The Incredible, Reimbursable Egg

Someone extremely powerful must have read my recent article, Why Being a Pelvic Floor Physical Therapist Inspired Me to Freeze My Eggs…And to Tell You All About It (link to article), because I have an exciting update about fertility treatment. I know, I know…I’m not that vain…I definitely know this law’s not about me. My blog alone can’t take credit for the Department of Financial Services of New York State’s decision, but a girl can dream.

I am happy that many important conversations ensued, both publicly on Facebook and privately, and I am grateful to the many women who shared their personal experiences. The more we discuss and share, the more we can support each other and normalize this process. I am thrilled to report that our voices are being heard and incredible changes are underway.

As of January 1, 2020, the New York State’s budget mandates that large group insurance plans (a group consisting of more than 100 employees) cover up to three cycles of in vitro fertilization for patients with a medical diagnosis of infertility. The definition of “infertility”, according to the Department of Financial Services is “a disease or condition characterized by the incapacity to impregnate another person or to conceive, due to the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or therapeutic donor insemination, or after six months of regular unprotected sexual intercourse or therapeutic donor insemination for a female 35 years of age or older.  Earlier evaluation and treatment may be warranted based on an individual’s medical history or physical findings.” The new phrase included this year is “therapeutic donor insemination,” which finally provides coverage to same-sex female couples and to single women, two demographics that were excluded in years past.

The new law also mandates coverage for “medically necessary” egg or sperm freezing procedures. These fertility preservation procedures are deemed “medically necessary” for patients at risk of iatrogenic infertility, or infertility resulting from an unrelated medical procedure (ex. chemotherapy, radiation, endometriosis surgery, or sexual reassignment surgery). The fertility preservation coverage under these circumstances applies to even small group and individual plans.

Insurance companies can require prior authorization, so if you are considering exploring this option, please contact your insurance company to inquire into their specific requirements.

True, certain groups won’t be covered under these laws (ex. women who elect to freeze their eggs without medical necessity and IVF treatment for individuals who do not have a large group employer). So yes, we still have more work to do. But overall, this is massive progress. The new, more inclusive laws are a giant leap for womankind. I look forward to the opportunity to share more positive updates on women’s sexual health and reproductive rights as they develop, hopefully sooner rather than later.

Missed Opportunity to Educate

Misinformation can be dangerous. With all due respect to author Dr. Jen Gunter, I found her most recent piece in The New York Times (link to article) lacking and misleading. In her recent article, “Is Incontinence Inevitable?” (1/14/20), she completely missed the opportunity to promote the benefits of pelvic floor physical therapy when it was handed to her on a silver platter.

The following questions was posed to her by a reader: “Dr. Gunter, I am a postmenopausal 63-year-old woman. I am wondering if the fate of all women my age and older is to wear pads for leakage. I understand your specialty is gynecology and not urology but thought you could weigh in on any advances in this area as the two specialties are related.”

Dr. Gunter proceeded to explain the difference between stress and urge incontinence and to cite several commonly known statistics about incontinence. She then offered several tips to her readers, the second of which was to limit fluid intake. According to her, the notion of drinking eight cups of water per day “is a myth.” I have found this to be completely not true. Anecdotally, patients who drink greater quantities of non-irritating, flat water fare better than patients who drink smaller quantities of poor-quality irritants (ex. caffeine, carbonated beverages, and artificial sweeteners). The solution isn’t to restrict fluids; it is to drink larger amounts of high-quality fluids to allow the bladder to fill and empty in a healthier manner.

She then encouraged readers to participate in Kegel exercises, both endurance and quick flicks exercises. The problem with this is that approximately 50% of people who attempt to perform Kegel exercises do not perform them properly and engage in substitution patterns. In other words, people use the wrong muscles, such as the buttocks or inner thigh muscles, rather than the pelvic floor muscles. The best way for people to learn how to correctly engage the pelvic floor muscles is with a physical therapist who can introduce the learner to the muscles by touching them through internal manual cuing.

While Dr. Gunter answered the question correctly, that incontinence is NOT inevitable, she neglected to mention a very important piece to the puzzle in addressing the issue. The fact that the words “physical therapy” did not appear once in the article was, in my opinion, an oversight on Dr. Gunter’s part. Pelvic floor physical therapy has helped many women improve their continence in a safe, conservative, and evidence-based manner. If you or anyone that you know stands to benefit from our services, please contact us at Revitalize Physical Therapy. It would be an honor and privilege to help you!