Interview with Author of ‘Conquering Infertility’ -Alice Domar, Mind Body Fertility Expert

Alice Domar

30/04/2018

Spence: Hello, everyone, welcome to the Conception Channel, a podcast brought to you by the Being Fertile Program and the Yinstill Reproductive Wellness. I am your host, Spence Pentland, and today, as I say almost every podcast, but today, especially, I’m really excited to be able to speak with our very special guest Dr. Alice Domar – thank you so much for being on the show.

Alice: My pleasure, Spence. Thank you for inviting me.

Spence: Excellent. She is going to help us all better understand, because if there’s an expert in the field on stress and fertility, it would be Alice. And we’re going to try and dive into psychological impacts of maybe pregnancy loss and how alternative medicine may impact fertility as well and the efficacy also of psychological intervention. I’m very excited, but first I’m going to give you a run through your CV here briefly, and please like I said before we hit record, correct me. In 1980, you got your BA, a Colby College in Maine, and in ‘86 you got your Ph.D. in Health Psychology at Yeshivah in New York, and in ’87, you became licensed in Massachusetts as a clinical psychologist. From there, she has gone on to author and co-author seven books, including one that tops — I don’t know if it’s ever fallen off of Amazon like front page at least, it’s called Conquering Fertility. Many of you probably know it, if not, it’s something you should pick up. The co-founder of new apps FertiCalm and FertiStrong, which is the newest one, we’ll go into those because those are very interesting. I’m super excited that more people get to know about those today. Obviously a leading expert between the relationship of stress and fertility, which we talked about, and you’re a board member of RESOLVE. In the U.S., it’s a National Infertility Organization for over 10 years, that is such great contribution. You’re currently the Executive Director at Domar Center For Mind-Body Health, the Director For Integrative Care at Boston IVF, senior staff Psychologist Department of OB/GYN at Beth Israel Deaconess Medical Center, Associate Professor of Obstetrics and Gynecology and Reproductive Biology, part-time at Harvard Medical School – fantastic. Obviously, there’s a big story, and you’ve been doing this for quite some time, Alice, and thank you so much on behalf of everyone for your contributions to the world. Just before we

hit record, you mentioned how things have changed, you just got an invite and maybe you could touch on that, but to start with a tradition with this podcast, I’d love to hear a little bit of your back-story so people kind of can connect and understand a bit more about you.

Alice: Well, it’s interesting because my parents went through primary and secondary infertility. I’m the result of secondary infertility. I think when my mom had my sister, my mom wasn’t getting, wasn’t getting pregnant, wasn’t getting pregnant, and she saw a specialist in California who put her on the equivalent of Valium and soon came along my sister. Clearly, I grew up with my mother feeling that there was a mind/body connection with infertility. And then as I got my Ph.D. and I wanted to focus on women’s health, that was always in the back of my head. And there was a very small study done in Bogota, Colombia in South, where they took 14 women who had unexplained infertility, and seven of them went through basically a mind/body program and seven of them didn’t. And I think within a few weeks, four of the seven women in the mind-body program got pregnant and none of the control group got pregnant. And it was a time in my life where I was looking for something to specialize in, and out of that came the mind/body program for infertility. So, I started that in September of 1987, that was 30 years ago, and since then, thousands of women have gone through the program. I’ve trained health care professionals around the world how to run the mind/body program. I’m actually doing a training this week. We’ve since then done two big randomized control trials. The first one was funded by the National Institute of Mental Health and the second one was funded by Johnson & Johnson. And what with both of them showed is that women who did that mind/body group had far higher pregnancy rates than the control group. So, the first study was 55% versus 20%. And the second study was 52% versus 20%. And we had observed that in the clinical mind/body program, like women kept on getting pregnant right. And so it suggested that in fact there is a mind/body connection.

Spence: Wow. The context of these studies a little bit, were they in conjunction with IVF or were they the control arms? Or were they women just trying to conceive naturally and they were in two groups?

Alice: For the second study it was women who were about to do their first IVF cycle. And the pregnancy rates of the patients were almost triple. So, they were statistically significant. The second study, actually there’s more attention on the first study. It was in the Prize Paper at the  

American Society For Reproductive Medicine meeting. I gave five talks in Dublin last week and they were asking me — it was the Irish Fertility Counsellors Association (IFCA), and they’re asking me sort of about my career, and I said, you know, until the second study came out, I got no respect in the field. People thought I was perpetuating the eminence of ‘just relax and you’ll get pregnant’. Any time I went anywhere, people were making fun of me. If I would publish a paper, people would submit nasty letters to the editor. I’d say for the first 20 years of my career, it was really hard.

Spence: You got bullied.

Alice: Oh, totally bullied. I understand that because I think it was my parents’ experience, I feel super protective of people with infertility, I feel like they’re very, very vulnerable and I think there are practitioners out there who take advantage of that vulnerability – I’m just not one of them. I think people felt like I was the whole ‘just relax and get pregnant’, and I said to someone when I was in Ireland, I said, I’m split, I’m half nerd, half clinician. Actually think what I said was half nerd, half marshmallow, because I’m a therapist, I see patients every day, I have a practice right in this office where I see individuals and couples, and I understand forwards and backwards, the emotional hit of infertility. But I’m also a researcher and I published dozens and dozens of studies on the relationship between stress and infertility. And it goes both ways. Infertility causes really high levels of stress. Most women going through infertility mode, the majority women expressed psychiatric levels of anxiety and depression, and we need to do something about that.

Spence: Right. If I may, in my practice, what I feel like I’ve observed is, and let me know what you think of this is, I feel that infertility becomes its own cause.

Alice: Yes. I agree.

Spence: Can you go into the basics of stress and infertility, maybe the physiology or the impact and how that translates to people?

Alice: I think the most important thing people need to remember is that infertility causes a lot of stress, and the reason it causes a lot of stress, it impacts every aspect of an individual’s life.

It affects their relationship with their partner, because I have never been in my career seeing two members of the couple in the same place at the same time. It affects their sex life because they often are told when they shouldn’t or should have sex. People start to associate sex with failure, it becomes no fun. It impacts their relationship with their family because in all likelihood their siblings are getting pregnant. It affects the relationship with their friends because in all likelihood all their friends are getting pregnant. It affects their job because coworkers are getting pregnant, and because you can’t do an IVF cycle if you have work obligation. It affects your financial security because treatments are really expensive, and it can affect your relationship with God because people feel like it’s the first time that God has not answered their prayers. So, here you have a disease, because it is classified as a disease by the World Health Organization, here you have a disease that affects every aspect of your life and yet women are still blamed. For like pretty much every patient I’ve seen in my career has been told by someone to just relax and you’ll get pregnant. And can you imagine saying that to someone who’s diagnosed with cancer, oh, just relax, your cancer will go away. And that’s a horrible thing to say to somebody, and it’s making the assumption that infertility is solely caused by stress, and that’s not true. Infertility is a disease, and in the vast majority of cases, there is a physiological reason. It’s an ovulation issue or a tubal issue or a uterine issue or half the time it’s the male factor issue. You can go to sit in one of those water tanks for ten years and if your tubes are blocked, you’re not going to get pregnant. But just like infertility causes a lot of stress, you then have to look at how does stress contribute. I don’t think stress per se causes most cases of infertility, but I think once one starts treatment I think it can contribute. And the reason I know it does is because if you look at the data of people in treatment, if a woman were to do some kind of psychological intervention, whether it’s a mind/body group or a support group or whatever, the statistics show she’s far more likely to get pregnant. And we also know that these interventions make her less anxious and less depressed. I do not believe in the myth of just relax and you’ll get pregnant, but I do believe, because what the data shows is, it’s doing some kind of psychological intervention does increase significantly your chances of having a baby.

Spence: So, sometimes just moving the needle a little bit, like you don’t need to get from here to relax, you need to just move the needle a bit and that can have a large impact on the outcome.

Alice: Exactly. I mean sometimes it’s like with weight, if somebody is underweight or obese, one can say, okay, if you gain 5 or 10 pounds, or if you lose 10 or 15 pounds, that can just bump you into the fertile range, and I think it’s the same thing with stress.

Spence: I was at a conference very recently and a mind/body practitioner there talked about the impacts – actually, it was a talk about trauma, and she went as far as to say that infertility for many can be a trauma and exhibit PTSD, like symptoms within the nervous system and it’s just you can’t shut it down, so that little needle movement is what you’re talking about?

Alice: What I found sad is that most of my patients would get pregnant, but they would go like, I’m pregnant but I’m not really happy, I’m actually more anxious. And it’s true, most women with infertility who then get pregnant tend to be anxious at least for their first trimester and they don’t have that same much ecstatic radiance that they expected. I think a lot of it is infertility impacts you, it’s really hard. We published a paper about 20 years ago that showed that women with infertility have the same level of anxiety as a person with a heart disease.

Spence: Heart disease.

Alice; So psychological infertility is equivalent to facing a potentially terminal illness. And I think people need to understand that.

Spence: Yeah. That’s very motivational as well for people to step in to say mind/body programs or just nurture themselves as they would when they’re pregnant, you know, take really good care of themselves in so many ways. I’ve heard recently, on the male side of things, which I’m excited to get FertiStrong here, but a semen analysis or male factor infertility more now these days too is pointing toward or correlating at least to future health concerns. That for man is an indicator and that helps some men step into this process as well with their wife I’ve seen in my clinical practice, which is really, really nice when they’re both really trying to move toward their dream. Okay, so that’s infertility, what about the impact of — people who are getting pregnant and having miscarriage or recurrent pregnancy loss, it’s so different, what’s your experience or your understanding there?

Alice: It is certainly medically different because they’re having miscarriages as opposed to

infertility. I’m not sure how that’s all that different. I wrote a paper, a review article a number of years ago about the psychological consequences of recurrent pregnancy loss, I can’t get it published. No one seems to care. I submitted to 2,4,5 journals – no one seems to want to read about it. Many women who had numerous live births, they still carry that pain with them, it’s excruciating. And for them getting pregnant is very anxious. I had a patient right now who had, I can’t remember how many losses she had, so she’s actually using a surrogate. You get this trauma, you lose the pregnancy, that’s a real loss. I know our society doesn’t understand that, they think, if it was before twelve weeks, who cares. But it’s a baby, and you could miscarry a week later. She had a bunch of kids and she was about six weeks and you know what, it was devastating. And the only people I got real support from were people who also had a pregnancy loss.

Spence: It’s a different club. It’s funny, I mean, in your career for sure even in mine, which is shorter, about fifteen years working in the reproductive health field, I have seen such a difference in public perception and understanding of fertility, but doesn’t miscarriage seem to be lagging so far behind?

Alice: I was talking to a reporter about this a couple weeks ago, and I said, you were too young to remember this, but I remember when Gerald Ford’s wife, Betty Ford were to reveal to the media that she had breast cancer, and the Vice President’s wife, Happy Rockefeller told the world she had breast cancer. And everyone was like, oh, my god, these women are talking about their breast cancer, and now, when woman is diagnosed with breast cancer, the world is supportive. And I’ve been waiting for 30 years for infertility and pregnancy lost to follow suit, and yes, it’s gotten better. There is no question there. Once a month in People magazine, there is a celebrity talking about her miscarriage or pregnancy loss. We did a study three years ago that shows that a majority of women still don’t tell anybody. If you tell somebody, you make yourself vulnerable for those stupid things. I told everyone when I miscarried and we had so much support.

Spence: Mind/body, that must involve a lot of other alternative approaches within your practice, I’m not totally positive, but can you speak to your experience and the effectiveness that you’ve seen probably largely connected with Boston IVF, I think, correct?

Alice: Right, we had a huge Integrative Care Center here at Boston, IVF we hit over 6,000 patient visits last year just to the Integrative Care Center, and so, we have the mind/body group, we have three psychologists who do a cognitive behavior therapy, even a nutritionist who’s actually there for underweight/overweight, and then we have five acupuncturist. We had four that’s been going all the time, we got four acupuncturists seven days a week and that’s our busiest practice. In terms of, I don’t ever use the word alternative or complementary care because I don’t think what we do is alternative. I think all of us have spent our careers trying to integrate and be a part of Western medicine. And the way I put this, if you are coming for infertility treatment, if you’re just seeing a physician, you’re not getting complete care, but if you’re just seeing an acupuncturist or a psychologist, you’re also not getting complete care. I really think you need to think of a holistic approach.

Spence: Within that realm you’ve got you said nutritionists, psychologists or clinical counselors, I’m sorry, my terminology in Canada might be a little different, and acupuncturists, I’ve read some statistics in some places and I don’t know the validity of them, but the percentage of people that are utilizing these, let’s just for sake of simplicity call them alternative or complementary in this instance for sure, is there a large percentage of women more now probably because of what you’re doing Boston is a high percentage, but what’s it look like across the U.S.?

Alice: I think acupuncture is pretty popular. I think a lot of infertility patients will do acupuncture. There are very human fertility centers in the U.S. that have integrated centers on-site because it’s a huge investment of space and time and money. I think most practitioners who work with infertility patients probably working in that other part. I mean, again, as I said, I’m half nerd and very focused and what the research shows, and in fact, we just had a meeting with our acupuncturists a while ago, and I’ve gone to China in December. And I met with one of the clinics and I was meeting with their acupuncturists, they were finding some really good results with what’s called ‘electric acupuncture’, which is as opposed to needles is like little tiny discs and there’s a little tiny bit of electrical current. And they’re finding a really great result of increasing blood flow to the pelvis using electro acupuncture. And so I was talking to our acupuncturists about integrating it here, and luckily for me, two of my acupuncturists here are Chinese and I said to them, can you look at the data so that we can decide if there is enough research to support the efficacy of adding that new modality. We do not do herbs here  

because as of today there still has not been a randomized controlled prospective trial supporting the use of herbs and supporting the safety of herbs; however, if study came out tomorrow showing they’re safe and effective, we would change our protocol. I worry about patients who are told too much — there’s a practitioner in Boston who tells patients that she can bring down their FSH level so they get pregnant and as far as I know there is nothing we know of that can bring down FSH levels and increase pregnancy rates. High FSH level tends to be an indication that there aren’t a lot of healthy eggs in the ovaries. As I said, I feel very protective of infertility patients and I want to make sure that they get not just responsible care from a clinic, which is sometimes in doubt, but they help you get responsible care from those of us who practice integrative care.

Spence: Of course. I love the movements toward more professional integration and more professional accountability on the acupuncture side – that’s what I can speak to at least. Because these lofty claims, from my perspective, acupuncture can do a lot for the stress and for the environment, and whether the FSH took a dip that cycle and there was a nice ovulation, that’s great. I don’t know what caused that, but if we can optimize for that cycle where that does happen and there’s a nice environment, there’s lots of blood flow and there’s a relaxed patient, hopefully that contributes to success – that’s my view of these days. But what the psychological aspects and maybe you could speak to both of these, also on the male side what you’re seeing and the participation on the male side, which traditionally maybe it’s because they don’t carry the pregnancy, maybe it’s because our traditional medical model, doesn’t have many treatments besides ICSI or IUIs that might help with sperm conditions that are unfavorable, but how do you see these complementary medical practices helping men?

Alice: Men in our field are ignored. I think we found that when we were creating the app for men. If you look at the data, there are at least half a dozen studies of randomized controlled perspectives of these supporting the efficacy of acupuncture for male factor infertility. We have a male acupuncturist here and I’ve talked to our urologist about referring more patients here, and it just hasn’t happened even though there’s really nice data showing that acupuncture can be effective for male factor. Psychologically, when I see the couple together, she will say, we never talk about infertility, he doesn’t care, but when I talk to the man alone, he‘ll say, I want a baby just as much as she does, I am devastated, but what about if that doesn’t hold us together. And if she’s a wreck, I have to appear strong. Now, Lauri Pasch is a psychologist at

University of California San Francisco published a study maybe a year and a half ago, which actually, remember when I said the majority of women are depressed and anxious, the data on men was stunning. I mean these guys, their rates of depression or anxiety are not as high as women’s but they’re still scary high. And RESOLVE, which is the National Infertility Organization in the U.S. put out a survey a couple of months ago, looking at the distress levels of men. And, you know, we’ve got to do something, that’s why we came out with the mail app, because there’s really nothing out there for men. They’re supposed to just suck it up and be strong for their wives and not care. Well, let me tell you, they do care.

Spence: I have the same experience, and I unfortunately believe it starts in their just being very little follow, I don’t know the legitimacy of it, it came from a urologist that is quite respected that said that IVF is one of the worst things that happened to men’s health in general in the last 40,50 years. Anyway, I’m not getting political here, but he said that statistics was somewhere around the number of 12% of men. That’s such a small number that actually even get to the point of getting a semen analysis done, which is staggering, and I hope that’s wrong.  

Alice: No, if a couple go to see a physician because of infertility, a 100% of men should be getting a semen analysis. I mean, you can’t assume that fertility is a woman’s issue because isn’t just as likely man’s issue.

Spence: Semen analysis is a frontline, and if there’s something that shows in there that points in another direction that should be investigated, something as simple as low volume, there should be physical exams and blockage ruled out. And so much of the time, this doesn’t happen, and so I think that complacency is a) just us being men and b) is that we’re not going to carry the pregnancy and we may be somehow what you’re saying though is where we are as attached to the outcome but we don’t get assured in taking accountability in the same way, so that reflects in how we act.

Alice: Well, I think for men like the sperm count or the sperm parameters, if they’re abnormal, I think for men they associate that with masculine inability, and it’s very scary to have that challenged, when in fact the amount of healthy sperm production has nothing to do with sexual power. It really doesn’t but I think a lot of men — I have a patient right now whose husband’s a firefighter and it’s a male factor. And when he mentioned it to his co-firefighters,

they made a lot of fun out of him. It was a terrible experience. It’s ridiculous but that’s what sort of societal bias is.

Spence: So, men don’t like to talk as much about that, but when you get them in the right environment and the right guy that’s into that, I mean, the psychological interventions must be huge because most men go through this without having a single person to talk to.

Spence: Okay, but what psychological intervention, Spence? I mean, that’s what’s so sad is honestly, I think with the FertiStrong app I think it’s one of the first entities ever designed for just men. I can’t think of research, which looks at psychological interventions for men with infertility. They are the ignored part of a couple.

Spence: For years, the male partner going through IVF, we’ve taken perceived stress scores, so someday we’ll have to review that data.

Alice: You should publish that data because people are finally waking up and beginning to realize that these men are suffering too.

Spence: Yeah, it’s not that they’re relaxed on the sidelines, that’s for sure, and it’s always done on embryo transfer day with the women and there’s a couple controls, and so yeah, we will. I’m not a researcher so I need help.

Alice: It’s easy, very easy.

Spence: While we’re on the men side, this FertiStrong, it’s a new app, can you talk about it?

Alice: Yeah, let me say just how FertiCalm came out. I’ve been doing mind/body for a lot of years, and I was at a RESOLVE event about two years ago, two and a half years ago, and Elizabeth Grill was sort of my equivalent at Cornell Medical Center in New York, I trained her to do mind/body, and she said, have you ever thought about doing an app, and I’m like, look at me, I have gray hair, do you think I know anything about that. So, she and I literally sat down at this event and she says, I have patients coming in every day, and there are all these relaxation apps out there, there’s Headspace, and there’s Calm, there is Insight Timer, and none of them are infertility specific. She and I literally sat down and on a napkin designed the  

app. And I think a year and a half later it was released in the U.S. We’ve got a pharmaceutical company Ferring to sponsor us, so it’s free for patients, and it was just released in Canada two weeks ago. And the basic idea, I hope you can see this, this is the flyer. So, what Liz and I did, we were actually in Chicago for a weekend at a conference, and we came up with 50 situations would cause our patients the most stress okay. It could be, you’re at a family event and someone announces a pregnancy, or you’re at work and get your period, or you’re driving somewhere and the doctor calls with bad test results. So, we came up with 50 scenarios. We’re both cognitive behavioral therapists and so for every scenario, and it looks like a flower, there’s six different cognitive behavioral solutions: how to use humor in that situation, how to self-nurture. We have ten guided relaxations: what you can do cognitively, how can you think in a different way, what to do behaviorally, like go in the bathroom, get away. And the one I like the best is we call Social Solutions. So, for all the stupid things people say to you, we have a polite response and an education, like if someone says something stupid, now you don’t think on your feet, you don’t know exactly what to say, so we’ve given you scripts for all 50 situations. FertiCalm came out exactly a year ago, it was April of 2017, and it’s been very successful. We have over 10,000. I think pretty soon after it came out, Ferring came to us and said, we really want one for men, which I thought it was really cool.

Spence: Really that’s great!

Alice: I think the only criticism we ever had about FertiCalm is it was designed for women, it’s very beautiful. Liz and I are not experts in male factor, in men with infertility so we hired two of our colleagues, Janet Takefman, who’s from Montreal, and William D. Petok from Baltimore, who both specialized in working with men and they wrote the content, and it’s real like FertiCalm, it’s just not pretty. It‘s a tree instead of a flower.

Spence: It’s got motorbikes on it and stuff.

Alice: Yeah, and they came up with 50 situations which are most stressful for men and it’s the same idea, cognitive behavior therapy relaxation. And it came out in the U.S. a week ago, week and a half ago. We have no idea, and it’s going to be a real one.

Spence: Just for my Canadian listeners too.

Alice: You know what, it’s up to Canada. If they want it in Canada, it will be available in Canada, but it’s not up to us.

Spence: Well, I will put my word in with one of the reps I know, so thank you.

Alice: Please do.

Alice: They just got FertiCalm about three weeks ago because U.S. versions are translated into Spanish, so to be released in Canada, it has to be in French as well. FertiCalm is now available in English and French Canadian.

Spence: The Canadian equivalent to ASRM, CFAS is in Montreal this year, so really close to you, so you should knock on their door for sure because that would be a good route in. I’m sure Ferring is a sponsor as always. These two fantastic apps, do they have meditations, like guided meditation?

Alice: Yeah, there are ten in my voice, there are five that are like Denny’s, like if you’re at work and you get bad news, you go the bathroom and you listen to my voice for two minutes, and then there are five that are longer, like meditation and progressive muscle relaxation imagery.

Spence: That’s great. Those things are lifesavers to so many of my patients. It gets so crazy to a point where an invitation to a one-year old birthday party of a friend, you know, like the whole week is gone. It’s crazy. But these little things are what get people back on — I don’t know how to put it, in control of their choices and their day and they kind of get strong again.

Alice: Our patients feel so out of control, out of every aspect of their lives, and so anything that they can do to increase their sense of control – it’s going to help them.

Spence: Yeah. Part of why I wanted you on the show, there are a lot of people popping up in this realm, in this field claiming to be whoever and coaching programs or whatever, one of my patients tell me that she is looking into a coaching program and it was quite expensive. And

when that was expressed, the coach on the other end just simply said well then you’re not ready to get pregnant. Isn’t that crazy? Literally!

Alice: I just had a patient come and see me, and she says, you know, I talked to someone who’s a coach, who offers a mind/body program and it’s $2,000. And I said, so tell me what’s in that program. It’s all science-based. It’s not going to happen. We don’t have that much control over infertility, and for a practitioner to say, you’re not ready to be pregnant, I mean, she should lose her license. it’s disgusting.

Spence: I don’t think she has any sort of license. I don’t know, you can become a coach or whatever without any sort of professional body. But I love what you’re doing, obviously, I have self-interest, but even within the acupuncture world, there’s schools that are very mechanistic and science-based. But the further you go into any condition, any medical condition that I have seen and in what I’m doing, the spiritual component or the mind/body component, it ends up being you get the mechanics wrapped up with a bowl because you can, you can put systems in place but the other is where the true healing really needs to end, and most often in my experience this does occur.

Okay, so what’s next for Alice?

Alice: Well, I got good news this morning. I had been approached by Cambridge University Press about co-editing a textbook. And they actually approved it this morning. And so I’m going to be the first author. If someone had said to me thirty years ago that Cambridge University Press is going to publish a textbook on infertility treatments and that a third of it was going to be a patient-centered care and the psychologist would be the first author, I would have laughed out the win. And that’s actually happening. We just got the contract this morning.

Spence: Congratulations!

Alice: It just shows how far our field has come that one of the most prestigious university presses in the world feels that reproductive medicine has to include the patient’s mind and body and soul. That’s probably the biggest endorsement I’ve ever had in my career.

Spence: You know what, I would like to think that you’ve helped create that change, Alice, and thank you.

Alice: I attend American fertility meetings for the first 10, 20 years, it’s very different. It’s very different, I feel like a rock star when you go to these meetings. All of a sudden, patient-centered care is interesting to people.

Spence: That is so great, that is happening. At ASRM, there is going to be the first time ever a pre-symposium full day on acupuncture integration. I know some of the people involved and they are brilliant, and I’m so excited for that. I’m a guy and I’m really passionate about that side, so thank you for talking about that and creating this FertiStrong app for men because there is very little out there and things for men need to be very tangible and simple and quite private and that is a great inroads, I’m excited to check it out a lot deeper. I will recommend it to all my men.

Alice: When this gets out there in Canada.

Spence: Yes, that’s great. Also, a motivator for men often is –have you ever heard of a site Don’t Cook Your Balls?

Alice: Yes.

Spence: They’ve got a great quiz for men and I recommend everyone to go and do that because it empowers men, just a simple outlook on what they are doing that is maybe helping and hindering, and some ideas of how they can maybe change their trajectory in life and help their fertility. So, men need to come up with their ideas, they can’t all come from their wives. This sounds very similar, you know, like once they are done that quiz, Don’t Cook Your Balls, they should be recommended this app.

Alice: I would love that. FertiCalm that’s for women, it’s all about how they can use these strategies to feel less anxious and less depressed, less stresses, for FertiStrong, it’s probably half what men can do for themselves and half what men can do for their partners. Because I think half of the stress for men is the distress level of their wives.

Spence: I totally agree, especially being a guy. If my wife is happy, I am a way more likely to be super happy too.

Alice: I get my husband a T-shirt a couple of years ago that actually says Happy Wife, Happy Life.