Episode 53: A Whole Range of Feelings on the Path to Parenthood
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Fertility challenges can come with a whole range of griefs — not just the loss of a pregnancy or the hopes of genetically related children, though those losses can be devastating.
There can also be grief around losing trust in one's body, around decisions made in the past that may or may not have impacts now, around identity and sense of self, or even around just not having things happen the way they seem to happen "for everyone else." The Whole Pineapple Podcast joins Wendy! In this episode with hosts of the incredible fertility podcast The Whole Pineapple, Grief Coach Wendy Sloneker and guests Ruby Booras and Anne Judge talk about not just the grief — they also talk about the many many reasons for hope. |
Wendy talks with Anne Judge and Ruby Booras of the Pineapple Podcast about fertility and the many reasons for hope.
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You are Invited
We hope you'll share this very special episode with anyone in your life who may be struggling to build their family.
You can find Ruby and Anne and their catalog of episodes all around fertility and wellness at https://thewholepineapple.com/. And if you're looking for support for grief of any kind, make an appointment now for a complimentary consult with Wendy at https://www.wendysloneker.com/.
About our guests:
Ruby Booras, DNP, ARNP, FNP-BC, DipACLM/DipIBLM (She/her, They/them), is a Doctor of Nursing Practice, Board Certified Family Nurse Practitioner and a self-proclaimed nutrition nerd. She specializes in Reproductive Endocrinology and Infertility and has been in clinical practice at Seattle Reproductive Medicine since 2012. Over the course of her career, Ruby has experienced personal and professional growth, unexpected challenges, mental health struggles, pregnancy loss, and the various ups and downs of her own journey toward wellness. Ruby has a certificate in Plant-Based Nutrition from the T. Colin Campbell School of Nutrition Studies at Cornell University and is an American College of Lifestyle Medicine Diplomat, holding Certification as a Lifestyle Medicine Professional. She has been integral to the launch of the Wellness Program at SRM. As creator and co-host of The Whole Pineapple podcast, Ruby’s goal is to provide a reliable, supportive and science-based resource to guide people to their fertility and wellness goals and to power their WHOLE lives.
Anne Judge, DNP, ARNP, WHNP-BC (She/her), is a Doctor of Nursing Practice, board-certified Women’s Health Practitioner, who has been working in the fertility field since 2007. She first graduated from Stanford University with a degree in Human Biology. She completed nursing school at the University of Washington and was working as a labor and delivery nurse when her own experiences with infertility led her to change paths into reproductive medicine. After almost 15 years working in the fertility field, she is excited to share her knowledge and compassion with our listeners. While finishing her graduate training she struggled with whether to complete her original dream and Nurse Midwife program, but ultimately felt called to stay in the fertility field as a Women’s Health Nurse Practitioner. While she is still always happy to talk about all things birth, she finds the process of creating families most valuable. She is reminded of the wise words from one of her midwife instructors, “Let someone else catch the babies, you will catch the mothers.”
We hope you'll share this very special episode with anyone in your life who may be struggling to build their family.
You can find Ruby and Anne and their catalog of episodes all around fertility and wellness at https://thewholepineapple.com/. And if you're looking for support for grief of any kind, make an appointment now for a complimentary consult with Wendy at https://www.wendysloneker.com/.
About our guests:
Ruby Booras, DNP, ARNP, FNP-BC, DipACLM/DipIBLM (She/her, They/them), is a Doctor of Nursing Practice, Board Certified Family Nurse Practitioner and a self-proclaimed nutrition nerd. She specializes in Reproductive Endocrinology and Infertility and has been in clinical practice at Seattle Reproductive Medicine since 2012. Over the course of her career, Ruby has experienced personal and professional growth, unexpected challenges, mental health struggles, pregnancy loss, and the various ups and downs of her own journey toward wellness. Ruby has a certificate in Plant-Based Nutrition from the T. Colin Campbell School of Nutrition Studies at Cornell University and is an American College of Lifestyle Medicine Diplomat, holding Certification as a Lifestyle Medicine Professional. She has been integral to the launch of the Wellness Program at SRM. As creator and co-host of The Whole Pineapple podcast, Ruby’s goal is to provide a reliable, supportive and science-based resource to guide people to their fertility and wellness goals and to power their WHOLE lives.
Anne Judge, DNP, ARNP, WHNP-BC (She/her), is a Doctor of Nursing Practice, board-certified Women’s Health Practitioner, who has been working in the fertility field since 2007. She first graduated from Stanford University with a degree in Human Biology. She completed nursing school at the University of Washington and was working as a labor and delivery nurse when her own experiences with infertility led her to change paths into reproductive medicine. After almost 15 years working in the fertility field, she is excited to share her knowledge and compassion with our listeners. While finishing her graduate training she struggled with whether to complete her original dream and Nurse Midwife program, but ultimately felt called to stay in the fertility field as a Women’s Health Nurse Practitioner. While she is still always happy to talk about all things birth, she finds the process of creating families most valuable. She is reminded of the wise words from one of her midwife instructors, “Let someone else catch the babies, you will catch the mothers.”
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Full Episode Transcript
Ruby Booras
You are listening to the Heart Healing from Loss podcast with Wendy Sloneker.
Anne Judge
And this is episode 53.
Wendy Sloneker
Thank you for coming on back. Thank you for the introduction, Ruby in an it's amazing that I have the Whole Pineapple podcast host here today with us. Ruby Booras and Anne Judge of the Whole Pineapple podcast.
Anne
Thank you so much for having having us. Yes
Ruby
I'm Ruby
Anne
This is our first time being guests on someone else's podcast. So we are very fancy.
Wendy
I had no idea because you guys have been like super champs, like this entire year. It's been an explosion of the Whole Pineapple podcast, which please go subscribe right now. Like, honestly,
Ruby
you got it.
Wendy
You gotta get somebody I ran into Incidentally, I I was talking on the social medias. And it was with somebody and they were saying, Oh, my gosh, you know, the Whole Pineapple. Of course, I know the whole pineapple podcast. The Whole Pineapple. Really like a delight to meet friends and fans. Just around in the world?
Anne
Well, it's so interesting, because you know, your episode just aired on ours not too long ago, even though we've recorded with you so long ago, I think you were only our second or third guests when we were recording. But then your episode was so great. And we thought it was very timely to wait and release it in October since that was pregnancy loss Awareness Month, and we thought it would be most helpful them. But that I do feel bad because I was like, oh, man, it's been a long time. So I'm glad we're finally here. Getting to return the favor and get yours.
Ruby
It's definitely like, yeah, we'll be on yours. You'll be on ours. And we're like, hey, thanks. See you later.
Wendy
No, no. Before the end of the year, it's totally like right on time a
Anne
new podcast who dis?
Ruby
We're spicy. We're a little punky today.
Wendy
Bring all of it. Awesome. So like, we can be just like candid, and and awesome. And the topic is serious, right? So we don't have to take ourselves seriously. But we can take like the nature of fertility and infertility very seriously. So I do want to honor the topic. And at the same time, like, allow for this conversation to be juicy, number one, and also just like really valuable, and with lots of amazing human feeling and education. Yes, for sure.
Anne
I mean, I think I'm pretty honest about this on that podcast, as in past infertility patient. And that's kind of what led me to work in here. And part of why we want to do what we're doing with the podcast. I mean, this is such a deep topic. And it cuts to the core of a lot of people's beliefs about themselves and what their family is going to look like. And it kind of can shake your foundation on religious aspects.
To me, there's so many hard topics that go along with it. But it also involves a lot of bodily functions, and things that we don't always talk openly about. And it has some humor said like, Yeah, I think you kind of have to end up seeing some of the humor in that situation to get through the absurdity of it all that you're like at a doctor's office talking about, you know, sexual positions, or if you've noticed cervical mucus or this and that. So, yeah, I think we're very open. And that's sort of what we wanted to do with our podcast is break down a lot of these walls that are up there about us being open about talking about something that is so incredibly common.
Ruby
It is one eight, I think is still the updated number one and eight people are impacted by infertility. And it's, I would say even a higher statistic for people that have experienced miscarriage or pregnancy or infant loss. So grief is kind of one of the things that we do certainly we have like we we are in the moments of celebration, but our we're in this field that's very unique, where we can have a yay congratulations, kind of like on down one one side of the hallway and then immediately go into another room and have to switch over to Okay, now we're dealing with something that is incredibly sad and hard. So it is it's definitely a different field. Lots of emotional, I don't know what you call it like breath, right?
Wendy
Total range. Yeah, total range in that and you know, grief or disappointment or frustration. It's just part of the package. It's just part of the package, especially around something that you want so dearly. And that is to you know, have a child or become a parent, create your family. So I think it might be useful and helpful to talk about conflicting feelings or a breadth of feelings, like you were saying, because I'm sure you you as practitioners, like who have to deliver, like clinical information with a human heart to human people. Like, yeah, what is that? What does that, you know, like? Or what does that entail or contain? I know, that's very wide crits question,
Ruby
Anna. And I have both been doing this for a long time, I think and just had her 15 year anniversary, I just had my 10 year anniversary. So we have a lot of experience within our jobs. So we've met a lot of people. But we do have these overarching, you know, themes that come up very frequently. And one actually just talked to a patient about just now before I walked in the door was how frustrating it is to get normal news, like, oh, everything's normal. It's like, yes, but I'm not pregnant. So, like, you almost want something to be wrong, or to be like you want, you just want to answer. There's something not satisfying of being told, like on paper, everything looks good,
Wendy
Right? Right. And this can feel similar to when people have losses of other kinds who are like, well, three days and like we're back to work, or we're back to whatever, like it's back to the normal when it's not normal, because your life has totally changed, or it hasn't changed in a way that you want.
Anne
Yeah, and I think you grief is such a good word that we don't use often enough when we're talking about people that are having this sort of fertility journey, because even before we do any kind of testing, like for a lot of our patients, the fact that they're scheduling a visit with us is a type of grief because they it's not typically what they expected. You know, a lot of people in their mind have this idea that when they're ready to try and get pregnant, it will just happen you and even if they knew that they were potentially going to be doing some sort of fertility treatment, maybe they are always do they'll gonna do donor sperm, maybe they thought they would just be doing home insemination, like they didn't realize that they would be suddenly entering this medical system to be able to achieve a pregnancy.
And so there's already that grief of the expectations having to kind of slowly get chipped away and a lot of infertility treatment for some people can feel like you just keep chipping away more people like Well, I'm willing to do some testing, but I would never do IVF well, maybe I'll do IVF. But I never do donor a well, okay, maybe we'll do one more time, you just sort of keep moving the goalposts of what you're open to, then we see that sometimes it's kind of a good thing. Because when people come in, we're like, you know, if you are committed to building a family, like it will happen, there are so many ways to build a family.
And it's all about figuring out the one that's going to work for you. But it's often not the one that you first expect it. And there's a lot of getting reef involved and having to let go of those expectations that you kind of might have had since childhood about the way you thought this is going to work out.
Ruby
Right. No one and I know that no one wants to come to see us. Yeah, right. Like there might be like, Oh, I'm excited. Yeah, right. Like, exactly. It's like, sometimes there's like this excitement like we're moving forward, we're doing something but there's no one that ever wants to come to a fertility clinic.
And when you think about grief in our field, they're automatically things come to your head, like yes, miscarriage and and those types of losses. But also I just saw a patient recently to where her fallopian tubes were blocked, and she was not expecting that. And so now we had to have a discussion like listen, our first plans not going to work. Now we have to move on to IVF, which is a more invasive and involves more medication and costly options. So there is grief, grief, all the way along the journey in different ways that are often coming up very unexpectedly.
Wendy
Right? Right. It's so wild, because there's no guarantee. But there's also like so much kind of, right, like the reward is so big as well. Right? It's like a heart's desire.
Anne
Well, that's what I had a friend of mine back forever ago, when I was a patient, she was talking about having to take out what seemed like this massive loan to be able to afford to do IVF and she's like, this is kind of crazy, like, I could buy a car and then she's like, but if I do buy a car, you know, how long am I going to have that car and you know, best case scenario maybe like 15 years and she's like, you know, this is talking about a child for the rest of my life and but there's also not a guarantee. It's not like you put down all the money for the car, and then they're like, hey, there's a 50% chance you drive off the lot with what we don't know.
And so it's definitely it's it's tough. And so what are the other things we want to get the word out for is hopefully next year, Washington state is going to be trying again to pass a bill to make fertility coverage be mandated which would be huge. So definitely encourage listeners of fertility is an issue near and dear to you and you live in Washington State. Follow because talking to your representatives, letting them know how important this is and how How much that financial piece can impact people's decisions? I mean, that's a huge source of great people that are told, hey, you need to do this to be able to, you know, try and achieve this dream of yours, but they just can't physically afford it. It's heartbreaking.
Wendy
Totally. Yeah. Yeah. Wow. I would, I would love to hear a little bit about what you recommend, because it's like, we've talked about grief. And we've talked about frustration. And I imagine that for many that there's a sense of like, time and timing, like to hurry, hurry, hurry, because like, there's the unknown piece of, how much time we actually have to do this, this process or go through this path, or this part of the journey in order to hopefully arrive with a child. So I would like to, I mentioned, stress is not helpful when it comes to going down this journey. So what would you offer or share? What do you frequently share with your patients around stress? And impatience? Because, yeah, that's a very
Ruby
Good question. Yeah, it's very rough. The biggest thing, though, and every person who has had any sort of fertility journey or know somebody who has, knows to not say the words, just relax, it's not helpful.
Anne
It's not helpful, or how to do that. Right? Just think about it and make a list of all the terrible
Ruby
a whole list of them. And they're, they're meant, you know, good as meant by that. Like, they're, they're well, meaning Yeah, but they don't, they, they don't work, it's actually the opposite effect, like, because how does one just relax or not think about something that you want with all of your heart. So that's the biggest thing, what I tell my patients a lot is, especially when they've had like pregnancy loss on top of their infertility.
And now like, let's say they're pregnant again, or something, and it's very early, and they have all this anxiety. One of the very first things that I say is like, you're gonna be anxious no matter what, you know, the one thing that you can control is like, just letting go of the fact that you're going to be anxious, because I don't know. And if you've noticed this a lot, but then we get patients that start being really worried about being anxious and anxious about being anxious. So that's an area that she's like, you know, what, just let yourself feel the feelings. They're gonna happen anyway. Really good.
Anne
Yeah. And I mean, going back to we've had decades of research now on stress and infertility. And everyone cites one of the original classic studies by Dr. Ali Domar. But showing that, you know, people with this infertility diagnosis have greater rates of distress and anxiety than people facing a cancer diagnosis and HIV diagnosis, you know, things that are, you know, just can be life threatening, but infertility is identity threatening, you know, it really, you feel like someone's taking away the future that you had imagined.
And that lack of control, you know, it's hard to know what the outcome is going to be. And even in a best prognosis type situation, it's still nothing is ever a guarantee. And that can be so hard that you, you get this diagnosis. In some ways, I think it's a little harder the way that medicine has shifted over the last couple of decades, and that we're trying to not be as directive as we used to be, like, there's probably something a little bit nice about the doctor in the white coat, who would say, Well, this is what's happening, and you're gonna do XYZ, and you just follow the plan. But really, their choices, their choices all along the way. And so we're trying to explain to people their options, and that I think is great in the big picture. But that can also sometimes it's whelming. Yeah, because people are like, Well, what should I do?
Ruby
Big Question.
Anne
Everyone's just like, tell me the plan. And I'll do the plan to get the outcome. And even if you do the plan, you might not get the outcome.
Ruby
And that's all I think you've said and before you said on our podcast, like I would have poked myself in the eye with a needle shots.
Anne
It's like you'll do the shots wherever whatever people want, if you knew it would lead to a baby. And it doesn't always and, and I think also, the long view is so hard when you're in it, because you're just in that tunnel of every individual cycle. And it's always funny to me how the longer that I've worked here, the really more hopeful I get for my patients because I have seen people for almost anybody, I guarantee you I've seen someone at a, you know, on paper or even a tougher situation.
And people often think well, they are the most dire and you know, there really are options out there for everybody. It's just, it may not be an option that you thought you were gonna take from the beginning. And we know that things take multiple tries reproduction is incredibly inefficient. I think that's the other all of our sex ed, as kids really focuses on that. Like if you get sperm are you ever gonna
Ruby
get pregnant? I'm totally not sneeze.
Anne
So it can be a lot of unlearning and realizing like oh my gosh, look at all the steps that have to happen, and just in, you know, even once a pregnancy occurs, we know that way more pregnancies than we realize, you know, end and very early miscarriage before it can even necessarily be detected on an ultrasound or even a home test. And so I think once people look at all the things that have to happen, then it's kind of crazy that anybody gets pregnant.
Wendy
Right? How that happen? It is a miracle.
Anne
But yeah, do you guarantee that your sister in law will get pregnant every single time while you're trying to do treatments? See the photo world out there all the time, which is also different, because infertility is often kind of a hidden condition, you know, if someone was going through a medical challenge, where they were, you know, in a wheelchair, people wouldn't want to come up and say, Oh, I ran the best marathon last week, and I couldn't believe it, it felt so good to get my pace on. But like, people don't know what you're going through with infertility. So they think nothing about sharing, casual conversation about oh, my husband just looks at me and I get pregnant and all these things that are just like stabbing you and people don't know it. They don't know.
Ruby
Yeah, and speaking of, you know, that, that like, sex ed, like, don't don't look at each other and get pregnant, I get a lot of my patients tell me, especially our female patients who identify female who have ovaries are female, quote, unquote, reproductive organs. I hear a lot. Why didn't anybody tell me this? Yeah. Like, why did we not teach our teenage and young women about how their bodies work? Like, if I would have known this, you know, it's there's a lot of grief and regret, just from something that you didn't even know.
Wendy
Right, then that can feel like a waste of time that can feel like a waste of resources that can feel like a waste of a different like, you could I could have pivoted earlier, I could have like, really chosen this other path a lot sooner. And that can that can be just a really difficult pill.
Anne
And even the cost side, I people who were like, do I get a refund on my 10 years of birth control pills like this taking that I maybe didn't need to be taking? Right? Yeah. Yeah, why would that sense of historical regret is a big one.
And again, like there's so many factors outside of people's control. And it's a tough thing, because you also mean, there are so many factors that decide into when you're ready to try and build a family. And so even if, from an evolutionary standpoint, maybe we should be having our children in from 15 to 25. But that's not great in terms of our emotional maturity, and life and everything else. And so, biology hasn't quite caught up to modern society. And there's so many, so many strong benefits towards delayed parenting in terms of what you bring to the table as a parent. But if you have and are using a finite supply of eggs, then time is definitely a factor in a way that isn't necessarily for a lot of other things that might happen to us.
Wendy
Yeah, that's so interesting about the biological factor of it being kind of way behind similar to, like that primal part of our brain that is just really, really old, old cave person wiring, like, just even around emotion or thoughts. Amazing.
You mentioned hope a little bit earlier. And so being more and more hopeful, I mean, seeing the gamut. And speaking of range, just like range of things that can happen and do happen. That's that's kind of a delight to hear, especially in, in this arena. Can you talk a little bit more about hopefulness?
Ruby
Well, did you know that the pineapple is a symbol of hope, if you didn't listen to our very first episode? There's a reason we named it the Whole Pineapple.
Anne
And we got a little mascot for our show, which is a pineapple, and we did listener vote, and her name is Hope. So yeah, hope is indeed very important to us. But yeah, but you have to have hope, again, fertility treatment involves a lot of invasive, sometimes painful, sometimes quite expensive procedures. And you wouldn't do that if you weren't hoping in the end that it would work for you. And yeah, that ability to have hope, even in the setting of loss is such a human important emotion.
And that's what lets people do these things that at a paper level don't make a lot of sense. You know, if you were looking at from cold hard stats, you'd be like, well, I shouldn't do that again. But you know, that hope is, is powerful. And I think sometimes, the hard part is you see patients deliberately shutting down from that hope, because they're worried that if they allow themselves to be hopeful, it's just going to hurt more if this cycle doesn't work out.
And so sometimes we are more hopeful for our patients than they are for themselves because it's just a coping mechanism that they're like I'm just going to go into this all assuming the worst and I can be surprised and not saying that's not a valid way to do it. But we have worked here so long and seen so many you so many people get to the other side. That's the thing I always say like you are going to resolve your infertility, the way you are feeling right now is not the way you're going to be feeling a couple years from now.
And so you don't know exactly how you're going to resolve it. It might be a genetic child, it might be, you end up pursuing other avenues. It might be you adopt and might be you decide that you're going to be child free, and you're going to enrich your life and be just fine in that scenario, too. And I've seen people go through all those scenarios, and everybody ends up in a good place. And it's just hard not knowing exactly what that place will look like for you.
Wendy
Right, right. We certainly have our preferences, like we certainly have our dreams and desires. And we're also an adaptable species. No one's going to want to hear that on this episode. But we are.
Anne
And that uncertainty, that's I've had people say to people, like if you would just show me the crystal ball, if I just knew that's what it's gonna look like, then I'm fine. I'll work towards that. It's that not knowing that is so hard for people. Yeah, yeah.
Ruby
And I think because where our patients are at in their lives, they often don't learn it very successful human beings. And the control it like everything else is like, going their way. And it just is something that no matter what they do, is not going their way. So it brings up a lot of negative self talk, a lot of regret a lot of shame. I get a lot of patients that they are struggling to get pregnant, they, you know, long 10, 15, 20 years ago, had an elective termination. And now they're like, it's because I did that it's either physical or moral or something that this is why
Anne
Or they had chlamydia in college. And you know, that's why the tubes are blocked, and oh my gosh, it's because I was being punished for having you know, sex before marriage. I mean, there's this brings up so many things that their society has so many.
Ruby
Yeah, there's a lot of societal reflection of societal shame on on to our patients for sure. Be and also as as a woman, or on the female side of things. Or if you identify a female, there is inherently a shame that like your body is not doing what it's supposed to do.
Anne
Childbearing is that like, you know, most biologic, you know, drive and need and like, how can your body not be doing this thing that is supposed to be so innate to quote unquote, womanhood. Almost like a betrayal. And of the other side, too, you know, people who are struggling more on the sperm side that's associated with a lot of masculinity issues, there's all this conversational stuff of oh, so potent. And I read so on both sides. Anytime that something doesn't go the way you think it's going to it makes you question because there's so much stigma around everything.
Ruby
Yeah, it's not unusual for for guys, when they get their men or identifying as men, people with sperm will get their semen analysis results back. And they're really great. They're like, Yeah, this is going on the fridge or I'm gonna Goldstar things like that. So it's hard, right? Yeah. A lot is attached to the identity aspect.
Wendy
Right, and what we believe, like our thoughts and beliefs around like, what I should be doing, or who I think I am, like, this is tremendous. This is also something I'd see in my clients as well, just around, you know, for, for a few people that I've talked to, it's about their body, they feel betrayed by their body. Because it's not, you know, we're quote, unquote, working and they can't make it work. And that's just, it's just hard. It's, it's really, it can be real, but there is also support and resources
Anne
for I mean, I think that's what's so wonderful about your podcast, and the work that you do with your clients is that to be able to move through this journey, you really do have to address what's going on. And I think there's a lot of people when they're dealing with infertility, even if they are really struggling emotionally, you just kind of like push that down, because you're just trying to focus on the treatment, and you just assume, well, this next cycle work and then when I'm pregnant, it'll be fine. I won't have to feel this way again. But all those feelings and the grief and then anxiety that doesn't go away that's still down there. And no, it's still going to it will come up in different ways of pregnancy or it will come up when you are a parent and you're now super worried about any time your child falls down, they just slippery or they have a neurological condition and, you know, your anxiety and you're not my fall to play is because I was worried when I was pregnant. And now that's linked to the I mean, the it's, it's all there.
And so, you know, it's just better to own and accept those feelings and work. Because there is there's a lot of good research out there and techniques that can help your brain kind of cope with all of this anxiety and the circling of thoughts and find a way to experience them and then kind of restructure to be able to to move on in a way that's acknowledging the reality, as opposed to just trying to like push it down and deal with it later.
Wendy
So huge. Oh, my gosh. Excellent. I have one more question. Do you guys have time for one more?
Anne
Yes, of course.
Wendy
Thank you. Okay. So I, I really want to sort of lift the, the veil a little bit around, like what to expect when you call about fertility treatment, because this is such a scary and vulnerable thing. And, you know, part of your brain may say, it's just a phone call, or it's just scheduling a, you know, on an email form, or whatever it is. But honestly, it's also about taking a really a big step forward in a little tiny action. So can you talk about, like, first, like, what to expect when you call? What is that first appointment? Like? I'd love to hear.
Ruby
Yeah, that is, we have our one of our very first episodes and continues to be one of our most popular episodes is about that first visit, because it is such a huge step for so many people. And a lot of us providers, do some level of congratulating people for getting to this.
Anne
Yeah, I just say even the phone call is a huge step because that, that didn't miss that. Okay, I might need to talk to somebody about this.
Ruby
I wonder if we can track how many like hang ups we get, like one ring hang ups, because I bet there is a fair amount of that. And I wonder if in today's world where we can send, like we can go on the website and send things like how many people opt to do with like the least, quote unquote, personal things.
Anne
Once we added that, like messages here on the website, I think that did improve our self referrals, because it does somehow seem a little less scary than to like, wait on the line and actually have to answer someone's questions right away. So if you can just pull up and fill a form saying, Yeah, contact me about an appointment. And then I can like decide later whether I engage or not, or just not even answer the phone. Yeah. But I mean, I personally, and again, I've worked here for 15 years, I can't think of a new patient, that at the end of that visit was like, well, I shouldn't even done that. I mean, people really like actually having that discussion talking about what's been going on having information about what here would be the tests that we might want to think about doing next, then it's at least out there in the open. And you can make a decision about whether you actually want to do tests or want to move forward. But you've at least gotten more information because there's so much misinformation online.
And so I would definitely encourage anyone that the definitions medically would be if you've been trying to conceive for more than a year, which means regular exposure to sperm and having regular ovulation and you're not pregnant. That's the time to seek help, or because we know that age is often a factor in terms of egg quality. If the egg partner is over 35, then we say to schedule after just six months, which can seem like not a lot of time. And again, the reason I say like sperm exposure is a lot of people consider quote unquote, trying to be once they have like actively decided to use the ovulation sticks and like make a conscious decision. But if you stopped using contraception a year ago, and you were having intercourse twice a week, on average, you've been covering that window, even if you don't know exactly when you might have ovulated.
Ruby
This time is an actual trial.
Anne
This time counts now and I don't have to count on for months beforehand, but from a medical standpoint, that it does count. And it's always better to, again, at least have the conversation I think what we've tried to get across by doing the podcast is that we're not scary. I mean, those of us that work in this field, do it because we genuinely want to help people. And everything is very patient centered, I have had people that once they kind of get an idea, because there's a lot that we can tell just from a conversation, just talking about your history really gives us some some clues as to what the next steps would be.
And then people can decide how much of that testing they might want to do. And from that how much treatment I think people have this expectation that going to a fertility clinic means you're going to be doing IVF. And that's really not the majority of people, a lot of people are going to be starting off with what we would consider low technology treatment. Maybe they need some pills to help them ovulate or maybe we do inseminations where we put the sperm in the uterus on the day of ovulation so they don't have to swim as far so certainly IVF is very important. And that has sort of a, you know, the big science guns behind you in terms of those higher chances of success.
But many, many people are going to either start off or achieve a pregnancy without necessarily going that path. And I don't want people to feel like well if they think they would never do IVF it's not worth even talking to a fertility clinic because there's a whole range between doing nothing and doing the most assistive technology
Ruby
One thing that's also important to point out there too as if you have anything that you know is fertility related, like you know, you have endometriosis or you know you have PCOS, which is polycystic ovary syndrome, a lot of people are told that in their early adulthood, that is probably a reason to see a fertility providers sooner like not wait the full year. Because if you have something like polycystic ovary syndrome, it's an ovulation issue, you're probably not releasing an egg.
So you're not going to have the same level playing field as somebody that does not have PCOS. So if there's something that you know, is related to your reproduction, it's definitely sooner rather than later is better. So we can help you most efficiently or even if there's something within your family and like genetic stuff. If you've had ever had a surgery or medical treatment that might have issues with your fertility, you should see us sooner, things like that to be considered. And if there's any ever question, the worst thing is that you talk to a nice person for an hour.
Wendy
Please, brings up a question though. I know I said the last one was the last one. But for those who are on partnered, but who have PCOS, and they know that one day they are going to want to be a parent. Should they call you?
Anne
Yes, we have a PCOS wellness program where we actually focus and when people come to see us, I know some people are already in that setting of wanting to achieve a pregnancy, but many people are just trying to like how do I manage the symptoms of PCOS right now, and also sort of protecting your future fertility. Same thing for as Ruby said endometriosis. So were these are lifespan conditions. This is not something where, you know, the only factor is whether it might make it a little harder to get pregnant, there are metabolic issues that can be important for your health.
And the sooner that you manage things and kind of figure out the lifestyle parts that can help you know be in the best control. That's just going to make it easier. If down the road, you decide to attempt pregnancy because many people may have no problems getting pregnant, but they still should have the optimal metabolic control to have a healthy pregnancy because PCOS puts you at risk of gestational diabetes and other things that can happen later.
So yeah, I mean, I think we have also as a society gotten much better about being open and understanding yourself. And the more that you really understand what's going on, because that's the other old school people be told in their teens. Oh, you have PCOS? Just take the pill to you're ready to get pregnant. And that was it. And there's no like education about all the other things that can be helpful in terms of that management.
Wendy
Right or anything specific to your body. Yeah, your body.
Ruby
Yeah. And that actually brings up a really good point about why we created the podcast. It wasn't just we wanted to create a fertility podcast. Well, me specifically one of my great loves in life is what we call lifestyle medicine, which is a whole person approach to to care and like Anne said, a lot of times people with PCOS that are they come into their provider in their late like their teens or early 20s. And like I have irregular periods and quote got the stamp that it's a reproductive issue. Here's your birth control pills See you later not realizing that it's a whole body every cell in your body is affected by PCOS
Anne
Not just your ovaries. It's very bad ovaries Yeah,
Ruby
Yes, it Yeah, it's it's definitely there has been talk of like renaming it because it is not descriptive. And there's so many things like that in fertility, that fertility does not just impact one point in your life and your life does not go away. When you walk into a fertility clinic, you're a whole person and you everything is all linked together. So that was one of the my one of my dreams building the podcast is to take together both the fertility aspect and the wellness aspect for to and are saying is to power your whole life.
Wendy
Please, oh my gosh, such a total pleasure. Is there anything that you would like to share before we wind down our episode?
Anne
No, just that you know, anyone that this topic kind of hits home if you go we have a whole year of back catalogue of episodes. So we have 24 main and 49 snacks and they're kind of organized by topic. So it's not a sequential podcast, you can dip in anywhere to any topics that might if you you know you're listening to this and you're like someone did tell me I have PCOS, go listen to some of our episodes to talk about that.
Or if you have a partner that's been diagnosed with a low sperm count, you know, so you can kind of see what episodes are good for you. And again, just talking about these things. These are so common one of our other guests this year. She is a nursing researcher and educator and she talks about when she has her students, she has people put up their hand if they have diabetes or know someone with diabetes and you see the hands go up, she's like, okay, no, put your hand down. Raise your hand if you have or know someone that struggle with infertility and it's a much smaller number and she's like, did you know infertility is more common?
And so you know, people don't talk about something because it's you know, by the nature that especially if by the nature of it is you I ended up having a child and people see what that child, they're never going to guess that maybe it was a lot of effort to get to that point. And they don't always ask, but the more we can normalize this experience, I think that's going to also help people move through grief because you are not alone. And you definitely shouldn't feel that way. But I know in the moment, it's a very isolating experience.
Ruby
Yeah. And if you're listening to this, and you're not personally affected by infertility, I guarantee you there's at least one somebody in your life that has or is going through fertility stuff. The other beautiful part about our podcast, too, is there's so many episodes that you do not have to be any way shape or form related to like our gut health one, like my whole family likes that episode, you know, because everybody poops, you know, so like, it's like, it's, there's something for literally everyone, because we're all humans, and we all need to be well, and even if it's not just strictly a fertility,
Wendy
100%. Oh, thank you so much for being here. Please consider this your leg formal invitation listeners to go and subscribe and download like every single, juicy episode of the Whole Pineapple. Thank you for being here.
Anne
And thank you so much for having us on. Wendy,
Ruby
Thank you so much for having us. This was really fun.
Wendy
Happy next year, and the year after, and all the days. Thanks.
Hi, this is Wendy, thank you so much for being here and spending time with me. For you. Yeah, the whole purpose of walking through grief and loss is to find out how to feel better. Did you know there are tools and skills to be learned about how to do this? Yeah, for real, and I do it.
Let's get on a connection call. It's a 45 minute free call. We'd love to offer to you when you're ready. And we'll just see if we'd be a good fit to work together. If you're ready for a little more support, and not less. And if you're ready to feel a little bit better. And to find out and how to learn these tools and skills.
I'm ready for you. Reach out through my website. Connect with me directly through [email protected] and we'll set it up and again we will tell them take really good care. Bye bye
You are listening to the Heart Healing from Loss podcast with Wendy Sloneker.
Anne Judge
And this is episode 53.
Wendy Sloneker
Thank you for coming on back. Thank you for the introduction, Ruby in an it's amazing that I have the Whole Pineapple podcast host here today with us. Ruby Booras and Anne Judge of the Whole Pineapple podcast.
Anne
Thank you so much for having having us. Yes
Ruby
I'm Ruby
Anne
This is our first time being guests on someone else's podcast. So we are very fancy.
Wendy
I had no idea because you guys have been like super champs, like this entire year. It's been an explosion of the Whole Pineapple podcast, which please go subscribe right now. Like, honestly,
Ruby
you got it.
Wendy
You gotta get somebody I ran into Incidentally, I I was talking on the social medias. And it was with somebody and they were saying, Oh, my gosh, you know, the Whole Pineapple. Of course, I know the whole pineapple podcast. The Whole Pineapple. Really like a delight to meet friends and fans. Just around in the world?
Anne
Well, it's so interesting, because you know, your episode just aired on ours not too long ago, even though we've recorded with you so long ago, I think you were only our second or third guests when we were recording. But then your episode was so great. And we thought it was very timely to wait and release it in October since that was pregnancy loss Awareness Month, and we thought it would be most helpful them. But that I do feel bad because I was like, oh, man, it's been a long time. So I'm glad we're finally here. Getting to return the favor and get yours.
Ruby
It's definitely like, yeah, we'll be on yours. You'll be on ours. And we're like, hey, thanks. See you later.
Wendy
No, no. Before the end of the year, it's totally like right on time a
Anne
new podcast who dis?
Ruby
We're spicy. We're a little punky today.
Wendy
Bring all of it. Awesome. So like, we can be just like candid, and and awesome. And the topic is serious, right? So we don't have to take ourselves seriously. But we can take like the nature of fertility and infertility very seriously. So I do want to honor the topic. And at the same time, like, allow for this conversation to be juicy, number one, and also just like really valuable, and with lots of amazing human feeling and education. Yes, for sure.
Anne
I mean, I think I'm pretty honest about this on that podcast, as in past infertility patient. And that's kind of what led me to work in here. And part of why we want to do what we're doing with the podcast. I mean, this is such a deep topic. And it cuts to the core of a lot of people's beliefs about themselves and what their family is going to look like. And it kind of can shake your foundation on religious aspects.
To me, there's so many hard topics that go along with it. But it also involves a lot of bodily functions, and things that we don't always talk openly about. And it has some humor said like, Yeah, I think you kind of have to end up seeing some of the humor in that situation to get through the absurdity of it all that you're like at a doctor's office talking about, you know, sexual positions, or if you've noticed cervical mucus or this and that. So, yeah, I think we're very open. And that's sort of what we wanted to do with our podcast is break down a lot of these walls that are up there about us being open about talking about something that is so incredibly common.
Ruby
It is one eight, I think is still the updated number one and eight people are impacted by infertility. And it's, I would say even a higher statistic for people that have experienced miscarriage or pregnancy or infant loss. So grief is kind of one of the things that we do certainly we have like we we are in the moments of celebration, but our we're in this field that's very unique, where we can have a yay congratulations, kind of like on down one one side of the hallway and then immediately go into another room and have to switch over to Okay, now we're dealing with something that is incredibly sad and hard. So it is it's definitely a different field. Lots of emotional, I don't know what you call it like breath, right?
Wendy
Total range. Yeah, total range in that and you know, grief or disappointment or frustration. It's just part of the package. It's just part of the package, especially around something that you want so dearly. And that is to you know, have a child or become a parent, create your family. So I think it might be useful and helpful to talk about conflicting feelings or a breadth of feelings, like you were saying, because I'm sure you you as practitioners, like who have to deliver, like clinical information with a human heart to human people. Like, yeah, what is that? What does that, you know, like? Or what does that entail or contain? I know, that's very wide crits question,
Ruby
Anna. And I have both been doing this for a long time, I think and just had her 15 year anniversary, I just had my 10 year anniversary. So we have a lot of experience within our jobs. So we've met a lot of people. But we do have these overarching, you know, themes that come up very frequently. And one actually just talked to a patient about just now before I walked in the door was how frustrating it is to get normal news, like, oh, everything's normal. It's like, yes, but I'm not pregnant. So, like, you almost want something to be wrong, or to be like you want, you just want to answer. There's something not satisfying of being told, like on paper, everything looks good,
Wendy
Right? Right. And this can feel similar to when people have losses of other kinds who are like, well, three days and like we're back to work, or we're back to whatever, like it's back to the normal when it's not normal, because your life has totally changed, or it hasn't changed in a way that you want.
Anne
Yeah, and I think you grief is such a good word that we don't use often enough when we're talking about people that are having this sort of fertility journey, because even before we do any kind of testing, like for a lot of our patients, the fact that they're scheduling a visit with us is a type of grief because they it's not typically what they expected. You know, a lot of people in their mind have this idea that when they're ready to try and get pregnant, it will just happen you and even if they knew that they were potentially going to be doing some sort of fertility treatment, maybe they are always do they'll gonna do donor sperm, maybe they thought they would just be doing home insemination, like they didn't realize that they would be suddenly entering this medical system to be able to achieve a pregnancy.
And so there's already that grief of the expectations having to kind of slowly get chipped away and a lot of infertility treatment for some people can feel like you just keep chipping away more people like Well, I'm willing to do some testing, but I would never do IVF well, maybe I'll do IVF. But I never do donor a well, okay, maybe we'll do one more time, you just sort of keep moving the goalposts of what you're open to, then we see that sometimes it's kind of a good thing. Because when people come in, we're like, you know, if you are committed to building a family, like it will happen, there are so many ways to build a family.
And it's all about figuring out the one that's going to work for you. But it's often not the one that you first expect it. And there's a lot of getting reef involved and having to let go of those expectations that you kind of might have had since childhood about the way you thought this is going to work out.
Ruby
Right. No one and I know that no one wants to come to see us. Yeah, right. Like there might be like, Oh, I'm excited. Yeah, right. Like, exactly. It's like, sometimes there's like this excitement like we're moving forward, we're doing something but there's no one that ever wants to come to a fertility clinic.
And when you think about grief in our field, they're automatically things come to your head, like yes, miscarriage and and those types of losses. But also I just saw a patient recently to where her fallopian tubes were blocked, and she was not expecting that. And so now we had to have a discussion like listen, our first plans not going to work. Now we have to move on to IVF, which is a more invasive and involves more medication and costly options. So there is grief, grief, all the way along the journey in different ways that are often coming up very unexpectedly.
Wendy
Right? Right. It's so wild, because there's no guarantee. But there's also like so much kind of, right, like the reward is so big as well. Right? It's like a heart's desire.
Anne
Well, that's what I had a friend of mine back forever ago, when I was a patient, she was talking about having to take out what seemed like this massive loan to be able to afford to do IVF and she's like, this is kind of crazy, like, I could buy a car and then she's like, but if I do buy a car, you know, how long am I going to have that car and you know, best case scenario maybe like 15 years and she's like, you know, this is talking about a child for the rest of my life and but there's also not a guarantee. It's not like you put down all the money for the car, and then they're like, hey, there's a 50% chance you drive off the lot with what we don't know.
And so it's definitely it's it's tough. And so what are the other things we want to get the word out for is hopefully next year, Washington state is going to be trying again to pass a bill to make fertility coverage be mandated which would be huge. So definitely encourage listeners of fertility is an issue near and dear to you and you live in Washington State. Follow because talking to your representatives, letting them know how important this is and how How much that financial piece can impact people's decisions? I mean, that's a huge source of great people that are told, hey, you need to do this to be able to, you know, try and achieve this dream of yours, but they just can't physically afford it. It's heartbreaking.
Wendy
Totally. Yeah. Yeah. Wow. I would, I would love to hear a little bit about what you recommend, because it's like, we've talked about grief. And we've talked about frustration. And I imagine that for many that there's a sense of like, time and timing, like to hurry, hurry, hurry, because like, there's the unknown piece of, how much time we actually have to do this, this process or go through this path, or this part of the journey in order to hopefully arrive with a child. So I would like to, I mentioned, stress is not helpful when it comes to going down this journey. So what would you offer or share? What do you frequently share with your patients around stress? And impatience? Because, yeah, that's a very
Ruby
Good question. Yeah, it's very rough. The biggest thing, though, and every person who has had any sort of fertility journey or know somebody who has, knows to not say the words, just relax, it's not helpful.
Anne
It's not helpful, or how to do that. Right? Just think about it and make a list of all the terrible
Ruby
a whole list of them. And they're, they're meant, you know, good as meant by that. Like, they're, they're well, meaning Yeah, but they don't, they, they don't work, it's actually the opposite effect, like, because how does one just relax or not think about something that you want with all of your heart. So that's the biggest thing, what I tell my patients a lot is, especially when they've had like pregnancy loss on top of their infertility.
And now like, let's say they're pregnant again, or something, and it's very early, and they have all this anxiety. One of the very first things that I say is like, you're gonna be anxious no matter what, you know, the one thing that you can control is like, just letting go of the fact that you're going to be anxious, because I don't know. And if you've noticed this a lot, but then we get patients that start being really worried about being anxious and anxious about being anxious. So that's an area that she's like, you know, what, just let yourself feel the feelings. They're gonna happen anyway. Really good.
Anne
Yeah. And I mean, going back to we've had decades of research now on stress and infertility. And everyone cites one of the original classic studies by Dr. Ali Domar. But showing that, you know, people with this infertility diagnosis have greater rates of distress and anxiety than people facing a cancer diagnosis and HIV diagnosis, you know, things that are, you know, just can be life threatening, but infertility is identity threatening, you know, it really, you feel like someone's taking away the future that you had imagined.
And that lack of control, you know, it's hard to know what the outcome is going to be. And even in a best prognosis type situation, it's still nothing is ever a guarantee. And that can be so hard that you, you get this diagnosis. In some ways, I think it's a little harder the way that medicine has shifted over the last couple of decades, and that we're trying to not be as directive as we used to be, like, there's probably something a little bit nice about the doctor in the white coat, who would say, Well, this is what's happening, and you're gonna do XYZ, and you just follow the plan. But really, their choices, their choices all along the way. And so we're trying to explain to people their options, and that I think is great in the big picture. But that can also sometimes it's whelming. Yeah, because people are like, Well, what should I do?
Ruby
Big Question.
Anne
Everyone's just like, tell me the plan. And I'll do the plan to get the outcome. And even if you do the plan, you might not get the outcome.
Ruby
And that's all I think you've said and before you said on our podcast, like I would have poked myself in the eye with a needle shots.
Anne
It's like you'll do the shots wherever whatever people want, if you knew it would lead to a baby. And it doesn't always and, and I think also, the long view is so hard when you're in it, because you're just in that tunnel of every individual cycle. And it's always funny to me how the longer that I've worked here, the really more hopeful I get for my patients because I have seen people for almost anybody, I guarantee you I've seen someone at a, you know, on paper or even a tougher situation.
And people often think well, they are the most dire and you know, there really are options out there for everybody. It's just, it may not be an option that you thought you were gonna take from the beginning. And we know that things take multiple tries reproduction is incredibly inefficient. I think that's the other all of our sex ed, as kids really focuses on that. Like if you get sperm are you ever gonna
Ruby
get pregnant? I'm totally not sneeze.
Anne
So it can be a lot of unlearning and realizing like oh my gosh, look at all the steps that have to happen, and just in, you know, even once a pregnancy occurs, we know that way more pregnancies than we realize, you know, end and very early miscarriage before it can even necessarily be detected on an ultrasound or even a home test. And so I think once people look at all the things that have to happen, then it's kind of crazy that anybody gets pregnant.
Wendy
Right? How that happen? It is a miracle.
Anne
But yeah, do you guarantee that your sister in law will get pregnant every single time while you're trying to do treatments? See the photo world out there all the time, which is also different, because infertility is often kind of a hidden condition, you know, if someone was going through a medical challenge, where they were, you know, in a wheelchair, people wouldn't want to come up and say, Oh, I ran the best marathon last week, and I couldn't believe it, it felt so good to get my pace on. But like, people don't know what you're going through with infertility. So they think nothing about sharing, casual conversation about oh, my husband just looks at me and I get pregnant and all these things that are just like stabbing you and people don't know it. They don't know.
Ruby
Yeah, and speaking of, you know, that, that like, sex ed, like, don't don't look at each other and get pregnant, I get a lot of my patients tell me, especially our female patients who identify female who have ovaries are female, quote, unquote, reproductive organs. I hear a lot. Why didn't anybody tell me this? Yeah. Like, why did we not teach our teenage and young women about how their bodies work? Like, if I would have known this, you know, it's there's a lot of grief and regret, just from something that you didn't even know.
Wendy
Right, then that can feel like a waste of time that can feel like a waste of resources that can feel like a waste of a different like, you could I could have pivoted earlier, I could have like, really chosen this other path a lot sooner. And that can that can be just a really difficult pill.
Anne
And even the cost side, I people who were like, do I get a refund on my 10 years of birth control pills like this taking that I maybe didn't need to be taking? Right? Yeah. Yeah, why would that sense of historical regret is a big one.
And again, like there's so many factors outside of people's control. And it's a tough thing, because you also mean, there are so many factors that decide into when you're ready to try and build a family. And so even if, from an evolutionary standpoint, maybe we should be having our children in from 15 to 25. But that's not great in terms of our emotional maturity, and life and everything else. And so, biology hasn't quite caught up to modern society. And there's so many, so many strong benefits towards delayed parenting in terms of what you bring to the table as a parent. But if you have and are using a finite supply of eggs, then time is definitely a factor in a way that isn't necessarily for a lot of other things that might happen to us.
Wendy
Yeah, that's so interesting about the biological factor of it being kind of way behind similar to, like that primal part of our brain that is just really, really old, old cave person wiring, like, just even around emotion or thoughts. Amazing.
You mentioned hope a little bit earlier. And so being more and more hopeful, I mean, seeing the gamut. And speaking of range, just like range of things that can happen and do happen. That's that's kind of a delight to hear, especially in, in this arena. Can you talk a little bit more about hopefulness?
Ruby
Well, did you know that the pineapple is a symbol of hope, if you didn't listen to our very first episode? There's a reason we named it the Whole Pineapple.
Anne
And we got a little mascot for our show, which is a pineapple, and we did listener vote, and her name is Hope. So yeah, hope is indeed very important to us. But yeah, but you have to have hope, again, fertility treatment involves a lot of invasive, sometimes painful, sometimes quite expensive procedures. And you wouldn't do that if you weren't hoping in the end that it would work for you. And yeah, that ability to have hope, even in the setting of loss is such a human important emotion.
And that's what lets people do these things that at a paper level don't make a lot of sense. You know, if you were looking at from cold hard stats, you'd be like, well, I shouldn't do that again. But you know, that hope is, is powerful. And I think sometimes, the hard part is you see patients deliberately shutting down from that hope, because they're worried that if they allow themselves to be hopeful, it's just going to hurt more if this cycle doesn't work out.
And so sometimes we are more hopeful for our patients than they are for themselves because it's just a coping mechanism that they're like I'm just going to go into this all assuming the worst and I can be surprised and not saying that's not a valid way to do it. But we have worked here so long and seen so many you so many people get to the other side. That's the thing I always say like you are going to resolve your infertility, the way you are feeling right now is not the way you're going to be feeling a couple years from now.
And so you don't know exactly how you're going to resolve it. It might be a genetic child, it might be, you end up pursuing other avenues. It might be you adopt and might be you decide that you're going to be child free, and you're going to enrich your life and be just fine in that scenario, too. And I've seen people go through all those scenarios, and everybody ends up in a good place. And it's just hard not knowing exactly what that place will look like for you.
Wendy
Right, right. We certainly have our preferences, like we certainly have our dreams and desires. And we're also an adaptable species. No one's going to want to hear that on this episode. But we are.
Anne
And that uncertainty, that's I've had people say to people, like if you would just show me the crystal ball, if I just knew that's what it's gonna look like, then I'm fine. I'll work towards that. It's that not knowing that is so hard for people. Yeah, yeah.
Ruby
And I think because where our patients are at in their lives, they often don't learn it very successful human beings. And the control it like everything else is like, going their way. And it just is something that no matter what they do, is not going their way. So it brings up a lot of negative self talk, a lot of regret a lot of shame. I get a lot of patients that they are struggling to get pregnant, they, you know, long 10, 15, 20 years ago, had an elective termination. And now they're like, it's because I did that it's either physical or moral or something that this is why
Anne
Or they had chlamydia in college. And you know, that's why the tubes are blocked, and oh my gosh, it's because I was being punished for having you know, sex before marriage. I mean, there's this brings up so many things that their society has so many.
Ruby
Yeah, there's a lot of societal reflection of societal shame on on to our patients for sure. Be and also as as a woman, or on the female side of things. Or if you identify a female, there is inherently a shame that like your body is not doing what it's supposed to do.
Anne
Childbearing is that like, you know, most biologic, you know, drive and need and like, how can your body not be doing this thing that is supposed to be so innate to quote unquote, womanhood. Almost like a betrayal. And of the other side, too, you know, people who are struggling more on the sperm side that's associated with a lot of masculinity issues, there's all this conversational stuff of oh, so potent. And I read so on both sides. Anytime that something doesn't go the way you think it's going to it makes you question because there's so much stigma around everything.
Ruby
Yeah, it's not unusual for for guys, when they get their men or identifying as men, people with sperm will get their semen analysis results back. And they're really great. They're like, Yeah, this is going on the fridge or I'm gonna Goldstar things like that. So it's hard, right? Yeah. A lot is attached to the identity aspect.
Wendy
Right, and what we believe, like our thoughts and beliefs around like, what I should be doing, or who I think I am, like, this is tremendous. This is also something I'd see in my clients as well, just around, you know, for, for a few people that I've talked to, it's about their body, they feel betrayed by their body. Because it's not, you know, we're quote, unquote, working and they can't make it work. And that's just, it's just hard. It's, it's really, it can be real, but there is also support and resources
Anne
for I mean, I think that's what's so wonderful about your podcast, and the work that you do with your clients is that to be able to move through this journey, you really do have to address what's going on. And I think there's a lot of people when they're dealing with infertility, even if they are really struggling emotionally, you just kind of like push that down, because you're just trying to focus on the treatment, and you just assume, well, this next cycle work and then when I'm pregnant, it'll be fine. I won't have to feel this way again. But all those feelings and the grief and then anxiety that doesn't go away that's still down there. And no, it's still going to it will come up in different ways of pregnancy or it will come up when you are a parent and you're now super worried about any time your child falls down, they just slippery or they have a neurological condition and, you know, your anxiety and you're not my fall to play is because I was worried when I was pregnant. And now that's linked to the I mean, the it's, it's all there.
And so, you know, it's just better to own and accept those feelings and work. Because there is there's a lot of good research out there and techniques that can help your brain kind of cope with all of this anxiety and the circling of thoughts and find a way to experience them and then kind of restructure to be able to to move on in a way that's acknowledging the reality, as opposed to just trying to like push it down and deal with it later.
Wendy
So huge. Oh, my gosh. Excellent. I have one more question. Do you guys have time for one more?
Anne
Yes, of course.
Wendy
Thank you. Okay. So I, I really want to sort of lift the, the veil a little bit around, like what to expect when you call about fertility treatment, because this is such a scary and vulnerable thing. And, you know, part of your brain may say, it's just a phone call, or it's just scheduling a, you know, on an email form, or whatever it is. But honestly, it's also about taking a really a big step forward in a little tiny action. So can you talk about, like, first, like, what to expect when you call? What is that first appointment? Like? I'd love to hear.
Ruby
Yeah, that is, we have our one of our very first episodes and continues to be one of our most popular episodes is about that first visit, because it is such a huge step for so many people. And a lot of us providers, do some level of congratulating people for getting to this.
Anne
Yeah, I just say even the phone call is a huge step because that, that didn't miss that. Okay, I might need to talk to somebody about this.
Ruby
I wonder if we can track how many like hang ups we get, like one ring hang ups, because I bet there is a fair amount of that. And I wonder if in today's world where we can send, like we can go on the website and send things like how many people opt to do with like the least, quote unquote, personal things.
Anne
Once we added that, like messages here on the website, I think that did improve our self referrals, because it does somehow seem a little less scary than to like, wait on the line and actually have to answer someone's questions right away. So if you can just pull up and fill a form saying, Yeah, contact me about an appointment. And then I can like decide later whether I engage or not, or just not even answer the phone. Yeah. But I mean, I personally, and again, I've worked here for 15 years, I can't think of a new patient, that at the end of that visit was like, well, I shouldn't even done that. I mean, people really like actually having that discussion talking about what's been going on having information about what here would be the tests that we might want to think about doing next, then it's at least out there in the open. And you can make a decision about whether you actually want to do tests or want to move forward. But you've at least gotten more information because there's so much misinformation online.
And so I would definitely encourage anyone that the definitions medically would be if you've been trying to conceive for more than a year, which means regular exposure to sperm and having regular ovulation and you're not pregnant. That's the time to seek help, or because we know that age is often a factor in terms of egg quality. If the egg partner is over 35, then we say to schedule after just six months, which can seem like not a lot of time. And again, the reason I say like sperm exposure is a lot of people consider quote unquote, trying to be once they have like actively decided to use the ovulation sticks and like make a conscious decision. But if you stopped using contraception a year ago, and you were having intercourse twice a week, on average, you've been covering that window, even if you don't know exactly when you might have ovulated.
Ruby
This time is an actual trial.
Anne
This time counts now and I don't have to count on for months beforehand, but from a medical standpoint, that it does count. And it's always better to, again, at least have the conversation I think what we've tried to get across by doing the podcast is that we're not scary. I mean, those of us that work in this field, do it because we genuinely want to help people. And everything is very patient centered, I have had people that once they kind of get an idea, because there's a lot that we can tell just from a conversation, just talking about your history really gives us some some clues as to what the next steps would be.
And then people can decide how much of that testing they might want to do. And from that how much treatment I think people have this expectation that going to a fertility clinic means you're going to be doing IVF. And that's really not the majority of people, a lot of people are going to be starting off with what we would consider low technology treatment. Maybe they need some pills to help them ovulate or maybe we do inseminations where we put the sperm in the uterus on the day of ovulation so they don't have to swim as far so certainly IVF is very important. And that has sort of a, you know, the big science guns behind you in terms of those higher chances of success.
But many, many people are going to either start off or achieve a pregnancy without necessarily going that path. And I don't want people to feel like well if they think they would never do IVF it's not worth even talking to a fertility clinic because there's a whole range between doing nothing and doing the most assistive technology
Ruby
One thing that's also important to point out there too as if you have anything that you know is fertility related, like you know, you have endometriosis or you know you have PCOS, which is polycystic ovary syndrome, a lot of people are told that in their early adulthood, that is probably a reason to see a fertility providers sooner like not wait the full year. Because if you have something like polycystic ovary syndrome, it's an ovulation issue, you're probably not releasing an egg.
So you're not going to have the same level playing field as somebody that does not have PCOS. So if there's something that you know, is related to your reproduction, it's definitely sooner rather than later is better. So we can help you most efficiently or even if there's something within your family and like genetic stuff. If you've had ever had a surgery or medical treatment that might have issues with your fertility, you should see us sooner, things like that to be considered. And if there's any ever question, the worst thing is that you talk to a nice person for an hour.
Wendy
Please, brings up a question though. I know I said the last one was the last one. But for those who are on partnered, but who have PCOS, and they know that one day they are going to want to be a parent. Should they call you?
Anne
Yes, we have a PCOS wellness program where we actually focus and when people come to see us, I know some people are already in that setting of wanting to achieve a pregnancy, but many people are just trying to like how do I manage the symptoms of PCOS right now, and also sort of protecting your future fertility. Same thing for as Ruby said endometriosis. So were these are lifespan conditions. This is not something where, you know, the only factor is whether it might make it a little harder to get pregnant, there are metabolic issues that can be important for your health.
And the sooner that you manage things and kind of figure out the lifestyle parts that can help you know be in the best control. That's just going to make it easier. If down the road, you decide to attempt pregnancy because many people may have no problems getting pregnant, but they still should have the optimal metabolic control to have a healthy pregnancy because PCOS puts you at risk of gestational diabetes and other things that can happen later.
So yeah, I mean, I think we have also as a society gotten much better about being open and understanding yourself. And the more that you really understand what's going on, because that's the other old school people be told in their teens. Oh, you have PCOS? Just take the pill to you're ready to get pregnant. And that was it. And there's no like education about all the other things that can be helpful in terms of that management.
Wendy
Right or anything specific to your body. Yeah, your body.
Ruby
Yeah. And that actually brings up a really good point about why we created the podcast. It wasn't just we wanted to create a fertility podcast. Well, me specifically one of my great loves in life is what we call lifestyle medicine, which is a whole person approach to to care and like Anne said, a lot of times people with PCOS that are they come into their provider in their late like their teens or early 20s. And like I have irregular periods and quote got the stamp that it's a reproductive issue. Here's your birth control pills See you later not realizing that it's a whole body every cell in your body is affected by PCOS
Anne
Not just your ovaries. It's very bad ovaries Yeah,
Ruby
Yes, it Yeah, it's it's definitely there has been talk of like renaming it because it is not descriptive. And there's so many things like that in fertility, that fertility does not just impact one point in your life and your life does not go away. When you walk into a fertility clinic, you're a whole person and you everything is all linked together. So that was one of the my one of my dreams building the podcast is to take together both the fertility aspect and the wellness aspect for to and are saying is to power your whole life.
Wendy
Please, oh my gosh, such a total pleasure. Is there anything that you would like to share before we wind down our episode?
Anne
No, just that you know, anyone that this topic kind of hits home if you go we have a whole year of back catalogue of episodes. So we have 24 main and 49 snacks and they're kind of organized by topic. So it's not a sequential podcast, you can dip in anywhere to any topics that might if you you know you're listening to this and you're like someone did tell me I have PCOS, go listen to some of our episodes to talk about that.
Or if you have a partner that's been diagnosed with a low sperm count, you know, so you can kind of see what episodes are good for you. And again, just talking about these things. These are so common one of our other guests this year. She is a nursing researcher and educator and she talks about when she has her students, she has people put up their hand if they have diabetes or know someone with diabetes and you see the hands go up, she's like, okay, no, put your hand down. Raise your hand if you have or know someone that struggle with infertility and it's a much smaller number and she's like, did you know infertility is more common?
And so you know, people don't talk about something because it's you know, by the nature that especially if by the nature of it is you I ended up having a child and people see what that child, they're never going to guess that maybe it was a lot of effort to get to that point. And they don't always ask, but the more we can normalize this experience, I think that's going to also help people move through grief because you are not alone. And you definitely shouldn't feel that way. But I know in the moment, it's a very isolating experience.
Ruby
Yeah. And if you're listening to this, and you're not personally affected by infertility, I guarantee you there's at least one somebody in your life that has or is going through fertility stuff. The other beautiful part about our podcast, too, is there's so many episodes that you do not have to be any way shape or form related to like our gut health one, like my whole family likes that episode, you know, because everybody poops, you know, so like, it's like, it's, there's something for literally everyone, because we're all humans, and we all need to be well, and even if it's not just strictly a fertility,
Wendy
100%. Oh, thank you so much for being here. Please consider this your leg formal invitation listeners to go and subscribe and download like every single, juicy episode of the Whole Pineapple. Thank you for being here.
Anne
And thank you so much for having us on. Wendy,
Ruby
Thank you so much for having us. This was really fun.
Wendy
Happy next year, and the year after, and all the days. Thanks.
Hi, this is Wendy, thank you so much for being here and spending time with me. For you. Yeah, the whole purpose of walking through grief and loss is to find out how to feel better. Did you know there are tools and skills to be learned about how to do this? Yeah, for real, and I do it.
Let's get on a connection call. It's a 45 minute free call. We'd love to offer to you when you're ready. And we'll just see if we'd be a good fit to work together. If you're ready for a little more support, and not less. And if you're ready to feel a little bit better. And to find out and how to learn these tools and skills.
I'm ready for you. Reach out through my website. Connect with me directly through [email protected] and we'll set it up and again we will tell them take really good care. Bye bye
