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By guest columnist Dr. Karen Wasserstein

What to do with another New Year? Being Jewish, I celebrate two New Years. Is it lucky to have two New Years or is it unlucky?

My family and I fully celebrate Rosh Hashanah as the Jewish New Year. We spend the month ahead of time talking about it, shopping and cooking for it, wishing everyone we see a Happy New Year. We greet each other with hopes for a year of growth, prosperity and blessing and readily accept those blessings in return. We wish each other a Shana Tova Umtukah, that we should have a sweet new year.

And then, about three and a half months later, as January rolls around, we bring in the New Year — again. We wind down the previous year and watch retrospectives on tv of the year in review. We watch as father time becomes an old man (with a sash with last year’s date) and turns into a newborn (with a sash with the new year date). We watch a ball drop in Times Square, get together with friends, wish each other a “Happy New Year!” and hope for a new year of promise, of potential and of hope for all of our dreams.

What both New Years have in common is a looking back on the last year and a look forward into the New Year. How was the last year? Did our dreams and hopes get fulfilled? Did we have a year of health? Of growth? How did our relationships weather last year and are they ready for the next one?

When one is facing fertility challenges, the New Year can powerfully remind us of all that has happened in the last year– and all that has not happened. Has another week, month, year gone by where there was no pregnancy? Was there loss? How many New Years will I face without knowing what my family will look like? How am I (or we) weathering this time? Am I ready to start another New Year plowing ahead on my fertility journey? This is when having two New Years can feel difficult, not so lucky. Another year gone by without having the family I am dreaming of and working so hard to build.

But on the other hand, maybe I have hope, even cautious hope. Maybe as I can turn the page, the last year which had its share of pain and disappointment can come to completion, and I can move into the next year with the potential for more, even as I know that I have no answers and no guarantees. I can take the lessons of last year as I move ahead. Maybe my partner and I have learned how to cope together in a way that we had not had a year ago. Maybe I have developed a network of others, or I attend a support group where I feel held up and able to face another day. This is when having two New Years can feel lucky; two opportunities to turn the page, to start again.

Every year builds on the one before. We are ever changed by the past and still try to live in the present. Overall, new beginnings are important. Some years, I would like to find even more New Years to celebrate– to help me pause and take a breath as I start a new beginning. But for now, I’ll stick with the two I’ve got.

A Happy New Year to all — may it bring you growth and fulfillment in all areas of your life.

Dr. Karen Wasserstein is a psychologist in Maryland and Virginia specializing in the area of fertility and family building. She can be reached at drkwasserstein@gmail.com

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This column originally appeared in The Jewish News of Northern California , November 12, 2019

 

Several months ago, I was asked to speak at an event for Hasidah, a Berkeley-based nonprofit that “raises awareness of infertility, connects people to support resources and reduces financial barriers to [fertility] treatment in the Jewish community,” according to its website.

I so wish my family had known about this agency’s work when we were struggling with these issues.

I care about helping build Jewish families. So many of us take for granted that when we are ready to build a family and have a child, it will happen. I know from my own family’s experience that it doesn’t always work so easily, or economically.

Topics such as infertility were rarely spoken about until recently.

Growing up, I knew our past generations had hard times, but my life and the future seemed simple. College, career, get married, have kids, be a mom, then a grandmother.

Fast forward. It was not so easy.

Seeing one’s children struggle with their health or struggle to create a family — it was not easy at all.

One of my daughter’s struggles began in high school with severe abdominal pain. Today we see commercials on TV about endometriosis, but 20 years ago I had never even heard the word. Many years went by — years of tests and surgeries and different doctors — with no diagnosis. Finally, one doctor was able to give her an experimental drug that took away her fertility for five years (ages 20 to 25) with the hope that it would just “pop back.”

Through all those appointments, shots and bone-density scans, the fear of “what if fertility doesn’t come back” was always looming, And there was no place to talk about it. Yes, her fertility returned, as UCSF had hoped, and she and her husband went on to have a family.

Then my other daughter married and learned she had issues getting pregnant. With her wonderful husband’s firm support, they tried many options, talked over all the possibilities, the what-ifs.

One day a friend of hers who knew the situation asked me, “How are you?” Seeing the dark cloud hanging over me and being a mental-health professional, she shared that the dark feeling isn’t just over the couple but over the whole family.

My husband and I were in a dark place, but we came to understand this was our daughter’s journey, and we were there to support her.

We tried not to show our pain to her when treatments failed and as she felt more and more isolated. Through many very expensive processes, a woman’s enormous generosity and modern technological miracles, we were granted two more beautiful grandchildren.

Every day we thank HaShem for those beautiful children.

I began to see how so many others could use this kind of support.

My daughters were fortunate that our family could help them financially. Not everyone is in a position to afford fertility treatment or to help their own children. There hasn’t been anything in the community to help.

I have since become involved with Hasidah, which provides “financial, spiritual and emotional support for people experiencing infertility or fertility challenges, and build[s] awareness about fertility,” according to its listing in the 2018 Slingshot Guide of outstanding Jewish organizations. Hasidah, which means “stork” in Hebrew, was founded in 2012 by Rabbi Idit Solomon.

Hasidah.org is packed with information, such as the average out-of-pocket cost for one in vitro fertilization treatment being $24,000, with a $61,000 total for “a successful outcome from IVF.”

People need so much support when they are facing infertility, which is why it was so important for me to step up and help. Not only for my own family, but I could help others overcome their fertility struggles, too.

It was imperative for me to help each of my daughters become a mother.  It is imperative upon all of us as a community to help others who are facing infertility and other family building challenges.

We need to replenish those lost during my parent’s generation. We need to support the mitzvah of being fruitful and multiplying. And it is the Jewish way to help others in need.

Jewish children are the future of the Jewish community. I have endless joy from each of my grandchildren. I hope our community can prioritize this issue for our sake, and for our future.

 

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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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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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#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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