Ep 12: Mind-Body Connection, Relationships, and Navigating Ovum and/or Sperm Donation with Lori Metz, Psychotherapist
Fertility Forward Episode 12:
Joining us today is Lori Metz, a licensed clinical social worker, and certified case manager who is also board certified in tele-mental-health and the host of her own podcast. Lori has adopted a positive psychology approach that includes mindfulness and cognitive behavioral health in partnering with her patients in an optimistic, goal-oriented manner, and embraces the idea that each of us has a unique path. In this episode, you will learn more about the importance of communicating and seeking support throughout the fertility journey and how to use mindfulness techniques to aid emotional regulation. There are so many complex and conflicting emotions involved in the process of getting fertility treatment and pregnancy and therefore it is important to seek any means possible to make the journey a bit easier on both partners.
Rena: Hi everyone! We are Rena and Dara and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Forward podcast brings together advice for medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.
Dara: Lori Metz is a licensed clinical social worker, a certified case manager and board certified in Tele-Mental health. She's adopted a positive psychology approach that includes mindfulness and cognitive behavioral health in partnering with her patients in an optimistic, goal-oriented manner. She understands that we are all unique and that we will all have our own unique path. In this episode, we discuss the importance of communicating and seeking guidance throughout the fertility journey and also using mindfulness techniques to help with emotional regulation.
Dara: Today's podcast is gonna be great. Not only is it Halloween, but we have Lori Metz, a dear friend of mine who is a licensed clinical social worker, and she has a podcast herself called Life, Love, Insight - Fertility Experiences. Lori, we're so glad to have you.
Lori: I was so thrilled to be here. I always love talking to you, Dara, you’re like one of my favorite people.
Dara: I'm sure this is strange to like be on the other side.
Lori: It's really strange.
Rena: How do you guys know each other again?
Dara: Well, we were put in touch, I believe, maybe five years ago now, 4 or 5 years ago, through a mutual friend in the fertility world, Miriam Pineles.
Lori: Yes, who's fabulous
Rena: Oh we also had on our podcast.
Dara: We had her on our podcast to talk about acupuncture. She's our acupuncturist.
Lori: Yes. And pulse diagnostic therapy.
Dara: And so she put us in touch and we all met and we realized we really did mesh well together. And we've done - What are they? They’re
Lori: We’ve done workshops and then we did different types of projects. And the interesting thing is that people get so engaged. And I think part of it's just the dynamic of how the three of us kind of meshed, which is really, really nice. And it's a wonderful experience to be able to do them because people get so much from them.
Dara: They really do! I wish there were more out there and I know, Lori, this might be a great plug for you. You are organizing or trying to organize a couple of these down the road. Is that correct?
Lori: I am absolutely. Thank you for mentioning that because a lot of people don't have the time to dedicate to finding out more about the bio-psychosocial aspects of fertility or mind, body and soul whichever way appeals to you more on and those are such important components, and very often we don't tune into them but they’re what helps us in our everyday life, because once you get involved in fertility and you begin treatment or even work before you begin treatment, it becomes a thought every day of every minute.
Rena: Oh totally. It consumes you.
Lori: It's totally consuming. And the further down the road you have to go through the journey, the more consuming it becomes. So I think that these were really helpful, especially if you can get like the partners together.
Lori: Not just the woman. Or, you know, whoever your partner may be because the partners are going through this, too. And very often I find myself saying to people who I'm working with, either individually or in a crew, ‘How's your partner doing?’ And you see this look of you know? Oh, my God, I never asked.
Lori: I had one woman who was crying and I said, Well, don't cry. I said, You know, he needs the support, too. But he's been so supportive of her, she hasn't thought of it.
Lori: Doesn't make her bad at all it just makes us realize kind of a spotlight on how much you go through when you start a fertility journey.
Rena: Oh, yeah. And I think it’s so different for each partner, right? To be the partner who's watching a loved one go through something they can't solve for them and that is difficult in a completely different way than to be the one who you know you're putting your body through it. Lori: It's very different. And also you can take more of a break like even if you go out with a friend.
Lori: You know, you can do that and eat what you want or do what you want.
Dara: And not think about it.
Lori: And not think about it. Although they're not talking about fertility with men and what they eat and what they ingest.
Dara: That’s definitely what I talk about when I do meet with the male partners. But I really do wish that no matter what, there was more conversation, not just on one, you know, the female partner, but female male partner just the idea of working together, of not just being exclusively the person who's carrying.
Lori: So we go from the statement, the I statement to the we statement, right? Which is something that we always talk about in couples therapy. So you want to be we not I And there's actually a research done at Berkeley about it in California about representing you and your partner's obey. So it's not just you going through it. It's both of you going through it.
Rena: Totally. You know it always breaks my heart I don’t know if I’m sure Lori, you hear this too, Dara, I don’t know if you do when somebody says, ‘Oh, it's my fault’ or ‘it's his fault’ or ‘her fault’ daughter. And I say, Okay, well, it’s nobody's fault.
Lori: Right. It's a medical condition.
Lori: It’s not a flaw. This is a medical condition, and we don't look at it that way.
Dara: And pointing the blame. It's hurt it can be hurtful, very hurtful.
Lori: Well, it's hard what people do to themselves, you know, it really and it fits into so much that you've gone through prior to even beginning this journey, we’'ll have this image of ourselves.
Rena: Right. Everyone brings a different pathology into this process
Lori: And if you came in insecure about yourself, or maybe always thinking that this one had it better than me. Or you know what's going on with me that I can't do this. Well that’s where all the secrecy comes in. And the secrecy isn't. It's okay to be private, not tell people what you're doing, depending on how you you go about things. But if you're keeping a secret because you feel bad about yourself, that's a whole nother story. And that may have started years ago.
Dara: Yeah, but festers and it builds and it could be quite destructive.
Lori: Well, it is because it throws you into a crisis, because many times, you know - I think I mentioned this to you really quickly - many times you're young when you start the fertility journey. Even if they say you’re like geriatric fertility because you're 35. That's kind of I hate to say this because I don't wanna get any physicians angry, but it's nonsense. 35 years old, you're still a young person. Maybe your eggs aren't quite as young, but there's no magic number. But many people haven't gone through a health crisis yet at this point in their life. And this becomes a health crisis, right? You have to go for the blood draws. You have to if you're just, you know, fortunate enough to not have to go through it, you know, a IVF cycle then maybe just go on Clomid that’s traumatic too.
Rena: Right. I always say to anybody look regardless of why you’re in this office, is it you're getting your blood drawn you're doing an IUI you're doing IVF it’s all traumatic because it's not what you expected. No one expect no one grew up or at least no one that I’ve come across, pictured as, you know, a child or a younger person oh okay, I'm gonna grow up and then conceive in a doctor's. So regardless of why you’re here, it's traumatic. It doesn't matter,
Lori: Right. Even making the phone call.
Dara: That’s a good point.
Lori: I have the chills she just said that because making the phone call does it right. You see this too? Picking up the phone and saying, I have a problem.
Lori: And you need to address it.
Dara: I just wish, my biggest, I don't know, I wouldn’t say disappointment but I wish this was more discussed. Maybe first line you come into an office and the first thing that should be mentioned by the way, it's a great thing to talk about it with someone who is an expert who could help give you some support.
Lori: Well, communication, you know, that's my big thing is so important because we have to learn how to communicate with everybody, not just our partners but our family our friends. You know, even when you go to the doctor's office.
Rena: Life is so much easier when you just communicate. I say, there's no such thing as over communication.
Lori: But it's knowing how to communicate. Because people could talk for hours. Like if I meet a stranger on the street, I’ll just be as friendly as
Dara: You could talk for hours, Lori, I know that.
Lori: But they will know nothing about me. I'll talk to them about absolutely nothing.
Rena: But imagine what a difference that makes you know. I always say look, if someone’s angry it's never about you.
Rena: Maybe they were rude to you or an ass to you. It’s not about you.
Dara: It's about them.
Rena: It’s about them. Maybe they're getting divorced. Maybe they're going through infertility They’re 30 minutes late to work. You know? So imagine,you know, in one of the things I talk a lot about with patients - I do a lot of positive psychology work - is random acts of love and kindness and introduce that into your day into your daily life and to imagine if someone’s rude to you, instead of responding with anger, respond with kindness. Oh, I'm so sorry. You know You must be going through a lot.
Dara: It's so interesting you said that. I actually, you know, I always get upset when I open, you know, when I open the door for someone and someone walks in without saying thank you, my response is often, you’re welcome.
Rena: I can’t see you doing that Dara, you’re too nice.
Dara: But I just feel like these days I've tried to, like reframe it and be like, Why am I saying that? I'm saying that to make them feel bad or to make myself feel better. But at the end of the day it doesn't make you feel great and realize that maybe culturally, they were never taught to say thank you. Or maybe they've had a really rough day and their mind is somewhere else. But I think if you can refrain that into, you know, not having that anger into everyday life.
Lori: But the anger comes from, like much more of a core.
Rena: But then they could really explore. You wan’t validation. spk_0
Dara: I do want validation. Rena you’ve got it. I want validation but I was always told you say thank you and please. Please and thank you.
Lori: And also it’s defensive. How do you not acknowledge that I'm trying to help you.
Rena: Right. But then again, it's like it's not really about you, right? It's about them and they’re in their own world. I always get very irritated when people walk into me on the street because they're looking at their phones. I think big into mindfulness, and I consciously do not walk around looking at my phone. Look around you be aware.
Dara: Thank goodness we don’t walk side by side.
Rena: Watch out!
Lori: That’s an exervise that I give people. I tell them that they have to walk well I don’t tell them that they have to nobody has to do anything but what I say is one of the homework assignments is smile to people on the street.
Dara: It makes such a big difference. And some people, their reaction.
Rena: They get freaked out.
Dara: But I often get smiles back, and it's such a simple thing, and it really does calm you down without having to meditate. It's like its just it’s an easy tool.
Lori: Smile therapy too.
Rena: And especially as you’re going through this, you’re in infertility, you know you're so in your head or these thoughts. Put your phone away when you're walking and just smile. Take yourself outside yourself and see you know what it does for you and your mood.
Dara: It's similar also in the subway. I look around, every single person is on their phone. I am too sometimes.
Rena: Ok same on the subway yeah.
Dara: But sometimes I'm just like you know what? Enough. I can take a couple minutes, put it away, look around. And sometimes you do like lock eyes with people and a smile. Its just its such a nice thing.
Lori: Well it’s a human connection. It’s communication. And when we talk about communication we talk about connection I mentioned, you know, I really believe in the five senses because we have five senses for a reason and they all allow us to communicate. So we don't usually talk about that. Nobody really talks about that.
Rena: I was just gonna say I don't think the last.
Rena: The last time I talked about senses yeah.
Lori: I don’t know I like to talk about it.
Rena: I love that.
Lori: And people usually like look at me when I first say it, but it's true, so communication is verbal and non-verbal we all know that. But also a smell, you know, whether it's good or bad, that when you think about going home for the holidays and you’re gonna be like, really nervous or cringing. But I don't know, maybe somebody's making something you love.
Dara: The spices.
Lori: So we smell, taste, touch seeing and hearing.
Rena: Oh I love that.
Lori: And they all help us communicate. If somebody's upset, you give them a hug or you touch their arm it just lets him know that somebody’s there who cares.
Rena: Super powerful
Lori: Right? They use musical after therapy. So our hearing.
Dara: That's a big one I think I really think that music can really stir up, of course, fond memories maybe not so fond but it can be used as a great tool I'm sure to help make you feel good.
Lori: But we also, in terms of the hearing, I think you also need to listen differently. So I'm sure you do this, but it's especially working with couples. It's what they're saying and what they're hearing right. And this is a big piece of the communication that I try and talk to people about going through this because it's important to think about your thoughts and your feelings. And lots of times one person might think about like what they're saying in terms of thought but not get to the underlying feeling. And that's where a lot of the imbalance comes in. That’s just my opinion and it could be wrong but it kind of makes sense right? And I'm sure it goes along with, like, a mindfulness type of thought process. So if we have our thoughts and we have our feelings and they don't correlate We're just balance. We're just not feeling 100%. But if we can least understand our thought and understand the emotion, maybe no, we should do something we feel like we don't want to. Well, then we could work on it.
Lori: And figure out. Do we have to? What would make us feel better about it, which was should we proceed. So you need to take that moment for a minute and whether that's mindfulness or just pausing or just being conscious, we need to take that moment and just look at it through a different lens.
Rena: Well, you know, I think that's so hard for people to do because especially I don’t know if it's a New York City thing or sort of the patient population but I know for me, too, it was a lot of work to learn how to do that to pause. Whereas, we're so used to going, going, going and find a solution being active, you know, doing something that feels like you're working to solve your problem. And so just pausing is very hard.
Lori: So I'm gonna do something - unpleasant perspective - which is something I started saying, I don't know, 7 or 8 years ago, to people. Let's just pause. You know get a perspective and all of a sudden I thought, Oh my God, that's like a great term.
Dara: It is.
Lori: To use.
Rena: I love that.
**Lori:** I kind of took some, I don’t know I probably shouldn’t even mention this right now, I took some website names so pause and perspective hits my website also but my website really comes up with my name because I love the terminology. I’m going to do a little talk on it. Because we need to do that. So everybody talks about mindfulness, which is fabulous. I love it. I'm a big proponent of it. I took a course in it, you know, I use it, but it becomes a little bit overwhelming for some people to think about. **Dara:** Even the term like mindfulness or even meditation can be overwhelming **Rena:** Right it can definitely turn people off they say oh I can't do that Lori. Right. Who has the time for this. I can't do it. But if you just ask them to pause for a minute and think about what's really going on **Rena:** Yeah **Lori:** And getting that perspective. It's really helpful. **Rena: **I love that and full disclosure here, I have the awareness to say I am a fairly reactive person and I can tend to be pretty trigger happy and having a reaction. And so I've been working a lot on how to not be like that. And this one story about Buddha really resonated with me, and I find myself sharing it with patients a lot and they all love it and the way it's written is much more eloquent than I'll tell you. But basically the gist is, Buddha sends a disciple to get him water from the lake, and the disciple goes to the lake and the lake’s dirty. So he comes back and he says, Buddha, I couldn't bring you water because the lake was dirty. Buddha says, Okay, well just wait 30 minutes, wait an hour, then go back and check again. So the disciple waits. He goes back, and then the water's clean. So he’s able to bring Buddha back the water. And he says, Buddha, how did you know? And then Buddha said, Well, like in life, anything with time settles. So he waited and in the lake the mud settled to the bottom and it was clean. And again the way it’s written is much more eloquent than how I said it. **Dara:** But we get the gist. **Rena:** And I love that and I carry that around a lot, and found myself sharing that with patients a lot. **Lori:** I think that's a wonderful analogy for you. It might not be wonderful for somebody else, but for you it’s the perfect analogy. And that's what we all need to do. We need to find what works for us. I was on the phone with somebody this morning really early seven o'clock and we were talking about the job opportunity that came along for her. Nothing to do with fertility at all. But the message is kind of the same. And she doesn't know she's taken so it’s a huge promotion. They want to bump her up three levels. **Rena:** Wow. **Lori:** Clearly, she's really, incredibly qualified and she's bright and she's beautiful and she's nice. I mean, she's really a nice, nice person, and she's worried she doesn’t want to get in over her head. And so while we're talking, you know the key there is just take a minute. And figure out where it fits into the rest of your life. And if it fits in, then go for it. What’s the downside. But if you keep mulling over that same thing and you don't take that moment, it's really hard to figure out what the next steps should be. **Rena:** Sure. And I think also the unknown and uncertainty are really difficult **Dara:** Can be scary. Very scary. **Lori:** I often recommend go to the worst. Sorry. **Rena:** The worst case scenario? **Lori:** Yeah. I often recommend it. I will say it because it, I don’t know if you find this or not, it’s a little freeing for somebody to hear it. **Rena:** Well, I forget the name of that it’s a specific therapeutic technique and I forget the name of it and exactly I have to look it up. But where you do that exactly. So you first come up with the worst case scenario. Then you back up from there. So first you would say the worst case and then you go backwards. **Lori:** Well I don't necessarily - it depends on the person. I won't do that right way. You know but after I get to know somebody or after maybe meeting them even once, if you know something is on somebody's mind, like fertility. And what if I have to use a donor egg? Or what if I have to use a surrogate? Or what if I go for adoption? You know, those are kind of some of the later options and potentials that come to the table and people will say No, I would never do that. And so you kind of want to address it. **Dara:** That's smart. **Lori:** Because they're carrying it around with them. I don't really know about the specific therapy that you're mentioning. It's almost innate that you want to state the obvious many times. We just talked about that when I was talking to you about the posting I did today. **Dara:** That's true, Lori. **Lori:** And somebody said to take down a sentence because it was too negative and in my mind it wasn't negative. It's stating the obvious. It's stating what people think about surrogacy. **Dara:** Yeah, or people are thinking about. If people are thinking about it good to get it out in the open and talk about all the possibilities. **Lori:** Because she could be embarrassed to say it. And you could be scared to think it. **Dara:**Or shameful even when you're thinking that. **Lori:** Well shame is horrible because I mean it gets in our way with this whole experience. The shame piece of it. That's what people struggle with a lot. I thin a lot of that though it also prior to **Dara:** You mean something that happened from childhood or from **Lori:** Something. **Dara:** Something like that. **Lori:** Something. We're not necessarily ashamed of something or - tell me what you think about about it, or like competitive on a certain level, then we might not be shameful quote unquote for this experience. We might feel badly. But being really because I've had people to the core who are so embarrassed and so ashamed that they can't become fertile, That it can't just be because of this. **Dara:** But it goes back to blaming yourself. **Rena:** Or people want a reason. I mean, I think that's sort of a two prong question so blaming yourself, I think is because people want to point to something because I find the most difficult cases are unexplained fertility or secondary infertility. **Dara:** I’m with you. **Rena:** Because it doesn't make sense right? It’s almost easier if oh Okay, I have PCOS or Oh, I have a fibroid or oh i have endometriosis. OK fine. You can point to something. There's a reason. When it’s like, well, we don't know. People find that very difficult to understand because people want reasons. They want certainty. **Lori:** Yeah, it’s a horrible thing. Unexplained infertility. And it's huge.What’s the percentage of it? Like 30% or something. **Rena:** It’s high. **Lori:** It’s high. And sometimes there is no real known reason. But with any medical condition it's always awful when the doctor doesn't know where it came from. **Rena:** Right. We want humans want certainty they want reason? **Lori:** Right, so what do we do? We blame ourselves. **Rena:** Exactly. I think it goes to that. **Lori:** But if we have an image of ourselves, which is what we're talking about before, where we have a certain kind of life and everything should go a certain way and we're very invested in it maybe more invested than we even realized and then it doesn't. Well we can be ashamed about that. We can feel badly about that. It kind of makes sense. **Rena:** And I think I've talked about this on here before, But I'm big on Renee Brown and her philosophy so being vulnerable, sort of the guilt and shame spiral and I find that resonates a lot with patients and I’ve looked at a lot of Renee stuff I’ve read a lot of her books and so I find you know working through guilt and shame, learning to love yourself kind of getting in the arena, which as Renee says, getting to the vulnerable place, allowing yourself to really get in there, you know, feel your feelings, try things out as opposed to living on the sidelines. It’s hard but I think that's sort of life. **Lori:** Yeah, well, there's no way not to do that when you're going through fertility. **Rena:** Right you’re in the arena. Right? You pick up the phone. You're in it. **Lori:** Yeah so it's really right there. And for a lot of people I think I said this already it's a first experience. **Rena:** Yep. **Lori:** See a first experience of medical treatment and feeling like, Why can't I do this? Everybody does it. It’s hard. It just is. And then you see all these women you know, a lot of celebrities now at 50 years old, they're having babies. Nobody says they're using donor eggs. I wish one person would come forward and just be honest and say well to Meril actually, to her credit she did say she froze her eggs. But be honest about it, you can't just unless you're really, really, really an outliner, get pregnant with your own egg at 50 years old. **Rena:** No. **Lori:** Or in your late forties, not because of any other thing but biology. **Dara:** But I always wonder if people don't speak up about it. It's not that they're ashamed, but maybe they want to keep something secret into themselves. **Rena:** Sure. And also if they use a donor then, you know, to disclose to the child first before the general public knows. **Lori:** So I do. Yeah, I do a lot of work with donor. I do. I have, like a lot of feelings about using donor eggs, and my heart goes out to these women or donor sperm but men won't talk about it. They really don't. They don't want to talk about it. They'll just proceed and go ahead and have the baby and not worry about it unless just a situation like a divorce and then all of a sudden they get a little nervous. Some people choose to tell the children some people don't. More and more people are choosing to tell the child. It comes down to, and please tell me if you don't agree with me, but it comes down to how you feel in terms of how the child's going to feel. If you can become comfortable with your choice then this is a child's life. They don't know any different. And I was talking to somebody on the phone the other night. This great guy who I’m gonna have on my podcast, who is 25. His mom used a surrogate to have him and his father, who was, you know, his natural biological father passed away. So his only blood connection in the world is his surrogate mom. He said, which is so true, nobody ever asks me how I'm born. Nobody assumes you’re born through a surrogate or assumes anything. And then you've heard the story. I'm sure where this little one was explained that he was born or she was born through a donor egg. And the way the parents explained it they were so excited show and tell the next day. Anybody have anything? Yes, and he tells the entire class that he was born through a donor egg. **Dara:** Wow. **Rena:** I love that. **Lori:** How fabulous is that? That's the parents’ comfort level in the way that they conceived. **Rena:** But I think research is showing that the best way is to disclose to your child from a young age. You normalize it, you assure them they’re loved and you know they don't know anything else. **Lori:** So I wrote a couple books that I'm going to have an illustrator. Somebody who I'm working with actually she might illustrate the books, but I want to see if she wants to or not, if she's comfortable doing it. If not, I'll get somebody else. But I wanted to offer the opportunity because people who go through this journey also for like 4,5,6 years, they kind of want to do something to help other people. And she's one of these people. And so I think it’s hard to get comfortable with it. And it's really about allowing the parent to become comfortable with the journey more than the children they’re reading books to. **Dara:** So that’s what the book’s on? **Lori:** Uh-huh. **Dara:** That's great. **Lori:** Yeah, I really haven’t talked about it ‘til now. **Dara:** Good for you. It’s out now. It’s good it’s on someone else’s podcast. **Lori:** I haven’t mentioned it on my podcast but I wrote them out of need. I think or just out of whatever I was concerned for this population and thinking of different ways to tell their story to their children. And I do believe it becomes important for the parent to be comfortable if the parent doesn't become comfortable then it resonates throughout. No, there will always probably be a side of them that wishes that they didn't have to do this. But once the baby's born, the bonding is like unbelievable. I run a group for people who already had the babies through surrogacy but or through donor egg, they adore their children. Part of them still wishes they could have biologically had the connection. But think of ‘til a point where they just don't think about it anymore. And how do they make sure that the child understands? I'm working with somebody right now who had just such a hard journey. Like just heart wrenching journey where where the pregnancy was lost 28 weeks after trying for years and my heart just goes out to her. Anyway she just had a baby, and the baby was five week early. You say, the pregnancy was challenging emotionally to go through because the preoccupation, the health of the child, the fetus. There was no time to think about the donor egg because she was too worried about viability of the fetus. Now, there was this beautiful baby who was born. She's so connected to the baby. But so scared of anything going wrong because she hasn't really had an opportunity to work through the loss of the 26 weeks. It makes sense. **Rena:** Oh sure. **Lori:** But we have to figure out how to become comfortable, and we all kind of work this way in different time frames in different ways. And if it doesn't happen before the baby’s born it happens after. So I'd really try to encourage people to try and talk about it, not with everybody, but with who they're comfortable talking about it with, prior to the birth. **Rena:** I think a lot of times people don't understand that you can really have two juxtaposing emotions. **Lori:** Absolutely, it's such a good point. **Rena:** You can be mourning the loss of that first pregnancy. But you can also be excited for your second and happy about the baby that was just born. And I think a lot of times people don't understand that you really can have those two opposite emotions at one time. They think. OK, well, first I have to feel sad and mourn this. Otherwise, it's really inappropriate for me to move on. But as we all know, a lot of you know, this work, unfortunately, is time sensitive, and sometimes people don't have, you know, everyone's mourning process is different, but they don't have the time to sit and mourn a loss. And so you really can have, you know, opposing emotions and they can fluctuate from minute to minute hour to hour. That's okay, and that's normal. **Lori:** Yeah, I’m glad that you said that because it's so important. Of course, you can have two opposing emotions at one time, and it makes sense. Look at secondary infertility. You love your child. But you're so sad that you’re not having another one. **Rena:** I think that's what’s very hard for people to grapple with and understand that that's okay and normal. **Lori:** And we do it in so many different areas of life. **Rena:** Oh sure. **Lori:** So if we tune into something that we do in different areas of life, it makes it easier to realize that it's normal when going through fertility. **Dara:** That's true. But sometimes you just need to be reminded **Lori:** You need a little perspective. **Dara:** Yes. **Lori:** Right we need to step back for a second and get some perspective and say wait a minute. You know what? I've gone through this before and that's life, and that's why we want or I want at least I’m sure you do, too, I think, just to encourage people to not just put every area of their life on hold while they're going through this. **Rena:** You can't. You have to live your life sort of in parallel, you know, going through this process. Wow, wearing all the other hats you have to wear, right? Professional, daughter, son, sister, brother, like, whatever it is and keep moving forward with your life. Otherwise, you're just stuck. **Lori:** Well you do get stuck. And I've heard people say you probably have to when they’ve had to take a break for a month, two months a year. It was such a relief. It was almost a burden off of them because they could take a deep breath now and live life they way they used to. You know, for whatever reason, that they had to wait. Maybe they decided to go for a donor egg, and there's like a nine month wait. Maybe just their body needed to regroup a little bit. But it's interesting to see the dynamic. And then, if you see the person their partner together, the partner’s so glad to have their old person back. **Rena:** Right. **Lori:** So you need those breaks and sometimes you feel like you can't take it cause you get on this roller coaster. **Rena:** Right and you feel like you've got to keep moving forward and being proactive. **Dara:** Don't think that would be an ideal time to meet with one of you guys? Like, I think that could be a perfect time when you feel like your life is more like it used to be that could be a great idea to plan, so you could maybe have a different perspective when you do jump back in. **Lori:** But think about it - who goes into therapy when they’re feeling good? **Dara:** That’s so true. **Rena:** I always tell people then look that's not a break because then you're coming here and talking to me about this difficult stuff and you're taking yourself back. **Dara:** Goes to show you I have no idea. **Lori:** I don’t know if I agree with you. **Rena:** Interesting? Yeah, that's what I say. I say, Look, if you want to take a break and not think about it, then don't come see me, because then you're sitting here, we're talking about all this negative stuff. I mean, everybody's different. I don't think there’s a black or white formula. **Lori:** No there’s no way **Dara:** I guess I’m the planner. I'm the planner so I’m like OK yes, I'm taking this break, but let's plan for what’s to come. **Lori:** It's still in your head. **Rena:** You talk about being proactive and doing something and still kind of on this journey. **Lori:** It's interesting. I always think that things can ruminate. And you may not want to talk to your partner or your friends about it. But, like right, you want to be able to get it out somewhere, but not let it impact. So rather than have it fester, sometimes I think it's better to get it out. But I believe in breaks from everything. I believe in breaks from therapy I believe in breaks from dieting. **Dara:** I’m with you. **Lori:** I’m sorry. I believe in breaks from everything. Probably not with dieting necessarily. **Dara:** Go, Lori. Thank you. I was hoping you would say that. **Lori:** You know I don't believe in dieting. I absolutely don't. I believe in just eating healthy. **Dara:** Or maybe being less focused on your eating habits. I think it's it is good sometimes to take a step back and just be. **Lori:** Absolutely we need to. **Rena:** Yeah, cut yourself a break. **Lori:** We absolutely need to. **Rena:** We say this on Halloween. **Lori:** Tomorrow I'm meeting my best friend in the whole world. I love her. One of my best friends in the whole world. I shouldn't say my best friend but one of my favorite people. Honestly, I know her for years and years, and you know, I have this group of friends that I'm so close with, and she's one of them, and I adore her, and so tomorrow we're just like taking a day off. **Dara:** Good for you. **Lori:** I don't think I've ever done that. The two of us are and we're just gonna spend the day and it's such a treat and actually my husband loves it too, he said. I'll come meet you and I said no. You can’t meet us. It’s like my day. So it's exciting. Yeah, I'm really looking forward to it. It's really gonna be just a day off. I told people I couldn't talk to them tomorrow. **Rena:** Good for you. Really unplug. Don't let me catch you walking around looking at your phone. **Lori:** No I’m not big on that. I'm not. I really try not to. Although if you talk to my husband,he’ll probably say I’m on the phone more than I should be. But you know, a lot of people connect to you that way from the patients and things and I like to be available. But I don't really care for people like... **Dara:** Well good for you that you tell other people to take a break. And you yourself are taking your own advice. **Lori:** I know can you believe it? **Rena:** You have to. You have to. Otherwise you can’t take care of anybody else. Take care of yourself too. **Dara:** I want to go back to relationships and the importance of having the discussion and a lot of times we all meet with 1/2 and we don't always meet if there is a partner in the picture, we don't always meet with that other partner. And I really do think it’s something that we need to… **Lori:** I'm so glad you brought us back to this because I had wanted to mention before that I actually was so lucky. I spoke with two men on a podcast about what it was like for them to go through the journey. **Dara:** I listened to it - great. **Lori:** Did you listen to that? It was actually my most listened to podcast because men don't talk about it and they both had very, very different journeys. **Dara:** Very different. **Rena:** Also, they weren’t in a couple they were each their own journey. **Lori:** So one of them is not married to his girlfriend. They've been together for I don’t know how long, many, many, many years at this point. 10 years, maybe more and gone through an incredibly long road and wound up using a donor egg. And the other one’s best friend passed away while they were starting their second round of IVF and she kind of took it all on herself because he was mourning the process of his best friend passing away. And so they both had totally different situations. But the message was totally the same, which is they wish they didn't feel so isolated. They wish they had people to talk to. And they just did such a good job expressing it and conveying a man's perspective on it or a partner’s. I don't want to just say just a man’s perspective because to just get, you know, couples also and lesbian couples. Also going through this, the partner’s perspective is important. **Dara:** And I think also, I mean, I don't want to make this generalization, but as women, I could speak for myself, and I'm sure you guys too, we tend to seek things out. We don't feel good, We go to the doctor, and I feel a lot of times men, or at least the men that I've experienced, often keep things inside. **Lori:** Well, they do. And I was talking to a physician who started a clinic in Brooklyn, and he's in charge of the reproductive endocrinology area in Maimomides, and he was saying that the men struggle alone. He was so happy that I was trying to get support groups together for the men and engage them. **Rena:** Well even in resources for men it’s so hard to find, even for those men that are seeking them at, you know, there's just unfortunately… **Dara:** Not enough. **Rena:** Not enough. **Lori:** I'm really thrilled that the fertility market or the fertility professionals are now starting to look at men because we need to. We need to do what we need to publicize it more. You know you trying to do all those support groups. **Dara:** It is and it’s step in the right direction, Lori. Give ourselves some credit. **Lori:** But remember we were doing something? We tried to separate the men from the women and have the men or the partners just sit and talk. **Dara:** That's what we wanted to do. **Lori:** Yeah, Yeah, because it's powerful. They're going through a lot, and we don't necessarily recognize it. I was working with one couple and the man kept his cell phone in the pocket and they were married and the wife was really angry about that cell phone being in his pocket. She said, I'm taking all these drugs and all this medication, and you can’t take your cell phone with, you know, whatever kind of rays are coming through out of your pocket? **Dara:** And it could affect their sperm. Yeah. **Lori:** Right. She was really angry about it, and you could understand it on a certain level. **Dara:** I see it also with my patients in terms of, I hope I didn’t cut you off Rena, but quickly I wanted to mention I see that a lot with you know, the women are get frustrated. I can't have alcohol or I need to reduce my alcohol consumption. I have to reduce my caffeine consumption and my husband like figures it’s not, yeah, it's not my issue it's her issue and they don't see eye to eye and they're not supporting each other. And so I love it when I see couples together, because I really got to mention that it is you guys are a partnership. You have to work together and support one another. You know, it takes two to tango. **Lori:** But men’s sperm does get affected by the BMI. **Dara:** For sure. **Lori:** So if you're not eating correctly and you're not healthy, your BMI is gonna be affected. **Dara:** Just like eggs it’s both and you know the collagen. **Lori:** I'm sorry, I’m cutting you off but the percentage and I don't know what it is I really apologize of men and fertility has increased but infertility situations... **Rena:** Of male factor? **Lori:** The male factor. I don’t know what the percentage is. **Dara:** Well I always thought it was like 30% around 30% male, 30% female, and then around 30% unknown or **Lori:** Yeah it's changing now, but the statistics haven't come out to justify it. But from what I understand, some of the newer figures and it's 9% now that are... **Dara:** I also wonder if you know I always think about food, and I wonder if something has to do with environment and something that has to do with diet. **Lori:** Oh my goodness! I just did a whole thing on this. I just did, yes we we're talking about the environmental factors. **Dara:** Yes. **Lori:** Which is really fascinating. The pollution. The plastic. **Dara:** Yes. **Lori:** You don’t want to scare somebody, though. **Dara:** Soda consumption, but not even the soda consumption. Anything in a can. **Rena:** Also increased marijuana use. **Dara:** Yes, that's a huge one. **Lori:** I had a talk with some people that I know about the marijuana use and the impact that has also. Everything we consume it's gonna impact our bodies. If it impacts our bodies there's no reason to think it wouldn't impact every organ or every system in our body. And one of the things with carrying a child is that you’re nurturing that fetus from the moment of conception. And when we think of that whether it's a donor egg or your egg or donor sperm or, you know, your partner's sperm, you are the person carrying it and you are the person nurturing it. So that's why all the sudden you tune more into you know this better than I do, you tune more into what you’re eating or what you're doing because you want to make sure that this fetus is growing as healthy as possible. But why not do that for ourselves all the time? **Dara:** I love that you make that point. And I think that's why sometimes it's good to work on it, going into a pregnancy during pregnancy to create those habits that hopefully can be translated when the child or children come into this world. **Lori:** So I have a horrific story to tell you. **Dara:** Thanks for prefacing that it’s horrific. **Lori:** Really, I'm working with this one woman now who is so sensitive and so sweet and so anxious because, you know, if you're very sensitive and very sweet then your anxiety level in certain situations could obviously go up. And they can come out in all different ways. So she went for a transfer, and the anesthesiologist told her that she was so fat that it was going to be a problem. Look at Dara’s face. **Dara:** Ugh, yeah. That's what this woman said? Or maybe that's what the aneisthesiologist said. **Lori:** I say, did you call the physician and tell the physician and she doesn't really want to tell the physician. And I've really encouraged her. I think her husband wrote the physician a letter because she doesn’t want to go back. So now she's gone on a diet, but a crash diet and taken off 20-25 pounds before the next round. I don't know like what does that do to your body? **Dara:** I mean, this is for a whole nother podcast discussion, because I think, you know, there is a lot to be said and there's lots of points of views. Every clinic has different protocol with anesthesiologists. I know here at RMA women can't undergo, not transfer, but the usually anesthesiologist comes in for a retrieval. When we retrieve the eggs our requirements are to have a BMI that's under 40 because it makes there are more complications associated with a higher BMI. Also it relies on more medication, and when there's more medication there can be more risk. **Lori:** It could be. There's also problems with being too thin. **Dara:** I'm so happy. I mean, I know we mentioned this on your podcast when I came to speak with you, and the unfortunate thing is that we typically just speak about the extreme and being overweight or obese and not always on the other side being too undwerweight. **Lori:** We want to be healthy. So what was so appalling about this interaction to me is the emotional impact it had. Yeah, there's so many different ways you could say something to somebody. And if somebody's BMI is high, they know it's high. You can point it out but they know it, and as a doctor or nutritionist or therapist you want to talk to them about it and what role that's playing. **Dara:** It has to be discussed. That's the thing and I think a lot of doctors **Rena:** It’s all about how you present it, right? **Dara:** Exactly. **Lori:** And how you can connect with the person so they feel empowered to start to take action, not a knee jerk reaction. **Rena:** Sure, but I think you know a lot of this process is about you know, how to deliver a message in an empathic way and a caring way. You know, this is a very personal, difficult experience and to remember that when you were talking to somebody you know and not this isn't the dentist, right? This is extremely personal, it’s dealing with family building, it’s dealing with intimate parts of your body and... **Dara:** Dentists are also personal looking in your mouth. But yes, I do agree. **Lori:** We both have dentists in our families. But you’re right. **Dara:** But I do agree with you, Rena, it is quite personal. **Lori:** It is and it really touches you to your core. **Dara:** Yeah. **Rena:** Exactly. **Lori:** And that's what happened. So we go back to the communication piece, it's listening and being able to hear what the other person is saying on both ends. **Rena:** Exactly. **Lori:** And this impacts friendships. Some people stop being friends with people because they feel like they're just not listening to them or understanding what's going on. Some people will choose not to share anything with their closest friends because they don't want to talk about it or they want to talk, but they don't want to hear what the other person has to say. **Rena:** Well, I always say, You know, you have to set someone up for success, and you have to communicate to them what you need **Dara:** You usually do to others how you would want. **Rena:** Right. And you have to tell someone, you know, listen, I'm gonna tell you this, and then I need you to text me every day to check in. I need you to ask me consistently how I'm doing or you say, I'm gonna tell you this, but then I don't ever want to talk about it. And so we can only talk about it when I bring it up. Otherwise, please don't ask. I will tell you if there's something to say. I think it's important to communicate to somebody what you need. Everyone needs different things. That's why I always tell patients, you know, you have to set other people up for success so that they can support you. **Dara:** So true. **Lori:** I think that’s fabulous. How does that work though what do people come back and tell you when you come back and see them are the people who they're saying that to responding in that way? **Rena:** Oh, yeah. And you know, I think the first step is you know, first you have to do the work with yourself to figure out what do I need? You know, and of course, to recognize it's always changing. You know, I always tell people this is a dynamic process. What you need today, what you need this week might be different than what you need next week, and that's okay, **Lori:** Right. And that's how we all are. Regardless of a situation, it could be dynamic, but this is just very intense and very consuming. So with communication, the interesting part is some people don't want to talk about what they're going through til after they go through it. And when it comes to what you were saying in terms of donor egg and talking about it with people coming forward, you know, I do believe it's a child's right to know first. I'm a strong believer in that proponent and the child will find out and five year olds go around telling everybody everything. Three year olds, Four year olds, right? They tell everybody everything. So you have to be sure that you prepare the people who you're in that family circle to be comfortable also, and being able to share information and retrieve the information that they're being told. And that I find sometimes a little bit challenging for people and that's why I think it would be nice if some people would come forward, because donor egg seems to be the hardest one for people to deal with that I'm working with. Surrogacy it's in the past, the people are doing it, people go to a surrogate for different reasons, and some of them because they physically can't carry a child and some because they don't have the time to carry a child. Two different ways of looking at it, especially for some of the agencies’ perspectives. Some of the agencies will not take celebrities. They won't take CEOs of companies because they feel as if you don't have the time to carry the child then how are you gonna have the time to raise the child. They want to take people with medical needs. Other people say this person could be a fabulous parent and or for this child, everything. And there's no reason not to happen use a surrogate. But it’s out there donor egg is not. **Rena:** Sure. Well I think sure, I think as you know I’ve talked about on this podcast you know, a big thing that I, you know, feel very strongly about is changing the dialogue, getting us out in the public, changing the stigma, talking about it more so where it has been so fabulous to have you on. I feel we could talk all day there’s so much to discuss. **Lori:** Thank you so much. I hope that the information is helpful for people **Dara:** I think it will be. **Rena:** And we like to end our podcast by asking you to tell us a gratitude something you are grateful for. **Lori:** Well I’m grateful for the two of you, inviting me here today, to be honest with you. It's so you know, interesting to be on the other side, being asked questions. So I'm very grateful for that. You know, each question what it is that you would talk about, but you have made it very easy so thank you. **Dara:** Rena? **Rena:** Uh, well, again I feel like every time I have the same gratitude, But, you know, Lori was so grateful to get to know you another caring, compassionate empathic person in the field. You know, it’s clear your patients are so lucky to have you not only are you a wealth of knowledge, but I could just tell how nurturing you are so so grateful to you and Dara for bringing Lori on today. So thank you. **Lori:** Thank you. **Dara:** And Lori similar vein as well. I'm very grateful for our mutual friend Miriam for introducing us because you have been a constant in my life recently. And just like you, I I'm so thrilled to have been on your podcast. Such a huge honor. I love listening to it, and really, And I'm proud of you now as a friend. I'm so proud of you for what you've accomplished. What you will be accomplishing with your book and your podcast as well, I know from today that our listeners are gonna get so much from this. **Dara:** Thank you so much for listening today. And always remember, practice gratitude. Give a little love to someone else and yourself. And remember, you are not alone. Find us on Instagram at fertility_forward. And if you're looking for more support, visit us at www.rmany.com and tune in next week for more fertility forward.