Posted on July 16th, 2020by RMANY

Ep 28: Helping the Jewish Community Fulfill Dreams of Building a Healthy Family with Rabbi Segelman

Fertility Forward Episode 28:

Whether individuals of Jewish faith are struggling with fertility, women's health, men's health, genetics, or intimacy, PUAH is here to help couples fulfill their dreams of building a healthy family in accordance with Jewish law. Today’s guest is Rabbi Segelman, the rabbinic advisor for PUAH in America. After studying in Israel for two years at Yeshivat Kerem B’Yavneh, Rabbi Segelman attained a B.A. in Psychology from Touro College’s Lander College for Men, as well as an M.A. from Touro College’s Graduate School of Jewish Studies. Currently, Rabbi Segelman counsels and guides couples across the USA through the most complicated and cutting edge questions in fertility, genetics, and Halacha.

Transcript of Episode 28

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: Today on our podcast, we are very lucky to have Rabbi Segelman. After studying in Israel for two years at Yeshiva at Kerem Avnet, Rabbi Siegelman obtained a BA in psychology from Touro College for Men, as well as an MA from Touro College’s Graduate School of Jewish studies. Rabbi Segelman currently serves as a rabbinic educator at New York Medical College and Touro college of Dental Medicine, Valhalla New York and he actually lives in Queens. Rabbi Segelman, thanks so much for being on our podcast today.
Segelman: Thank you so much for having me. It's an absolute pleasure to be here, to open up a conversation about such an important topic for so many listeners and it is my hope and my prayer that we'll be able to really service the listenership and be able to give some insight and help to all those people. So thank you so much for having me.
Rena: Thank you. Yeah, I think we're thrilled to have you on, I know for myself, I've often referred patients that are religious and I'm so happy to have PUAH as a resource since oftentimes they have questions that I may not be able to answer in the best way and so I’m thrilled to send them your way to really help guide them in their fertility journey. So maybe I don’t know if you want to open by kind of talking to us about PUAH, what it is, what it stands for and what you guys offer.
Segelman: Sure, absolutely. Yeah. So PUAH, I serve as the rabbinic advisor for PUAH in America. PUAH was originally began in Israel about 30 years ago. And we have a branch here in America for about 15 years, 12, 15 years, and PUAH really began way back when, when the fertility questions were really coming to the forefront. It was shortly after Louise Brown was born so we're talking 1978, 1980 and a lot of the questions were reaching the rabbi's table, the rabbi's desk. Is this treatment permissible? So we're talking about the Orthodox Jewish community where IVF had just begun. And there were so many questions whether the Jewish community could accept and celebrate this new opportunity to help countless couples, or is that something that the Jewish religion would not allow, would not accept? And PUAH the organization began to help navigate all of the issues to help those couples navigate all of the various issues that these Jewish couples were facing, trying to balance their fertility and the procedures that were now becoming available with the advances of reproductive medicine. And really, I would say the slogan, the motto, although it's nothing official, but you know, everyone who works on the team, our job is to open doors. We want to open doors for couples to help them as I said, navigate the system without closing doors. You know, it's very easy to say no, to say that the religion doesn't allow it, Jewish law doesn't permit. It's much more difficult to say yes, and to explain why it is permissible. So that really is how PUAH was founded. It's how we began to try to help as many couples as we can utilize the various technologies that are available under the guidance of Jewish law.
Rena: So now what do you say? I mean, I know a big tenant of Judaism is procreating and reproducing and that's pretty biblical. It goes right back to Adam and Eve. And I know for people in general, not regardless of religion with patients that need a productive technology to conceive, there's a lot of guilt and shame that goes with it because it kind of goes against what we think is our biological right. So now in the Jewish faith, if you are religious, how do you approach that if you need reproductive assistance to conceive, what do you say to a couple? How do you kind of navigate the emotional aspect of that?
Segelman: Yeah, it's, it's an excellent question. It's something that we get every single day and the questions are similar, but they really run the gamut from people having, experiencing a lot of guilt because they feel that what they're doing is not actually permitted according to Jewish law. And even if we can tell them and explain to them why, what they're doing, is permissible according to Jewish law, they feel that fundamentally and theologically, they feel that what they're doing is wrong. You know, people make comments like if God didn't want me to have a child, so then how am I able to now go ahead and take advantage of reproductive technology? If God wanted me to have a baby, then I'd have a baby myself naturally. So I feel guilty going ahead with this. And often we have lengthy conversations with couples. And I think the basic idea is that there are many challenges in this world. And it's true. I can't tell anyone why this couple is experiencing infertility and that couple are able to conceive year after year without stopping. But one thing is true and for sure true that God runs the world and God creates man and creates everything, creates science. God allows for all of the advances of reproductive medicine to take place. So it's true that Hashem God has given this couple, unfortunately, a difficult hand, but on the other hand, he also made RMA available for people to go ahead and seek treatment and to get help. That medical intervention, as we've seen, has produced thousands upon thousands of children and thousands and thousands of couples have been able to have children successfully because of this medical intervention, which is all from God. It's true that the doctors are the conduit and the messengers see to it what he's been able to shower upon the people, but through the doctors, through medical intervention, we're able to utilize what God has given us and to use it in our favor. So I don't think it's a contradiction that kind of saying, no thank you to God, turning away from God and then utilizing doctors, instead of God. It's understood that the reproductive technologies that people are using is also an extension of what God has given us in 2020. And we have to be cognizant of that. When I explain that to people and we have that conversation, I would say nine out of 10, if not 10 out of 10 times, people hang up the phone or they leave the meeting very comfortable, much more comfortable than when they came in.
Rena: I was gonna say…
Dara: Reassuring them.
Rena: Yeah, it makes total sense and what is people's response normally to say, okay, and that's kind of the end, or do they really then continue to question?
Segelman: Some, it depends on what stage of the game they're in. Sometimes it's that initial hump that they need to get over to get started. Also, the more conversations we have and the more we talk and the more people are aware of how common it is, you know, it could be that sometimes people come in, they call, they come to the office, not knowing really anything. They have no idea how common or uncommon it is. They think that they're the only ones in their community who are undergoing such treatment. And sometimes it just takes one conversation where you inform them and you educate them how common the issue it is globally and how prevalent it is in the community. And they know that they're not the only ones that are calling me. They're not the only ones that are going through this. I mean, anyone who goes to the waiting room in any fertility center in seven o'clock in the morning, you know, it's packed. But I think that that is a very reassuring notion to know that they're not alone, they're not alone and really what they're experiencing, their neighbors experiencing it, their next door neighbor, they're down the block neighbor. So many people in their community, wherever that may be, they're going through the same things, they're questioning that same questions and they're having children and they're actually having children. So that is a very comforting piece, knowing that it's a community, they're a part of a community and there are resources for them knowing that there is help at whatever avenue they will seek help. There will be answers that will be someone standing there to help them to guide them. That's really what the organization is here for to see to it, that the callers, the couples, whoever they may be and whatever stage they're approaching us, they know that there is a resource available to help them and to get them through the very difficult and dark time.
Dara: That's great. I mean, just having that reassurance for people to know that there's a place that can honor them and help guide them and navigate through a potentially difficult time, help answer questions in a safe space without support. It's great. I wish this was something provided for all different people all different religions to have that safe space to go to.
Rena: And I think too, the message that really applies to both people that are religious or not religious is a lot of people go through this feeling alone when really it's so common. And it could be your neighbor, your friend. I mean, once you kind of opened the door to discussing it, people really do come out of the woodwork and you find so many people went through this in one way or another.
Segelman: Another angle is that when they ask questions from a Jewish law perspective and we actually have the answers and we have the answers, and we say, I spoke to this rabbi and it's written in this book. And as you begin to share with them, this wellspring of knowledge and experience, not just from our organization, but the correspondence that we've had with other rabbis also goes to show that this is a conversation that has been had hundreds of times before, with the most prominent of rabbis. This is not something which is shunned upon. It's not something which no one wants to talk about. It's a topic that has hundreds and thousands of pages in the Jewish literature that you can research and you can see for yourself. So I think once the couple sees that these questions that they're asking are the very questions that have been asked so many times before and have been answered by these prominent rabbis who are very comfortable dealing with these questions and conversing about these topics. That's also extremely comforting knowing that this is not a restricted area. This is not something which is inappropriate, restricted, something that should only be discussed under the table. On the contrary, we bring it on top of the table, try to break the stigma as best as possible, because really it can be very uncomfortable, but it doesn't have to be and it shouldn't be
Rena: Definitely agree. And what, you know, in terms of Jewis law, I mean, so how would you navigate around with fertility treatments? It's a lot of monitoring going to the office and et cetera. So how do you navigate that around someone who does during the Sabbath, or it does fall on a holiday? How do you explain that?
Segelman: That's a very good question. That is a concern because, you know, as we say, Shabbat happens every seven days, the Sabbath is every seven days. There's no surprises, it's on the calendar, it's there. And when we talk about a cycle, it's not very often, especially when you're talking about an IVF cycle, we're not talking about like, oh one day a month, kind of thing. We're talking about injections, we're talking about blood tests, we're talking about monitoring and I'm actually giving a presentation tomorrow to rabbinical students and part of the talk is about how to answer those questions about Sabbath, observance and treatment. And I found online just on someone's blog, a picture of their calendar, their monthly calendar, and which dates they're going in for first bloodwork and sonograms. And it happens to work out perfectly that two of the four Saturdays of the month she is expected to go in and she, for whatever reason, I forget exactly if it's for monitoring or for the sonogram, for the retrieval itself. But I just present this picture of the calendar to the rabbinic students and say like, this is a classic calendar for a woman who's going through IVF. And you see right here that on two Saturdays of the month, she's expected to either present in the lab with blood work and sonograms or for actual retrieval. And that could pose a major issue, a major question for a Sabbath observer, how are they supposed to navigate their cycle knowing that the doctor's expecting them to be there two Saturdays of the month. So I'll, I'll answer that question on two fronts for the couple and for the physician as well. I think that for the couple, they have to know that there are ways to navigate the situation. Not just because the doctor wants you to come in to give blood work on Saturday. Doesn't mean you actually have to come in. For example, we have a system worked out that we have a non-Jewish nurse come to their house on Saturday morning, early in the morning, we'll take blood. And then we'll hand deliver that blood to the lab for the center to run the blood tests. Almost all centers are aware of this. They're comfortable with this. And it's a way that we could prevent them from getting into a car and driving or being driven to the center, which is something that typically we would not allow on the Sabbath. And that's great for the patient. And it also is really great for us that the doctors are comfortable with that. As I said, there's the patient. Then there's also the physician. There's also the doctor. And one thing that I really am trying to keep it a wonderful working relationship with as many doctors as I can, because usually there's a lot of gray area when it comes to fertility. And just because let's say a retrieval day falls out, I just had this, this past Saturday, this past Sabbath that had a question, the doctor said, really, I think you should come in on Saturday for the retrieval. And I called the doctor and I said, do you really think they have to be there on Saturday? You think we could do Friday or Sunday? And he said, well, let me look again. And you really analyzed the chart. And he said, you know what? I think we're definitely okay with Sunday, we'll push it off to Sunday. I think it actually, it might even be better for them to do it on Sunday. So I think that the doctors and it happened to be a Jewish religious doctor and I think that the doctors, as they're more sensitive in the religious observance, they make it a more comfortable environment for their patient. I cannot explain to you the world of a difference it is when a patient comes home and calls me and says, I had such a pleasant experience because the doctor knew where I was coming from. The doctor knew that I'm an Orthodox patient. The doctor knew that I have this obstacle called the Sabbath that I wouldn't be able to come in. And a doctor even told me that I can call PUAH and arrange blood work, or don't worry, we'll leave it. Have the retrieval on Friday, we'll have the retrieval on Sunday. We don't have to worry about the Sabbath. We're going to work with you. Just knowing when the patient knows that the doctor and the patient are on the same page religiously, I think it's such a comforting feeling which makes the whole process that much easier. And who knows maybe even more successful, you know, the less stress maybe even to go have a higher success rates. So I definitely think that there should be a conversation between patient and doctor and rabbi to make sure everyone's on the same page. And in my personal experience, the doctors are almost always very, very flexible and welcome to accommodate the requests. Obviously we're not interested in compromising care, but that we never would want to do. But within that framework, everyone has been very accommodating and it's been a great working relationship.
Rena: So it sounds like an open dialogue and communication is really important. And hey, this is who I am. You know, I'm a religious Jew, and this is how I live my life. And how can we accommodate that?
Segelman: You know, there are so many people have called me and who have reached out to PUAH for assistance who are not religious, but they understand that this endeavor, this lofty endeavor of having a child, not being able to do it naturally and needing this medical intervention, whether it's coming from like, we don't want to anger God, we want to be on God's team. Or we want as many merits as possible. We have so many calls from irreligious Jews. They're not necessarily Sabbath observers, but they don't want to do anything wrong when it comes to their fertility. You know, they don't want to do anything wrong. And as I said before, we open doors and our doors are open. We are more than happy to help with all callers. And I think that's actually a very helpful thing for the, even the religious Jews, just knowing that they're doing everything above and beyond, you know, above the letter of the law and certainly even out of their comfort zone, but they want to do it because they'll do anything for a child.
Dara: And it also sounds like, Rabbi, that you guys provide that emotional support also for the individual, for the couple. And it's great that it's not just for the community, the religious community per se, but that is something that can be for people who are not as religious and especially because there often is that shame and that guilt that can surround you when you think your duty is to be able to have children and it doesn't come so easily. The fact that you guys are there to give them the support and guidance and to help answer questions, that's wonderful.
Segelman: There is a lot of shame and guilt, and it comes from different places. I heard a conversation recently between one of my colleagues and someone who is meeting with, he told me that the grandparents were really eager to have a grandchild. They had this pressure that as Holocaust survivors, it's our duty in the world to continue the Jewish religion and the thought of having, you know, a dead end, the thought of having survived the Holocaust, having survived Hitler's Germany, making their way to America, rebuilding, and then not having a grandchild and even the children of survivors to not be able to continue the Jewish lineage is something which is a horrific thought. And unfortunately, some of the questions that we get, the calls that we get are just broken couples who are getting pressure from parents, grandparents, friends, aunts, uncles, just, Hey, when are you going to have a baby? Hasn’t enough time passed. Like when are you guys going to get off of birth control? And those comments and those inconsiderate and insensitive comments just are so hurtful. And so we get a lot of those. We have a designated team of social workers and therapists who are on staff to help those callers. We even get callers from parents who don't want to be insensitive, but they don't know how to address their children. They don't know how to start the conversation. I've had callers who are willing to pay for everything. They understand treatment is expensive and they're willing to pay for their children's treatment from A to Z, but they just don't know how to start the conversation. It's just so awkward and uncomfortable, and they don't want to say anything insensitive. And as I said before, the questions really run the gamut, whether they're questions about Jewish law or about how to handle a situation emotionally from the couples, from the parents. You know, I wish I had more calls from parents and grandparents, how to be more sensitive. I wish more of those calls came in. Unfortunately, it's not too often we get those calls, but I'm so grateful when the calls do come in and we're actually planning on a webinar. Now we've shifted to the virtual platform. So we'll do webinars. It's proven to be pretty successful. Thank God. So we're planning on having a webinar for the parents of couples who are going through infertility. And actually I think the one that we're working on now is parents of single girls, how to talk to your daughters about fertility preservation and how to understand. A lot of these parents have no idea what fertility is, what fertility preservation is, what it means, how important it is, and really just how to have that healthy conversation with your daughter about fertility preservation and why it's important and help them along. You know, don't put more pressure, they get that they're not married and they get it that they're feeling pressure from their biological clock. You don't have to make it worse. You know, on the contrary, there are things that you can do to make it better. So I think the more education that's out there, which is another, which is really one of PUAH’s missions, not just the actual guidance and support for the couple, but education for the physicians, for rabbis, for the general public, the more information out there, the more we can empower the listeners with good decisions, with helpful decisions, and informed decisions. I think everyone will be in a much better place.
Rena: I couldn't agree more. And I love that you have parents calling in. And I think that's, you know, you touched upon something that's so difficult for people which is how to navigate around parents or friends, you know, Hey, when are you going to have kids and how to navigate those questions? I think it's something most people face in. It's extremely difficult. I love that you guys are offering resources as to how to navigate that. And then I guess that also made me think about sort of a twofold question. One is so in terms of the idea, you know, of conceiving and that’s sort of, you know, our biological right, how do you navigate around someone who is told they need to use a donor would be my first question. And then my second one would be around egg freezing and fertility preservation. You know, how do you navigate around someone who says, you know I’m still single, but I want to preserve my fertility. I need to freeze eggs.
Segelman: Typically, I think the most appropriate way is to answer your first question first and the second question second, but in this case, I'll begin where you left off. So we mentioned that already. I think it's so important for people to know, for girls to know that there is something called fertility preservation, that there is the treatment called egg freezing, which is available to them. The worst calls that we get is from older singles. When they say, how come nobody told me about this? How come no one told me that there is something called egg freezing and now I just went to the doctor and I'm 45 and my AMH is zero point something and my FSH is through the roof. So how come no one told me? And the doctor told me, I'm sorry, you're not a candidate for egg freezing. It’s that call of just complete brokenness?
Like, how come I didn't get the memo? So I wouldn't want that to happen to anyone. On the other hand we want to make sure that people aren't jumping to freeze their eggs too early. We want people to have a chance to go out with guys, socialize, get married, try to have children naturally, you know, maybe you won't even need medical intervention, but there is that gray area. That fine line. When you're, I don't know, maybe 33, 34, 35, 36. It really depends on the lady. And the truth is when I have a conversation, I'll ask them, everyone is different. Take a 33 year old. I ask them, how actively are you dating? And she says, you know, really not active at all. I haven't dated anyone since I was 31. And I don't see anyone dating anyone in the near future. So it could be for that woman. Maybe it might be more appropriate to be slightly more aggressive and let's consider egg freezing maybe now, as opposed to a 33 year old, who is out every weekend, this date and that date. And she has so many different leads. So I would say, you know, let's maybe hold off for a year and let's revisit when you're 34. When the 35 age approaches. And as we all know that once a woman hits 35, plus the quality of the eggs really does begin to decline. So then we would a little bit more aggressive. And certainly as they get closer to 40, much more important, it's a sensitive issue. We try to encourage the women to freeze their eggs without feeling a sense of hopelessness. That it doesn't mean that you're freezing your eggs. You're freezing your life. And that's it. Like I'm never going to get married, I’m never going to have children naturally. I'm just going to be a product of the doctor's office my entire life. It's not true. Just because you're freezing eggs doesn't mean that we gave up on you. You don't have to give up on dating. You don't have to give up on your family. Continue, continue with the same fervor and the same excitement. You have an insurance policy, you have your eggs cryopreserved and I tell people, you know, what will be the biggest blessing? If you never use them. I hope you never use them. You'll get married, have children naturally and you'll be able to discard the eggs at a later time. Okay? You don't have to worry about it, but should you need them they'll be available. I don't want to hear that the door was closed for you because you opted not to engage in a certain treatment or that you weren't aware of a certain treatment. That we would never like. So part of our mission over the past few years, we’ve been very heavily advertising the opportunity to freeze eggs. We've had a number of webinars, just a few weeks ago. We had a webinar about egg, freezing, an informative webinar from a medical front and with the rabbi also just to shed light on the Jewish perspective. And that's always well attended. It's not publicized loudly. It's not heavily publicized. It's kind of under the table, but we always get a really, really nice showing. I think they were close to a hundred if not more single girls who attended this and this again, we're not even advertising it in the papers or anything. A few people, this girl has this friend in this chat and it goes to show how much of a need there is because we always have high attendance when it comes to fertility preservation. Unfortunately, we'll segue into the next conversation. Unfortunately, sometimes either women are getting married at a later age and they didn't freeze their eggs for whatever reason, or they froze their eggs and unfortunately it wasn't viable. And the doctor kind of breaks the news that it might be a good idea to consider egg donation. That usually comes as a huge shock to women. They never ever, ever considered the fact that they were going to post the eggs of somebody else. It's such a foreign and really for some women it's even like a horrific thought like it's despicable. I can’t be the mother of my own children. So we have a lot of callers who met with the doctor, the doctor mentioned and they're angry, they're offended. Like how could the doctor give up hope? How could the doctor not even consider going another cycle with my own genetic material? We usually have a meeting with those couples. You know, our policy is that we have conversations over the phone. A lot of our meetings are over the phone. When we talk about third party, we insist on having an in person meeting. So, you know, remember those days when people had in person meetings, I don't know if you remember, during the days when people had in person meetings, we would always insist on them coming to the office if they were in LA or elsewhere that they have a lot of callers from LA. So if they're not in the New York area, the Tristate area, we did zoom meetings when it wasn't popular, you know, it's unbelievable.
Dara: Ahead of your time.
Segelman: But yeah, totally. I was one of the only people with a zoom account before COVID so we would have meetings, but we would insist because it's such a sensitive and delicate topic. And really, I think, as we said before, after the conversation, I've never had a conversation that went sour. I really have never had a meeting with a couple that went sour, all of my meetings and I can't they're way too many to count all the meetings with these couples. You speak to them about how number one, there are many, many rabbis in the Jewish religion that do accept it. There are certain guidelines, but within the guidelines, number one, it's totally acceptable. It's totally common, right? There is not one week that goes by without a meeting with a couple about egg donation. When they hear that it's like a whole new world, knowing that they're not the only ones considering and actually going through egg donation is a game changer for these couples. And knowing that, just hearing from so many mommies, who've had babies through egg donation that all of this fear and fright and concern will literally go out the window when that baby is born and skin on skin, the baby starts crying and you're holding your baby. It's like, the conversation never happens. It's like all those details become blurry. And the thing that you focus now is that this is your baby. And once that baby is born, it's a different world. And I think that that really gives so much encouragement to the couples, knowing that this is temporary, assuming that medically, this really is the most appropriate decision and the fear and the discomfort is temporary until the baby's born. Once the baby's born and I love speaking to my couples that have had babies through egg donation because it doesn't even come up like the fact that it was like, it doesn't come up. But yeah, my daughter, this, my baby that it's so amazing to speak to them and it's like, everything was natural. It wasn’t even a question.
Dara: That’s wonderful.
Rena: Sperm donation? Same thing?
Segelman: Sperm donation is interesting. You know, recently I've had a few conversations about sperm donation and I'll share with you an interesting insight that the wives have expressed to me privately, that they don't want to go ahead with sperm donation because they don't want their husbands to feel gypped. They don't want their husbands to feel really that I'm inadequate and recently it's interestin I've had it from that one, not two, I think three or four or the past month or so, women called me with this concern that they didn't want to go ahead with sperm donation because they didn't want their husbands to live this life of shame every time they see the baby, to see their child. So they would always, it would be like a constant reminder that their husband is aspermic or whatever the issue was. It’s again, it's a similar discussion. A lot of times, it's just rightfully so, just having the couple, speak out their thoughts, be open about it. The more you speak about it, the more you learn about it, the more you know about it, the more people who are involved in the situation, it makes it a lot more comfortable. But it's interesting according to Jewish law, the egg donation is a little bit easier to find rabbis who say that it's permissible than sperm donation. It's a little bit complicated, but the mitzvah, the obligation and the commandment to procreate and to have children is really technically the man's mitzvah. Obviously the woman is necessary to facilitate that the commandments is fulfilled. It takes two to tango, but in terms of the commandment, the mitzvah checklist. So this one would be on the man's checklist. So when it's a donor, and there's a whole question whether the donor egg should be Jewish or non-Jewish, there's a whole discussion about that. What's preferred in that in a case of egg donation, at least the man's sperm is there that ingredient, that key ingredient is there when it comes to sperm donation. So really it's not even there. The sperm is coming from a donor. So the husband is really out of the picture of the whole driving force as you mentioned earlier that such a critical component of Judaism is the commandment to procreate and to have children, if that's the driving force, that's really the, the man's responsibility in terms of I'm talking now about technical commandment checklists in a sperm donation when his genetic material isn't even present. So then it makes it slightly more complicated, but a number of great, great rabbis that we cosult with on a daily basis do feel that it is permissible. Most notably Feinstein who is one of the leading rabbis in America. He wrote a well known response and where he writes that it's permissible. So there is certainly grounds to permit such a treatment if that’s what's necessary.
Dara: That’s good to see that there are guidelines for both men and women. And there is that discussion available on your end, which is wonderful. Is there a closing message that you would like to give to the religious community or anything that you haven't mentioned that you would like to add to this discussion?
Segelman: I think that one of the most important messages is that, as I said before, that you're not alone. And what that means is you're not alone as a couple who is struggling, but you're also not alone without resources. Our organization, every day we think, and we think, what else can we provide? What other service can we provide that would really make it the life, the journey of a couple or a single who is going through fertility preservation, what can we do to make their lives easier, better, more enriched? How can we serve as the community? And that really is our mission. And knowing, as I said before, knowing that there are resources available to help and to answer questions and to be there for guidance and support is I think such a critical ingredient and component in a successful cycle. I think that that really does contribute to the overall success and people should know, people should know what's out there and should know that we're here to help.
Rena: Wow. Rabbi, thank you so much. This has been fascinating. I feel like we could ask you so many more questions and we're both so grateful to have you as a resource for our patients and another organization who also wants to kind of change the stigma and have open dialogue. So thank you so much for this information and your time. And we like to close all of our podcasts by saying something we're grateful for and doing gratitude. So would you like to tell our listeners a gratitude that you have?
Segelman: Gratitude? I am grateful that we live in the time that we're living. You know, if we were living 50 years ago, we would not be having this conversation. We wouldn't be having the conversation because of the stigma. We wouldn't be having the conversation because of the medicine that was available. The fact that we live in 2020 and I can have the most unbelievable conversations. I have forwarded this morning, a complicated medical records with a very, very rare genetic disease across the world to Israel with one of my colleagues who is a genetic counselor, the fact that we could send records to Israel, to analyze together in a matter of minutes, and then get back to the couple exactly what the best guidance is, to help couples be successful in their treatments when these treatments weren't even a dream 50, 60, 70 years ago. I'm grateful that we live in a society and a world that is so advanced and is continuing to advance to be able to help countless couples navigate one of the most heartbreaking and difficult challenges in their lives. I am grateful that we have all this available to us. I can't wait for more. I’ve said before that I was once driving and I was listening to a recorded presentation that took place about 10 years ago from a doctor and they were the way they were speaking you know, maybe one day I believe they were talking about PGD and certain genetic tests that they run in the embryos. Maybe one day we'll be able to do this. And I just couldn't believe it. Like we do this every single day, but the way they were talking about it 10 years ago, it was like, wow, maybe in the future, we'll be able to have X, Y, and Z. X, Y, Z is literally something that we do a million times a day. And that was just 10 years. And I'm excited to see, hopefully you'll have me back on the show in another 10 years and we'll be able to reflect on all of the advances that have taken place, and we'll just be able to be so grateful the fact that we have the science and we have the technology available to help so many people. So that's really what I'm grateful for.
Dara: Wow.
Rena: Oh I love that. Beautiful. You know, I feel like I always say the same thing and I always say I’m so grateful for this podcast and our guests, but you know, it really is the truth. I think for us, Dara and I, we see patients and normally, you know, I spend so much my day seeing patients and kind of in the rhythm of that and then I get this break to speak to other people in this space, it's really such a nice reset to be reminded there are other people out there who care, just like we do, who share the same message. You know, I'm grateful to work for a clinic who onboard with us starting this podcast and saw the importance of giving this to our listeners. And again, to take this time, to meet other people who share our message and be able to share this with people and hopefully make a difference in other people's lives. I think we all know in some way or another, how devastating and horrible this can be to go through. And so I love it makes me feel really so great about humanity to meet other people who care and who want to make it better for somebody going through it.
Dara: Similar vein to Rena. I feel like we have a similar thought process, but just the fact that there is this support system, the fact that there is this network of resources to help reduce that stigma, to help lower the stress levels in these women, men, couples who are going through this. It could feel so lonely and to know that there is a place to go to, there is a support network of people who can help provide some guidance, some guidelines to help answer those really tough questions that often you can't always get from your peers, your family members is such a blessing. It's so wonderful. And it makes me so happy to know that there is that resource out there that we can send our patients to. And it's so apparent your passion, your excitement for what you do, and that you give back so much to people. And we are truly grateful. And for those listeners who want to get more information on PUAH is the best place to reach you on PUAHfertility.org?
Segelman: Yeah. They could definitely go to the website, www.puahfertility.org. You can call us directly at (718) 336-0603. You could ask for Rabbi Segelman. You could ask for one of my colleagues or Rabbi Weitzman, the team is a fantastic team. I'm so proud and privileged to work for such an organization, and really we're here for you. So if anyone needs anything, anything at all, please do not hesitate to reach out whether online or on the phone. We would be more than happy to set up a free consultation.
Rena: Thank you so much. It really has been such a pleasure and we'd love to have you back then hopefully sooner than 10 years,
Segelman: Sooner than 10 years. Okay. My pleasure.
Dara: Thanks Rabbi Segelman.
Segelman: All the best.
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.

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