In Honor of...

Memorial Day is such a mixed bag on the American cultural horizon. For most, it's a great holiday, the unofficial start of summer. The day it's acceptable to start wearing white again.

For some very special families, however, the term "Memorial Day" reverts to its original meaning: the day for recognizing those very brave men and women who lost their lives in the service of our great country.

In the course of my work advocating on behalf of families with infertility, I've become acutely aware of how this disease affects military families in such unique ways.  In honor of the very special people who have dedicated - and lost - their lives to protect our freedoms and for those who have survived, only to try and start to live normal lives, I share these stories.

While my then-husband and I were struggling with our efforts to have a baby, I met a woman with a unique issue. She and her husband had desperately wanted to become parents, and while in training, he had an accident that resulted in his death. Fast thinking medical personnel, knowing of their dreams, retrieved his sperm in a timely manner, preserving it for her attempts to become a mom to her husband's child.  Unfortunately, military coverage for reproductive treatment being deplorable, and unable to treat her issues, that dream didn't happen for her. Since then, I have been working with RESOLVE: The National Infertility Association on legislation to improve access to treatment for military families.

A few months ago, I spoke with Meredith Beck, who works for the Bob Woodruff Foundation.  The Foundation was named for, and started by, the ABC reporter who suffered a brain injury in Iraq and provides grants for post 9-11 injured warriors working in Iraq.  She previously worked at Wounded Warriors.

As we all know far too well, people suffering from infertility feel alone and think they are the first ones to experience it.  For vets, it's no different, and goes to the essence of how they feel about themselves post-injury.

I asked Meredith to tell me some of the stories of vets she encountered and she was happy to comply.

After being shot by a sniper in Iraq, Matt became a quadriplegic and wouldn't be able to have children without Assisted Reproductive Techonology.  Tracy, his wife, was on the fence on how she felt about infertility treatment. But Tracy said "that sniper took everything from me, they can't take a family." And paid for infertility out of the funds they received from Traumatic Members Group Life Insurance.  Although the money is intended to pay for immediate expenses upon injury, for bringing family to bedside, Matt and Tracy wisely allocated the funds to preserve resources for the treatment of Matt's infertility, enabling them to become parents.  Tracy says that Matt is an amazing father, even from a wheelchair.

Tricare (military health insurance) regulations around infertility are confusing to everyone.  Few people understand how the legal, religious and emotional details affect members and veterans of the military.  No one knows exactly what benefit is available to whom and when. I am proud that RESOLVE is helping to figure it out and educate what the Department of Defense system can do and what should be made available. Because of all of the advocacy we have devoted to this issue, language was included in the 2015 Defense Authorization Bill to provide that Tricare will now pay for fertility services (IVF) for those on active duty, but once service members leave active duty, it will not pay for "medically retired people". 

As we've heard about on CNN and other news sources, service members are dangerously at risk from "Improvised Explosive Devices" (IEDs). Once hit by an IED, a soldier gets "medically retired" pretty quickly, so they would have to use the benefit immediately while in the hospital.  Imagine waking up in a hospital after being blown to bits - do you think that your first words will be "Extract my sperm, NOW!"?  (I wonder if we should make medical bracelets for these men, like for hemophiliacs, Jehovah's Witnesses or allergies.)  Meredith told me a horrifying story of another soldier, serving with a British group when he was injured. The British policy is to automatically extract sperm from a soldier injured in the relevant area, but, shamefully, it's not the American policy.  The Brits thought he was British, and while in the field hospital were about to extract, when they discovered that he was American.  So they didn't extract his sperm and he forever lost the opportunity to have children with his own DNA.  "If they don't decide at that exact moment to extract, he loses it," Meredith said.   "The excuse is that it's not life saving, but there are decisions made for quality of life.  We have the ability to make them whole, why not do it?" 

We are all too familiar with the awful conditions that existed for returning service members from the Viet Nam War...how they were vilified by society, how many ended up out on the streets, handicapped and unhireable...  In mental institutions, homeless shelters, or worse, in prison.  The Department of Defense has been committed to not letting these conditions recur for veterans of more recent wars.  "The goal is to successfully transition service members or veterans to the community, with the highest quality of life possible," Meredith said.

If that's the case, then the military has an obligation, Meredith pointed out, to provide the best tools for successful transitioning.  Another story she shared was about a man with uro-genital trauma from an IED in Afghanistan.  He's not married nor in a relationship, but is acutely aware that for the rest of his life, he has to tell women that he can't provide children. Twenty two members of the military are committing suicide each day.  Sex, children and intimacy are huge portions of forming meaningful relationships.  If Tricare doesn't cover treatment, and if the Veterans Administration continues its ban on providing in vitro fertilization treatment in VA facilities, how can we hope that service members will be successfully transitioned?

With the advice and cooperation of RESOLVE, Senator Patty Murray recently introduced The Women Veterans and Families Health Services Act of 2015 (S. 469), which will provide, among other things, coverage for veterans injured in the line of duty for medically necessary infertility treatment.  Additionally, it will provide for cryo-preserving sperm and eggs for service members before they are deployed.  And just a few weeks ago, Rep Jeff Miller introduced HR 2257, to improve access to reproductive treatment (IVF) for disabled veterans (that is, lift the ban on IVF at VA facilities).

Military families deserve our help and support, not only as memories, but for their future.  They deserve this long overdue legislation.  In honor of this holiday weekend most of us enjoyed with beaches and barbecues, please ask your elected representatives to support this critical legislation.

PS After I wrote this, I learned that The Washington Post covered the proposed legislation over the weekend. 

This is great news.  Although the House legislation, introduced by Chairman of the Veterans Affairs Committee doesn't go as far as the Senate bill, it is still a great step forward and would help so many military families.  Baby steps....

Click here for article.

Eggs and the Single Woman

Thoughtful? Forward thinking? Prudent? Single women who choose to freeze their eggs are all of these descriptions, but they are not, despite what one physician says, "desperate".

A major breakthrough in preserving women’s reproductive options was achieved about a decade ago and has begun to be embraced by more and more women with the financial means in their 30’s and early 40’s: egg freezing. Even two family-friendly tech companies have announced plans to cover the pricey procedure by insurance. While this won’t help the 7.3 million American families currently diagnosed with infertility, it is certainly great news for the next generation of women who desire to become parents at some point in their future.

Although there are many factors leading to a diagnosis of infertility, the inevitable aging process or the incidence of certain diseases are certainly prominent and incontrovertible facts. Changing socio-economic dynamics in our population means that people - men and women - are staying single longer, which, given longer life expectancy due to scientific advances, is a logical behavioral adjustment for both sexes. The egg freezing technology doesn't exactly extend fertility in the same way that Viagra extends libido or hip replacement surgery provides for extended mobility, but it does provide new opportunities. It liberates not only women, but men too, who find themselves in love with a woman their own age and don't want to choose between a real partner who they love or a mythical partner who can still conceive with her own eggs. It gives women options, puts them on par with men who can delay genetic parenthood until the timing is more optimal in their lives. For women who formerly had the choice to risk their fertility in order to save their lives with chemotherapy or radiation treatment, egg freezing is a godsend. It is undoubtedly a majestic opportunity - for those who can afford it - to preserve their dreams of becoming moms.

Elle Magazine published an article about Egg Freezing in the April Issue ("Frozen Assets"), which lays out some of the obstacles and successes of egg freezing for women, as well as the impact on the choices freezing has on women.

One infertility specialist, however, used his interview for this article as an opportunity to denigrate women and reduce egg freezing (from which his clinic no doubt benefits greatly) to nothing but a salve for the hysteria of spinsterhood: "The freezing effect is a real phenomenon," according the Alan Copperman, M.D.. He claims that women's dating lives improve after freezing their eggs: "They're more relaxed. They're not desperate." (emphasis added)

In one sentence, Dr. Copperman insulted and dismissed the legitimate fears and pain of infertility patients and sent single women back to the 50's: He referenced the " 'just relax' and you'll get pregnant" fallacy, undermining the fact that infertility is actually a disease recognized by the CDC and the World Health Organization. And he demoted the legitimate choices of women to preserve their eggs for future conception pursuit to their need to reduce their alleged desperation to escape the curse of being left on the shelf. He ignored the socio-dynamic changes that affect both men's and women's choices to delay marriage as well as the economic realities of an increasingly competitive environment where two income families are the necessary norm. Copperman's dating advice to single women is "just freeze your eggs and you'll find husband", as if egg expiration anxiety was the primary reason for prolonged single-hood. Most egregiously for publication in a women's magazine, he made women sound like their sole reason for looking for men is to get knocked up. Silly women! Just relax!

The decision to undergo treatment to freeze one's eggs is not made lightly. For cancer patients, it is simply a miracle. And for single women, whatever their reasons for delaying the attempt to conceive, it is a phenomenal opportunity to not have to sacrifice one dream for another - if you can afford it (or work for a socially advanced company). Responsible choices should never be relegated as the acts of "desperate" women. And men, particularly those benefitting from those choices, should stop promoting this outdated idea that catching a man is a woman's reason for everything.

This Bird You Cannot Change...or Can I?

I get most of my news from Facebook and Twitter, where I can manipulate my news feed for selective exposure to only the information I want to know. Thus, I am the first to know when House Republicans proffer anti-choice legislation, immediately tipped off to the latest UN Resolution against Israel, up to date on the latest companies to remove GMOs from their food, and urgently instructed to race out for the newest eye cream before I irrevocably lose elasticity in the delicate area above the cheekbone. The randomness of my interests is, not surprisingly, echoed by many of the people who appear in my Facebook feed.  

"We like the same music - we like the same bands - we like the same clothes," my Boss sang.  

It's only when I travel outside of my self-made community with my highly focused information input, that I become aware that not everyone knows about the things that are intrinsic to my approach to the larger world. 

I have known my way around Capitol Hill since I was a freshman in college, when I advocated on behalf of Soviet Jews imprisoned behind the Iron Curtain. Throughout my adult life, I have made my way down to DC regularly to rally for reproductive rights or traipse through the halls of Congress in support of foreign aid to Israel. I was never alone in any of these missions, rather, it would have been unthinkable for me, in the world I made for myself, not to join my friends on these junkets. And when I arrived in DC, I encountered dozens upon dozens of acquaintances I knew from various stages of my life. It was always one big reunion. But I always advocated for issues far beyond my personal experience, for change in policies that would benefit people far from me, rather than affecting my individual life.

Then along came infertility. 

Infertility stripped me of my dignity, my dreams, and my hopes for a certain kind of future. But it also forced me to align with women all over the country who live differently than I do, with different values, education and focus. Except for one thing: the desire to become a mom.  

My infertility posse have literally been my lifeline for the past eleven years. They have supported me and comforted me and advised me and changed me. They are teaching me to fly. I don't know where I would be without them.  

So in their honor, I began to advocate for rights for people trying to build their families. And that means (among other things) each year I travel to Washington, D.C. For RESOLVE: The National Infertility Association's Advocacy Day, where I capitalize on my experience on Capitol Hill and relationships with members of the New York Delegation and female members of Congress to pursue an agenda to alleviate the suffering of those with the disease of infertility.  

Advocacy Day is different than any other previous philanthropic or political activity I have ever engaged in. Because infertility is different. It doesn't just affect Jewish/Zionist, health-obsessed, Pro-choice women with a passion for effectuating change through the political process. In fact, it is indiscriminate in who it afflicts.  

So, when I attend Advocacy Day, I never know who I'm going to meet. And what I will have in common with them. I don't know what pages they follow or to whom they tweet. And yet. Somehow, we all understand each other, have tolerance for each other's idiosyncrasies, differing views and values. And appreciate the understanding eyes and sharing a common goal.  

I have come to understand that most people don't grow up marching up and down the Mall for rights, that most only have a vague idea about what the role of a senator is, and how that differs from a governor's. What a Bill is. And how it becomes a Law. But encouraging people - especially women - to advocate for themselves, to get off the sidelines and pursue a better world, to speak truth to power, is something I love doing. So, I’m gratified to meet the women and some men who attend Advocacy Day: church-going pro-lifers who have struggled to make sense of their disease and to find a comfortable moral ground for themselves; people who live 15 miles from The Hill but have never been there before; women far from the fashion-obsessed east coast who questioned the dress code over and over, and have carefully crafted an appropriate ensemble to meet their representatives. I meet husbands who proudly describe the learning curve they overcame to understand their wives’ challenges, and wives who have travelled from the furthest reaches of our country's borders to make their voices heard. Warriors and goddesses who don't let a little train derailment or a shooting at Penn Station deter them from their mission. DC or Bust. And I meet women who carried with them the stories and letters of thousands of others, impressing upon legislators the breadth of this disease.  

Patiently, I explain the difference between state government and federal government; between the House and the Senate; between the Blue and Red Agendas. As I listen to some newbie advocates stumble over the unfamiliar words to present the legislative program we are pursuing, their unwavering commitment to making a difference gives me chills. We present the necessity for making the Adoption Tax Credit refundable, so that lower income people can benefit from it to ease the financial burdens of adopting. We explain the plight of so many of our brave service men and women, injured in the line of duty, who find upon their return that the necessary treatment to enable them to build their families is not covered by their military insurance. Sometimes the procedural matters are blurred somewhat, but the message comes through and the passion of the volunteers gives me chills. 

They enter the imposing white fortresses housing their elected representatives as shy, nervous innocents. They exit the Halls of Congress taller, empowered, and excited by their success. Committed to holding their representatives accountable. Understanding that with their words, they are changing the lives of would-be parents for generations to come. I am so in awe of the transformation wrought in one day - They entered as novices. They exit as Advocates.  

Now, as I confirm their Facebook friend requests, and we follow each other on Twitter, I know the repertoire of subjects that appear in my news feed will expand, as they too, will hear more about my interests, which exposure will help us in our shared goal of implementing the CDC’s National Public Health Action Plan for Infertility.  

Together, we will fly.

No Signature Required

I've always been a little mystified by the public celebration of private events. Like wedding anniversaries. The wedding, of course, is this big public spectacle, an opportunity to re-engage with old friends, introduce them to your new friends, give work colleagues a glimpse into your personal life, and the best of all, showing your family how well liked you are - no loved! - by so many.  

But the anniversaries of that date...isn't that something you just want to celebrate with your spouse? Privately, with perhaps some champagne and the things you only be enjoyed without spectators? 

Why would you need more than the two of you involved? 

It seems like everything today needs an audience to make it matter. Everything needs to be lived out on Facebook, witnessed on 
Instagram, analyzed in 140 characters on Twitter. Needing hundreds (or thousands) of people sending good wishes to validate your importance. So it goes with Mother's Day. My inbox is full of requests to sign cards to Michelle Obama or Nancy Pelosi or Hillary Clinton (who I actually do consider a friend) or other female politicians or famous types. Why? Are their leadership capabilities measured in how many people sign the card? Will their celebrations of motherhood (or grandmotherhood) be enhanced by all of these mostly anonymous well-wishers? Do they really need my signature on a computerized card to make their day complete?  

All of these marketing come-ons cause people to miss the whole point of the day. Does a mom really need anything more to celebrate the joys of motherhood beyond knowing she has children she loves and who love her? Isn't the fact of being a mother on Mother's Day special enough?  

I have a thing about this day of flowers and gifts. And cosmetics promotions and sales. It's a painful day for me. A national celebration of the hole in my life that comes from not being a mom. A day when even the doorman who alerts me to my solo food deliveries wishes me a Happy Mother's Day. A day I tend to spend under the covers surfing for reruns of The Devil Wears Prada, Dirty Dancing, or some other movie that conveys hopefulness and achievement without involving the heroine's uterus.  

One year I actually bought myself an "I'm-not-a-mother Day" gift. A ring that I wear every day. I love the ring, but it doesn't fill the hole and I've decided against making that my practice. Even diamonds can't outshine the dull ache in my heart that comes from my childlessness. 

I have tried to immunize myself against the new spasm of pain from each of the endless hawkers pushing mother’s day gifts, Facebook posts about the joys of motherhood, strangers wishing me Happy Mother’s Day, but have failed miserably. Now I just grit my teeth and rely on the inevitability of it ending in another day. Until next year. And avoid people as much as possible.

If I have one wish for this day, however, it’s that people start putting the emphasis on where it belongs, on their own relationships, and leave me out of it. 

And Michelle Obama? No, you don’t get my name on a card - or a contribution - from me today. 

Embryonic

I am fascinated by the outpouring of opinions on the Sofia Vergara/Nick Loeb dispute over the embryos that they voluntarily froze together. But I am also dismayed by the (mostly) inappropriate assumptions and judgements being disseminated in mainstream and sensationalist media about the case. To be clear: You don’t wake up one morning and decide to freeze embryos. The process is long and laborious. And uncomfortable, sometimes even painful. And expensive. Maybe not if you’re a world-renowned actress and the heir to a banking dynasty. But for normal people, like I am, the cost is exorbitant. I don’t know what motivated that particular couple to freeze embryos comprised of each of their genetic matter. And I mostly don’t care, except for the impact that the assumptions that people are now making about frozen embryos on the legality, the cost, and the negativity for all of us for whom creating embryos - and losing them - is encumbered by difficult and painful decisions. When my husband proposed to me, his words were “I want you to be the mother of my children.” And it was when he said he was eager to become a Dad, that I went off the pill, starting, what people euphemistically call “trying” to make a baby. When it became apparent that it wasn’t happening easily, we went to a fertility specialist, beginning the long cycle of “cycling”, round after round of in vitro fertilization procedures, which meant, for me, hundreds upon hundreds of self administered injections in upper thigh, belly and butt (which generated acres of black and blue marks over my body, lumpiness in my butt and pain when I walked) and ended up in either miscarriages or lots of failures. The four embryos that we had frozen were the culmination of 3.5 years of back-to-back cycles, multiple exploratory surgeries, expensive escapades with acupuncturists, dubious dips into alternative medical practices, prayer circles, on-line support groups, blessings from rabbinic charlatans, and lots of trips to the porn...uh...donation room for my husband, all in the effort to make a baby. To say that it was clear what the intent of the parties after all of this is something of an understatement. When the marriage ended and it came time to decide what to do about the embryos, however, I discovered that the consent form that we had signed over and over for each cycle was woefully inadequate. Although I would have had the right to use the embryos to get pregnant if he had died during the marriage, there was no direction for disposition in the event of a divorce. And we were at an impasse. Much of the discussion I’ve seen on the celebrity case is about forcing someone to become a parent who doesn’t want to be. Feminists are “outraged” by the so-called reproductive coercion. What coercion? Embryos don’t spontaneously appear in a cryopreserved state by accident. Or from a night of too much drinking. I consider myself a proud feminist, but where was the outrage for me, who had put my body through untold torture? I still have pain in my butt where I injected 1.5 inch needles for progesterone shots for weeks at a time, a roll of scar tissue across my belly where I injected over 600 needles over double digit cycles and I have a visceral reaction to the sight of a sonogram probe - not a good one. Did I do this without my then-husband’s consent? Of course not. We were, purportedly, in this together, and signed multiple pages of consent forms confirming our desire to become parents. We each wanted to be parents. When we divorced, it wasn’t me who had changed my mind about parenthood, it was him. It is public policy in New York not to force someone to become a parent who doesn’t want to be ("oops" pregnancies aside). Much of the country agrees that parental child support obligations shouldn’t be imposed on someone who doesn’t want to be a parent. I get it. But has the law kept up with medical practice and technology? Is it fair that my desires - and the abuse to my body - didn’t entitle me to use my embryos on the small chance that it would have worked that time? No one will really know the truth about the Vergara-Loeb case, nor should it be used to direct policy on embryo freezing cases. But to assume (absent proof) that there is any coercion in a process that takes two people to engage in, which is far more intrusive and burdensome for the woman, is simply absurd. No woman should contribute to the creation of embryos capriciously, and no man should be encouraged to change his mind on a whim knowing that the current state of the law will shield him. Embryos, representing the potential for life - which at least at one point was badly desired by the two people who created them - are not conjured up by magic spell. Rather, through long, thoughtful analysis, commitment, sacrifice and investment. As such, the frivilous or retaliatory act by one party changing their mind should not dictate the disposition of the embryos. And this whole silly “how dare we force someone to be a parent” nonsense has to stop. We do it all of the time by not forcing women to get abortions after a drunken night. Certainly, we should not be worried when so much thought and effort went in to creating the embryos at the outset.