August 31, 2023 • 27 mins
Family Planning plays a vital role in ensuring positive health outcomes in communities of color. This episode of MEternal features Dr. Michael Simoni of Reproductive Medical Associates (RMA) and will teach multicultural mothers about what reproductive health should look like when it comes to women of color.
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Episode Transcript
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(00:01):
Me turn. We know that overone fifth of women have experienced some racial
discrimination in a healthcare setting just inthe past year, So that's definitely up
there, and they just don't knowwho to trust and where they get their
opinions from. You have the ideathat black women may feel like their pain
is not being heard, they feelneglected, and there's this you know,
(00:24):
black girl magic is great, butat the same time, you need they
need to kind of take inventory ofis this normal? Should I have to
deal with this? Because maybe Idon't, And we want to help them
if they don't have to. Welcometo Maternal Home to access in information for
mothers of color. Family planning playsa vital role in ensuring positive health outcomes
and communities of color. This episodeof Maternal features doctor Michael Simminee, a
(00:48):
Reproductive Medical Associates, and we'll teachmulticultural mothers about what reproductive health should look
like when it comes to women ofcolor. So tell me a little bit
about how you ended up at Armyof New Jersey. So I graduated medical
school in twenty fourteen. After thatyou go into residency, which is training
for a particular specialty, and Ipicked ob G. I N. I
(01:08):
found that during my med school rotations, when you're in the hospital, a
lot of sadness is going on inthe hospital and on the wards, and
I found myself to be a morepositive person. And I just didn't expect
all that going into medicine, nofamily history of someone being a doctor or
no exposure to anything kind of beforethat. And then so when I'm on
the wards, I do ob gI N and I was thinking, Wow,
(01:30):
you know, this is actually kindof fun, kind of happy you're
there for. You remember your firstbirth that you're that you witness and I
remember that particularly it was a mother'sday actually in my third year of med
school. And so when I wastrying to pick what I want to do,
that was really the best thing Ithought for my mental ill health in
a way even or just like whatI wanted to see myself doing in the
future. Helping people build families,helping people bring life into the world,
(01:53):
and also helping them deal with thesad portions of trying to do all that.
So when intob g I n overat Yale School of Medicine Yale New
Haven Hospital, did training there,and then during that even you have to
think all right, Am I goingto just deliver babies? Am I going
to do maybe gynecology oncology? AndI chose to do reproductive ender chronology and
(02:14):
infertility. I find that the sciencein that part of the field is actually
still so brand new, it's sovery interesting, so many places to go
genetics, what we can do forolder women, what we can do for
access to care, and so allof those things made me want to pursue
fertility treatment as my profession and helpingpeople build their families in that aspect,
(02:36):
And so went to fellowship at Universityof Pennsylvania, and then after that realized
I wanted to be at a placethat really had a lot of resources,
was really still involved in education oftheir trainees in the field of infertility,
and also was this very strong inthe nation, that a really good reputation,
And so our may New Jersey wasa great choice for that. Oh
(02:58):
that's awesome. So what would yousay productive health and family planning looks like
in twenty twenty three verses what itmaybe looked like ten years ago. So
ten years ago, people were definitelydoing things differently in just of their own
family planning. They were having childrenearlier in life, there were the average
age I believe was somewhere around twentythree somewhere like that, I think for
the age of the first child,and then as time has progressed they even
(03:22):
look back over twenty thirty years,even the average age of a mother at
the time of our first child hasincreased by multiple years, and it has
changed even more among particular women,sometimes women of color, sometimes women who
are pursuing careers, and so sociallywe have accepted that and understand that women
may want to pursue family at differenttimes for whatever reason that they have.
(03:44):
It's their own choice. However,biologically we have not changed. So the
human body is still used to andin a sense kind of prone to and
built for having children. In thereproductive years between anywhere from like eighteen to
as high as third six thirty sevenis when it's a little bit easier,
and then it starts to get harder. So it just exponentially gets worse after
(04:06):
certain ages, just due to phytheological limits that we have. But it's
still possible, still possible, everyit's still possible. Literally, it's still
possible till women stops having their period. That means that your fertility is over
just because you are not producing anymore eggs monthly. But otherwise, if
you got period, then you havea chance to have a menstrual, chance
to have a pregnancy. So it'sinteresting. You make me feel a little
(04:28):
bit better about myself and that Iwas a teen mom when I had my
son. So I was eighteen whenI had him, right, I'm a
woman of a certain age now,So what does I guess fertility look like
after forty? For folks, fertilityafter forty looks like it's going to be
a journey as soon as they decidethat they should actually seek fertility specialists,
(04:49):
because they need to be aware ofwhat it may mean to them in terms
of getting pregnant, and what itmeans to them being pregnant, and what
it means afterwards and the end stagesof pregnancy such as labor, postpartum period,
and so on. So many thingshave increased in terms of their risks,
in terms of how their bodies aregoing to adapt to pregnancy, what
it's going to take to get pregnant. Just getting pregnant alone, you're looking
(05:13):
at issues with eggs, egg health, genetic issues with the eggs, increased
risk of mutations, increased risk ofthings like down syndrome or tries only twenty
one, and those things exponentially getworse years and years after that, and
so the seeking of fertility specialists isjust to start that planning in terms of
what you could expect, in termsof how hard it could be, what
you may have to do with beingpregnant. We're talking about increased risks of
(05:34):
hypertension in pregnancy, increased risk ofdiabetes in pregnancy, increased risk of needing
a c section, postpartum hemorrhage,a lot of things that can go wrong
even for normal women, but justhave an increased risk of happening. And
unfortunately, something we have to calladvanced maternal age after forty and that's for
some places it's actually forty five,but obviously all those risks that are even
(05:54):
more increased at that point, soit's actually considered a high risk pregnancy at
that point, and when women areforty in most places, just because of
all those increased issues, and theyneed to be aware of what they are
potentially going into. Sure. Solet's talk a little bit about fibroids for
a second, because I feel likemaybe a lot of people don't really have
a good understanding of what they actuallyare and then how they have played a
(06:15):
real critical role healthwise in the Blackcommunity, especially sure so fib well,
first let me start with the uterus, just so everybody can get a basic
understanding. The uterus is a muscle. It's contracts when these and that's how
you women go through labor. That'show women go through their menstrual cycles.
Those are their feeling contractions. Sothat muscle is contracting. A fibroid is
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a piece or a cell in thatmuscle that is growing into a tumor because
it's just keeps growing and exponentially andmore so, and eventually it collects into
this ball that can keep out growingand get bigger because it's responding to hormones,
environmental factors, all these things,and it's it's location as well as
its growth and the things that comeinvolved that could affect fertility, could affect
(07:00):
pregnancy, could affect quality of life, could affect women's overall health, and
so all these things. And sothis is how fibroids have an impact.
And then so in addition to that, we know that Black women are two
to three times more likely to bediagnosed with fibroids than white women, and
as well as they're more likely tosuffer from complications from fibroids, whether it
be surgical complications or issues with reoccurrence. And so we need to inform women
(07:27):
just like what to expect or interms of how to know if you may
have one, maybe you get treatmentearly, know that they could breach out
for maybe like a second opinion,if there's anything that they're unsure of.
And these are things that we're tryingto get the black community involved in.
So why is it more prominent incommunities of color than other demographics? Good
question. Some of it is alittle bit known in terms of we we're
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pretty sure that genetics has something todo with that. We know that there
are horrmones that are responsible for fibroidgrowth, and that's estrogen and progesterone,
and actually studies how I seen thereare genetic differences in terms of the expressions
of either proteins that have to dowith the hormones such as receptors and how
(08:07):
hormones are metabolized and changed into otherhormones, and these could have an effect
on fibroids. And we also knowthat we have done studies to see that
there's actually a difference in the muscleof the uterus and the cells not even
around the fibroid, so the normaluterus muscle. That these differences can lead
to increased fibroid growth potentially. However, we also see that there's a relationship
(08:31):
with behavioral issues or things that aredirectly and indirectly related to racism and sexism.
Things such as coping strategies, alcoholism, diet, vitamin D deficiency,
chronic stress. All of these thingscan also contribute to fibroids and have been
seen to be associated with fibroids.And probably some fashion or another. And
(08:52):
so there are things in the blackcommunity that's maybe that women can have control
over that can help alleviate whatever symptomsor issues they may be having with fibroids.
Interesting, is there anything that wecan do to prevent these? Most
likely no, that is unfortunate.Actually, they're so common. That's one
thing that women need to understand,especially in Black women. You're talking about
(09:13):
twenty five percent of Black women beforethe age of thirty have fibroids, and
that goes up to upwards of thirtyfive forty percent by age thirty five,
and then upwards of like eighty percentby age fifty. So we're talking about
a lot of women who have them, and women should just know that it
is the thing. But the earlieryou can detect it, if it is
causing problems and deal with it,then you are helping yourself. There's nothing
(09:35):
that you can do to prevent them. Maybe there's treatments to slow their growth,
to remove them early. The earlieryou remove them, then you eventually
are not going to get big untilyou're hoping to prevent things like symptoms of
this huge mass pushing on your bladdercausing urinary frequency an increase in that,
or constipation or other issues that arejust what we call bulk symptoms because there's
(09:56):
such a big mass in there inyour pelvis that should not be there,
and so there's nothing to really preventthem, but we need to make sure
that we get to them early.Yeah, I was going to ask you,
like what some of the symptoms arelike if you feel like you might
be having them. So I'm gladthat you covered some of that, but
if there are there any others thatthey should look for. Definitely, the
biggest one is abnormal uterine bleeding andwhat we mean by that is heavy periods
(10:18):
lasting really long. There is noreason why a woman's menstrual cycle or the
bleeding part of that portion, shouldlast for a month. If women is
experiencing that, they should go seekout an opinion either from their OBGI N
maybe a fertility specialist, just anybodyjust even there, tell their primary care
doctor about it, because that isnot normal. And especially it's not normal
to go through like a super tamponevery hour, or they're maybe feeling they're
(10:41):
they're feeling fatigued from this bleeding andthey may not realize that their bleeding is
not normal, because that is theissue too, is that some women just
don't have anything to compare it to. You know, you can't. It's
a stigma among the communities sometimes totalk how we are, How are your
periods? Are they really painful?Are they really heavy? And when a
fibroid is there, especially in thecavity, because like I said before,
it can be in many different locations. But think if you're the uterus as
(11:03):
a house and a fibroid could bebasically on the wallpaper or something like that,
or bulging into the rooms, andif it does that, you are
not your body is not going torespond the same during a menstrual cycle,
and so you're going to have somuch bleeding, maybe a lot heavier and
more painful episodes, and just seeit, is this normal for people?
Because there's no reason if you cantry to avoid it or to just get
(11:26):
this treated and maybe increase the qualityof life. Yeah, what do you
think causes a delay in getting treatment? So multiple, multi factorial definitely social
issues, whether that be women whodon't have trust of the healthcare system due
to issues of race. We knowthat over one fifth of women have experienced
some racial discrimination in a healthcare settingjust in the past year, So that's
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definitely up there, and they justdon't know who to trust and where to
get their opinions from. You havethe idea that black women may feel like
their pain is not being heard,they feel in the neglected, and there's
this black girl magic is great,but at the same time, you need
they need to kind of take inventoryof is this normal? Should I have
to deal with this? Because maybeI don't, and we want to help
(12:11):
them if they don't have to.And then there's access to care issues,
right, there's can they even getto a specialist? What are their specialists
good at and are they giving theright information? Are they getting the right
information? What is their health literacy? All of these factors can delay someone
to treatment. Yeah, so whensomeone comes to the Reproductive Medicine Associates and
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sits down and has a conversation withyou, like, what is that experience
like? So usually they're coming tous with the idea that they are trying
to conceive at least or thinking aboutdoing it in the future. That's also
some consolets we get or maybe evenwant to preserve their fertility because they might
be going through a fibroard surgery soonand that could have an effect on future
fertility as well, and they justwant to hear what they can expect if
(12:52):
they do go through this surgery.But if they're trying to conceive, then
what we're thinking about with these fibroidsis how would the fibroid effect either a
pregnancy, either going through pregnancy meaningthey're already pregnant, or even how is
it going to affect them conceiving.We know, like I said, if
you think of a fibroid as thisthing bulging in a room, there's this
floating embryo that's trying to sit downsomewhere in the uterus, and if it
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sits down on this fibroid, that'sprobably not going to work out too well
for it. It could have issueswith getting blood vessels to come to it,
It may never implant in the firstplace, and so that could be
a problem, and this fibroid couldjust misshape the cavity or distorted or do
something to it that could cause issues. Additionally, we know that during pregnancy
it can lead to things of likefree term delivery, abnormal placentation, meaning
(13:37):
the placenta kind of growing into themuscle. That fibroid being there can make
that not go well basically and havesome abnormalities later on. And it can
also lead to things like the babybeing in wrong positions and eating a c
section, or having early rupture oftheir membranes or breaking their water early,
all these problems that can occur.So they're coming to us being like,
what can I expect when I getpregnant or is this stopping me from getting
(14:01):
pregnant in the first place? Yeah, so what are some of the management
options and like the risk and thebenefits of like maybe some treatments that you
offer. Sure, so when womenare trying to come to us with the
idea of they are looking to getpregnant, most likely because that's the primary
cases that we see. We wantto get their cavity or their uterus looking
as good as it possibly can toachieve a pregnancy, and that may include
(14:22):
a surgery to take out a fibroid. The surgery could either be done usually
one of two ways, either fromthe top and coming in from the outside
of the uterus, or going fromthe inside and trying to clear up the
cavity that way. The inside isa much more minor procedure, how and
going through the abdomen is actually definitelya lot bigger procedure. We call those
major procedures. Usually when people aregoing through the abdomen, it's because they
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have bigger fibroids, ones that needto be taken out for either the health
of the patient or they're experiencing bulksymptoms, or we're worried about maybe a
huge fibroid. Going all the wayfrom the outside to the inside, it's
not big. Usually from the inside, it's they may not have many fibroids,
and we know that if we cankind of shave them down and get
them flush with the cavity or whatwe say, like make the wall smooth
(15:07):
at least of the cavity, wecan increase their chances of getting pregnants.
But sometimes they may have to betaken out because there are theories that fibroids
just being around, even if they'renot in the cavity or like I said,
bulging into that room, if they'rejust behind the wall, they actually
may secrete some chemicals that make ithard for an embryo to implant appropriately.
And so we have to seek whatwe think may be happening and try to
(15:28):
take the whole situation into account.That's surgically and there there's other options maybe
if they're not trying to deal withfertility, like some medications to shrink fibroids,
you're an artery embolization, But theseare ones that they may not be
able to conceive after the facts.So those are other categories. So once
you treat someone who has fibroids,right, like, does the success rate
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of the pregnancy go up exponentially?Like is there like a scale that you
kind of see That's also a goodquestion and probably multi factorial. Was there
one definite one kind of we thinkblocking a pregnancy from conceiving. Was it
right there in the uterus and rightthere in the cavity as well, and
was that the only one? Andif we take that one out, are
there any left? I would sayif that's the case, then probably hopefully
that would be the one of theanswers to the patient's problem. If there's
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multiple ones, and we could tryto clean it up as much as we
can, but that may be difficult. If it's one huge one that we
think might be getting in the way, then hopefully when you take that out,
then that would increase their pregnancy.I wouldn't say it's a guarantee.
You can't say anything's a guarantee inmedicine, unfortunately, but we do have
suspicions based on other diagnostic testing andwhatnot. Yeah, that's kind of the
(16:37):
best that we can do in medicine. Unfortunately, I can't tell if patients
anythings one hundred percent, but definitelywe think it would increase their chances if
they could deal with it surgically insome aspect at least. Sure. So
when you take a look at familyplanning, right like one is a good
time to sit down and start likeassessing your options and taking a look at
what that map for what your futurefamily will look like. It's a good
question, probably the number one questionwe get whenever somebody learns that I'm a
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reproductive meta chronologist or an infertility specialist. They're like, when do I freeze
my eggs? Or when do Ihave to worry about I don't have a
partner, or you know, whatam I looking at if things getting harder?
And I would say at thirty sixish thirty five for a single woman,
that's what the age I give them, because if they don't have a
partner in sight, then you're lookingat a potential by the time they do
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get one and come around to havinga family, because we usually think about
it's a couple of years to kindof get that comfortability and get those planning
thoughts in your head. So thenthey would come back around like what thirty
seven, thirty eight, And that'swhen things are now approaching the fifty fifty
percent of their eggs might be damagedin some capacity, and what I mean
by that is genetic issues. Andso that's when we like to say at
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thirty five thirty six, that's whenyou should really think about potentially freezing your
eggs potentially if you're thinking about justtrying to conceive immediately, then the earlier
the better. Obviously at any point, yeah, I always tell a woman
your eggs will never be as goodas today. So sure you could wait
some time, but the quality coulddecrease, the number could decrease, the
(18:03):
incidents of genetic issues in the eggswill increase over time. You have months
before. It's a huge difference,don't get me don't get me wrong,
but you do want them to actas fast as possible, or at least
have a plan as fast as possible. And then like freezing your eggs,
like what is that process like?And then I guess when you do freeze
your eggs, like what is usuallythe survival rate of eggs on the back
(18:23):
end when you can actually use them. Egg freezing has come a long way.
Was experimental years ago. Now itis standard practice, and so the
results that you may have heard aboutyears ago, if you went even probably
seven ten years ago, I wouldsay, you know, revisit the situation,
or don't try to dissuade friends whomaybe doing it now. The process
involves egg harvesting or what's called anoo site retrieval, it's what we call
(18:47):
it in the medical field. Yeah, and ocite stimulation. We have to
grow as many eggs and in theovary as we can at one time.
Now that sounds a little weird,However, your ovary actually a bunch of
eggs coming more than one time amonth, and if you really want to
get in the nitty gritty, we'reactually rescuing a lot of eggs from dying.
(19:07):
Actually, all the eggs that wherewe're growing, we're rescuing them from
dying because normally women just ovulate oneegg, but they got a lot coming
and it's just that one egg thatkind of grows and shuts the other ones
down. Unfortunately, those don't goback into an ovary. They just die
off. And so that's what we'rerescuing. So we're not making women go
into early menopause or anything like that. We're just growing a week and see.
And so we want to grow allthese and eventually, usually about thirteen
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twelve days, we have to goharvest them, and that's a surgical procedure.
Their risks involved with that. There'sa st anesthesia. But in the
grand scheme of things, we dohundreds of these over a year, Thousands
across the country are done, millionsacross the world they're done, and so
it's a relatively safe procedure, butsure there's still risks. That's procedure.
There's just a couple like thirty minutes, twenty to thirty minutes, maybe even
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and they know, wake up,they go home the same day and it's
hopefully, you know, no complications, and by the next day they're able
to usually go back onto their normalwhen they get those eggs, if they're
freezing them right there, we freezethem that day, and so we can
tell a woman even when they wakeup, how many eggs we got.
And so that's that's one of thepluses, you know immediately kind of what
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you're looking at. Obviously they're notfertilized yet, they're not embryos yet,
so you're gonna lose eggs along theway. You never keep all of them.
What we like to tell women interms of the thaw rate, that's
what you are kind of alluding towith how many survives. Anecdotally it's ten
percent of eggs don't survive the thaw. I will say I feel like that's
a little bit higher nowadays that mightbe like an older stat but that is
(20:32):
what we quote. It's about tenpercent freezing embryos, So if you do
have a partner, that is actuallymuch more stable. We only quote about
a one to two percent loss ratewhen we do thought the embryos, So
that is a plus of having apartner. And if you're thinking of you
know your eggs are never going tobe as good as they are now,
freeze embryos instead, as if you'reyou know pretty sure this is a partner
you want to create embryos with.And then we have data and stats and
(20:55):
little calculators that we have in ourat our disposal to kind of allude to,
all right, you have this manyeggs, your chance of getting a
pregnancy is probably x percent from thesein the future based on your current age
and situation right now. Interesting,So what advice would you give to somebody
who's been thinking about family planning but'skind of been on the fence. I
would say, like I said before, you're never going to be better than
(21:17):
it is today in terms of youroptions, and you can't wait, but
you're taking a risk at that soat least just get an idea of how
many kids do you want, becausethat's huge. I always tell women you're
going to just state you're going tothen not be able to have another person
not recommended to have another pregnancy,give uterus a break, and then you're
gonna maybe want a breastfees. You'relooking at like two years of not trying
again till you still you know you'regoing to get right back, and the
(21:41):
thick of things with your ovaries andso time is passing faster than you think.
And so I would say reach outto a fertility specialist kind of see
what your goals are, see whatyour biology matches with your goals, yes
or no, And we could alsojust do other diagnosis to make sure that
everything else is as good as itcan because the mails also involved. You
want to see if there are anyissues with the sperm and whatnot, especially
(22:03):
if they've never had a kid before, then you definitely want to just make
sure kind of everything is working ifyou are delaying for whatever reason that may
be. But just talk to somebody, because you read a lot of things
online. Doctor Google is our numberone nemesis, but there are good there's
some good information out there, andwe can just direct you to where that
maybe, Yeah, I was gonnaI was just reading in a little note
here that I feel like it's superimportant to mention is inclusive research is key.
(22:26):
Yeah, So that is very important, just because if we can get
more women involved in the process ofjust being understanding of what it is about
women's health, then hopefully they wouldbe more likely to participate in research,
particularly minority women. We know thatthe research for these women is so inadequate
at the moments. Just to putit in perspective, I think a few
(22:48):
years ago there was eighteen million dollarsspent on five roid research when this disease
affects over one hundred and fifty millionwomen a year. That's the same amount
of money for a disorder like dystonia, which the neurological disorder that affects like
twenty five million, no, actuallylike two hundred thousand people a year.
And then Sharco Marie tooth, whichis another neurologic disorder, has about fifteen
(23:10):
million a year. That only affectsone hundred twenty six thousand women a year,
So very dispropore actually people a year, not even women, very disproportionate
in terms of where the money isgoing in research, and this is such
a huge problem, like I mentionedin the African American community. So if
we could just get better research,we can hopefully improve outcomes, improve treatments,
increased knowledge, know what women arekind of going up against in terms
(23:30):
of getting a diagnosis, terms oftheir symptoms, what their best options may
be, how we can help themin the future. And we just have
to make sure that their parts thereare a part of these studies when there
are being conducted. That's awesome.So what can we do as a community
to kind of help this along.So for somebody maybe not dealing with any
(23:51):
five right issues, just the knowledgeof them. That way, if somebody
ever mentioned, hey, I'm havingheavy bleeding, I'm having these terrible cramps,
I gotta take days off work somethinglike that, then I could pass
along, hey, you should maybego see r O bgi N. Get
this looked at. It might bea fibroid. So just having the knowledge
alone is beneficial. Also for malesto also have that knowledge, so they
can if they ever hear of somethingthat they might be able to assist.
(24:11):
That's one thing. Also for peopledealing with them, know that or have
an idea that this may not benormal. Maybe you should kind of go
get it checked out. If you'reexperiencing heavy bleeding, really bad issues increase
bulk symptoms like I mentioned before,and so go seek an opinion, Go
get your own knowledge if you caneducate yourself, or go to one of
(24:32):
these all these organizations kind of thatare out there about fibroid research, and
the American Society of Reproductive Medicine isour national organization for fertility and reproductive health
in general, and so anywhere youcan go with with those and also support
in Congress, support in the governments. They are trying to increase research.
There is a bill actually that wasintroduced this year by one of the representatives
(24:53):
actually of New York, you've gotClark, called the Fibroid, Uterine,
Fibroid Research and Education Act. It'ssomething that should be increasing fibord of research
tow one hundred fifty million dollars,although every year I'll lay up to like
twenty twenty eight, So that wouldbe awesome if we can get that past
for sure, definitely, And theyshould come see you at Reproductive Medicine Associates.
(25:14):
That would be great if they needto, If they need help with
that, that's what I'm here for. You know, I went into this
field because I do want to helpwomen conceive that their goals and to help
them get past any issues they mayhave, and particularly minority women. I
was raised by a single mom whoworked really hard to make sure that,
you know, we had a stablefamily, a stable living, and so
whatever I could do to help peoplealso have successful families and stable lives would
(25:38):
would be great. That's awesome.Well, I appreciate having you here today.
I'm eternal. I'm Kenya Gibson sittinghere with doctor Michael Simony of Reproductive
Medicine Associates And how can people findyou and get in contact with you?
Social media? The RMA network ison Instagram, is on Twitter or x
now I guess and myself. SimonyUnderscore MD is on Instagram, Twitter,
(26:00):
Facebook, LinkedIn all those things.It's easy to find me. Awesome,
and you're here in New Jersey,but you also are national as well.
Our remain Our Reproductive Medicine Association issorry. The Reproductive Medicine Associates is a
national organization of fertility clinics throughout California, Pennsylvania, Texas, so all these
different states, the New Jersey officesare scattered throughout. We're all connected,
(26:23):
we all have similar practice guidelines andso it makes it easier for patients to
kind of go from office to office. But I am in the South Jersey
office over in Marlton, so comesee me if you need anything there.
Awesome. Well, thank you forcoming here today and being on Maternal.
I know this conversation is super helpfulto our audience and we appreciate you being
here and informing us and enlightening ustoday about all the options we have available
(26:45):
to us as a community when itcomes to family planning. Thank you for
inviting me, pleasure to be here. Thank you for joining us for another
episode of Maternal. This conversation aroundreproductive health will help women of color identify
management options for infertility and overall allwomen's health, acknowledge disparities in fibroid care,
and understand the importance research plays increating access and quality of care.
(27:07):
Be sure to visit Meternal dot infoto learn more about how iHeartRadio is committed
to combating the Black maternal health crisis
Me turn. We know that overone fifth of women have experienced some racial
discrimination in a healthcare setting just inthe past year, So that's definitely up
there, and they just don't knowwho to trust and where they get their
opinions from. You have the ideathat black women may feel like their pain
is not being heard, they feelneglected, and there's this you know,
(00:24):
black girl magic is great, butat the same time, you need they
need to kind of take inventory ofis this normal? Should I have to
deal with this? Because maybe Idon't, And we want to help them
if they don't have to. Welcometo Maternal Home to access in information for
mothers of color. Family planning playsa vital role in ensuring positive health outcomes
and communities of color. This episodeof Maternal features doctor Michael Simminee, a
(00:48):
Reproductive Medical Associates, and we'll teachmulticultural mothers about what reproductive health should look
like when it comes to women ofcolor. So tell me a little bit
about how you ended up at Armyof New Jersey. So I graduated medical
school in twenty fourteen. After thatyou go into residency, which is training
for a particular specialty, and Ipicked ob G. I N. I
(01:08):
found that during my med school rotations, when you're in the hospital, a
lot of sadness is going on inthe hospital and on the wards, and
I found myself to be a morepositive person. And I just didn't expect
all that going into medicine, nofamily history of someone being a doctor or
no exposure to anything kind of beforethat. And then so when I'm on
the wards, I do ob gI N and I was thinking, Wow,
(01:30):
you know, this is actually kindof fun, kind of happy you're
there for. You remember your firstbirth that you're that you witness and I
remember that particularly it was a mother'sday actually in my third year of med
school. And so when I wastrying to pick what I want to do,
that was really the best thing Ithought for my mental ill health in
a way even or just like whatI wanted to see myself doing in the
future. Helping people build families,helping people bring life into the world,
(01:53):
and also helping them deal with thesad portions of trying to do all that.
So when intob g I n overat Yale School of Medicine Yale New
Haven Hospital, did training there,and then during that even you have to
think all right, Am I goingto just deliver babies? Am I going
to do maybe gynecology oncology? AndI chose to do reproductive ender chronology and
(02:14):
infertility. I find that the sciencein that part of the field is actually
still so brand new, it's sovery interesting, so many places to go
genetics, what we can do forolder women, what we can do for
access to care, and so allof those things made me want to pursue
fertility treatment as my profession and helpingpeople build their families in that aspect,
(02:36):
And so went to fellowship at Universityof Pennsylvania, and then after that realized
I wanted to be at a placethat really had a lot of resources,
was really still involved in education oftheir trainees in the field of infertility,
and also was this very strong inthe nation, that a really good reputation,
And so our may New Jersey wasa great choice for that. Oh
(02:58):
that's awesome. So what would yousay productive health and family planning looks like
in twenty twenty three verses what itmaybe looked like ten years ago. So
ten years ago, people were definitelydoing things differently in just of their own
family planning. They were having childrenearlier in life, there were the average
age I believe was somewhere around twentythree somewhere like that, I think for
the age of the first child,and then as time has progressed they even
(03:22):
look back over twenty thirty years,even the average age of a mother at
the time of our first child hasincreased by multiple years, and it has
changed even more among particular women,sometimes women of color, sometimes women who
are pursuing careers, and so sociallywe have accepted that and understand that women
may want to pursue family at differenttimes for whatever reason that they have.
(03:44):
It's their own choice. However,biologically we have not changed. So the
human body is still used to andin a sense kind of prone to and
built for having children. In thereproductive years between anywhere from like eighteen to
as high as third six thirty sevenis when it's a little bit easier,
and then it starts to get harder. So it just exponentially gets worse after
(04:06):
certain ages, just due to phytheological limits that we have. But it's
still possible, still possible, everyit's still possible. Literally, it's still
possible till women stops having their period. That means that your fertility is over
just because you are not producing anymore eggs monthly. But otherwise, if
you got period, then you havea chance to have a menstrual, chance
to have a pregnancy. So it'sinteresting. You make me feel a little
(04:28):
bit better about myself and that Iwas a teen mom when I had my
son. So I was eighteen whenI had him, right, I'm a
woman of a certain age now,So what does I guess fertility look like
after forty? For folks, fertilityafter forty looks like it's going to be
a journey as soon as they decidethat they should actually seek fertility specialists,
(04:49):
because they need to be aware ofwhat it may mean to them in terms
of getting pregnant, and what itmeans to them being pregnant, and what
it means afterwards and the end stagesof pregnancy such as labor, postpartum period,
and so on. So many thingshave increased in terms of their risks,
in terms of how their bodies aregoing to adapt to pregnancy, what
it's going to take to get pregnant. Just getting pregnant alone, you're looking
(05:13):
at issues with eggs, egg health, genetic issues with the eggs, increased
risk of mutations, increased risk ofthings like down syndrome or tries only twenty
one, and those things exponentially getworse years and years after that, and
so the seeking of fertility specialists isjust to start that planning in terms of
what you could expect, in termsof how hard it could be, what
you may have to do with beingpregnant. We're talking about increased risks of
(05:34):
hypertension in pregnancy, increased risk ofdiabetes in pregnancy, increased risk of needing
a c section, postpartum hemorrhage,a lot of things that can go wrong
even for normal women, but justhave an increased risk of happening. And
unfortunately, something we have to calladvanced maternal age after forty and that's for
some places it's actually forty five,but obviously all those risks that are even
(05:54):
more increased at that point, soit's actually considered a high risk pregnancy at
that point, and when women areforty in most places, just because of
all those increased issues, and theyneed to be aware of what they are
potentially going into. Sure. Solet's talk a little bit about fibroids for
a second, because I feel likemaybe a lot of people don't really have
a good understanding of what they actuallyare and then how they have played a
(06:15):
real critical role healthwise in the Blackcommunity, especially sure so fib well,
first let me start with the uterus, just so everybody can get a basic
understanding. The uterus is a muscle. It's contracts when these and that's how
you women go through labor. That'show women go through their menstrual cycles.
Those are their feeling contractions. Sothat muscle is contracting. A fibroid is
(06:36):
a piece or a cell in thatmuscle that is growing into a tumor because
it's just keeps growing and exponentially andmore so, and eventually it collects into
this ball that can keep out growingand get bigger because it's responding to hormones,
environmental factors, all these things,and it's it's location as well as
its growth and the things that comeinvolved that could affect fertility, could affect
(07:00):
pregnancy, could affect quality of life, could affect women's overall health, and
so all these things. And sothis is how fibroids have an impact.
And then so in addition to that, we know that Black women are two
to three times more likely to bediagnosed with fibroids than white women, and
as well as they're more likely tosuffer from complications from fibroids, whether it
be surgical complications or issues with reoccurrence. And so we need to inform women
(07:27):
just like what to expect or interms of how to know if you may
have one, maybe you get treatmentearly, know that they could breach out
for maybe like a second opinion,if there's anything that they're unsure of.
And these are things that we're tryingto get the black community involved in.
So why is it more prominent incommunities of color than other demographics? Good
question. Some of it is alittle bit known in terms of we we're
(07:47):
pretty sure that genetics has something todo with that. We know that there
are horrmones that are responsible for fibroidgrowth, and that's estrogen and progesterone,
and actually studies how I seen thereare genetic differences in terms of the expressions
of either proteins that have to dowith the hormones such as receptors and how
(08:07):
hormones are metabolized and changed into otherhormones, and these could have an effect
on fibroids. And we also knowthat we have done studies to see that
there's actually a difference in the muscleof the uterus and the cells not even
around the fibroid, so the normaluterus muscle. That these differences can lead
to increased fibroid growth potentially. However, we also see that there's a relationship
(08:31):
with behavioral issues or things that aredirectly and indirectly related to racism and sexism.
Things such as coping strategies, alcoholism, diet, vitamin D deficiency,
chronic stress. All of these thingscan also contribute to fibroids and have been
seen to be associated with fibroids.And probably some fashion or another. And
(08:52):
so there are things in the blackcommunity that's maybe that women can have control
over that can help alleviate whatever symptomsor issues they may be having with fibroids.
Interesting, is there anything that wecan do to prevent these? Most
likely no, that is unfortunate.Actually, they're so common. That's one
thing that women need to understand,especially in Black women. You're talking about
(09:13):
twenty five percent of Black women beforethe age of thirty have fibroids, and
that goes up to upwards of thirtyfive forty percent by age thirty five,
and then upwards of like eighty percentby age fifty. So we're talking about
a lot of women who have them, and women should just know that it
is the thing. But the earlieryou can detect it, if it is
causing problems and deal with it,then you are helping yourself. There's nothing
(09:35):
that you can do to prevent them. Maybe there's treatments to slow their growth,
to remove them early. The earlieryou remove them, then you eventually
are not going to get big untilyou're hoping to prevent things like symptoms of
this huge mass pushing on your bladdercausing urinary frequency an increase in that,
or constipation or other issues that arejust what we call bulk symptoms because there's
(09:56):
such a big mass in there inyour pelvis that should not be there,
and so there's nothing to really preventthem, but we need to make sure
that we get to them early.Yeah, I was going to ask you,
like what some of the symptoms arelike if you feel like you might
be having them. So I'm gladthat you covered some of that, but
if there are there any others thatthey should look for. Definitely, the
biggest one is abnormal uterine bleeding andwhat we mean by that is heavy periods
(10:18):
lasting really long. There is noreason why a woman's menstrual cycle or the
bleeding part of that portion, shouldlast for a month. If women is
experiencing that, they should go seekout an opinion either from their OBGI N
maybe a fertility specialist, just anybodyjust even there, tell their primary care
doctor about it, because that isnot normal. And especially it's not normal
to go through like a super tamponevery hour, or they're maybe feeling they're
(10:41):
they're feeling fatigued from this bleeding andthey may not realize that their bleeding is
not normal, because that is theissue too, is that some women just
don't have anything to compare it to. You know, you can't. It's
a stigma among the communities sometimes totalk how we are, How are your
periods? Are they really painful?Are they really heavy? And when a
fibroid is there, especially in thecavity, because like I said before,
it can be in many different locations. But think if you're the uterus as
(11:03):
a house and a fibroid could bebasically on the wallpaper or something like that,
or bulging into the rooms, andif it does that, you are
not your body is not going torespond the same during a menstrual cycle,
and so you're going to have somuch bleeding, maybe a lot heavier and
more painful episodes, and just seeit, is this normal for people?
Because there's no reason if you cantry to avoid it or to just get
(11:26):
this treated and maybe increase the qualityof life. Yeah, what do you
think causes a delay in getting treatment? So multiple, multi factorial definitely social
issues, whether that be women whodon't have trust of the healthcare system due
to issues of race. We knowthat over one fifth of women have experienced
some racial discrimination in a healthcare settingjust in the past year, So that's
(11:48):
definitely up there, and they justdon't know who to trust and where to
get their opinions from. You havethe idea that black women may feel like
their pain is not being heard,they feel in the neglected, and there's
this black girl magic is great,but at the same time, you need
they need to kind of take inventoryof is this normal? Should I have
to deal with this? Because maybeI don't, and we want to help
(12:11):
them if they don't have to.And then there's access to care issues,
right, there's can they even getto a specialist? What are their specialists
good at and are they giving theright information? Are they getting the right
information? What is their health literacy? All of these factors can delay someone
to treatment. Yeah, so whensomeone comes to the Reproductive Medicine Associates and
(12:31):
sits down and has a conversation withyou, like, what is that experience
like? So usually they're coming tous with the idea that they are trying
to conceive at least or thinking aboutdoing it in the future. That's also
some consolets we get or maybe evenwant to preserve their fertility because they might
be going through a fibroard surgery soonand that could have an effect on future
fertility as well, and they justwant to hear what they can expect if
(12:52):
they do go through this surgery.But if they're trying to conceive, then
what we're thinking about with these fibroidsis how would the fibroid effect either a
pregnancy, either going through pregnancy meaningthey're already pregnant, or even how is
it going to affect them conceiving.We know, like I said, if
you think of a fibroid as thisthing bulging in a room, there's this
floating embryo that's trying to sit downsomewhere in the uterus, and if it
(13:13):
sits down on this fibroid, that'sprobably not going to work out too well
for it. It could have issueswith getting blood vessels to come to it,
It may never implant in the firstplace, and so that could be
a problem, and this fibroid couldjust misshape the cavity or distorted or do
something to it that could cause issues. Additionally, we know that during pregnancy
it can lead to things of likefree term delivery, abnormal placentation, meaning
(13:37):
the placenta kind of growing into themuscle. That fibroid being there can make
that not go well basically and havesome abnormalities later on. And it can
also lead to things like the babybeing in wrong positions and eating a c
section, or having early rupture oftheir membranes or breaking their water early,
all these problems that can occur.So they're coming to us being like,
what can I expect when I getpregnant or is this stopping me from getting
(14:01):
pregnant in the first place? Yeah, so what are some of the management
options and like the risk and thebenefits of like maybe some treatments that you
offer. Sure, so when womenare trying to come to us with the
idea of they are looking to getpregnant, most likely because that's the primary
cases that we see. We wantto get their cavity or their uterus looking
as good as it possibly can toachieve a pregnancy, and that may include
(14:22):
a surgery to take out a fibroid. The surgery could either be done usually
one of two ways, either fromthe top and coming in from the outside
of the uterus, or going fromthe inside and trying to clear up the
cavity that way. The inside isa much more minor procedure, how and
going through the abdomen is actually definitelya lot bigger procedure. We call those
major procedures. Usually when people aregoing through the abdomen, it's because they
(14:46):
have bigger fibroids, ones that needto be taken out for either the health
of the patient or they're experiencing bulksymptoms, or we're worried about maybe a
huge fibroid. Going all the wayfrom the outside to the inside, it's
not big. Usually from the inside, it's they may not have many fibroids,
and we know that if we cankind of shave them down and get
them flush with the cavity or whatwe say, like make the wall smooth
(15:07):
at least of the cavity, wecan increase their chances of getting pregnants.
But sometimes they may have to betaken out because there are theories that fibroids
just being around, even if they'renot in the cavity or like I said,
bulging into that room, if they'rejust behind the wall, they actually
may secrete some chemicals that make ithard for an embryo to implant appropriately.
And so we have to seek whatwe think may be happening and try to
(15:28):
take the whole situation into account.That's surgically and there there's other options maybe
if they're not trying to deal withfertility, like some medications to shrink fibroids,
you're an artery embolization, But theseare ones that they may not be
able to conceive after the facts.So those are other categories. So once
you treat someone who has fibroids,right, like, does the success rate
(15:52):
of the pregnancy go up exponentially?Like is there like a scale that you
kind of see That's also a goodquestion and probably multi factorial. Was there
one definite one kind of we thinkblocking a pregnancy from conceiving. Was it
right there in the uterus and rightthere in the cavity as well, and
was that the only one? Andif we take that one out, are
there any left? I would sayif that's the case, then probably hopefully
that would be the one of theanswers to the patient's problem. If there's
(16:15):
multiple ones, and we could tryto clean it up as much as we
can, but that may be difficult. If it's one huge one that we
think might be getting in the way, then hopefully when you take that out,
then that would increase their pregnancy.I wouldn't say it's a guarantee.
You can't say anything's a guarantee inmedicine, unfortunately, but we do have
suspicions based on other diagnostic testing andwhatnot. Yeah, that's kind of the
(16:37):
best that we can do in medicine. Unfortunately, I can't tell if patients
anythings one hundred percent, but definitelywe think it would increase their chances if
they could deal with it surgically insome aspect at least. Sure. So
when you take a look at familyplanning, right like one is a good
time to sit down and start likeassessing your options and taking a look at
what that map for what your futurefamily will look like. It's a good
question, probably the number one questionwe get whenever somebody learns that I'm a
(17:00):
reproductive meta chronologist or an infertility specialist. They're like, when do I freeze
my eggs? Or when do Ihave to worry about I don't have a
partner, or you know, whatam I looking at if things getting harder?
And I would say at thirty sixish thirty five for a single woman,
that's what the age I give them, because if they don't have a
partner in sight, then you're lookingat a potential by the time they do
(17:22):
get one and come around to havinga family, because we usually think about
it's a couple of years to kindof get that comfortability and get those planning
thoughts in your head. So thenthey would come back around like what thirty
seven, thirty eight, And that'swhen things are now approaching the fifty fifty
percent of their eggs might be damagedin some capacity, and what I mean
by that is genetic issues. Andso that's when we like to say at
(17:42):
thirty five thirty six, that's whenyou should really think about potentially freezing your
eggs potentially if you're thinking about justtrying to conceive immediately, then the earlier
the better. Obviously at any point, yeah, I always tell a woman
your eggs will never be as goodas today. So sure you could wait
some time, but the quality coulddecrease, the number could decrease, the
(18:03):
incidents of genetic issues in the eggswill increase over time. You have months
before. It's a huge difference,don't get me don't get me wrong,
but you do want them to actas fast as possible, or at least
have a plan as fast as possible. And then like freezing your eggs,
like what is that process like?And then I guess when you do freeze
your eggs, like what is usuallythe survival rate of eggs on the back
(18:23):
end when you can actually use them. Egg freezing has come a long way.
Was experimental years ago. Now itis standard practice, and so the
results that you may have heard aboutyears ago, if you went even probably
seven ten years ago, I wouldsay, you know, revisit the situation,
or don't try to dissuade friends whomaybe doing it now. The process
involves egg harvesting or what's called anoo site retrieval, it's what we call
(18:47):
it in the medical field. Yeah, and ocite stimulation. We have to
grow as many eggs and in theovary as we can at one time.
Now that sounds a little weird,However, your ovary actually a bunch of
eggs coming more than one time amonth, and if you really want to
get in the nitty gritty, we'reactually rescuing a lot of eggs from dying.
(19:07):
Actually, all the eggs that wherewe're growing, we're rescuing them from
dying because normally women just ovulate oneegg, but they got a lot coming
and it's just that one egg thatkind of grows and shuts the other ones
down. Unfortunately, those don't goback into an ovary. They just die
off. And so that's what we'rerescuing. So we're not making women go
into early menopause or anything like that. We're just growing a week and see.
And so we want to grow allthese and eventually, usually about thirteen
(19:27):
twelve days, we have to goharvest them, and that's a surgical procedure.
Their risks involved with that. There'sa st anesthesia. But in the
grand scheme of things, we dohundreds of these over a year, Thousands
across the country are done, millionsacross the world they're done, and so
it's a relatively safe procedure, butsure there's still risks. That's procedure.
There's just a couple like thirty minutes, twenty to thirty minutes, maybe even
(19:48):
and they know, wake up,they go home the same day and it's
hopefully, you know, no complications, and by the next day they're able
to usually go back onto their normalwhen they get those eggs, if they're
freezing them right there, we freezethem that day, and so we can
tell a woman even when they wakeup, how many eggs we got.
And so that's that's one of thepluses, you know immediately kind of what
(20:11):
you're looking at. Obviously they're notfertilized yet, they're not embryos yet,
so you're gonna lose eggs along theway. You never keep all of them.
What we like to tell women interms of the thaw rate, that's
what you are kind of alluding towith how many survives. Anecdotally it's ten
percent of eggs don't survive the thaw. I will say I feel like that's
a little bit higher nowadays that mightbe like an older stat but that is
(20:32):
what we quote. It's about tenpercent freezing embryos, So if you do
have a partner, that is actuallymuch more stable. We only quote about
a one to two percent loss ratewhen we do thought the embryos, So
that is a plus of having apartner. And if you're thinking of you
know your eggs are never going tobe as good as they are now,
freeze embryos instead, as if you'reyou know pretty sure this is a partner
you want to create embryos with.And then we have data and stats and
(20:55):
little calculators that we have in ourat our disposal to kind of allude to,
all right, you have this manyeggs, your chance of getting a
pregnancy is probably x percent from thesein the future based on your current age
and situation right now. Interesting,So what advice would you give to somebody
who's been thinking about family planning but'skind of been on the fence. I
would say, like I said before, you're never going to be better than
(21:17):
it is today in terms of youroptions, and you can't wait, but
you're taking a risk at that soat least just get an idea of how
many kids do you want, becausethat's huge. I always tell women you're
going to just state you're going tothen not be able to have another person
not recommended to have another pregnancy,give uterus a break, and then you're
gonna maybe want a breastfees. You'relooking at like two years of not trying
again till you still you know you'regoing to get right back, and the
(21:41):
thick of things with your ovaries andso time is passing faster than you think.
And so I would say reach outto a fertility specialist kind of see
what your goals are, see whatyour biology matches with your goals, yes
or no, And we could alsojust do other diagnosis to make sure that
everything else is as good as itcan because the mails also involved. You
want to see if there are anyissues with the sperm and whatnot, especially
(22:03):
if they've never had a kid before, then you definitely want to just make
sure kind of everything is working ifyou are delaying for whatever reason that may
be. But just talk to somebody, because you read a lot of things
online. Doctor Google is our numberone nemesis, but there are good there's
some good information out there, andwe can just direct you to where that
maybe, Yeah, I was gonnaI was just reading in a little note
here that I feel like it's superimportant to mention is inclusive research is key.
(22:26):
Yeah, So that is very important, just because if we can get
more women involved in the process ofjust being understanding of what it is about
women's health, then hopefully they wouldbe more likely to participate in research,
particularly minority women. We know thatthe research for these women is so inadequate
at the moments. Just to putit in perspective, I think a few
(22:48):
years ago there was eighteen million dollarsspent on five roid research when this disease
affects over one hundred and fifty millionwomen a year. That's the same amount
of money for a disorder like dystonia, which the neurological disorder that affects like
twenty five million, no, actuallylike two hundred thousand people a year.
And then Sharco Marie tooth, whichis another neurologic disorder, has about fifteen
(23:10):
million a year. That only affectsone hundred twenty six thousand women a year,
So very dispropore actually people a year, not even women, very disproportionate
in terms of where the money isgoing in research, and this is such
a huge problem, like I mentionedin the African American community. So if
we could just get better research,we can hopefully improve outcomes, improve treatments,
increased knowledge, know what women arekind of going up against in terms
(23:30):
of getting a diagnosis, terms oftheir symptoms, what their best options may
be, how we can help themin the future. And we just have
to make sure that their parts thereare a part of these studies when there
are being conducted. That's awesome.So what can we do as a community
to kind of help this along.So for somebody maybe not dealing with any
(23:51):
five right issues, just the knowledgeof them. That way, if somebody
ever mentioned, hey, I'm havingheavy bleeding, I'm having these terrible cramps,
I gotta take days off work somethinglike that, then I could pass
along, hey, you should maybego see r O bgi N. Get
this looked at. It might bea fibroid. So just having the knowledge
alone is beneficial. Also for malesto also have that knowledge, so they
can if they ever hear of somethingthat they might be able to assist.
(24:11):
That's one thing. Also for peopledealing with them, know that or have
an idea that this may not benormal. Maybe you should kind of go
get it checked out. If you'reexperiencing heavy bleeding, really bad issues increase
bulk symptoms like I mentioned before,and so go seek an opinion, Go
get your own knowledge if you caneducate yourself, or go to one of
(24:32):
these all these organizations kind of thatare out there about fibroid research, and
the American Society of Reproductive Medicine isour national organization for fertility and reproductive health
in general, and so anywhere youcan go with with those and also support
in Congress, support in the governments. They are trying to increase research.
There is a bill actually that wasintroduced this year by one of the representatives
(24:53):
actually of New York, you've gotClark, called the Fibroid, Uterine,
Fibroid Research and Education Act. It'ssomething that should be increasing fibord of research
tow one hundred fifty million dollars,although every year I'll lay up to like
twenty twenty eight, So that wouldbe awesome if we can get that past
for sure, definitely, And theyshould come see you at Reproductive Medicine Associates.
(25:14):
That would be great if they needto, If they need help with
that, that's what I'm here for. You know, I went into this
field because I do want to helpwomen conceive that their goals and to help
them get past any issues they mayhave, and particularly minority women. I
was raised by a single mom whoworked really hard to make sure that,
you know, we had a stablefamily, a stable living, and so
whatever I could do to help peoplealso have successful families and stable lives would
(25:38):
would be great. That's awesome.Well, I appreciate having you here today.
I'm eternal. I'm Kenya Gibson sittinghere with doctor Michael Simony of Reproductive
Medicine Associates And how can people findyou and get in contact with you?
Social media? The RMA network ison Instagram, is on Twitter or x
now I guess and myself. SimonyUnderscore MD is on Instagram, Twitter,
(26:00):
Facebook, LinkedIn all those things.It's easy to find me. Awesome,
and you're here in New Jersey,but you also are national as well.
Our remain Our Reproductive Medicine Association issorry. The Reproductive Medicine Associates is a
national organization of fertility clinics throughout California, Pennsylvania, Texas, so all these
different states, the New Jersey officesare scattered throughout. We're all connected,
(26:23):
we all have similar practice guidelines andso it makes it easier for patients to
kind of go from office to office. But I am in the South Jersey
office over in Marlton, so comesee me if you need anything there.
Awesome. Well, thank you forcoming here today and being on Maternal.
I know this conversation is super helpfulto our audience and we appreciate you being
here and informing us and enlightening ustoday about all the options we have available
(26:45):
to us as a community when itcomes to family planning. Thank you for
inviting me, pleasure to be here. Thank you for joining us for another
episode of Maternal. This conversation aroundreproductive health will help women of color identify
management options for infertility and overall allwomen's health, acknowledge disparities in fibroid care,
and understand the importance research plays increating access and quality of care.
(27:07):
Be sure to visit Meternal dot infoto learn more about how iHeartRadio is committed
to combating the Black maternal health crisis
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