What do I do? Answers For Men Faced with Infertility

Interview with Alice (Ally) Domar & Elizabeth (Liz) Grill

The psychological journey through infertility for a man is a lonely confusing one. Most men recoil due to ignorance or ego, and the ones that try to step in and play active role do so with little support or understanding of how to ‘be’ with their wife through this difficult time. Well, Ally and Liz have gone to great lengths to try and remedy this situation. They have planted the seed and now it is all of our turn to help ‘fertilize’ the male mental-emotional side of modern reproduction.  ~ Spence

Email
domar@domarcenter.com
lizgrill@yahoo.com

Websites
ferticalm.com
fertistrong.com

ALICE DOMAR

Professional Profile
1980 BA Colby College, Waterville Maine
1986 MA and Ph.D in Health Psychology, Yeshiva University, New York NY
1987 Massachusetts clinical psychologist license
Author or co-author of seven books including Conquering Infertility
Co-founder of the new apps FertiCalm and FertiStrong
Leading expert on the relationship between stress and infertility
Board Member for Resolve: The National Infertility Organization, 2006-2016
Currently Executive Director, Domar Centers for Mind/Body Health
Director of Integrative Care at Boston IVF
Senior Staff Psychologist, Dept of Ob/Gyn, Beth Israel Deaconess Medical Center
Associate Professor of Obstetrics, Gynecology and Reproductive Biology, part-time, Harvard Medical School

ELIZABETH GRILL

Professional Profile
Director of Psychological Services at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine
Associate Professor of Psychology in the Departments of Obstetrics and Gynecology, Reproductive Medicine and Psychiatry of Weill Cornell Medical College
Assistant Attending Psychologist at New York-Presbyterian Hospital.
Experienced psychologist and medical researcher with a special focus on the emotional aspects of infertility, IVF treatment, third party reproduction, fertility preservation, oncofertility, stress and infertility, and sexual dysfunction.
Postdoctoral training includes a fellowship year at the Center for Reproductive Medicine of Weill Cornell Medical College.
Trained and certified at the Mind/Body Institute at Harvard Medical School and developed and conducts stress management workshops for infertility patients focusing on relaxation techniques, cognitive restructuring, assertiveness skills and other helpful ways to manage emotional distress
Completed a two-year fellowship as a sex therapist at the Human Sexuality Program, Payne Whitney Clinic of the New York Presbyterian Hospital, founded over thirty years ago by Dr. Helen S. Kaplan.
Member of the National Register of Health Service Providers in Psychology, the American Psychological Association, and was Past Chair of the Mental Health Professional Group of the American Society for Reproductive Medicine.
Served two terms on the Content Review Committee of the American Society for Reproductive Medicine. Executive Board of RESOLVE, the national infertility association and is the Continuing Education Officer on the Executive Council for The Society for Sex Therapy and Research.
Cofounded and is CEO of FertiCalm, an app that provides coping strategies to manage infertility related distress.
Editorial reviewer for Fertility and Sterility and Journal of Andrology.

[/x_tab][x_tab active=”false”]Alice Domar/Liz Grill

9.7.2018

Spence: Hello, everyone, welcome to the Conception Channel podcast, brought to you by the Being Fertile Program and Yinstill Reproductive Wellness. I am your host, Spence Pentland and today, I’m excited to be able to speak with two guests. Technology allowing us to stream in from three different locations. We’ve got a return guest, Allie Domar or Alice D. Domar from Boston, and Elizabeth Grill. Welcome, ladies.

Alice/Liz: Thank you very much.

Spence: They’re here today, we’re going to discuss and help everyone better understand men. Is that what in general we could say?

Alice/Liz: Sure, how much time do we have?

Spence: That doesn’t take long. They’ve got some really great stuff going on, Allie is the current Executive Director at Domar Centers for Mind/Body health and the Director of Integrated Care at Boston IVF. She’s the senior staff psychologist at the department of ob/gyn at Beth Israel Deaconess Medical Center and Associate Professor of Obstetrics and Gynecology and Reproductive Biology part-time at Harvard Medical School. Also has co-authored, if you’ve been to Amazon and searched for books on infertility, Conquering Infertility would be in those top view for, I don’t know however long I’ve ever looked, and that is one of her seven books that she’s authored or co-authored, and also is a leading expert, has been working with mind/body and reproductive health since the eighties. So, really, a leader in that field, and has recently developed an app for men, which is exciting and going to be largely a foundation of what we’re talking about today. And Elizabeth Grill, welcome. She is Associate Professor of Psychology at the Center for Reproductive Medicine and Infertility Weill Medical College of Cornell University Weill Greenberg Center in New York. Did I get that?

Liz: You did.

Spence: Is this Andrew Weills? Is that somehow tied through him?

Liz: No.

Spence: No, okay. Can you tell people a little bit about yourself? I apologize for getting you the form so late about your profession profile, can you just give people a little bit of your background?

Liz: Yeah. I’m kind of Allie’s counterpart in the world of reproductive medicine over at Cornell, so, I’m Director of Psychological Services at Weill Cornell Medical College, and I work for a New York-Presbyterian Hospital there and Weill Cornell Medical College, directing psych services, seeing patients, individuals, couples, groups, doing a lot of the mind/body work that I trained with Allie with quite a while ago. And I also have another specialty in sexual health medicine. I did my postgraduate work at Cornell in the Human Sexuality Program there as well.

Spence: That’s great. So, you’ve worked with men and women alike in the sexual health as well?

Liz: Yeah, and definitely, we brought that into the app, we can talk about that a little bit later, but it is a huge part of what our couples go through in terms of the breakdown in intimacy and sexuality and closeness through the reproductive piece to this.

Spence: Yeah. Allie, just a little quick background from you, from the eighties to today, if you can do that in like one minute for people who haven’t watched the other podcast – can you give some highlights of your career and credentials?

Alice: Yeah. All these references from the ‘80s are making me feel really old. I’m a health psychologist by training, and I’ve been in the world of infertility, I started my first mind/body program in 1988, which is really scary because it means the program is 30

years old. So, in my background is mind/body medicine, behavioral medicine and infertility male career. And then over the last 30 years, I have also been very interested in integrative medicine. I now direct two integrative centers in IVF centers, where we offer psychological services, nutrition, acupuncture. And my latest, I got into why patients drop out of treatment and trying to figure out what can we do to better support people and lower stress levels to keep them in treatment so that they can have a healthy baby. I’m also interested in how to better support nurses who were in reproductive medicine. And as you mentioned, my big effort for the last year and a half almost is working with Liz to get these apps out there that women and now men can use to decrease their stress level as they try to build their families.

Spence: I don’t want to forget — Elizabeth or Liz and Allie, is that fine?

Liz: That’s fine.

Spence: I don’t want to forget about the sexual health or medicine part because I wanted to touch on some of that anyway, so that’s great, we’ll put that in our back pocket, but who can intro the process, maybe you could touch on FertiCALM, but the process of what brought about the FertiSTRONG, the new app for men?

Liz: Sure. It started about almost a couple years ago. This fall, Allie and I were at Resolve, the National Infertility Associations Benefit, and I sort of pulled her aside and I said, hey, come over here for a second, got a little napkin out, started doodling some ideas down, and I said, what do you think about an app. Yeah, it all started on a little napkin, tactile napkin. So, what I was noticing basically with patients was that they were coming in and showing me the apps they were using to relax, but they were generic ones like, you know, Headspace or other mindfulness ones that are wonderful apps but not specific to fertility. So, I started doing some research just to see if there was anything that existed, and most of the apps in the fertility space were really related to monitoring ovulation and tracking but nothing in the mind/body medicine field. So, I started talking with Allie about the ideas, she loved it, and I think within a week, we had

sort of formed an LLC and the learning curve started in terms of researching developers and designers, but it’s been an amazing, creative process for the two of us, to put all of the things that we do every day in our practices into an app that can reach so many more people than we can reach in our offices.

Spence: Scaling. You started with a female, one for women, right?

Liz: FertiCALM, yep.

Spence: And then, more recently, just released, I don’t know if that was the release but at a conference in Chicago, the FertiSTRONG?

Alice: Yes, FertiSTRONG, yeah. The way that apps are designed, there’s nothing out there like it. Liz and I see patients every day, and every day patients come in, men and women and talk about all the situations, the experiences every day which cause them stress. They’re at a family event and someone announces a pregnancy, or the woman’s at work and she gets her period or just, you know, things happen every day. We see our patients but we can’t be in their back pocket, we can’t be with them every moment every day, so that’s what the apps are meant to do. We identified 50 situations which we perceive as causing the most stress for our patients, and for every situation, there’s six different cognitive behavioral or relaxation solutions. When you have the woman who’s at work and the doctor calls with bad news and she’s freaking out, she literally pulls out her phone, FertiCALM is free. It was licensed by Ferring, so it’s now free to anyone in the U.S. and Canada. They pull out their phone, they find the exact situation they’re in and out pop six different things that they can do in that moment to feel better. Based on FertiCALM success, you know, very quickly, people came to us and said, okay, this is great, this is wonderful for women, you do an amazing thing for women or for men. Around the time FertiCALM came out, all of a sudden, study start to come out showing how distressed the men are and how helpless they feel. There’s literally nothing out there for men. And so very quickly, Ferring came up to us and said, look, we need to do a brother app, so that’s where FertiCALM came from. And we’ve launched

FertiSTRONG at the MRS meeting in Chicago, and then a real launch was right before Father’s Day in June. The idea is the exact same design, well, that’s not true, FertiCALM is a flower and it’s pastel colors and it’s really pretty, it’s meant for women, and FertiSTRONG is a tree. And we actually, Liz and I tend to see more women than men and so we hired two of our colleagues who actually do work with men on a daily basis, Dr. Janet Takefman, who is in Montreal and Dr. William D. Petok, who’s in Baltimore, and the two of them wrote the content. It’s what the guys face on a daily basis. So, I’d say for FertiCALM, all the content is for the women who used the app. For FertiSTRONG, half of it is what men can do to help themselves feel better when they’re feeling really stressed out, and half of it is what they

can do to better support their partner as they treat infertility.

Spence: There’s a physician from Montreal…

Alice: A psychologist.

Spence: A psychologist. That was going to be my next question, how did you understand where to even start with men, because, you know, men will come in often with their wife, and most often, in my experience at least being an acupuncturist, unwillingly, because of the needles. Literally, maybe once or twice. But just having conversations with men, it’s just such a different picture, I know we’ve been talking over email – can you give any other nuances that might be kind of different, and I love that it’s highlighted, that it’s a good portion of it is support for the woman. Because especially in assisted reproductive technology, that field, the emphasis is so much on the woman, the IVF, most of the medications are with the woman, and then likely because they’re going to carry the pregnancy.

Alice: It’s 100% that the woman’s going to carry pregnancy.

Spence: Well, yeah, that is still true. But what were some of the things that you came up with that are kind of specific to men so women can understand and start to pitch this

app to their husbands, because that’s primarily who will be listening today.

Liz: I think men tend to be on the sidelines. We know that they want to support their partners, the stereotype is of course that they want to fix everything, and so there’s a tremendous sense of helplessness for men to sit and watch the people they love, experience pain and not be able to fix it. So, they often wind up being avoidant or walking away or scheduling a few more business trips, which infuriate than their partners. This gives actual skills that they can use to respond to their partner’s comments in any kind of stressful situation that we know happens. It actually gives them the concrete words they can say to their partner, when certain things are said or other people who are well intended but wind up saying very hurtful things to people. I think it makes them feel less helpless. It’s like training, they have something on their phone that can really help, and that’s sort of the couple’s work we do in our offices.

Alice: Yeah, I think that men, and I say this because I’ve been married for almost 20 years, I think men are often afraid of making a situation worse through obliviousness, not because they want to tick off their wife but because they don’t know what to say that often comes out wrong. And so we are in effect giving the men tools. I mean, one of the options for example for every situation is what we call ‘social solutions’, and so we have 50 different situations where someone says something really stupid to the guy, which people say all the time, and it gives them a script. So, it’s either a polite response, like thank you very much or an education response, where you want to educate the person. And it makes men feel less helpless. Like, the next time someone says something stupid to them, it can be considered as very offensive, they have a script, they can memorize some of these situations and they can say, oh, well, you know, as a matter of fact, that’s not true because… It also gives them ways to communicate better with their partner, because when women go through infertility, we know that both members of the couple get depressed and anxious, but the women tend to have a much higher degree of anxiety and depression. And as I’m saying, it’s really frustrating for the guys because they don’t know what to do. And here, we’re telling them what to do, not in a dictating way but, okay, so here’s the situation, your wife is upset because of this, here’s what

you can do to help yourself feel better, and here’s what you can do to support your partner in a better way.

Spence: I love that. There’s a training you said, Liz, or an educational piece, because a lot of the time, men might be out with their wife and a situation arises and they may not even pick up on the fact that their wife has been triggered. It’s like, oh, okay, this is maybe going on and I should maybe help extract her from that situation or step in and be the protector that we want to be, but it’s difficult to understand.

Liz: There’s a different response. Take for instance the woman who is out to dinner and someone announces a pregnancy or someone’s not ordering wine and eating sushi, and so she starts to get triggered and starts to unravel, and the man sitting there, having a great time, not understanding anything that’s going on with their partner, their partner could be sort of kicking them under the table. So, the those exact situations are listed in this, you know, how can you work as a couple together, what kind of signals can you give each other, do you text someone from the bathroom saying, we need to leave now, you need to pretend you’re sick and we need to go home. You know, squeeze of the hand under the table that signifies three squeezes as, we’re out of here. It gives them actual, concrete ways to manage the situations and it educates men. You may not be triggered by the situation but I’m triggered by the situation, so here’s how we need to find our way out of it.

Spence: There a component that’s just pure learning through it which every man could definitely benefit from, just downloading the app, learn, and even if they don’t end up using it in certain situations, they’ve maybe learnt it off the start or as educational upfront.

Alice: I think everybody when they’re going through a medical crisis feels really out of control. And there’s so many situations which either trigger the man, trigger the woman or trigger both, it gives them tools. So, no matter what the situation, like, okay here’s a behavioral solution, here’s a cognitive solution, here’s a social solution, here’s a way to

use humor. And then, there are also ten pre-recorded relaxations so when they’re just feeling really anxious, they can go, okay, you know what, I need five minutes to just bring me down. I mean, to bring me down back to a less anxious data. So, they push that button and they can do a five-minute relaxation, and that helps them feel more in control and less anxious.

Liz: And, you know, this survey came out coincidentally right as we were launching with Resolve and then another one in the UK, and it said that, I think it was like 83% of men feel like they’re marginalized, like the offices and clinics aren’t talking to them, they don’t feel like they have a 93% so they don’t have the resources available to them. It’s sort of a woman’s world in this field, and so they’re feeling very marginalized, without all of the kind of support strategies that women are being offered. So, we really hope that this fills that gap.

Spence: Yeah, it plays a bigger role now. Go ahead, Allie.

Alice: No, it was interesting how within a few months, like all of a sudden, all those data came out showing how distressed men are, because I think one of the big battles with infertility has been trying to educate people that it’s not just a woman’s issue, that in terms of the physical cause of infertility is just as likely to be a male factor as a female factor, which I think still most of the world believes the problem lies with a woman. And so, we’ve come a long way at recognizing the male factor is a significant contributor, but we still left the man out of the psychological equation. Like, what resources there are to support people going through infertility are very focused on women. And it’s like, oh, yeah, he’s the rock, he’s fine, don’t worry about him. But when you get these men alone, these guys, they want babies too. I think they feel like no one really understands how much they want to have a child, no one really understands how hard it is for them to sort of stay the rock while their wife is going through treatment, because even with male factor, most treatment does involve treating the wife or making them super fertile. So, he’s feeling really guilty, he’s feeling very worried, but all along, there seems to be this like societal expectation that all his energy needs to go to taking care of her and helping

her feel better, which we’ve observed over the years, but I think it is because no one is really paying attention to how they feel. And they’re upset too. And I think that we’re suddenly getting all this data showing how to stress these men out. And now we need to step up and do something about it. And, you know, it was fortuitous that FertiSTRONG came out just as all this data was coming out.

Spence: I mean, in any situation in life, how can you ever truly support someone else if you’re not doing well yourself. It’s that analogy of donning your mask before putting it on your children.

Liz: There’s a whole section on the app just for self-care and just for recommendations for what men can do. First, just giving them permission to take care of themselves and then a whole list of things they can actually do to take care of themselves so that they have the energy to take care of their partner.

Spence: Nice, nice. Examples of like is it exercise or diet-related or is it kind of all encompassing?

Liz: All of it.

Alice: I think what’s also missing for men is that the way our society works is that women can talk about being distressed, and a lot of women with infertility choose to tell people about her infertility, and she’ll seek out support groups or online groups or whatever – men don’t do that. I have a patient right now whose husband’s a firefighter and he’s very open about his infertility, and he recently went to the fire station and was talking about how hard it was for him that his first IVF cycle didn’t work. And he got like verbally abused, like, oh, you’re shooting blanks and

what’s wrong with you, and that was really hard for him. And it became like this macho thing. That’s I think how a lot of people think of it. They don’t think about it as, infertility is a disease, it’s been classified by the World Health Organization as a disease. And the emotional hit that both members of the couple experience is really significant.

Spence: Yeah. Well, that locker room banter I would call that. It is so what’s embedded in all of us, and I would postulate that some men would find — depending on who the other men are — would find some comfort in that, and I’m speaking for every man on earth want to talk at length always with our buddies, just an acknowledgement and stuff sometimes is what’s needed. Just so we’ve got our tribe knowing what we’re going through kind of idea is. But I feel bad for him.

Alice: But apparently, after he got abused very surreptitiously, a number of other men in the firehouse have been coming to him and saying that they were going through infertility too, and they’re asking him for advice. So, end story is, now he feels empowered because he is helping other people, but there was a little bit of a baptism by fire.

Spence: He was a martyr.

Alice: A great guy.

Spence: Yeah, that’s great. I mean, he has to start those conversations. They might be short but, like you said, we don’t go online, we’re trying to find out too with some of the men that we see out here. It’s like, how do you want to be supported or what does that look like, or can you help us learn. And it would be nice to have a psychologist on call, like five-minute call, or what do you need, because sometimes it may just be that.

Alice: That is sort of what we want. We can’t talk to a patient on Saturday at 11:00 o’clock. I had a patient a few weeks ago who was freaking out because she had her pregnancy test on a Monday, and she emails me over the weekend, she’s like, I don’t know what to do, I’m so anxious. I said, download the app and follow this and this petal, because FertiCALM is a flower. On Monday, she said to me, it was amazing. She was able to feel much more in control, that she could find her situation was just waiting for pregnancy test results, and there are all these things that she could do to calm her

down, make her feel more in control or feel more empowered.

Liz: And not everyone has the time and money and access to care. So Allie and I are in these major metropolitan areas, so people have the luxury sometimes of coming in, but a lot of people don’t have the money to come in, a lot of people don’t have access to that in parts of the country and the world. So, while this is no substitute for seeing a therapist, obviously it does allow people to have the skills based training we’re trying to offer and the mind/body techniques to try out at home.

Spence: Even if they do sometimes have access to that support, it might not be knowledgeable support. It might kind of simulate the locker room banter, I don’t know, despite it being professional or whatever it might be. It’s scary, men don’t want to burden their wife. This is great. You guys have planted a seed and are already fertilizing it – there was no pun intended there but I’m glad it came out. This is a start of something that will be a platform hopefully for men to look through, and it’s like, oh, yeah, and also when this happened, maybe that hive mentality or the collective wisdom can help build it further to FertiSTRONG 2.0. It’s a bit of a tough world, the app world, there’s always consistent updating, I don’t know much about the technical side but good for you, guys.

Alice: Three years ago, we didn’t know either.

Spence: Yeah, now you do.

Alice: I think we don’t know too much about the technical side at this point.

Spence: Well, you are experts and you hire others. How people can download? Do they have to do it at the website, which we will have in the show notes below, or is it in the Apple?

Alice: It’s both in the Apple and Android stories in the U.S. Right now, in Canada, only FertiCALM is available and only in the Apple version.

Liz: You can also go to the website fertistrong.com or ferticalm.com.

Spence: And if they go to the website, can people outside of the U.S. download it?

Alice: Yes, there’s a link on both websites.

Liz: But only FertiCALM can be downloaded in as Allie said.

Spence: Okay. It will be exciting when that gets international.

Alice: That’s how it would go in the immediate future.

Spence: I would assert most people that will watch this will be U.S.-based, but there will be a large component in Canada. Is there any way that they can access some of that? Is there writing or papers or something that kind of could help women outside of the U.S. to understand sort of how to better support their men so their men support them?

Alice: That’s on FertiCALM. There’s a whole section on FertiCALM on relationships. One of the

petals of the flower is relationships, so there’s definitely information and content available and skills available on that.

Spence: Fantastic. We were going to chat a little bit about your subspecialty or secondary focus, the sexual health or the sexual medicine. So, what do you see happen in relationships primarily, and what do you see help when — I know that with time, trying to conceive is difficult, not necessarily maybe on the relationship but on the sexual relationship, it becomes so mechanical and systematized, and what’s even less talked about than male infertility would be erectile dysfunction or premature ejaculation or these things that I want to highlight some – can you touch on some of them?

Liz: You are right. It’s very important. And this is certainly where you see the locker room talk not happening. It’s going to be more like, oh, I heard you’re shooting blanks, you can’t get your girlfriend pregnant. So, the stereotypes for men are that you should be ready willing and able at all times, that you should be able to spread your seed as often as you want and procreate, and so when this suddenly isn’t happening, the ways that they fought it, there’s an incredible sense of shame. And no one to really talk to about it unless they’re trained sex therapists because even therapists and doctors shy away from this, you don’t really find that people are asking the questions because it’s taboo or they don’t know what to do with it. So, the app definitely addresses this, both apps have an entire section just on sex. So, there’s a petal or a tree leaf that’s called sex. The major themes are that sex for pleasure becomes sex for procreation. And sex as expression of love and intimacy becomes associated with failure or pain, because women don’t want their bodies touched if they’re doing injections or if they feel bloated or if they’re cramping. And so, it absolutely breaks down the fabric of the sexual relationship and intimacy and sexuality of both people. And even their sense of sexual identity, just within themselves and grappling with that. And then what it does to the intimacy of the relationship because now

it turns to monitoring and time sex and performance on demand. So, what you will see then as a result of that is 2- 3% of men with erectile dysfunction or premature ejaculation. There’s a lot of ejaculatory disorders, either delayed ejaculation, so there’s a lot of people that come in with that. And you sort of have to unpack that and figure out what that’s about, is it that a person doesn’t want to have a child or is it just that they’re feeling pressure, you know, in this crosses over to the samples that they have to give too. So, it’s not just in the bedroom with their partners anymore, now they’re feeling nervous when they come in to give a sample and they may not be able to perform. So, a lot of stress associated in this area, and it feels so good to be

able to have this in the apps now because a lot of men are not going to talk about this with people.

Spence: No, no, no. I don’t know the statistics, you guys would be far more adept at this

but the number of cases of things like erectile dysfunction and premature ejaculation that are of psychosomatic, or let’s simply put, stress-related likely is quite high in my experience at least.

Alice: Absolutely. We always recommend they get checked by urologist, just making sure that everything’s functioning well organically but, most of the time, it does seem to be psychogenic

in nature.

Spence: What are some techniques for men to stop that cycle, because it’s like a snowball, once you have premature ejaculation or erectile-dysfunction, it’s hard to undoing it.

Alice: That’s right. You take a natural process that people are used to having in their whole life, and then it becomes rewired with this thought process that interferes with the ability to function, you have to break that down and help them. The interesting piece to this is, you have to address with couples whether they want to address the sexual piece, whether they want to separate the sexual piece and just say, you know what, we’re just going to do IVF or IUI, and we’re going to work on our sexual relationship, separate from procreation, or, if they want to do both. So, it becomes sort of an interesting ethical question, because sometimes people don’t have the luxury of engaging in sex therapy if they’re just trying to have a baby, and if she’s 38 years old, she may not be on board to do three to six months of sex therapy to see where they’re at, to see if you can function properly. And then sometimes it takes the pressure off for the man to bring it back into the medical facility, and then suddenly, he can perform just fine at home. It takes some finessing to figure out what the couple wants and what they’re trying to treat and in what order.

Spence: You mentioned the possibility of, if someone maybe does not want babies or they are unsure – do you see that affect sexuality and sexual function as far as erectile

strength or ejaculation issues?

Liz: Absolutely. That really becomes much more of a relationship couples counseling issue or bringing him in alone and talking to him. I think the more typical thing that we see is this sex on demand performance problem. There’s actual exercises on the app that recommend, have sex during non-fertile times of the month, get a hotel room, go back to play, pretend this is when you first met, what was that like, you know, really concrete, just learn to flirt again. So, ways to really help couples separate the times that they’re trying to have a child and the times that they’re trying to be close and intimate.

Spence: That’s so important for even how playful and funny it feels to have that conversation. It’s like, well, what did you do when you’re dating or role-playing or whatever sexual excitement and fun is there. That would be such an essential or such a nice piece for couples to focus back on. If you ever heard of a guy named Mantak Chia?

Alice: No.

Spence: It’s this Thai or Indonesian old, old book. It’s called Cultivating Male Sexual Energy, and there’s one for women too, female sexual energy, all breathing techniques and all kinds of exercises. I’ll send you a link to it if anyone’s interested. It’s just sometimes about putting the focus back into sex or it being that time for pleasure.

Liz: Or acknowledging that they can’t. It’s too difficult to do that, because they’re so focused on the goal of trying to have a child that maybe they need permission not to for now. And even engage in other activities that aren’t sexual now, in terms of just being close again and physical intimacy. There’s lots of different ways and techniques to get at it depending on what the problems are. And then a woman’s desire goes down, and just I think, being able to tell people that what they’re experiencing is normal helps them really feel very validated.

Spence: I believe that. The whole idea, back to FertiSTRONG, when women come into

my clinic and there’s any sort of relationship — I’m not a relationship counselor at all – it becomes something you listen to a lot when you’re working clinically with people. My best advice to women often is, don’t ever assume that your male partner, husband, whatever, is trying to figure out what’s going on with you and how to help. You’ve got to tell us, just tell us what to do, we’re good fixers, we want to protect you if that’s what it comes down to. So, this what you’ve done, that must have been a ton of work, the FertiSTRONG.

Alice: I think actually, FertiCALM, it was funny because when it came to running the content, Liz and I both happened to be in Chicago for a couple days, for different conferences, and we had about a six or eight-hour common, free block. And we basically got one set in my hotel room and just wrote at least half the content, because this is what we do every day. I’ve had patients come in every hour and they’re like, oh, this happened to me, and this is what we do. We could put that knowledge and experience into the app with the idea that we really don’t want people to suffer. We really don’t want someone to be in a family party and have a sister announce they’re pregnant and then just cry for three days. We really want them to take their phone and go into the bathroom, and be proactive and do something that in that moment to feel better. Or when the wife is just really upset, and as you said, the husband is like, I have no idea why she’s upset, I don’t know if I did something, the number one thing I tell my female patients is, they can’t read your mind, you’ve got to tell them. But if they go to the app, and it goes, you know, my partner is upset, it will say, oh, this is what you can do to improve that situation. Because people don’t like being unhappy and they don’t like to be out of control, and that’s what cognitive behavior therapy is all about. It’s giving people rules which they can use at that moment to help themselves feel better.

Liz: And there’s over 500 different coping strategies in each app. So, there’s a lot to choose from.

Spence: Yeah, there’s different types of men, there’s different ways to deal, you know, more sensitive, more strong, or, I don’t know, driven with testosterone, or there might be

some religious differences even as well with the conversations around sexuality and stuff too, which gets pretty complex. I am totally impressed and excited for it to have access to it, because I think it’s a conversation that’s seems to be gaining, and you guy said this the data coming out of Resolve and things kind of coinciding with FertiSTRONG, it’s like when a wave happens, anyway, we can contribute or I can, I would love that. I’ve started meeting with some men in my local area, just out of my own curiosity as a man. It’s like how can we support men more and young boys growing up, because I’ve got boys and I’m a man. You know, wellness center for a man in my mind looks more like, it’s all inclusive, it’s got your financial adviser, it’s got your dietician, it’s got your psychologists, it’s got your physician and your banker and everything that’s involved so men can have this peace of mind, just to know they’re not screwing up, and they got their affairs in order and a relationship. We are just starting the conversation, and our intention is to create more groups where we can just chat with men, and say what’s going on, like where do you need help and support. Like, what are your questions in life, or where have you seen your dad or your uncle, or where do you think you’re slipping, and to try and find out more about how to better support men in the generations of men that are coming up, because it’s complicated, you know, life is hard.

Alice: I think we also have to do a shout out for men because my husband I have talked about this, his role model, his father was traditional, his mother was a stay-at-home mom. I think my husband figured out once that his mother made him 4335 sandwiches because she was a stay-at-home mom with two kids. His role model of a dad was someone who went to work every day and the mom did all the home stuff. And now, my husband, or current men are married to women who work full time. So, our expectations of men are completely different than from what men grew up with. So, current men may have no father as a role model in terms of their current circumstance, and there’s an expectation now that men do 50% of home responsibilities, childcare responsibilities, etc., and these guys tend to be a little clueless because they don’t know. Frankly, when I see couples, I’m always saying to the man, tell me about your dad, tell me about the relationship with your parents. Because if he’s not meeting his wife’s needs in some way, is it that he won’t or is it that he can’t? He just doesn’t know how.

Spence: Ignorant, yeah.

Alice: I think we have to be appreciative of the massive, sort of social and generational shift that’s happened and what our expectations of men are now compared to expectations of men thirty years ago. And they’re really different.

Spence: Well, it might be homologous to what we’re seeing with fertility, primarily with women, with that shift into the workforce, when you meet reproduction time clock. Maybe that’s half the cause of the stress and difficulties that we see. Thank you for acknowledging that, Allie. For most the men that I speak with, it’s hard for them to know when they’re supposed to be big, strong man and sensitive man. And bounce back and forth, you know, should I be making all the money and high-roller or should I be nurturing my wife into her career and stepping back and being in the male or the dad role more. These are great conversations that you’re starting in, and this tool, it’s 500 scenarios to help men – that’s huge.

I just appreciate that, and I’m speaking for men as a whole again.

Alice: Thank you.

Spence: We’ll put it in the show notes, but it is fertistrong and ferticalm.com. You are domarcenter.com, Allie, and that is more on your mind/body program if they wanted to understand more about what Boston IVF is doing.

Alice: domarcenter.com is about the center we have here in Boston and we have one in Albany, where there’s psychological counseling, mind/body program nutrition and acupuncture.

Spence: When someone comes in for ART counseling or possible IVF, you are integrated fully into them.

Alice: Yeah, we have three psychologists here for individual couple’s counseling.

Spence: And you are in New York, Elizabeth, and you have got a website called ivf.org.

Liz: That’s just the company website for Cornell, so that’s the University website. If they want to find out about the apps, they can go to the ferticalm.com or fertistrong.com. And then, in terms of my practice at Cornell, the ivf.org.

Spence: Okay. You practice at Cornell. Are you with an IVF center like Allie?

Liz: Yeah, yeah, Center for Reproductive Medicine.

Spence: At Cornell.

Liz: Yeah, headed by Dr. Rosenwacks, he has been there forever. I’ve been there for 18 years working with them.

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