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A recent news piece from ABC news highlighted a study that found “When men smoke marijuana once a week or more, their partners are twice as likely to experience a miscarriage when pregnant, according to Boston University researchers who examined over 1,400 couples before they got pregnant”

The study is not final because it was not able to show causation and did not have peer review. However, “The research comes just days after researchers in China released a study that found a father’s alcohol intake may actually affect a future child more than a mother’s intake.”
More studies please.
Here are some real takeaways to consider:
1) Let the research play out if you really need hard evidence to be convinced.
2) If you are willing to considering common sense, weed and alcohol may not be best when trying to conceive. So lay off.
3) MEN! Yes, most of the blame and focus falls on women when the conceiving is not happening. Seems we might be overlooking half of the equation. This is showing that miscarriage rates may possible be quite influenced by male health. 

 

Men: take notice!

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Facing Tefillah, Community, and Family as a Couple Struggling with Fertility

Rosh Hashanah and Yom Kippur. It is a time of reflection, a time of spirituality. For many people, tefillah, community and family feel like a warm embrace. To others, such as those experiencing infertility, these can feel more like a straight jacket.

I always ask my patients about their religious affiliation. Religion can be a tremendous comfort when someone is in pain, but it can also be a stressor. During the chaggim, it can be both to the couple experiencing infertility. If you are in this position, please try to understand how you feel, what you think the experience will be like for you this year and discuss with your spouse some strategies to assist you during this time of year.

First, let us set the scene: The davening during the High Holy Days has many images and themes. It discusses G-d as King; a G-d who is slow to anger, full of mercy and compassion. But it also speaks of a G-d who is deciding, “Who will live, and who will die…who will be born and who will perish.” The language used in our prayers can evoke strong feelings.

Communities spend more time together in shul at this time of year than at any other time. But with packed shuls, and often assigned seats, the couple experiencing a difficult personal time often feels crowded and overwhelmed. Young children and pregnant women seem to be everywhere, parents revel in bringing young children in for shofar blowing, and babies are passed from relative to relative. All of this can serve as powerful emotional triggers.

Lastly, family gatherings are often part of the yom tov season. Some families are very sensitive to members who are struggling with infertility, and some are not. Some couples have shared their fertility struggles with their families, and some have not. Intrusive questions, whether well-meaning or not, can ruin a holiday for a couple. The same can be said when families seem to only focus on children and not on the adults at the gathering. Many clients of mine have related how they feel that their parents “only care about the grandchildren,” and so even though they are expected to attend, it does not seem as though they are important as well.

What are some suggestions for the couple who is struggling with infertility to get the most out of the holiday experience and minimize painful experiences?

Family:

  1. Talk with your spouse about how much to disclose to family members. Decide what you will share and what you will not share BEFORE you are with the family.
  2.  Remember there is an inverse relationship between privacy and support. The more privacy you have, the less support you may receive. Decide together where the line is with each family member. If you both feel someone will be a big support to you, consider sharing with them your experiences.
  3. In these pre-chaggimdiscussions with your spouse, be honest about family members with each other. Not every family member is the same. If one of you does not feel comfortable sharing with someone, respect each other’s feelings.
  4. If you are with family that can be intrusive, come up with some phrases that you can repeat throughout the holiday. “Thank you for asking. We have decided to keep that private for now.” “We will let you know when there is something to know but have decided to keep the details of treatment to ourselves.” “Thank you for caring, but it’s not something I am comfortable talking about right now.”
  5. Know your limits. Create a signal between you and your spouse so that when you have reached your fill, you can take a break and leave the environment. You can take a walk, read a book or separate yourself in another room.
  6. Discuss with your spouse where you want to spend yom tov. What do you need as a couple now? What do you want to do for the chaggim THIS year. It does not have to be a permanent plan.
  7. Try to make sure that you cope together. Couples struggling with fertility are generally newer couples, couples who are still finding their way in each other’s extended families. Make sure you turn towards each other, not away.

Shul:

  1. Distractions: For some people, it is hard to concentrate, to have kavanah, when they have little children or a pregnant person in their line of sight. You can often move to the wall and stand and have some private time to daven off to the side.
  2. Change of minyan: There are times that you are better off in a different environment. Some minyanim seem to be more “family-oriented”; this may not be the minyan you chose to go to this year.
  3. Plan ahead: Know yourself. If you do not want to stand “catching up” with everyone after tefillah, make a plan with your spouse or another family member or by yourself to leave as soon as services are over. If you plan it ahead of time, it can reduce the anxiety through shulthat you will have to make small talk, and if others know you are leaving right away, it reduces the need to find them and tell them where you are going. Make a plan that “We will meet at home.”

Machzor:

  1. Take some time in this month of Elul to look through the tefillot. Even though it is familiar to you, you may be in a different place emotionally and spiritually this year; spending some time with the machzor ahead of time can help reduce the emotions of the words that poke at your wounds.
  2. Try to find the images and the words that bring comfort to you, words that help you relate to this experience so that they will stand out when you are saying them in shul. For example, is the image of “G-d as King” or “G-d as a caring Father” more helpful to you this year such that you want to make sure you focus on the verses that contain that image? You can use sticky note flags or mark those passages so that they envelop you during services.
  3. Spend some time with the more challenging images ahead of yomtov. What do they mean to you? How can you relate to them this year? How do they contribute to your relationship with G-d, and how do you talk to G-d about that? The conversation with G-d can begin at home, in a quiet room, just you and a machzor, and can continue through yom tov. While Rosh Hashanah is a two-day holiday, and Tishrei is a month-long, ideally we are in a lifelong conversation and relationship with G-d.
  4. Consider your resources: Some of the words and images may be difficult. Images of “barrenness” and of judgement are particularly jarring. If you have a relationship with a religious leader or current or former teacher, consider meeting together privately beforehand to discuss it if you think this can help.

Overall, you will have your own strategies and methods for coping with the holidays. Be thoughtful about who you and your spouse are, and what strategies work well for you and what does not. Know your limits and what you can change and what you cannot. Most of all, in the spirit of Yom Kippur and forgiveness, forgive yourself. Forgive yourself for having complicated emotions and sensitivities. Be kind to yourself and take care of yourself, as an individual and as a couple.

Shana Tova Umtuka

By Karen Wasserstein

Dr. Karen Wasserstein is a psychologist in Maryland and Virginia with a specialty in working with those facing fertility challenges. She can be reached at drkwasserstein@gmail.com. This article was written as part of the Just for You: PuahCare Article Series. Because your fertility journey is so much more than a medical experience

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In the US, we pride ourselves on the American dream of working hard and earning based on our merit. Our economy today, however, shows that many people who work hard are earning less and are not as well off as their parents. Truth be told, the real old fashioned way of earning money still works – inherit it. In addition to younger generations earning less, another difference that is becoming more evident is when having babies the old fashioned way doesn’t work either.  People are now turning to their parents to pay for infertility treatment.

The Future Grandparents Club

In vitro fertilization (IVF), which now accounts for a percentage of births in the US, is becoming more common. However, its affordability is not. The average out of pocket expenses for a round of IVF exceeds $24,000 and the average spent on treatment over all exceeds $60,000. So where are people turning to get this kind of cash to fund their IVF? Hopeful grandparents. 

One of the remaining stigmas of infertility is that it is mostly older wealthier women who are likely to have infertility treatment. However,  at least half of the women seeking IVF are under 35. Infertility has many causes. Hasidah has had clients facing PCOS (Polycystic Ovarian Syndrome), premature ovarian failure (at age 27), genetic diseases, cancer, recurrent pregnancy loss, and one of the most frustrating situations, unexplained infertility. Infertility affects young and more mature, rich and poor alike.

What’s A Parent to Do?

Hopeful grandparents seem motivated regardless of the situation. When it is a late bloomer, they want to help. When the couple is young or maybe doesn’t have any savings yet, the future grandparents are often there. One hopeful grandparent called Hasidah for help because she had already dipped into her retirement savings to help her daughter and still wanted to find additional ways to help. Not all parents have the financial capacity to help their children, and not all children are comfortable or able to turn to their parents. However, the vast majority of people Hasidah has seen that have spoken to their parents get some funding from them. When it is their own child looking for help to have the same blessing of having a child, it is a pretty sensitive heart string to pull.

To be sure, funding from grandparents has it draw backs. It is complicated to have financial ties to family members and IVF has no guarantee. However, one thing is for sure. More and more grandparents are going to have earned their title the new old fashioned way. They will have paid for it. 

Check out this article in Fast Company for more about IVF funding from grandparents featuring Rabbi Idit Solomon.

 

 

 

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Doctors and health care providers are not to blame for an “infertility industrial complex” and patients are not baby crazed. Wanting to provide people with medical care that will help them have a baby is a noble profession and wanting to be a parent is really deep desire. There are exceptions, but or every doctor who may take advantage of a patient who didn’t do their research, there are scores of doctors feeling tied up trying not to raise false hopes. And for every patient that is beyond their boundaries trying anything and everything, there are many more trying to be reasonable during an incredibly stressful and painful time.  The truth is that we are all vulnerable.
 
A recent article from the UK discussed the delicate balance attempted in the wellness industry that doesn’t always respect that vulnerability.  It can be quite easy to take advantage of people who want to improve their chances for having a baby and are willing to try  something that seems to be a viable option. In reality so much of the “wellness care” is stress reduction, which is legit, but not baby producing. A lot of add on’s in clinics just control for various factors, but may not increase chances of having a baby. Some treatments or “wellness care” may help certain conditions, but it isn’t necessarily a condition that you have.
 
So hold tight to your candy while focusing on having your own baby. Respect your own boundaries and vulnerabilities. Ask questions. Use your heart and your head.  Take care of yourself by keeping your body, soul, heart and mind in balance as best you can.
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#IVFContests #IVFAwareness #BuildJewish Families

Another group held a video conference for a free IVF. This was a new twist however, because the host of the contest was a radio station in Utah. The ends of the contest – the chance for someone without the financial means to be able to receive treatment that may lead to having a baby – is a wonderful goal. An important question is if those ends justify the means.

Unlike most coverage of these contests, a recent article reporting about this contest shared both sides of this story. The pro’s include building awareness about infertility, the emotional and financial costs that it takes, and providing someone with treatment. It may also help people speak out and get support they may not have otherwise received.

The con’s are another story.  “Asking couples to create a video for a radio station about raw, difficult experiences can feel like making entertainment out of someone’s misery” said one contributor to the story. Another shared that the contest is, “ a very offhand or casual way to deal with something that we generally view as being a more serious issue.” Indeed.

The public votes on the videos submitted by the finalist for the radio station contest. Imagine you are applying for this and were told you were a finalist. Do you make your story the saddest? Do you show yourself as the most hopeful? The most desperate? Do you need good production values? Do you have others speak for you? Should you be funny? How do you get people to vote for your video? Whatever the criteria for earning IVF treatment, it seems as much a reflection of how to use publicity to show yourself as deserving treatment.  And that is a problem. Someone deserves treatment more than others? Someone’s story is more compelling? Or is it a popularity contest with extremely high stakes? None of the answers are good.

Another con is that these contests overshadow an underlying issue of why the treatment is not funded in the first place. The insurance industry is not taking on this issue and the idea that it is expensive is not a legitimate answer. Cancer treatment is not cheap. Neither is a mastectomy, cataract surgery, diabetes treatment or treatments for accidents and traumas. We ought to be asking more challenging questions about why treatment for infertility like IVF is not available and affordable.

For Hasidah, these issues are not taken lightly. The medical appropriateness, financial need, and personal information are taken seriously to ensure the best possibility of building a Jewish family. Hasidah grant applicants take a significant amount of time and effort to apply which often is not rewarded with funding. We try to honor that with continual efforts to build awareness, to treat our clients with the utmost respect and not make a spectacle of their experiences.

If there was a contest to be held, perhaps it ought to be finding the most effective strategy for making IVF affordable and making insurance coverage for it part of standard health insurance. That would be the mother of all contests.

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Does your income potentially affect the chances that you will access treatment for infertility. In an already much cited article, the answer was a resounding yes. Education plays a role too. People with a college degree are more than twice as likely (11.6 vs 5) to access fertility treatment with those who do not have a high school diploma.

The infertilty sword cuts both ways because those with less education are likely to earn less and be able to afford less and therefore be less likely to seek treatment. And while this recent study does not tie education to infertility, research has shown that people with higher levels of education are more likely to have children later and therefore have higher rates of infertility. Basically, we can’t get around it.

One thing this study of treatment access cannot account for is who is seeking the treatment and the effects of not getting treatment. In other words – the reality that some people really want to have a child and want to pursue treatment vs others who may not feel as strongly about having  child. For Jews, being part of a pro-natal and family oriented community can increase pressure and isolation that infertility causes and make the desire to seek treatment higher.

At Hasidah, we know well the variety of ways in which one can experience infertility – from genetic diseases, to cancer, to age, to low ovarian reserves or sperm, to unexplained infertility. The people seeking help from Hasidah have earned from $25,000 to over $350,000. They are married, single, LGBT, older, younger, teachers, singers, lawyers and doctors. They all want to have a Jewish family.

The study shows for sure that the infertility rate is 12.5%. That’s about 1 in 8. That number only increases with age and body mass index. And Jews are no exception.

Infertility is not likely to change, but our response to it can.
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According to the internet, just about everything effects fertility. This nut hurts your fertility, this fruit boosts your fertility.  Give your reproductive system some credit. It’s yours and yours alone and it is much more complex than that. However, there is something to be said about what we eat and our general health and its affects on our reproductive system. Check out this guest post by Dr. Laurence Jacobs for some  good health = good reproduction advice.

Decreasing Your Consumption of Processed Foods 

Everyone is busy these days, and our waistlines are suffering for it. The American diet relies heavily on processed foods, and this is not healthy and can decrease fertility.
A recent National Institutes of Health study found that eating processed foods may actually encourage people to overeat. The offending foods are not only the empty- calorie, starchy, high carbohydrate foods that are obviously processed, such as potato chips. Some foods that are considered ultra-processed, such as yogurt with added fruit, might surprise you.
 
The Study
NIH scientists looked at 10 healthy men and 10 healthy women who were of stable weight. They randomly assigned the study participants to one of two diets that were matched for calories, sugars, fiber, fat, and carbohydrates.
One group was fed an unprocessed diet, such as a lunch of spinach salad with chicken breast, apple slices, sunflower seeds and grapes. The other group received an ultra-processed diet, such as a lunch of Chef Boyardee beef ravioli, parmesan cheese, white bread, and diet lemonade. Participants could eat as much or as little as they wanted.
The researchers found that the people on the ultra-processed diet ate more carbs and fat. People on the ultra-processed diet also ate much faster, and ultimately they ate an average of 508 calories more per day and ended up gaining an average of 2 pounds over a two-week period. The people on the unprocessed diet lost about 2 pounds on average over the two-week period.
Processed Foods and Fertility
The NIH’s small, controlled study links the consumption of processed foods to weight gain, and we know that being an unhealthy weight can negatively affect fertility. Being overweight can cause hormonal imbalances and problems with ovulation, and obesity is also associated with  Polycystic Ovarian Syndrome, a common cause of infertility.
In addition, other studies have linked the consumption of processed foods to lengthening the time it takes to get pregnant. One study found that women who ate fast food, such as burgers, fried chicken, pizza and chips, four or more times a week became pregnant, on average, a month after women who never ate fast food.
What Is Considered Ultra-Processed Food?
The NIH study categorized foods by the NOVA classification system, which considers foods “ultra-processed” if they have ingredients predominantly found in industrial food manufacturing, such as hydrogenated oils, high-fructose corn syrup, flavoring agents, and emulsifiers.
These foods go through multiple processes, such as extrusion, molding, milling, etc. They are highly manipulated, and they may contain many added ingredients. Soft drinks, sweetened breakfast cereals, packaged soups, chicken nuggets, hotdogs, fries and more fall into this category. Other foods that can fall into this category include jarred sauces, frozen sausages, and other reconstituted meat products.
Weight loss of as little as 5 to 10 percent can increase your fertility and your overall health. Summer is a great time to change your eating habits and consume a healthy diet with minimal amounts of processed food. To eat more healthfully, read the food labels when grocery shopping. Buy only foods that have fewer ingredients, as well as ingredient names that you understand. Visit local farmers markets to choose fresh fruits and produce to increase your intake of important nutrients, and stick to shopping the sides of a grocery store. Avoid the middle aisles, which are generally filled with boxes and bags of unhealthy foods.
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It’s a great day to introduce new political platforms.  One area particularly open to change is support for building families. Today one candidate said that tax credits for adoption and insurance coverage for fertilty treatment like IVF would be instituted in her first 100 days. According to Politico, no Democratic candidate is currently opposing any of these suggestions which also includes pre-K childcare.

Not opposing is not the same as endorsing. It is a beautiful and silent way of squashing legislation – just don’t endorse it. Since the primary races are starting early, this means we can start speaking up early and often to make this a platform for all candidates. And regardless of what side of the isle you are sitting on, this opens up the conversation about reproductive healthcare in a new way. Reproductive care is healthcare. Reproductive justice includes support for having a child. The biggest barriers to parenthood are financial and they include a lack of financial support for family building and the expenses of childcare for working families.

We can make this happen. The first step is to get the issue on the table. So keep talking!

 

 

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The debate about questions and their stupidity is on-going. Dumb is subjective. Thoughtless or insensitive is a little more precise. Questions about people’s family planning are often in that category. In the Jewish tradition, the Talmud guides a lot of our behavior and provides guidelines for prioritizing situations. However,  Rav Abby, sister of Rabbi Landers, who might have been a cousin of Rabbi Manners have words of wisdom on this topic too.  They had a consistent approach which almost always applied to these questions: you are not required to answer someone else’s question.

How do I answer when someone (fill in the blank question that reflects someone else’s curiosity or possible good intentions but is a raging trigger for you and you are just trying to get your copies made already!)? Or even from a friend, how do I respond when (fill in the blank question that you have no intention whatsoever of answering at that moment regardless of your relationship to the person asking).

A recent NYTimes Social Q’s answer summed it up beautifully. Their fill-in-the-blank-question was a curious friend who wanted to know whose fault was causing the infertility for a couple (!?!). “Rather than bringing a useful talk to a screeching halt because of one dumb question, how about redirecting it (“That’s not what I was talking about”) or brushing it off (“Oh, that doesn’t matter”) and returning to the valuable part of the discussion?”  Besides that this does bring us back to the issue of “dumb questions” (there are two sides to that debate), they further point out that sometimes you are entitled to end a conversation and make others squirm. This is accomplished by one of my favorite responses, and tone is everything in this one, “Why do you ask?” That could be stated with chin downward looking out of the tops of your eyes, or with lips pursed and an icy tone, or a head tilt and furrowed brow and a dramatic forefinger and thumb around the chin for effect. All of these squarely place the issue into the hands of the person asking the question – to whom attention ought to be directed – rather than on you or your partner’s reproductive organs and private life.

The first attempts to redirect or brush off, however, are useful when we know or are hopeful that the other person really does have good intentions or is a good friend and just fumbled the attempt to open a conversation. As noted above, this is still accomplished without answering the question.

So here is your mantra. Repeat after me: “I am not required to answer someone else’s questions.”

And here are your multiple choice stock answers to keep at the ready:

a) “That’s not what I was talking about”

b) “Oh, that doesn’t matter”

c) “Why do you ask?”

d) “Interesting that you ask. What’s really on my mind is…” (To talk about it or to change the subject)

d) “That reminds me, I have always wanted to ask you and I know it’s not really any of my business… ” Silence. Blank stare. (Okay. Maybe not, but I’ve always wanted to do that).

Happy not answering!

 

 

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