By Brooke Borel|April 17, 2020

"The early scenes of “Private Life,” a 2018 Netflix film about a New York City couple who are trying to conceive, present an unsettling scenario for anyone pondering their biological clock: A 40-something woman wakes up after an infertility procedure to find that things can’t progress as planned. Her doctors successfully extracted her eggs — but they also realized that her partner can’t produce any sperm. There might be a fix, but there’s a catch: It’ll cost another $10,000. Oh, and the doctors need the check today.

The scene, of course, is fictional and is meant to draw laughs, but it’s also a good reminder of how unpredictable and costly infertility treatments can be. If you’re thinking about having kids, what’s the best way to achieve that goal without unexpected and costly medical intervention?
For most heterosexual couples, the first step is to try to conceive the traditional way, said Dr. Sherman Silber, M.D., director of the Infertility Center at St. Luke’s Hospital in St. Louis, Mo.: “I recommend, frankly, if they are young and fertile to make sure they have enough sex.”

But intercourse isn’t always a sure-fire route to pregnancy; many couples struggle with infertility because of age, illness or reasons that aren’t yet known to science, said the two fertility doctors and one researcher I spoke to for this guide. Around one in 15 married American couples are infertile, according to the most recent published data from the Centers for Disease Control and Prevention. And there are special considerations for people who are transgender, single or in same-sex relationships.

Then there’s the high cost, which “Private Life” got right: According to the Society for Assisted Reproductive Technology, as well as a fertility benefits expert I interviewed for this guide, treatments may run to thousands or tens of thousands of dollars and aren’t always covered by insurance.

​What to do?"

By: Katelyn Denning

"When was the last time you felt overwhelmed? Last week, yesterday, earlier today? My guess is, it probably wasn't that long ago. If your triggers are anything like the moms I work with, overwhelm can hit you at any point and in any situation.
Sometimes it's in the middle of the workday when the responsibilities and stresses of the job get to be so much that you think there's no way you'll ever climb out of this hole, let alone your inbox.

Sometimes it's in the evenings when you look around at the mess in your house, a pile of laundry and no certain plan for dinner that you feel like you've let your family down and what you should really do is quit your job so you could actually stay on top of all of it.

Sometimes overwhelm shows up when you're surrounded by two children who are wallowing in their own overwhelm of emotions, crying and whining, that you think life will be this way forever. And you're overwhelmed by the fact that you are the adult here.

Or sometimes, overwhelm waits to hit you until the craziness of the day has ended and you have your first quiet moment to yourself. When you finally sit down, exhale a big sigh of relief, and think about doing it all over again tomorrow, the crushing weight of overwhelm sits on you making it hard to breathe.
Can you relate?

No matter how it shows up for you, overwhelm feels heavy. It creates the feeling of being out of control in terms of practically everything you can think of. And like the temper tantrums we often witness in our children, it can be hard to snap out of.

Trust me—we have all been there and some of us probably more frequently than we would like to admit.
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But just like we're taught how to approach and calm a toddler who is stuck in an emotionally overwhelming moment which often manifests as a screaming fit, there are things that we can do to help ourselves snap out of it, too. Things that can help us stop spiraling into that feeling of being out of control, and instead, grounds us in the present moment.

You will get through this.

Everything is not lost.

This is only temporary.

You've got this.

So the next time you feel that feeling, you know how it goes—your breath becomes short, your head starts to feel heavy, you can't see past your own nose and you just might break into tears if anyone asks you if you're okay—try one (or try all) of these things to catch your breath and reset."

​By Pooja Lakshmin|may 27, 2020

"New and expecting moms are facing pandemic-related fears on top of social isolation."

Photo: Mikyung Lee

"After going through a harrowing bout of postpartum depression with her first child, my patient, Emily, had done everything possible to prepare for the postpartum period with her second. She stayed in treatment with me, her perinatal psychiatrist, and together we made the decision for her to continue Zoloft during her pregnancy. With the combination of medication, psychotherapy and a significant amount of planning, she was feeling confident about her delivery in April. And then, the coronavirus hit.

Emily, whose name has been changed for privacy reasons, called me in late-March because she was having trouble sleeping. She was up half the night ruminating about whether she’d be able to have her husband with her for delivery and how to manage taking care of a toddler and a newborn without help. The cloud that we staved off for so long was returning, and Emily felt powerless to stop it.

Postpartum depression and the larger group of maternal mental health conditions called perinatal mood and anxiety disorders are caused by neurobiological factors and environmental stressors. Pregnancy and the postpartum period are already vulnerable times for women due in part to the hormonal fluctuations accompanying pregnancy and delivery, as well as the sleep deprivation of the early postpartum period. Now, fears about the health of an unborn child or an infant and the consequences of preventive measures, like social distancing, have added more stress.

As a psychiatrist who specializes in taking care of pregnant and postpartum women, I’ve seen an increase in intrusive worry, obsessions, compulsions, feelings of hopelessness and insomnia in my patients during the coronavirus pandemic. And I’m not alone in my observations: Worldwide, mental health professionals are concerned. A special editorial in a Scandinavian gynecological journal called attention to the psychological distress that pregnant women and new mothers will experience in a prolonged global pandemic. A report from Zhejiang University in China detailed the case of a woman who contracted Covid-19 late in her pregnancy and developed depressive symptoms. In the United States, maternal mental health experts have also described an increase in patients with clinical anxiety.

In non-pandemic times, as many as 14 percent of women will suffer from pregnancy-related anxiety, which refers to fears that women have about their own health and their baby’s over the course of pregnancy and delivery, and up to 20 percent of women will experience postpartum depression.

Samantha Meltzer-Brody, M.D., M.P.H., who is the chair of the department of psychiatry at the University of North Carolina at Chapel Hill and the director of the Center for Women’s Mood Disorders, said, “The natural vulnerability of this major life transition is exacerbated when you just have sort of global anxiety, and things like going to the grocery store to pick up diapers suddenly become a much more anxiety-producing event than it ever was before.”

In my clinical practice and in a Covid-19 maternal well-being group I co-founded, women have voiced their fears about a number of possible distressing scenarios: delivering without a support person; being one of the 15 percent of pregnant women who is asymptomatic for Covid-19 and facing possible infant separation; and recovering during a postpartum period without the help of family or friends to provide support. There’s also grief about the loss of a hopeful time that was meant to be celebrated with loved ones."

By: Mikaela Kiner

"Pre-pandemic, being a mom meant figuring out the tricky balance between parenting, home, career and self. What that meant in practice was that women in heterosexual relationships took on about two-thirds of domestic responsibilities.

The global coronavirus pandemic has resulted in dramatic shifts for everyone, especially for families, with parents working from home, school and day care closures and a general loss of stability and support. Now moms are homeschooling older kids, caring for little ones, feeding their families three meals a day, and sanitizing everything, all while trying to keep everyone healthy and keep up with their day jobs.

While many partners have stepped up to take on more responsibilities at home during the pandemic, the workload balance has not shifted enough (despite nearly half of men claiming they do "all" the homeschooling, a claim that most women disagree with).

Women are legitimately concerned that they will become the default caregivers and take on most or all of the household chores, leaving little or no time for their careers or their own well-being.


Here's how to keep that from happening by coming to an agreement with your partner about sharing the workload at home.

1. Have the hard conversation.

Many people avoid hard conversations out of a fear that things will become adversarial. But now more than ever, we need to talk about roles and expectations. Remember that your partner also wants what's best for you and the family. View this conversation as a collaborative conflict, one where the two of you are working together toward a win-win solution.

Phrase to try: "Let's sit down for half an hour this evening and review both of our to-do lists," or "Can we find a time in the next day or two to go over everything we're both trying to get done?"

2. Start with your goals in mind.Your goal is to come up with a plan that works for both of you. The focus is you both teaming up against the problem.

Phrase to try: "I'd like to talk about how we can both find a good balance between work and helping the kids," or, "So much has changed. Let's talk about how we're going to make this work for us both."

3. Share your hopes + fears.

Tell your partner what you're worried about, and what's been most challenging. Be honest about your experience and what you're afraid of. You'll notice there are no assumptions, personal attacks, shaming or blaming, which is important. My friend Melissa Strawn was in the middle of launching a business when the virus hit. Her husband works full-time and they're raising five boys. Melissa suggests, "Communicate openly and honestly about what's working and not working. Sometimes, I am just looking to feel validated given how much I actually juggle with five kids and a startup. Other times, I need him to just #getitdone."

Phrase to try: "I'm concerned that I've taken on all of the homeschooling and I don't have time to do my work," or, "I realize I'm trying to cook, clean and watch the baby. When I sit down to focus on my job, I'm already exhausted."

By David Dodge| April 17, 2020

"This guide was originally on October 11th 2019 in NYT Parenting."

"From the time they began dating as teenagers, Rita and Erikson Magsino, now 39 and 43, talked about the family they hoped to have together one day. Almost immediately after marrying in 2005, they tried to make that dream a reality.

But parenthood would have to wait — Magsino learned she had an aggressive form of endometriosis that made it difficult for her to become pregnant. For over a decade, the couple tried everything to conceive — including fertility drugs and advanced treatments like intrauterine insemination and in vitro fertilization. Twice, Magsino became pregnant, only to miscarry late in the second trimester. “After we lost twins at 20 weeks, we decided enough was enough,” she said. A generation ago, the couple’s attempts to have a biological child most likely would have ended there. Instead, thanks to improvements in reproductive medicine, they welcomed a baby boy into their home in May with the help of a gestational surrogate.

Surrogacy has also created an avenue to biological parenthood for thousands of others who can’t conceive or carry children on their own, such as same-sex couples and single men. As a gay, H.I.V.-positive man, Brian Rosenberg, 54, figured biological fatherhood was forever out of reach. But thanks to surrogacy, and a technique known as “sperm washing,” which prevents H.I.V. transmission, he and his husband, Ferd van Gameren, 59, welcomed twins, biologically related to Rosenberg, in 2010. “It’s still hard to believe,” Rosenberg said. “I thought this was a door that was shut to me.”

Still, would-be parents need to be prepared for a process that is far longer, more expensive and emotional than many people expect — it’s called a “surrogacy journey” for a reason. For this guide, I interviewed the types of experts you can expect to encounter during a surrogacy journey, including two fertility specialists, a lawyer, a psychologist and an agency caseworker."

May 19, 2020 in Policy

"A new Center for Disease Control (CDC) study finds that around 1 in 8 women report experiencing symptoms of maternal depression. The analysis, which looked at 2018 Pregnancy Risk Assessment Monitoring Survey (PRAMS) data from 30 states and Puerto Rico, found that rates of “postpartum depression” symptoms ranged from a little under 10% in Illinois to almost 24% in Mississippi.
​
​The majority of women reported making at least one visit to their physician after giving birth, and most reported being asked about their mental health during this visit. But this also varied by location: Women in Vermont were almost always asked about their mental health, while those in Puerto Rico were among the least likely to be asked. At the same time, women who were younger than 19, or white or Pacific Islander, or had a history of depression during prenatal visits were more likely to be asked about depression during a postpartum visit."

​By Jyoti Madhusoodanan| April 16, 2020

Photo: Kit Agar

"Lizette Galvan’s home pregnancy test was positive a few days after her expected period. But at her first ultrasound, she heard the words: “This is where the heartbeat should be.” Just six weeks into her first pregnancy, Galvan — like approximately one in 10 pregnant women — had miscarried.

Most early pregnancy losses occur within the first 12 weeks. Although the risk drops with each passing week, a miscarriage can occur any time until the 20-week mark. (Later losses are considered stillbirths.) About 10 to 15 percent of all pregnancies end in such an early loss, according to the American College of Obstetricians and Gynecologists. “Miscarriage is the most common complication in pregnancy,” said Dr. Courtney Schreiber, M.D., an associate professor of obstetrics and gynecology at the University of Pennsylvania. “Many occur even before a woman has connected with a prenatal care provider.”

Thanks to improved home tests, women like then 38-year-old Galvan learn sooner than ever if they’re expecting. “In the past, women would not even have known about a lot of pregnancies that would’ve ended in a miscarriage,” said Dr. Pamela Geller, Ph.D., an associate professor of psychology, ob-gyn and public health at Drexel University in Philadelphia. “They might have had a bit of pain and bleeding but would have just thought of it as a heavy menstrual cycle.”

​This early knowledge also means more women grapple with the emotional consequences of early pregnancy loss — which are often no different than the grief of losing a loved one.
For this guide, I read through the science, and spoke with three practicing ob-gyns and a researcher who studies miscarriages to help you understand early pregnancy loss, treatment options and ways to optimize recovery."

By: Karen Kleiman 

"The awesome responsibility of caring for a newborn naturally warrants a heightened sense of vigilance. Sometimes this necessary state of watchfulness can be confusing. At every turn, a new mother believes a crisis is looming. Afraid of slipping and dropping the baby, she holds them extra tightly while she goes down the stairs. Afraid of a disaster in the night, she keeps herself awake to hear the silent sounds of breathing. If she falls asleep from sheer fatigue, she dreams of causing the baby harm through her own negligence.

Here are some reasons why postpartum women don't share these scary thoughts:

1. The ambiguity factor

One reason why postpartum women don't talk about the thoughts that are having is that they are not sure what is "normal" and what may be problematic. This is due to the overlapping experiences between women with postpartum anxiety or depression and women with no such diagnosis.

For example: fatigue, loss of libido, moodiness, weepiness, changes in weight, sleep disturbance, and low energy can all be attributed to anxiety and depression, yet they are also considered to be within normal expectations for postpartum adjustment. Because moods and other internal experiences are expected to fluctuate following childbirth, women sometimes decide it is best to brave any discomfort and hope it goes away by itself.

Unfortunately, scary thoughts are not easy to ride out. What's more, without proper assessment, a woman's worry about these thoughts can rapidly disintegrate from initial concern to panic.

2. The critical inner voice

The shame that can accompany upsetting thoughts is unbearable. What is wrong with me? How can I be thinking these things? Good mothers don't think such terrible thoughts. Often, the only explanation that makes sense to a mother who is trying to reconcile this disturbing experience is that there is something profoundly wrong with her, something is broken inside. Maybe she is close to insanity. Or maybe she is not fit to be a mother. Either option, or anything in between, is a nightmare. This nightmare stuns many women into silence. They hope that if they can just hold their breath and carry off this role-play, their awful thoughts will somehow go away. In some instances, the thoughts actually do go away. Usually, they do not.

Other women tirelessly try to push the thoughts out of their minds, but are distraught when the thoughts return in full force. Some women can express the horror of their thoughts along with the abysmal shame that accompanies them, but, for many, the actual articulation of the specific thoughts, the words they fear would somehow make the thoughts come alive, remain locked inside.

Women say they are embarrassed, ashamed, mortified, humiliated and guilty beyond description. They say they feel hideously exposed, naked, repulsive, raw, nauseous, ugly and sickened by their own thoughts. Some say they feel so appalled by the nature of their thoughts that they feel inhuman, as if only a monster could possess and admit such atrocities.

An important point here is that high level of distress indicates that the scary thoughts are ego-dystonic, or incompatible with the woman's sense of herself. Although it is never easy to experience such high levels of distress, there is considerably more concern when a woman expresses no such distress or displays no strong affect attached to this worry. Thus, a woman's agitation is often a signal that anxiety is the mechanism at work and not something more worrisome, like psychosis. Knowing this can reassure both the distressed mother and her healthcare provider.
Shame-based barriers to disclosing one's thoughts can be fueled by the critic inside one's own head. With regard to the critical inner voice, mothers report they are reluctant to reveal scary thoughts because they:

• Fear that they are the only mother who has ever felt this way and that no one could possibly understand.
• Believe that the thoughts they are having are an indication that something is terribly wrong.
• Worry if they admit this, they will indeed be crazy.
• Worry they will be locked up or institutionalized.
• Fear that saying it out loud will make the bad thought a reality.
• Believe that good mothers don't think these thoughts.
• Hate themselves for having the thoughts and remain stifled by intense shame and guilt.
• May not be comfortable talking about how they feel, in general."

"The pain of pregnancy loss lingers and can take a toll on your relationship."

By: Mira Ptacin| April 19, 2020

Photo: Mira Ptacin and her husband, Andrew, wed one month after a pregnancy loss.Credit...via Mira Ptacin

"Five months into my pregnancy and moments after we went in for a sonogram, a deafening silence filled the air. The image on the ultrasound screen revealed the child in my womb had a constellation of birth defects and no chance of survival outside of my body.

Right after doctors gave me the diagnosis — holoprosencephaly — I was given three options: terminate the pregnancy, induce and deliver a doomed fetus or wait for the tragedy to unfold on its own terms. Ten days later, I was no longer pregnant. One month after that, my fiancé, Andrew, and I got married. My breasts were leaking milk, I was wearing a trampoline-sized maxi pad and still bleeding when I said the words “I do.”

Since this loss 12 years ago, I’ve seen my share of therapists and bereavement experts. As Andrew and I waded through the bleary stages of our sorrow, many of these professionals warned us that divorce rates after experiencing child loss are staggeringly high. “Up to 90 percent” was the common refrain — a statistic most likely drawn from one of the earliest books on grief and child loss, Harriet Schiff’s groundbreaking “The Bereaved Parent.”

But this book was published in 1977, and Schiff’s study is hardly conclusive. First of all, she cites little empirical evidence. Also, it’s hard to statistically control for all the variables in a relationship; separating the influence of child loss from other causes of marital problems in bereaved couples is essentially impossible. Still, professional therapists, grief counselors and couples can agree on this: Marriage is difficult, and managing to stay married after the death of your child is incredibly, incredibly difficult.

“You’re the only two people who have shared the loss of your child, and it feels like you can get lost in the pain,” said Anne Belden, M.S., a family planning coach who runs a private practice that focuses on women and couples who are going through infertility, adoption and child loss. “To look in the eyes of your partner and see equally deep despair — it magnifies your pain and can almost be too much to bear.”
​
Being with your own grief is hard enough, Belden explained, but sometimes, sharing our sorrow with the person who has experienced the loss with us fails to promote healing. Quite often, the opposite occurs."

By Jennie Agg| May 5, 2020

"After losing four pregnancies, Jennie Agg set out to unravel the science of miscarriage. Then, a few months in, she found out she was pregnant again – just as the coronavirus pandemic hit"

"I stepped out of Oxford Circus tube into mid-morning crowds and cold, bright sunshine. The consultant’s words were still ringing in my ears. “Nothing.” How could the answer be nothing? This was January 2018, six months since my third miscarriage, a symptomless, rather businesslike affair, diagnosed at an early scan. The previous November, I’d undergone a series of investigations into possible reasons why I’d lost this baby and the two before it.

That morning, we had gone to discuss the results at the specialist NHS clinic we’d been referred to after officially joining the one in 100 couples who lose three or more pregnancies. I had barely removed my coat before the doctor started rattling off the things I had tested negative for: antiphospholipid antibodies, lupus anticoagulant, Factor V Leiden, prothrombin gene mutation. 

“I know it doesn’t feel like it, but this is good news,” he said, while the hopeful part of me crumpled. We were not going to get a magic wand, a cure, a different-coloured pill to try next time.

Now, my husband, Dan, was back at work and, for reasons I can’t really explain, I had decided to take myself shopping rather than go home after the appointment. I stood staring down the flat, grey frontages of Topshop and NikeTown and willed my feet to unstick themselves from the pavement.

I ended up wandering the beauty hall of one of London’s more famous department stores. I let myself be persuaded to try a new facial, which uses “medical-grade lasers” to evaporate pollution and dead skin cells from pores to “rejuvenate” and “transform” your complexion. Upstairs in the treatment room, the form I was handed asked if I’d had any surgery in the past year. I wrote in tight, cramped letters that six months ago I had an operation to remove the remains of a pregnancy, under general anaesthetic. When I handed the clipboard back to the beautician, she didn’t mention it. I wished that she would.

As I lay back and felt the hot ping of the laser dotting across my forehead, I thought how ridiculous this all was; that this laser-facial is something humans have figured out how to do. How has someone, somewhere, in a lab or the boardroom of a cosmetics conglomerate, conceived of this – a solution to a problem that barely exists – and yet no one can tell me why I can’t carry a baby?

There is no doctor who can reverse a miscarriage. Generally, according to medical literature, once one starts, it cannot be prevented. When I read these words for the first time, three years ago, after Googling “bleeding in early pregnancy”, a few days before what should have been our 12-week scan, I felt cheated. Cheated, because when you’re pregnant you are bombarded with instructions that are supposed to prevent this very thing. No soft cheese for you. No drinking, either. Don’t smoke, limit your caffeine intake, no cleaning out the cat’s litter tray. I had assumed, naively, that this meant we knew how to prevent miscarriage these days, that we understood why it happened and what caused it; that it could be avoided if you followed the rules.

You learn very quickly that the truth is more complicated. After a miscarriage, no medic asks you how much coffee you drank or if you accidentally ate any under-cooked meat. Instead you find that miscarriage is judged to be largely unavoidable. An estimated one in five pregnancies ends in miscarriage, with the majority occurring before the 12-week mark. Seventy-one per cent of people who lose a pregnancy aren’t given a reason, according to a 2019 survey by the baby charity Tommy’s. You are told – repeatedly – that it’s “just bad luck”, “just one of those things”, “just nature’s way”.

Just, just, just. A fatalistic shrug of a word. But this is not the whole story. “There is this myth out there that every miscarriage that occurs is because there’s some profound problem with the pregnancy, that there’s nothing that can be done,” says Arri Coomarasamy, a professor of gynaecology and reproductive medicine, and director of the UK’s National Centre for Miscarriage Research, which was set up by Tommy’s in 2016. “Science is trying to unpick that myth.”

Unfortunately, the roots of this myth run deep. It’s an idea reinforced by the social convention that you shouldn’t reveal a pregnancy until after 12 weeks, once the highest risk of miscarriage has passed. It goes unchallenged thanks to age-old squeamishness and shame around women’s bodies, and our collective ineloquence on matters of grief. The bloody, untimely end of a pregnancy sits at the centre of a perfect Venn diagram of things that make us uncomfortable: sex, death and periods.
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An impression persists that, while unfortunate, miscarriages are soon forgotten once another baby arrives – that you’ll get there eventually. It’s true that the majority of people who have a miscarriage will go on to have a successful pregnancy when they next conceive (about 80%, one study carried out in the 1980s found). Even among couples who have had three miscarriages in a row, for more than half, the next pregnancy will be successful. Accordingly, the prevailing logic seems to be that not only is miscarriage something that cannot be fixed – it doesn’t need to be fixed. There is little research or funding for trials, and only glancing attention from the healthcare system. What is not being heard, in all this, is that miscarriage matters."