 Monica Moore is a Women’s Health Nurse Practitioner, specializing in REI (reproductive endocrinology and infertility). The founder of Fertile Health, LLC, she works to educate REI nurses and other practitioners, giving them the tools to provide a caring and productive experience for each individual patient. She is also an amazing advocate for PCOS sufferers, being one herself. She can help navigate the winding and often confusing path of infertility and PCOS. Find out more at: http://www.fertilehealthexpert.com/. What led you to a career in fertility? Interestingly, although I can’t imagine doing anything else, I wasn’t initially drawn to it. I had just graduated with my Women’s Health NP degree, moved to NYC and tried to find a job in an OB/GYN office but couldn’t. I interviewed at Cornell’s infertility center as a nurse. The physicians there didn’t really know what a NP was or could do (this was 20 years ago). We made a deal. I would work “as a nurse” for 6 months and learn reproductive endocrinology and infertility (REI) and if, after the 6 months, they thought that I could add value to the practice as an NP, then they would segue me into that role, and it worked. I’m forever grateful that they believed in me and gave me a chance. You started Fertile Health, LLC as a way to teach providers and others how to empower patients. What led you to do so? I love the comments, texts, holiday cards and other little thank-you’s that I receive from patients. On one occasion, my daughter was in the same class as my patient’s son and she never failed to recognize or thank me at every single school occasion. Made me feel so proud of doing what I do, but I realized that I wanted to make an impact on a greater level, if I could. When I was in graduate school for a Master’s in Women’s Health, I was taught REI for 1 day. I had a total of only 2 classes the whole time that I attended school there, and my Master’s was in Women’s Health! Then, when I started my first job in infertility, I was taught REI on the fly by a smart, knowledgeable and well-meaning, but very busy nurse. There was no formal orientation program and the learning materials were suboptimal. They were still using a slide projector for their patient teach class. We converted it to power point and made the slides more robust and informative. It was very clear to me that we were lacking a formal infertility teaching program and that this led to nurses feeling a bit less empowered and confident, which bothered me. I started making my own learning modules that I used to train nurses where I worked, and other centers asked me to help them. After that, I had a graphic designer make special images, just for me, and have created 9 learning modules, of which I’m very proud. I’m also hoping to make an online course for REI nurses so that they can log in and review the information when they get a free moment, and I will be available for added support. What are the most common issues you find for nurses who work in fertility practices? For sure, there is a lack of comprehensive orientation for fertility nurses. There are some online options through the American Society of Reproductive Medicine (ASRM) and drug companies but, in my opinion, they are not very interactive. Many small to medium REI practices don’t have a dedicated nurse educator, so the new nurse’s orientation can be sub-par. Again, many of the nurses and physicians are incredibly smart and talented, but might have time constraints and/or poor materials. When I hear some nurses answering question on fertilization results, for example, I can tell if they have a true understanding of meiosis (cell division) or if they could benefit from some enrichment in that area. Also, infertility can be a stressful field. It takes a special person, one who has empathy and compassion, yet can multitask and have a sense of urgency, to succeed. In my experience, that combination is difficult to find and when you do, you have a special nurse who really excels in this field. You state that each patient is unique and you work to teach nurses how “to provide a considerate and productive experience.” I love this because I think people can often feel as though they are just one of a million patients that day, and their providers are just going through the motions without listening to their concerns. Can you talk a little more about what you mean by this? I have learned, over time, to treat every patient as if they were my sister, friend, or special person. I can tell you, though, honestly that there was a time when I was newer to REI that I rushed patients off the phone after a negative pregnancy test or out of the room after a bad pregnancy ultrasound. This was not because I didn’t care, but because I was uncomfortable being the bearer of bad news. I felt like I was breaking their heart and their spirit in those moments. So, I did my best to escape them, an admission about which I’m embarrassed now. Then, I had my own pregnancy loss and realized that I could be a real resource for these women when they really needed it. As a result, I spend the time I need with patients, sometimes comforting them, sometimes just listening, sometimes being the target of a venting session. Whatever someone needs. My hope is that I can instill the need to do this in all fertility nurses and that they won’t need to have had their own loss to empathize with those who have suffered one. I’m happy to share this experience with them when I teach my Early Pregnancy learning module as it’s just as important to understand the grieving experience as it is to understand the physiology of loss. I find nurses to be the heart and soul of pretty much all health practices. What are some things you tell fertility nurses in particular that are helpful in treating patients? Fertility patients are incredibly savvy and usually hungry for knowledge. We can’t always tell them why their cycle didn’t work, but we can teach them about their bodies and and the process that they will be experiencing. Also, don’t assume that women have a good understanding of the menstrual cycle. Most of us are taught to ignore it or combat the symptoms of it, now it seemingly runs our lives for the entire process of the fertility journey, and this often isn’t an easy shift to make in terms of our thinking. People often assume providers know everything there is to know about treating patients. As an educator for these providers, what questions do they most often ask you? I get a lot of questions on the intricacies of the endocrine system and on cell division. Many nurses barely learned about these in school and, if they did, don’t remember the details (probably due to PTSD after these intense, and often, boring lectures). Also, I am often asked how best to deliver bad news, such as a negative pregnancy test. Finally, male factor issues come up a lot. Since we barely see male partners, nor have we learned much about male anatomy, this is always an area in which I find a large knowledge gap. What changes have you noticed over the years in regard to providers and practices in the field of infertility (besides medical advances). For example, are more practices incorporating or suggesting other forms of treatment (yoga, counseling, acupuncture, etc.)? This has been one of the most exciting and encouraging areas of growth in the REI field, in my opinion. There are numerous studies about the positive clinical effects of acupuncture, such as relaxing smooth muscle (such as the bladder and uterus). Acupuncture, yoga, exercise, and massage, are such great self-care interventions, which are crucial during this process. The fact that REI centers now offer some of these services in-house reflects the fact that we are finally learning to treat the infertility patient holistically. The importance of having many options self-care cannot be overemphasized as we remove many or our stress-release methods as part of preconception counseling (like alcohol consumption and strenuous exercise) right when patients are often the most stressed. Seems unfair to do this and not offer other options. You have personal experience with PCOS. Have you found that this has affected your professional life, working in the field of fertility? In a word, greatly. PCOS patients (like myself) often have fragmented and suboptimal care. You see a dermatologist for acne, a pediatrician or GYN for the menstrual irregularities, maybe a medical endocrinologist if pre-diabetic, and no one communicates with each other. I have seen friends with PCOS being diagnosed with seizures and migraines when really, what they are experiencing, is hypoglycemia as a result of the insulin resistance that is inherent in PCOS. I have seen PCOS girls placed on high-androgen activity birth control pills, just because they were low in estrogen. High androgenic activity is exactly what they don’t need! When the REI center where I work (RMA of CT) would get a PCOS patient referral, we would provide them with comprehensive care, communicate with all of their other providers, but only see the patients once a year or so, and really more follow-up was needed. As a result, the medical director, Mark Leondires, M.D., agreed not only to starting a PCOS clinic within the practice but also to hiring a nutritionist who specializes in endocrinology (this is very important) who works in-house. It has been so incredibly positive for our patients! The nutritionist also refers them to other complimentary care providers, such as psychologists, exercise physiologists, and acupuncturists so that their mental and physical needs are addressed. Can you talk more about what PCOS is and how it affects fertility? Simply put, PCOS is a disease the creates an environment in the ovary that is not conducive to follicular growth and ovulation. As a result, women with PCOS rarely ovulate, which can lead to infertility and endometrial hyperplasia (build-up of the lining of the uterus). We think that the “culprit” in this disease process is insulin resistance. Insulin is the ‘key’ by which blood sugar (glucose) is let into the cell where it can function as energy for cell processes. Patients with insulin resistance produce insulin in response to glucose, but the cells are not sensitive to it, so the pancreas keeps pumping out insulin, a process called hyperinsulinemia. Both hyperglycemia (excess glucose outside of the cells) and hyperinsulinemia are damaging to the cells (and body as a whole) over time. Excess insulin results in elevated androgen (male hormone) levels that already plague PCOS patients in the form of excess hair growth, acne, and/or male-pattern hair loss. Hyperinsulinemia also has metabolic consequences, such as high cholesterol and triglycerides, an increased risk for type 2 diabetes mellitus and other cardiovascular risks. Being overweight or obese exacerbates these risks, so the key to managing PCOS (and it can’t be cured, just managed) is to strive for a healthy weight and to eat and exercise in a way that promotes insulin sensitivity. What would you tell someone who has just been diagnosed with PCOS? I see PCOS as a ‘disruptor’, and I mean that term as defined as something that creates a challenge, a roadblock, takes you out of your rhythm or comfort zone. But the beauty of a disruptor is that it causes discomfort, which makes you decide to make a change in your life, usually for the better. In business, disruptors can lead to innovation. PCOS has been that for me, it provided the incentive that I needed to make mental and physical health a priority in my life. I would caution a newly diagnosed PCOS patient that it can feel overwhelming and frustrating at first, but it is manageable, controllable and might actually put you in a better place than your peers. For example, many of my friends who don’t have PCOS and are now in their 30s or 40s are struggling with weight loss after pregnancy or just an accumulation of weight over time. They could eat and drink whatever they wanted when they were younger and it eventually caught up to them. I was already disciplined by the time I had kids and it was a blessing in the long run. Are there any tips you can give someone diagnosed with PCOS? Come to terms with the fact that you have to eat differently than your friends or peers. Ultimately this is a good thing because it is the basis for a life-long approach to nutrition but it’s hard, at first, to see your friends eating pizza or pastries or ice cream and not gaining a pound, whereas you are more likely to gain weight and feel badly. Combining a ‘slow’ carb (usually one that is not white, like brown rice, quinoa…etc) with a healthy fat (such as avocado or natural nut butter) and a low fat protein in each meal can help avoid hyper- and hypoglycemic (low blood sugar) episodes. I’ve gotten to the point that I know what to eat to feel great and how I feel when I eat sub optimally. For example, I cannot have a meal that is solely carbs, like most breakfasts. I have had to automate my breakfasts because I know what works. I have either steel cut oats, eggs or avocado toast. By automating meals, it takes the indecision out and also assures that I have the ingredients in my house because it’s likely that I’ll be eating one of those three things every morning, so I have them on hand at all times. Automating meals, like breakfast and lunch and having a day for meal prep (mine is on Sunday) are huge in terms of being committed to healthy eating. What advice would you give to someone about to begin the process of infertility interventions? I would say to realize that the outcome is most likely going to be good because the great majority of people who undergo fertility treatments are able to achieve a pregnancy. The journey, though, can be bumpy. It can actually suck, if I’m allowed to say that. It’s so important to identify some forms of stress release that you can employ when attempting to conceive. I also advocate being “selfish” and let me explain what I mean about that. It’s ok to not go to everyone’s baby shower. It’s ok to feel sad or annoyed at pictures of babies that seem to have taken over social media. It’s ok to not want to listen to everyone’s problems or issues. It’s ok to have good and bad days, to feel that you go two steps forward and one step back. And it’s ok to lean on people, like your partner, friend and absolutely your nurse. No question is too stupid, no emotion too intense, no choice is wrong. I can’t emphasize that enough.
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Gary DeVane, M.D. is board certified in obstetrics and gynecology as well as reproductive endocrinology and infertility. The founding partner of the Center for Reproductive Medicine in Orlando, Fl., Dr. DeVane developed the first in vitro fertilization (IVF) program in Central, FL in 1985. Now retired, Dr. DeVane focused on providing high quality in vitro fertilization (IVF) with special emphasis on cost-effective minimal approaches to ensure that all couples have access to this treatment.
Please read more about Dr. DeVane and his work here: http://www.ivforlando.com/ For further information please visit www.ASRM.org a wonderful multidisciplinary organization dedicated to the advancement of the art, science, and practice of reproductive medicine. A note: This was a very special interview for me to conduct, as Dr. DeVane was my RE when I went through treatments. He was not only incredibly knowledgeable, but so kind, caring and genuinely concerned about each of his patients. Speaking with him years later, he is the exact same individual, someone I am very fortunate to have had as my physician. What motivated you to focus your career on fertility? I attended a training center for my internship and residency that was strong in internal medicine. It was a rotating internship and I spent a lot of time in OB/GYN. At the time, they were doing more interesting, cutting edge, endocrine science and I just got caught up in what was happening. I gravitated toward GYN Endocrine and that dovetailed into infertility. At what point would you suggest someone having trouble conceiving seek help? The insurance companies set the guidelines to actively trying to conceive for one year. I think that's fine for females under 33. But, as you age, everything becomes more difficult. When you're 35 and older, maybe six months. When you're over 38 you should probably start being tested right away. What factors should one consider when choosing a fertility specialist or a fertility center? I've always felt that a good OB/GYN should be the first step. A lot of OB/GYN's are just not too interested in infertility, though. They'll give you some information, read this, read that. Sometimes they'll try a simple oral medication. If the doctors are going to refer you out to a specialist or you want to be self-referred, you need to go to a physician that is full-service so that you have all the options on the table. If they offer everything, it means they've got the depth and resources so that you can make informed decisions. What should expect from first visiting a fertility clinic? It can be intimidating. I always felt, as a physician, it was important to review everything you had done up until that point so you didn't have to waste your time trying to tell me what happened. We always allocated 45 minutes to an hour for a new patient appointment so it was an extended visit. Usually there's a comprehensive but limited exam. We’d always do an ultrasound and you can expect to probably have some blood studies drawn. Sometimes you have to have them drawn at certain times during a menstrual cycle. Some women don't have cycles, which makes the process a bit longer. The work up takes roughly six to eight weeks and then you should have a follow up visit for a plan. One of the things I always felt was difficult was the amount of visits. When people are working and with traffic and everything, it's really hard to coordinate your schedule. That's one of the reasons we decided to do satellite offices-to make it a little more convenient. But honestly, there's nothing convenient about doing studies and being poked and prodded and all of the other things that have to be done to decide if there's something that needs to be focused on to be treated. What do you think you could tell someone dealing with infertility that might help put them at ease at the start of their treatment? They're not alone. It's a pretty prevalent problem. There are a lot of things that can be done, so many options, high tech and low tech. Some people don't want to go high tech and I certainly understand that. It doesn't work every time. One of the things I tried to always explain is, not every egg is going to be a baby and not every month is going to be a good month. There's going to be built in disappointment. It's hard because everybody is sort of a perfectionist and they want everything to be immediate. That's just human nature I think. That's where you come in. Counseling helps a lot. What are your thoughts on the mind/body connection regarding infertility? I’ll be honest, I used to think, with IVF, we were sort of taking control of the situation. It wasn't until Alice Domar published a great study that I changed my opinion. She showed how the mind body approach could affect IVF outcome results, through stress release and other factors. It was just mind boggling. Everything is interconnected and towards the latter part of my career, the last five to ten years, I was really pushing yoga and meditation and, under certain circumstances, acupuncture. I totally believe that mind and body are interconnected and both need to be working right for things to work correctly. I've always been interested in hormones and endocrine studies but it's very clear that stress effects a lot of your endocrine system and it definitely effects your health. Can you tell me anything about the current and most effective treatments for infertility or any advancements on the horizon in the field? It's all about genetics and the ability to determine if an embryo is genetically normal. You can do certain enzyme studies to make sure that the energy part of the embryo is normal, the mitochondria. It's heading into high-tech techniques that improve outcome. Is there something that you used to find yourself saying to most patients over and over? I would always reassure them that it's going to happen, but it's going to take some time. When you have a long career, you saw that. Sometimes I'd also think a break from treatment was a good idea. Sometimes during the break, they'd get pregnant. In those cases, I knew it wasn't anything I did. It was meant to happen. What does a success story look like to you? The patients, and I remember them, who did everything recommended, and it still didn't work, yet had a good experience. They didn't say, “oh it was misery, the whole thing was misery,” even though it was misery at times. To me, that's a success. But in our little field, it's all about take home baby. That's the gold standard. Are there any outcomes that have stuck with you or made you proud? Every baby made me proud. Everybody wants a family, but when you work as hard as couples have to when they have to go through all that we make them go through, it means that these babies are really wanted. What was your favorite thing about working with your patients? It's all about the patients. I like the idea of life and helping couples achieve their life goals. It's all about the patients. I had delightful patients and it was just an honor. It was a pleasure to be in a position in dealing with people who were so highly motivated to achieve an outcome. If I asked people to stop extensively exercising, as much as they enjoyed the exercising, they usually did it. Weight loss is very difficult but patients would do it. Weight gain is even more difficult. They would do that. Highly motivated, wonderful patients. Every day was almost a good day. Why do you think that there's often secrecy surrounding infertility or miscarriage? I think it's probably because it's private. I think that's part of the problem too. You want to internalize everything and keep it even from your parents but I've found that people who were more open about it seemed to do better. I think it's very private. It's a part of your marriage, your sexuality, all of these things. Some people just aren't comfortable sharing that with others. Any advice you can offer to those that have experienced a miscarriage? It's painful and the scientific, important factor is that one or even two miscarriages doesn't necessarily mean that you're going to have another miscarriage. As a matter of fact, it's something like 70% chance your next pregnancy will be successful. Miscarriage is always a loss. One of the things I would stress to couples is, you need to wait before you get pregnant again. Your body, your mind, everything isn't back to normal yet so I always thought you needed a little time to reflect on the loss and also to let your body return to normal. Do you think that there's ever a point when enough is enough? What would your advice be then? Yes, unfortunately. It's hard because you read about all these people that are getting pregnant at 47, movie stars and other famous people and you think, “why not me?” I had patients who did everything, donor egg, everything. There were factors that we couldn't control and the only real option, which is a very difficult option, it's expensive and it's not for everybody would be using a gestational carrier. Sometimes they would decide, “We're going to move on with our lives and we're going to stop doing all of this.” It's hard. That's a very hard discussion for sure. Dr. Alice Domar, Ph.D., is a pioneer in women’s wellness. The founder and Executive Director of the Domar Centers for Mind/Body Health and the Director of Mind/Body Services at Boston IVF, she established the first Mind/Body Program for Fertility. Dr. Domar is also a senior staff psychologist at Beth Israel Deaconess Medical Center and an Associate Professor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School. Her cutting-edge research focuses on the relationship between stress and different women’s health conditions for which she creates innovative programs to help women decrease these physical and psychological symptoms. She has earned an international reputation as one of the country’s top women’s health experts.
Dr. Domar also recently lauched an app called FertiCalm. A Mind/Body relaxation app, FertiCalm gives the user more than 500 custom coping strategies for over 50 specific potentially distressing situations that can arise throughout one’s infertility journey. Find it here: http://FertiCalmApp.com/ To read more about Dr. Domar, her internationally-recognized work, and to find information about her speaking engagements, please visit: https://www.domarcenter.com www.bostonivf.com http://www.dralicedomar.com/ How did you become interested in fertility counseling? My parents went through primary and secondary infertility. It took them about seven years to get pregnant with my sister and five years to get pregnant with me. They talked a lot about how hard it was to go through infertility, so I was very aware of it growing up. And hearing about it really impacted you? It did. I got my Ph.D. in health psychology and the program called for a medical specialty as well. I chose OB/GYN because no one was really doing anything for the mental health of women who had OB/GYN medical issues. When I was doing my post doc, the head of the infertility center of Beth Israel Hospital proposed that we do a study looking at the impact of relaxation techniques on unexplained infertility. I started doing that project, and then began offering The Mind/Body Program for Infertility in September of 1987. It was immediately extremely popular, and we started noticing that women were getting pregnant. This led to getting two sequential grants from the National Institute of Mental Health, to study the impact of stress on reproduction. I've trained people all over the world in the Mind/Body Program. I lecture constantly about the stress/infertility relationship. I believe there are lots of people out there who have benefited from looking at this equation. Can you talk a little bit about how stress affects fertility? Well, it's a chicken and egg question. We know that infertility causes a tremendous amount of stress, and fertility affects every aspect of a person's life. It affects their relationship with their partner, it affects their sex life, it affects their relationship with their family, and their relationship with their friends. It affects their job or career. It affects their financial security, and it affects their relationship with God. There is really no other disease that does that. And, on top of it, people blame you for your condition. If you're diagnosed with cancer no one says to you, "Oh, just relax, your cancer will go away." But when you tell someone you’re dealing with infertility they say, "Oh, just relax, just adopt, stop working so hard." Infertility has been classified as a disease by the World Health Organization and yet it's not covered on most insurance policies in this country. People see it as an elective entity. The disease itself causes tremendous stress, and unfortunately, I personally think that stress then contributes to infertility. And the reason I can say that with relative authority at this point is there have been a lot of different studies looking at psychological interventions for infertility patients. And pretty much every one of them has shown that when women do some kind of stress management regime, their pregnancy rates double. In fact, in two of my studies they almost triple. You also did a study that talked about how stress levels of those dealing with infertility are on par with cancer or heart disease. Yes, they are. The one I did was the first to show that, and there have been two or three studies since then, and they all show that fertility patients and cancer patients incur comparable stress levels. You established The Domar Centers For Mind/Body Health, can you tell me more about the program? At The Domar Centers we have a lot of different modalities and we only offer ones that have research behind them. We offer the Mind/Body Infertility Program. We have three psychologists who do individual and couples counseling, mostly cognitive behavior therapy. We now have five acupuncturists, and I think we're going to have to bring on a sixth. We offer acupuncture 7 days a week, 365 days a year. And we have a nutritionist because we know that obesity or being underweight make you less fertile. Speaking of nutritionists, you advocate health care professionals making better lifestyle recommendations for patients. Yes. When I see a patient for the first time, that's what we call the Mind/Body Consult, where we go over all their lifestyle behaviors, because we know that excessive exercise, alcohol, nicotine, caffeine, depression, all those things can reduce fertility. I've had so many patients who literally cut back on exercise and spontaneously got pregnant. Or, look at the impact of anti-depressants. We published a paper about three years ago, a literature review showing that anti-depressants may hinder fertility. And yet, our own data show that anywhere from 11-13% of infertility patients are taking an SSRI, and no one's telling them to try going off it. In regards to using modalities that have research behind them, you’ve talked about how group interventions might be more helpful than individual sessions. Yes, the more powerful data is on group. A researcher in Wales found that skills acquisition, not simply talking about how hard infertility is, benefits women the most. And another meta-analysis showed that interventions that were more than five sessions were more effective than interventions that were fewer than five sessions. The Mind/Body Program is ten sessions. It’s CBT with probably ten different relaxation techniques. One of the ten is mindfulness, but muscle relaxation, autogenic training, hatha yoga, imagery. We do a lot of different ones so that patients can pick and choose the ones that work for them. Why do you think the groups are so helpful? I think it feels really safe. And I think infertility is still really so isolating. A lot of people don't talk to anybody about their infertility, they’re not going to post on Facebook, "Oh, my IVF cycle failed." With a group, someone can walk in a room and say, "I just found out my sister's pregnant," and everyone will go, "oh, we're so sorry." Which is exactly what she needs to hear, rather than, in the real world, people think, well, you should be happy for your sister. I think being with other people who really get it, you can talk about stuff and they say, “oh yeah, me, too.” Or hearing other people say stuff that you were embarrassed to even think about. It’s very reassuring. Why do you think there's so much shame and secrecy surrounding infertility and miscarriage? It’s a question I've asked a lot. I think because it involves sex, and shame, and loss of femininity, or masculinity, virility. It's embarrassing. It’s part of your reproductive organs and we don't usually talk about stuff like that. Which makes it really hard because there's very little public discourse about it, and so all these ridiculous myths keep on going around. And celebrities that have twins at fifty, they keep those myths alive, and so when someone does confide in another that they're going through infertility, that person proceeds to repeat all these myths. Speaking of those myths, what are your thoughts on when people just say, "just relax and you'll get pregnant?” I want to slap them. There is no data anywhere that shows that relaxation leads to fertility. When you look at the data on these psychological interventions like the Mind/Body Program, my patients work really hard. They’re coming to a class for 2 1/2 hours, for ten weeks. They're practicing relaxation techniques every day. They're doing cognitive behavior therapy every day. They're changing all their lifestyle habits. They're learning to communicate with their partner in a different way. That is not relaxation. That is a whole reset button. You have seen extraordinary rates of success with your Mind/Body Infertility Program. Can you talk more about the outcomes that you've seen? The outcome I focus on is psychological improvement because I'm a psychologist. I always tell patients that pregnancy is a happy side effect. The goal of the program is not pregnancy. The goal of the program is to get your life back, so that you don't live in 28-day cycles, that you become who you were before, someone who just also happens to be going through infertility. That said, usually more than half of our patients get pregnant within six months. You wrote, in Conquering Infertility, “I always tell infertility patients that if you want to be a parent, somehow, some way you will.” I do believe that. I think, a lot of the work I do with patients is, if they need to be moving in that direction, is to start thinking about what parenting really means to them. Are you becoming a parent to reproduce yourself or your parents? Are you becoming a parent because you want the experience of parenting a child? It’s a hard journey, but when people make it, and they move on to donor egg or donor sperm, and they have children, they are invariably ecstatic. You just had that baby, it's your baby. No question. There's no data to show that parenting a donor egg child is any different from parenting a genetic child. What is your favorite thing about working with your patients? When they get happier. When they get back to being the person they were before infertility. And I do, I love the babies, I certainly got into this field because I love babies. About every couple of weeks either someone brings in a baby to visit, the donor egg babies and the adopted babies and the pregnancy babies, it's really nice to see my patients happy. Is there something you find yourself saying to most patients? Something you find yourself saying over and over again? Yeah, it sucks. Infertility sucks. It's really hard and I think people going into it don't know how hard it's going to be. What advice can you offer to someone seeking therapy while dealing with infertility? I would ask your infertility doctor who they recommend. There are a lot of people who put out shingles saying they specialize in infertility, which means they've seen one infertility patient. They also can go to the American Society for Reproductive Medicine website, www.ASRM.org, and look under the Mental Health Professional Group, and all the members are listed. Those are the people who really specialize in reproductive medicine counseling. *interview has been edited and condensed for clarity. Dr. Rodgers is board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility, and has been practicing medicine since 2004. She currently practices at the nationally and internationally-recognized Fertility Centers of Illinois. Dr. Rodgers’ personal experiences with both secondary infertility and pregnancy loss give her unique insight into reproductive medicine, and she is well-known for her compassionate and individualized patient care. Dr. Rodgers’ blog Destination: Parenthood is featured on ChicagoNow.
What motivated you to focus your career on fertility? I was really drawn to the physiology of pregnancy and conception, so in medical school, I came to the conclusion that this was what I wanted to do. Once you started experiencing your own personal struggles and issues with infertility and loss, how did that affect your work? I think that as physicians, as health care providers, we need to be able to be very empathetic and take care of a whole host of things. As a cardiologist, you don't have to have a heart attack to be able to take care of someone who has a heart attack, right? We don't need to have to go through everything our patients have gone through to take care of them. However, from the emotional side, I gained the very personal insight of how difficult it is. They say that going through an infertility diagnosis is as stressful as cancer or HIV. I saw patients struggling but it wasn't until I went though it myself that I could really relate in a unique way. What would you say is your favorite thing about working with your patients? Building relationships with patients. You take them through this very difficult journey-you’re their guide, cheerleader, and coach. You share tears of pain with them and then at the end, share tears of joy. To witness the happy endings-it's the best thing in the world. What do you find yourself saying to these patients? I spend a lot of time with patients who have not been successful and are coming to see me for another opinion. I think a lot of people come in feeling very hopeless and, in fact, their situations are so hopeful and there is so much that can be done for them. I try to give patients realistic expectations and I spend a lot of time talking to them about what a good prognosis they really have. Do you find that most patients are more apt to be hopeless and then find they can get pregnant, or vice versa? I think there is a mix, obviously, but I do think there is a significant number of patients who, by the time they come to me, have been trying on their own for a long time. Or they have been trying with their OB for a long time, and are finally getting to me-I think that they're feeling pretty frustrated and upset by the time I see them. That makes sense. What does a success story look like to you? I think that helping people get what they want, whatever that may be. Are there any outcomes that have stuck with you or made you really proud? The majority of patients that I see have a very, very good prognosis and end up being successful. I think that there are definitely a lot of stories where people have tried with other doctors and have not been successful and then they come to me and we are very successful. I've had lots of patients like that. The hard cases, the cases that have the poorest prognosis and helping those patients be successful, that's the best. What can you tell somebody dealing with infertility that may help put them at ease at the start of their treatment? I try to give patients a very realistic expectation about what their prognosis is. I do really think that the process can be overwhelming so I really try to give patients resources and contact information- to my nurse, myself, et cetera. That way, when they go home and think about it and have questions or are worried, they can have someone to reach out to. Someone to reassure them about what we're doing, what the next steps are, all that. Are there any misconceptions about infertility that you want to put to rest? I live in a state that has a state mandate for fertility coverage. But there are a lot of places not like that. So, a lot of people say, “oh, it's going to be crazy expensive.” I also hear: “you're going to end up with twins;” “you're going to have to do IVF;” or “you're going to feel miserable.” I think when people talk to the people in their lives about going through treatment, there's always somebody's horror story or somebody's misconception about what I do that I have to dispel. I would encourage patients that technology is moving extraordinarily fast and there is so much we can do to be helpful to them. I would encourage them to talk to a medical professional about what concerns they have about treatment, etc., instead of the people in their lives who may be well-intentioned but may not be giving them the right information. Do you have any thoughts on less traditional methods to treat infertility? I think that there's a lot of people who do amazing work. Obviously, I'm a medical doctor, so I'm very interested in evidence-based medicine, research trials showing that differences can be made. I'm very interested in numbers and statistics and I want my patients to be as successful as possible. But, we're not just a physical body. We are a mind, a soul, a body, and I think that incorporating things like yoga and acupuncture are really helpful for a lot of patients for stress management and help to get through treatment. I feel like some people are very well-intentioned but really don't know what they're doing. People who prey on those who are hopeless and will charge a lot of money for things that have not been proven to be effective. People are hopeful because it's quote unquote natural or something and it's not successful. I think some of these things it doesn't hurt to try, but not if you're wasting precious time. Obviously, age can be a factor and you don't want to be wasting a lot of time that may be the time that you have to get pregnant. I always encourage patients trying to take a very holistic approach and incorporating different modalities of treatment but obviously I'm biased with where I'm coming from. What are your thoughts on stress and infertility? I do think that there is for sure evidence that stress decreases pregnancy rates. The hard part is that we're all stressed. A lot of us work and have to balance the stress of a job, financial stress, trying to make sure there is food in the refrigerator and you don't run out of bleach. I'll tell you about the million things on my list every day that are just normal living, right, and then this on top of it can be very hard! I really encourage patients to do stress management. I myself saw a therapist when I was going through this and it was extremely helpful. I think that by the time you walk in my door, you probably could use a therapist because it's such a difficult thing to go through. There's a lot of other things such as, yoga, acupuncture, and massage. People do painting classes. People do all kinds of things for stress management. I really encourage my patients to explore things and I give patients the homework of taking some time for themselves. At what point would you suggest someone having trouble conceiving look for help or seek out a reproductive endocrinologist? The traditional thought is that anybody who is 35 or older should come at six months of trying. Anyone who is under 35 should come at a year. That being said, if you're not getting regular periods, then you may not be ovulating. So: if you have any menstrual irregularities; if you've been previously told there is an issue with your eggs; or if you've had surgery on your ovaries before, there may be issues. If you have diagnosis of endometriosis, there may be issues, or if there is any sort of male sexual dysfunction. Those are some things where you should see somebody sooner. Any thoughts on what somebody should consider when choosing their fertility specialist or center? There's a lot of people who get pregnant without needing IVF. But, for IVF, the quality of the lab is extraordinarily important. For all fertility treatment, it's really important that you feel very comfortable with your physician and the physician's team, including the nurses and their support staff and that you feel like you're able to address concerns, get questions answered, and have someone to go to when you're not sure what's going on. What should one expect when first visiting a fertility clinic? I know it's hard to say definitively because everybody's treatment is so individualized. When I see a patient for the first time, I take a very detailed history, review any previous records they have done, and then I put together an evaluation plan of what I would like to see in terms of answering the questions I have about their case. Some general health stuff, typically: an evaluation of semen analysis; evaluation of the tubes; the uterus; ovarian reserve ovulatory function; and a bunch of other things just for general health and a healthy pregnancy. I usually talk with the patient, then do a consultation, and then make some recommendations on evaluation. Typically we do that evaluation during certain parts of the menstrual cycle so it takes a couple weeks to get all that testing done. Then I like to meet back with the patient and go over all the results and work together as a team with the patient to come up with a treatment plan. Is there any question you feel they should be sure to ask? It sounds like it may not be an issue for your patients since you keep the lines of communication so open? I think we all tend to think about things later as we're driving or whatever, mulling things over and processing, and I think my patients leave my first appointment with literally a checklist of the things that I would like to see from them. I have myself and my nurse go over things in a very detailed manner. Then I also give them emails for myself, my nurse, phone numbers so that if they have follow-up questions or they're not sure when to come back, whatever, they can ask anything that comes up along the way. What are the most current and effective treatments for infertility currently? Generally, fertility treatments include pills or shots to help make more eggs and then we combine that with either intercourse, inseminations (where we put the sperm up inside the uterus), or IVF (more invasive and more successful). Any advancements that we haven't really heard about in the public in the field? There is so much going on right now. I think a lot of it is looking at trying to improve genetic analysis of embryos and genetic analysis of the uterine lining. There is also a lot of research done on IVF techniques. There is all kinds of new stuff coming out of trying to change or alter the way we do IVF to be more successful and more cost effective. Any advice you can offer to those that have been through a miscarriage? Obviously there is a huge loss when patients have gone through a miscarriage and I think it's important to grieve that loss. And, I would encourage people that, as awful as it was to go through a loss, there is a silver lining that you were able to get pregnant-not always but almost always, it's something wrong with the embryo or the baby and not necessarily the patient's body. Time is not totally on our side but as soon as you can gather the strength to move forward, you should. I can tell you, literally, the day I found out I had my miscarriage, I was like, okay, when can we move forward again? Not that I didn't grieve. I did, but I was like, okay, let me try to get myself one step closer to my goal of having a baby. I do see a lot of patients who say, “I need a break,” and they just sort of step back. Is there ever a point where you realize somebody is not going to get pregnant and if so, what do you do then? I think that there are definitely times where I have multiple conversations with patients about how it may be time to start thinking about donor eggs or maybe it's time to start thinking about using a gestational carrier. Those are hard things so I bring them up early: “hey, this is always an option, let's think about it.” And, as treatments fail, it's something people consider more and more. I think it's really a case by case as an individual basis but I have patients who goes through a couple IVF cycles with no embryos. Either we didn't get eggs or the eggs didn't fertilize or they weren't mature. Those are cases that are heartbreaking obviously for a patient but it's really important to tell them, “Hey, there's a lot of hope. Let's think about other options.” Obviously, nobody wants to think about other options like that. Why do you think there is so much secrecy surrounding infertility and miscarriage? I think that there's a lot of people who have a lot of sadness and grief around what's going on with them. We all have a little bit of keeping up with the Joneses a little bit, and I think for some, it sort of represents failure of a woman, failure of a marriage, failure of your body. I think there's a lot of women who feel like they're failing and they're so sad and ashamed and upset about it that they don't really feel comfortable talking about it. It's a really hard thing to go through. There's plenty of things that our friends and our family members go through financially, emotionally. We have no idea. People are having difficulty in their marriage. People are having difficulty paying their mortgage. You have no idea. I think that this is just another one of those super difficult things that people go through that people just aren't very open about. Dr. Rodgers, thank you so much for your time and insight, I look forward to talking to you again soon! My pleasure. |