Every country handles rules and regulations around fertility care a little differently — or, in many cases, very differently. Cultural nuances play a powerful role, too. These differences create a challenge for companies looking to provide fertility benefits that meet the needs of all of their employees. We talked with Julie Fernandez of Momentive, the creators of SurveyMonkey, about how her company solved this challenge — and the impact fertility benefits have had since then.
Find more tips on finding fertility benefits for a global workforce from Carrot’s Global Solutions team.
Read more about Momentive’s experience with Carrot in our case study.
[00:00:00] Welcome to Baby Steps, a podcast from Carrot Fertility about the intersection of work and fertility health. To kick off our second season, we're taking a look at the big picture. The entire world.
[00:00:12] Cultural differences are one thing that makes it so interesting to travel. I remember going to Spain and learning that it was considered rude to order certain drinks in the evening, instead of in the afternoon. My friend and I really had no idea, but when you're traveling you always learn little things like that that make every place unique.
[00:00:32] On a more serious note, cultural differences, as well as differences in laws, healthcare systems, infrastructure, access, you name, all make a big impact on how people are able to access fertility care and family-forming resources.
[00:00:48] Something like egg freezing that's culturally acceptable in one country might be unacceptable in another. Some countries have better access to high-quality fertility care, and people might even need to [00:01:00] travel between different countries to access care. This all creates a challenge for companies that have global employees, which is most large companies these days. It's important for these companies to provide employees with a comparable level of support, no matter where they are in the world. And when it comes to fertility benefits, that's particularly challenging.
[00:01:23] I wanted to learn more about this problem and hear from someone who solved it firsthand. I'll let Julie introduce herself.
[00:01:30] Julie: So my name is Julie Fernandez and I am the benefits manager at Momentive. You probably know us more as the maker of Survey Monkey.
[00:01:41] Nancy: Julie Fernandez knows a lot about how her company's benefits differ in the half dozen countries, her coworkers live in. She joined me from the San Francisco Bay area. The first thing I wanted to know was how she got her start in HR and what attracted her to employee benefits and in particular.
[00:01:58] Hey, Julie.
[00:01:59] Hi, Nancy. Good morning.
[00:02:00] I would love to start by just hearing a little bit about how you first got into employee benefits.
[00:02:06] Julie: Yeah, so I actually started my career as an HR specialist, so I graduated with a communications major and didn't really know exactly what I wanted to do. I knew I was a people person so I started as a kind of all things, HR person.
[00:02:22] And my next job thereafter actually was with a benefits consulting firm. And so the rest is kind of history. I've been head first in all things, employee benefits ever since. So that's really where it all started. It was thanks to one of my coworkers from my first company moved to the firm, got me in as well, and I just loved it and it became my passion thereafter.
[00:02:44] Nancy: So as you were getting into HR, what specifically appealed to you about benefits?
[00:02:52] Julie: It was really just all about being able to be a part of something that is so impactful to people, benefits when you work [00:03:00] somewhere, they can be everything they provide so much meaning. And they also are just so important in allowing you to take care of yourself and having a little bit of that work-life balance.
[00:03:12] And so I just loved everything about it. I loved what it stood for and how important it is in your career and in your journey.
[00:03:21] Nancy: And tell me a little bit about managing benefits at Momentive. Do you have a benefits philosophy that you try to follow?
[00:03:28] Julie: Yeah. Our benefits philosophy really is all about what we say, taking care of the whole you, so making sure that we're providing rounded benefits that allow employees and their family members to take care of themselves and to bring their best selves to work. And of course now with it's become more of meeting people where they are. It’s a constantly ever-changing environment. And, keeping up with people's needs is obviously always super important to us as well.
[00:03:59] Nancy: Are your [00:04:00] employees mostly remote or do you have kind of a hybrid set up?
[00:04:03] Julie: Pre pandemic of course we were pretty office space. We did have a handful of remote employees, but it was certainly the minority. And now with the sort of shift that the pandemic brought, we are all over the map. So we allow employees, uh, the choice to select whether they want to be primarily an office-based employee, a remote employee, or a hybrid of the.
[00:04:28] So we have folks who've picked all three choices and some of our European colleagues tend to be a little bit more office focus, and we've seen quite a lot of, uh, folks in the U.S. go remote.
[00:04:41] Nancy: Oh, that's interesting that, that you noticed kind of a regional difference. And where are your offices? I know there are, they're all over the world, right?
[00:04:48] Julie: Yeah. So we're, we're primarily in nine countries where we have employees that is in nine countries. That includes the U.S. we have offices in San Mateo in the bay area. In [00:05:00] Portland. We did have an office in Seattle previously, and we also did in New York as well. Those were smaller locations. And then we have a big presence in Ottawa in Canada, as well as in Ireland, Dublin and Amsterdam, and another lens, those are key hubs as well as Australia. I forgot to mention. And then, like I said, we have also employees in a few other countries, including the UK, Germany, Italy, Austria.
[00:05:25] Nancy: Wow! Yeah, the list goes on. That's great.
[00:05:27] Julie: Yes!
[00:05:27] Nancy: And what are some of the challenges of providing benefits to people in so many different countries? I mean, every country has its own existing healthcare regulations. And then there are also cultural differences in terms of what people are interested in having us as benefits. So, yeah, I'd love to hear about that.
[00:05:44] Julie: Yeah, it can be very challenging. Certainly. There's always this fine balance of looking to provide global programs while also being locally mindful. So there's always this balancing act of making sure that what you're providing is [00:06:00] competitive and relevant in country while also still being manageable as a U.S. headquartered company dealing with benefits in many locations and a global employee base. So I would say that's the biggest challenge is finding ways or knowing when it can be appropriate to offer a single global benefit, for example, versus a more country-specific benefit that may vary depending on where you're at.
[00:06:26] Nancy: That's a great segue into talking about fertility benefits specifically. And I know that the conversation started actually with your leadership team. What was that process like?
[00:06:37] Julie: Our chief people, officer Becky Cantieri was really the one who kind of spearheaded this initially, but she had her own personal journey where after having her first daughter, she unexpectedly encountered some trouble getting pregnant again. And she ended up having to turn to IVF in vitro fertilization to have success. And she ended up realizing she was [00:07:00] hardly alone in that journey. And over the years, we were starting to get more and more employee feedback in our annual benefits and perks survey about folks who are interested in having more in the space of fertility, folks knew about Becky's personal journey.
[00:07:16] So a lot of employees oftentimes reached out to her and shared their sentiments with her directly. And of course, that really resonated with her, and certainly it was becoming a more popular offering in the space of employee benefits overall. And so we looked at, okay, what can we do? What do we have now in our medical plan, we came to realize it was quite limited.
[00:07:37] It was also quite challenging to access. You would have to have a diagnosis of medically confirmed diagnosis of infertility in order to even access the benefit. And even then it was really limited. It wouldn't cover things like costs for actual IVF. It would really only cover things relating to treating the cause of infertility, which doesn't exactly get people there. Right? So that's [00:08:00] ultimately what led us down this path and what ended up having us look to Carrot to implement something.
[00:08:06] Nancy: What was the research process? Like, did you, what did you learn? What were some challenges that you ran into?
[00:08:12] Julie: The kind of market review was largely led by our benefits broker, since they were experts in the space and were familiar with the companies that were doing this at the time, mind you, this was in 2018, right?
[00:08:25] So this space was not nearly as dense as it is now. There weren't quite as many players and our options were a lot more limited. And ultimately one thing that was super important to us, just in light of bringing on this benefit and making sure that it was something that supported DE&I was to be able to provide it globally.
[00:08:45] And so at that time, things certainly have changed since then. But at that time, Carrot was the only company that we came across and that our broker helped us find that could support that. So allowing us to provide the benefit in the U.S. as [00:09:00] well as in all of our global locations.
[00:09:02] Nancy: And in your research, did you end up learning about some of the differences in fertility care in different countries? Was that something you kind of got into the weeds about or that the broker looked into at all?
[00:09:12] Not too much, actually, no, no. I mean, we were aware that there were going to be different challenges depending on the country. Right. Some countries just may have more resources available for this kind of thing and others may not, but we didn't really do a deep dive in that.
[00:09:25] I mean, as unfortunate it is to say that the. A bit out of our own control, but what was certainly in our control was being able to provide a benefit that employees can access. So if they can find the care and the clinics that they need, we want to be able to support that.
[00:09:40] So you're really looking for a company that had connections with clinics and resources within each country.
[00:09:47] Julie: Right. And we did largely intent on relying on Carrot for that support in country as well, knowing that we didn't know what existed in these. And knowing that we could point any employees to you [00:10:00] guys to help with that direction should they need it.
[00:10:04] Nancy: And did anything surprise you about the process of looking into fertility benefits? Did you learn anything about the different journeys people take or anything like that?
[00:10:13] Julie: I'm not sure. I would say I learned anything different. I think the one thing that resonated was just how. How in demand some of these kinds of non-traditional ways of family forming actually are prior to going through this exercise and putting this in place.
[00:10:30] It just, it wasn't something I ever really thought much about, to be honest with you. How does a single mom look to start a family or a same-sex couple or a couple that has tried fertility treatments, but it's just, it's not working. How can we support that adoption in that case? So all of these varying levels of difficulty and inability in some ways to have a family start a family in the super traditional way was actually quite common, much more so than I had [00:11:00] originally thought.
[00:11:01] Nancy: So it's been a few years since Momentive launched Carrot. What have you heard from employees?
[00:11:07] Julie: We've gotten a lot of feedback. One of the things with this type of benefit, right, is it does affect a small portion of the population, right? Like it's very niche. So it's a very small subset of our employee base that will access it.
[00:11:20] But for those that do, it's super meaningful and super impactful and means the world to them. That's the kind of feedback we've heard. Over and over again, please don't get rid of this benefit. This is truly a great benefit. Even one of the quotes we got in one of our surveys once with this benefit, as part of the reason I stay here, this means everything to me and my family.
[00:11:40] So it just goes to show, you know, it affects a small number of people, but it's incredibly impactful for those who, who really do need it.
[00:11:48] Nancy: I think you mentioned hearing from someone maybe in the Netherlands who shared her experience with you?
[00:11:54] Julie: Yeah. Yeah. So one of my own HR colleagues actually heard her story is so [00:12:00] interesting, so incredible and, and a success in the end, but she was a single mom by choice.
[00:12:06] So she turned to donor-assisted reproduction, essentially. She was single and she wanted to start her family. And so she sought out a sperm bank to get a donor and go through that process herself and had a ton of success. She had her son, I think she said he's just about turning 15 months, so just a little over a year ago. And it's just been the light of her life. And she shared with me, just how proud she was, that this was an option for her and for women like her because 30 years ago, you know, in the Netherlands, this wasn't something that would have even been available to her. So she just really appreciated the ability in modern day to even have this option, but also really appreciated that this is something that our company Momentive really cares about.
[00:12:56] Nancy: And do you feel like more people have felt comfortable talking [00:13:00] about this kind of thing at work? Since it sounds like your leadership brought it up and now you offer Carrot, but I know a lot of the time people don't really feel comfortable talking about fertility and family forming in the workplace, but do you feel like there's been a shift.
[00:13:13] Julie: It definitely is still on the quieter side. I will say that it's one of those things that people don't freely come to you and give feedback on is what I've noticed. And I'm sure that's just largely because of the nature of this is just incredibly personal and private and chances are, you're probably not hearing much about it, unless it is a success story. I wouldn't expect employees who perhaps haven't had success to come give us their feedback on how things went, where I largely get the most feedback is. And this is just because of the nature of it is more of an anonymous forum is through our annual benefits and perks survey where employees can leave their anonymous feedback.
[00:13:54] It allows us to see what they think, and it allows them to rate the benefit as well. And [00:14:00] just allows us to kind of pinpoint the success of the program, knowing that we're not going to hear tons about it from them proactively.
[00:14:08] Nancy: That definitely makes sense. In that more anonymous setting, people would feel a little more comfortable sharing.
[00:14:15] That's great. I'd love to hear what advice you have for other benefits leaders who are just starting to look into fertility benefits, where do you recommend they start?
[00:14:24] Julie: Especially in the U.S., I would say this is almost becoming a baseline benefit. It's getting to the point where having more around the area of family-forming benefits is almost going to be table stakes.
[00:14:37] It's going to be as important as medical, dental, and vision and life insurance. And it's just going to be something that if you want to be sure you're competitive enough in the market, it's just going to be expected that employers are doing more in this. So my advice per se would really be to be open to bringing something like this on.
[00:14:58] Even if you have to keep costs [00:15:00] low, you have the flexibility to indicate the benefit amounts that you are willing to I have reimbursed to employees, but the idea here is that something is always better than nothing. And I also really believe that putting something like this in place is a testament to the company values and to where the company sees their employee needs.
[00:15:21] And just recognizing the importance of this and doing more. So the bar is, has gone up if you will, in the last few years, in terms of what employees are expecting from their company.
[00:15:33] Nancy: And do you hear questions from job candidates to do they ask about what your parental leave and fertility benefits? Or are they asking about these kinds of things all the time?
[00:15:44] Julie: In fact, I remember there was one, one critical candidate we have. That was probably over a year or two ago. And this was such a key point in her decision between our offer and another company's offer [00:16:00] and ended up having to do quite a deep dive into this benefit and exactly what we offer. And that was just a huge decision point for her in deciding where to go.
[00:16:10] So it was great to be able to, to have this and, and to be able to say, here's what we do and, and show that this something that we value as a company and, and show that this is how we value our employees as well. And it goes, like you said, hand-in-hand with parental leave programs. I mean, if you're going to start really offering something rich like this in the space of family benefits, it's really key that you also consider doing the same when it comes to parental leave and, and offering something that can benefit both mothers and fathers in terms of having proper bonding time off.
[00:16:45] And aligning with the values that putting a program.
[00:16:50] Nancy: Yeah, they definitely are paired together. It would be hard to not have the leave once you have your child, but like, oh no.
[00:16:58] Julie: Yeah, [00:17:00] exactly.
[00:17:01] Nancy: Do you have any advice for other companies in terms of the global piece specifically?
[00:17:06] Julie: You know, the only advice I could really say, and quite frankly, I think we could use some of our own advice too, is one thing I'm learning this benefit, especially in Europe, as some of my colleagues has shared with me is so valuable. And I think it's just because outside the U.S. it, this is not something that is very commonly seen from employers to provide now, perhaps other multinationals, like us. Sure. But by and large, this is not a prevalent benefit in many locations. So I think it's really critical to not hesitate, to promote this and make sure employees really do know about it.
[00:17:46] Find ways to keep it top of mind, find ways to keep employees engaged. Even some of the feedback we get, which is something I know I keep in mind as I actually forgot about this benefit or. I overlooked it, it would be interesting to have [00:18:00] a session about it. People who maybe when they joined, heard about it once.
[00:18:03] And I haven't really thought about it again. And, and in Europe where things like annual open enrollment doesn't exist in most cases. Right. There's. Typically the set period of time, once a year, where you make a point to educate employees on their benefits, like we usually use open enrollment as an opportunity for, so that would be my advice is to make sure that if you're rolling something like this out, that you do have a plan to keep it top of mind and, and make sure that you get the return on the investment in essentially that's a good point.
[00:18:35] Nancy: So how does Momentive make sure everyone stays aware of these employee benefits, especially with people in so many different locations.
Julie: Yeah, that's something we're actually focusing in on this year is really producing some more formality on the wellness front and tying in our benefits to those wellness pieces throughout the year.
[00:18:54] So, you know, if say there's some theme X theme on April, we [00:19:00] might look for ways to, how does that connect with our existing programs? That's just an example of really how we promote any kind of benefit and inclusive of Carrot. So we're working through that now is kind of building out our plan for the year where do each of our benefits tie in and then using that as an opportunity to make touch points? Definitely in Slack. We also have what we call our weekly insider email, which is basically our weekly company updates where we can update on reminders about things or happenings or say, if there's a Carrot webinar that we're going to have running, we can, you know, announce it there and make sure it's top of mind for folks to join.
[00:19:44] So that's one thing we did last year during mental health month, I believe it was in May, was we made sure we promoted one of the Carrot webinars that related to mental health and kind of kept it top of mind that.
[00:19:57] Nancy: That's a good point. You might join a company and [00:20:00] not know you're going to need this kind of resource. So maybe you weren't even really listening, you know, when you first sign up, you're like, oh, that's not something I'm going to use. And then, yeah, like just finding ways to remind people of the resources they already have.
[00:20:13] Julie: Exactly. It's so critical.
[00:20:21] I would just really further emphasize, you know, if you're a leader of a company and considering this kind of benefit, I would highly encourage you you do consider it. It is just the marker of top value for somebody when they really need it. And it's so meaningful and I really do believe that's what this job is all about, providing meaningful benefits and ways to make people's lives better. And this is just one way that as a leader, you can do more for an employee for years to come.
[00:20:51] Nancy: Amazing. Thanks so much.
[00:20:54] Julie: Thank you. It was a pleasure[00:21:00]
[00:21:06] Nancy: After talking with Julie, I wanted to get some more insight on what exactly makes fertility care so different around the world. So I called my colleague Mikayla Johnson. She's VP of Carrot’s Global Solutions team, which is responsible for Carrot's global operational infrastructure. That basically means if you have a question about fertility care in pretty much any country in the world, someone on Global Solutions has an answer for you.
[00:21:34] Hey, Mikayla. Thanks for joining us.
[00:21:36] Mikayla: Hey Nancy, thanks so much for having me.
[00:21:38] Nancy: Could you just start by sharing your title here at Carrot?
[00:21:41] Mikayla: I am the Vice President of Global Solutions at Carrot.
[00:21:44] Nancy: You've been with Carrot pretty much since the beginning. What initially brought you to Carrot?
[00:21:50] Mikayla: I joined carrot in 2017.
[00:21:52] So at the time prior to carrot, I was working on the operations team for a U.S. digital health company, which essentially [00:22:00] administered healthcare plans for U.S. companies and their employees across the country. And at that time, personally and professionally seeing the need for a better experience when it came to accessing fertility care, I also knew that this need was not unique to the U.S. I'm originally from Canada.
[00:22:15] Then it also spent time working in Asia, in Shanghai with multinational companies there. And it wasn't limited to the U.S. I really wanted to see fertility benefit options that were inclusive, global and offered the member experience I felt the patients deserved. And so I ended up spending a lot of spare time diving deep into and talking to healthcare investors, operators, entrepreneurs, and learning more about what was being built in the fertility space. So when I met Carrot's CEO, Tammy, and chief medical officer, Dr. Asima Ahmad, I knew that this was really the team who building something that would ultimately help employers now and in the future, as well as truly build that world where fertility care was accessible to everyone.
[00:22:57] Nancy: What does your team do? What’s your [00:23:00] role like?
[00:23:01] Mikayla: So Global Solutions as part of carrots product organization, and we're responsible for the global operational infrastructure. So it includes everything from understanding local fertility care regulations and translating that to how our product can work within state local health systems.
[00:23:18] Being able to understand which providers can people go to, to access fertility care, be that fertility clinics, attorneys, agencies, and therefore, how can we offer a local and global. Product experience, whether you're an employee sitting in San Francisco, San Paulo, Munich, Tokyo, really anywhere, what does fertility access look like for you and then forming your family?
[00:23:39] So the global solutions team is made up of a, a really, really talented global team of healthcare and operations leaders, as well as regional country-level legal and subject matter experts who are able to really understand what's happening on the ground.[00:24:00]
[00:24:00] Nancy: I love working with your team over on the marketing side. Whenever we have some information to share about something that's going on in another part of the world. So that's really why I wanted to have you on, because earlier we talked with one of our customers Momentive and she was sharing how they have these offices all around the world.
[00:24:20] But when they start looking into fertility benefits, they realized how different things really are. In the U.S. versus other countries. And it was challenging to find a solution that, that really worked for all of their employees. So what would you say are some of the biggest differences around the world and in how fertility care is managed?
[00:24:39] Mikayla: Some of the biggest differences are the regulatory pieces. So for example, what are the local rules and regulations when it comes to accessing fertility care and who can access those services? And that looks different in each country and also then regionally within each country as well. Another piece of that is the [00:25:00] financial component.
[00:25:00] So what is the local health system? What is the cost of care and how does accessing care and paying for services in those locations? What does that look like? In addition to that really, there's also the cultural considerations, religion, or different kinds of ways that impacts locally accessing care in those locations.
[00:25:17] And then also the provider piece too. So which providers can people go to and how does that look different in each place? So we'll look at all of those aspects to really understand what that experience can be for each of our geographies and then how to best really support the product experience for our members.
[00:25:35] Nancy: Yeah, it's always interesting. You know, when I've learned just from working here, you have something we see as pretty, every day average here in the us that something like egg freezing is actually like against the law in a lot of parts of that world. And Julie, who we talked to mentioned a specific member, Carrot member in the Netherlands who wanted to be a single intending parent.
[00:25:56] Is there anything specific about fertility care in the [00:26:00] Netherlands compared with the us that, that you've come across?
[00:26:03] Mikayla: Generally even looking regionally, it looks very different within Europe app. And that's something to also keep in mind that it looks different within the Netherlands. It even looks different within the country itself, but one of the key differences is the health system.
[00:26:16] So a lot of people think in those locations kind of fertility care it's really easily accessible and there are aspects of it where there's coverage, but navigating the local health system looks very different than in the U.S. where it's primarily through employers. Whereas in the Netherlands lens, there is a really robust local health system that offers actually financial coverage for care for, for patients who are part of it.
[00:26:40] And that includes both citizens and ex-patriots who are, who are living there. And so one of the key pieces that we look at is really what is that journey? How can our members understand that and then help them navigate that system? Whether they may have access to say the local health system in the Netherlands and choose to go through that [00:27:00] pathway, or if they may go the private route and what that may look like as well.
[00:27:03] So those are some of the, one of the major differences between when looking at say the U.S.. I ended up the ones.
[00:27:10] Nancy: Yeah, it would be great to hear too, if you have any examples of maybe cultural differences, either in the Netherlands or maybe somewhere else in Europe that come to mind, when you think of kind of U.S. versus Europe?
[00:27:21] Mikayla: Cultural differences are definitely a really key part.
[00:27:24] So one example is looking at religion and how it influences someone's experience or someone's access to care in their location. There are also places where something may not be legally not allowed, but maybe difficult to access based on kind of the local cultural factors. So for example, in Japan of the say 90 plus fertility clinics in Tokyo prefecture, there's less than say 10 that are typically offering egg freezing services to single females.
[00:27:51] So while it's not illegal, there is that aspect of what culturally it looks like in accessing care, in that location. [00:28:00]
[00:28:00] Nancy: Yeah. And, and so important, you know, when we're supporting members that we're aware of those cultural differences. How does your team learn about all of these different nuances and even the laws and regulations, and they're always changing.
[00:28:12] Mikayla: There's a lot to follow. So our global team and team members who are boots on the ground utilize various databases as well as they work with our partner clinics and local experts. And they do all this to really identify, understand, and then best support the product experience that our customers and members have.
[00:28:31] And so at any point in time, our team is actively monitoring changes, which includes those related to say, like rules and regulations too. And so we look at over the past two years of the pandemic, when clinics were changing in some countries and having to temporarily suspend fertility services, we were closely monitoring that and being able to really translate that to the experience that members have. A big change was one in France where a law was passed, allowing single women and same-sex female [00:29:00] couples to access fertility treatments. And so all of these really fit into being able to understand how are things changing for our members as well, and how were they, how will their experience also look different now after these changes in say, laws and regulations so that we can then really fuel that to the content and support experience that our members have as well.
[00:29:24] Nancy: I'm going back to my conversation with Julie. What advice do you have for other HR leaders who are looking into global fertility benefits and really want to make sure that they can support all of their.
[00:29:37] Mikayla: Julia mentioned this about the fertility benefits, that really, that was becoming table stakes. And we see that with global fertility benefits as well.
[00:29:44] That's the expectation now and really becoming that and not the exception. Each fertility and family forming journey is different. And so personalization is really important. And being able to understand how that looks for access to care for all of your employees, no matter what. [00:30:00] Age, race, sex, gender identity, or geography, and being able to really support them in their journey no matter where they are around the world.
:30:08] Nancy: Thanks, Mikayla was, it was really great having you and just shedding some light onto how fertility coverage works around the world. Thanks so much.
[00:30:16] Mikayla: Thanks so much for having me Nancy and yeah. Letting me speak on the topic.
[00:30:21] Nancy: To learn more about Carrot, visit carrotfertility.com.
[00:30:25] Baby Steps is produced and edited by Eric Montgomery of the Podcast Haven and Christopher Olin of Angeleno Audio. To get notified when new episodes are released, subscribe to Baby Steps on Apple, Spotify, or wherever you get your podcasts.
[00:30:41] And wherever you are in the world, have a great rest of your day. And thanks for listening.
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