Let’s Get Started

By: Danielle E. Lane, M.D.

Summer has come and is almost gone. We are now into the early days of fall and that means…open enrollment! But before open enrollment, employers re-negotiate their benefits packages with their carriers. Around the Bay Area, competitive benefits packages are a way of life. The better the package the more attractive the company is to work for. As a result, an increasing number of companies are offering fertility benefits that include in vitro fertilization (IVF) coverage.

Some of the biggest employers for our area are Google and Salesforce, and both offer IVF coverage. But while both entities cover fertility services to include in vitro fertilization, that’s where the similarities end.

an increasing number of companies are offering fertility benefits that include in vitro fertilization (IVF) coverage

Through the 2015 year, Google’s healthcare benefits have been administrated by Blue Cross. Their package offers each employee a lifetime maximum of $20,000.00 to be used for fertility services. The savvy patient will find a contracted provider and have 2-3 cycles of care available from that amount due to contracted rates which drop the cost of each cycle to somewhere in the $6000-$8000 price range. At Google, fertility medications are also covered and are NOT part of the $20,000.00 lifetime maximum. As a result, patients are typically only out of pocket the cost of very specialized optional services such as their embryo biopsy.

Salesforce, alternatively, chose Aetna for their administrator. Patients have coverage for 50% of six insemination cycles and 50% of three in vitro fertilization cycles. But wait, first you have to call the company to register with the Fertility group at Aetna. Then you have to submit current laboratory test results, two semen analyses and await authorization which can take up to thirty days. Oh and this only applies if you have had unprotected intercourse for up to six cycles. So single women and same sex couples… beware. Further, once the Aetna fertility nurse agrees with your physician that you need fertility treatment, Aetna (not you or your physician) gets to determine your first step. They still believe in the concept of lesser before greater (ie. Insemination before IVF). That is great if it is in line with what you want to do, but no good if you want to bank embryos (or freeze eggs) for future use. This is also a problem if you wish to perform embryo biopsy to ensure that a good quality embryo is implanted and avoid complications like miscarriage which typically further delay you by months on end.

Google and Facebook continue to lead the way and have gone a step further. Last year, these companies report spending over $9 million in expenses related to high order multiples and fertility complications. Enough! They have carved out the fertility benefits from their respective Blue Cross and Aetna administrators and moved them over to a new PPO that only works with fertility benefits. Therefore, as of January 2016, no more silly hoops to jump. These PPO’s are working with providers to ensure that the packages offered to patients actually make sense. They are including the technology that has pushed our field forward in 2015 such as embryo biopsy and preventative banking of eggs and embryos.

Finally, a plan that makes sense! Kudos to Google and Facebook for seeing the light and here’s to hoping that the other Bay Area corporations catch up in offering plans that truly benefit their employees.

In the rest of this issue, you will find a guideline to preparing for your first fertility appointment, a savory end of summer recipe, some advice of keeping your relationship intact during your fertility journey, and the findings of a recent survey on how patients experience miscarriage. We hope you will find the answers to some of your questions.

Enjoy!
ABOUT THE AUTHOR

Danielle E Lane, MD, Reproductive Endocrinology and Infertility specialist. Dr. Lane attended McGill University before completing her medical training at the University of Pittsburgh school of medicine, her residency at Yale-New Haven Hospital and her fellowship at the University of California, San Francisco. She opened the Center for Reproductive Health at Kaiser Permanente in Napa-Sola-no in 2005. In 2009 she founded Lane Fertility Institute. The Institute has grown to a four physician, multi location practice with a state of the art embryology laboratory. She is committed to providing education for women about preservation of their fertility and developing lower cost models to improve access to care.

On The Cutting Edge

Father’s Day is just around the corner, and although you may still be on your fertility journey, it is an opportunity to celebrate the father-to-be in your life. Remember why you partnered with him to build a life together. Find the activity or relaxation technique that gives him the most joy, and create a time to do that with him.

Our next issue will feature a segment by a fertility psychologist on keeping your relationship healthy during your fertility treatment. We will also highlight additional insurance updates. We will have an article on the predictors of fertility success. Our patient story will feature a couple who has struggled with weight on their fertility journey. We will also feature the latest information on the benefits of vitamin D and DHEA as supplements to your fertility treatment.

As always, we are eager for your feedback. Please use our Facebook page or email contact to make suggestions and let us know how we are doing.

Best

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Who’s Taking Care of YOU … Self-Care During Conception and Pregnancy

By: Valerie Mendels, L.Ac, Dipl.Ac, M.Ac.

As an acupuncturist specializing in fertility and pregnancy, one of the most important areas that I coach my patients in is caring for themselves. Whether you are trying to conceive, or you are already pregnant, in order to be optimally healthy during this special time you must raise your self-care to the highest level.

The word “self-care” might conjure up the nice things that one ideally would do for oneself: getting weekly acupuncture, taking a relaxing bath, meditating daily. These are all wonderful things (and of course, I am a big advocate of acupuncture for fertility and pregnancy support, as well as for self-care) but let’s discuss the absolute basics of self-care, the most fundamental things that you need to do: eating, drinking, and sleeping. Strange as it may seem, in our busy modern lives most of us have forgotten how to tend to these basics.

Lane_Mag_2015_Self_Care_ChartMaybe your life is made up of long days at the office or you are in a helping profession where you are busy caring for patients; perhaps you are at home taking care of a small child or you may have a high pressure job that includes lots of travel. Whatever your day to day life involves, it is easy when you are busy to ignore your body and push aside your own basic physical needs. Ask yourself how many of the self-care questions apply to you.

Most of us would answer yes to some or all of these questions, and realistically speaking it is quite “normal”, although not ideal, to neglect one’s needs in these ways when busy with a job, taking care of a child, or both.

But when you are trying to conceive or get pregnant, ignoring your body’s basic needs in this way can be quite harmful. Now is the time to do something new and actually start listening to your body! This means that when you are thirsty, don’t wait – DRINK. When you are hungry – EAT. When you are tired –REST or SLEEP. Sometimes, however, you may not hear your body’s signals (especially if you have been ignoring them for many years), so you also need to use your mind and your intention to remember to take care of yourself.

Remembering to eat

Your pre-pregnancy and pregnancy diet should be balanced, made up of whole foods (free of processed foods), nutrient dense, and organic. A healthy diet is a critical part of your self-care. To learn more, I recommend “Real Food for Mother and Baby” by Nina Planck.

An important goal should be to keep your blood sugar stable by avoiding refined sugar, and eating frequent small meals, or low-glycemic snacks between meals. Never skip breakfast, include some protein with every meal, and try not to go more than 4 hours (during your waking hours) without eating something, to prevent low blood sugar. Once you are pregnant, be sure to carry healthy snacks with you everywhere, so that when you suddenly get hungry, you always have something on hand. This does not mean that you will be eating more food than usual; you will be eating more frequently but having smaller meals.

By keeping your blood sugar stable, you can not only help to reduce your risk of gestational diabetes, but you will also keep your cortisol (stress hormone) levels more stable, and help prevent adrenal fatigue.

Remembering to drink

As a general guideline the National Institutes of Health recommends, pregnant women need 8-10 glasses of water per day. In addition, 1 glass of water should be consumed for every hour of exercise. The NIH further confirms that most municipal water contains fluoride which can be helpful in the development of teeth and bones in the growing fetus. Be sure to get a water filter to purify your tap water, and also consider getting your water tested to determine whether there is any risk of heavy metal contamination. Studies have shown that water tainted with lead can result in spontaneous abortion, decreased stature and neurodevelopmental deficits in the growing fetus. Plastic bottles that leach harmful chemicals such as Bisphenol A (BPA) should also be avoided.

According to the principles of Chinese medicine, it is best to drink room temperature or warm water, and to avoid drinking cold water and ice water.

Remembering to sleep

When you are trying to conceive or are pregnant, sleep needs to become a high priority. If you have little ones at home who wake up during the night this may be a challenge, but do your best.

Here are a few suggestions to help you think about your sleep.

  • Go to bed early. The sleep before midnight is much more restorative than the sleep after midnight. The more sleep that you get before midnight the better.
  • Sleep as much as you can. Fertility treatment can be as exhausting as your first trimester of pregnancy. Once pregnant, some women need as much as12 hours of sleep per night. Don’t feel lazy or guilty about it; think of sleep as medicine for you while you are pregnant or trying to conceive.
  • Take naps. If you can’t fall asleep during the day, at least lie down. Getting horizontal and closing your eyes for a while will give your body and mind a chance to rest.
  • For deeper sleep, avoid all caffeine and turn off electronic devices at least 1 hour before bed.
  • If you have insomnia, try acupuncture. Be sure to see an acupuncturist who is specialized in fertility and pregnancy.

By following this advice for basic self-care you will be well-nourished, well-hydrated and well-rested, and your levels of stress hormones will be reduced . . . a great foundation for a healthy pregnancy and a happy baby and mom.

ABOUT THE AUTHOR

ValerieValerie Mendels, L.Ac., Acupuncturist (specialized in fertility). Valerie’s practice is based in Petaluma, California. She has been treating patients with acupuncture since 1999, and holds a Master’s degree from the traditional acupuncture Institute, School of Philosophy and Healing in Action (TAI Sophia) in Maryland. In addition to acupuncture, Valerie uses Chinese herbal medicine, nutritional and dietary therapy, and lifestyle counseling to help her patients gain optimal health and fertility. Valerie is passionate about helping her patients experience greater peace, joy and well-being while working with them to achieve their fertility goals. Her website is www.valeriemendels.com

Let’s Get Started

By: Danielle E. Lane, M.D.

LFM_Lets_Get_StartedMother’s Day is one of the most challenging holidays for our patients. Every brunch, card, or bouquet of flowers is aimed at the idea of motherhood and the joy of being a mother. Instead of focusing on the sadness of not yet being a mother, try to devote some energy to the joy of being you! Take some time to think about your physical, emotional and spiritual health and find ways to support each element.

Fertility treatment can make you forget about your physical self-care. Daily exercise is still an important element of your health. Exercising as little as 15-20 minutes per day can reduce your stress. In addition, a healthy diet is a good balance to your exercise regimen. Consider walking, yoga, swimming and bicycling.

Pamper thyself! Taking care of yourself emotionally is critical as you travel through your fertility journey. Ensure that you are surrounding yourself with positive relationships. Spend time with friends and family who are warm, caring and respectful of your needs around your fertility issues. Devote some special time to your partner! Make sure that you are giving your relationship the attention that it needs away from the fertility treatments.
Partake in activities that make you happy such as a spa day, a bubble bath or a massage.

Everyone’s spiritual beliefs are different. Consider whether you find comfort in your religion or in meditation. Once you find the spiritual resources you find comfort in and set aside 10 to 15 minutes each day to relax, unwind, meditate, and imagine positive things in your life.

Discovering ways to support yourself physically, emotionally and spiritually can be energizing and healing. Take one or two actions in each of these areas and focus on being good to yourself!
ABOUT THE AUTHOR

Danielle E Lane, MD, Reproductive Endocrinology and Infertility specialist. Dr. Lane attended McGill University before completing her medical training at the University of Pittsburgh school of medicine, her residency at Yale-New Haven Hospital and her fellowship at the University of California, San Francisco. She opened the Center for Reproductive Health at Kaiser Permanente in Napa-Sola-no in 2005. In 2009 she founded Lane Fertility Institute. The Institute has grown to a four physician, multi location practice with a state of the art embryology laboratory. She is committed to providing education for women about preservation of their fertility and developing lower cost models to improve access to care.