll get pregnant.” That’s not true.

There’s no evidence to mention that “trying too hard” (whatever that means) will make it take longer to urge pregnant. Someone who is trying to urge pregnant is probably going using fertility awareness methods to trace ovulation and is more likely to possess sex once they are most fertile. If anything, they'll be more likely to urge pregnant.

A Word From Verywell

There are tons of misconceptions out there on getting pregnant and ovulation. Not enough is taught in class about fertility, because the focus is typically on avoiding sexually transmitted infections. How could you've got known differently? Don’t feel bad if you believed a number of these myths.

If you ever have an issue about your fertility, remember that your medical care physician or gynecologist is a superb source of data . do not be afraid to ask questions! they need to assist you.

[eichy815]

Loads of Fungible

We all know what a contentious issue abortion is.  It always will be.  And, as a gay male who will never have to worry about getting a woman pregnant, I don’t feel it’s my right to make the decision for another person whether or not they can get an abortion, pre-birth (although I also oppose “forced paternity” for males).

In my April 2015 op-ed entitled “The Sanctity of Strife,” I outline my own views on abortion rights.  I only support partial-birth abortion (i.e. the Dilation & Extraction procedure) if a biological mother’s life is in danger.  Other than that, I support the option of abortion being 100% legal in all circumstances leading up to the delivery – unless a qualified doctor determines that termination of the pregnancy after a woman’s water breaks is somehow necessary in order to save her life.

Additionally, while I don’t consider myself to be “pro-life,” I do share the position of many pro-lifers that tax dollars GENERALLY shouldn’t subsidize an abortion (with the exception of rape, incest, or life-saving necessity).  Aside from those circumstances – if a woman and a man accidentally make a baby, then they should have to share the costs of paying for the abortion completely out-of-pocket (and, if the woman wants to raise a baby as a single mother, I also believe the biological father should have the option to sign away his parental rights...although that’s obviously a separate issue).

So, my overall position is that abortion should always be a legal option for every woman right up until she goes into labor – however, it should NOT be funded by taxpayers unless it’s for one of the aforementioned circumstances I’ve specified.

This leads me to the ongoing war over federal funding of Planned Parenthood.  Last May, I attended a town-hall meeting hosted by my U.S. Representative; one of his other constituents challenged this Democratic congressman of ours by confronting him about how taxpayers end up indirectly paying for abortions due to the existence of “fungible funds.”

I hadn’t been familiar with the term “fungible funds” (in relation to abortion policy) until six months earlier, when I had been visiting one of my old college campuses:  a local conservative student activist filled me in on the concept of “fungibility” (in respect to Planned Parenthood) at a booth being hosted by their local Students For Life organization.

Like clockwork, there always seems to be someone in the crowd (presumably planted there by a Far Right anti-abortion group) who finds a way to rail against abortion policy in public forums – especially when the lawmaker or aspiring candidate happens to be a Democrat.   In my July 2015 op-ed entitled “Messaging in a Bottle,” I recalled a vivid experience I’d witnessed at a local state assembly candidate’s Q&A session during the 2004 election season.  In that scenario, I’d piped up and “hijacked” the discussion to promote a more centrist position on abortion rights (much to the chagrin of that forum’s moderator).

Similarly, during that May 2017 town hall meeting (thirteen years later), I did a similar thing when one of my fellow townsfolk tried to play “Gotcha!” with our U.S. Representative.  I spoke up, reframing the discussion by saying, “Why can’t we just crack down on ‘fungible funds’ while still robustly funding all NON-abortive services from Planned Parenthood at the federal level?”

But, for those of you who are unfamiliar with the “fungibility” argument, I’m going to discuss the details that fuel this particular debate.

Carol Novielli of Live Action News cites Title X funds as a sneaky way in which public tax dollars are manipulated, in a backhanded manner, to fund abortions.  For example, Title X funds (federal grant money designated for preventative health services and family planning) can be used to pay staff overhead and operational expenses at facilities where abortions are performed.  That same Title X funding is used for “options counseling,” which cohesively includes the advertisement of prenatal care, adoption, and full termination of a pregnancy.

Pro-life activists make the claim that individual facilities receiving Title X funding have emphasized – or outright encouraged – abortions within their health facilities.  Novielli uses the statistic that, in 2015, the performance ratio for Planned Parenthood was 35:1 in terms of abortions vs. prenatal care services (i.e. abortions are performed 98% more of the time than prenatal services are administered).  Many people in the anti-abortion camp allege that private funds raised from outside sources should be enough to specifically keep the abortion services solvent.

Social commentator Amanda Marcotte challenges this type of accusation.  She says that pro-life activists want the public to believe that abortion funding draws from one large pot under Title X; however, she points out the fact that remains of Medicaid funding simply not covering abortions.  So, Marcotte explains, if you get an abortion performed at a Planned Parenthood facility, the cost of that abortion gets billed to you separately.  Abortions don’t get charged or funded in the way something like birth control does – where a recipient can acquire $50 worth of contraception at a reduced rate of $10 under Title X.

I’m not a fan of Marcotte or her writing – because I find her overall worldview to be pompously neoliberal and unduly hostile to those who disagree with her.  However, in this case, I agree with her factual efforts to call out those on the Far Right who want to deceptively “muddy the waters” when conveying to the public how Title X actually works; its main distinction is that Title X is funded through grants for low-income patients.  If any of those patients get an abortion, however, the direct cost of the procedure itself isn’t covered by tax dollars.

Joerg Dreweke of The Guttmacher Institute further points out how federal funding of elective abortion procedures have already been banned by the 1973 Helms Amendment and the 1976 Hyde Amendment.  However, Dreweke acknowledges the pro-life argument that more than a dozen different states voluntarily fund abortions for low-income women by using STATE-level funds.

Dreweke also defines how the “Global Gag Rule” on American-facilitated abortions performed overseas works.  First instituted during the Reagan Administration, the Global Gag Rule prohibits the United Nations Population Fund (UNFPA) from receiving U.S. funding if it finances international family planning services that offer abortions.  Since the 1980s, every Republican president has enforced this policy, whereas every Democratic president has rescinded it.  President Donald Trump has obviously overturned the Obama-era policy that had lifted the Global Gag Rule.  A murkier gray area is over whether or not Non-Governmental Organizations (NGOs) will still be allowed to provide birth control and other forms of contraception – or related counseling or referrals – and still be eligible for U.S. funding.

Casey Mattox of The Alliance Defending Freedom brings up other loopholes that appear to exist within the context of “fungibility.”  She cites the overbilling of Medicaid funding in some Texas facilities during the Obama Administration, as well as chemical abortions that were allegedly provided by tax dollars in Washington state back during the Great Recession.  She trumpets former Planned Parenthood employee Sue Thayer as someone who has become a “whistleblower” on Medicare fraud – supposedly uncovering $26 million in fraudulent claims within Iowa’s family planning services alone.

The Daily Online’s David Benkof makes what is perhaps the most ideologically-balanced overview of “fungible funds” in abortion policy.  Benkof acknowledges that unrestricted money leftover in a budget can, theoretically, be reallocated and reused to fund abortions – or any other discretionary services, for that matter.  The very concept of fungibility itself allows for money to be moved around between itemized budgets.

But Benkof expresses his view that if funds are limited to “free and low-cost contraception, morning-after solutions, counseling for family planning, even combating sexually transmitted diseases” – then abortion rates would fall dramatically on their own.

First, I would be in favor of the permanent lifting of the Global Gag Rule – however, in practical terms, the only way to really make it permanent (to any significant degree) would be through passing a U.S. Constitutional Amendment.  I’m generally very conservative when it comes to the hypothetical application of passing U.S. (or state-level) Constitutional Amendments (with the future overturning of Citizens United being one of the lone exceptions I’d support).  Perhaps a middle ground could be if a future Democratic (or moderate Republican) president might lift the Global Gag Rule while narrowly-defining how it can be utilized on U.S. military bases.

Then, let’s look of the question of overall funding for Planned Parenthood.  As I’ve alluded to, I believe that Planned Parenthood provides many essential family planning services – e.g. STD testing, emergency contraception, physical exams, cancer screenings.

So when it comes to abortions directly performed at a Planned Parenthood facility...if “fungibility” is such a big problem, perhaps our beloved lawmakers should construct bipartisan legislation that narrowly-defines (and, thereby, limits) which activities specifically constitute “fungible funding” in relation to federal abortion policy?  Are there any reasonable consequences (e.g. a financial penalty, employment termination, a short-term prison sentence) for any Planned Parenthood employees who violate such narrowly-defined standards for curbing “fungibility?”

But I don’t think any elected Republicans will engage in such a good-faith effort.  I think they want abortion to be a perpetual “wedge issue” amongst voters, and the concept of “fungibility” continues to keep that discussion alive.

If we suddenly overdefine “fungibility,” there will be way too much additional bureaucracy and uncertainty related to the administration of family planning services.  Assuming that there are classical conservatives out there who genuinely want to solve the “fungibility” conflict, it’s imperative that “fungible funds” not become so broadly-categorized as to render most non-abortive family planning services obsolete.

I think back to when U.S. Senator Debbie Stabenow (D-MI) spoke up about the lack of federal funding for Great Lakes protection in the 2017 Budget Bill. During OMB Director Mick Mulvaney’s May 2017 testimony, he hemmed and hawed (in response to Stabenow’s inquiry) about how the new budget was striving to encourage more localized funding to create a leaner federal budget.  He implored Stabenow to explain how he was supposed to tell voters in, say, Arkansas, that they should have to foot the bill to replenish natural resources that are completely outside of their geographic region.

Stabenow’s response was profound:  “Yes, that’s called ‘having a country,’ with all due respect.”

A similar parallel can be drawn when debating “fungibility.”  Just because employees of Planned Parenthood are tasked with administering abortion procedures for some women, does that mean their overhead costs and personal salaries should disappear?  By that same logic, you could argue that someone who uses Planned Parenthood to purchase birth control shouldn’t have to pay for another woman’s mammogram.  You could make the case that someone who uses Planned Parenthood to receive prenatal counseling services shouldn’t have to pay for someone’s SDI test.

Where would you draw the line?

Such comparisons, of course, are ridiculous.  It’s like saying that taxpayers should no longer have to support and fund public schools just because not all students necessarily enroll in Music, Art, or other elective courses.  Or saying that someone in Boston shouldn’t have to pay for a federal stretch of highway that runs past Salt Lake City.  

If we break down every single thing that’s funded right down to its literal dollars-and-cents...there will be no point in funding ANYTHING any longer.  And the economic repercussions of that would be ugly and chaotic.

Whenever someone from the pro-life camp starts yammering about “fungibility” – ask them what their exact proposed solution for eliminating abuses of “fungible funds” would be.  If their response is a suggestion that federal funding for Planned Parenthood should just be eradicated altogether, that is a clear indication that they are searching for a backhanded technicality through which they can shrink abortion access in and of itself.

There are ways in which we can set up stricter guidelines and parameters for “fungible funds” without creating legislative language that goes completely off the rails.

[ihugoan-blog]

Causes of unintended pregnancy

According to the survey, more than fifty percent of women have accidental pregnancies while using contraceptive methods. Why contraception, but still pregnant, and this is mainly caused by the following reasons.

Women who take the pill do not have regular doses. A large number of people who use condoms do not follow the standards and have to determine the quality of condoms. If you are using a birth control ring, you should always check whether the ring is shifting or falling off.

1, in order to achieve the best contraceptive effect, contraceptive tools must be used consistently. If you're taking the pill, just forget to take one pill, and you'll get a better chance of conception. Contraceptive devices such as condoms and the uterus ring must be kept in use until they work. Women who participate in family planning must have accurate and continuous use of contraceptives, or they may not succeed. Remember, just one unprotected sex can make you pregnant.

2 、 condom rupture before intercourse. About 2% to 5% of condoms will break down during use. In general, this is due to improper use, such as using no hydrophilic lubricant, or tearing through jewelry and nails. Condoms that fail to store well, or condoms that are damaged before and after production can lead to condom failure. The use of a vaginal sperm killer in combination with a condom can reduce the unintended pregnancy caused by a contraceptive failure of the condom.

3 、 take antibiotics at the same time as you use the pill. Scientifically proven, a steroid hormone that lowers the contraceptive ingredient in the blood. Women who are used to oral contraceptives should use other forms of contraception when they start taking antibiotics. The magazine contraceptive method recommends that women use other methods of contraception within 14 days of using antibiotics.

4, they believe that they will not become pregnant during menstruation or during the period of safety, so they try unprotected sex. Successful conception usually occurs during the menstrual cycle. However, some women in menstrual period, or the safety of unintended pregnancy. The belief that you will not conceive during menstruation or during a safe period will increase the risk of conception. In addition, you may also increase your risk of developing sexually transmitted diseases or other infections.

Special reminder: for your health, before you are ready to baby, please be sure to do contraceptive measures.

[nancygduarteus]

Growing Cheaper Embryos for IVF Inside the Vagina

As the number of U.S. babies born as a result of fertility treatment tops 1 million—an all-time high—clinics are under pressure to keep up to date with pricey lab equipment that can create, develop, and test embryos. But some fertility doctors have started to offer a new low-tech device that enables a woman to incubate them in her own body.

The catch: She grows them inside her vagina.

A doctor places a mixture of surgically extracted eggs and sperm inside a device that looks like a tiny acrylic saltshaker and inserts it deep into a patient’s vaginal canal near her cervix. That’s where it will hover, like a thimble-sized satellite, for up to five days until the doctor retrieves it, removes the resulting embryos and transfers one or more to her uterus in the hopes of creating a pregnancy. “It’s like having a tampon in the vagina,” explains Kevin Doody, a Dallas reproductive endocrinologist who’s led studies on the device, called INVOcell, which was approved by the U.S. Food and Drug Administration in 2015. “It’s not going to come out.”

It’s a concept designed to appeal to patients who prefer a less tech-heavy approach to scientific baby-making. That could include Catholics who’ve rejected traditional in-vitro fertilization (IVF) treatment because it facilitates conception outside the body.

But INVOcell could be a game-changer for the $2 billion assisted reproductive technology market. The protocol calls for fewer eggs (and less hormonal medication) than traditional IVF, and only requires about one-third as many office visits. The vaginal incubator also costs one-third to half the price of regular IVF treatment.

That’s no small matter for the estimated 1 in 8 couples in the United States who have trouble getting pregnant or carrying a baby to term—three-fourths of whom don’t receive the care they need because they can’t afford it, according to the American Society for Reproductive Medicine. Although the average price range of regular IVF is quoted as between $10,000 and $15,000, the real-life costs are closer to $20,000 by the time medications, sperm injection, and genetic testing services are factored in, according to data from 3,200 IVF patients that was analyzed by the fertility doctor review site FertilityIQ for the personal finance website NerdWallet.

Insurance coverage for traditional IVF is sparse: About 26 percent of workplaces offer infertility benefits, according to the Society for Human Resource Management. Just 15 states mandate that employers provide any kind of infertility coverage, and only eight states require that to include IVF treatment. (Insurers have yet to start paying for INVOcell.) As a result, many patients blow through their savings, load up their credit cards—one survey of more than 200 women who’d gone through IVF found that 44 percent racked up at least $10,000 in debt—or beg for financial help on crowdfunding sites. More than 8,500 GoFundMe campaigns created to raise money for fertility treatments have collected $13.5 million in the last six years, according to figures provided by the company.

By contrast, INVOcell, which is manufactured by INVO Bioscience in Medford, Mass., costs about $6,800, including medication. “We can pay for this without going into debt,” says Katie Whited, 28, a nurse from Durham, N.C., who’s tried nearly every fertility treatment short of IVF, including ovulation induction drugs with timed intercourse, acupuncture, and intrauterine insemination in which a doctor injects sperm directly into a patient’s uterus. “We wouldn’t have been able to find $18,000 for IVF.”

Early numbers are promising: One randomized clinical trial of 40 women under 38 found no significant difference in success rates between traditional IVF and INVOcell. Although IVF produced more quality embryos overall, the birth rates were similar: Of the 20 women undergoing IVF, 12 got pregnant and delivered 15 babies, including three sets of twins. In the INVOcell group, 11 of 20 women gave birth to 16 babies, including five sets of twins.

“I see so many patients who can’t have kids because they can’t afford IVF. We’ve got to do better. It’s a matter of medical ethics,” says Doody, who has trained a couple dozen doctors on using the vaginal incubator for INVO Bioscience. “Now a greater number of people will be able to access care, and it’s going to open up the market.”

According to Doody, doctors who offer INVOcell can cut the number of office visits for one round of treatment from eight (for traditional IVF) to two or three, which is a big deal for patients in underserved areas, especially in the southeastern and southwestern United States, who often must drive several hours to reach fertility clinics. That means there’s less work for staff who administer blood draws and ultrasounds and play phone tag with patients with updates after each visit. “Patients take less medication, and we’ve gotten better at dosing and predicting how they will respond so we can do less monitoring,” says Doody, who is also the president of the Society for Assisted Reproductive Technology, the organization that reports fertility clinics’ data to the government. “We’re not trying to get 10 to 15 eggs like with regular IVF. We just need six to eight eggs to get one or two good embryos to transfer.” His rationale: More eggs aren’t always better, and doctors should aim for a handful of quality eggs, rather than the larger quantity typically generated during regular IVF.

And because the embryos are grown in the mother’s body, there’s no need for lab staff to run costly incubators with extensive security systems around the clock, which also brings down the price.

The fact that INVOcell preserves some of the mystery of baby-making was a big selling point for Brittney Koch-Dowell, since she and her wife are depending on help from science to conceive. (They each plan to take a turn carrying a baby.) “We’re already using donor sperm, so this helped it feel more real and natural,” says Koch-Dowell, 37, a restaurant manager from Elsberry, Mo., who’s scheduled to undergo the procedure this month. “I get to be the incubator. My body and my heat are producing the child.”

* * *

In some ways, the rationale behind INVOcell sounds so obvious. (“It’s like what’s old is new again,” quipped John Couvaras, a fertility doctor in Phoenix who’s helped four women conceive with the device.) Yet it took French embryologist Claude Ranoux nearly 30 years to fine-tune his invention, which has been available in Europe since 2008. Since the birth of the first “test-tube baby” in 1978, Ranoux had been fascinated by the idea of growing embryos inside the human body rather than in a petri dish. And he wasn’t impressed with the unreliable incubator at his workplace, the Cochin Hospital at Paris Descartes University. “I was forced to be an innovator because I had a bad machine,” says Ranoux.

So Ranoux rigged up a little portable incubator from plastic tubing. At first, he considered sewing it under the abdominal skin, but that would require two surgeries to implant and extract the device and risked causing an infection. Taping it under an armpit would provide a nice warm place, but he thought it would feel too uncomfortable over several days. He also considered securing it in the back of a patient’s mouth, but he didn’t want to risk shocking the embryos if she drank cold water or hot coffee. Besides, there was the chance she could accidentally swallow it.

Next he considered having a patient swallow the capsule and letting the embryos grow over the two to three days it would take the device to wind its way through the digestive tract. But he feared the intestinal environment would be too toxic. “Also, it would be a nightmare for the embryologist to retrieve the device later,” he says.

He came to the most logical place last. “I didn’t think about it initially because I worried the capsule could lead to infections or irritate the cervix and interfere with embryo transfers,” he says. Those concerns were unfounded; instead, he found that the vagina provided the best consistent temperature, pH, and oxygen balance and enabled easy insertion and removal of a device. He also believed that embryos would benefit from the slight temperature variations that women undergo throughout the day, which embryos that are created during natural conception experience as they grow in the uterus.

Although INVOcell is designed to stay in the vaginal canal on its own, doctors have the option of adding a diaphragm net to catch it, just in case. If it somehow works its way out completely, patients are advised to wash it off and push it back up.

* * *

In the meantime, patients still have to get used to the idea.

Anne Swart, 38, of Berkeley, California says she and her husband decided against using INVOcell to help them conceive their second child after enduring two miscarriages, even if it meant paying close to $25,000 out of pocket for IVF, including sperm injection and genetic testing. “It hasn’t been around in the U.S. for a long time and just felt risker,” she says. “We didn’t want to go through more heartbreak. We just wanted to do everything to give us the best chance.”

The main challenge with marketing INVOcell is that it’s recommended mostly for younger women with uncomplicated fertility issues and partners with normal sperm counts, says Fady Sharara, a fertility doctor from Reston, Va., who’s only treated one patient with INVOcell after advertising it for a year. “My patients are older, and they want to get the maximum amount of eggs with IVF, so they can do genetic testing to make sure they have a normal embryo to transfer,” he says. “They have a small pot of money. They say, ‘I can’t afford to try INVOcell and then IVF later.’”

The lab also provides important feedback on growing embryos that’s impossible with INVOcell’s “in the dark” approach, adds Michael Tucker, the director of IVF and embryology labs at Shady Grove Fertility, the largest fertility center in the U.S. He argues that modern lab technology, including time-lapse imaging of developing embryos, helps embryologists pick the best ones to transfer to the uterus. “The idea of INVOcell is clever, but in a diagnostic sense, you lose so much,” he says. “You have no idea what’s happening inside the body. You don’t know if fertilization was normal. There’s something to be said [for] following the entire process.”

It’s also unknown whether mainstream fertility medicine is ready to embrace an IVF alternative that might cut into clinic bottom lines. “When clinics don’t offer lab services, they strip out a major profit center,” says Jake Anderson-Bialis, co-founder of FertilityIQ.

Yet most clinics can afford to add INVOcell to their menu of treatment options, says Richard Paulson, a reproductive endocrinologist at University of Southern California Fertility and president of the American Society for Reproductive Medicine. “We have a very expensive heavy-handed approach to IVF in the U. S. There’s definitely room to bring the cost down,” says Paulson, who wrote a paper on ways to broaden access to reproductive care, such as offering minimal stimulation of eggs, retrieving immature eggs or embracing vaginal incubation, like INVOcell’s device. He says the pressure to report the best clinic pregnancy rates to attract patients has caused doctors to shy away from trying more cost-effective alternatives that have smaller chances of success.

The acceptance of INVOcell could make doctors more open to other innovative technologies that might bring down the cost of fertility medicine, adds Alan Penzias, a fertility doctor at Boston IVF and a professor at Harvard Medical School. Other inventions in the works include a portable ultrasound that IVF patients could use with their electronic tablets, a spit test to measure hormone levels that would replace blood draws, and an at-home semen analysis test that uses a smartphone app.

Or doctors could use INVOcell to extend the reach of clinics to underserved areas. “I might be able to put some equipment in a van and set up a temporary shop in a hospital a few times a year,” suggests Penzias. “It could provide another outlet to expand access to fertility care.”

So could a Catholic endorsement. The Vatican has long opposed IVF on the grounds that it enables creating babies outside the bounds of marital intercourse. “The rule of thumb is that you can assist reproduction but not replace reproduction,” explains Father Kevin FitzGerald, an oncologist who specializes in Catholic health-care ethics at Georgetown University. So reproductive scientists have tried to find creative solutions, such as a procedure invented in the late 1980s called gamete intrafallopian transfer (GIFT) involving shooting a mixture of sperm and egg directly into the fallopian tubes through a catheter. But multiple births were common with that procedure, and doctors eventually stopped using it as IVF success rates improved.

While the Church has yet to issue an opinion on INVOcell, experts say it’s a potentially Catholic-friendly alternative to traditional IVF because the device technically helps fertilization occur inside the body. By the time doctors insert the incubator containing the egg and sperm soup inside the vagina—about 15 to 30 minutes following egg retrieval—the sperm have just started to attach to the eggs’ outer layer and haven’t yet started to burrow inside. It takes at least 18 hours for the chromosomes to join together and fertilization to finish.

“INVOcell is a move in the right direction to a more natural assisted method,” explains FitzGerald. His ideas for making it even more acceptable to Catholics: Collecting the sperm during sex in a condom, rather than asking men to masturbate into a cup in a fertility clinic closet. It would also help if doctors only inserted the number of eggs they estimated might turn into embryos. “You must use what’s fertilized so you don’t discard embryos and destroy human life,” he says.

What’s appealing for some Catholic patients of Julie Rhee, a fertility doctor in St. Louis, is that INVOcell eliminates the role of the embryologist tinkering with sperm. “The part that makes them feel comfortable is that you’re not determining which sperm will be injected inside the egg or whether fertilization will even happen at all,” says Rhee, who just started offering the vaginal incubator in May and has 10 patients lined up for treatment.

Ranoux, the founder of INVO Bioscience, didn’t set out to appease the Vatican at first, yet he’s found a way to accommodate his Catholic patients. In addition to collecting the semen in a condom (there’s a special coitus room at his clinics), Ranoux also pricks the bottom of the condom, to leave open the possibility of a natural conception.

But still, unlike GIFT, which enabled embryos to travel to the womb on their own, INVOcell requires a doctor to take the embryos out of the device and manually insert them into the uterus. That interference in the baby-making process—plus the act of selecting embryos and potentially freezing the extras, which could later be destroyed—makes a Catholic endorsement less likely. “You’re interrupting the natural chain of events,” says Daniel Sulmasy, who studies clinical bioethics at Georgetown University.

What could be acceptable, he argues, is if someone invents an incubator that is placed directly in the uterus, and then dissolves. But it’s a tricky timing gamble. The device would have to self-destruct at the exact moment the embryos have developed and were capable of attaching to the uterine lining. Still, it might not be impossible. “I have some ideas,” says Ranoux.

from Health News And Updates https://www.theatlantic.com/health/archive/2017/07/growing-cheaper-embryos-for-ivf-inside-the-vagina/533205/?utm_source=feed

[ionecoffman]

Growing Cheaper Embryos for IVF Inside the Vagina

As the number of U.S. babies born as a result of fertility treatment tops 1 million—an all-time high—clinics are under pressure to keep up to date with pricey lab equipment that can create, develop, and test embryos. But some fertility doctors have started to offer a new low-tech device that enables a woman to incubate them in her own body.

The catch: She grows them inside her vagina.

A doctor places a mixture of surgically extracted eggs and sperm inside a device that looks like a tiny acrylic saltshaker and inserts it deep into a patient’s vaginal canal near her cervix. That’s where it will hover, like a thimble-sized satellite, for up to five days until the doctor retrieves it, removes the resulting embryos and transfers one or more to her uterus in the hopes of creating a pregnancy. “It’s like having a tampon in the vagina,” explains Kevin Doody, a Dallas reproductive endocrinologist who’s led studies on the device, called INVOcell, which was approved by the U.S. Food and Drug Administration in 2015. “It’s not going to come out.”

It’s a concept designed to appeal to patients who prefer a less tech-heavy approach to scientific baby-making. That could include Catholics who’ve rejected traditional in-vitro fertilization (IVF) treatment because it facilitates conception outside the body.

But INVOcell could be a game-changer for the $2 billion assisted reproductive technology market. The protocol calls for fewer eggs (and less hormonal medication) than traditional IVF, and only requires about one-third as many office visits. The vaginal incubator also costs one-third to half the price of regular IVF treatment.

That’s no small matter for the estimated 1 in 8 couples in the United States who have trouble getting pregnant or carrying a baby to term—three-fourths of whom don’t receive the care they need because they can’t afford it, according to the American Society for Reproductive Medicine. Although the average price range of regular IVF is quoted as between $10,000 and $15,000, the real-life costs are closer to $20,000 by the time medications, sperm injection, and genetic testing services are factored in, according to data from 3,200 IVF patients that was analyzed by the fertility doctor review site FertilityIQ for the personal finance website NerdWallet.

Insurance coverage for traditional IVF is sparse: About 26 percent of workplaces offer infertility benefits, according to the Society for Human Resource Management. Just 15 states mandate that employers provide any kind of infertility coverage, and only eight states require that to include IVF treatment. (Insurers have yet to start paying for INVOcell.) As a result, many patients blow through their savings, load up their credit cards—one survey of more than 200 women who’d gone through IVF found that 44 percent racked up at least $10,000 in debt—or beg for financial help on crowdfunding sites. More than 8,500 GoFundMe campaigns created to raise money for fertility treatments have collected $13.5 million in the last six years, according to figures provided by the company.

By contrast, INVOcell, which is manufactured by INVO Bioscience in Medford, Mass., costs about $6,800, including medication. “We can pay for this without going into debt,” says Katie Whited, 28, a nurse from Durham, N.C., who’s tried nearly every fertility treatment short of IVF, including ovulation induction drugs with timed intercourse, acupuncture, and intrauterine insemination in which a doctor injects sperm directly into a patient’s uterus. “We wouldn’t have been able to find $18,000 for IVF.”

Early numbers are promising: One randomized clinical trial of 40 women under 38 found no significant difference in success rates between traditional IVF and INVOcell. Although IVF produced more quality embryos overall, the birth rates were similar: Of the 20 women undergoing IVF, 12 got pregnant and delivered 15 babies, including three sets of twins. In the INVOcell group, 11 of 20 women gave birth to 16 babies, including five sets of twins.

“I see so many patients who can’t have kids because they can’t afford IVF. We’ve got to do better. It’s a matter of medical ethics,” says Doody, who has trained a couple dozen doctors on using the vaginal incubator for INVO Bioscience. “Now a greater number of people will be able to access care, and it’s going to open up the market.”

According to Doody, doctors who offer INVOcell can cut the number of office visits for one round of treatment from eight (for traditional IVF) to two or three, which is a big deal for patients in underserved areas, especially in the southeastern and southwestern United States, who often must drive several hours to reach fertility clinics. That means there’s less work for staff who administer blood draws and ultrasounds and play phone tag with patients with updates after each visit. “Patients take less medication, and we’ve gotten better at dosing and predicting how they will respond so we can do less monitoring,” says Doody, who is also the president of the Society for Assisted Reproductive Technology, the organization that reports fertility clinics’ data to the government. “We’re not trying to get 10 to 15 eggs like with regular IVF. We just need six to eight eggs to get one or two good embryos to transfer.” His rationale: More eggs aren’t always better, and doctors should aim for a handful of quality eggs, rather than the larger quantity typically generated during regular IVF.

And because the embryos are grown in the mother’s body, there’s no need for lab staff to run costly incubators with extensive security systems around the clock, which also brings down the price.

The fact that INVOcell preserves some of the mystery of baby-making was a big selling point for Brittney Koch-Dowell, since she and her wife are depending on help from science to conceive. (They each plan to take a turn carrying a baby.) “We’re already using donor sperm, so this helped it feel more real and natural,” says Koch-Dowell, 37, a restaurant manager from Elsberry, Mo., who’s scheduled to undergo the procedure this month. “I get to be the incubator. My body and my heat are producing the child.”

* * *

In some ways, the rationale behind INVOcell sounds so obvious. (“It’s like what’s old is new again,” quipped John Couvaras, a fertility doctor in Phoenix who’s helped four women conceive with the device.) Yet it took French embryologist Claude Ranoux nearly 30 years to fine-tune his invention, which has been available in Europe since 2008. Since the birth of the first “test-tube baby” in 1978, Ranoux had been fascinated by the idea of growing embryos inside the human body rather than in a petri dish. And he wasn’t impressed with the unreliable incubator at his workplace, the Cochin Hospital at Paris Descartes University. “I was forced to be an innovator because I had a bad machine,” says Ranoux.

So Ranoux rigged up a little portable incubator from plastic tubing. At first, he considered sewing it under the abdominal skin, but that would require two surgeries to implant and extract the device and risked causing an infection. Taping it under an armpit would provide a nice warm place, but he thought it would feel too uncomfortable over several days. He also considered securing it in the back of a patient’s mouth, but he didn’t want to risk shocking the embryos if she drank cold water or hot coffee. Besides, there was the chance she could accidentally swallow it.

Next he considered having a patient swallow the capsule and letting the embryos grow over the two to three days it would take the device to wind its way through the digestive tract. But he feared the intestinal environment would be too toxic. “Also, it would be a nightmare for the embryologist to retrieve the device later,” he says.

He came to the most logical place last. “I didn’t think about it initially because I worried the capsule could lead to infections or irritate the cervix and interfere with embryo transfers,” he says. Those concerns were unfounded; instead, he found that the vagina provided the best consistent temperature, pH, and oxygen balance and enabled easy insertion and removal of a device. He also believed that embryos would benefit from the slight temperature variations that women undergo throughout the day, which embryos that are created during natural conception experience as they grow in the uterus.

Although INVOcell is designed to stay in the vaginal canal on its own, doctors have the option of adding a diaphragm net to catch it, just in case. If it somehow works its way out completely, patients are advised to wash it off and push it back up.

* * *

In the meantime, patients still have to get used to the idea.

Anne Swart, 38, of Berkeley, California says she and her husband decided against using INVOcell to help them conceive their second child after enduring two miscarriages, even if it meant paying close to $25,000 out of pocket for IVF, including sperm injection and genetic testing. “It hasn’t been around in the U.S. for a long time and just felt risker,” she says. “We didn’t want to go through more heartbreak. We just wanted to do everything to give us the best chance.”

The main challenge with marketing INVOcell is that it’s recommended mostly for younger women with uncomplicated fertility issues and partners with normal sperm counts, says Fady Sharara, a fertility doctor from Reston, Va., who’s only treated one patient with INVOcell after advertising it for a year. “My patients are older, and they want to get the maximum amount of eggs with IVF, so they can do genetic testing to make sure they have a normal embryo to transfer,” he says. “They have a small pot of money. They say, ‘I can’t afford to try INVOcell and then IVF later.’”

The lab also provides important feedback on growing embryos that’s impossible with INVOcell’s “in the dark” approach, adds Michael Tucker, the director of IVF and embryology labs at Shady Grove Fertility, the largest fertility center in the U.S. He argues that modern lab technology, including time-lapse imaging of developing embryos, helps embryologists pick the best ones to transfer to the uterus. “The idea of INVOcell is clever, but in a diagnostic sense, you lose so much,” he says. “You have no idea what’s happening inside the body. You don’t know if fertilization was normal. There’s something to be said [for] following the entire process.”

It’s also unknown whether mainstream fertility medicine is ready to embrace an IVF alternative that might cut into clinic bottom lines. “When clinics don’t offer lab services, they strip out a major profit center,” says Jake Anderson-Bialis, co-founder of FertilityIQ.

Yet most clinics can afford to add INVOcell to their menu of treatment options, says Richard Paulson, a reproductive endocrinologist at University of Southern California Fertility and president of the American Society for Reproductive Medicine. “We have a very expensive heavy-handed approach to IVF in the U. S. There’s definitely room to bring the cost down,” says Paulson, who wrote a paper on ways to broaden access to reproductive care, such as offering minimal stimulation of eggs, retrieving immature eggs or embracing vaginal incubation, like INVOcell’s device. He says the pressure to report the best clinic pregnancy rates to attract patients has caused doctors to shy away from trying more cost-effective alternatives that have smaller chances of success.

The acceptance of INVOcell could make doctors more open to other innovative technologies that might bring down the cost of fertility medicine, adds Alan Penzias, a fertility doctor at Boston IVF and a professor at Harvard Medical School. Other inventions in the works include a portable ultrasound that IVF patients could use with their electronic tablets, a spit test to measure hormone levels that would replace blood draws, and an at-home semen analysis test that uses a smartphone app.

Or doctors could use INVOcell to extend the reach of clinics to underserved areas. “I might be able to put some equipment in a van and set up a temporary shop in a hospital a few times a year,” suggests Penzias. “It could provide another outlet to expand access to fertility care.”

So could a Catholic endorsement. The Vatican has long opposed IVF on the grounds that it enables creating babies outside the bounds of marital intercourse. “The rule of thumb is that you can assist reproduction but not replace reproduction,” explains Father Kevin FitzGerald, an oncologist who specializes in Catholic health-care ethics at Georgetown University. So reproductive scientists have tried to find creative solutions, such as a procedure invented in the late 1980s called gamete intrafallopian transfer (GIFT) involving shooting a mixture of sperm and egg directly into the fallopian tubes through a catheter. But multiple births were common with that procedure, and doctors eventually stopped using it as IVF success rates improved.

While the Church has yet to issue an opinion on INVOcell, experts say it’s a potentially Catholic-friendly alternative to traditional IVF because the device technically helps fertilization occur inside the body. By the time doctors insert the incubator containing the egg and sperm soup inside the vagina—about 15 to 30 minutes following egg retrieval—the sperm have just started to attach to the eggs’ outer layer and haven’t yet started to burrow inside. It takes at least 18 hours for the chromosomes to join together and fertilization to finish.

“INVOcell is a move in the right direction to a more natural assisted method,” explains FitzGerald. His ideas for making it even more acceptable to Catholics: Collecting the sperm during sex in a condom, rather than asking men to masturbate into a cup in a fertility clinic closet. It would also help if doctors only inserted the number of eggs they estimated might turn into embryos. “You must use what’s fertilized so you don’t discard embryos and destroy human life,” he says.

What’s appealing for some Catholic patients of Julie Rhee, a fertility doctor in St. Louis, is that INVOcell eliminates the role of the embryologist tinkering with sperm. “The part that makes them feel comfortable is that you’re not determining which sperm will be injected inside the egg or whether fertilization will even happen at all,” says Rhee, who just started offering the vaginal incubator in May and has 10 patients lined up for treatment.

Ranoux, the founder of INVO Bioscience, didn’t set out to appease the Vatican at first, yet he’s found a way to accommodate his Catholic patients. In addition to collecting the semen in a condom (there’s a special coitus room at his clinics), Ranoux also pricks the bottom of the condom, to leave open the possibility of a natural conception.

But still, unlike GIFT, which enabled embryos to travel to the womb on their own, INVOcell requires a doctor to take the embryos out of the device and manually insert them into the uterus. That interference in the baby-making process—plus the act of selecting embryos and potentially freezing the extras, which could later be destroyed—makes a Catholic endorsement less likely. “You’re interrupting the natural chain of events,” says Daniel Sulmasy, who studies clinical bioethics at Georgetown University.

What could be acceptable, he argues, is if someone invents an incubator that is placed directly in the uterus, and then dissolves. But it’s a tricky timing gamble. The device would have to self-destruct at the exact moment the embryos have developed and were capable of attaching to the uterine lining. Still, it might not be impossible. “I have some ideas,” says Ranoux.

Article source here:The Atlantic