Dealing with Loss

It would be nice if life included only sunny days and happiness, but we all know dark times are inevitable. During painful times, it’s helpful to have teachers, guides, mentors and friends who can hold us, comfort us and help us grow.

I shared my personal experience with losing my hopes and dreams of motherhood in an earlier blog post. Sadly, a few years after my miscarriage, I lost five family members in four months.

During this sorrowful time, I was so grief-stricken, raw and vulnerable; I could literally feel the immense sadness pervade my body every moment. It truly was too much to bear. I knew that I needed help and decided to seek therapy.

In one of my sessions, my therapist, who is a very gifted and wise man, gently shared, “Nancy, you need to add people to your life, specifically five people, not to replace your loved ones but to add new life and meaning to your life.”

As I heard this, I silently asked myself, “Where am I going to find five people?” In another session, he invited me to participate in a women’s retreat to help me move through this mournful time. Initially, I said no to the invitation; however, the next morning I felt an undeniable yes.

In some ways, I felt an invisible hand guiding me along the way, moving me in a direction that was unfamiliar to me. Perhaps it was something larger than myself. The support I received from a community of women was one of the most healing components of this women’s retreat.

It was through my vulnerability and leaning into others that I found my strength.

Here, I met five people who became my trusted allies, those who were willing and capable to help me through my intense grief. These connections have affected my life in immeasurable ways.

I had wanted to find meaning in my life after losing so many beloved family members, to honor their lives and live a happy and fulfilled life myself. I came to see that it is possible to find peace, hope and healing after our devastating losses.

When you say “yes” to new possibilities and to the potent medicine for meaningful connection, things can unfold in ways you couldn’t have imagined. When the veil of intense grief lifts, all that remains is love.

We need to grieve our losses fully. We can also remember that grief is a sign that we have loved greatly, and that our love doesn’t end.

In the poem Zero Circle, the poet and mystic Rumi tells us that when we completely surrender, “Then a stretcher will come from grace/ To gather us up” and “Miraculous beings come running to help.”

This captures the essence of what can happen when we open ourselves to receive support and our friends and allies show up for us in our time of need.

Not only did five miraculous beings come running to help during my crisis but I also have gathered many more allies along the way. To survive your dark days, I encourage you to find a few kind souls who will surround you with love when you grieve. This will enhance your days and help you grow through the pain.

Zero Circle

Be helpless, dumbfounded,
Unable to say yes or no.
Then a stretcher will come from grace
To gather us up.

We are too dull-eyed to see that beauty
If we say we can, we’re lying.
If we say No, we don’t see it,
That No will behead us
And shut tight our window onto spirit.

So let us rather not be sure of anything,
Besides ourselves, and only that, so
Miraculous beings come running to help.
Crazed, lying in a zero circle, mute,
We shall be saying finally,
With tremendous eloquence, Lead us.
When we have totally surrendered to that beauty,
We shall be a mighty kindness.

~ Rumi

To read more insights from Nancy Lishack, M.Ed., founder of Calm Waters Holistic Healing visit her blog. You can also sign-up for her new workshop on Preconception Care, which is scheduled for September 29, 2018.

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The Essential Ally

“The idea we can go it alone defies the natural world. We are like animals; we need ties to others to survive. We live in the shelter of each other.” ~ Dr. Susan Love

“Most people with infertility don’t tell anyone they are going through it,” said Alice Domar, a psychologist at Boston IVF. “Most don’t even tell their mothers because there is a deep sense of shame.”

Yes, I was one of them.

I didn’t share my fertility journey with my mother or any other family member until I had a miscarriage at age 41. As I sit here and write this, I realize that the immense sadness, grief, and shame that I was carrying truly got in the way of reaching out to my wonderful mother to help support me through one of the most agonizing times of my life.

Once I shared this painful loss with my parents, I was beautifully held in their love and deep compassion. I found myself calling my mother every day, sometimes multiple times a day, if only to hear her voice, which calmed me in every way. No one seemed to have the magic touch of soothing this immense hurt, knew what to say and when to listen — except my mother.

She became my essential ally, the person who simply listened and let my heart unravel.

Only three weeks after my miscarriage, my beloved mother suddenly passed away. The last three weeks that we shared together became ingrained in my soul. I was filled with profound gratitude that we connected in such an authentic and meaningful way during those precious three weeks.

I carry this sacred time with me; those three weeks are now moments that I continue to hold as treasured gifts. Those three weeks taught me that I don’t want to go through this life alone, that we need people to support us in our darkest hours, to ‘live in the shelter of each other.’

Unfortunately, too many women and couples struggle with infertility in silence. A survey conducted by Schering-Plough revealed that 61% of infertility patients hide their struggle to get pregnant from family and friends.

Why do humans need to connect and confide in others? As Dr. Daniel Siegel, a clinical professor of psychiatry at the UCLA School of Medicine explains, “We are hardwired to connect with one another, and we connect through our emotions. Of all the factors in human life that predict the best positive outcomes, supportive relationships are number one. Relationships are the most important part of our having well-being in being human. It’s that simple. And it’s that important.”

Sharing our stories with others and asking for help can decrease the intense lows of infertility; provide valuable peace of mind, and a greater sense of control.

When it’s your heart’s desire to start a family — and you are having difficulty doing so — it is important to gather allies who will wholeheartedly support you, especially when conception weighs heavy on your mind every hour of every day.

This may lift the heavy burden of feeling alone and help you regain a sense of hope. It is important to find essential allies, a small group of people who are trustworthy companions, those who you allow them to be a part of your fertility journey.

You might think your partner can fill this role, especially if you consider this person your best friend. Remember though, they are on this journey with you, feeling their own sense of sadness. For that reason, it’s best to find others who can listen and support you. A miscarriage affects both partners.

My mother was truly my essential ally and, in many ways, still is today even though she is no longer in the physical. When I meet with clients, I want them to feel that I can sit with them in their pain, to truly be “in it” with them, while holding compassion and understanding as my mother had done for me so long ago.

It doesn’t surprise me to witness many of my clients trying to move through their pain and sorrow by themselves. As I remember my mother graciously listening with such love and attention and without trying to fix anything, I impart her wisdom to my clients and share with them the value of letting someone in.

Who is your essential ally? If the image of a trusted friend or relative doesn’t immediately pop into your head, take a moment to think who could play that role in your life. Then set up a time to get together, talk, cry and help each other navigate life and improve your health and well-being.

Building relationships and connection with others you trust is fundamental to the healing process. We have a great need for each other.

To read more insights from Nancy Lishack, M.Ed., founder of Calm Waters Holistic Healing visit her blog. You can also sign-up for her new workshop on Preconception Care, which is scheduled for September 29, 2018.

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RHS in the News: The Safety of Your Frozen Eggs and Embryos

In October 2012, the American Society for Reproductive Medicine (ASRM) made the revolutionary announcement that egg freezing was no longer considered an experimental procedure. “Oocyte cryopreservation is an exciting and improving technology, and should no longer be considered experimental. Pregnancy rates and health outcomes of the resulting children are now comparable to those of IVF with fresh eggs,” said Eric Widra, M.D., Chair of the Society for Assisted Reproductive Technology (SART) Practice Committee.

Fertility preservation via egg or embryo freezing offers couples and individuals the opportunity to preserve their ability to have children in the future. For some women, a medical reason, such as cancer treatment, may lead them to seek fertility preservation. For others, the reason is personal, such as to defer child bearing or to pursue a chosen career path.

In addition to freezing embryos to preserve fertility, excess embryos may be frozen after a fresh IVF cycle. These embryos can be implanted at a later date in a Frozen Embryo Transfer (FET). Sperm may also be frozen to be used for IUI (intrauterine insemination) or IVF (in vitro fertilization) at a later date.

A storage tank failure at a Cleveland fertility clinic earlier this year compromised more than 4,000 frozen eggs and embryos. Understandably, this accident has raised questions and concerns about tank maintenance and safety protocols. RHS is committed to the best practices as outlined by our accrediting body, The College of American Pathologists. Tanks are monitored 24 hours a day and any issues are immediately addressed by the laboratory staff.

Dr. Maria Simbra of CBS affiliate KDKA-TV recently completed a story about tank safety measures and spent the better amount of an afternoon visiting the RHS lab and interviewing our experts for our story, including lab manager Jennifer Hamilton. Take a look inside our embryology lab and learn about RHS’s commitment to maintaining the integrity of your eggs and embryos by linking here.


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Another Successful Zoo Celebration!

RHS hosted another fun and love-filled day at The Pittsburgh Zoo and PPG Aquarium. Our annual event celebrates miraculous RHS families, regardless of how they are created. We invited a record number 623 families and, despite the rainy, cold weather, we had 486 guests. While O’Ryan the O’Mazing kept the guests of honor entertained with his juggling, plate spinning and magic, parents and RHS staff had the opportunity to reconnect and share stories of the journey to becoming a family. We’ve noticed an increase in the number of older children attending! Returning this year was our popular kids coloring contest. Congratulations to our four winners: Fiona, age 14 months, Blake, age 5, Dominic, age 6 and Nicole, age 12. They received a special treat in honor of their artistic efforts!

We want YOU at the zoo! The RHS staff looks forward to this event every year and we would love to ensure that all of our past patients receive an invitation. Please link to our blog to register with us and ensure your invitation arrives. This blog also provides information about how to update your contact information and how to have your child’s first name and date of birth added to a leaf for one of our trees. There is also an opportunity to send us pictures via upload (which we love second best to seeing you at the zoo!).

Fingers crossed for a warm and sunny day next year. We’ll see you there!

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How to Cope with the Emotional Aspects of Infertility

First in a series of guest blogs from Nancy Lishack, M.Ed, founder of Calm Waters Holistic Healing 

If you or someone you love is dealing with fertility issues, you know that stress is a constant companion. But did you know you have the power to help control that stress?

I created Calm Waters Holistic Healing after studying with Dr. Alice Domar, Associate Professor at Harvard Medical School, one of the top women’s health experts and creator of an innovative mind/body program for fertility care. According to Dr. Domar, “infertile women report equivalent levels of anxiety and depression as (do) women with cancer, HIV status, or heart disease.”

It’s impossible to review everything I cover in my Mind-Body Fertility Program in one blog post. Since Dr. Domar has conducted numerous research studies looking at the relationship between stress and fertility, and it has been shown that decreasing stress may increase your chance for a successful pregnancy, I will share tips and techniques, you can start using this very minute to help control your stress levels.

Tapping into the power of deep breathing

The simple act of breathing can help reduce stress hormones. Unfortunately, many of us don’t breathe deeply and it’s through controlled deep breathing that you can have a positive impact on your health.

Dr. Andrew Weil, MD, a renowned expert in the field of integrative medicine, recommends breathing exercises to calm the mind. Here is his 4-7-8 breathing technique:

Exhale completely through your mouth, making a whoosh sound. Close your mouth and inhale quietly through your nose to a mental count of four. Hold your breath for a count of seven. Exhale completely through your mouth, making a whoosh sound to a count of eight. This is one breath: Repeat three times.

Learn how to stay in the moment

It can be very hard to stop yourself from having regretful thoughts about what has happened in the past or fearful thoughts for what might happen in the future. However, dwelling on “what if” and “if only” types of thoughts can lead to anxiety and/or depression. When you are truly present in the moment, you cannot simultaneously let your mind dwell on the past or the future.

Sitting on the sofa watching television or meeting friends for happy hour does not help elicit the relaxation response. However, yoga and meditation do. I suggest trying yoga or meditation to quiet your mind and help your body experience the healing power of deep relaxation.

Practice self-compassion

If you’re like most people, you have a to-do-list that is packed; yet your own name isn’t on that list. Simple things like sitting down with a cup of tea, taking a walk outside or getting a massage can help nourish your soul.

Self-compassion is the act of being gentle with yourself. Gentleness is essential when moving through difficult emotions. Gentleness creates a soft flow, a yielding heartfelt connection with ‘what is’ in the present moment. When you are feeling raw, vulnerable and highly emotional, slow down, breathe deeply, feel your feet on the ground, and place your hand on your heart holding yourself in unconditional love as you would a dear friend.

Part of self-compassion also includes the way you speak to yourself. Many things in life you cannot control; but you can control how you react and think. Eckart Tolle compares negative self-talk to, “a little yappy dog that never shuts up and follows you everywhere, biting your pant leg forever.” When you find your mind ruminating thoughts, stop and simply ask yourself this question: Is that thought really true?

Don’t go through this alone

One of the most powerful components of the Calm Water Holistic Healing Mind-Body Fertility Program is the personal sharing from the women and couples in the group. Sharing their stories in a safe place and with those who are going through the same trials helps to normalize their journey and creates a place of comfort and understanding.

When they discover how many others feel the same confusion, fear or shame, their loneliness abates. This type of significant support is potent medicine, especially for those who have suffered in silence, in isolation or have hidden their pain from loved ones.

Incorporating these coping strategies may soften and support your healing process, through the depression, anxiety, anger and isolation to cultivate a sense of control, a new perspective and a life filled with vitality and contentment even in the midst of your journey towards parenthood.


To read more insights from Nancy Lishack, M.Ed., founder of Calm Waters Holistic Healing visit her blog. You can also sign-up for her next 10-week Mind-Body Fertility Program, which starts June 23, 2018.

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It’s Time To #FlipTheScript

National Infertility Awareness Week (NIAW) begins April 22 – 28, 2018. Currently 7.3 million Americans are facing infertility, no matter what race, religion, sexuality or economic status you are, infertility doesn’t discriminate. Anyone can be challenged to have a family. All throughout NIAW, we will unite millions of Americans who want to remove the stigmas and barriers that stand in the way of building a family of their own.

RESOLVE, The National Infertility Association, wants to change the conversation around infertility so the public, media, insurers, healthcare professionals and lawmakers understand:

• The scope of the problem and who is struggling to build a family. (Hint: it’s not just older women who waited too long to start a family)
• There are many barriers for millions of people who struggle to build a family. These barriers include: lack of insurance coverage, out-of-pocket costs, faith and religion, sexual orientation, and state and federal laws.
• The impact of infertility is far reaching—it impacts family, friends, co-workers, and employers.

How will you #FlipTheScript?

• Share your infertility advocacy story on Facebook and Twitter. Your story alone is something that will move hearts and will allow opportunities to educate people on this disease.
• You can download official NIAW Social Media Images and get your networks to #FlipTheScript on infertility.
• Add a Twibbon to your social media profile picture.
• Post a fact about infertility or family building options in your status update.
• Share RESOLVE’s Infertility Etiquette page.
• Send messages of support to friends and family members struggling to build a family. A whisper of encouragement goes a long way for someone who is need of a lift.
• Snap a selfie and share it with your “#FlipTheScript” caption or hashtag.
• Create a Pinterest Board about your infertility journey during National Infertility Awareness Week.  RHS has a NIAW 2018 board!
• Create your own National Infertility Awareness Week meme and send to RESOLVE at
• Create a YouTube video about your infertility journey and let RESOLVE know about it.

We hope NIAW will encourage you to begin your infertility advocacy!

Content for this blog was taken directly from RESOLVE. For more information, link to

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Ectopic Pregnancy and Fertility

An ectopic pregnancy is one in which the fertilized egg implants in a site other than the uterus. The most common place for an ectopic pregnancy to implant is in the fallopian tube; therefore an ectopic pregnancy is sometimes referred to as a tubal pregnancy. The fallopian tube cannot support a growing embryo, and after several weeks the tube may rupture and bleed, resulting in a potentially serious situation.

Ectopic Pregnancy -Illustration courtesy of ASRM

Ectopic pregnancy can be caused by pre-existing tubal damage. This may stem from prior pelvic infection or inflammation, endometriosis, appendicitis, and DES (Diethylstilbestrol) exposure. Prior pelvic or tubal surgery or tubal ligation which has caused scar tissue or adhesions may also be the reason for ectopic pregnancy. Tubes may also be malformed because of birth defects or other anomalous growths.

Symptoms of ectopic pregnancy include missed menstrual period and bleeding during pregnancy. Pain and cramping may be one sided pelvic pain or pain in the shoulder or neck. Pain may come and go and/or cause nausea and vomiting. Dizziness or weakness may accompany symptoms.

An ectopic pregnancy is usually diagnosed by pelvic exam followed by an ultrasound and serial measurements of human chorionic gonadotropin in the blood.

Because and embryo will not survive outside the uterus and because allowing such a pregnancy to further develop is dangerous to the mother, your doctor must intervene. If there has not been rupture of the fallopian tube, Methotrexate injection is the preferred treatment. Methotrexate is very effective in destroying the ectopic tissue and allowing it to be reabsorbed by the body. It may take several weeks to resolve the ectopic pregnancy with the Methotrexate injection. A large number of early ectopic pregnancies can be successfully treated with the injection, leaving the tube open in a majority of women. Patients who have liver and/or kidney disease are generally not candidates for Methotrexate therapy. Other patients that are not candidates for this injection are those who are breastfeeding, those with an active lung disease, and those with active peptic ulcer disease.

In some cases, surgery to remove the pregnancy may be required. Generally, surgery is performed using a laparoscope which is used through small incisions in the belly button and lower abdomen. Surgery with a larger incision, called a laparotomy, may be needed in some cases.

There is still a good chance you can achieve a normal pregnancy after experiencing an ectopic pregnancy. Talk to your physician about your specific circumstances and when you can try again.

Download our pamphlet about the Methotrexate injection


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Fibroids and Fertility

Uterine fibroids are benign growths of the uterine muscular wall and occur in 25-50% of women. Fibroids can develop within the uterine wall, on the surface of the uterus or within the uterine cavity itself. Although fibroids occur frequently, they rarely require treatment. The most common symptoms that occur as a result of fibroids are heavy menstrual bleeding and pelvic pressure; however, some women with fibroids have no symptoms. Uterine fibroids can be detected through a pelvic exam and confirmed by a pelvic ultrasound.

Most women with fibroids do not have difficulties with conception or pregnancy. However, there are certain situations when the location of the fibroid can lead to infertility or miscarriage. If you have been diagnosed with fibroids during the course of your evaluation, we will counsel you on the effects of the fibroid(s) on your ability to conceive and/or successfully deliver a baby. There is no definitive answer to the effect of fibroids on conception and pregnancy outcome.

Rarely, a fibroid will block one or both fallopian tubes, preventing the egg from passing into the uterus or the sperm from entering the fallopian tube. Surgical removal of the fibroid may improve the chance of pregnancy. In vitro fertilization (IVF) is an alternative treatment to surgical removal in this situation because IVF bypasses the fallopian tube.

A fibroid that grows into the uterine cavity may prevent an embryo from implanting. Surgical removal of fibroids that distort the inside of the uterus may increase your chance of a successful pregnancy.

The fertility specialists at RHS can counsel you on appropriate management of fibroids depending on your individual factors, as well as risks and the potential benefits of surgical removal.

RHS ultrasound image of a uterine fibroid

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Share Your Good News and Join in the RHS Celebrations!

Did you have your baby through IVF? We want to hear from you! Did you have your baby via ovulation induction? We want to hear from you! Did you have your baby with help from an IUI? We want to hear from you! Did you get pregnant on your evaluation cycle? You guessed it; we want to hear from you! Regardless of how your miracle happened we want to share in your joy. So share your good news and join the celebrations!

We love to receive birth announcements, private or public messages on Facebook, phone calls, portal messages, or even a personal visit! It doesn’t matter how we hear about your baby news, we will share your announcement with the RHS staff. WE LOVE to ooh and aaah over your gorgeous babies.

How do you join in on the celebrations and fun? It just takes a couple of easy steps to make sure that we have all of the necessary information so that you are able to participate in any current or future RHS celebrations.

First – Complete the pregnancy outcome card (below) that we gave to you when you graduated, and mail it back to us. Has that card gone missing? You can send us a birth announcement, note or call us!

Once the pregnancy outcome card has been received, we’ll mail you the postcard pictured below. Simply click on the link on our “Keep In Touch” page in order to access the “Congratulations – We Heard the Good News” form, enter the password RHSFamily and follow the instructions.  Through this link, you will be able to provide information that allows you to share your joy in a variety of ways.  You can choose to (1) Be invited to the annual RHS party (think zoo!), (2) Add your child to the RHS family tree, or (3) Share pictures to be posted on the RHS website and Facebook.  You can select any or all of these options.  Providing the requested information will permit us to communicate with you regarding any upcoming RHS events. If you have already registered, but wish to make changes to  your preferences, you can do that here also.

We hope to hear from you!

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What do you mean the lab couldn’t inject ALL my eggs during ICSI?

A lot of times the lab hears feedback from the IVF coordinators that patients were surprised, or upset, that when performing intracytoplasmic sperm injection (ICSI) , the embryologist was not able to inject every single egg that was retrieved. The main cause of this is due to the maturity stage of the egg itself.

Females are born with the total number of eggs that they will ever have in a lifetime. Prior to puberty, these eggs are arrested at an early stage of meiosis I, or at an “immature stage”. At this immature stage, the egg has a full set of chromosomes. As a female enters into puberty, luteinizing hormone (LH) surges occur during the menstrual cycle. These LH surges stimulate the resumption of the meiosis process in the egg and prepare the egg for ovulation and fertilization. Meiosis is an essential process that must occur within the egg because it reduces the number of chromosomes of the egg by half. When this meiosis process is complete, the egg is considered to be in the “mature” stage and is now ready to be fertilized. When fertilization occurs, the egg will once again have the proper number of chromosomes, one set coming from the egg and one set coming from the sperm, to form the embryo with a full component of genetic material.

During the IVF (in vitro fertilization) cycle when the follicles reach a certain size, an HCG injection is given. This HCG injection functions similarly to the role of luteinizing hormone (LH) in the menstrual cycle; it attempts to induce the eggs to undergo that final maturation step (or resumption of the meiosis process). You are instructed to give this HCG injection at a specific time prior to the egg retrieval so that the eggs have sufficient time and exposure to the HCG in hopes of yielding mature eggs from the follicles.

So, what does the lab look for when it is time to perform ICSI?

In preparation for fertilization, the egg undergoes the meiosis phases to reduce its number of chromosomes by half. The excess DNA or chromosomes are extruded out of the egg as a small cytoplasmic body known as a polar body. When extruded, this polar body sits in the perivitelline space between the oocyte and the zona pellucida and is visible under the microscope. When the embryologist sees the presence of this polar body they consider the egg to be mature and ready to be injected with the sperm to attempt fertilization. If the embryologist does not see this polar body under the microscope they consider the egg to be immature. Immature eggs are not capable of fertilization.

It is possible, however, that immature eggs can mature in the lab. This is called in vitro maturation. For optimal success, it is critical that the ICSI procedure be performed in the IVF lab within a specified time window following HCG injection and egg retrieval. When immature eggs are observed at time of ICSI the embryologist will wait the full allotted fertilization time window to see if the egg will undergo in vitro maturation in the lab. If the embryologist sees the polar body within the allotted time window, ICSI will be performed. If the embryologist does not see the polar body within the allotted time window, ICSI will not be performed and it is considered that the egg has arrested development and will not mature. As per lab protocol, immature eggs are discarded if they do not reach the appropriate stage for ICSI.

It is common to have immature eggs obtained during IVF. Typically about 10-15% of the eggs retrieved are immature. There are times in the IVF lab when all eggs are mature at the time of ICSI. There are times in the IVF lab when in vitro maturation of the eggs occurs and the embryologist is able to perform ICSI. There are times in the lab when ICSI does not occur as the eggs remain immature. Just know that our embryologists do make every attempt to give each egg a chance to mature and a chance to fertilize. It is a challenge that the embryologists are more than willing to undertake especially since sometimes the result is worth every effort in the lab!

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