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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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Take the one with the best benefits. My dad gave me that advice when I was faced with the enviable position of choosing which job to accept after college. The advice struck me because it was not on my radar at all. It didn’t influence me much at the time, but it did in the long run. Benefits like health insurance, savings plans, and retirement plans become more important every year of our lives. Lately baby benefits are making news. They come with good intentions to be sure, but they are a privilege nonetheless.

Baby benefits are a growing trend in large corporations and provide various financial incentives, insurance, and other accommodations for family building. Young women are already  looking at jobs considering when they plan to have children. More often it is with the idea that they will postpone having a family until they feel they are established. So why not take the job that helps ensure you can have a baby whenever you want?

That sounds wonderful. What an amazing corporate citizen to help women in the work place, to support family building for men and women,  and to be family focused as an organization. However, what message is this sending to people who don’t have those jobs and benefits?  That’s most of us.

At a recent conference, one of the brainstorming topics was the growth of entrepreneurial endeavors that help companies provide fertility benefits to their employees. Hurray. It is about time that someone realized the connection between women, families, the workplace, and the need for full reproductive and family care. However, woe is us that we keep weaving family building into the fabric of business and not part of our culture. These endeavors are replacing the insurance industry – just as fertility clinics operate outside of most hospitals – because our culture has not made reproduction a part of any social policy. To be clear, outside of birth control, family building it is not part of insurance legislation, employment legislation, or conversations about inclusion and equity. The baby benefit is a business response to a social issue that isn’t being addressed otherwise.

Thank you to these innovative leaders who are responding to a need. Thank you also to the companies who see that supporting families benefits the bottom line and their employees.  That is perhaps a move towards social responsibility.  A healthy doubt about the insurance industry’s ability to navigate fertility or our government’s ability to legislate family friendly policies is warranted. But can we also ensure this does not create a have vs have not culture for baby benefits? Can we make sure this approach doesn’t effectively privatize fertility insurance? Can we consider the effects on small business and just about everyone else? What about the attempts to change the system and make healthcare include proper reproductive care? We cannot ignore the larger need for family planning and support.

Perhaps the introduction of business backed #BabyBenefits can be the beginning of a change in our social policy. People certainly will want to work at companies that offer good benefits. But the real success comes with #BabyBenefitsForAll.

 

 

 

 

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Some things are just human and it doesn’t seem to matter much where you live. Facing challenges to building a family might be one of them.  A recent survey in England got the following stats from people struggling to become parents.

  • 90% say infertility feels like a trauma.
  • 94% don’t think their friends, family or colleagues really understand what they are going through
  • 55% feel hopeless and like a failure
  • 68% believe other people think less of them because they do not have a child.
  • 54% feel annoyed by other people’s comments
  • 37% feeling angered by what others say
Healthcare in England is different than in the US, but again, some things seem similar. The stats there revealed that 34% of those who paid privately for IVF put themselves in financial risk in doing so.
One third of people paying for IVF are putting themselves at financial risk.
So for those who didn’t put themselves “at financial risk,” what did they have to give up?  
What are you giving up to try to have a child?
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Reproductive rights have been hijacked. When someone mentions the phrase “reproductive rights,” the first things that usually come to mind are either birth control or abortion. However, the ability to prevent pregnancy is only part of reproductive rights. What about the right to have a child? This conversation has fallen by the wayside. Ironically, every year at Rosh Hashanah, Jews assert the centrality of having children, and we would do a great service to the world if we embrace that message a little more.

A married woman’s right to sex, which means access to fertility, was codified early in Jewish tradition. Initially included in the Torah’s injunction of a husband’s minimum obligations for food, clothing and sex (Exodus 21.10), the Talmud explains the women’s right to sex through an outline of the minimum sex a husband must provide for his wife (Ketubot 61b). For sure, mortality rates were influential in that process, but essentially Judaism has always been a pro-family, pro-child tradition. Early declarations of human rights spoke of enabling people to exercise their right to determine freely and responsibly the quantity and spacing of their children, along with the means for having them (see, e.g., the UN’s 1969 Declaration on Social Progress and Development, Part 1, Article 4). The language was not exclusive to birth prevention. It was inclusive of having children. The implied shift towards prevention has painful repercussions for millions who face fertility challenges.

Rabbi Daniel Polish, a contemporary leader on interfaith dialogue, wrote in that context in the 1980s, “The recognition of the importance of human life is at the same time both integral to the Jewish faith system and the first and necessary precondition for a belief in human rights.”

On Rosh Hashanah, God is coronated, and God’s rule is epitomized through opening the Book of Life and beginning to decide who shall live and who shall die. Fertility is the ultimate example of that synthesis and exemplifies the other themes of the holiday: the birth of the world, the beginning of humanity and its frailty, and God as ultimate ruler and source of life. The first words of the Torah reading for the first day of Rosh Hashanah (Genesis 21:1-34) describe God “remembering Sarah,” meaning opening her womb to pregnancy. The Haftarah text (1 Samuel 1:1-2:10) then introduces Hannah, who is loved yet barren. She tearfully pours out her heart, God remembers her, and she has a child.

God’s ultimate power is exemplified through fertility. The connection comes together directly in a Talmudic passage:

Three keys the Holy One, blessed be [God], has retained in [God’s] own hands and not entrusted to the hand of any messenger: these are the key of rain, the key of childbirth, and the key of the revival of the dead. (Taanit 2a)

While Jews remain a little skeptical about anyone’s ability to overcome death, most of us have come to recognize our ability to affect the rains. Environmental action is real, and can affect our planet for the better. The medical community enabled assistance for reproduction. When it comes to pregnancy prevention, modern Jews have spoken out. Are the steps leading to childbirth some exception that, unlike other areas of healthcare, we should stay out? Is assistance for conceiving a child exceptional and beyond our realm of action? The politicization of all things related to reproduction, the lack of insurance coverage, and the assumption that attempts to procreate will work whenever we want all seem to have silenced the topic.

Jews have almost always been open to intervention when our bodies have not performed as intended. The Torah states “Make sure he is healed” (verapo yerapei)( Exodus 21.19) in double (repetitive) language. The Talmud gleans from the double language that not only do doctors have permission to heal, but that healing is not considered to be an intervention counter to the will of God. (Baba Kamma 85a). Much of childbirth is out of our control, but bringing healing and relief to those facing infertility is something we can address.

I experienced years of infertility before becoming a parent. I have counseled hundreds of people dealing with a variety of fertility challenges. Wanting a child and then facing the prospect of not being able to have a child brings the importance of human life front and center. One of the ultimate expressions of our Judaism, of our faith in God and humanity, is through the creation of a new life.

Support, resources and advocacy are needed for people experiencing infertility and fertility challenges.

How can you help? Awareness is important and appreciated. As Rosh Hashanah’s messages of life, fertility, creation, and God’s power come upon us, remember those who feel isolated from that message. When we wish that others be inscribed in the Book of Life, include a prayer for those hoping and praying to be a part of creating life too.

Rabbi Idit Solomon is the founder and CEO of Hasidah, a Jewish nonprofit dedicated to building awareness about infertility in the Jewish community, connecting people to resources and providing financial support for treatment. She lives in Berkeley, California with her husband and three children.

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Is egg freezing a good thing? A recent article in the Forward by Amy Klein explores the personal stories of a growing number of Jewish women considering egg freezing. Egg freezing  is empowering for some, a relief for others and scary for others. For cancer patients it ought to be a given option.  For the general population, however, more questions are in order.

Egg freezing may add to the societal pressure on women’s bodies. We cannot treat women’s bodies as machines that can simply have parts temporarily preserved. As with all technologies that have the potential for good, society needs to change too. How we think about family building needs to change. The attitude of work versus family needs to change. The role of men in all of this needs to be discussed. How can we stop the I-never-thought-about-it, now-it-is-getting-late and we-can-control-it-all rat race and begin to have meaningful conversations with young people about the role of fertility and family?

To be sure this is not about blaming women for taking the opportunity to utilize this amazing technology to help them preserve their chances of motherhood. For sure, egg freezing has benefits and women absolutely deserve and have the right to control their bodies and their fertility. However, most technologies have unintended consequences as well as negative effects and it is important to consider them. Some of those are the issues about careers, fertility, family building, parenting, gender roles, and the politics of women’s bodies that are not being addressed. Let us not utilize this technology to prevent these conversations from happening.  These conversations are needed – early, openly and often – to empower women from the start. Not just to justify looking at the the freezer for a back up.

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Ever see that headline that addresses a question that’s been nagging at you? When you are struggling with infertility, a lot of things are nagging at you. Is there something I could be doing differently to resolve this? Did I forget to ask a question? Is there a treatment or method I don’t know that could help? And headlines can answer questions – or create questions – you never knew you had.

Here is a sample of some (not all) headlines that came out about a recent study. I took the liberty to highlight what I learned just by reading enough headlines (and share some of my reactions).

  • This over-the-counter painkiller has been linked to male infertility (what is it?!? I have to click, right???)
  • Study Links Ibuprofen with Male Infertility (oh)
  • Study: Ibuprofen may lead to male infertility (may lead?)
  • Ibuprofen use linked to male infertility, study finds (linked or leads?)
  • Ibuprofen linked to Male Infertility in Small Study (how small?)
  • New study suggests ibuprofen could be linked to male infertility (getting vague now)
  • Ibuprofen use may be linked to male infertility (back to links and maybes. But there is a lot of headlines. Maybe there is something here)
  • Taking a lot of ibuprofen could mess with men’s fertility – here’s what you should know (Wait, how much? And what does mess mean?)
  • Regular Ibuprofen Use May Contribute to Male infertility, Study Says (how often is regular?)
  • Daily Ibuprofen usage associated with infertility (that’s pretty regular, but how much? And what is associated? for what kind of infertility? Nothing male here!)
  • Should you worry about new study linking ibuprofen to male infertility? (Why are you asking me this?)
  • Ibuprofen could cause male infertility? (Cause? How come you can’t decide if this is a question or a statement?)

Did you want to click? Did you want to know more? If there is a male involved with your fertility struggles, did it make you think about perhaps switching to acetaminophen? Did you consider past use? Did you wonder if maybe it effects women too?

Here is a question I have for you now: Do you trust your doctor? If you do, tell him or her about any medications you take and ask questions. If the doctor is not sure, ask your doctor where you can learn more. Stay away from the random newspaper or internet site that gives quick quotes about research. Because here is what you really need to know:

  • Infertility is complex
  • There are more causes and possible scenarios for fertility challenges than any one article could ever address
  • It is not your fault. There is rarely a quick “fix”
  • The news is not meant to make you feel better or address your situation. A lot of news is meant to sell, and fear sells
  • The last thing someone experiencing infertility or fertility challenges needs is another reason to worry.

In case you were curious, the study is with 31 men. The test was only for six weeks. The results were not causal and they were reversible. So to the last question, does Ibuprofen cause infertility (was that really a question?). No. Ibuprofen maybe, could be linked to “messing” with men’s fertility if he is taking a lot, daily.

Summary: Talk to your doctor about any medications you and your partner are taking.

And read a good book, have a cup of tea or take a walk outside to give you a break from the stress of reading the news.

 

Update: Ransom paid here (Headline: The truth about ibuprofen and male infertility)

 

 

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Traditionally called the Season of Joy, Sukkot is inherently wrapped in fertility. Historically and religiously associated with agriculture, Sukkot is a harvest festival celebrating the fertility of the earth. Living in booths (Sukkot) commemorates the Israelite’s wanderings in the desert. Their temporary and unstable nature also reminds of of how fragile our lives and the world is.

The special reading done for this holiday is from Kohelet, which begins, “To everything there is a season, and a time for every purpose under the heaven. A time to be born, a time to die…”

Fertility and the fragility are related. Those of us who have experienced fertility challenges know this all too well. But time plays a role as well. Most of it during a fertility journey seems to be spent waiting. A time to wait… and another time to wait. But Kohelet’s perspective can be helpful during fertility challenges. The verses continue that there is “A time to weep and a time to laugh; a time to mourn and a time to dance.” Indeed all things under heaven have a time and a purpose. While fertility can feel all consuming, we do have other purposes in life. And time will continue. The message of fragility at this season is also a reminder of what endures. Our choice to laugh or cry endures. Our ability to reach out to another for support when we mourn and to dance when there is joy endures.

So if this Season of Joy seems hard to reach for you, if you are intimately feeling the fragility of the fertility world, remember there is a purpose for you in this world. Feel the enduring presence of your self and your ability to laugh and cry. And if you are mourning, know too that there will be a time to dance.

Always, there will be time.

Chag Sukkot Sameach – Warm wishes for a joyous Sukkot Holiday

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In this very clearly written article, Dr. David Adamson from ARC fertility explains the different genetic tests performed on embryos during in vitro fertilization (IVF).  Many people think that this testing is a guarantee or insurance. It is neither. However, it can be instrumental in improving chances of IVF success and protecting children from deadly and debilitating diseases. Understanding it better is very helpful for the many who can benefit from its use on their IVF journey. Read all about it in his Huffington post article.

 

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When couples struggle with fertility challenges, things can feel more unhinged. We are told by our faith to “go forth and multiply” or that sex on the Sabbath is a mitzvah. The frustration and self-doubt that creeps in when couples try to honor these teachings, and are unable to create new life can be deep. Inherently, there is a sense of shame that many couples experience when they are unable to fulfill their dreams of parenthood, and often times, this struggle is kept silent.

Infertility is not something that a member of a couple ever forgets, especially during their road to parenthood. Seemingly innocuous questions like, “when are you going to have kids?” or “have you tried to just relax?” add salt to an already open wound, despite those that ask them being well-meaning in their intentions. Since reminders of fertility are all around us (in the form children playing, commercials for baby products, and pregnant women) one doesn’t have to go far to feel that twinge of jealousy and longing as well as the reminder of the uncertainty about when it is their time to be parents.

Having a medical professional enter into the sacred space of childbearing changes the dynamic between a couple. An act that was supposed to have occurred in the sacred space of a couple’s bedroom has now shifted to a medical building.  Here is another place where the push and pull between having faith (that things will work out and a baby will be created) and experiencing fear (such as the doubts that can creep in) creates a tension in both individuals and between a couple. Many partners have different coping styles, and when it comes to experiencing something hard, few couples have had the history together to give them insight around what coping together looks like rather than coping separately.  Managing the emotions around infertility call for couples to increase their communication, particularly around what each might need. It also indicates that couples might need to allow for some space for one or both members.

Learning about how, as individuals, we process information can be vital in then teaching our partner.  An example might be a couple where the wife is an externalizer and likes to talk to others when things are hard but who is married to a man that is an internalizer, or someone who likes to keep his feelings close to the vest until he has figured out his next course of action. These are two styles that tend to be exhibited in many couples. The wife might be talking to whomever will listen about their fertility journey, while the husband keeps the information to himself. This can make his wife feel like she is alone within the couple on this journey whereas the husband might feel like his wife is broadcasting something personal to the entire world. Both are correct in their experiences, and through communication and knowing their styles of coping, they can manage their coping styles together while being respectful and responsive to the other’s differing style.

For some couples, struggling with infertility or another unforeseen challenge might turn one member towards their faith while the other member is turned away. Developing outside areas of interests can also be important in coping with the unknown, as a way of distracting and distancing people from the path they are on. Areas of interest can be faith based, sport based, or creatively based as just some arenas that couples might want to explore. Certainly, for many engaging in a variety of mindfulness practices assists with managing feelings of uncertainty. For others, finding a support group or a mental health provider is equally important in dealing with factors beyond one’s own control.

Infertility impacts one in eight couples, and can have a lasting impact on how individuals experience themselves, how a couple connects, and how a couple is able to cope.   Learning strategies to manage the unknown, whether it be faith based, therapy based, or developed on your own enables individuals and couples to have more of a sense of control around an area in their lives that is not within their bounds to always directly change. Additionally, learning how to communicate as a couple about what each individual member’s needs are is a skill that will last well beyond the initial challenge of infertility.

Dr. Julie Bindeman is a member of Hasidah’s healthcare advisory board. She is a reproductive psychologist and co-director of Integrative Therapy of Greater Washington outside of the Nation’s Capital.

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Lots of news articles and social media posts say what to do to combat infertility, how to get pregnant, 5 ways to “fix” your infertility, or other simple solutions to painful, complex and difficult barriers to building your family. These articles may have some new research to share or possibly an intention to be helpful, but often thinking an easy solution exists leads us to more disappointment

Summary of the these answers: make healthy choices and seek support and advice. No silver bullet exists. Be skeptical of anyone who gives a simple “solution” or any advice without knowing a whole lot about what is happening in your situation.

To save you reading about the magical powers of walnuts, the new research on smoking, the ancient techniques that still work in the 21st century, the secrets to infinite fertility, and how you can take control of your womb/sperm/ovaries/reproductive health, here are the basics that summarize most of those articles:

Eat a healthy diet if you are not
Quit smoking if you are smoking
Lose weight if you have a lot of excess
Be kind to yourself if you are struggling
Find support if you are feeling alone

Notice that this doesn’t even begin to diagnose the majority of fertility issues or speak about treatment or other family building options. These basics alone take some effort to maintain.  No silver bullet can do them for you.

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