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Mind your own womb

Nadirah Angail

pregnant bellySomewhere there is a woman: 30, no children. People ask her, “Still no kids?” Her response varies from day to day, but it usually includes forced smiles and restraint.

“Nope, not yet,” she says with a chuckle, muffling her frustration.

“Well, don’t wait forever. That clock is ticking, ya know,” the sage says before departing, happy with herself for imparting such erudite wisdom. The sage leaves. The woman holds her smile. Alone, she cries…

Cries because she’s been pregnant 4 times and miscarried every one. Cries because she started trying for a baby on her wedding night, and that was 5 years ago. Cries because her husband has an ex-wife and she has given him children. Cries because she wants desperately to try in vitro but can’t even afford the deposit. Cries because she’s done in vitro (multiple rounds) and still has no children. Cries because her best friend wouldn’t…

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Help Lift the Ban On IVF for Wounded Vets! #IVF4VETS

Serena H. Chen MD, IRMS at Saint Barnabas, 2015 @DrSerenaHChen

Just got back from Washington DC where I walked a few miles to visit the offices of NJ Senators and Representatives on behalf of two bills:  S 469 in the Senate and HR 2257 in the House.  I spoke, along with other members from the American Society for Reproductive Medicine (ASRM) to staffers about these bills which give access to our vets for technology they need to build their families.  Soldiers that sustain injuries during war that render them infertile are covered for IVF under their benefits through the Department of Defense (DOD) but as soon as they leave active duty their medical care comes under the Veterans Administration (VA) which bans IVF under a very old congressional law that was passed before we knew that IVF would be so helpful in helping so many people have families.

The irony is that many of the injuries that render soldiers infertile also render them unable to remain on active duty and that although the VA is committed to taking care of Vets and giving them medical care for the injuries they sustain while serving their country, the VA is specifically banned from caring for their patients need for IVF.

I have never been a very political person, (have always been a science geek) and like most physicians just want to take care of patients, but this particular situation seems so unjust and unfair that I decided to break out of my comfort zone and come down to DC to learn more about how our government works from ASRM and to understand this issue and help bring it to the attention of our congress.

ASRM showed us a CBS special on this issue that highlighted one soldier who lost one of his legs due to a blast injury, severely injured his other leg and also sustained severe injury to his testicles.  He and his new wife really needed IVF to conceive.  They are great candidates for the procedure since they are both young, and this young man, while he can play soccer very well on his prosthetic leg and leg brace, is unable to continue in active duty due to his injuries.  He receives health care for all of his medical issues from the injury from the VA but his VA doctors are forbidden by law to treat his infertility.

So HR 2257 seeks to just make the infertility benefits that soldiers receive under active duty under the DOD exactly the same as the benefits they would receive once they retire from the military and are under the VA health care system.  The senate bill S 469 also seeks to lift this ban and improve fertility coverage in the VA system.

Yesterday it was sunny and beautiful and over 60 degrees on Capitol Hill as I walked from office to office to speak with Congressional staffers who work on veterans affairs, health care and legislative issues about these bills.  Most of the staffers agree that it makes sense to support these bills, and as a NJ constituent, I asked for the Representatives and Senators to support these bills and consider cosponsoring them.  While a couple agreed that they would cosponsor, many staffers felt that while the bills made sense they would need to research and discuss further before making a commitment. THIS IS WHERE YOU COME IN.  If you agree that these bills make sense then please let your Representative and Senator know that this is how you feel.  As a patient that has struggled with infertility and a constituent, your voice means a lot.

IRMS and ASRM have already created programs to help vets with the costs of infertility.  So if you or your partner are a vet, please let us know, we are committed to helping vets access the care they need to have the families they want.  For more information please visit us at www.sbivf.com.

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From Your Fertility Doctor: Questions I Wish My Patients Would Ask

From-Your-Fertility-Doctor-5-Questions-I-Wish-My-Patients-Would-Ask-750x375

From Your Reproductive Endocrinologist/Infertility Doctor:  Questions I Wish My Patients Would Ask Me…. Or Just Because I Want You To See The Therapist Does Not Mean I Think You Are Crazy

Excerpted from original blog on MD.com

After over twenty years of taking care of patients, I realize that patients often do not ask me the questions that are really on their minds.  Of course, I try to tease that out when I meet with you and make sure I address the most common questions that patients in your situation ask. But still, many patients walk out the door with unanswered questions. Wouldn’t you feel better if I just addressed ALL your questions? This is what I’m here for please just ask!  Check out these questions I wish my patients would ask.  For more questions please see the full post on MD.com

Ask Me What You Are Really Wondering And Thinking About

If you think you might have cancer,then ask me: “Dr Chen, I’m worried that I might have cancer, do I?”. If you think that you are not having sex at the right time to conceive, then ask me: “Dr Chen, when is the best time to have sex in order to have the best chance to conceive a baby?”  No question is off limits or is something that I haven’t been asked before.  The only stupid questions are the ones left unasked.  (Sorry guys, but no, you don’t need to have sex twice a day, every day, in order to have a baby).

Ask Me Why I Am Recommending This Particular Treatment/Course of Action For You

I want you to understand where I’m coming from. I want you to know what I think and what the pros and cons are. I want you to be informed. I want you on board with your treatment, both heart and mind. You can only do that if you understand why I’m making the recommendations I make. You may have come in with some preconceived notions and ideas and it can be difficult to let go of these. Even if you completely agree with my recommendations, I still feel that your treatment will go a lot more smoothly and your stress levels will be a lot less if you understand the process as well as you can. You will be living with the consequences of these decisions for the rest of your life. Your active participation and understanding will prevent regrets later. (Yes, a baby can be exhausting. No, you cannot return the baby).

Ask Me For A Recommendation For A Therapist That Can Help You With Stress Management

Yes! I’m serious! See the therapist! No I don’t think you are crazy, but I do know that you are in my office for a reason and that reason causes a tremendous amount of stress no matter how grounded and well-adjusted you are. We have many studies demonstrating that while stress does not cause infertility, infertility causes huge amounts of stress. Really awful stress. Pathologic stress.  Stress that leads to clinical depression and anxiety disorders. Stress that leads to marital issues, even divorce.  Stress that affects parents even after a healthy baby is born. We don’t want to make healthy babies while making our patients mentally unhealthy.

Counseling patients on stress management really works. We have the data to prove it. No, we’re not taking about lying on a couch for years analyzing how your mother toilet trained you. We’re talking healthy stress management strategies because medical treatment is very stressful and the better you handle the stress the more successful your treatment will be. Yes! There is data! Lots if it! Please consider.  Please. (It’s ok if you are a little bit crazy, I’ll still take good care of you. :-))

OK. Enough yakking. Back to work making babies and freezing eggs. I can’t wait to hear what you think of my suggestions. Have any questions you were too nervous to ask your Reproductive Endocrinologist? Leave them in the comments below. I really want to hear from you – please write!

Xoxox

Serena H Chen MD

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The Taiwan Blog

By Serena H. Chen, MD
Livingston, NJ
December 2014
Disclaimer – the author is a Reproductive Endocrinologist at The Institute for Reproductive Medicine and Science (IRMS), headquartered in Livingston, NJ. That’s the formal way of saying that she’s a doctor who helps to make “test tube babies” for a living. She is NOT a writer, so she cannot guarantee complete sentences or correct grammar……

Subject: Taiwan Blog one week prior 12 11 14

Hi my name is Serena Chen. I was born in New York City to Chinese parents who were born and raised in Taiwan. In a week I will be going to JFK with my two younger brothers, my sister in law, 22 year old niece and 16 year old nephew so we can board a plane to Taiwan. My parents are fulfilling a lifelong dream (actually mostly my dad’s dream) of spending 6 months in their home country hanging out with family and they are flying all their kids out for the Christmas holidays. We’ve been talking about this trip for months – it’s hard to believe it’s almost time to go.

Subject: Taiwan 2014 – 6 days to go
I leave for Taiwan in less than a week. I haven’t been there since 1988. My dad and mom are there for 6 months, so my dad got tickets for his three kids to come visit. Two out of three of us are divorced/separated – fitting national stats. My brother with the “intact” family is bringing his wife and two kids – one just graduated from college and one is still in high school. My kids are not going (long story – buy me dinner sometime and you will get an earful). Anyway, it will be an adventure, I am sure.
I am looking forward to lots of food – high glycemic foods like dumplings and Chinese bread (Bao) – just the kind of food I daily tell my patients to avoid. My dad’s family is huge (he had eight siblings), so there will be many relatives to visit. Both of my parents met while attending medical school in Taipei, so I will probably meet a lot of their classmates as well.
Now I am starting to regret that I rebelled against Chinese school as a child. I was born in New York City and grew up in the Philly burbs. My parents wanted me to go to Chinese school but did not insist and they spoke a mix of English, Japanese (they lived through the Japanese occupation of Taiwan as children), Taiwanese and Mandarin. It is sad that I probably know more Hebrew than Chinese from helping my two boys prepare for their Bar Mitzvahs. I am sure there will be a lot that I do not understand and will get asked a hundred times, “Why you no speaka Chinese??? Ay Yaaah!” (That is the Chinese expression that most closely approximates the Yiddish “Oy Vey)”

Subject: Taiwan blog – 2014 – 3 days to go
Feeling a little nervous about leaving the practice and my patients for 2 weeks. I have never taken this much time away from the practice (I am a full time fertility doctor in a busy IVF practice at IRMS in Livingston, NJ).
My longest time away was in 2012 when I spent a week in Beijing to speak to a group of Chinese physicians who were IVF program directors from all over the country about IVF in the USA. This was comprised of an entire week of lectures at Beijing University China Center for Economic Research. Luckily the 40 hours of lectures were really only 20 because we needed translation time. Most of the physicians seemed to speak English quite well but seemed to appreciate getting the information in both English and Chinese. It was an amazing experience.
My dad is now busy sending my resume around to various relatives in healthcare in Taiwan (he is a retired general surgeon and my mom is a retired pediatrician) trying to get me a speaking gig. I told him I want to talk to as many people as possible about my favorite topics – IVF, freezing eggs and health and wellness. There are a lot of things I cannot talk to my dad about. He’s not the most approachable person in the world, a classic general surgeon. I remember hearing him yelling at the residents over the phone, so as a little girl I just tried to stay out of trouble. He never seemed to know what to do or say to me back then. Once I went to medical school, everything changed. We had so many things to talk about, so many things in common – it’s still a good thing. “Serena”, he would say as I practiced the surgical knots he taught me, “You need to tie a thousand percent outside the OR so you can be one hundred percent inside the OR!” He had classical training – lots of call, yes sir, no sir, should I cut the suture too short or too long sir? He passed a lot of that along to me, which definitely helped me at Hopkins. At that time Hopkins was a very macho residency, the more call the better, because then you got to see more patients. You got grilled in rounds and if you didn’t know something, you got reamed. I expected all that ahead of time just from talking with my dad. I knew not to feel entitled to do anything in surgery until I could be a good surgical assistant. This required anticipating the lead surgeon’s moves, actually understanding the surgery, the anatomy, and actually assisting the surgeon instead of being the anxious intern who is eager to jump in and just do as much as possible (which just annoys the surgeon).
Anyway, it might be nice to give a lecture or to talk to some people about IVF and what I do, now that my resume is all over the country! My dad may be retired from medicine but he’s not really retired. He’s having a great time.
My mom is not the retiring kind either. They have not been able to go to Taiwan until now because my mom was afraid to leave her busy pediatrics practice. Finally at age 80 she decided to retire. She had a hard time saying good bye to her patients, but her internist finally convinced her it would be better for her health to retire. My mom was always on call for her patients. I remember many family dinners as a child being interrupted by my mom being on the phone with a worried parent who had a sick baby….”How much diarrhea does the baby have? Is the stool completely liquid or just soft?” Yeah… great dinnertime conversation – I can eat through anything – nothing phases me.
Back to me feeling nervous about leaving the practice. I have been telling everyone about my trip; letting the patients know, clarifying their plans and the things they have to do to get ready to cycle (start treatment), and informing them who will be their resource while I am gone. I am very nervous but my patients seem very happy for me often sending me well wishes such as, “have a great trip Dr Chen!”, “Have a great time!”, “That is so exciting!”, and , ”That’s really awesome for you!”.
It warms my heart and I feel really grateful to have all these amazing and wonderful people in my lives. Such a cliché –but it really is a privilege to be a doctor, to take care of patients, to be trusted with such intimate information and to be able to make a difference. I’m sounding like a sappy lifetime movie now, but it really amazes me how my patients are wishing me well while they are struggling with infertility, which can be such a heart-wrenching personal tragedy.

Subject: Taiwan blog day minus 1
Leaving tonight!
Our car will be picking up six Chens and hauling us to JFK in an hour. My two brothers, sister in law, and niece and nephew. My niece works at a film production company and is busy downloading movies onto her laptop. I plan to hang with her on the plane.
I finally finished packing. I feel that I have both too many and too little of everything. Too many dressy clothes, too many casual clothes, not enough toiletries, not enough shoes? I suppose that “too many” depends on your point of view. I was quite proud of my packing, just four pairs of shoes! One pair of sneakers, dressy sandals, less dressy sandals, and casual sandals. All in neutral colors that would coordinate with all my neutral colored clothing. My brother was disappointed that he needed more than one pair of shoes. Everything is relative.
Now I am busy asking Dr. Google about best strategies to handle jet lag. Many different recommendations. Some are fun like, “reset your light-dark cycle by wearing sunglasses on the plane. You can pretend you’re a rock star.” I like that one. Some are not so appealing. “Avoid alcohol”, Hmmmm…Not fun. I have brought some melatonin and Benadryl. Jet lag is what I am dreading most.

Taiwan Itinerary

Subject: Taiwan blog: Day One

We are here! Mom and Dad were waiting at the gate outside customs for us. It is very early Sunday. We went for a traditional Chinese breakfast in the heart of Taipei. It consisted of half-diner and half-food cart. It is very crowded. I eat big bowls of hot sweet or sour tofu and crusty fried bread, so good!
We drop our bags at the hotel but can’t check in for another 7 hours.
We spend the time walking around the city. We visit NTU: National Taiwan University. My parents started medical school here in 1951. Then they met, fell in love, became doctors, came to the U.S. for training and had three kids.

Taiwan Blog Day 3-4

Today is the second day of bus touring Taiwan style: big orange bus with tasseled curtains, comfy reclining seats and multiple built in microphones and speakers for…Karaoke!

Yesterday we went to a national park and the North Coast of Taiwan. We had unusually beautiful weather despite this being the rainy season. After lots of walking, we watched a DVD on the bus about the Northern Coast. The rest of the trip consisted of a women singing French songs which played softly over the bus sound system. This kind of gave our trip an Indie movie feel, “The Watermelon Road: An extended American family of Chinese descent loses their way but finds meaning in their lives on a bus trip in Taiwan”.
Okay fine, I agree, I will never find success as an Indie filmmaker… I suppose I will try to stick to making test tube babies.

The Chinese diet is very high on the glycemic index. So many carbs! Tons of sugary treats to be had at the market, and tons of rice and noodles with every meal. I try to focus on the veggies but cannot resist the incredibly delicious juicy pork dumplings. I will get back to trying to eat healthier after vacation.

We have lunch at a market by the sea. The market has a crazy chaotic order: lots of loud talking and movement but everyone is polite, although the shopkeepers push their wares very assertively. The eating area is very crowded. We grab two tables for our party of 14 then walk half a block down the street to the famous duck and crab stand stationed right outside a Buddhist temple. Butchers chop roasted duck with lightning speed on butcher blocks in the open air and we quickly walk back to the tables with large plates of steaming noodles, veggies and cow stomach, sliced duck with fresh ginger, delicately fried crabs, sautéed veggies and big plates of tender and fresh bamboo shoots. Tons of people are here, but unlike US food courts there is a fast turnover and someone is there to clean the table as soon as one party leaves, efficiently loading the bright and shiny metal tables with clean plastic plates, chopsticks, napkins and cups of tea for the next group.

Today’s bus ride starts with a short Discovery Channel piece on the Hsuehshin Tunnel, an engineering marvel that has cut the long commute from the eastern burbs into Taipei by 75%. Pretty awesome, but now that I know all of the details about the massive geologic challenges they faced in digging this tunnel I can’t help but be just a little worried about it collapsing around us. After about half an hour, we literally see the light at the end of the tunnel and I feel a little better.
For our first rest and tour stop we go to the Taiwan Center for Pastry Innovation: more carbs!

Now the 18 of us climb back into the bus: This is four generations of Chens. The youngest is Andrew at age 4, the oldest is my dad’s older sister Auko (“older sister”) at 90 (and still going very strong).

We are winding on a cliff-side road halfway up an Oceanside mountain. I look over the side rail as the mountain drops steeply into an intense Aqua to deep blue sea. Beautiful.

We stop for construction in the road. This allows us to get out, stretch our legs and take photos of the view. Once we are back on the bus, more food of course. One of the aunts passes out packs of dried squid, (think beef jerky only with squid). Next some sugar cane to chew. Uh-oh, now the karaoke book is being passed around.

We do okay with Let It Be by The Beatles, but bring it home with Country Roads. You really haven’t lived until you sing about West Virginia in a bus full of Chinese people channeling John Denver in the mountains of Taiwan.

Taiwan Blog Day 5 Christmas Day

It’s now Christmas here as we are 13 hours ahead of the East coast. We settle into an unfamiliar rhythm. All of our cellular data is off to avoid international data charges. We take photos all day long then post dozens of photos at night when we get to a hotel with wireless access, this gives us much needed electronic brain rest.

It is cloudy, rainy, and gray today. We make our way out of Taroko Park and head down to the east coast of Taiwan.

On the way there are multiple tourist stops. It is very civilized, with bathrooms available at every stop. We look at ancient prehistoric stones – Taiwanese Stone Henge. I teach my sister-in-law how to do selfies on her iPhone. Now she wants to do selfies with everyone. I think her 23yo daughter and her 17yo son are going to strangle me. (Sorry guys!) There are scenic outlooks over cliffs which plunge into a blue sea. We stop for lunch at an organic farm, eat boar meat, stinky tofu, wild greens, and watch a demo of cooking with hot stones. We stop at the marker for the Tropic of Cancer and move into the tropical zone (and a little closer to the equator). Then, another stop at a famous bao (Chinese bun) place, where the fluffy hot steamed bread is filled with juicy pork.
Some other random places we stopped include a large pool filled with fish and surrounded by souvenir shops, and a place where water runs uphill.
Throughout the journey the 4 TV screens always have something on: Taiwan Has Talent; A sitcom featuring the adventures of a chimp in overalls wearing a bandana and a bulldog wearing a backpack; A drama about an FBI investigation of a murder of a Chinese American that takes place in Taiwan; and last but not least…..Karaoke!

Taiwan Blog Day 6, December 26, 2014

I woke up early this morning. There is no fitness center in the hotel, so I find a conference room to do my 7 minute High Intensity Circuit Training (HICT) workout and a few minutes of yoga and stretching. I am very stiff from so many hours on the bus.

For breakfast we try the Buddha Head (shijia) fruit that is unique to Taiwan. It looks like a plump artichoke on the outside, the inside is very soft, a little slimy, and very sweet. The grandparents are very excited for us to love this stuff as it brings back fond memories of childhood. I am really not enamored of this stuff but nonetheless I smile and eat. My politeness is rewarded about an hour later when the older aunties stop the bus to buy an entire crate of the stuff. We end up carrying this fruit around with us wherever we go. Hungry? No worries! We have more of the sweet, slimy, weird Taiwanese fruit! Happy! Happy! (not). My dad has been yacking about this fruit for days and days, on and on about how he had this when he was a child. But in the end, if you ask him if he likes it, he says no he really does not. I guess he just wanted us to experience the same food torture?

We are now driving down the coast, eating watermelon, dipping our toes in the ocean at Baisha beach at the southwestern tip of Taiwan, and birdwatching at Longluan Lake. We stop at South gate Pin Tong County at a baseball field to view the sunset and a rainbow.

For dinner we eat Pintong fish stomach. It is Shi Jiongs birthday. We drink to his birthday, family and health. “Genbei!” (Bottoms up, literally “empty cup”) We say as we raise our glasses of Taiwan beer.

930p arrives finally at my dad’s home town, the port city of Kaohsiung. My aunt and her niece have two big apartments in a luxury high-rise downtown. My mom and dad are staying with my aunt for 6 months. They arrived around Thanksgiving and will stay through April.

I go out with my brother Mike and my niece Lauren to get some gum, beer and scotch. Once back in the apartment we can relax, log into the Internet and upload all the photos of the day onto the Chen family cloud and Facebook. It is weird to have such limited episodic access to the Internet.

Taiwan Blog Day 7

Back on the bus! Today we are going to a famous shipbuilding yard at the port in Kaohsiung.

Kaohsiung’s brand new sparkling main library sports a dramatic four story mural on the glittering glass face. The art was rendered by my young cousin, rising artist and industrial designer YenAn Chen (aka “Anson”).

At Jong Shiyn Shipbuilding Group we see Jade Yachts, Coast guard boats, tugboats, and huge commercial tuna, grouper, mackerel, and squid fishing boats. The owner is neighbors and friends with my aunt so we go to the shipyard and get a film and tour of two of the shipyards, and get to board a 30 foot/ 5 bedroom/ 4 bathroom luxury yacht. My niece and nephew decide that the hospitable and gentlemanly Mr. Han who owns this hugely impressive company reminds them of an evil villain in a James Bond movie (mostly because of his somewhat dramatic looks, unusually long wavy hair, expensive tailored clothing and dark glasses) “Mr. Han, the name is Bond…James Bond” (followed by piercing, significant looks into the camera).

Taiwan Blog Day 8

It is Monday December 29, 2014. We go to Tainan, the oldest Confucius Temple in Taiwan. My niece and nephew torture my parents by taking dozens of photos in front of the Confucius scrolls while calling out to them to “Look wise Ama and Pop pop!”
My parents can’t stop smiling and the photos get a lot of likes on Facebook.

At the Fish Market at Ohahliao “Oyster Village” we watch fishermen gutting fish on the dock. Pulling out roe, testicles and stomachs out of the Mullets to be sold separately. We eat mullet testicles. They are kind of mushy, but not really fishy, kind of creamy. If you can wrap your brain around what you are eating, they are actually much tastier than fish or pig stomachs.

Taiwan Blog day 9

There are 10 of us plus our driver in a very efficient Hyundai van (4 rows of seats, 3 rows of 3 plus 2 people up front). We have to load ourselves in order, like a human puzzle in a metal box. Once we buckle up, it’s quite comfortable.

We drive up north to Chisan to visit the family graves. My aunt has a bag full of incense. After a little bit of a search for the headstones at the immaculately clean hillside site we find Uncle Number 5’s gravestone, light incense, say a prayer, and take photos. Then on to cousin Akiong (uncle number 2’s only son who died of a heart attack at age 49. We just met the three sisters the other night). Same routine: incense, prayer, photos. Then a prayer to the God who watches over the graves along with incense. Finally after walking through a dozen rows looking for the character for “Chen” and finding a lot of Chen’s but not the right one, we find the one that has a double red headstone 4 rows above the black stone section. We perform the same routine. Incense, short silent prayer and a few photos under an incredibly clear blue sky.

The country air is clear, Kaohsiung clearly has a smog problem in comparison. What are we humans doing to our health with all this pollution? New Jersey’s air is so much cleaner – hard to believe.

For dinner we eat small freshwater eels at a street side cafe. They are smoky from the hot wok, and yummy. After midnight I wake up with a stomach ache, nausea, vomiting and diarrhea. Not fun. Could it be the eels? Everyone else is fine. Hopefully this will resolve. This will not make the 14 hour flight back very easy (ugh).

Taiwan Blog Post Script
Today is my 6th day back, and first full day at work. Sleep has been odd and the brain is definitely still feeling jet lagged. Like dropping my keys inside my car, right underneath my nose and not being able to locate them for 20 full minutes.
The trip was amazing and wonderful. The best part was hanging out for hours and days with family I hardly ever get to see. Seeing my parents happy and full of stories and memories was amazing. Just hanging out with the New Jersey Chens for an extended period of time was wonderful. They get hungry as often as I do and are not surprised by the frequent requests for bathroom breaks. They are totally supportive of late night runs for scotch and love to post on Facebook and like all my photos – my people!
So nice to go to the cafeteria and get a big cup of Starbucks and a big avocado and cheese wrap. Pizza has got to be one of the greatest inventions ever – how does anyone in Asia survive without it?

Copyright Serena H. Chen MD 2014-2015

Chen Family Taiwan Trip 12 2014

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Egg Freezing, Fertility, Fertility Preservation, Health, Infertility, Trying to Conceive

Facebook and Apple Pay for Egg Freezing: Good, Bad or Ugly?

Facebook-and-Apple-Egg-FreezingImage courtesy of Photokanok / FreeDigitalPhotos.net

As a reproductive endocrinologist and fertility specialist in NJ, I talk about and actually freeze eggs every week. For many years I helped to conduct egg freezing research, so the fact that egg freezing is no longer considered experimental is liberating for me as a physician. It is wonderful to be able to tell women that they have yet another option, with measureable and very reasonable success rates. Young women with cancer do not have to give up hope of having a family just to survive – egg freezing can significantly improve their chances to conceive after egg-toxic, but life-saving chemotherapy and radiation. Egg freezing can be used to preserve fertility for any medical condition that threatens fertility or mandates a delay in child-bearing.

Now, Facebook and Apple have taken the bold step of paying for egg-freezing for non-medical reasons – covering egg freezing for employees that want to freeze their eggs not because they have cancer or some other medical condition that causes infertility but so they can electively delay child-bearing or preserve their fertility if they do not have a partner or are not yet ready to have a baby.

The announcement of this new employee benefit at these highly visible companies has many people wondering: is this a good thing or a bad thing? Is this a pro-family, pro-female, supportive move by these companies to give their employees more choices? Is this an effort to give women what they want, and position these companies as highly desirable places for the best and brightest young, talented females to work? Or is this a patriarchal move in a male-dominated sector to signal to their female employees that egg freezing is in,

is this a #Patriarchal move to signal to their #FemaleEmployees that #EggFreezing is in?

but pregnancy, and all the workplace issues attached to pregnancy: maternity leave, family obligations, child-care issues, are out?
#pregnancy #WorkplaceIssues #MaternityLeave #FamilyObligations #ChildCare issues are out?

I am taking the glass-half-full point of view: so many of the highly successful technologies in my field of infertility are not covered by insurance, I applaud Apple and Facebook for giving this benefit to their employees. I hope they make certain that the egg freezing benefit is only one component of family friendly policies for both men and women, so people can thrive at work and at home. I see egg freezing as a very positive, proactive option in an entire range of things that women can do for themselves to preserve their fertility, health and wellness and I hope women at these companies will see this in the same way: as another choice they can make for themselves.

@DrSerenaHChen hopes #Women @Facebook #Apple will see this as #AnotherChoice they can make

Egg freezing is not for everyone, but every woman should know about it and understand the basics. All physicians who care for women should know and understand how to counsel women to be proactive about their fertility and their reproductive health. Physicians should be telling women that smoking will kill their eggs and that excess weight significantly increases the risks for infertility and miscarriage and that fertility in women declines significantly with age, especially after age 35. Physicians should tell women that if they have fibroids or endometriosis, or PCOS (PolyCystic Ovarian Syndrome) or a family history of any of these conditions that they should be proactive about getting an evaluation before they are ready to conceive, that there are things they can do now about these conditions to try to give themselves a better chance at conception later. The ideal age for egg freezing is between 25 and 35 and this can be a complex decision that requires time and consideration. Women should know about and understand their options without the pressure or panic of the biological clock and that means being proactive about counseling all young women, starting in their early 20s. Having this benefit available to employees gives them the space, the comfort and resources to be able to consider this as an option, one of many. One of the best things about this new benefit at Facebook and Apple is the media attention it has generated. Knowledge is power and Facebook and Apple have dramatically raised awareness of fertility issues and the option of egg freezing for fertility preservation for women everywhere. Hopefully other corporations will follow their lead and realize that paying for prevention of problems may have more benefits for employees and employers than only paying for treatment of disease.

http://femaledoc.org/facebook-and-apple-pay-for-egg-freezing-good-bad-or-ugly/

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Thinking About Freezing Your Eggs? Get Healthy Now!

Originally Posted on http://www.fertilityauthority.com/

Fertility preservation is a hot topic these days. With recent dramatic improvements in live birth rates using previously frozen eggs, the American Society for Reproductive Medicine (ASRM) just declared in October 2012 that freezing your eggs prior to cancer treatment is no longer experimental. Then, in July of 2013, the American Society for Clinical Oncology stated that all women of reproductive age with cancer should have counseling about egg freezing before they undergo cancer treatment. Egg freezing for fertility preservation is rapidly becoming more main stream and is now becoming an important option outside of the cancer setting. With live birth rates that are essentially the same as fresh eggs, freezing eggs may make sense for any woman who, for whatever reason, medical or social, cannot have a baby right now. This is exciting, cutting-edge technology, but there are other, very simple things you can do right now to preserve your fertility and maintain reproductive health.

More and more women who are concerned about aging ovaries but not yet ready or in the right circumstances to have a baby are coming in to my office to consider freezing their eggs. One of the biggest barriers to this technology is that it is expensive ($8,000 to $15,000 dollars to freeze each “batch” of eggs) and is not covered by insurance (many insurers are starting to cover freezing prior to cancer, but elective egg freezing is almost universally not covered). This is why the new EggBanxx program to make egg freezing more affordable and accessible is so exciting. It is also exciting that the technology is now so advanced that at many high quality IVF programs, the money for egg freezing can really be worthwhile given excellent pregnancy rates that are improving every day. At the very least, it may be very worth your while to at least sit down for a consult with a reproductive endocrinologist experienced with egg freezing to get an evaluation of your current fertility, your fertility risks and a detailed discussion of the process and whether or not it Is something that is reasonable for you to consider.

Now let’s talk about other things that can be done to preserve your fertility besides freezing your eggs.

Get Healthy

Number one – get healthy. A healthy body and mind support fertility and may even protect against infertility.

Quit Smoking

Smoking will cause you to go through menopause 1 to 2 years earlier, and even more importantly, before menopause there is a significant association between smoking and diminished ovarian reserve. Bottom line – smoking prematurely ages your ovaries – also your skin. And don’t forget about the dramatically increased risks for cancer, heart attack and stroke! Quit smoking! Do it now – while you still have eggs. Nicotine patches, gum, Zyban (Wellbutrin) and even Chantix may be healthier alternatives to smoking. Talk with your doctor if you feel you need help to quit.

Smoking is such a powerful ovarian (and testicular) toxin that, in one large study, even when neither partner smoked, if only one partner was regularly exposed to second hand smoke, these couples had higher rates of infertility, miscarriages and children with birth defects.

Get To Or Maintain a Healthy Weight Through a Healthy Diet and Exercise Routine

Overweight and obesity is associated with many medical problems including higher rates of cancer, cardiovascular disease, diabetes, kidney, liver and joint problems. It is also associated with significantly higher rates of infertility, miscarriages and birth defects. We also know from a very large study by Drs. Chavarro and Willet at Harvard that a low glycemic index diet is associated with higher rates of fertility. A low glycemic index diet is essentially a healthy diet – one that avoids sugars and processed carbohydrates and has lots of vegetables and is low in fat and high in nutrients. Even people with a normal weight can improve their fertility by improving their diet.

Exercise in addition to a healthy diet can help with getting to or maintaining a healthy weight.

See Your Doctor for Regular Check-ups

Make sure you have a yearly visit to your gynecologist and primary care doctor. The practice of medicine is becoming more proactive today and we are starting to learn much more about wellness. While doctor’s visits in the past were all about diagnosing and treating disease, good doctors today can help you do the right things today to lower your risks for disease tomorrow.

Address Specific Risk Factors

Your doctor can address specific risk factors to help you be healthier. Do you have a family history of diabetes? You may need to be more careful about your diet even if you are a normal weight. Does anyone in your family have endometriosis? That increases your risk for endometriosis significantly. Endometriosis is strongly associated with infertility and women on birth control pills tend to have much slower progression of their endometriosis. So if you have endometriosis, part of your fertility preservation plan may be to take birth control pills.

Birth control pills may be a good fertility preservation plan for women with irregular cycles. Many women with irregular periods or no periods have a condition known as PCOS or PolyCystic Ovarian Syndrome. Birth control pills can normalize the hormonal environment in these women’s bodies and lower their increased risks for ovarian cancer and endometrial cancer (cancer of the lining of the uterus).
For women with no periods due to a condition called hypothalamic amenorrhea, birth control pills can also help them to stay healthy by maintaining hormonal support of their reproductive organs and protecting their bones from osteoporosis.

Do you have a family history of premature ovarian failure? Do any genetic diseases run in your family? Do you have fibroids? Does anyone in your family have fibroids? Have you had previous pelvic surgery? These are examples of factors that may impact your reproductive health risks. Talk with your doctor about your personal and family medical history to assess your personal risks. Talk with your doctor about ways to further assess those risks and to lower them.

Don’t Delay For Any Reason – The Biological Clock is Real

You cannot have a baby before you are ready, but at the same time, do not delay becoming pregnant for no reason. Infertility treatments today are quite successful but do not guarantee success. Age related female infertility is still one of the most difficult forms of infertility to treat successfully. Be informed about your decisions – don’t be the woman who “forgot” to have a baby – be the empowered, informed and proactive woman you are and plan for a healthy pregnancy.

Preserving Fertility Is More Than Freezing Your Eggs

Bottom line – even if egg freezing is not for you, you can help to preserve your fertility by creating healthy habits, breaking unhealthy habits and becoming informed and proactive about your own, personal risk factors for infertility.

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Health, Pregnancy

Obesity and Pregnancy: Time For Straight Talk

The New York Times just published an article on the tremendous risks to mom and baby from maternal obesity (http://well.blogs.nytimes.com/2014/07/07/overweight-and-pregnant/?_php=true&_type=blogs&_r=0) because the American College of Obstetrics and Gynecology (ACOG) Committee on Ethics just released a Committee Opinion on Ethical Issues In the Care Of The Obese Woman (http://journals.lww.com/greenjournal/Fulltext/2014/06000/Committee_Opinion_No__600___Ethical_Issues_in_the.49.aspx ).
The prevalence of obesity in the United States is growing rapidly and many physicians feel that it is becoming an epidemic. While we debate about whether or not we can call obesity a medical condition, the reality is that excess weight and obesity is the cause of multiple medical issues and can worsen the course and outcome of many conditions, including pregnancy. The impact is so great that we can confidently say that the risk of dying during pregnancy, labor, delivery or postpartum (the period of time from 0 to 8 weeks after delivery) is significantly increased for mother and baby, if the mother is obese. Dying – that means – DEATH. Sounds serious doesn’t it? But there are numerous issues involved in dealing with obesity, not the least of which is the social stigma that surrounds being overweight and the natural tendency for physicians and patients to feel uncomfortable discussing it.
ACOG recommends that we classify obesity as a medical condition. They state that “Classifying obesity as a medical condition can serve to reduce bias toward obese patients and to change the approach toward the patient from one of blame to one of caring.” They recognize that we should not deny care to patients based upon bias but upon medicine and that sometimes, obesity can create risks that require a physician to decline treatment or to refer to another specialist if a physician cannot provide safe and effective care.
While I am not at all interested in the debate about whether or not obesity is a medical condition, I am very happy about the ACOG approach. If calling obesity a medical condition makes patients and physicians take this issue seriously, and removes the stigma from directly addressing this at every visit with every overweight patient, then that will go a long way towards solving these issues.
If you are overweight, it is time for us to talk – directly, without bias, and with compassion… but we need to talk! And as your physician, I need you to take me seriously but not take it personally. I am not trying to insult you, I am trying to help you become healthier and to have a healthier pregnancy and baby. Getting to a healthier weight will make a difference now and for the rest of your life. Work with me.
Serena H. Chen, MD, FACOG
http://www.sbivf.com
http://serenachen.md.com/
Copyright 2014 Serena H. Chen, MD

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