The Whole Pineapple

Content warning: there are mentions of abortion, incest, and rape in this episode.

Advocacy is on the menu for today's episode — and to quote our Season One guest Lara Hayden in episode 13, listen up to learn how we can all "be prepared, not scared."

Sean Tipton, Chief Advocacy and Policy Officer for the American Society for Reproductive Medicine (ASRM), is a fantastic resource for getting prepared. Mr. Tipton formulates and executes media and government affairs programs for ASRM, the country's leading organization for professionals involved in reproductive health care and infertility. In this role, he has worked in policy venues ranging from local zoning boards to the United Nations. Sean has degrees in political science from Transylvania University and The Ohio State University.

As he says, part of his role is being a translator: explaining healthcare to policymakers and media, and explaining law and changes in policy to healthcare professionals and laypeople.

So how do we "be prepared"?

First, Sean says, know your rights. The First Amendment guarantees us freedom to petition our government for redress of grievances. We all have the right to complain to our elected officials when we have a genuine grievance. As Anne says, she needs a tee shirt that says, "I have legitimate grievances."

Be informed and operate from a position of knowledge. There's a lot of fear surrounding the Dobbs decision: how will it affect women's choices and health? How will it affect assisted reproduction? For legislators, it can be a minefield: they often don't really know enough to debate the topic from an informed position, and they may not know what their constituents or party will accept. Information genuinely is power.

Listen carefully to language and interpretation. A lot of terms are being thrown around, sometimes by people who aren't careful or expert enough to handle those terms. Be sure you understand what someone is truly saying when they talk about reproduction, and the technology and the rights involved. Are legislators listening to the experts and passing on accurate information? If not, there may be an opportunity to challenge and educate.

• What has changed with the Dobbs decision? 8:51
• How does personhood laws impact IVF? 13:30
• How to promote access to reproductive care. 24:58
• The complexity of IVF and abortion bans. 30:40

To stay informed and engage in advocacy, check out ASRM at asrm.org. Find Sean Tipton on LinkedIn (linkedin.com/in/sean-tipton) and check out his episode on the ASRM Today podcast.

As always, find more from Anne and Ruby on thewholepineapple.com, and don't forget to rate, review, and share this episode with anyone who can benefit!

How do you stop "catastrophizing"? And if it's not clear from context, "catastrophizing" is the art/science/self-destructive spin-out of getting stuck in what Bridget Jones referred to as a "negative thought bog," like getting mired in a swamp of despair. Like "doom scrolling," catastrophizing is that rut of negativity you just can't seem to fight free of.

Not to make this a list of metaphors, but Anne's Roomba story in this episode is perhaps the most perfect example of catastrophizing. But you'll have to listen to get the joke. 🙂

Fortunately for us, Jaime Mammenga is back to talk us down, allow us a space to express our concerns, and help us learn to let go. And if anything is confusing, Anne has a Roomba analogy to help you through!

In this episode, Jaime and Anne discuss how emotions need wiggle room, they need to move. You can't just push emotions away and expect them to stay gone. Complaining to a patient friend, writing it out in a journal, pummeling a punching bag — those things can allow you to vent rather than explode, stop catastrophizing, and get that feeling of being in control back.

In this episode, Jaime and Anne cover:

• How to focus on the present moment. (1:04)
• How does this work in your relationship? (4:38)
• The importance of journaling and venting. (8:31)
• Letting go of the worry. (13:10)
• Worry dolls and how they help. (17:12)
• The difference between sexy time and worry time. (21:37)
• Jaime's meditation (23:06)

If you need more Jaime (and who doesn't need more Jaime??) you can find her meditations on The Whole Pineapple podcast, wherever you get your podcasts. You can also find them here, along with all the episodes with hosts Anne and Ruby: thewholepineapple.com. Jaime is on to new adventures in her professional life; stay tuned for updates!

We often refer to fertility as a "journey" — but sometimes it can feel like a slog through disappointment, bewildering medical terminology, treatments, surgical termination, physical and emotional pain, and more horrors that you really don't need us to list out.

One of the hardest parts may be feeling so isolated, like no one's journey has been as complicated and fraught as yours, and no one will truly understand what it feels like to be you.

In this episode, reproductive psychology expert Dr. Julie Bindeman tells her story. It is a roller coaster that will probably feel all-too-familiar to many: miscarriages, bad news from the ultrasound, medical professionals who don't have a proper sense of urgency (to put it politely, though we're screaming on the inside).

But there are two very important takeaways here:

1. You are not alone. And you deserve to have safe spaces to talk about your experience with others who understand.
2. You need to advocate for yourself. It sucks. It really sucks that sometimes you may feel you're the only one taking your concerns seriously, but if it happens, you have the right to stick up for yourself and insist on being heard.

A bonus takeaway: even professionals in the field find the fertility journey really tough. If someone in your life (maybe even you?) tries to make you feel you're being "high-maintenance" or "too sensitive" or "hyper-vigilant" or any of the other ways we dismiss the concerns of those with uteruses, just refer to the takeaways above. You know your body best

We also urge everyone to know the reproductive rights (or lack thereof) in the state where you live. You can find up-to-date information on The Center for Reproductive Rights website: reproductiverights.org/maps/abortion-laws-by-state.

To learn more about Dr. Bindeman and find a whole host of resources, be sure to check the Pregnancy After Loss Support website: pregnancyafterlosssupport.org/author/juliebindeman. Find out more about hosts Anne and Ruby, and listen to more episodes, at thewholepineapple.com.

And of course, we hope you'll share, rate, and review this episode. If you're listening on a podcast app, you can rate and review right now! We hope you will; it makes it easier for others to find us.

Content Warning: This episode focuses on pregnancy loss and termination of pregnancy for medical reasons. If you're not in the right head space to hear this episode, we suggest you skip ahead and come back if and when you're ready. Please take care of you.

Worst-case scenarios suck. There's no way around that. But one way to make it suck slightly less is to be sure everyone involved is invited into the tough conversation about termination of pregnancy (TOP) for medical reasons. When the bad news is fresh is a really tough time to make a decision; having a planned path can at least remove some of the pressure.

And not to get too political (but it's hugely relevant), legislation around "personhood" and abortion are making these decisions much harder and limiting the choices patients have regarding their health, their bodies, and their fertility. Everyone needs to know the options available in their state and the risks they may be taking by virtue of where they live.

Enter Dr. Julie Bindeman. Dr. Bindeman is a licensed psychologist specializing in reproduction and fertility psychology. She is Founder and Co-owner of Integrative Therapy of Greater Washington, an organization focused on helping people navigate fertility challenges, including pregnancy loss and TOP.

Given the sensitivity of the topic, we've included some timestamps for anyone who prefers to skip around and listen only to what's most relevant to them. What you'll hear in this conversation:

• How Dr. Bindeman got into the field of perinatal mental health. (3:23)
• The limits of our knowledge on infertility. (9:08)
• The importance of talking about miscarriages and abortion. (11:45)
• Abortion and the downstream effects. (15:26)
• The problem with using euphemisms to describe prenatal testing. (20:50)
• Framing the decision to terminate a pregnancy. (26:43)
• Weight loss medications and fertility. (35:10)
• Mirror Syndrome and delivery. (37:52)
• Risk of multiples and miscarriage. (42:54)
• Pregnancies that cause fertility difficulties. (48:44)

Resources:

Integrative Therapy of Greater Washington: greaterwashingtontherapy.com

greaterwashingtontherapy.com/some-resources

More about Dr. Bindeman:

Dr. Julie Bindeman received her Doctorate from George Washington University. She has served on many professional committees including in the Mental Health Professional Group of American Society for Reproductive Medicine (ASRM). She was elected to the Executive Committee in 2021. She is the former board member of the Maryland Psychological Association for 10 years and was appointed by the Governor of Maryland to serve on its Maternal Mental Health Task Force. She was recently awarded the Karl Heiser Award for her legislative efforts on behalf of the field of psychology. She has also authored and published several book chapters and articles pertaining to Reproductive Psychology.

You can find Dr. Bindeman at the Integrative Therapy website: greaterwashingtontherapy.com/julie-bindeman-psyd. You can find Anne and Ruby at thewholepineapple.com.

Q: What is a cyst?

A: It's a pocket of fluid.

Q: Why do I have cysts?

A: Because you have ovaries.

Q: Is it bad?

A: Great question. Let's talk.

Not all cysts are bad news. In fact, bodies with ovaries generate cysts pretty regularly as part of the menstrual cycle. For example, what you see on an ultrasound isn't the egg; the egg is inside a "follicular cyst," which is what's big enough to see and measure on an ultrasound.

As you listen to the episode, you'll hear about "functional" cysts that have a job to do and are good things to have. So if you hear the word "cyst," that's not necessarily cause for alarm.

That confusion is what this episode is all about — there are different kinds of cysts, some good, some less positive — and knowing what kinds of cysts there are and what they do can help you know what's happening in your body.

In this episode, Ruby and Anne talk about:

1. Different kinds of cysts
2. What you can do about them (if they need something done)
3. Symptoms of cysts
4. What impact cysts can have on your cycle, fertility, and fertility treatments
5. What you or your doc might see on an ultrasound and what that might mean
6. What a "dermoid" cyst is and why it's … wow. You'll just have to listen.
7. PCOS (polycystic ovary syndrome)

The good news is, cysts are largely benign. They can cause some issues, but if you get a diagnosis of a cyst, it's time to ask more questions, not to panic!

Have a listen, then pass the episode along to others with ovaries — it's such important information for everyone to know! To hear more from Ruby and Anne, check out thewholepineapple.com. Please rate and review, to make the podcast easier to find for others!

Welcome back to Dr. Kelly Casperson, urologist, author, and expert in sexuality, and not to jump in, but let's "fix" sex already!

It's really challenging to get even our own ideas on sex straight, given what we were taught (or weren't) and how societal and cultural "norms" around sexual behavior are … often not about sex.

Controlling sexuality is a time-honored tradition for controlling women in particular, and Dr. Casperson is ready to help women claim their bodies and their sexual responses through education and by shedding stigma.

In this episode, Dr. Casperson, Ruby, and Anne talk about how participants can improve their sex lives, including….

• What "should"s might be crowding our brains and how to get to our own genuine ideas about sex. (Sex should be about procreation; sex should occur X times per week; you should be having sex to keep your heart healthy, even if it's not pleasurable.)
• What is "sex etiquette"? Is it OK to talk about the quality of the encounter while you're cuddling, or should you save it for later? How do you introduce something new to the bedroom (or the kitchen floor or the back of the Volvo)?
• What tools are out there for easing into uncomfortable conversations?
• Gently educating men on women's bodies (if we weren't taught much about our own, how much education do you reckon THEY got? Hint: porn is NOT educational.)
• How bodies and preferences change over time.
• How sex is like coding. :)
• Erotica for telling your brain, "Hey, this is sexy time."

Be sure to check out Dr. Casperson's website and book for LOTS more information: kellycaspersonmd.com/home, and be sure to share this episode. (It might be kind of embarrassing upfront to share an episode on sex tips, but just imagine how grateful the receiver will be!)

Find more from Ruby and Anne at thewholepineapple.com

Resources:

Sssh.com

Quinn

AudioDesires

Beware the 7-year itch, says Dr. Kelly Casperson. Around that mark (or so the thought goes), many of us start getting a little bored in our careers and in our relationships.

But sometimes it works out perfectly: Just as she was getting a little itchy, Dr. Casperson met a patient who was finding her sex life as uninspiring as, well, moldy lettuce. (You'll get that reference in a minute.) That led to a whole new direction, and one you'll appreciate!

Many of us now approaching potentially "itchy" times are finding out where the gaps were in our sexual education. We were taught the sex = unintended pregnancy and STDs version of human sexuality, and now, with the stress and physical changes of fertility treatment, having sex can start to feel like a job — one we don't remember signing up for and desperately need a vacation from.

Women's sexuality in particular is hugely overlooked and under-discussed. Did you know the clitoris looks like a wishbone (oh, the irony…)? Why does the clitoris keep getting lost and rediscovered? Have we ever "lost" the penis and had to rediscover it? (spoiler: no.) Here's another jaw-dropper: only 30% of those with vaginas orgasm from having a penis put in them.

As Dr. Casperson says, it's not necessarily true that those with vaginas don't like sex — it's far more likely they just don't like the sex they're having. And that can usually be fixed.

In this episode, Dr. Casperson talks with Ruby and Anne about how couples can work together toward good, satisfying, enjoyable sex. As the doc says, you don't say, "I don't like movies" when you only watch horror films, right? So maybe it's time to try some different varieties.

Dr. Kelly Casperson is a board certified urologist and a founding member of Pacific Northwest Urology Specialists in Bellingham, Washington. She is an expert in comprehensive urology care, treating all genders for a wide range of conditions. She also specializes in urogynecology including things like stress urinary incontinence, pelvic organ prolapse, vaginal atrophy related to menopause, and sexual health.

Be sure to check out Dr. Casperson's podcast, You Are Not Broken. Find her on her website: kellycaspersonmd.com and order her book! You Are Not Broken: Stop "Should-ing All Over Your Sex Life

As always, please rate, review, and share The Whole Pineapple (AND You Are Not Broken) and find out more about our hosts at thewholepineapple.com.

Did you know: We can take cells from the outside of an embryo and test them?

Formerly, "embryo biopsies" were done only if there was a risk of serious disease like cystic fibrosis. It wasn't routinely done because taking a cell or two from an embryo that is only 8 cells brought with it the possibility of damaging the embryo.

Nowadays, the cells are taken later and aren't part of the inner cell mass that becomes the actual fetus. These cells still have the information embryologists are looking for (does it have the correct number of chromosomes), but the procedure doesn't incur the same risk.

Why do it at all? This level of testing gives doctors and patients more information about the health of the embryo and its possibility of yielding a successful pregnancy.

Let's talk about "assisted hatching" — it may make Anne and Ruby think of Austin Powers, but come on, Jurassic Park, right? Remember the dino egg hatching during the tour?

These days, assisted hatching is done with a laser on Day 3 (it used to be done with acid and THE EMBRYOLOGIST'S MOUTH). Basically, the idea is to create a tiny hole in the "shell" so cells can ooze out during development and be collected for testing. Rest assured, hatching is a normal part of the process of implantation, laser-wielding Embryologist or no.

For more fascinating science (and movie references), you really need to listen to this episode. It's seriously jaw-dropping how far we've come in fertility treatment.

Get more information on Julia, Ruby, Anne, fertility, Embryology, and treatment at www.seattlefertility.com. And learn more of the amazing science of fertility at thewholepineapple.com.

Find more information in these previous episodes:

[Bonus] Snack 56.5: What is PGT?

Episode 29: My Embryos are Mosaic? Interpreting Your PGT Results

Content Warning: There is discussion of animal testing some listeners may find difficult.

Continuing our digital/audio tour of a fertility clinic, we're stopping off at the Lab, a place full of lovely humans, according to Ruby and Anne.

One of those lovely humans is Embryologist, Julia Aliabadi. Julia graduated from the University of Washington in 1992 with a Zoology degree (which apparently is a common path for folks who end up in Embryology). She first worked in andrology before joining Seattle Reproductive Medicine in 2005.

So, what actually happens in the lab with the sperm and eggs and embryos? Well, life in the lab has changed as technology has evolved. For example, Embryologists used to test sperm's penetrative abilities by introducing it to animal eggs and see if it could get through. These days, there's a process called ICSI (intracytoplasmic sperm injection) where a tiny needle injects the sperm directly into the center of the egg.

Why do this? Well, as Anne says, "Life is a struggle!" and there's a lot more involved in reproduction (no matter how it's achieved) than most of us know.

If you're curious what goes on in a fertility lab, this is a great introduction and tour. It's also a great mini-tour of some of the history of fertility treatments: imagine making your own pipettes! Or doing all your embryo freezing at one time because the freezer took three hours to complete a cycle. Or realizing embryos actually do better when we look at them less.

So since we no longer get a daily update, what happens between Day Zero and Day Five? And how do strippers work into all this???

Take a listen to hear how far Embryology has come and what life is like in the lab now. And find out more about Julia Aliabadi and hosts Anne and Ruby at Seattle Reproductive Medicine: www.seattlefertility.com. As always, listen and share episodes of The Whole Pineapple at thewholepineapple.com.

You've decided to give IVF a(nother) try: what should you do or not do during treatment?

And how does this relate to Miami vs Pacific Northwest "chic"? Well, let's just say, it really helps to know the rules in advance….

There are a lot of mythunderstandings (misunderstandings + myths!) out there about IVF, so in this snack, Ruby and Anne are going to talk about the things you genuinely need to know.

Here's what you'll learn: (and yes, you need to listen to get the full answer!)

1. Exercise: yes, no, decrease, increase, and why?
2. Alcohol: can you have a glass of wine?
3. Caffeine: please o please, Mother Nature, may I?
4. Tobacco/nicotine: spoiler — NO. For so many reasons…
5. Bath, hot tub, sauna?
6. Sex during an IVF cycle?

As always, please consider sharing this information with anyone you believe could benefit. It not only helps that person, it helps make The Whole Pineapple more discoverable on podcast apps, which could help a whole lot of people.

Find more at thewholepineapple.com.