Intrauterine insemination versus in vitro fertilization: What is the role of IUI in modern fertility practices?
As fertility practices mature and in vitro fertilization (IVF) becomes more efficient, safer, and successful, the hot topic of conversation centers on the benefits of intrauterine insemination (IUI) as a first line treatment. In the past, IVF was not significantly more successful than IUI, especially in patients with diminished ovarian reserve. Now with improved technologies such as freezing embryos and preimplantation genetic screening (PGS), we are beginning to see a wider and more significant gap in success rates between IVF and IUI cycles.
A study published in May 2017 showed that over a five-year period, 35 percent of women of all studied age groups gave birth with IUI treatment versus 53 percent of women with ART treatments over the same time period. Although 53 percent is a much larger number, 35 percent still were able to achieve live birth without undergoing IVF. This still gives relevancy to IUI as a treatment, especially in a properly chosen patient population.
Choosing the Right Treatment
In general, IUI can be performed with and without ovarian stimulation, and can be achieved with oral agents and injectable hormones. The goal of IUI is the ovulation of one or more follicles to increase the per cycle pregnancy rates to match normal controls. On the other hand, IVF is almost exclusively done with high-dose injectable medications, requires anesthesia, and places significant physical/financial burden on the patient given the complexity of laboratory procedures. Although there are clear differences between the two treatment processes, there are associated complications with both procedures that make both of them risky to the patient.
One of the main concerns in modern fertility practices is the birth of multiples. IUI does not seem to be associated with increased rates of multiple births as compared to standard IVF cycles. However, most of this data is old and with the introduction and acceptance of genetic screening of preimplantation embryos, we are seeing higher and higher rates of elective single embryo transfer cycles – leading to significantly decreased rates of multiple gestations in IVF treatments. The modern practice of IVF as compared to 5-10 years ago most likely has a significantly decreased rate of multiple gestations and new randomized clinical trials prove this benefit of single embryo transfer.
Another consideration in the choosing of an optimal treatment pathway involves a cost analysis. The FORT-T trial, an important randomized, controlled fertility trial, showed the benefit of foregoing an IUI cycle and moving directly to IVF. The study argued that success rates are significantly lower in IUI cycles than IVF in patients ages 38 to 42. In fact, many of these patients required IVF after multiple failed IUI cycles. In the first arm of IVF, there were 36 percent less treatment cycles than the arm where IUI was attempted first. Given that the cost of multiple IUI cycles approaches the cost of a single IVF cycle, the conclusion can be made that in certain patient populations (specifically older and diminished ovarian reserve patients) there may be benefit to moving directly to IVF based on costs.
Reducing the Burden of Fertility Treatment Cycles
Finally, infertility is a disease and has been recognized as one by the World Health Organization since 2009 and the American Medical Association as of June 2017. Beyond this fact, infertility is an emotionally charged diagnosis and the treatment itself can be physically and emotionally draining. Drop-out rate is a real phenomenon in fertility treatment and the negative effect is that couples that could have been helped never had the opportunity to benefit from successful treatment. The FORT-T trial showed improved pregnancy rates with fewer cycles, demonstrating that one of the most important arguments for moving straight to IVF is this decrease in treatment time and, consequently, a decrease in drop-out rates. IUI is, without question, a useful treatment modality in a properly selected patient. Ultimately, proper counseling and realistic expectations must be discussed with the patients prior to the selection of any fertility treatment.
Progyny’s Patient Care Advocates Receive Exemplary Net Promoter Score
Progyny is proud to announce that its Patient Care Advocates recently received a net promoter score of 81.53 on its patient satisfaction survey. A net promoter score is an index, ranging from -100 to 100, that measures the willingness of customers to recommend a company’s services to others. The average net promoter score for health insurance organizations is 18, placing Progyny far ahead in patient care as opposed to traditional insurers.
Since January 2016, 355 Progyny patients completed the survey. What is most striking is that Progyny received no return scores of 0. “Progyny’s Patient Care Advocates truly go above and beyond for their members.” said Maggie Cacciotti, Director of Patient Care. “The level of care and support the PCAs provide is admirable, and I’m thrilled to see that our net promoter score reflects the depth of satisfaction that our members have with Progyny benefits and staff.”
Patients received these surveys following their initial consultation with the facility of their choice from our extensive list of supported clinics.
For more information on our patient care advocates, stay tuned for our ongoing series, “Getting to Know your Patient Care Advocate,” here on the Progyny blog. Click here for the first post in this series featuring Lisette.
Listen Up to Your Family Building Options
This week is National Infertility Awareness Week and we at Progyny are excited to remind those who have been diagnosed with infertility issues that there are many ways to become a parent.
This year’s NIAW theme is “Listen Up!” and given that infertility issues affect 7.4 million women, this is a terrific week to raise your own awareness and listen up to all of the options you have available to you. They are:
Artificial Insemination: A doctor inserts sperm directly into a woman’s cervix, fallopian tubes, or uterus. The most common method is called “intrauterine insemination (IUI),” when a doctor places the sperm in the uterus.
In Vitro fertilization (IVF): In Vitro Fertilization is an assisted reproductive technology (ART) commonly referred to as IVF. IVF is the process of fertilization by retrieving eggs, attaining a sperm sample, and then manually combining an egg and sperm in a laboratory dish. The embryo(s) is then transferred to the uterus.
IVF plus Preimplantation Genetic Diagnosis (PGD): The IVF process and PGD involves removing a cell from an IVF embryo to test it for a specific genetic condition (cystic fibrosis, for example) before transferring the embryo to the uterus.
IVF plus Preimplantation Genetic Screening (PGS): The IVF process and PGS tests for the overall chromosomal normalcy in embryos. PGS is not looking for a specific disease diagnosis – it is screening the embryo for normal chromosome copy number.
Donor eggs: Egg donation are eggs (oocytes) provided from a woman who has healthy eggs to make pregnancy possible for women who might not otherwise be able to get pregnant using their own eggs.
Donor sperm: Donor sperm can be used when the husband/partner has no sperm, a very poor semen analysis, or when there may be a genetic concern which could be inherited from the male. Single women or lesbian couples can also use donor sperm as an option.
Reciprocal IVF: This is an option for lesbian partners in which one partner provides the eggs and the other partner carries the pregnancy.
Freeze All Cycles: In a traditional in vitro fertilization (IVF) cycle, eggs are fertilized the day of the egg retrieval and the fertilized eggs (embryos) grow in the laboratory until the best quality embryos are transferred three or five days after the egg retrieval. This is referred to as a “fresh” transfer. A “freeze all” is when the good quality embryos that are produced are frozen using vitrification and stored until they are transferred at a later time.
Frozen Embryo Transfer: The thawing and transfer of a previously frozen embryo.
Adoption: There are three different kinds of adoption: international, domestic and foster.
Surrogacy: Surrogacy is when another woman carries and gives birth to a baby for the couple who want to have a child. Usually this is done with one woman being the gestational carrier and a separate woman providing the egg.
Egg Freezing: This is when a woman’s eggs (oocytes) are extracted, frozen using vitrification, and stored. In the future, the eggs can be thawed, fertilized, and transferred to the uterus as embryos.
Of course, it’s up to you, your partner, and/or your doctor to decide what is the best course of action and what you feel comfortable with. It can also be a challenge to pursue any of these pathways if you can’t afford them and/or if you do not have coverage through your employer.
Since this is National Infertility Awareness Week, if you found this blog helpful and informative, help us spread awareness and share with your friends, family, and coworkers!
Listen Up: Know How Fertility Benefits Can Help You
Every year, a week is set aside in the month of April to raise awareness about infertility. This year, National Infertility Awareness Week (NIAW) is April 23-April 29. It’s an opportunity to inform the public about the medical and emotional issues faced by the millions of Americans with infertility, as well as highlight available family building options.
Infertility is more common than you think — one in eight women between the ages of 15-44 suffer from infertility, 9 million LGBTQ individuals in the United States are without infertility coverage, and 58 percent of individuals forgo fertility treatments due to lack of coverage. Fertility issues do not discriminate based on race, religion, sexuality, or economic status. This means that you or several people you know are struggling to conceive, and may not have the coverage or access needed to build a family.
While some may only think about infertility once a year, this is a topic we discuss every day at Progyny. We are a company founded by those who have experienced infertility firsthand and know the impact — both emotionally and financially — it can have.
When we consider this year’s NIAW theme, what comes to mind is for those interested in their fertility options is to “listen up” to the increase of fertility benefits large employers are now offering.
Since 2015, companies have discovered that their employees want more than the traditional health and dental insurance plans, and have been looking for additional opportunities to support their employees with paid parental leave, adoption support, and fertility benefits. Regardless of what vertical the company is in, fertility benefits, including IVF and egg freezing, seem to be a larger part of the conversation than ever before.
According to a survey by Mercer Health and Benefits and commissioned by RESOLVE: The National Infertility Association, 65 percent of employers offering fertility treatment cited they were responding to employee requests for covering fertility benefits. If you are someone who has received an infertility diagnosis or are simply interested in learning more about fertility health, our advice is to listen up to what these benefits entail and understanding the arguments for introducing these benefits within your company. Listen up to facts you can share with your human resources department about how providing fertility coverage will not only save the company money but spare their employees the heartbreak of not having options when it comes to treatment. Your company could also actually see a decrease in absenteeism and an increase in attracting top talent with the addition of these benefits. Listen up, listen carefully, present what you’ve learned, and make it necessary for your company to listen up to you!
National Infertility Awareness Week overall is an opportunity to listen up, learn more, and educate others on this life-impacting issue. If you’d like guidance on what to present to your HR Team, please click here.
SONGS OF SPRING
Jay Palumbo, Member Engagement
The warm weather is here and as the saying goes, Spring has sprung! Whether you want to celebrate the sunshine, you’re looking for a personal theme song or want to listen to songs to lift your mood, here are some songs from my personal playlist to inspire you no matter where you are in your fertility journey:
A New Day Has Come Celine Dion
Beautiful Day by U2
Brave by Sara Bareilles
Brighter than the Sun by Colbie Caillat
Calling All Angels by Train
Carry On by fun
Express Yourself by Madonna
Fight Song by Rachel Platten
Firework by Katy Perry
Girls Just Wanna Have Fun by Cyndi Lauper
Good Woman Down by Mary J. Blige
Haven’t Met You Yet by Michael Buble
Hereomes the Sun by The Beatles
I Believe I Can Fly by Yolanda Adams
I’m Every Woman by Whitney Houston
Independent Women by Destiny’s Child
Keep Breathing by Ingrid Michaelson
No More Bad Days This Wild Life
Not Afraid by Eminem
Pocketful of Sunshine by Natasha Bedingfield
Roar by Katy Perry
Salute by Little Mix
Skyscraper by Demi Lovato
Soak Up The Sun by Sheryl Crow
Steal My Sunshine by Len
Stronger by Britney Spears
Stronger by Kelly Clarkson
Sun is Shining by Bob Marley
There’s Hope by India Arie
Tubthumping by Chumbawumba
Walking on Sunshine by Katrina the the Waves
We’re All In This Together by Ben Lee
Who Says by Selena Gomez
You Are Not Alone by Michael Jackson
You Gotta Be by Des’ree
GETTING TO KNOW YOUR PATIENT CARE ADVOCATE: CHASLYN
What do you enjoy most about being a PCA?
Being a PCA coincides with my primary values. I am very family oriented and being able to help others build families gives me joy. I come from a big Italian family where quality time, genuine conversation is a big deal. There are also lots of babies in my family right now and I’m so grateful that we are growing. We are always there for each other and I believe everyone should have the opportunity to experience that.
What is your favorite/best moment so far at Progyny?
Honestly, Fertility Benefits 101 training was my favorite. Jay Palumbo, Director of Patient Engagement, led Fertility Benefits 101 on 10/11/16 and told her story about her fertility journey. There was a PowerPoint presentation involved and she walked me through different battles that different patients’ face when undergoing fertility treatment. Initially, I assumed she was leading this training and discussing fertility treatment in general. I wasn’t expecting her to eventually show a slide with a picture of her baby…and refer to her battle. As I grew with Progyny, I did not realize how many of my colleagues endured this pain and the struggle of starting their own families. It gave me more insight, more faith in positive outcome, and definitely more of a purpose to advocate for my members preparing to face the same journey.
What does family mean to you?
Family is everything to me. My parents particularly are my best friends. I spend as many weekends as I can with them. I also have 8 siblings some of which also have children and it makes me so proud! I truly believe that family is a blessing.
Give one word to describe the impact you have made on a patient’s life: Solace
What is your favorite baby name? Scarlet
Who is your favorite celebrity baby? Reign Aston Disick
What was the last gift you gave?
After a long conversation about time and an emotional roller coaster that lasted longer than it should have, I ordered a specific vinyl record for a friend. The album referenced time and an hourglass – it wasn’t easy to find and my friend loves the band. I think it delivered a message that was better stated through music.
Where was the last place you traveled?
My parents have a house in Mexico. We’ve had it for about ten years. It’s our sanctuary and it’s in Cabo San Lucas, Mexico and that was the last place I traveled.
What is your favorite movie? Gone With the Wind
Last TV series you binge watched? AH! …Keeping Up with the Kardashians. It is my guilty pleasure!
April is Stress Awareness Month
In April 1992, the Health Resource Network (HRN), a non-profit health education organization, launched an annual “Stress Awareness Month” to make the public aware of the dangers of stress as well as options to explore for successful coping strategies. Every April since, health care professionals across the country come together to increase public awareness about both the causes and cures for our modern stress epidemic.
Even though Stress Awareness Month is in April, we can all agree that stress occurs year round. Especially when you’re having fertility issues and are going through treatment, it can be an incredibly stressful and upsetting time.
Involuntary childlessness is often described as a life crisis and is even likened to Kubler-Ross’ stages of death and dying. It can impact relationships, finances and self-esteem. Add to that the stress of going through either insemination or an IVF cycle; taking hormones, an increase in doctor appointments, not being able to predict the outcome, etc. and it’s very easy to understand why fertility treatment can create anxiety.
While it’s not clear how stress can directly impact fertility, finding ways to minimize stress while pursuing treatment, if nothing else, can provide moments of calm and reminders to breathe. Below are some suggestions of well-known stress reliving techniques:
While stress reduction doesn’t completely eliminate stress, by finding a technique or approach that best serves your needs, you can at least help reduce it.
HOW TO ASK FOR A FERTILITY BENEFIT AT YOUR COMPANY
Written by Progyny’s Director of Human Resources and Recruiting, Cassandra Pratt, and posted on FairyGodBoss.com.
If you are an employee interested in advocating on your own behalf for fertility benefits at your company, there are many ways to start the conversation. In fact, according to a survey by Mercer Health and Benefits and commissioned by RESOLVE: The National Infertility Association, 65 percent of employers that offer fertility treatment said that they began doing so in response to employee requests.
If you’re comfortable sharing your concerns, a great place to start is with your HR department. It’s also smart to enlist the help of other colleagues to show there is a real desire to have this type of benefit within your company. You also might try speaking to your manager and other senior level employees who might be able to assist in moving the request forward. Think of it like developing a grassroots campaign – open as many channels as possible!
When presenting your case to HR and/or the benefits team, talk in terms of where your current plan falls short. You can explain how adding a fertility benefit would improve your health and your work environment and how you feel it would fit with your company’s values.
A nice touch is to offer help with the next steps. This might include finding out who else may be interested, what you think it would accomplish for the organization (i.e. employee retention, stress reduction, or attracting a new / diverse talent pool). If you can identify current pain points for you, your team and the overall company, it will go a long way in moving the initiative forward.
Adding any benefit to a company can take time. The process is dependent on the size of the organization, whether it’s replacing a different kind of coverage, and what the process entails internally to make the decision. Depending on the company, you may need approval from the CEO, CFO or even the board.
It’s important to be patient, respectful and persistent. If this is something that affects you, odds are it will affect others within your organization. If you’re open to representing the cause, be persistent — and remember that you’ll likely be helping not only yourself, but also your colleagues and future employees who can relate to your experience.
TAX SEASON TIPS FOR FERTILITY EXPENSES
Tax Season is upon us! Brent Atkins, Progyny’s Vice President of Business Development, presents some helpful information about deductions on medical expenses on your tax return:
WHY COMPANIES SHOULD OFFER FERTILITY BENEFITS
Written by Progyny President of Healthcare Services, Karin Ajmani, and posted on FairyGodBoss.com
While more and more companies are adding benefits to support families by extending their maternity leave (and overall parental leave) policies and implementing programs that help employees return to the workforce after taking care of a child or loved one, only a handful of companies offer a benefit that addresses fertility-related issues.
In fact, according to the International Foundation of Employee Benefit Plans’ 2016 employee benefits survey, only a quarter of employers (with 500 or more employees) offer fertility services as part of their health care benefits. 19% cover in vitro treatment (IVF), 12% cover fertility medication and 9% cover non-IVF fertility treatments. However, even employers who do cover often don’t see the value since employees will exhaust their benefit before achieving a successful pregnancy.
The reality is that infertility has always been a complex issue, and some of the biggest challenges associated with it have been the high cost (the average cost for IVF treatment, for example, is $12,500) and the stigma surrounding it.
The good news is that more and more people are being vocal about their struggles, and we are becoming more aware of the problem. The bad news is that there is still a lot of red tape around receiving quality care. While the World Health Organization recognized infertility as a disease in 2009, only 15 states have a mandate on insurance coverage. With over 7 million people dealing with infertility and the small percentage of companies that offer a solution, the numbers just don’t add up.
When an employee is battling infertility, the employer will ultimately lose. The employer will be hit with soft dollars (the employee’s moral and presence in the workplace) and hard dollars (typically the hidden costs in treatment and possibility of high-risk maternity, multiples and NICU.)
The financial burden is not just on the employee. Due to the lack of coverage or restrictions from a limited benefit, an employee will pay out-of-pocket for treatment. This leads to choosing a treatment that is less expensive, less effective and has a higher chance of producing twins or multiples. Often, fertility medications are combined with artificial insemination. If that doesn’t work, IVF is often utilized and multiple embryos are transferred to increase the chance of pregnancy. While this sounds like a decent option, twins and multiples are incredibly risky, and 20% of twin babies will go into NICU (this goes up to 80% for triplets).
And who gets stuck with the bill? The employer. They’re responsible for the costs related to the high-risk maternity care that will likely include a C-section, pre-term birth and NICU expenses.
Next is the emotional distress that can leave an employee drained. When people go through infertility, they can suffer depression, absenteeism in the workplace and have higher rates of divorce. One employee’s morale can impact his or her team, which ultimately impacts the company overall.
Lastly, as more employers wonder what type of benefit will attract and retain employees, a survey has shown 90% of people with infertility issues are willing to change to an employer that provides fertility coverage.
The benefits of providing a comprehensive fertility benefits plan outweigh the downstream costs from maternity care — and they help a group of people who aren’t typically recognized.
It’s time to support your employees who are enduring this stressful and expensive journey — it will help both parties in the long run.
IT’S POSSIBLE TO HAVE IT ALL: A LIFE, CAREER & ENDOMETRIOSIS
Sherika Wynter, Voices Of Endo
Being a woman in corporate America is far from easy. Endometriosis does not help. Generally, I’ve chosen to be rather quiet about my endometriosis at the workplace. It’s not because I am ashamed but I do not need or want any other strikes against me. As I become more comfortable at a workplace, I may decide to share some of my experiences with other female coworkers if the opportunity arises. Women always seem to bond over “Aunt Flow”. If you choose this route, be ready for a positive and negative reaction. In my experience, I’ve had women be very sympathetic and show interest in learning more for their own benefit as well as their loved ones. I’ve also experienced the opposite and I’m told, “You are just looking for attention. It can’t be THAT bad.” In either situations, do not ingest those emotions. You have enough to deal with. Unless individuals show a vested interest in your condition, I would advise you not to look for a support system in the workplace.
I’ve never wanted endometriosis to have an impact on my daily activities. In the past, I would always try to push through the pain. But now, I’m now starting to accept I am not superwoman, even though I want to be. I’ll never forget, about 7 years ago, I went to work knowing that I was not feeling well. I wanted to push through because I was tired of being and being treated like I was sick. I was able to get through the first few hours and then things quickly went south. All of a sudden it felt like I urinated on myself. I looked down and blood was leaking out of my pants. I was newly diagnosed so I didn’t have an “exit strategy” in place. All I could do was grab my things and head home.
Since then, I haven’t pushed my body to its limit. My comfort level at that job was never the same. It just felt like everyone looked at me differently. That being said, when I feel pain higher than a 7 (on a 1-10 scale), I will immediately attempt to remove myself from my workplace. I do this because I’m not sure of the level of intensity that’s coming and the excruciating pain can be an extremely emotional experience. It’s also important to remember, you don’t need to explain yourself to anyone.
If you are aware of a procedure on the horizon, please notify human resources (HR). This way, if you need more time off and/or need to work from home, they will be able to discuss it internally with management. For example, when I went through egg freezing, HR made provisions during my treatment. I didn’t go straight to my management team, instead I spoke with HR to advise me on next steps. By law, they are your advocate. Use them. Also, establish your “exit strategy”. For me, I carry anti-inflammatory medications, menstrual pads and panty liners at all times. When I feel an onset of pain, I immediately go to the restroom and triage the situation. If after an hour, I’m unable to control the pain, I begin to clear my schedule so I can make it home safely. I may return to work later in the day, but I can never make any promises. If there is an immediate leave of absence, the next day I’ll inform HR about it. It’s hard enough to go through an episode, so it’s easier and safer for me to tell my job about it afterwards.
At the end of the day, it is possible to work, have endometriosis and be successful. It all revolves around proactivity, accepting your condition and listening to your body when it says, “I’ve had enough”.
BATTLING ENDOMETRIOSIS; A DECADE LATER
Sherika Wynter, Voices Of Endo
I have a very different outlook on life in my 30s after battling endometriosis for the last 10 years. I often find myself reminiscing on some of the promises I made in my early 20s: upper management by 30, married with child by 30, own a house by 30… All things society placed on me as necessities.
But here is my reality, I had my 4th laparoscopy a month after my 30th birthday. It was my longest, most draining and complicated surgery to date. It was also where they discovered my left ovary appeared to be non-operational. I was devastated and cried from the depths of my soul. I was left wondering..What did I do wrong? Where do I go from here? Is this the beginning of infertility?
All my questions no one had answers to. But as my reproductive endocrinologist said, “We don’t give up. We fight this. You will be fine.” For the last 8 years, he’s never been wrong, so there was no need to start doubting him now. I knew I needed to take my faith to the next level, believing, “What is for me, is for me.”
Putting Myself First
As I rounded the corner of 30, I began to place my personal life first because, at work, I am dispensable. In life, however, I only have one shot. I have to make it count. With that I mind, I started to prioritize my visits to my reproductive endocrinologist . During these visits, we would check my AMH (anti-mullerian hormone) levels, my ovaries and ensure my uterus is fluid free. Yes, I’ve frozen my eggs but I wanted to ensure that my body is still in a position to carry when the time is right. (Notice I said “when” not “if” — I believe my time is coming.) I’m also more cognizant of my food intake. As my dad would say, “You are no longer a spring chicken, Sherika!” I’m preparing my body for the long run as I’m ready to put up one hell of a fight.
Key Benefits for Work
Many don’t realize the impact endometriosis has on your career and it took time to learn what I needed from a company to balance both sides. Company benefits are more important now that I am diagnosed. When I interview for jobs, I make sure they have an option to work remotely. This way, if I’m not feeling well on a particular day, I can take the time I need to heal. I can go to my doctor appointments without feeling guilty or needing to take the entire day off just for an hour appointment. I also ensure their insurance is accepted by my physicians. It sounds extreme but it is very difficult to switch doctors with endometriosis. Our condition is complicated and coverage may be denied. For example, I’m currently paying for my last surgery because it wasn’t a covered procedure. I was able to negotiate a $52K procedure to an affordable amount but I was taught a valuable lesson. You have a right to inquire about these details in order to be proactive about your health.
2 for 1 Deal
Lastly, I’ve finally accepted that my endometriosis is a 2 for 1 deal, you get me, you get it. We are a perfect package for the right life partner and the right set of friends. For years, I’ve wondered if it was a hindrance, the reason why past relationships failed and the source of my singleness. I would beat myself up about it. Now, I realized it’s just another piece of the puzzle that makes me unique. Granted, every so often I find myself going down that self-guilt road but I remind myself, “There isn’t a more beautiful picture of you available. Shine with what you have.”
INTERNATIONAL WOMEN’S DAY
Whether its women who want to have children or women who want to help others have children, we aim to create access for all who may need to utilize family building options. This is why on International Women’s Day, we want to remind everyone to #BeBoldForChange when it comes to reproductive health.
One of Progyny’s regular messages is to be proactive when it comes to fertility. This entails seeing your doctor, getting the necessary blood work, an ultrasound (if needed) and speaking with a reproductive endocrinologist about your family history. It’s also about providing support and a shoulder to lean on when it’s needed.
In the spirit of International Women’s Day, as women gain more social, economic, cultural and political equality, we also need to be mindful that global support is needed to accelerate gender parity. The more you educate yourself about your health, the more you can become an advocate and lend your voice when it comes to the reproductive rights of those both near and far.
THERE’S NO SUCH THING AS “NORMAL” WHEN FACING ENDOMETRIOSIS
Sherika Wynter, Voices Of Endo
October 14, 2008.
You never forget your diagnosis date. It’s one of the most bittersweet days of your life. You finally get to let go a sigh of relief but you struggle with your next breath at the same time. You’re faced with difficult decisions and very little guidance. What you thought was the end of a long journey is just the beginning of an even longer and lonely expedition. You are never ready, but you have to fight.
My cycle started off as “normal” – 5-7 days with little to no pain and 28 days to the calendar. I was 13. About a year or so into my womanhood journey, things went south. Every month, my pain increased, my flow decreased and my lack of knowledge… it stayed the same. You see, no one tells you what to expect from your menstrual cycle. Your “normal” is based on the women you’re surrounded by, their knowledge and experience. It’s a part of parenting that no one speaks to. It’s the blind leading the blind.
The downward spiral
My ability to cope ceased around the age of 22, approximately 6 weeks prior to my emergency procedure. For first 8 years of my menstrual cycle, I knew I was out of commission for the first 24-48 hours of my cycle. Everyone in my family knew the routine. We had a system. Suddenly, that changed. I was experiencing daily pain, with no explanation. I visited the ER twice, within the first 2 weeks but was told I had everything from colitis to gas. Of course, I was unable to replicate the pain once at the hospital, making my story even more unbelievable. My parents believed me but that wasn’t enough. For the next 4 weeks, I kept a pain journal, marking my body with a sharpie for every place that hurt. I was determined to figure out the source of my ailment while others thought I was going insane. My logic was: if I cannot reproduce the pain, I can at least track it.
The morning of my diagnosis, I went to my OB-GYN. It was my Hail Mary. She was on call at the hospital and her colleague saw me. Her colleague did an ultrasound, concluded I had ovarian torsion and told me to meet my OB-GYN at the hospital immediately. Upon arrival, I was examined again and was told it was a misdiagnosis, that all my symptoms and problems were caused by endometriosis. I pleaded with her to look a little further as I was mentally, physically, and emotionally exhausted from all the pain. But she was certain and I had to figure out what all this meant.
The winner of this battle
From that day forward, I learned everything I could about endometriosis. I learned my trigger foods. I tried different medications. Some worked, others were an epic fail. I specifically focused on the havoc it could wreak on my reproductive system. I wanted to be an expert and an advocate for myself. I knew that if I didn’t speak up for me, this disease would kill me. Not literally, but my spirit, my drive, my mental stability. My mother and I searched the internet for a reproductive endocrinologist who valued both: wellness and fertility. Finally, we struck gold.
Upon finding my physician, we discussed my future and how we could ensure I would get my heart’s desire: a child. After finally getting my cycles under control, he urged me to freeze my eggs. Insert shock factor here. At 24, who wants to speak about the possibility of infertility? Is this real life? I didn’t want to think about it. But if I was going to be proactive, I needed to adhere to counsel. I finally agreed. For my 27th birthday, I froze my eggs. It was the best decision I’ve made thus far along my endometriosis journey. I finally felt like I won a battle in this war.
There’s no right or wrong way to cope with endometriosis. It really boils down to personal preference and priority. Over the last 8.5 years, I’ve had 4 laparoscopic surgeries and 1 cycle of egg freezing. For some, that’s plenty; for others, it’s a dream. One thing is sure: we all wish we knew sooner. For me, I wish OB-GYNs and parents were more proactive. I believe every girl who is menstrual should have basic knowledge on all reproductive issues. My mom had no idea what was right or wrong and for most OB-GYNs, “bad periods” are considered normal. They are not. There is nothing normal about it. The more the idea of “normal” is engrained, the harder it is to diagnose. I was told it was “in my head” by medical professionals and most of the women I’ve encountered that had similar experiences.
I also wish there were more prominent support avenues. It was hard for me to find the right group of women to support me through my acceptance phase. It takes years to accept an endometriosis diagnosis. Why? Because it’s constantly changing.. As a woman grows, her priorities change, her needs change, her body changes. The support I needed at 22 is very different than the support I need approaching 31. You often feel lost, resetting your support system each step along the way.
However, I urge you to start listening to your body and start asking questions. If you feel that something is wrong or isn’t “normal”, there’s a really good chance you’re right. It’s not “in your head” because you know your body best. Don’t be scared of speaking up, be scared of not knowing what could happen if you knew.
GETTING TO KNOW YOUR PATIENT CARE ADVOCATE: LISSETTE
What do you enjoy the most about being a Pateint Care Advocate?
I mostly enjoy having a role that allows me to provide personalized guidance, especially when briefing new members on how their benefits work and making sure they have a good understanding of it. Progyny provides the most generous fertility coverage in the United States right now and you can sense member’s excitement and relief, through the phone, when they hear that we do not limit them to a dollar amount in coverage. Whether it’s someone who’s undergone multiple treatment cycle or new to fertility treatment, being part of their support system already makes the member’s experience unique and positive.
What’s your favorite/best moment so far at Progyny?
A great moment was when we were able to send a member to an in-network clinic that was closer to her home. As you know, we’re growing and that means our network of providers is also growing. When she first came to me, the closest clinic was over 100 miles away making it hard for her to receive treatment. I reached out to our provider relations team to see if they could help provide this member with a closer clinic and it turns out this was a project they were already working on! How neat is that? The provider relations team recognized the need for more clinics in this particular area and it became a win – win for everyone. It was incredibly rewarding to tell this particular member that we had a clinic in her area. She was so grateful and I was so happy that I was able to help her utilize her Progyny Benefit as soon as possible!
What does family mean to you?
I have a small family and I love them very much. But I’ve also come to realize that my closest friends are also part of family. Family are the people that have seen and supported me through rough patches in life but also during my most joyous moments. Life wouldn’t be as meaningful without them! The best part is that my family keeps growing – at Progyny I already consider some colleagues to be part of my family and I enjoy being part of this team!
Give one word to describe the impact you’ve made on a patient’s life: Succor
What’s your favorite baby name?
Mila. It’s an adorable baby name! I’m also just a huge Mila Kunis fan!
Who’s your favorite celebrity baby?
My favorite celebrity baby would of course have to be Ashton Kutcher and Mila Kunis’ very own baby boy named Dmitri Portwood Kutcher! I’ve always been a fan of That 70s show where they played a couple on it before they actually dated. Now I’m happy to see these two awesome actors building their own family!
What was the last gift you gave?
I gave my boyfriend a beautiful MVMT watch because It was something he had talked about for a while. It was an unexpected gift and he really liked it!
Where was the last place you traveled?
I went to Montreal, Canada last year. I was there for a music festival with friends and it was so much fun! The food was amazing and being in a very bilingual city was a unique experience for me. You could see the French and English influence throughout. The architecture was just beautiful!
What is your favorite movie?
My favorite movie is Shutter Island. I’m very into psychological thrillers and anything Leonardo Dicaprio.
Last TV series you binge watched?
I am a huge Fan of The Magicians, a show on Syfy. I’m usually good at predicting what is going to happen on a T.V. show/movie, but this show has its many twists and turns. I enjoy the surprises!
WHAT BEYONCE’S FERTILITY CAN TEACH YOU ABOUT YOUR OWN
Jay Palumbo, Member Engagement
Beyoncé’s recent pregnancy announcement is causing the internet to rejoice, but while thanking Queen B for giving us something in the news that’s positive, this is also a great opportunity to discuss fertility and age. Why? Because Beyoncé’s news should be urging women to think about family planning and what exactly that means.
In 2009, I began down the path of infertility treatments to build my family and through my research I was able to find a strong community of people just like me. Over the years, we’ve cheered each other on, supported one another and shared a deep appreciation for whenever a celebrity has “come out” to discuss their own fertility journey. Mostly because it helps bring awareness to our community.
Now you may be asking, “How does this relate to me?”
If we take a look back, Beyoncé’s first baby was born at 31 and now at 35, she’s pregnant with twins. Regardless if she went through fertility treatments or not, this should be a good reminder of our biological clock. When you’re over the age of 32 years old (which in the real world isn’t old but in fertility years, it’s beginning to get up there), your egg quality starts to decline.
According to Dr. Maria Bucur, clinical nurse educator at Progyny, a woman’s ability to conceive naturally each month declines as she gets older. At age 30, the ability to naturally conceive is 20% each month and at age 40 it drops to 5% each month.”
An additional factor to consider as you get older, there’s an increase a woman will suffer a miscarriage. Even Beyoncé was open about her miscarriage, which I know those who have endured similar losses really respected.
Another celebrity who caused some speculation was Janet Jackson when she announced she was pregnant at 50 years old. Those in our community wondered if she used her own eggs, donor eggs or again, given the statistics, if she was just one of the luckiest, most fertile 50 year old ever.
Whether they didn’t do treatment or had any assistance, it’s ultimately nobody’s business. People are genuinely happy for them able to have a family. The real point is when we see a celebrity who is “older” (again, I use that term loosely) who is expecting, my concern as an advocate is it sends out false hope that you can delay having children and have no problem conceiving.
I’m not saying everyone should have children in their early twenties nor am I saying that everyone will absolutely have to go through fertility treatment if they wait. It’s simply smart to gauge your fertility not by what you read in the news or what someone tells you in the gym locker room (i.e. “I had a sister who got pregnant when she was 40!”) but more by being proactive and getting the necessary tests.
If you’re a woman, this would entail a consultation with a reproductive endocrinologist where you’ll review your medical history, get a sonogram (to check your ovaries, uterus and fallopian tubes to see if there are any polyps, fibroids, cysts or blockage) and a blood test to check your hormones, specifically your Follicle-Stimulating Hormone (FSH) and Anti-Mullerian Hormone (AMH). This will give the doctor an overall idea of roughly the amount and quality of your eggs as well as your fertility health. If you’re a man, you would go to an urologist and get a semen analysis to check the health and viability of the sperm produced.
So while we are all excited about the two new members of the BeyHive, I hope those interested in having children will use this moment to consider their own fertility health. I know it’s not quite as exciting as watching Lemonade but it’s equally empowering!
REPLACING HORMONE SHOTS WITH CUPID’S BOW
Jay Palumbo, Member Engagement
Valentine’s Day is upon us! If you’ve been trying to conceive or actively going through fertility treatment, there’s no doubt that the months upon months of contrived and controlled sex would affect your love life. When you first met your significant other, all you needed were two things: passion and privacy. It didn’t matter what day of the month it was, what position your cervix was in and lying down for an hour afterwards was by choice and not required. Although it may be easier said than done, it’s important to put fertility aside if only for one night and have some fun again. Here are some suggestions that might help!
TTC Free Night
No talking about sperm counts, ovulation prediction kits or anything perfunctory related to conceiving. It may also help to write down other topics you like to discuss that are in no way related to your uterus. It can be a hobby, a recent book you’ve read or a recent accomplishment at work. You are more than your reproductive organs so feel free to talk about the thousands of other topics that matter to you!
Netflix and Chill
If there’s any form of entertainment that helps get you in the mood, whether it be a romantic comedy, a romance novel, vampires, car repair (just throwing that out there), then make sure you have it on hand. Get lost in binge watching a show you both enjoy or a movie that transports you to another place and time.
Schedule Your Own “Sex Summit”
Plan a dinner where you sit down and tell each other what you like, don’t like, what you want to do more of and suggest at least one new thing to try. The summit alone can get you back in a fun, sexy mood.
Go Old School
First, borrow your parent’s car. Then, get a six pack, drive to a make out spot, hop in the back seat and get frisky. Who knows? You may get lucky in more ways than one.
Remember the Romance
Light some candles, get the music going, prepare a bubble bath and put on that sexy nightgown. Set the scene and enjoy all of it! How can one resist chocolates, rose petals and silk sheets? You’ve been stressed and serious enough so why not pull out all of the stops.
Book a Hotel Stay
Sometimes, when you’re out of your usual surroundings, you’re less distracted from household chores. No dishes to wash, garbage to take out or bed to make. So why not book a night away and treat yourself to the luxury of being removed from the house.
Forget the Rules
Every TTC couple has read a million anecdotes on what the best way to conceive. Sure enough those anecdotes have made their way into both our brains and bedroom. Let’s all give ourselves permission to just have sex for sanity’s sake! So before you have another “Baby Dance” while suspended from the ceiling in gravity boots listening to Barry Manilow’s ‘Mandy’ because your best friend’s cousin’s hairdresser told you that she got pregnant once doing just that — remember that sex is supposed to be fun!
The best gift you can give yourselves on Valentine’s Day is a night off from obsessing about conceiving and simply enjoy each other’s company. Whether you have children yet or not, you have each other and that’s something worth celebrating!
DON’T LET THIS STUDY FREEZE YOUR DECISION
Trish McMorrow, MSN, Clinical Educator at Progyny
Researchers in Australia sought out to answer the question, “What are the reproductive experiences of women who cryopreserve oocytes for non-medical reasons?” They surveyed nearly 100 women who underwent egg freezing at Melbourne IVF between 1999-2014. Of the 96 respondents to the survey nearly half said they had frozen their eggs in the past 2 years. While the study found that only 6% of the women had used their frozen eggs and only 3% had given birth using their frozen eggs, there are many limitations to this data.
A major limitation is, most of these women have recently frozen their eggs. Egg freezing has only recently gained traction and it doesn’t surprise me that of the 96 respondents from 1999 to 2014 nearly half had frozen in the past two years. I suspect that some of these women will plan to use these eggs in their future. This study can be used as an extra piece of information that a woman can use to help inform her decision, but I would take it with a grain of salt considering the limitations.
More Research Is Needed
More research is needed as the number of healthy women who freeze their eggs are proactively electing this procedure in order to avoid age-related infertility. If this study was conducted in a year or two, it would’ve had the potential to help women make more informed decisions. In the meantime, I always recommend for women to go for an initial consultation. Family planning can and should be a very informed process, whether in preventing pregnancy or planning for it.
The reality is that egg freezing is essentially an insurance policy. It is not meant to be a guarantee that you will need or want to use them. It gives a woman or couple the option shall you need or want to in the future, to use these eggs from their younger years when egg quality is potentially better.
Get the Facts
I always encourage women to get all the facts, consult with your OB/GYN and even make an appointment with a fertility specialist. You’ll be armed with the information you need to make the best decision for your future. Have an initial consultation, a fact-finding mission. More information is never a bad thing. Some may find out that they already have a decreased ovarian reserve and you can save yourself from the heartache in the future. Maybe your fertility specialist tells you they see no benefit in going through egg freezing. You never know until you get all the facts. Egg freezing is not a “one size fits all” family planning method but it can be seen as an insurance policy on your future family. Family planning is very personal and unique to each individual or couple.
It’s time to really consider your 5 to 10-year plan. There are a number of questions to ask yourself and your partner such as, where do you see yourself? What are you doing in life? Where do you want to be in your career and family? Do children fit into that equation? How important is it to have biological children?
Once you’ve had your consultation, considered the facts, and your desires for the future then you can decide if egg freezing is the right option or not. Till then, don’t let this study intimidate you from egg freezing.