Ep 76: Single Parenthood by Choice with Dr. Rachel Gerber
Fertility Forward Episode 76
A growing awareness that you don't need to have a partner in order to become a parent is changing the narrative about parenthood. Today’s guest to discuss this topic is Dr. Rachel Gerber, a reproductive endocrinologist, infertility specialist, and board-certified obstetrician and gynecologist who cares for patients at RMA of New York’s Eastside and Westchester offices. In this episode, we discuss all aspects of single parenthood by choice or single motherhood by choice (SMC), from selecting a sperm donor to considerations regarding disclosure, artificial insemination, and fertility preservation, as well as the importance of prioritizing your mental health and finding a good support system. Hopefully, this conversation will inspire those who are thinking about becoming a single parent by choice and enlighten those who are unfamiliar with some of the nuances of this powerful journey. Tune in today!
Rena: Hi everyone. We're 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 from medical professionals, mental health specialists, wellness experts, and patients, because knowledge is power and you are your own best advocate.
Dara: We are both thrilled today to have a recurrent guest back on our show. We have one of our fabulous reproductive endocrinologists at RMA, Dr. Rachel Gerber, back on to discuss something that I don't think we've had much of a discussion yet. We are here today to discuss single parenthood by choice. So Dr. Gerber, thanks for coming back on.
Dr. Rachel Gerber: Thanks for having me. I'm so excited to talk about this topic - something I'm seeing a lot of in my personal patients and something I'm very passionate about.
Rena: Well, thank you so much. I'm so excited to talk about this. I get single parents by choice or single mothers by choice SMC, or SMBC as the acronyms are known, frequently. And I think it is super powerful. It's a really amazing community. And I'm so excited to have you on to hopefully inspire others who are thinking about it or just enlighten others who don't know about it and about what the journey is. Maybe the different nuances that someone who is pursuing this as a single person may face that's a bit different.
Dr. Rachel Gerber: Yeah. I agree. I find people come to this decision through different venues. Some people, you know, are out there looking for a partner and it's just not happening. And you know, they kind of, I say, some people want, you know, everything, you know, in this ideal of, you know, I have this partner and we'll have a child together and for some people it's like either you get that ideal of what you always imagined as a child or I'm not going to have a child. But then there's other people who say, no, I actually want a child more than I want the ideal, you know, more traditionally societaly expected family unit. And for them, this is a really very powerful choice and something that allows them to have, you know, this dream that they've wanted. I have other patients though, who don't really have even an interest in finding a partner. You know, it's not like this is a plan B where it's like, well, I wish I have a partner, but you know, this is kind of the next best thing. Some people really don't necessarily have an interest in doing it with a partner. This is really the end goal for them. They just, you know, are happy with their current lifestyle. It's not about the fact that this is a plan B and that they're, you know, because they couldn't find someone that now they're doing this as a backup. You know, some people, this is actually plan A and something they're choosing right off the bat without wishing that there was another parent involved.
Dara: Yeah. I'm assuming that there are a lot of treatment options available for this group and take us through, walk us through kind of what you discuss with these patients and kind of what the first steps would be.
Dr. Rachel Gerber: So what I've seen is traditionally mothers so usually single women who want to pursue parenthood. So it is a little bit easier for a single woman or someone with biologically who has ovaries and a uterus because they have, you know, most of what you need to create a baby and the steps that are most difficult to outsource, which are the pregnancy and the obtaining of the egg, they actually often don't have to do that. So there's certain amount of, you know, and when you talk about different categories of people who might want to do single parent, but there is a lot of benefit to people who have a uterus and ovaries that we have a good starting point and that there are more options and more cheap and less invasive options for them. So, you know, one thing I will discuss is, is this something you want to do right now or is this something you want to plan for for the future? Because again, we all have careers. We have an idea of what's the perfect time potentially to have a family and it may not be at the time that they are seeing me. That might just be a consultation about, you know, this is something I want, but I'm not ready to do it right now. So that's first one thing I piece together is what's the timeline for you. If the plan is I want to do this right now, the first thing I will discuss is the option of doing insemination. So donor sperm insemination. And the choice of which way to start or how to start your treatments, you know, we'll often start with a basic fertility workup even though these patients often don't have a diagnosis of infertility because, you know, they haven't been trying, you know, you want to still make sure that the egg counts look like, how does the uterus look, is there any, you know, fibroids or anything else that could affect implantation and also do a fallopian tube test. So I would still want to do all those things because sperm is not always cheap and you wouldn't necessarily want to put sperm, you know, it can be, you know, $500 to $1000. You know, that's just a rough estimate. There's a lot of different companies and it's not cheap and you want to make sure you're not putting sperm into a uterus that, you know, has something that would make it hard to implant and you won't want to do an insemination if the fallopian tubes are blocked. So I'd still start off with the fertility workup.
Dara: What about genetics? Is that something that's often done as well?
Dr. Rachel Gerber: Yes. So that's really, really important. So when it comes to selecting sperm, so regardless in this situation, whatever treatment have you decided on, whether it's insemination, intrauterine insemination where we take the sperm and actually plunge it into the uterus using like kind of a syringe and a small catheter or IVF, there's definitely some things to think about when you're talking about how to choose the sperm. So there's two things to think about. First of all, there's anonymous sperm and there is what we call directed donor sperm. So anonymous sperm means that you're usually buying it from the sperm bank and that you are not getting personal protected information about the sperm donor. You usually have an ID number and you will get information about their interests, their background, their family history, any health issues they may have. You usually get, you know, ethnicity, religion, you know, things that, you know, you may want to connect with. So that's just kind of some basic background you get and you frequently will get baby pictures as well. But I believe sometimes you can also get adult pictures in certain circumstances if that’s really important to you.
Rena: Hold on. I just want to interrupt because that, I mean, choosing sperm is something that can be really, really tough and a lot of people struggle with. So, you know, a lot of times I have patients say, well, can you pick for me or what should I look for? And of course, I don't know, it's, it's very individual. Do I think it's important? Touch upon, too, if a patient is using a sperm donor, is there, people often ask, is there a bank you recommend? What would you say about that?
Dr. Rachel Gerber: So we frequently work with California Cryobank and Fairfax are two very large ones that we work with frequently. I know we work with California Cryobank because some of the genetic screening that they do is through the same company of the genetic screening that we do. So it makes it simple when you're trying to align the genetics to confirm that there are no issues between, you know, the intended parent and the donor sperm that can be prevented in terms of genetic disease. And I'll go a little bit into that more in a moment. So that's the main banks that I'd say I've seen, and that do a really good job with getting the genetic analysis, which is often a critical point when we are picking donor sperm. One thing I found, which is interesting, is I've had a lot of patients who during, you know, we'll meet and then we'll get some of the information, they'll come back and they'll have a few donors that they're interested in. They often liked to go through them with me. And they're like, I want you to look at them, you know? And so I will go through them just really more of a look at their genetics with them and look at, you know, some of the other more medical related things. Well, you know, we often kind of get into the conversation of, well, what is most important to you? Sometimes it's an ethnicity or religion or sometimes it's a characteristic or their interests, you know, sometimes maybe, well, I'm very artistic, you know, and I want someone who's artistic as well. You know, like there's something that might just pull you in about the person that you can relate to about the donor that you can relate to. You know, and so I find when I go through this and I've done this a handful of times at the patient's side, though, they'll get it down to just a handful and then they'll really want to look through it with me and discuss it in more detail. And I will definitely kind of in that explore exactly what, you know, pulls them to one donor versus the other, try and understand with them to help them. What is really most important to you here? Like what's a non-negotiable and what are things that would be nice but are more, you know, it'd be nice, but I would pick a donor without it versus something that, you know, this donor must have this characteristic. Like, for instance, some people for religion really feel strongly, you know, that they want a donor of a specific religion or a specific ethnicity. So those can sometimes be non-negotiables for certain people, you know, while for others, that's really not important. And they're focused more, like I said, well, what was their major in college? Were they good at science? Or were they more of an artistic, you know, brain? And that's what speaks to them the most. So it's very individualized, but I definitely think it's a conversation that I find patients often want to go into a little bit to just get a little support and try and tease out exactly. You know, what's the most important thing to them within what is medically appropriate.
Dara: I find it so fascinating Dr. Gerber, that it's great that they, that they ask your opinion. And it's nice that instead of, you know, trying to have a, a subjective opinion that you really do, you know, reach back out to them to ask them, like, let's try to rank what's the most important. And I believe I remember years ago, RMA, we've done some research just to see the trends of what people typically go for, but it'd be interesting to see and I, and I don't want to quote, but I remember it was something like blue eyes, tall, academic. I'm not sure what academic means, but perhaps, maybe at least have had, has graduated college. It'd be interesting to see if there's any changes over the years as I'm assuming it probably would. It's fascinating.
Dr. Rachel Gerber: It is. So that's, you know, the anonymous donors.
Rena: The other thing I'll interrupt you. Sorry, again there, but to say, because another question people always ask is about disclosing and how to tell friends and family or how to tell the child that a donor was used. So we may not touch upon it in this episode, but I will tell our listeners to refer back to the episodes we've done with Nancy Kaufman and third-party parenting because we talk all about disclosure in those episodes. So that, that would be a very important listen.
Dr. Rachel Gerber: And I think it's in this case, you know, in some cases where it's a couple with a male and a female, you could, in theory, not disclose and whether that's the right decision or not is, you know, a whole other conversation. In this situation you're going to have to disclose, right? I mean, there's going to have to be an explanation at some point as to who's the genetic father of this pregnancy. So that definitely is an extremely important point and something that's very unavoidable in this situation. And even right away when you're pregnant, your friends and family are immediately gonna know you're not in a relationship that they're aware of. You know, they're all going to immediately be wondering and maybe want answers as to, well, how did this pregnancy come to be exactly? So it's a bit of an unavoidable question when it comes to single parenthood. So very important to discuss and definitely seek sometimes professional help with mental health counselors about those really difficult decisions and conversations that will come from this. So there is another type of donor it's called a designated donor, and that's using a donor from somebody that, you know, it can sometimes be a friend, believe it or not, I've even seen co-workers, which I wouldn't necessarily recommend, but I did see that once where two coworkers decided to..one coworker gave their sperm through a formal designated donor sperm system But yeah, I mean, it's using somebody you know, but you are not in a romantic relationship with and do not plan on co-parenting with. So in this situation, there is actually a whole process in getting their sperm kind of cleared for use. We want to make sure that, you know, they don't have any infectious diseases and that, you know, there's nothing about the sperm that is not being disclosed to you that should be disclosed. So there's actually a whole FDA process. You know, the person needs to take a drug test, undergo infectious disease screening, like HIV, hepatitis, those kinds of things. And then it actually has to be quarantined for three to six months and then the donor then has to be retested for the infectious disease to make sure that there wasn't a silent infection at the time of when they gave the sample that came out after the fact. So essentially, they, they would come and freeze the sample, do this blood work to, you know, make them FDA eligible. And then the sperm would have to sit for three to six months. It's going to be different, you know, different protocols and then get tested again. And then, you know, we'd say, okay, now this is FDA eligible, cleared for use. So that definitely comes with its own set of issues and concerns that, you know, you might say, oh, it's great to have the genetics from someone I know versus someone I don't know, but on the same hand, it can actually sometimes be more confusing and more complicated, particularly if this is someone who the child might interact with, especially on a regular basis, that there could end up being confusion or feelings of on their part of, well, actually, maybe I do want to role in this child's life. So that is definitely, in my opinion, something that should really be discussed with a professional and really tease all this out, make sure that both parties are on board and understand what they're getting into. And just to be clear at RMA, when the designated donor first gives their semen sample to be frozen and analyzed, they actually sign a contract that gives up their parental rights. So they can't come and sue you for custody. I mean, they actually could do that, but you would have some contractual defense against that. And you are also agreeing that you won't sue them for child support. So there's liability on both ends when you use a designated donor. And we do have a contract at the time of freezing that kind of sets into place the roles that, you know, this is a donor, this is not someone who intends to parent. This is not someone who will have a legal or financial obligation to the child. So as you can see, there's definitely more complication and more risks sometimes when using a designated donor which is why you need sometimes for these special agreements, because things can happen where, you know, it ends up on the backend, not going so well. So while there's pluses to it, which is, you know, you have access to this person if anything happens to the child medically, you know, maybe in your mind, this person could have some in the child's life, just not a legal, custodial role and that is a positive thing to you. It has to be weighed against some of the risks that comes with using a designated donor. And that's a very difficult decision. What I would say is the majority of people use anonymous donors in this situation.
Dara: I’m glad that you at least, you know, educated our listeners because at first glance hearing the term designated donor, it appears as though that was a much more simple route to take. But I think that's great that you're, you know, informing us that it does come with its complications and it does seem like there's a lot more paperwork and discussion that's involved in that, but that's great that our fertility clinic does provide the information and giving them the options, which is great. My next question I had was in terms of like the IUIs, some of them could be natural and some of them can be medicated. How do we determine that?
Dr. Rachel Gerber: So, you know, with someone who comes to do single parenthood and specifically single motherhood, assuming that they have no infertility diagnosis. So let's say you do the workup. They ovulate every month. You know, their fallopian tubes are open, their uterus looks healthy. We really have no reason to believe that they have an issue with infertility. So for your typical patient, that's ovulating, I would frequently err on going the natural route, which means not using any medication to help boost ovulation because when someone is fertile, you know, and doesn't have a history of attempting pregnancy for, you know, six months to a year without success, when someone really, you know, has in theory, normal fertility or no reason to believe otherwise, when you add in medications that in a boost ovulation like Clomid is a very famous one, you're increasing the risk of twins, right? Because a lot of those medications make you ovulate more than one egg at a time. And for patients who have infertility and are already ovulating one egg at a time, you kind of want to do something different which is maybe make them ovulate two or three and, you know, hope that each egg might give them an additional chance. For patients without that infertility diagnosis, we have no reason to believe one egg wouldn't be enough. And when you add in medication that increases the number of eggs you ovulate. You are putting them at risk for a multiple pregnancy, twins or more. And we in general, particularly, you know, in the fields of infertility where we've seen throughout our history in the field, a lot of complications that have come from pregnancies with multiple births, with twins or more, we're really cognizant of trying to produce the healthiest possible child with the healthiest possible parents. So the way to do that is to have one baby at a time and we want to maximize that chance of having one healthy baby at a time. So in patients who have no history of infertility and, you know, really the only thing that they're missing is the sperm being there at the right time. I would recommend to go at least at first with the natural route so that we don't run the risk of having multiple pregnancy which for a single parent on top of the fact that for anyone, I don't recommend a twin pregnancy, for a single parent that may even add additional layers of complication when it comes to, you know, what it means to have newborns and, you know, the resources that that takes. So I think in this population, although like, as I said, in every population, I do not support it. I have found that my patients strongly are opposed to the idea of twins and really would like to do everything they can to prevent that from happening because they understand that, you know, this already is quite the undertaking and to be a single parent with twins would require a huge amount of resources and could be something that is difficult in this population.
Rena: And also too, I think that route, you know, for those worrying about finances and hearing, you know, potentially the cost of IVF, it's a lot cheaper to start that route as well.
Dr. Rachel Gerber: Yes, that's true. But there are cases where I would potentially start with oral medications. So if someone is not ovulating regularly, so kind of the same reasons why you would need, you know, there are certain reasons why you would need it at a baseline. So if someone's not producing an egg every month, then we need it to help regulate their ovulation. You know, another reason is for women who are potentially, let's say in their late thirties, early forties, who are pursuing this, I might discuss with them using medication sooner than later, because at that point, you know, a high percentage of the eggs that are produced through spontaneous ovulation can be genetically abnormal and, you know, not able to end up with a viable pregnancy. So in those cases, sometimes especially 40 and over when you can get two or three eggs ovulated, that can be an important tool to combat the issues with aging, infertility and egg quality. So there are certain cases in which I would recommend medication right off the bat, but for your average patient, the goal would be to try unmedicated inseminations, where we watch your ovulation on your own. And when the egg is ready, we usually give one single injection just to time the IUI that injection is called the ABA drill or HCG just to time the IUI. So we can make sure that the sperm is there at the perfect time for fertilization.
Dara: So another topic which I think our listeners will be interested in hearing about is, is fertility preservation. So a lot of women are coming in just to kind of see where they are in their fertility at this point in time and considering freezing eggs or perhaps freezing embryos using, you know, embryo, donor sperm. How do we start this discussion? And what do you typically recommend in this case?
Dr. Rachel Gerber: When I talk about fertility preservations I always discuss eggs and embryos in every conversation. So there's benefits to each of them. And the primary benefit of freezing eggs is that it is not attached to a sperm. That's really the primary benefit because you can't undo fertilization. Once you have that egg and sperm fertilized, you are now tied to that sperm if you want to use that egg. So for people who, you know, want the option to be able to meet someone or are still unsure, you know, maybe they would consider single parenthood, but they're not ready to commit to it. You know, they might say, I want to freeze my eggs. And maybe in a couple years, if I don't meet someone or I don't find the sperm of my dreams, I always say, like that perfect sperm, so that I want to have children with, then I would choose single parenthood, but I'm not ready to make that commitment quite yet. But there is definitely benefit to embryo freezing over egg freezing. And I think a lot of people there's definitely debate about this, but I think from my perspective, there's at least one clear benefit. Now the question of do the eggs do better when they're frozen versus when they're fresh? So that's not actually what I'm going to go into. What I'm going to go into is when you have frozen eggs, you ultimately don't know what's going to happen when they're thawed, when they're fertilized, when you grow them into embryos, whether they're going to be chromosomally more as in happy, 46 XX and 46 XY, and whether they're going to implant. So you're about five steps or more from a baby when you freeze those eggs. So we can model out all bunch of statistics and likelihoods and say, okay, if you have this many eggs, you have a 60% chance of having live birth. But ultimately the model is based on so many different variables that, you know, in the end, you really don't have that much guarantee. It's a model that is based on a lot of different things that could fall in your favor or could fall out of your favor. You're not going to know that until you go use them. You know, you could end up finding the sperm that you want to reproduce with and they have bad sperm. You expected to have great fertilization rates, but now, you know, person who you want to reproduce with has low sperm counts, low motility, and now your fertilization rates are lower than your average. So you don't actually know these things. You're only hoping that you meet the averages of what is quoted. When you have an embryo, you know, you've already gone so far down that line that. You know, the egg has now been fertilized has grown into a nice embryo and you actually can even test it to ensure that it's chromosomally normal. So here now, just one step away from implantation. And we can tell you with a lot more certainty that with this embryo, you have a 50 or 60% chance of a live birth. And I could tell you that with a lot of confidence because you've already hit all those milestones that create uncertainty in this process. So that is why always discuss this with the patient. That eggs are great and they allow you to, you know, still leave the option of the sperm open, but an embryo makes me feel a lot more sure and comfortable that, you know, you are likely to actually, you know, to have a live birth and have a child from this. So, you know, what I talk about at a consultation is first of all, would you ever consider having a child with donor sperm through single parenthood? Is that something you would ever consider? And I talk about this at every fertility preservation consultation. A lot of people say, no, a lot of people say, no, I would not have children if it was not with a partner. Okay. Then egg freezing is definitely the route for you. Another group of people might say, yes, I definitely would. Right? So then you have to talk about, okay, well, are you ready to make this decision now? Is it, you know, I would definitely do that and I plan on pursuing single parenthood, but I'm not going to be ready to do it for three, four years because of my career or because of that's when I'll be financially ready or have the support system. You know, in that case, I would say, right, let's go ahead and freeze embryos at this point with donor sperm. A lot of people lie somewhere in the middle where they still to leave the option for having, you know, to meeting somebody who will provide the sperm. But they also would want to potentially secure the certainty that having an embryo and do that with donor sperm. So I have actually some patients who will do both. So they might say, I actually want to do an egg freezing cycle and an embryo freezing cycle. And therefore you kind of have both options where you feel really good. Like, okay, I have this two chromosomally normal embryos that, you know, I will use if that's the best option for me down the line. But I also have eggs if I need someone and I want to create embryos with somebody I meet in the next couple of years. And I've had numerous patients who I've discussed this with and have chosen this route.
Dara: Oh wow. I never would have even thought, but that's actually, I mean, I'm sure that's a lot more, you know, more of an investment financially, but I feel like there's the fact that there's the flexibility that way, I never would have thought that.
Dr. Rachel Gerber: Yes. And this is often something I find that is more common in women who are a little older, let's say in the late thirties to forties. That this is something that they might pursue because ultimately if you're in the position, let's say in your late twenties, early thirties, where you have a good number of eggs, you can feel still pretty secure that you will make it through all those steps from egg to embryo, it's normal embryol, and are very likely to have a healthy embryo and your chances are good to have a live birth. But when you kind of hit your late thirties, definitely into your forties, those probabilities, unfortunately, go down with the eggs. So if you can get embryos, if you're 41 and you have 10 eggs versus you're 41, and you know you have one or two chromosomally normal embryos, that's a very different situation for that patient because the situation with the eggs is much more unsure in terms of the viability and the chromosomal health of those eggs. So I do find that, you know, in patients who are a little bit older, who really still are not ready to commit to single parenthood, but really would, tell me, this is something I really will do. I just need a couple more years to see through kind of like the dating and trying to meet somebody. But they understand that having an embryo is a very meaningful thing, you know, versus eggs when you're in your forties, that's when a patient who may be much more likely to do a cycle of each.
Rena: I'm so glad you've talked about that. I think it is important. I think a lot of times people often ask because they want to maximize their return on investment, so to speak and I think oftentimes people don't understand the difference. And so I love to present both options so people really can maximize their chance of success.
Dara: Rena, I would love to ask you in terms of, you know, I know there's such an importance in terms of having a good support system and helping them mentally go through this. So I would love to hear your insight of kind of the topics or what you discussed with this group of patients?
Rena: Sure. Dr. Gerber so astutely brought up, you know, you have two kind of camps here. So one is the camp of someone who’s just like, I want to have a kid and a partner doesn't matter to me. Like I'm making this empowered choice that has nothing to do with a lack of a partner. So I'm not mourning that. And I'm just powering ahead. I think that person usually has a very different mindset than someone feels as though they are kind of unwillingly do this, doing this. That they very much want a partner, they're upset that they're going through this without a partner and they're scared that they never will find a partner because they're making this choice. Do I think that counseling for both are different? You know, certainly for the patient who is kind of mourning the loss of the partner and going through fears and anxieties that, you know, they'll never be able to find someone, you know, that's a lot to unpack there. It meant a lot to kind of help them work to reframe this picture that they had had for their life, kind of mourning the loss of that, acknowledging that, that's always extremely important, but then helping them feel empowered, helping them reframe, helping them to find hope that they still can achieve that goal. And maybe they're just doing things in a different way. Maybe they're kind of flipping their timeline and they always thought they'd get married then have a baby, but they're having a baby and then they'll get married later if that's what they want. So those are usually what comes up in sessions with, with patients like this.
Dara: Fascinating. A lot to think about
Rena: Totally. One thing I would point out too is I think it's really important to connect with others who have gone through this to join groups because I think it can tend to feel super isolating. And I think connecting with others is very helpful in terms of navigating with friends and family. Certainly different cultures may have different perspectives on this and so it can be very difficult if you find your family's really not supportive. And two, it is really important to connect with others who kind of walk this path, especially, you know, if you're someone who is mourning the loss of that relationship to connect with others and see like, wow, they did this and now look, they ended up married and their life, you know, took a totally different direction. So two organizations I often refer to are choicemoms.org and then single moms by choice, both wonderful, both great communities. And again, SMC or SMBC are the acronyms. So if you just search there's a million Facebook groups, if you just search in your toolbar, single moms by choice a lot will come up. Any books, you know, searching with those acronyms. There's a lot of resources out there.
Dara: Fabulous. Wow. So much to think about and so much education on my part. I'm learning a lot from both of you. Dr. Gerber, we are thrilled to have you on again. And as you know by now how we end our sessions are all about discussing gratitude. So Dr. Gerber, what are you grateful for today?
Dr. Rachel Gerber: I’m grateful that I have reached my one year anniversary at RMA and that I’ve helped a lot of people, couples, individuals become parents over the last year. So it's just amazing to reflect on that. And that's what I'm happy for.
Rena: Love that. Well, happy anniversary! Celebrating at Fertility Forward. Dara what about you?
Dara: I was reflecting. I have been very grateful this past week. You know, things are opening up in the City and I'm grateful for, I went to see a play this weekend. I went to see 6 and I absolutely loved it. So it's nice that Broadway is back. And I went to see a concert yesterday in Central Park. I saw the Indigo Girls. So just, you know, it's nice to see the changes in the city and then being a little bit more social.
Rena: I love that. I love that.
Dara: What about you Rena?
Rena: I guess I am grateful for hoping that a vaccine is on the horizon for my five-year-old and I've really, really been trying to kind of protect her since she started back in school. And obviously she wasn't vaccinated yet. So I'd been sort of leading a little bit more of a sheltered life and hearing you talk about what you've been doing has given me some FOMO. So I'm grateful to hear that there might be a vaccine on the horizon because I’ve missed all of those things and look, I'd love to be able to get back to them.
Dr. Rachel Gerber: I agree with that. I can't wait.
Dara: In due time. Let's be hopeful. Well, thanks so much for being on, Dr. Gerber. I'm sure we'll have you on down the road and we're so appreciative.
Dr. Rachel Gerber: Thanks for having me.
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.