Category: Assisted Reproductive Technology

ASRM Guidelines on Fertility Care During COVID-19 Pandemic

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ASRM guidelines COVID-19

ASRM Guidelines on Fertility Care During COVID-19 Pandemic: Calls for Suspension of Most Treatments

ASRM Guidelines on COVID-19: The American Society for Reproductive Medicine (ASRM), the global leader in reproductive medicine, today issues new guidance for its members as they manage patients in the midst of the COVID-19 pandemic.  Developed by an expert Task Force, of physicians, embryologists, and mental health professionals, the new document recommends suspension of new, non-urgent treatments.ASRM guidelines COVID -19

Specifically, the recommendations include:

  1. Suspension of initiation of new treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF) including retrievals and frozen embryo transfers, as well as non-urgent gamete cryopreservation.
  2. Strongly consider cancellation of all embryo transfers, whether fresh or frozen. 
  3. Continue to care for patients who are currently ‘in-cycle’ or who require urgent stimulation and cryopreservation.
  4. Suspend elective surgeries and non-urgent diagnostic procedures.
  5. Minimize in-person interactions and increase utilization of telehealth.

The above recommendations will be revisited periodically as the pandemic evolves, but no later than March 30, 2020, with the aim of resuming usual patient care as soon and as safely as possible.  ASRM has been closely monitoring developments around COVID-19 since its emergence. Data on its impact on pregnancy and reproduction remains limited. However, the task force used best available data, and the expertise and experience of the members to develop the recommendations. Until more is known about the virus, and while we remain in the midst of a public health emergency, it is best to avoid initiation of new treatment cycles for infertility patients. Similarly, non-medically urgent gamete preservation treatments, such as egg freezing, should be suspended for the time being as well. Clinics who have patients under treatment mid-cycle should ensure they have adequate staff to complete the patient’s treatment and should strongly encourage postponing, the embryo transfer.

Ricardo Azziz, CEO of the ASRM stated, “This is not going to be easy for infertility patients and reproductive care practices. We know the sacrifices patients have to make under the best of circumstances, and we are loath to in add, in any way. to that burden. And it will not be easy for our members. The disruption to routines, the stress on staff members and the very real prospect of economic hardship loom large for ASRM members all over the world.  But the fact is that given what we know, as well as what we don’t, suspending non-urgent fertility care is really the most prudent course of action at this time.”

Dr. Racowsky added, “We should recognize that the situation on the ground is fluid, and as such we will continue to revisit and review our recommendations at least every two weeks, to provide providers and their patients with the best information and support we possibly can.”

ASRM Press Release – May 17, 2020

Click here to read the entire release

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Source: Time for Families

The Latest Study on Regulation of Compensated Gestational Surrogacy in New York

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compensated gestational surrogacy

The Latest Study on Regulation of Compensated Gestational Surrogacy in New York

The Latest Study on Regulation of Compensated Gestational Surrogacy in New York underscores the need to pass this legislation and shows that it would provide the most comprehensive protections for gestational carriers in the US.compensated gestational surrogacy

This report on the regulation of compensated gestational surrogacy in New York, issued in March 2020 to the New York State Legislature by Weill Cornell Medicine and the Cornell Law School is one of the most comprehensive reports of its kind and leads the reader to now other conclusion but that New York’s pending legislation, The Child Parent Security Act, would be the most protective of gestational carriers, or surrogate mothers, of any piece of legislation in existence in the US.  Surrogacy legislation  can be ethical and comprehensive.

To quote from the article, “The trend among state legislatures in the United States is to permit rather than prohibit compensated gestational surrogacy. Since 2000, fifteen states and the District of Columbia have acted to explicitly permit compensated gestational surrogacy. On the other hand, only four states have taken a prohibitive approach since 2000 and two of those states permit uncompensated gestational surrogacy.”

“In forty-four states there is no prohibition on surrogacy by statute or there is explicit or implicit permission. Even in the six states that have statutes that appear to prohibit surrogacy, courts have granted pre-birth orders to intended parents and have issued other pro-surrogacy decisions. Consequently, surrogacy in varying ways, including by approving pre-birth orders.”

“In sum, the health and medical literature does not weigh in favor of continuing to prohibit gestational surrogacy in New York. There are generally no disparate health outcomes for gestational carriers as compared to non-gestational carriers using assisted reproductive technology (ART) nor are their disparate health impacts on children. Additionally, there are no disparate psychological impacts on gestational carriers as compared to women who have had spontaneously conceived pregnancies. States across the country are moving to legalize and regulate gestational surrogacy in the last decade.”

March 20, 2020 by Cornell Weill Medical Center and Law School 

Click here to read the entire article.

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Source: Time for Families

Commercial Surrogacy – a Complicated Legal Picture

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finding a surrogate mother

Commercial Surrogacy’s Complicated Legal Picture

After trying to conceive through nine cycles of IVF, unsuccessfully, Alexis Cirel’s doctor suggested she and her husband take a different route: a gestational surrogate and commercial surrogacy.commercial surrogacy

“It was a hard decision and it took months of introspection,” says Cirel, an attorney in New York City. Ultimately, she agreed with her doctor. But surrogacy wasn’t legal in her home state, and she worried about the risk that her “biological child would not be my legal child” under state law.

New York is currently one of three states (along with Louisiana and Michigan) that don’t allow surrogacy contracts (though the remaining states vary greatly in their regulation of surrogacy) but may soon join the majority, with legislation on the table to make paid (aka commercial) surrogacy legal.

In the absence of a national policy, state legality issues date back to 1984, when a couple put an ad in the newspaper seeking a surrogate. Mary Beth Whitehead, of New Jersey, responded, and gave birth to Baby M. But everything soured when she wanted to keep the baby, which was conceived with her own egg. The New Jersey Supreme Court found that the payment to Whitehead was illegal, but ruled against her on the issue of custody: Baby M. went to the intended parents, though Whitehead received parental rights.

After the debacle, New York criminalized gestational surrogacy by fining parents and anyone who assists them, says Anthony Brown, New York-based founder of Time For Families Law, and the founding chairman of Men Having Babies, a nonprofit organization that educates gay men about surrogacy. The law was created to address traditional surrogacy (fertilizing the surrogate’s egg), but was extended to prohibit gestational surrogacy, where the child has no genetic relationship with the surrogate, rendering any contracts for “altruistic” surrogacy void and all commercial surrogacy contracts illegal.

Many people think it’s time to revisit the issue.

New York Gov. Andrew Cuomo recently launched a campaign to legalize gestational surrogacy, after a 2019 effort failed, and he has support from families, attorneys, LGBTQ rights groups, and even celebrities (Bravo’s Andy Cohen was present for the campaign announcement).

“This antiquated law is repugnant to our values, and we must repeal it once and for all and enact the nation’s strongest protections for surrogates and parents choosing to take part in the surrogacy process,” Cuomo said in a statement.

The new legislation would create protections for surrogates so they could make their own health care decisions, including whether to terminate a pregnancy; would create legal protections for parents of children conceived by reproductive technologies such as artificial insemination and egg donation; and would eliminate barriers to second-parent adoption (a single visit to court to recognize legal parenthood while the child is in utero would suffice).

Many New Yorkers use surrogates but travel to other states to use them. Repealing the bill would simply make it easier and safer for everyone involved, Cirel says. She switched from her corporate law role to become a family law and matrimonial attorney after going through the surrogacy process, and she is a member of New York’s Love Makes a Family Council, created in conjunction with the proposed law.

Romper.com, February 19, 2020 by Danielle Braff

Click here to read the entire article.

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Source: Time for Families

Fertility Fraud: The U.S. Is Experiencing An Explosion Of Legislation. And That’s A Good Thing

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More and more cases of fertility fraud have been uncovered. And more and more lawsuits have been filed. However, each prosecution or lawsuit has faced an uphill battle.

Direct-to-consumer DNA kits have changed our reality. The wall of secrecy that was once behind conception and parenting — including adoptions, affairs, and the use of donor eggs, sperm, and embryos — is crumbling. One major facet of this reckoning with the truth has been the stark realization that many, many doctors were using their own sperm, a form of fertility fraud, to “treat” their unknowing patients.fertility fraud

Sometimes this practice was in place of “anonymous donor” sperm; sometimes, it was actually in place of the spouse or partner’s sperm. It’s pretty gross to think about. But even grosser is the complete lack of accountability for the doctors who must have known of the ethical and moral shortcomings of their actions.

The Justice System Has Been Failing Us

A doctor using his own sperm to impregnate a patient, without her knowledge or consent as to the source of the sperm, must be a crime, right? Or at least a pretty solid tort – fertility fraud? For many states, you guessed wrong. More and more cases of those doctors’ egregious practices have been uncovered. And more and more lawsuits have been filed. However, each prosecution or lawsuit has faced an uphill battle.

Take, for example, the case of Donald Cline, formerly a licensed medical doctor in Indiana. In one of the most notorious cases of fertility fraud in the United States, DNA tests have shown Cline to have used his sperm in unknowing patients, resulting in at least sixty children. When the betrayed patients and offspring sought legal remedies against Cline, they were unsuccessful. After all, the patients had consented to Cline inseminating them with sperm. Cline did plead guilty to two charges of obstruction of justice, after lying to officials about using his own sperm with patients. But that, to most victims, was not sufficient.

Time To Change The Law

Since current law has been failing the victims, many have sought, and are currently seeking, to change the law. State by state, if necessary. Last year, two successful bills were passed. One was in Indiana, unsurprisingly, as ground zero of the Cline fiasco. Another was in Texas, where Eve Wiley led the charge. (Listen to this podcast where Wiley and her believed-donor tell the twisting and fascinating tale of uncovering the truth of Wiley’s genetic history.) In Texas, without a civil cause of action due to the state’s recent tort reforms, and without a viable criminal cause of action to charge him, Wiley’s “doctor daddy” is still actively practicing medicine even today. That’s crazytown.

Now other states are following suit, and closing the legal loopholes that existed for doctors to take advantage of their patients in this most intimate of areas. And while I doubt that as many doctors are so casually using their own sperm these days, there are certainly modern horror stories involving assisted reproduction, including that of a staff member at a Utah clinic swapping out countless sperm samples with his own.

The states currently making progress in this area include my own home state of Colorado with HB20-1014 (Go, Representative Kerry Tipper!), Nebraska with LB 748, Ohio with HB 486, and Florida with SB 698. Other states, as well, appear poised to introduce their own fertility fraud legislation. While the proposed laws vary, they are consistent in their goals of ensuring or clarifying that this type of behavior by trusted medical professionals is not acceptable and not legal, and providing a path forward for justice.

AboveTheLaw.com, by Ellen Trachman, February 12, 2020

Click here to read the entire article.

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Source: Time for Families

Paying gestational carriers should be legal in all states

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gestational carriers

Every year, hundreds of thousands of babies are born in the U.S. using assisted reproductive technologies, including the use of gestational carriers, a multibillion-dollar industry that is controversial and largely unregulated.

One of the controversies involves the use of paid gestational carriers, women who agree to carry a fertilized embryo, created from another woman’s egg, give birth, and give the baby to its parents. This is different from tradition (or genetic) surrogates, who provide both their own eggs and their own wombs. Gestational surrogacy now constitutes 95% of all surrogacy in the U.S.gestational carriers

State laws about arrangements for gestational carriers vary widely and are in flux. This kind of surrogacy is currently allowed in 10 states; prohibited but with various caveats and additional legal proceedings in 30; practiced with potential legal obstacles and inconsistent outcomes in five; practiced but with legally unenforceable contracts in two and prohibited in three. Several of the 40 states with real or potential legal hurtles require that couples be married and heterosexual, or allow surrogates to choose at any point to keep the baby.

Commercial surrogacy first gained wide attention in the 1980s through the Baby M case. Elizabeth Stern had multiple sclerosis and feared that pregnancy would worsen it. Through a newspaper ad, she and her husband connected with Mary Beth Whitehead, who agreed to carry a fetus for them as a traditional surrogate, providing both an egg and a womb. But after giving birth, Whitehead decided to keep the child. A New Jersey court awarded the Sterns custody of Baby M, but banned all such future surrogacy contracts.

Since then, practices have changed and the use of gestational carriers has grown dramatically. In many states, however, prospective parents need to travel to other states, like California, to avoid legal obstacles. Some seek surrogates in the developing world, which has its own set of problems.

Competing proposed bills in New York state highlight the conflicts involved in gestational surrogacy.

In June 2019, the New York state Senate voted to legalize gestational surrogacy. The pushback was swift and strong. Noted feminist Gloria Steinem argued strongly against the proposal, raising concerns that poorer women of color would disproportionately serve as gestational carriers. She also pointed out that the bill would require surrogates to be state residents for only 90 days, which could prompt human traffickers to bring women to New York to serve as surrogates. The State Assembly then rejected the proposal. Lawmakers are now considering at least two different revised versions of the bill — one from Gov. Andrew Cuomo and one from the bill’s original sponsor — that address these criticisms.

I believe the state should legalize gestational surrogacy, providing it includes protections to avoid the problems Steinem highlighted.

In the debates in New York, as well as those in other states, both sides have been arguing in the relative absence of data, without acknowledging this deficit. In fact, the limited data available so far do not suggest that women become gestational carriers because of financial distress, nor do the demographics reflect racial disparities.

StatNews.com, by Robert Klitzman, February 12, 2020

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Source: Time for Families

French Senate passes bioethics law allowing lesbians to artificially procreate

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French Senate

The bill passed by the French Senate is watered down but still extremely transgressive.

The French Senate adopted the draft bioethics law currently under discussion in that body by a relatively small margin of 10 votes on Tuesday. One of its most spectacular elements, the legalization of access to artificially assisted procreation for single women, including those in lesbian relationships, was confirmed, as well as the widening of possibilities for research on human embryos. Other articles of the law were modified by the Senate, which canceled some of its more shocking propositions.French Senate

Although the higher chamber in France still has a right-of-center majority, the text, which remains deeply transgressive, obtained 153 votes in its favor, while 143 senators voted against and 45 abstained. The voting was not uniform right and left — 97 of the 144 “Les Républicains” mainstream right-wing senators rejected the law presented by Emmanuel Macron’s left-wing government, while 25 voted for the text, thus bearing responsibility for its adoption.

The presidential party “La République en marche” (LREM), created for the last presidential election and not very strong in the Senate, was itself divided: six of its 24 senators voted against the text.

Almost all the 348 senators were present, a sign that the revision of France’s bioethics laws is being taken seriously. The first such law was adopted in 1994 and was already transgressive because it legalized artificial procreation and embryo selection.

From the start, it was decided that the bioethics law would be revised every five years in order to take medical and scientific progress and new techniques into account. As a matter of fact, the laws were revised over larger intervals. Each time, new possibilities for embryo research, pre-implantation diagnosis, and other such transgressions were added.

The draft bioethics law now being discussed has been substantially amended by the Senate and will therefore return before the National Assembly, probably in April. Laws are adopted definitively without a second reading in France only when adopted by both chambers in exactly the same terms.

Lifestienews.com, by Jeanne Smits, February 7, 2020

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Source: Time for Families

Fresh Eggs For IVF Offer Slightly Better Birth Outcomes

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fresh eggs

Using fresh donor eggs for in-vitro fertilization (IVF) provides a small but statistically significant advantage in birth outcomes compared to frozen donated eggs, research finds.

The national study in the journal Obstetrics & Gynecology was the largest head-to-head comparison of the two IVF approaches, measuring the likelihood of a good perinatal outcome, defined as a single baby without prematurity and with a healthy birth weight.fresh eggs

“Our study found that the odds of a good birth outcome were less with frozen than with fresh, but it was a small difference,” says lead author Jennifer L. Eaton, medical director of assisted reproductive technology and director of the Oocyte Donation Program at the Duke Fertility Center.

“From a clinical standpoint, given that frozen eggs have many benefits such as ease, cost, and speed, the decision to use fresh or frozen donor eggs should be made on an individual basis after consultation with a physician,” Eaton says.

Eaton and colleagues, including senior author Alex Polotsky of the University of Colorado Advanced Reproductive Medicine, studied three years of data from the Society for Assisted Reproductive Technology. Nearly 37,000 IVF attempts were analyzed, including 8,381 (22.7%) that used frozen eggs and 28,544 (77.3%) using fresh.

Controlling for factors such as the quality of fertilized eggs and the age of both mother and donor, the researchers found that fresh eggs resulted in a good perinatal outcome in 24% of fertility attempts compared to 22% of the attempts with frozen eggs. Implantation, clinical pregnancy, and live birth rates were all significantly higher among the women using fresh eggs vs. frozen.

“As IVF with donor oocytes has become standard treatment for women with decreased egg supply or advanced reproductive age, there has been an increased demand for donor oocytes, making frozen eggs an attractive option,” Eaton says. “In general, IVF with frozen donor eggs is cheaper and faster than with fresh donor eggs.

Fututiry.org by Sarah Avery-Duke, February 7, 2020

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Source: Time for Families

The Number of Employers Who Offer Fertility Benefits is on the Rise

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fertility benefits

Fertility benefits rank high on the list of valuable benefits that make recruiting top talent, retaining valuable employees, and reducing turnover easier. Providing coverage for family building options has been shown to increase employee retention and loyalty.

According to a recent FertilityIQ survey, 68 percent of millennials consider fertility benefits when choosing an employer, and 9 out of 10 employees with fertility issues will switch jobs for benefits.fertility benefits

This scenario was very true for millennial, Katie Goad and her husband Adam. They had an 8-year-old daughter and wanted to expand their family. After giving birth to her first child, Katie had surgery that meant she would have to undergo in vitro fertilization (IVF) in order to have another child.

Lacking insurance for IVF, Katie was determined to expand her family without going into debt in the process, so she explored her employment options and discovered that Starbucks offered benefits to cover IVF, even to hourly, frontline workers. Starbucks is revered for being among the first to provide fertility benefits to hourly and part-time employees.

“I was honest with them in my interview about what my goal was, and what my intentions were,” Goad said in a recent interview with Benefit News.

She landed the job and started working as a part-time barista.

In a recent survey, FertilityIQ, author of the extensive Family Builder Workplace Index, found that 73 percent of fertility patient respondents felt more gratitude toward their employer because of fertility benefits, 61 percent said it made them feel more loyal, and 53 percent said it influenced them to stay with a particular employer longer.

“In this tight labor market, millennials are entering the family building years and flooding the workforce. Companies eager to recruit top talent know that offering fertility benefits, paid parental leave, and flexible schedules fosters a great sense of loyalty,” said Patty Stull, Chief Marketing Officer of SGF.

Once Katie qualified for health benefits through Starbucks, she began fertility testing and treatment under the care of Dr. Mark Perloe at Shady Grove Fertility Atlanta.

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Source: Time for Families

Virginia Senate approves bill to prevent surrogates from being forced to abort multiples

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Virginia Senate

The Virginia Senate unanimously approved a bill Tuesday that would prevent surrogates from either being required to or prohibited from aborting multiples in their surrogacy contracts.

The bill passed through the House of Delegates in January, and the Virginia Senate proposed an amendment that will see it sent back to the House for final approval.new Va. surrogacy

With the amendment from the Virginia Senate, the bill reads: “Any contract provision requiring [or prohibiting] an abortion or selective reduction is against the public policy of the Commonwealth and is void and unenforceable.”

TheJurist.com, by Angela Mauroni, February 5, 2020

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Source: Time for Families

More LGBTQ millennials plan to have kids regardless of income, survey finds

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LGBTQ millenials

 The price of parenthood can be costly for LGBTQ millennials, and all LGBTQ families, especially those dependent on assisted reproductive technology.LGBTQ millenials

Since they married in 2015, LGBTQ millennials, Jonathan Hobgood, 37, and his husband, Kerry Johnson, 36, have wanted to be dads. At first, the couple saw adoption as the best path to parenthood, but South Carolina, where they live, is one of 10 states with religious exemption laws that make it more difficult for same-sex couples to foster and adopt, and they worried that adopting would set them up for a legal nightmare down the road.

“Our concern was that if we did a private adoption and the birth mother decided a couple of years later that she wanted her child back, we would be in for a rather extensive legal battle to try to keep the child,” Hobgood told NBC News. “So we just decided, ‘Well, let’s take ourselves down the surrogacy path from there.’”

In reality, a court-ordered private adoption would have provided the secure, legal parent-child relationship Hobgood and Johnson were looking for, but it is common for prospective parents to have misconceptions about how the law treats parental rights, according to Denise Brogan-Kator, chief policy officer at Family Equality.

The couple did their research. The cost of hiring a female surrogate, they learned, would be steep — $120,000 to $150,000, a price that Hobgood, a project specialist for a medical insurance company, and Kerry, a management analyst with the U.S. Department of Veteran Affairs, could hardly afford. But it did not deter them.

“I knew I wanted to be a child’s father,” Hobgood said. “I really just wanted to go through and enjoy bringing up this wonderful child who is a part of our family.”

Hobgood and his husband are among an increasing number of lesbian, gay, bisexual, transgender and queer people in the U.S. planning to have children, according to data released this year by Family Equality, a national nonprofit that advocates for LGBTQ families. And despite the additional financial barriers for many prospective parents in this group, this increased desire to have children was found across income levels, according to a report the group released this month, “Building LGBTQ+ Families: The Price of Parenthood.”

Family Equality polled LGBTQ millennials -500 LGBTQ and 1,004 non-LGBTQ adults, and found that the desire to become parents is nearly identical among both lower- and higher-income lesbian, gay, bisexual, transgender and queer people. Forty-five to 53 percent of LGBTQ people between the ages of 18 and 35 are planning to become parents for the first time or add another child to their family (compared to 55 percent for their non-LGBTQ counterparts, a gap that has narrowed significantly compared to older generations).And those making less than $25,000 a year plan to have children at a similar rate to those making over $100,000, according to the report.

Amanda Winn, the organization’s chief program officer, was surprised by the findings.

“I was expecting that folks who were living at the poverty line would report lower rates of wanting to bring children into the home knowing that finances were tight, but that’s not the case,” Winn told NBC News. “That innate, strong desire to have families exists regardless of income levels.”

LGBTQ prospective parents are more likely to face financial hurdles than their heterosexual peers, according to the report. Reasons include their relatively lower annual household incomes and the additional costs associated with having a child using an option other than sexual intercourse, which is considered by only 37 percent of LGBTQ people planning to start their families or have more children.

Assisted reproductive technology: ‘an impossible barrier’ for some

Thanks to advancements in assisted reproductive technology (ART), such as artificial insemination, in vitro fertilization and surrogacy, more LGBTQ people can have children through nontraditional methods, and interest is growing. Forty percent of LGBTQ people are considering such technology to conceive children, according to a Family Equality survey published in February — but many of these prospective parents will pay for it out of their own pockets, and the technology can be expensive.

“Most LGBTQ+ individuals will learn that their health insurance plan does not cover the cost of fertility treatments at all, and, if they do, the individual or family unit must prove that they have been ‘trying’ to conceive for 6-12 months before coverage begins,” the Family Equality report states. “This stipulation in the policy results in high monthly expenses for some and creates an impossible barrier for others.”

nbcnews.com, by Julie Compton December 27, 2019

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Source: Time for Families