Women's Health by Mediaplanet_USA

A Mediaplanet Guide to Reproductive Health & Family Planning

Future of Fertility

Camille Guaty Read the exclusive interview with the actor about the highs and lows of her fertility journey

Learn about the innovations in genetic testing that are changing the game in pregnancy success Discover how prospective parents are finding a way to fund international adoptions

MARCH 2021 | FUTUREOFPERSONALHEALTH.COM

You carry the baby. Bundl carries the financial risk. bundlfertility.com | 888-BUNDLME

An Independent Supplement by Mediaplanet to USA Today

Fighting Egg Donation Stigma With “Scorpion” Actor Camille Guaty In a Q&A, Camille Guaty talks in vitro fertilization (IVF), egg donation, stigma, and the journey that brought her to her son.

playing a character that was 38 weeks pregnant. I remember wardrobe strapping on my pregnant belly, feeling like this was a preview of what was to come in the next few weeks. But I soon discovered the procedure didn’t work, and we had to start all over again. There was a scene where I had to hold this newborn in my arms and I just lost it. I cried five years of silence and heartache take after take.

What advice would you give to couples who are struggling to make ends meet yet are desperately trying to become parents? I remember when we were in escrow on our first home, my financial advisor told us to hold off on buying if we were starting IVF. I was genuinely confused. Surely it would work after the one round. Well, five years later he was right. IVF is very expensive, and most health insurance policies don’t cover the procedure or baseline testing to gauge a women’s fertility. It’s a conversation that needs to be started and a change that has to happen.

There is a lot of stigma around IVF, donor eggs and sperm, and fertility challenges. How have you worked to start this conversation and actively try to break some of these stigmas?

PHOTO: KATIE ABBOTT

Did your professional career of playing a mom to a newborn impact you while you were trying to become pregnant? My husband and I had decided on an egg donor. We were at the last stage of the process when I had booked a role on “The Good Doctor.” I was

@MEDIAPLANETUSA

@FUTUREOFPERSONALHEALTH

It was after I had my son that I realized going through IVF, and specifically donor egg treatment, was loaded with so many negative stigmas. It dawned on me that as a public figure, I had a perfect platform to help people understand that this path is a beautiful one. My son’s existence is not down to my failure, but he is here thanks to a community of people, especially the donor, and that is an amazing thing to celebrate. n

INQUIRIES: US.EDITORIAL@MEDIAPLANET.COM AND US.ADVERTISE@MEDIAPLANET.COM

PLEASE RECYCLE

Publisher Sloane Ackerman Managing Director Luciana Olson Lead Designer Tiffany Pryor Designer Kayla Mendez Lead Editor Mina Fanous Copy Editor Kathleen Walsh Partnership and Distribution Manager Jordan Hernandez Director of Sales Stephanie King Director of Product Faye Godfrey Cover Photo Katie Abbott All photos are credited to Getty Images unless otherwise specified. This section was created by Mediaplanet and did not involve USA Today.

READ MORE AT FUTUREOFPERSONALHEALTH.COM

fit as part of their full compensation package until insurance companies get up-to-speed and understand the importance of this vital coverage. With regards to surrogacy, what factors are most important to consider during the decision-making process? There are many surrogacy agencies to choose from so it can be a daunting task to research who to work with. Weigh the pros and cons of attorneys, mental health professionals, and escrow being held in-house rather than a separate entity. Another consideration is the surrogate’s location. You may be led to believe that only California is acceptable, but if

you broaden your requirements to all 46 states that recognize gestational surrogacy, you can vastly increase your options when deciding on who will be your surrogate. The nuances of each state are reviewed with you in detail during the legal process of the journey. What are the most common myths about egg donation? 1. Egg donors are motivated only by money. The vast majority of egg donors have a strong desire to help others create a family. For them, being part of someone else’s story is an incredible, fulfilling experience. Women who are interested in egg donation solely for money are weeded out by the psychological eval-

uation and other checks and balances during the screening process. Although egg donors are compensated for their time and effort, money is rarely the primary motivation. 2. Egg donors are not properly screened. Prior to the medical testing stage, egg donors are thoroughly counseled on the donation process, obligations, and risks involved. Wellscreened egg donors have carefully considered their decision and are ready to participate when an intended parent chooses them. In addition, fertility practices must abide by strict FDA guidelines regarding eligibility of a donor. Any type of red flag in the FDA questionnaire or test results will prevent a donor from continuing in the process and could be disqualified indefinitely. 3. Egg donation is 100 percent anonymous. With the advent of at-home DNA test kits, egg and sperm donation can no longer remain completely anonymous. Even if a donor does not do the test themselves, with enough of the population using the ancestry kits, it is easier than ever to be linked to a distant relative. Full disclosure of this loss of anonymity is prudent for donors and recipients alike. n

READ MORE AT FUTUREOFPERSONALHEALTH.COM

to meet any standards involving education, experience, insurance, or personnel. Facilitators are not monitored. They have no license to lose. They typically charge a substantial amount of money for advertising and “matching” prospective adoptive parents with a birth mother. Once they make a match, they are no longer involved. They do not provide counseling or legal advice. They do not help make sure your adoption plan is followed and finalized. In many states, it is against the law to use and pay a facilitator to be matched with a birth parent, so both parties should be aware of their state’s laws regarding facilitators. Failure to know and understand this information may prevent the adoption from being finalized. While it may be tempting to respond to a facilitator’s advertisement promising quick matching, prospective adoptive parents should obtain advice on their home state law by first consulting with an experienced adoption attorney or a licensed adoption agency. n Debra E. Guston, Esq., Adoption Director; Genie Miller Gillespie, President, Academy of Adoption & Assisted Reproduction Attorneys

ADVERTORIAL

Adoption Brings Families Together, but the Cost Can Keep Families Apart

There are countless reasons families pursue adoption, but every journey shares a similar goal: to provide a loving, permanent home for a child in need. Far too often the adoption journey comes with obstacles, one of the biggest being financial. The average adoption costs $43,000 and the median income in the United States is just under $36,000. Knowing those figures, it’s easy to see why so many families start the adoption process asking, “How am I going to afford this?” The adoption grant organization Helpusadopt.org receives over one thousand applications a year from

couples and individuals struggling with the high cost of adoption. During the pandemic, the number of applications received has only increased. Families are facing unforeseen challenges, including travel restrictions, court hearing delays, job losses, and increased health risks. These challenges have caused delays in the adoption process and increased costs. Adoption grants help to solve these problems by reducing the financial burden and giving families peace of mind. Often these grants allow medically at-risk children to be brought home sooner, reducing the time they must wait to receive life-changing medical treatments. Grants impact families

in the long term as well. By saving on high-interest loans, families are able to avoid long-term debt, oftentimes allowing them to pursue adoption again, giving another child in need a safe, loving home. Unfortunately, many adoption grants are not available to everyone. Single parents and LGBTQ+ families especially face additional roadblocks when trying to apply for financial assistance. Another hard truth when it comes to adoption is that the need for financial assistance is far greater than the resources available. Far too many families are forced into debt to fulfill their dreams of parenthood. Others, unable to pay the fees, must abandon the process altogether. Adoption grants and other financial assistance programs are paving the way for more families to be built, and more children to find homes. Until adoption becomes more affordable and more accessible to all, cost will continue to be a barrier between children in need of permanent, loving homes and the families willing and waiting to provide for them. n Nasha Foster, Director of Communications, HelpUsAdopt.org

Partner Spotlight: Special Angels Adoption This is a fully licensed 501(c)3 nonprofit, private adoption agency founded by women who are adoptive parents themselves. Special Angels Adoption is the country’s only special needs adoption exclusive agency helping families in all 50 states. We support all types of families in all their choices. We empower parenting by providing resources and support to families. We offer a peer counseling program where birth parents can speak with other parents raising a child with the same or similar condition. Special Angels Adoption is also the only adoption agency partnered with CGI for Project Heritage — a program designed to give parents more options with prenatal screening test results. Birth parents are provided lifetime support whether they choose to terminate, parent, or place for adoption. We help birth, adoptive, surrogate, and intended families all over the country. We have helped with over 1,200 special needs adoption situations since 2013, and we have never not found a family for any infant or child with special medical needs, even children who are terminal. We always have a family. Jennifer Kelly, Medical Director For more information on Special Angels Adoption, please visit www. SAAOhio.org.

MEDIAPLANET

Infertility Is One of Many Misunderstood Consequences of Endometriosis Endometriosis, which affects 1 in 10 women in the United States, is a complex disease with many faces. One of those faces is infertility. Endometriosis can inflict unbearable physical and psychological pain, and typically with little sympathy or understanding from the general public. The disease occurs when tissue, like the endometrium (the interior lining of the uterus), is found outside of the uterus. Because of a lack of

awareness and the normalization of pelvic pain in women, it can take 6-10 years or longer to get diagnosed. By then, someone who has been trying to get pregnant may have suffered through years of pain and infertility. Endometriosis may cause infertility in a few ways. One is that it creates an inflammatory environment throughout the reproductive system and other organs as it grows and spreads. Another is that chocolate cysts — cysts filled with old blood — push inside the ovaries and

READ MORE AT FUTUREOFPERSONALHEALTH.COM

cause them to malfunction. A third is that adhesions and scar tissue caused by the disease block the pathway as eggs try to travel to the fallopian tubes. While we have come a long way in learning about endometriosis, we took a step back in recent years in tying it to infertility. In the 1950s and 1960s, before we had laparoscopic surgery, a lot of infertility was unexplained. When laparoscopies were performed in the late 1970s and early 1980s to explore infertility, doctors often found and

treated endometriosis in the absence of pain. As the success rate of in vitro fertilization (IVF) increased in the late 1990s, doctors bypassed laparoscopies and went straight to IVF when there was no pain. Today, women with no pain may have endometriosis-associated immunological problems that contribute to “unexplained” infertility without a surgical diagnosis. However, surgical diagnosis and treatment may not be needed as these women may respond to medical suppression.

Most infertility doctors are aware of endometriosis and its connection to infertility. If your doctor does not discuss endometriosis with you or doesn’t know anything about it, ask them to refer you to a doctor who does. If they don’t know anyone, do your homework by contacting hospitals, endometriosis specialists, or national organizations such as EndoFound. Almost 2,000 peer-reviewed papers about endometriosis are published yearly; we are making significant strides with this disease. And it’s this knowledge about the connection it has to infertility that can help explain the unexplainable and put future parents on a path toward healing and pregnancy. n Dr. Dan Martin, Scientific & Medical Director, Endometriosis Foundation of America

If you’ve just found out you’re pregnant, there may be a lot running through your mind, especially where to start when it comes to your prenatal care. Having a healthy pregnancy is one of the best ways to promote a healthy birth. Which means taking care of yourself has never been more important. Luckily, it’s not hard to find your prenatal support system, and that you can get strong prenatal care through nutrition, exercise, working with a doula, and acupuncture. Nutrition Prenatal nutrition is impactful for both parents’ and babies’ health, which is why it is such an important part of your prenatal care. A well-balanced prenatal diet includes plenty of protein, which can reduce morning sickness and nausea, help

The Importance of Strong Prenatal Care with fetal development, and balance blood sugar levels when paired with carbs. It’s also important to incorporate healthy fats into your pregnancy nutrition. Fat can help provide energy, facilitate digestion, and absorb certain vitamins and antioxidants. Additionally, omega-3 fats are especially helpful, supporting your baby’s brain and eye development. Lastly, prenatal vitamins are very important when it comes to strong prenatal care through nutrition. You should look for folic acid, iron, vitamin C, calcium, and omega 3s

when looking for the prenatal vitamin that’s right for you. Exercise Exercising throughout your pregnancy has a tremendous number of benefits. Prenatal exercise can help you feel more energized and emotionally balanced, improve sleep, reduce constipation, lower blood pressure, decrease the likelihood of complications like gestational diabetes, and it also supports better physical and cognitive outcomes for your baby. Each trimester brings new changes and challenges, so beyond these general benefits,

exercise can help with the specific changes your body goes through in every stage of your pregnancy. Work with a doula A doula provides informational support, emotional support, and physical support throughout your pregnancy, childbirth, and postpartum experience. Doulas can help you find a childbirth class, formulate questions for your care provider, and provide labor support — all while also being your hype person because you’re about to give birth to another human! As a core aspect of strong prenatal care, doulas are

the extra support system you and your partner may need beyond your medical care. Acupuncture Acupuncture is important for prenatal care for many reasons. It can help with morning sickness and fatigue, heartburn, lower back pains, sleeplessness, stress, digestive issues, and the anxious preparation as you approach your due date. Prenatal acupuncture can also be effective in adjusting a baby’s breech presentation so that a vaginal delivery is possible, and can also assist with labor induction leading up to your baby’s arrival. Acupuncture is a holistic, whole-person approach and has an amazing ability to treat multiple symptoms and multiple body systems at the same time. n Allison Kasirer, Founder, Robyn

E S T. 1 9 8 2

VITAMINS & SUPPLEMENTS

PIONEERING NUTRITION FOR HEALTHY BABY & YOU Moms-to-be love how New Chapter® prenatals are formulated for absorption with fermented vitamins and minerals. Gentle even on an empty stomach.

FORMULATED FOR ABSORPTION | NEW WITH CHOLINE! *This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

MEDIAPLANET

A lack of access to affordable fertility treatments makes starting a family out of the question for many military servicemembers. More than 95 percent of activeduty servicewomen are in their childbearing years, and an increasing body of evidence shows the unique risks to reproductive health posed by military service, yet their access to infertility care is severely limited. TRICARE, which provides healthcare benefits to activeduty service members, does not cover key reproductive health procedures, including IVF and egg freezing. Without insurance, infertility care is unaffordable for many. It’s time to fix that. The 117th Congress and the incoming Administration must establish permanent infertility benefits for active-duty members of the military. This idea is not new. Last session,

The Unspoken Sacrifice of Military Service bipartisan, bicameral legislation to achieve this goal — the Access to Infertility Treatment and Care Act of 2019 — gained traction before the pandemic crisis pulled legislative focus. Addressing cost barriers to infertility care isn’t solved with a one-size-fits-all solution. Military leadership also must address other barriers to

READ MORE AT FUTUREOFPERSONALHEALTH.COM

family building, such as the impact of months-long deployment or shared barracks. But covering the cost of these treatments would be a tremendous first step. Meeting the reproductive healthcare needs of service members is critical to ensuring military readiness and mission accomplishment. It is a moral

imperative that we provide the best quality care to facilitate family building for those who sacrifice so much to protect the health and safety of our country. As president of the American Society for Reproductive Medicine, which has, for more than 75 years, been the global leader in multidisciplinary reproductive medicine

research, ethical practice, and education, I signal ASRM’s commitment to ensuring all who are serving in our armed forces have affordable access to infertility care. Our armed forces and future generations are counting on us. n Hugh Taylor, M.D., President, American Society for Reproductive Medicine

MEDIAPLANET

Family Equality’s research shows that nearly four million LGBTQ+ millennials are considering starting or growing their family in the years ahead — but serious economic and systemic barriers stand in the way of many LGBTQ+ people’s parenting dreams. Becoming a parent is expensive regardless of who you are, where you live, or what your family structure is. But for people who are in same-sex relationships, living with HIV/AIDS, or medically transitioning, costs can increase by up to hundreds of thousands of dollars. “We’ve put our wedding gifts, tax refunds, and COVID-19 stimulus checks all towards building our family,” said Family Equality’s family engagement manager, Jess Venable-Novak. “We’ve spent tens of thousands of dollars out of pocket so far — not including the costs of things like second-parent adoption, which I’ll have to do to make sure both my partner and I are recognized as the legal parents.”

The Cost of Parenthood for LGBTQ+ Families It’s not just the cost of assisted reproductive technology (ART), surrogacy, or adoption and foster care that needs to be considered when financially planning for LGBTQ+ family-building. For example, people living outside a metropolitan area may have to pay to travel and take time away from work just to find affirming providers and agencies willing to work with them, due to a lack of federal nondiscrimination protections for LGBTQ+ people. Additionally, LGBTQ+ folks disproportionately live below the poverty line, and poverty rates are even higher for those who are Black, trans or gender non-conforming, and bisexual

female-identified, making elevated costs for treatment an even greater burden. This is particularly true in a country where most health insurance is provided via employer. With the LGBTQ+ community’s higher rates of unemployment — particularly in the time of COVID-19 — many have no choice but to pay out-of-pocket for these expenses. Even for those who can access health insurance through their employer, most companies require 6-12 months of “trying to conceive” before coverage for assisted reproductive technology kicks in. Many LGBTQ+ couples — specifically LGBTQ+ couples without the anatomy necessary to “try” to conceive

on their own — can’t meet this criteria. Despite all this, LGBTQ+ households making less than $25,000 a year (which is nearly the cost of one IVF cycle and only a fraction of the cost of gestational surrogacy) are considering becoming parents at very similar rates to those making over $100,000 a year. Their parenthood aspirations aren’t pipe-dreams. Investing in policies and practices that address economic insecurity in historically oppressed communities can ensure that LGBTQ+ people have the opportunity to build and, crucially, sustain their family. Healthcare policies can be revised to ensure that LGBTQ+ people who need to use ART to build their families get the same coverage as non-LGBTQ+ people. Employers can implement supplement coverage for foster care and adoption costs. Non-discrimination protections can ensure that LGBTQ+ people living in non-metropolitan areas don’t have to sacrifice necessary paychecks in order to find and access inclusive providers or agencies. n Anna Libertin

READ MORE AT FUTUREOFPERSONALHEALTH.COM

work digitally — things that eliminate paper-intensive activities, phone calls, and emails to the practice.” The advantages of a digital transition are not just patient facing. Providers reap benefits like increased staff efficiency when these manual tasks are digitized and automated.

reducing errors, and that patients benefit from the ability to engage with the clinic easily and make convenient, contactless payments. “They have a very well worked out, comprehensive system that can make it easier for the patients and easier for the staff,” says Dr. Adamson. n Kristen Castillo

Streamlined solution Over a year ago, ARC Fertility partnered with Rectangle Health to help their member clinics improve their day-today processes. Dr. Adamson says that Rectangle Health’s Practice Management Bridge® solution helps offices run smoothly by saving staff time and

To learn how Rectangle Health can help your clinic improve practice workflow and patient satisfaction, contact Brian Doyle at bdoyle@rectanglehealth.com

Why Doesn’t Insurance Cover Fertility Treatments? Infertility is a medical concern just like any other, so activists want to know why it isn’t covered by insurance. Barbara Collura of Resolve: The National Infertility Association, argues that infertility and fertility treatments are reproductive healthcare in the same way that pregnancy prevention is reproductive healthcare. So why have medical procedures to treat infertility in both women and men, such as in vitro fertilization (IVF) been ignored when it comes to insurance coverage? For whatever reason, fertility treatments haven’t been widely viewed as medically necessary. “The ability to get pregnant and carry a pregnancy to term, I would argue, is a very key part of reproductive health,”

Collura said. “I mean, that’s what reproduction is.” Collura pointed out that when any other system in your body isn’t functioning, you can get treatment covered by insurance no problem. IVF has been around for decades, and is known to be common, safe, and effective. Yet because of the high costs associated with it, it is only easily accessible to a small segment of the population. This also leads to misguided perceptions about which demographics are most affected by infertility. And there are large demographics who need options outside of IVF, such as single people, same-sex couples, or people who are prevented from getting pregnant due to health issues like uterine cancer. Donor sperm, intrauterine insemination, and gestational carriers are all medically viable options for these

populations. “Why shouldn’t everyone have the right to build a family?.” So, what is there to be done? Collura’s organization is focused on getting fertility covered by insurance across the board, and they are attacking this goal on multiple fronts. The first and most basic effort is raising awareness and encouraging individuals to fight for insurance coverage in their own workplaces. “We have a program called Coverage at Work and what we are trying to do there is motivate employees to advocate within their companies for coverage.” Collura said that in the same way the organization advocates in Congress, they are trying to motivate individuals to argue for this coverage in their own HR departments. “We really feel that bottom-up employee advocacy approach will really make a difference with employers,” she

said, explaining, “You’ve got employers being pressured by their employees to add it, and then they’re gonna go to insurers, and they’re gonna say, ‘I need to add this coverage.’” Like any other big, systemic goal, getting fertility covered by medical insurance as a matter of course isn’t going to be easy and it takes a village. But Collura stressed that reaching out as an individual can be hugely gratifying and personally beneficial. “For many of us, going through infertility is very isolating,” she said. “But also you feel like you lose control completely. And a lot of us when we advocate — whether it’s with your employer or with a legislator even just telling your story — people feel very empowered. They feel like, ‘I grabbed a little bit of control back.’” n Lynne Daggett SPONSORED

How Providers Can Partner With Patients to Help Finance Fertility Solutions One in 8 couples grapples with infertility. With hopes of building a family, many couples turn to expensive fertility treatments. Basic in vitro fertilization (IVF) costs $12,000 and is typically paid for out-ofpocket. Many couples borrow money from family or save for years to afford treatments. But there are other options, such as affordable financing solutions, to consider on the path to parenthood. “People should be able to get the services they need at a price point they can handle,” says Hans Zandhuis, head of Ally Lending, the personal lending arm of Ally Bank, a subsidiary of Ally Financial Inc. Ally Lending

gives consumers the option to pay over time through financing. “People need solutions for highcost healthcare treatment,” says Chris Klemick, Ally Lending’s head of healthcare sales. “Financing gives them more flexibility and time. They have the option to pay off over 12-60 months depending on the need, cost, and what works best for their budget.” Ally Lending’s end-to-end digital process is appreciated by fertility providers as well, as they experience no start-up fees and receive hands-on assistance from the Ally team. Providers like that they can pre-qualify patients for financing with no impact to their credit score.

Preferred lender MCRM Fertility began working with Ally Lending over a year ago. “Ally is our preferred lender, because they have the lowest interest rates, long payment terms, no penalty for early payoff, and an easy application process,” says Kelly Gittemeier, MCRM Fertility’s billing and revenue cycle manager. She says clients appreciate the personalized approach and customer service. When patients apply, they choose a plan that’s manageable for them. Ally Lending then pays the fertility center in full on the patient’s behalf following treatment. “We’ve used a couple of banks previously but teaming up with Ally has

been the best decision we ever made,” she says. Helping patients and providers The infertility journey is a stressful time for patients. Offering them flexible financial options eases that stress. n

Kristen Castillo

To begin offering Ally Lending financing at your office, enroll today www.ally.com

MEDIAPLANET

The Bonds That Form Between Nurse-Midwives and Their Patients When Luz Sheth and her husband were thinking about starting a family, they had an easier time than most finding the right medical professional to help them through the process. As a labor and delivery nurse in Louisville, Kentucky, Sheth had worked regularly with nurse-midwife Damara Jenkins, a Frontier Nursing graduate, and saw firsthand how Jenkins’ patients benefited from her services. “When I had my first delivery with Damara as a nurse, I remember just getting very emotional and coming straight home and telling my husband that when we have a child, we are going to use the midwife at work,” Sheth said. “For me, it was beautiful, intimate. And the more I worked with Damara, the more I knew that decision was just great for me and our family.” As Jenkins sees it, there’s a fundamental difference between how nurse-midwives and physicians go about offering reproductive healthcare. “Midwives treat pregnancy as just one of the normal life changes women undergo,” she said. “We practice from a wellness model instead of an illness model.” For Sheth, having Jenkins as a nurse-midwife was completely different from any healthcare experience she had before. “They sit down, they listen,” Sheth said. “They give you all that you need to know education-wise, and let you use that knowledge to choose what’s best for you and keep with the way you want to go.” Dustin Brennan

For Couples Trying to Conceive, Eating Right Plays an Essential Role

When dealing with fertility issues, a proper diet is important for both women and men. Maintaining a nutritious diet and healthy exercise regimen is always a good idea, but it’s especially important when you’re trying to have a baby. “Nutrition can make a difference in fertility, research shows,” said Isabel Maples, a registered dietitian and spokesperson for the Academy of Nutrition and Dietetics. “Plus, it can set you up for a healthier pregnancy and establish some good eating habits for raising a healthy family.” Start with the pros Couples hoping to welcome a bundle of joy may want to reach out to a food and nutrition expert for advice. Doing so can help them from becoming overwhelmed by the changes they may need to incorporate. “There are many reasons a couple might have trouble getting pregnant, but a healthy diet can help to normalize blood sugar and

circulating insulin levels, improve sperm count/movement, and improve ovulation and hormone levels,” Maples explained. Finding folates While folic acid doesn’t affect fertility, experts suggest all women take a prenatal vitamin or mineral supplement, or even a regular multivitamin or mineral supplement, for at least a month before trying to conceive. “Low levels of folic acid can affect early development of the brain and spine,” Maples pointed out. “This spinal/brain development of the neural tube happens just 3-4 weeks after conception, typically before women realize they are pregnant, so improving folate levels early is critical.” Food sources of folic acid include dark leafy greens such as spinach, arugula, and kale, and green veggies like asparagus and brussels sprouts. Whole grain and fortified cereals are other options, along with dried beans, peas, and lentils.

Pump the iron Adding foods rich in vitamin C to meals will help the body to absorb more iron. Think tomatoes and orange juice. Stock up on fruits and low-fat or fat-free dairy and limit your intake of added sugars. “Choose leaner cuts of meat, moderate portion sizes, and diversify protein intake by also choosing protein from eggs, nuts, seeds, quinoa, and low-fat or fat-free milk and yogurt. Choose less solid fat and avoid trans fats in foods,” Maples advised. Get moving Try to include moderate-intensity physical activity for at least 30 minutes each day. Regular physical activity helps reduce stress, and improve blood flow and heart health. “Exercise regularly, but not excessively, especially if body weight is very low, such as a BMI under 18.5,” said Maples. “Increasing muscle mass may help. If one has too little muscle and more fat, it can change hormones, which affect fertility. Increase muscle mass with weight-lifting, resistance bands, yoga, pilates, yard work, and gardening.” Maples added, “Couples trying to conceive can feel a lot of pressure to control everything, including diet. A registered dietitian nutritionist can help them make sense of it all.” n Cindy Riley

FOR A HEALTHIER TOMORROW Prenatal supplements backed by science* 14

READ MORE AT FUTUREOFPERSONALHEALTH.COM

@SmartyPants www.smartypantsvitamins.com

MEDIAPLANET

How Nurse-Midwives Provide a Lifetime of Good Health Part advocate and part healthcare provider, nurse-midwives play a critical role in the lives of their patients and the communities they serve. Specializing in women’s reproductive health and childbirth, nurse-midwives work closely with their patients — listening to their wants and needs, offering advice and recommendations, and providing the care that’s best for mother and child. “It’s the best job on the planet,” said Tonya Nicholson, DNP, CNM, WHNP-BC, CNE, FACNM, chair of Frontier Nursing University’s Department of Midwifery and Women’s Health. “What an honor and a privilege, and also a great responsibility, to be with women and with families as they’re growing.” While nurse-midwives are mostly known for the care they provide women during pregnancy and birth, they offer care for women throughout their lives. “Nurse-midwives actually care across the lifespan,” said Nicholson, who has worked as a nurse-midwife in Dublin, Georgia, for more than 20 years. “Basically, from the onset of adolescence for a young girl to the rest of a woman’s life. So, prenatal care, care for birth, gynecologic care, menopausal care…” Because they are there before, during, and after pregnancy, nurse-midwives often develop close bonds with their patients. That bond, Nicholson says, makes it easier to get patients to follow health recommendations, which in turn has a major impact on public health. Dustin Brennan

Midwives Provide Personalized Care and Improved Birth Outcomes for Families In an evolving healthcare landscape in the United States, midwives provide safe, evidencebased, and personalized care that improves birth outcomes and patient satisfaction. Pregnancy is an exciting time and there is a lot to prepare for your new arrival. Midwifery may have crossed your mind, but it might be an unfamiliar avenue. What is a midwife Midwives promote normal physiological birth, supporting a woman’s own innate body processes to give birth. They are often integrated into their communities and bring a unique perspective on how to provide care while keeping the whole person in mind. Certified nurse-midwives (CNMs) and certified midwives (CMs) are educated in graduate-level accredited midwifery programs. CNMs and CMs pass a national certification exam to receive the professional designation of CNM (if they have an active RN at the time of the exam) or CM. Midwives provide a full range of primary care services from adolescence through post-menopause and everything in-between, including primary care, gynecology, family planning, pre-conception, preg-

nancy, childbirth, postpartum, and normal newborn services. You will find them working in clinics, birth centers, hospitals, and home settings. They specialize in low-risk pregnancies and if complications arise in pregnancy or birth, they are educated to identify abnormal occurrences and collaborate with other health professionals to assure safety.

who receive care from providers who look like them. As such, there is also a need to diversify the midwifery profession to address this growing health crisis. Midwives provide an impactful solution to geographic areas that experience a shortage of maternity providers as they are poised to meet the needs of communities.

Why a midwife Midwives provide evidence-based, individualized care, continuous partnerships, and therapeutic use of human presence and skillful communication. Research shows that midwifery improves birth outcomes, including increased rates of spontaneous labor, vaginal birth, and breastfeeding. Midwifery care results in lower rates of unnecessary interventions. Many women that use midwifery care report higher rates of satisfaction with their overall healthcare experience. There is currently a maternal healthcare crisis in the United States, with women experiencing high rates of maternal death and injury from pregnancy-related complications. These rates are higher among people of color. Midwives and their philosophy of care are key to changing these statistics. Evidence-based research shows better health outcomes for patients

Making the choice When deciding who will provide your prenatal care, it is important to know yourself, what you are comfortable with, and what concerns you. Where will you feel most relaxed receiving care and delivering your baby? Be sure to collect information on what is available in your area; your decision will be impacted by your location, insurance coverage, and other logistics. If you are feeling wary about going to a hospital during the pandemic, you may explore if there is an option in your state to have a home birth or birth center birth with a midwife. Midwives are the experts in normal pregnancies and the American College of Nurse-Midwives has a vision to ensure a midwife for every woman. n Lily Bastian CNM MSN, Midwifery Clinical Practice Advisor, American College of Nurse-Midwives

Nurse-midwives…there with you in all stages of life. Pregnancy, birth, routine women’s care, menopause and more. Learn more about nurse-midwifery care at frontier.edu/midwife. 16

READ MORE AT FUTUREOFPERSONALHEALTH.COM

MEDIAPLANET

Tracking Fertility at Home Romance in marriage is very delicate and should be continuously nurtured, or it may fade away, including while trying to conceive. Infertility is a huge challenge that can destroy not only romance but also the marriage itself. Women suffer more than their fair share when it comes to infertility. Society assumes the woman is generally responsible when a couple struggles to conceive, when it is actually about a 50/50 split between men and women. Sexual pleasure is an integral aspect of sexual wellness that can dramatically affect a couple’s daily lives. For instance, hormonal contraception can reduce the sexual desire in women, and the condom can reduce the sexual pleasure of the couple. Women produce one egg per month that lasts 24-36 hours. If the egg is not fertilized within this short window, the body continues the menstrual process and expels it. So timing is critical. There are a few signs that indicate ovulation. Many expensive devices can monitor ovulation; however, none of them are precisely accurate. Cervical mucus is the most accurate way to pinpoint your fertile window. The FemCap, an FDAapproved device, can collect the cervical mucus directly from the source with astonishing accuracy. Alfred Shihata, M.D., Medical Director, FemCap Inc. This has been paid for by FemCap Inc.

Easing the Isolation and Uncertainty of Infertility

Helping Jewish couples conceive is only part of A TIME’s mission. Orthodox rabbi Shaul Rosen knows all too well the emptiness associated with infertility. He and his wife Brany struggled to get pregnant almost three decades ago. “We were alone. It was not a topic discussed even in the secular world and finding the right doctor to see was complicated. We would be given a doctor’s name only to find out he could not help us,” Rosen said. He explained the experience inspired him to form his nonprofit A TIME, so that they could help others in their position. “One day, while on the train traveling to an appointment with a specialist, we

made a promise that if we were helped, we would make sure there was one phone number people could call.” Establishing A TIME The initial goal of the New Yorkbased nonprofit was to make sure other people had access to information about physicians and their specialties. “We fulfilled that promise in more ways than we ever thought possible,” said Rosen. “Today, our organization offers medical guidance, emotional support, educational events, and community awareness.” Each person or couple who contacts the office receives individualized care.

“They are offered guidance regarding their specific medical situation, which insurance they have and what would make the most sense for them. They speak with a counselor who can follow their case and be with them for every step of their journey.” Making a difference With branches across the United States, Israel, the UK, and Belgium, A TIME coordinates resources for financial aid for costly fertility treatments. Emotional support ranges from an online forum, texting groups, a pregnancy loss support program, and peer counseling. “The most common feeling is that of being a failure,” Rosen explained. “Many struggle with the idea that their bodies seem not to know how to do what everyone else seems to do so easily. Infertility brings with it a monthly reminder of that perceived failing. And that generates a great deal of sadness and pain.” Offering hope at a critical time “The journey to have a child is too difficult to do alone,” said Rosen. “The strain it puts on a person’s physical and mental well-being cannot be overstated. The strain it puts on a relationship can be devastating. Having a place to turn to where you are understood and validated goes a long way to helping relieve that stress.” n Cindy Riley This has been paid for by A TIME.

T H E ON LY H O R MON E- FR E E B I R T H C O N T R O L T H A T C A N H E L P W I T H F E R T I L I T Y !

I D E N T I FY T H E P R E CISE DAY O F O VULAT IO N W IT H FEM CAP ™ www.femcap.com 18

READ MORE AT FUTUREOFPERSONALHEALTH.COM

ADVERTORIAL

The Donor Sibling Registry Is Helping Connect Biological Families For all of human history, we have been driven by a desire to know where we come from. This quest for knowledge was the inspiration behind the Donor Sibling Registry.

reated in 2000, the Donor Sibling Registry (DSR) — as described by co-founder and director Wendy Kramer — is a vehicle through which sperm and egg donors, parents, and donor-conceived people, can find and communicate with their own or their child’s biological families. And all of this can be done privately, allowing users to connect and develop relationships at their own speed. “When we started DSR, it was the first time these people understood they had the right to be curious, the right to search for, and the right to find these genetic relatives,” Kramer said. “And they also had the right to define their relationships with these genetic relatives.” The DSR is the only registry of its kind, and to date contains 73,000 donors, parents, and donor-conceived children from 105 countries, and has connected more than 20,250 people. Growing popularity As commercial DNA testing companies like AncestryDNA and 23andMe have exploded in popularity over the

past decade, so too have the number of donor-conceived people looking to connect with their biological parents and half siblings. That’s where the DSR comes in. “Ninety-nine percent of people just find us,” Kramer said. “They’re donors who are curious: ‘Hey, did I have any kids? I would love to know who they are!’ Or there are parents who are curious about their kids’ half siblings. And then there are donor-conceived adults curious about who their genetic relatives are.” In addition to satisfying curiosity and helping ease people’s social and psychological distress related to learning where half their DNA comes from, there are major advantages to sharing and learning about family medical history. Better care Many diseases and conditions are genetic in origin, and can be better screened, diagnosed, and treated if care providers know their patients’ full family medical history. However, as Kramer explains, sperm and egg donation centers will rarely work to seek full histories from their donors or follow up with

them to see if health records change. “Most of these donors are just college kids and money is the main motivator; sometimes these donors will just say what they need to say so they’ll get accepted into the donor program,” Kramer said. “Some people get a snapshot of one day in the life of a healthy young donor, but they don’t know what happens the next year or five years.” In fact, Kramer says that one DSR survey of 164 egg donors found that 97 percent were never contacted for a medical update, despite the fact that nearly one-third indicated that either they or a close family member had developed a medical condition their biological children should know about. Promoting transparency In addition to the people who seek out the DSR on their own, about two dozen egg clinics and agencies now include DSR registration in their contracts and consent forms. This automatically creates a path for donors and their recipient families to find each other and connect (as privately as they like) when they’re ready. To date, no sperm banks

have taken this important step forward. Kramer hopes this practice becomes more common, and that transparency about infertility treatments, sperm and egg donations, and the biological ties between donors and their offspring increases. “The donor industry as a whole works so hard to put this false sense of anonymity out there,” Kramer said. “They put this fear on donors that parents are going to disrupt their lives, so they can’t know them. They put this fear on parents that donors are going to want to be parents to their children.” “Meanwhile, in reality, we know when these connections happen right from the get-go, people are 100 percent respectful of boundaries, and meaningful relationships can be formed and family expanded. A lot of the work we do is pulling the plug on all of that kind of negative influence to say, ‘You have every right to be curious, to search for, to find, and then define these new relationships with your close genetic relatives.’” n Dustin Brennan To learn more about the DSR, visit donorsiblingregistry.com.

MEDIAPLANET

Financial Planners Share Tips on Financing Fertility Treatments Budgeting is an important part of any family’s life, but for couples embarking on fertility treatments, it is an even greater necessity. Finances can be a huge barrier to having a child, so how can a couple plan ahead for their future? Michael Metzger, a professional financial planner at Lifepoint Financial Design, said that fertility treatment is some-

thing “near and dear” to his heart, as he and his wife have been struggling to get pregnant for years. “As a financial planner,” Metzger said, “I knew the costs were high, but I never considered the staggering added costs as the years pass.” According to Metzger, there are a few things to focus on when planning for fertility expenses. One is to maximize contributions to your Health

READ MORE AT FUTUREOFPERSONALHEALTH.COM

Savings Plan (HSA). “If you have a high deductible health plan, you should be contributing to an HSA for unforeseen medical expenses on a tax-efficient basis,” said Metzger. “Fertility treatments like IVF as well as egg and sperm storage are considered qualified medical expenses.” He also recommends researching payment programs, which many clinics offer with “little or no interest

added to the total cost,” as well as refund programs. Jennifer Grant, a financial advisor and investment manager at Perryman Financial, is also personally familiar with fertility expenses, as she had to undergo fertility treatments for all of her pregnancies. She acknowledges that overcoming infertility is a huge financial goal. “Know ahead of time what your insurance will

and will not cover,” Grant advised. “If changing coverage during open enrollment is an option, you want to know in advance.” She also urges couples to research how much treatment will realistically cost ahead of time. “Doctors’ offices have different pricing structures, so shop around,” Grant said. “Having a good doctor is important. Having a good doctor with a great staff who understands how to handle insurance is more important.” Having a clear budget before embarking on fertility treatment is imperative. There’s a huge emotional toll to failed treatments, so defining what you and your partner can take on financially can help you make clearheaded decisions. n

Lauren Hogan

ADVERTORIAL

Frozen Cycles Offer the Best Chance for IVF Patients At Overlake Reproductive Health in Bellevue, Washington we pursue an in vitro fertilization (IVF) protocol that allows us to achieve high success rates for our patients. Here’s how we do it. First, we try to get to the bottom of “unexplained infertility” and fix the problem if it can be fixed. If there is a less invasive way, we will try that first. But when IVF is needed, we are a frozen cycle clinic, meaning we no longer do fresh IVF cycles. After 30 years in fertility, we know our patients have a higher chance of success with frozen cycles.

Frozen cycles allow time to do preimplantation genetic testing for aneuploidy (PGTA) on each embryo, so that we know which embryos are chromosomally normal before implantation. This gives us the ability to implant just one embryo at a time and allows a break between the ovaries being asked to produce multiple mature egg follicles and the uterus creating the perfect fluffy nest of endometrium for one healthy embryo to mature.

water molecules do not have time to form ice crystals and instead instantaneously solidify into a glass-like structure. We are highly skilled at this process to the point that it is over 99 percent effective. A sperm and an egg can be fertilized, then the embryo can be grown to day 5-7, biopsied and frozen, and later thawed, implanted in a uterus, and grow into a healthy baby. If additional embryos are healthy, they’re ready when our patient is ready for baby two or three.

Freezing eggs and embryos with vitrification Vitrification is the process of freezing so rapidly that the

Preimplantation genetic testing for aneuploid Frozen cycles also allow for PGT-M, preimplantation

genetic testing for monogenic/ single gene defects for people who are at high risk of passing debilitating diseases like Duchenne muscular dystrophy, Huntington disease, or cystic fibrosis. Eliminating these diseases can save unmeasurable emotional distress as well as hundreds of thousands of dollars in chronic medical care. PGT-M and PGT-A can be performed together. The proof is in our numbers. In the last complete reporting year, our implantation rate reached 86.4 percent in patients under the age of 35. That means 86.4 percent of the transfers we performed in 2018 resulted in a pregnancy.

Now, not every early pregnancy (implantation) results in a live birth, just as not every retrieval will result in a viable embryo to transfer. Biology is just not that simple. Our 72.7 percent live birth rate in patients under 35 makes us the No.1 fertility clinic in Washington state and No. 5 in the United States according to IVF Authority. Mirroring our technology with compassion and skill is why patients choose ORH for help with creating their family. n Emily Frogget, Marketing & Physician Liaison, Overlake Reproductive Health

MEDIAPLANET

David Henrie and Maria Cahill On Their New Family and Miscarriage Stigma On Instagram, the former “Wizards of Waverly Place” star documented the couple’s path to parenthood from beginning to end — including four miscarriages. In an interview, David Henrie and Maria Cahill discuss their experience, and why they’re so open with their story.

bodies before trying to start a family. After suffering multiple miscarriages, tons of doctors’ visits, endless blood draws, even a minor surgery for my wife, our problem was simple: my wife has a progesterone deficiency. Once we solved that, we were able to have our two kids. Maria, what stigmas do you feel were placed on you as a woman who has experienced several miscarriages?

Can you share the emotions of having a child after your fourth miscarriage? Maria: My labor and delivery were very special for this baby. I had a miscarriage from Christmas Eve into Christmas day in 2019 which was very traumatic, especially considering it was my fourth one. When I went into labor on Christmas morning this past year, it felt completely surreal. When James was born Christmas night, I knew that he wouldn’t be here if I didn’t go through what I did the previous year. Needless to say, this little guy has gotten an endless amount of kisses and cuddles because I am so grateful to have him.

PHOTO: CHRISTINE SKARI

David, you were very outspoken on social on the day your wife was giving birth. Why was that? David: When we had our second child, I wanted to peel back the curtain and show how profound and beautiful the process could be. The way my wife and I look at it, it’s one of nature’s gifts to humanity and one of the most primal learning lessons anyone can undergo: after the suffering comes the reward. Boy, is it worth it.

Maria, how did you feel about him documenting your journey publicly?

weeks along, sometimes just not feeling alone in that process can be very therapeutic.

Maria: Even though I don’t have social media, once David started opening up to his followers, he would read me the messages from women who were going through the same things and struggling with similar issues. I feel like when a woman is going through something as traumatic as losing their child, no matter how many

David, you mentioned in a recent interview that you felt compelled to share your story because you didn’t realize how difficult starting a family would be. What education do you wish you had earlier in life on this topic? David: I wish people would have stressed the idea of trying to get to know your

Maria: I will never forget leaving an ultrasound to confirm my second miscarriage and the technician flippantly telling me on my way out of the door, “Better luck next time.” As I have discovered is common with women in my situation, I went through different stages: A stage of thinking that the miscarriages were my fault, to thinking I was “broken,” to thinking that my feelings of profound sadness shouldn’t be there at all. “Better luck next time” made it seem like it shouldn’t feel like a big deal. Yet it did. n

Family Planning Providers:

virtually

UNSTOPPABLE

2021

August 10-13, 2021 CTCFP.org 22 READ MORE AT FUTUREOFPERSONALHEALTH.COM Untitled-3 1

MEDIAPLANET 3/1/21 2:18 PM

Give Them the Best Start.

Expertise. Partnership. Service. We recognize the critical role our reproductive media products play in helping to foster life at the most vulnerable phases of development. We offer complete workﬂow solutions of advanced assisted reproductive technologies (ART) designed to increase pregnancy rates through innovation, and to safeguard precious life with media of the highest quality, consistency and reliability in the industry. Extremely supportive, and deeply collaborative, our experts work with each of our customers to provide education, solutions, and training to exceed expectations. With an unwavering commitment to full-spectrum support, we dedicate our resources and expertise to help you successfully fulﬁll your patient’s dreams of having a family. Bring more dreams to life with our support.

Bringing new life to

hope.

Scan this to visit ZyMotFertility.com/Hope

We’ve discovered a proven way to help you realize your greatest hopes. Learn about ZyMōt products and how to start a conversation with your doctor at ZyMotFertility.com/Hope.