Ep 21: Third Party Donor with Nancy Kaufman
Fertility Forward Episode 21:
Having a solid support structure during your fertility journey is extremely important, whether that be a partner, a friend, or an established support group. Nancy Kaufman is a licensed psychoanalyst practicing in New York City for more than 30 years, working with individuals, couples, and groups dealing with infertility and parenting after infertility. Following her graduation from Columbia University School of Social Work, she completed her analytic training at the Centre for Modern Psychoanalytic Studies, serving on the faculty and as a training fellow.
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.
Rena:Dr. Nancy Kaufman is a licensed psychoanalyst practicing in New York City for more than 30 years, working with individuals, couples, and groups dealing with infertility and parenting after infertility. Following her graduation from Columbia University School of Social Work, she completed her analytic training at the Center for Modern Psychoanalytic Studies serving on the faculty and as a training fellow. For the past 15 years, she has run the third party parenting network, a support group for those pursuing donor assisted reproduction with an emphasis on issues related to disclosure.
Rena:We're so excited to welcome today to fertility forward, Nancy Kaufman, who I had the pleasure of meeting for the very first time at this year's ASRM conference in Philadelphia. And we connected, and it was this wonderful meeting and Nancy is an expert in third party. So we had her on today to talk about third party, something we think will really pertain to so many of our listeners. So we are so excited to have you!
Nancy: Very happy to be here. Nice to see you both.
Dara: So nice to meet you, Nancy.
Rena: So we'd love to really, you know, start out by talking about, like I said, at RMA we call it third party. I think that's probably an RMA term. And for us here it means our donor department and they deal specifically with egg donors. So, and I know that you started something called third party parenting network. So I guess you also do use that lingo too in your work?
Nancy: Well, it's a very interesting point. I'm just going to bring it up before you did. Third party is an older term. More currently, people are playing a lot with the language that's used in the field and donor assisted reproduction is one of the terms, not the only one, but one of the terms that seems to fit a broader spectrum. Because if you think about it, there's not always a third party. If you're talking about a single intended parent.
Dara: It’s so true. I never thought of that.
Nancy: And there can be more than a third party.
Nancy: I am talking about multiple donors and or a surrogate, multiple family members. So donor assisted reproduction is more of an umbrella term that more people might be included under.
Dara: I love that. I think that I think a lot of terms these days need to be updated to be more inclusive. My question is, does it also involve donor sperm or is it just donor egg?
Nancy: Donor assisted reproduction, egg donation, sperm donation, surrogacy, embryo donation, the whole gamut.
Dara: The whole gamut.
Rena: The whole thing. I guess, so for, I think most people would probably know egg donation, sperm donation, surrogacy, but embryo donation? I think a lot of people don't know exactly what that is. Do you want to maybe explain that?
Nancy: Well, that is a newer part of this field and complicated legally from state to state as is surrogacy, of course, and that is not really my area of expertise, but there are different ways to donate an embryo either from, as someone who has completed their fertility journey that has extra viable embryos. And then there are different venues that those can be donated through.
Rena: Yeah I know that’s a whole other thing. And there's sort of a lot of ethics that go with that.
Nancy: Absolutely. I know myself and I was getting divorced and we were, I had extra embryos and, you know, we had to make the choice of what to do. And then the embryo donation was an option. It's definitely a hard choice. So I guess tell us more maybe about your, what you're still calling third party parenting network and the group you run.
Dara: And how you got involved.
Nancy: Well, I still call it the third party parenting network because I had to change the name. It's a, it's a group that's been running for about 15 years and it is comprised of people at all points along the journey of creating families using donor assistance. So people who are just beginning to think about it and are very distressed about the idea, continuing through people who have already made the decision to use donor assistance and are in treatment possibly pregnant, as well as families who have already created their families and are actively involved or wanting to be actively involved in discussing disclosure with their children. And that's really the major focus of the group.
Dara: Is it predominantly families or is it also friends and peers? Cause that could also be…
Nancy: That's a wonderful idea. Oh, do you mean who attend or what we focus on?
Dara: In terms of what you focus on? Because yes. I think the idea of bringing up, you know, the way a child was conceived, whatever age can be something that can be tough, but also the idea of sharing the news with family and friends and colleagues and learning how to, the strategies or how to start the conversation.
Nancy: It is on most everyone's mind and there are two separate, but very, of course, related issues with disclosure. One is the intended parent or parents disclosing to the child, which is really our major focus. But then who do you tell outside of the family? When do you tell? Do you tell at all? Issues of privacy and secrecy come up all of the time and people really, really struggle with this notion of if I want to tell how do I tell and what if I don't want to tell other people?
Rena: So what do you say to that. I think that’s the burning question. I think a lot of people, you know, I know my patients come and they basically want sort of a blueprint outline. Okay. How do I do this? You know? And so what are your recommendations?
Nancy: It's a very individual, each individual and each family, each culture have very different dynamics. And the first thing that I work with people toward is becoming comfortable themselves. And if we just go back one minute to the issue of disclosure to the child, what I always say is that if you are comfortable, your child will be comfortable.
Dara: That's so true.
Nancy: And the other, I think major difference when we see people as both of you do in our offices, in the beginning of this process, they are going through a traumatic, very long-term situation. No one chooses donor assistance as a first option.
Nancy: So people have gone through often years and years of terrible losses. What I always remind intended parents is that a child conceived through donor assistance, hasn't gone through anything terrible.
Rena: I like that way of thinking about it.
Nancy: They haven't lost anything. They don't start off with any negative preconception, which then going back to the intended parent, the importance of feeling okay about the decision, what it means for them, for their extended family, for their child to convey that positive feeling. And also a small child doesn't need to know all of the terrible steps that led to the choice of them being donor conceived. So you can start almost at the end of the process, which is that, that is how they came to the family. And that is a wonderful, joyous thing. Particularly.
Rena: I think that this comes up a lot for me and I would assume probably for you too, right, is that people's struggle with how do you, you kind of have juxtaposing emotions, right? How you mourn the loss of not being able to have a biological child and this, what is an intangible loss, which I often think and discuss it, those are the most difficult types of glasses to mourn, but how then are you happy and excited about what's to come and how can you deal with both things at once? And I like how you put it. I never thought of it that way. That for the child, right? This is the beginning. Now for the parents, it's the beginning, but it's also the end of something very traumatic and I think it's really such a complex thing. You know, how do you process all this loss and emotions, but then more forward and be excited about the next steps. And I find that people really struggle with that. Understandably. I think it's very difficult.
Nancy: It takes a long time. And as I'm sure you see, people are very anxious to keep going and keep going quickly.
Dara: And not always reflect.
Nancy: And reflect and take time to process each loss along the way and address the question. And then I have a little example that might illustrate it. People who do take the time to reflect more on each loss over time often do come to the other side, even just saying things out loud over, and this is why therapy and actually do work. The process of repeatedly expressing emotions inwards has an effect at diminishing the hold that those feelings have. It's not that the feelings aren't there, but they no longer control the narrative or the behavior. I like to think of it that you become in control of your emotions rather than the emotions being in control of you.
Dara: That's great.
Rena: And I think you're letting somebody else hold them for you too.
Rena: Which I think is really helpful. Let someone else hold your pain and emotions. And hopefully that takes some of the pressure off also.
Nancy: And in the group, the really remarkable thing is when people hear strangers say exactly how they feel.
Rena: So powerful.
Dara: They can relate.
Nancy: And often in exactly the same words and they feel heard, understood, not quite as crazy, you know, people don't talk about these. They’re terrible dark feelings along the way that people think I’m the only person who feels this way, what's the matter with me?
Rena: I encourage groups so much. And I think so many people are reticent to go and, you know, once they do go, they come back and they say, Oh my gosh, that was so powerful because you know, I always say, this is sort of like the sorority you never wanted to belong to, or the club you never wanted to join, but you're in. And so it's better to meet as many members as possible and realize you're not alone and so many people feel this way. And you could be from two totally different walks of life, not connected in any other aspect of life, but this shared experience is a bond. And it is so powerful to share that with somebody and find, you know, you're not alone.
Nancy: People often say that this is the first time that they’ve spoken publicly in front of other people about how they feel. And just even that release is very powerful. So I have a little example just to…
Dara: Love to hear.
Nancy: One intended parent who used a surrogate and a donor egg has now a three year old daughter and was telling her the story of her birth. And this woman took years to make the decision, to use a donor egg. And along the way, then also had to find out to use a surrogate. So it was not an easy road. Here she is with her beautiful three year old daughter, telling the story of the birth. And the little girl knew the surrogate's name, part of ongoing discussion, but didn't necessarily know the connection of how she was really connected to this woman and what the woman's role was in the family. So this intended mother said to her daughter, you were in Lucy's tummy and Lucy pushed and pushed and pushed and out you came and the doctor put you in my arms and said, here is your daughter. And I finally saw your beautiful face. And I said to myself here finally is my daughter. And I looked at you and you were so beautiful. And she tells this story with genuine great joy and love. And the little girl is delighted as all children are about learning to be the center of any stories. It's the best first story. And she said, Oh, mommy, tell me again about the day I was born. So what you have, there is someone who never thought she could do this. I don't mean not even the disclosure piece, using a donor at all. And here she is many years later with a beautiful little girl able to tell the story with joy. And it's the joy that gets communicated. So the little girl's first experience about her conception story, look, her birth story later the conception.
Dara: Details later.
Nancy: Exactly. Is one of joy. It's not being different as parents fear that I don't want my child to feel different. What the child needs is a communication of happiness, joy at their birth that they're coming into the family.
Rena: I love that so much.
Dara: I love that it was spoken about at such a early age and I'm sure every situation is different. And I like that you said that a lot of times when children feel uncomfortable, it's often the parents who feel uncomfortable and they sense that, is there a general rule of thumb of when to bring up this conversation? I, you know, a lot of times, or at least I've been told by peers that, you know, you have to wait until the kids start asking questions, but I love that she, it sounds like she said it before the daughter even asked.
Nancy: Well, my view and many of my colleagues’ view is that the earlier the better for a variety of reasons. One Dr. Linda Applegarth and I did research several years ago about the question of did intended families do what they wanted to do regarding disclosure? So that's what we were looking at. What we found is that even among families that wanted to disclose, many hadn't because they were waiting for a right time. Which of course...
Rena: Right. In life.
Dara: I get that.
Rena: I think people wait for the right time for so many things, right?
Nancy: So what happened was that these families who wanted to disclose, the families that don't want to disclose, of course, don't participate in research, which is another problem. But these families who wanted to disclose hadn't and now had teenagers, even college age children, and it's never too late. But for these families, they had inadvertently created an additional problem because telling a teenager or a young adult is a very different thing than telling you a young child who can grow into their understanding of their conception story. That little girl that I just spoke about, she doesn't understand why she was in someone else's tummy. She will grow into an understanding as the story continues to unfold. And developmentally you add pieces of information that a child can comprehend as you want about anything.
Dara: So true.
Nancy: But I've had many, many people who say, well, I told my child when they were two, they never brought it up again. So I haven't either.
Rena: I always say that, you know, kids respond to love sort of first and foremost. And, you know, as you touched upon, it’s about how you tell the story. And if you tell this as one of great pain and sadness and trauma, you know, to get to that point, you know, a child’s going to pick up on that, but you say, you know how you said, and you know, one of joy and love and excitement that’s what the child's going to know. And I think, you know, at least my sort of understanding is the more you normalize it from a young age, the better. That's what a child knows. They don't know any different. That's all they know. It's not some great shock. You know, I've certainly had patients in my office who have only found out because of some fluke medical test, maybe, you know, one of those DNA tests, whatever, maybe later in life, you know, post 20, 25, 30, that the parent that, that was a biological parent is not. And that has been extremely traumatic. You know, I have, I have seen the kind of result of that in my office. And that is very difficult, you know, versus, you know, children who are told from a young age, this is your story. This is it. You know, it's like, I think a child that's adopted, that's not usually ever a secret. I think that's harder to hide than a donor per se. And you just normalize it and show a child they're loved, at least that's, you know, sort of my understanding.
Nancy: Well, and I completely agree with that. One slight variation - a woman who carries a child, having used a donor egg, is in fact the biological mother, not the genetic. It's not a genetic link, but her biology carried the pregnancy.
Rena: Hold up. This, this is very new information.
Dara: I never thought of it that way.
Rena: Yeah, I guess I always thought of it as okay I used a donor and I never thought that, okay, you used a donor, but you are still the biological parent?
Nancy: From carrying the child that’s your blood, that feeds the child. Yeah.
Rena: So now if you use a donor with a surrogate though, are you not considered the biological mother because you don't have the experience with caring?
Nancy: That would be correct.
Rena: So then what would the language be for that?
Nancy: You know, it's, it's a very good question.
Rena: I mean I think if you're a mom. It doesn't matter. A mom is a mom, right?
Nancy: Absolutely. And the field is trying desperately to come up with uniform language that conveys the right information. So when people refer to a donor mother, there is no donor mother. a mother is someone who intends to parent.
Dara: To care.
Nancy: Right. And a donor never intends to parent. A donor sperm donor nor surrogate. So those are never parents. People, particularly at the beginning are very interested in, well, who am I to this child? You are the mother.
Rena: Right. That's what I always say. Right? You're you're the mother. Doesn't, that's just how it is. But I did not know that you could so technically say you're the biological mother if you carry it with a donor egg. I'm trying to wrap my head around that. Because you're, it's your blood feeding the child and the placenta and everything? Even if it's not your DNA and the egg?
Nancy: Well you start with a genetic piece that's introduced, but the rest is the intended mother's body carrying
Dara: Sustaining it.
Nancy: Now you may want to check with your medical staff about the, um,
Dara: The logistics.
Nancy: Exactly. But I just wanted to make the distinction. If you use a donor, if it's a sperm donor or an egg donor, that person is not related genetically, but we don't really even like to say, they're not the genetic parent. They're not related genetically. They are the parent, they intend to be.
Rena: Right. That is so interesting. Did you know that Dara?
Dara: I didn’t. Now it makes sense, but it wasn't something that ever really, I thought too much about.
Rena: No me neither, but I feel also like mentally, that must be very reassuring to people to even hear that language to say, okay, I'm using an egg donor, but I am still the biological parent. I feel that totally reframes the whole thing. And then of course, I think, well, that's rather unfair to a man, you know, if you're using a sperm donor because they don't have that option. Right?
Dara: On that note, I was actually thinking, do you often see the partner come along in the meetings or the support?
Nancy: What I have found in the group meetings is that the meetings that are primarily people at the beginning of the process, often couples, if it is a couple, there are often single parents that come, but often couples will come during those initial phases, whether it's an egg donor or a sperm donor, once they have a child, it's generally the mother who comes.
Dara: Oh interesting.
Nancy: Partly for childcare.
Dara: OK that makes sense.
Nancy: But I also think that in my experience that, not always, but often it's the mother who drives the conversation about donor.
Rena: Regardless of if it’s egg donor or sperm donor?
Rena: And then I guess speaking of couples, my other question would be, how do you see the use of a donor impact couples the, both the parent who is using a donor and then the parent who is still there, it's their genetics, right. So how do you, what's sort of the different and impact that you see?
Nancy: It's a very good question. Of course it depends, of course, on the individuals and the couples. But what I often see is sort of a push pull where one person in the couple will feel one way, perhaps, ready to take the next step. The other person might not, then they catch up to each other. Then there's another step they might not be in sync. Perhaps it's the other partner who wants to go ahead. And, but talking over time helps them generally to end up on the same page and both feel good about the steps they're taking at the same time. That can take awhile to get in step.
Rena: Are there any sort of recommendations you make in terms of how to best support each other?
Nancy: Keep talking.
Dara: Communication. I think the reason why I had asked that previous question is because I, even in what I do, you know, working with food on how that could impact fertility, when I see couples together, they can support each other and lift each other up. And if they're not part of that discussion, I still usually tell them, like, speaking of, if you have a partner, speak to them about it, see if you guys can be aligned. If they have any concerns they can reach out. But I do think that sometimes things can get miscommunicated or that bond can really be strengthened if they come together and they can sometimes with that third party can voice their concerns and their opinions and help support if one person is struggling.
Nancy: Absolutely. And when they're in either struggle together, they're both individually or together in a struggle in the topic to begin with of how to build their family. They're in terrible pain and it's even harder to do, to support each other to think we'll get to the other side of this when there's an impasse in a couple, not just in fertility, but in many things. It's hard to believe that it can get this resolved.
Rena: Oh, sure. I always say kind of the only way out is through. And sometimes it's so hard to see the light at the end of the tunnel that you have to just keep going.
Nancy: And it's very important that both people really be on board because you're talking about a lifetime decision.
Rena: Well so here’s a question, what happens when you're not?
Nancy: Well, sometimes when people come in and they are working toward, let's say using a donor egg or sperm and they can't come together, we explore other options. I've had people who go on to adopt, people who go on to choose child-free living.
Rena: Do you see this impact people's relationships? You know, in terms of it, it can be the end of our relationship?
Nancy: Well, you know, I deal with a very skewed population because the people who come to me…
Dara: Usually want the support and the help.
Nancy: So I would say generally people do work it out, but that's in the population of people who may be more predisposed to working it out than not. I don't really know.
Dara: But I think having some sort of support group throughout, you know, beginning during, afterwards, and really trying to, you know, try to push both partners to be there, I think could be great. Or even if they are doing this alone, to bring a family member, to bring a dear friend to also have that support, especially I think even more so, because sometimes they don't always, they might have the right questions, but they may not feel as open. And having someone there that can perhaps see it from a different point of view that still really wants the best for them.
Nancy: It’s very hard to go through alone.
Rena: Sure. I encourage you to build out their supports and have as many people as possible. And then you don't rely on one person to fill allyour needs. Because I think if you do that, ultimately they're going to fail. And especially in a partnership, you know, each partner is experiencing something different. And to add to your supports, each have multiple people you can talk to your text and relate to. And I think that not only serves you as an individual going through it, but serves you as a couple as well. So I think, but of course, asking for help and being vulnerable is
Dara: Not easy.
Dara: In order to break that barrier
Nancy: At the most vulnerable…
Dara: Oh for sure.
Nancy: …in your life. But the interesting thing about the group is that it's an open-ended group. So people have come for 10, 15 years. Not consistently. They may come in the first year or so through those difficulties then they have a baby. And of course, no one's coming. We have a baby coming currently. And then they'll come back as the next set of questions arise or people who really want to begin disclosing and haven't fully worked out all those last feelings about.
Rena: So this is really an ever-evolving thing. You know, it's not kind of open and shut, black and white, and it's something, it’s evolving.
Nancy: It evolves as the family evolves. As the child grows up. The child who at three begins to learn her story at seven, hopefully we'll have more information and more questions. I wanted to refer Rena to what you had said earlier about people finding out inadvertently. The advent of 23 and me and other commercial DNA testing has really blown the roof off the issue of disclosure because not just kids, adults are finding out, you know, people buy it as a holiday gift for each other.
Dara: I've done that before for my grandmother.
Rena: My dad just got one as a holiday gift.
Nancy: College kids buy into each other and information is being discovered inadvertently. So one major difference that I conceptualize is that if an older child, a young adult, an older adult finds out inadvertently, they feel betrayed. And the feeling of betrayal is their first experience of learning they were donor conceived. So think how different that is from a little three year old girl squealing with delight and a 35 year old person finding out that something they always thought was true, wasn't true. And then you have to untangle the feeling of betrayal from being donor conceived. It's not that it can't be done, but what a long hard road that never has to be done if a child grows into their understanding from a very early age.
Rena: You know, I think the point from that too, is to show people that, you know, there's so much uncertainty and loss of control that I think goes with this process. But that story, I think, points to, even though you may feel, this is not your choice, your first choice, whatever to use a donor. And you know, you have to grapple it out, but you still very much have the control to write your story, right? And to write the rest of it and you are in control then of that child. Do they find out and experience betrayal or do they find out and experience love? And that is a piece of your story. You have every single element of control over.
Nancy: And what we're telling families, we know even five years ago, families who feel they do not want to disclose. Obviously they continue to have that right. But we as professionals now really have to tell them and donors that the issue of anonymity is no longer guaranteed because of the commercial DNA. And just as we couldn't imagine even five or 10 years ago, how it would grow, I'm not sure we can envision five years from
Dara: What's gonna happen. How much more.
Rena: Right. Our society is now just testing DNA for fun. Who knows what we're doing in 5 years. Yeah. It's certainly an ever-changing very interesting field.
Nancy: And if intended parents feel that that is something that they really choose not to contend with, people may think in a different way about the choice of using donor conception.
Rena: Sure. And I mean, I think it's important too, for us to point out that as much as we can guide people, we can't tell them what to do. There's no law when you choose to use a donor, your way of disclosing or not is up to you. We cannot, there's no rules or regulations with that. And so all we can do is guide and serve as, you know, people that, to help you unpack it. And I think, you know, it's so important that people seek counseling just to figure out what path is right for them. Um, and again, to also understand that just because you choose one thing in the moment, doesn't mean you're going to feel the same way in a year and that's okay too. And to be okay with that.
Dara: And discuss options and to get that support. I think it's great if you can to start early, but knowing that even if you haven't, you know, prior to a birthing story, there's still help after the fact. And it's never too late.
Rena: Yeah. And I know you're in New York City so anyone here, how could they find you and your group the third party parenting network?
Nancy: Well, they can contact me directly.
Dara: And what's your email address if you would like to disclose it?
Nancy: It's [email protected]
Dara: And that's with a K and we'll have that in the notes.
Rena: Yeah we’ll have that in the notes. Anyone, if they're interested, you can contact Nancy about her group. And then of course, you know, there's more information about, we'll put some more links to other reputable third party donor sites in our show notes too. So people can check those out if you're not located in New York City. Yeah. And just some other really great resources we can share also.
Dara: I’ve learned so much today, I really came in with zero knowledge about third party or whatever it should be called, the support network. And I think it's great. I can't wait to share this knowledge with others.
Rena: But before we wrap up is there anything else that you want to share with listeners that you think would be really pertinent, important information?
Nancy: Well, I just want to, I think go back to the issue that we had talked about before, about the compounded losses along the way, and my colleague, Dr. Nancy Freeman-Carol and I have been speaking about how the multiple losses of infertility really may interfere with people's ability to disclose early and easily. And so we really found that when people have the opportunity to do that, that they feel freer from the past and able to look forward.
Rena: Sure. And I think you and I also had a conversation prior to this about the importance of working through this, because if you don't, you know, you see it cropping up later in life and how you deal with things five, 10 years down the road if you don't take the opportunity to deal at all of this intangible or compounded loss now.
Nancy: I mean, that would certainly be my position about any kind of drama or losses. Bu these, when you think about it, these repeated compounded losses that may not have had a chance to be mourned individually to be dealt with individually while looks things up a little bit. Because one question that we had was how is it that some people disclose easily and others anguish for years over that problem? So that's one inroad into that. I'm sure not the only one.
Rena: Yeah. And I think, you know, sort of fertility in general, right. Everyone comes in and there really is no blueprint because everyone comes in with their own pathology, right? And so how you process something is totally different from each individual. And it's so variable.
Nancy: And their own characters.
Dara: For sure.
Rena: Exactly. So I feel like we could talk all day, but we will save that for maybe a part two for this. because I think there's so much more to discuss, but for today we like to end each of our sessions by going around and sharing a gratitude and end on a positive note. So would you like to share first, Nancy, a gratitude for today?
Nancy: Well, I am very grateful to the people who come to my office and open their hearts and their souls to me and to others to help themselves, to help the community that they are with. It's a brave and powerful thing that I daily am grateful for.
Rena: I love that.
Dara: How nice you learn from them.
Rena: So nice. Dara?
Dara: I was actually speaking with Rena before recording this and I was saying my youngest daughter, who's seven, every night we have this routine where we go in, we do a little bit of a meditation and we also talk about the things that are on our mind, things that we're grateful for, things at school that have happened and I'm just, I'm grateful for both of my daughters for really opening up on their own and sharing with me their thoughts and their feelings at such a young age. For me, I always bottle things in and they're teaching me to open up. So I'm really grateful for what I've learned from them.
Nancy: And you're giving them that opportunity.
Dara: I never saw it that way, but I am. Rena, what about you?
Rena: I guess today I'm grateful for really sort of the power of groups. You know, I recently joined a group myself for something personal that I'm working through and it's been so amazing to really remind us of the power of people coming in, being brave, sharing their stories. And you know, of course, wonderful people like Nancy for facilitating these groups. So really grateful for that. And people's kind of just bravery and we’re all kind of in the struggle of life together, just trying to do our best.
Dara: And that support is key. So thank you so much for being here, Nancy.
Nancy: Well I'm very grateful for the opportunity.
Rena: Thank you so much.
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 @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.