Infertility affects millions yet so many are told to “just relax,” “wait it out,” or “stop stressing.” In this powerful and compassionate episode of Cry It Out Loud, we speak with Dr. Melanie Ochalski, a board-certified reproductive endocrinologist at Shady Grove Fertility, about why infertility is a real medical condition, not a personal failure or mindset.
Dr. Ochalski breaks down the myths surrounding infertility, explains when and why to seek professional fertility care, and discusses the emotional and physical toll infertility can take on individuals and couples trying to build a family.
This episode also explores:
When to seek help for infertility and recurrent pregnancy loss
The truth about home ovulation predictor kits and basal body temperature tracking
How long to try before seeing a fertility specialist
The emotional impact of infertility, IVF, miscarriage, stillbirth, and infant loss
Compassionate, evidence-based guidance for next steps
Whether you are navigating infertility, IVF, miscarriage, pregnancy loss, stillbirth, infant loss, or pregnancy after loss, this episode offers validation, clarity, and hope.
Every loss matters. Grief has no timeline. And no one should walk this journey alone.
Chasing the Rainbows provides free daily support, trauma-informed peer groups, and resources for those impacted by infertility and baby loss. If you are seeking support, want to volunteer, donate, or host an event in honor of your baby, we invite you to connect with us at:
🎧 Listen now and share this episode with someone who needs to hear they are not alone.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:13):
Crying out loud a podcast by Chasing the Rainbows with your.
Host. Bernice Quisenberry.
Welcome back to Cried Out Loud, the podcast where no story is
too heavy, no grief too small, and where every family
(00:34):
navigating infertility, pregnancy, or infant loss has a
voice. Today, we're honored to welcome
a guest to Work literally changes lives, helping families
who long for a child find answers, support, and hope.
Doctor Melanie Ohowski is a board certified reproductive end
chronologist at Shady Grove Fertility.
She has decades of experience treating infertility,
(00:55):
reoccurring pregnancy loss, and ovulatory disorders.
Doctor O has published numerous peer reviewed scientific
manuscripts, received multiple teaching awards, and is
dedicated to combining medical expertise with compassionate
care. In today's episode, we're going
to explore infertility as a medical condition, debunk those
myths that can unintentionally harm patients, and provide
(01:18):
guidance on the questions everyone asks, from home
ovulation kits to when to seek professional help.
This episode is for anyone who has ever felt frustrated,
confused, or alone on their own fertility journey.
Doctor O, thank you so much for joining us today.
It is an honor and thank you forreaching so many patients and
(01:39):
being a beacon of hope and lightwhen sometimes it feels like
everything seems dark. So truly, thank you.
Oh, thanks, Doctor O That means the world.
And it's such an honor to have you here and to connect you, we
know, with our listeners. And I would love for you, you
know, to start from the beginning, you know, what got
you into this field and what youdo, you know, for your patients.
(02:03):
Yeah, I initially was interestedin the field because of the
science behind it. Human reproduction is so cool.
I mean, just female reproductionand the ovary, how this small
little nugget has millions of eggs and effects our hormones
(02:25):
that affect so many other aspects of female health.
I mean, it's incredible. So I went into the field very
interested in the science of it and the research.
I performed some early research on preventing chemotherapy from
affecting women's fertility in the future, but very quickly I
(02:49):
realized what an amazing patientpopulation the women who sought
my care were. And so it started to feel like I
was helping a friend rather thanreally like the medical part of
it came second. And the impact of listening and
(03:11):
being part of such an important journey really is the number one
reason why I'm still doing this 20 years later.
And I feel really blessed and honored that patients trust me
with their care. And I think I'm so inspired by
patients. So that was that's my journey.
(03:32):
Yeah. Oh, that's so beautiful.
And it's true. You know, when someone comes to
you like their future and, you know, their family, planning is
really in your hands with them as a partner and a true partner,
you know, walking alongside themin this journey.
So that just, you know, means the world to have that kind of
compassionate level of care of someone who treats it so gently.
(03:53):
It really is a relationship because when I'm first meeting a
patient, I don't know if I'm going to know them for a month
because they'll be very quickly successful, or if it's going to
be a year or two because it's it's it's unpredictable.
But I think knowing that they'renot alone and that we're in it
(04:14):
together till the end is is really an important part of the
equation. Absolutely.
It really is and you know, another part of that is really
educating others on, you know, infertility and and not being as
easy as go take a vacation or just relax and it'll happen, you
know, and that this is a true medical condition.
(04:36):
I think understanding that too. And the earlier that I know
we're talking pre show, you know, it's that early detection
or you know, doing deeper. I would love to hear your
opinion about that. Yeah, I think that in the US
there's so much emphasis on preventing pregnancy when it's
unwanted and we don't do enough education about how our
(04:59):
fertility is time sensitive, especially women's fertility,
and that we're most fertile in our early 20s.
And, and I think that's, I thinkthat's really important.
And I, it's a take home message.I try to emphasize anyone that
will listen. So my poor nieces in college
(05:20):
have heard me say this very often.
But I, I do think it's, it's, it's important, especially for
women who are embarking on careers that may delay their
fertility, knowing their, knowing their options and having
a, a strategy is, is important. But one of my talk talking about
(05:47):
kind of myths or, or things thatare, are, are said, one of my
pet peeves is that, you know, like, you just have to relax.
It's if you're just too stressed.
And when I think about it, like when would you ever go to a
doctor and you know, you're diagnosed with strep throat and
the doctor says, oh, you're stressed, you just got to relax.
(06:09):
That'll do it. I mean, factor ability is a
medical condition and it's no one's fault.
And I, I, I completely understand that we don't want to
medicalize something that shouldbe natural too early, but it's
really not about medicalizing anything.
It's about picking up cues that can help a, a patient or a
(06:34):
couple be successful and kind ofstreamline their journey.
So whenever I hear someone say like, you just need a glass of
wine or you just need to go awayit, it makes me sad because it
does a disservice. And it also kind of points the
finger and puts the blame on theperson, like they're doing
(06:55):
something wrong, yes. It's very dismissive and also,
you know, telling someone that then they're trying for let's
say 3 or 4 years and they're not, and then they finally get
back. Well, that might put them in
their 30s then, you know, or, orwhatever timeline that is
because they felt like, oh, like, I just need to do this.
Because as you know, time flies by and like when you're tracking
(07:15):
all of that and it's like, or not knowing what to do and it is
dismissive like that, you're, you then get in your own head.
Am I just coming up with this? But as women, we know our bodies
so well from a young age and, you know, know that.
So we, if we feel like something's off or something
isn't happening, it probably is,you know, just better to get.
Looked at, I think women's intuition is very powerful and
(07:39):
one of the, one of the points I always try to emphasize when I'm
talking with a couple is here's,I'll give them my
recommendations and then I'll say whatever you decide to do,
you'll take this at your pace. However, put time limits, time
stamps on it because it is so common that a year, 2 years goes
(08:00):
by and we're still at the same point.
We haven't made any progress. So if you put time points like
OK, if next by 4th of July or bythis date, if we haven't seen a
difference, then we're going to execute on part of this plan
because time goes by so fast. And unfortunately it is a really
(08:21):
important factor when it comes to how successful we we are.
Yeah, absolutely. And I love the time stamping
because it almost feels like that's what you need to keep.
And also, it kind of gives you hope and goals, so it doesn't
feel as daunting as it can be when you're in the midst of it.
Yeah, I, I, I think the only wayto survive this is to think
(08:44):
about the end goal. Like if you're thinking about,
oh, I got to take this pill or Igot to do this test, who would
ever want to do that? But if, if you think, OK, this
time next year, I want to have been successful, like that's the
goal. And then that gets you up every
morning and, and moving on. It's that hope for that.
Absolutely, yeah. And I think it's so important to
(09:06):
remember this isn't our fault and you know, anything, it's,
you know, just evidence based medicine.
It's so important, you know, running tests or doing more and
would love to hear, you know, what you do with your patients
doctor when they come to you, what that kind of looks like.
Yeah, I, I'm so glad you said it's, it's not your fault
because I think a lot of people,their brain knows that, but
(09:30):
their heart feels like what, what, what am I doing or not
doing? And when someone has been trying
to get pregnant and hasn't been successful, and then they end up
in my office, I think there's a little, they're grieving the
(09:51):
fact that it hasn't been easy and everyone around them, you
know, has an oopsie and, and youknow, there's, that's a loss to,
to know that that there, there'spossibly some tests or some
treatment needed. So I think just acknowledging
that that that's normal and it's, it's not fair, but you
(10:12):
know, we're going to get throughit and, and we're going to get
there. And so typically when a patient
has been trying for 12 months orlonger, we recommend an
evaluation. And it's not as though at 12
months something breaks and and it's all downhill after that.
(10:34):
It's simply that at the 12 monthmark, it is worth investigating
some clues that can help identify what what might be
helpful for the patient. And sometimes we would like to
see a patient sooner. If there are some known issues
that can affect fertility like PCOS or endometriosis or a known
(10:59):
male issue, then no reason to delay, no reason to wait till
that 12 month mark. Let's see you sooner.
And then I think age of the female partner is really
important. So 35 or older, we say give it
six months and then let's just talk about maybe doing some
tests. And then at 40, we say let's
(11:22):
come in as soon as you're ready.No reason to delay just in case
there's something a little off. Let's try to optimize it while
time is still on our side. Absolutely.
And I think you're, you know, that's so beautiful that you're
recognizing to the innocence of the pregnancy kind of being
taken from this couple. Not just like getting deprived
of that, like, oh, I get to surprise my husband with a
(11:43):
pregnancy announcement because Igot to take a test and him not
know about it, you know, or justunplanned and just like
sporadically, like we're pregnant.
Yeah. Like that, you know, isn't the
case. And it, and it can, it's so
heartbreaking in those moments because everything then does
feel like it is planned out and it's not that, you know, and
then we also are aware of complications and risks and HCG
(12:07):
levels and all of these different things that the
normal, you know, person who's getting pregnancy unexpectedly,
you know, isn't experiencing like we are, you know, in this
population. Yeah, I can, I, I will share
with you that I, I having gone through a miscarriage, it is
true that when you are mourning that loss, everyone around you
(12:29):
has a big belly and is there's baby announcements everywhere.
And it's like, seriously, is this, it's constant reminders
and it can feel really isolating.
So. Yeah.
Especially around the holidays, I feel like, you know, I'm
seeing again and again. But yeah, maybe it's just the
season and reason we're in, but it's like, here is, you know,
(12:52):
this person getting pregnant, Everybody wants to announce them
around the holidays. It just feels almost like, like,
when is it our turn, right? When's it gonna happen?
Yeah, the the holidays can be particularly tough.
Yes, that's a one thing that youmentioned reminded me that when
(13:15):
a couple is successful having gone through an infertility
diagnosis and possibly treatment, there are ways of
still holding on to some of the like spontaneity and excitement
that that we see patients who may not have had that same
struggle have. So, for example, calling with a
(13:38):
positive pregnancy test when both partners can listen in or
like doing, still doing gender reveals, even if it was an IVF
genetically tested pregnancy, westill like can put the, the
gender on a on in a sealed envelope.
And, and, and I think those little things really can make a
(14:00):
difference. And, and it really, I mean, it's
even more meaningful when it's been a little more difficult to
to get to. Absolutely.
But it's our favorite thing is when we get the gender reveal
videos or like we hear the stories and it's such a what a
celebration. Oh, Doctor.
(14:20):
Oh. And that's so great that, you
know, still. Yeah.
Like finding those celebratory moments, especially in the midst
of all of it, is so important. Oh, that's so beautiful.
Yeah, oh, so yeah, you know, going from doing like at home
ovulation kits, how, you know, reliable?
Are they like in any of the testing at home?
(14:43):
I have to admit, I was guilty ofbuying different teas, lozenges.
I mean, you know, we got to the point of like progesterone and
corrective surgeries, but what'sinteresting is, you know, it,
it's not as easy, you know, likejust you read all these things
and you just can't help it. Like I will try anything to try
to get pregnant at that point, so.
(15:04):
Oh, yeah. And I think nowadays more than
ever, when there's so much information available to
patients and there is a movementand I think it's a good movement
to think about holistic remediesand making sure that we're we're
as optimal, like we're as healthy as possible.
And so it's very common when patients come to see me that
(15:28):
they've already like tried out different supplements and how
are using home devices. And I think that can be helpful,
but I always caution to like continually evaluate whether
those things are serving you andat any point that you're like
(15:48):
starting to hate on the, the kitor the the wearable device, then
that's just that the stress thatthat's causing isn't worth it.
Like when I, when I see patientscoming in having done some of
their home initial evaluation, very often they're either using
ovulation kits, which are the urine kits that can predict
(16:11):
ovulation, basal body temping. And and then like more recently,
the wearable devices that, that can tracks your cycles and then
start to give predictions on your, your fertile window and
when to expect your cycle. And so I think the merits of
those things are that number one, they help you have insight
(16:35):
into your body. And you know, up until these
things existed, we were going off of symptoms like breast
tenderness or cervical mucus andand now these these products can
give you a little more objectivedata.
So that's good. And I think it also helps a
situation that feels so out of control, like, you know, if
(17:01):
you're, if you're someone who you work hard, you set a goal
and then you you get it. And now suddenly you're doing
all the right things and this isnot happening.
Sometimes the devices and the products can help you feel like,
I'll let like you're taking backthe reins a little bit.
The, the thing to caution listeners about are that any
(17:22):
test, especially some of these at home tests are not always
reliable. So you always want to take it
with a grain of salt. And I they can be influenced by
other things going on in your life.
So like particularly the basal body temping and the, the
wearables, those algorithms can be affected if you were sick or
(17:47):
you were super stressed or didn't get a good night's sleep.
And so you just want to like notlet that be the end all be all.
But I, I think it can be helpful.
But when someone's coming in andI can tell like it's stressing
them out, I say just like, let's, let's put that aside
because right now it's this daily reminder about you needing
(18:10):
to do it and it hasn't happened yet.
Why hasn't happened yet. And it, it's, it's not worth it.
Ovulation kits can be helpful when like couples are apart and
they need to time things a little bit better.
I think of the ovulation kits aslike your turn signal, it's
(18:32):
going to tell you what you're about to do, whereas basal body
temping is your rear view mirrorto say, oh, Yep, I did ovulate.
So can be helpful, but you know,keep it.
I I think keeping the perspective that it's not, you
know, you don't have to do it. No, no fertility Dr. will say
what you're not doing this already that because it's.
(18:58):
Yeah. Oh, I know, I know, I as you're
talking, doctor, I was like I was guilty of that, you know,
doing all of the charts, checking everything daily, you
know, especially first thing in the morning and like tracking it
all and it was almost obsessive.It takes away from even the joy
of the journey or any part of it, right?
And it just makes it almost likeAI mean loving the control over
(19:20):
a feeling like you know, I have a sense of control over it.
But then it is, it can be and I know you know it.
It almost felt like a job after a while.
Yeah, and I think there's many reasons why intimacy can be
affected during the fertility journey.
But it when when you're looking at your your kit or your chart
(19:42):
and then you're saying, come on,honey, we need, we need to be
intimate today. That kind of takes some of the
excitement out of it also. But you get to that point like,
you know, like you try the easy way and that doesn't work.
So you want to do something different.
And I think that's that's fine, but not for a year's worth.
(20:03):
And I would say the same thing about supplements.
So there's so much out there. It's overwhelming for me as a a
doctor to vet what products are needed or helpful.
So I could only imagine how overwhelming it is when you're
the patient trying to navigate these supplements and and
(20:23):
devices. But when someone comes to see me
and they ask my advice about supplements, as long as it's not
harmful, I'll say that's fine ifyou want to give it a try.
But if you've given it 3-6 months and it really hasn't made
a difference then probably not necessary.
(20:45):
And also seeing how it makes youfeel.
Some supplements can cause side effects and not worth toughing
it out if if that's the case. No.
And it and get expensive. I mean, all of these products
will be really, really expensive.
So, you know, I think it's greatthat people, patients are
(21:08):
empowered to try, like to do their research and try these
things. And I always welcome patients to
share with me what they're doingso that I can give my $0.02 on a
supplement or a product. But most of the time, if it's
making you healthier, that's a good thing.
(21:29):
I caution patients, my, my male and female patients to avoid the
supplements or products that claim to like enhance your
vitality or like that that's more of a, a, a men's supplement
thing. But it what if they're claiming
that it's increasing your libidoor increasing your, your
(21:52):
vitality? I, it makes me wonder, is there
a plant based type of male hormone in there that actually
can be working against us? And then for female patients,
any supplement that claims to regulate your cycle, I would, I
would caution because birth control regulates your cycle
(22:13):
because it totally takes over. So you just, you know, sometimes
in an effort to try to make everything perfect, we can, you
know, do a little, you know, more harm than good.
But that's why you're never meant to do it alone.
Like there is, there are people out there who can, can help you.
So always I think remembering that is important.
(22:35):
Yes, and I think too like understanding when is it
important to make the change over from a clinician, you know,
AGP or OBGYNII know we get this a lot, you know, in support
groups or different support services.
We have infertility loss parentscoming to us and you know, they
go to their doctor. It's kind of, you know,
(22:56):
dismissed, like we said about, you know, go home, relax kind of
thing or not doing further testing or they had ADNC or a
procedure from, you know, a pregnancy loss or, you know,
have experienced endometriosis and PCOS.
And maybe, you know, it's something that a surgery can go
in. And I mean, I needed that.
(23:17):
And you know when you would seekan RE doc to talk through all of
these different things compared to staying with an OBGYN or
feeling like your answers aren'tbeing heard by a clinician?
That's a great question. I think it's never wrong to
start with your GYN or your PCP and share your your your current
(23:39):
situation and get their advice. But if you feel as though
there's kind of this like stall out and not much is happening,
anyone can self refer to an RE II would say at least at Shady
Grove. I would, you know, at my
practice, anyone can self refer and I it's not unusual.
(24:00):
I have someone who hasn't been trying, you know, probably
doesn't need to be here, but sheneeds to be here.
If she needs to hear from me that everything sounds OK and we
can do these tests to reassure you.
But like that, that's OK. That's I, I think there's,
that's why we're here to, to, you know, hopefully reassure
(24:22):
patients. But if something is up, the
sooner we know the better, right?
We're just trying to come up with putting clues together and
coming up with a road map. So I would say if, if, if ever
someone is feeling like they need just a little bit more
evaluation or listening to then then that either ask for a
(24:46):
referral or just self refer. And I will also say that your
intuition, whether you are a male or female, your intuition
is important. And so if you, if your primary
or your gynecology says now you're fine, you know, you're
young, you're healthy, relax andthat doesn't sit well with you,
(25:10):
then, then, then. Seek.
The expert care because no one knows you as well as you know
you and and so. Absolutely, Doctor.
Oh, no, that's fantastic. You know, if someone is
listening today, you know takeaways, you know from our
(25:30):
conversation, what would be the main ones that you would like
them to take away? You're not alone.
It feels like you may be the only one going through this, but
that's not true. There are resources and people
around to help you. And I really do believe there's
(25:56):
a light at the end of every tunnel.
And sometimes the tunnel's longer than we think or there's
a little more, you know, scary parts of that journey.
But I think that that getting tothat that end of that tunnel is
so amazing. And so like keeping your sights
on that is, I think, the only way we all get through it.
(26:21):
Yes. Oh, doctor, that was so
beautiful. Thank you.
It it just means so much. Thank you for sharing your
expertise with such heart and clarity today.
It means the world to have you here.
It's I thank you for having me and for everything you do.
Thanks Doctor. Oh yeah, For anyone listening,
remember that infertility is notyour fault, your questions are
(26:43):
valid and seeking help is a signof strength.
If you need support, guidance, or simply a community that
understands, Chasing the Rainbows offers a bunch of
different daily support servicesand we're here for you to walk
alongside navigate this journey with you.
Until next time, be gentle with yourself and remember that hope
is always possible. Thank you again, Doctor O.
Thank you.
Crying out loud a podcast by Chasing the Rainbows with your.
Host. Bernice Quisenberry.
Welcome back to Cried Out Loud, the podcast where no story is
too heavy, no grief too small, and where every family
(00:34):
navigating infertility, pregnancy, or infant loss has a
voice. Today, we're honored to welcome
a guest to Work literally changes lives, helping families
who long for a child find answers, support, and hope.
Doctor Melanie Ohowski is a board certified reproductive end
chronologist at Shady Grove Fertility.
She has decades of experience treating infertility,
(00:55):
reoccurring pregnancy loss, and ovulatory disorders.
Doctor O has published numerous peer reviewed scientific
manuscripts, received multiple teaching awards, and is
dedicated to combining medical expertise with compassionate
care. In today's episode, we're going
to explore infertility as a medical condition, debunk those
myths that can unintentionally harm patients, and provide
(01:18):
guidance on the questions everyone asks, from home
ovulation kits to when to seek professional help.
This episode is for anyone who has ever felt frustrated,
confused, or alone on their own fertility journey.
Doctor O, thank you so much for joining us today.
It is an honor and thank you forreaching so many patients and
(01:39):
being a beacon of hope and lightwhen sometimes it feels like
everything seems dark. So truly, thank you.
Oh, thanks, Doctor O That means the world.
And it's such an honor to have you here and to connect you, we
know, with our listeners. And I would love for you, you
know, to start from the beginning, you know, what got
you into this field and what youdo, you know, for your patients.
(02:03):
Yeah, I initially was interestedin the field because of the
science behind it. Human reproduction is so cool.
I mean, just female reproductionand the ovary, how this small
little nugget has millions of eggs and effects our hormones
(02:25):
that affect so many other aspects of female health.
I mean, it's incredible. So I went into the field very
interested in the science of it and the research.
I performed some early research on preventing chemotherapy from
affecting women's fertility in the future, but very quickly I
(02:49):
realized what an amazing patientpopulation the women who sought
my care were. And so it started to feel like I
was helping a friend rather thanreally like the medical part of
it came second. And the impact of listening and
(03:11):
being part of such an important journey really is the number one
reason why I'm still doing this 20 years later.
And I feel really blessed and honored that patients trust me
with their care. And I think I'm so inspired by
patients. So that was that's my journey.
(03:32):
Yeah. Oh, that's so beautiful.
And it's true. You know, when someone comes to
you like their future and, you know, their family, planning is
really in your hands with them as a partner and a true partner,
you know, walking alongside themin this journey.
So that just, you know, means the world to have that kind of
compassionate level of care of someone who treats it so gently.
(03:53):
It really is a relationship because when I'm first meeting a
patient, I don't know if I'm going to know them for a month
because they'll be very quickly successful, or if it's going to
be a year or two because it's it's it's unpredictable.
But I think knowing that they'renot alone and that we're in it
(04:14):
together till the end is is really an important part of the
equation. Absolutely.
It really is and you know, another part of that is really
educating others on, you know, infertility and and not being as
easy as go take a vacation or just relax and it'll happen, you
know, and that this is a true medical condition.
(04:36):
I think understanding that too. And the earlier that I know
we're talking pre show, you know, it's that early detection
or you know, doing deeper. I would love to hear your
opinion about that. Yeah, I think that in the US
there's so much emphasis on preventing pregnancy when it's
unwanted and we don't do enough education about how our
(04:59):
fertility is time sensitive, especially women's fertility,
and that we're most fertile in our early 20s.
And, and I think that's, I thinkthat's really important.
And I, it's a take home message.I try to emphasize anyone that
will listen. So my poor nieces in college
(05:20):
have heard me say this very often.
But I, I do think it's, it's, it's important, especially for
women who are embarking on careers that may delay their
fertility, knowing their, knowing their options and having
a, a strategy is, is important. But one of my talk talking about
(05:47):
kind of myths or, or things thatare, are, are said, one of my
pet peeves is that, you know, like, you just have to relax.
It's if you're just too stressed.
And when I think about it, like when would you ever go to a
doctor and you know, you're diagnosed with strep throat and
the doctor says, oh, you're stressed, you just got to relax.
(06:09):
That'll do it. I mean, factor ability is a
medical condition and it's no one's fault.
And I, I, I completely understand that we don't want to
medicalize something that shouldbe natural too early, but it's
really not about medicalizing anything.
It's about picking up cues that can help a, a patient or a
(06:34):
couple be successful and kind ofstreamline their journey.
So whenever I hear someone say like, you just need a glass of
wine or you just need to go awayit, it makes me sad because it
does a disservice. And it also kind of points the
finger and puts the blame on theperson, like they're doing
(06:55):
something wrong, yes. It's very dismissive and also,
you know, telling someone that then they're trying for let's
say 3 or 4 years and they're not, and then they finally get
back. Well, that might put them in
their 30s then, you know, or, orwhatever timeline that is
because they felt like, oh, like, I just need to do this.
Because as you know, time flies by and like when you're tracking
(07:15):
all of that and it's like, or not knowing what to do and it is
dismissive like that, you're, you then get in your own head.
Am I just coming up with this? But as women, we know our bodies
so well from a young age and, you know, know that.
So we, if we feel like something's off or something
isn't happening, it probably is,you know, just better to get.
Looked at, I think women's intuition is very powerful and
(07:39):
one of the, one of the points I always try to emphasize when I'm
talking with a couple is here's,I'll give them my
recommendations and then I'll say whatever you decide to do,
you'll take this at your pace. However, put time limits, time
stamps on it because it is so common that a year, 2 years goes
(08:00):
by and we're still at the same point.
We haven't made any progress. So if you put time points like
OK, if next by 4th of July or bythis date, if we haven't seen a
difference, then we're going to execute on part of this plan
because time goes by so fast. And unfortunately it is a really
(08:21):
important factor when it comes to how successful we we are.
Yeah, absolutely. And I love the time stamping
because it almost feels like that's what you need to keep.
And also, it kind of gives you hope and goals, so it doesn't
feel as daunting as it can be when you're in the midst of it.
Yeah, I, I, I think the only wayto survive this is to think
(08:44):
about the end goal. Like if you're thinking about,
oh, I got to take this pill or Igot to do this test, who would
ever want to do that? But if, if you think, OK, this
time next year, I want to have been successful, like that's the
goal. And then that gets you up every
morning and, and moving on. It's that hope for that.
Absolutely, yeah. And I think it's so important to
(09:06):
remember this isn't our fault and you know, anything, it's,
you know, just evidence based medicine.
It's so important, you know, running tests or doing more and
would love to hear, you know, what you do with your patients
doctor when they come to you, what that kind of looks like.
Yeah, I, I'm so glad you said it's, it's not your fault
because I think a lot of people,their brain knows that, but
(09:30):
their heart feels like what, what, what am I doing or not
doing? And when someone has been trying
to get pregnant and hasn't been successful, and then they end up
in my office, I think there's a little, they're grieving the
(09:51):
fact that it hasn't been easy and everyone around them, you
know, has an oopsie and, and youknow, there's, that's a loss to,
to know that that there, there'spossibly some tests or some
treatment needed. So I think just acknowledging
that that that's normal and it's, it's not fair, but you
(10:12):
know, we're going to get throughit and, and we're going to get
there. And so typically when a patient
has been trying for 12 months orlonger, we recommend an
evaluation. And it's not as though at 12
months something breaks and and it's all downhill after that.
(10:34):
It's simply that at the 12 monthmark, it is worth investigating
some clues that can help identify what what might be
helpful for the patient. And sometimes we would like to
see a patient sooner. If there are some known issues
that can affect fertility like PCOS or endometriosis or a known
(10:59):
male issue, then no reason to delay, no reason to wait till
that 12 month mark. Let's see you sooner.
And then I think age of the female partner is really
important. So 35 or older, we say give it
six months and then let's just talk about maybe doing some
tests. And then at 40, we say let's
(11:22):
come in as soon as you're ready.No reason to delay just in case
there's something a little off. Let's try to optimize it while
time is still on our side. Absolutely.
And I think you're, you know, that's so beautiful that you're
recognizing to the innocence of the pregnancy kind of being
taken from this couple. Not just like getting deprived
of that, like, oh, I get to surprise my husband with a
(11:43):
pregnancy announcement because Igot to take a test and him not
know about it, you know, or justunplanned and just like
sporadically, like we're pregnant.
Yeah. Like that, you know, isn't the
case. And it, and it can, it's so
heartbreaking in those moments because everything then does
feel like it is planned out and it's not that, you know, and
then we also are aware of complications and risks and HCG
(12:07):
levels and all of these different things that the
normal, you know, person who's getting pregnancy unexpectedly,
you know, isn't experiencing like we are, you know, in this
population. Yeah, I can, I, I will share
with you that I, I having gone through a miscarriage, it is
true that when you are mourning that loss, everyone around you
(12:29):
has a big belly and is there's baby announcements everywhere.
And it's like, seriously, is this, it's constant reminders
and it can feel really isolating.
So. Yeah.
Especially around the holidays, I feel like, you know, I'm
seeing again and again. But yeah, maybe it's just the
season and reason we're in, but it's like, here is, you know,
(12:52):
this person getting pregnant, Everybody wants to announce them
around the holidays. It just feels almost like, like,
when is it our turn, right? When's it gonna happen?
Yeah, the the holidays can be particularly tough.
Yes, that's a one thing that youmentioned reminded me that when
(13:15):
a couple is successful having gone through an infertility
diagnosis and possibly treatment, there are ways of
still holding on to some of the like spontaneity and excitement
that that we see patients who may not have had that same
struggle have. So, for example, calling with a
(13:38):
positive pregnancy test when both partners can listen in or
like doing, still doing gender reveals, even if it was an IVF
genetically tested pregnancy, westill like can put the, the
gender on a on in a sealed envelope.
And, and, and I think those little things really can make a
(14:00):
difference. And, and it really, I mean, it's
even more meaningful when it's been a little more difficult to
to get to. Absolutely.
But it's our favorite thing is when we get the gender reveal
videos or like we hear the stories and it's such a what a
celebration. Oh, Doctor.
(14:20):
Oh. And that's so great that, you
know, still. Yeah.
Like finding those celebratory moments, especially in the midst
of all of it, is so important. Oh, that's so beautiful.
Yeah, oh, so yeah, you know, going from doing like at home
ovulation kits, how, you know, reliable?
Are they like in any of the testing at home?
(14:43):
I have to admit, I was guilty ofbuying different teas, lozenges.
I mean, you know, we got to the point of like progesterone and
corrective surgeries, but what'sinteresting is, you know, it,
it's not as easy, you know, likejust you read all these things
and you just can't help it. Like I will try anything to try
to get pregnant at that point, so.
(15:04):
Oh, yeah. And I think nowadays more than
ever, when there's so much information available to
patients and there is a movementand I think it's a good movement
to think about holistic remediesand making sure that we're we're
as optimal, like we're as healthy as possible.
And so it's very common when patients come to see me that
(15:28):
they've already like tried out different supplements and how
are using home devices. And I think that can be helpful,
but I always caution to like continually evaluate whether
those things are serving you andat any point that you're like
(15:48):
starting to hate on the, the kitor the the wearable device, then
that's just that the stress thatthat's causing isn't worth it.
Like when I, when I see patientscoming in having done some of
their home initial evaluation, very often they're either using
ovulation kits, which are the urine kits that can predict
(16:11):
ovulation, basal body temping. And and then like more recently,
the wearable devices that, that can tracks your cycles and then
start to give predictions on your, your fertile window and
when to expect your cycle. And so I think the merits of
those things are that number one, they help you have insight
(16:35):
into your body. And you know, up until these
things existed, we were going off of symptoms like breast
tenderness or cervical mucus andand now these these products can
give you a little more objectivedata.
So that's good. And I think it also helps a
situation that feels so out of control, like, you know, if
(17:01):
you're, if you're someone who you work hard, you set a goal
and then you you get it. And now suddenly you're doing
all the right things and this isnot happening.
Sometimes the devices and the products can help you feel like,
I'll let like you're taking backthe reins a little bit.
The, the thing to caution listeners about are that any
(17:22):
test, especially some of these at home tests are not always
reliable. So you always want to take it
with a grain of salt. And I they can be influenced by
other things going on in your life.
So like particularly the basal body temping and the, the
wearables, those algorithms can be affected if you were sick or
(17:47):
you were super stressed or didn't get a good night's sleep.
And so you just want to like notlet that be the end all be all.
But I, I think it can be helpful.
But when someone's coming in andI can tell like it's stressing
them out, I say just like, let's, let's put that aside
because right now it's this daily reminder about you needing
(18:10):
to do it and it hasn't happened yet.
Why hasn't happened yet. And it, it's, it's not worth it.
Ovulation kits can be helpful when like couples are apart and
they need to time things a little bit better.
I think of the ovulation kits aslike your turn signal, it's
(18:32):
going to tell you what you're about to do, whereas basal body
temping is your rear view mirrorto say, oh, Yep, I did ovulate.
So can be helpful, but you know,keep it.
I I think keeping the perspective that it's not, you
know, you don't have to do it. No, no fertility Dr. will say
what you're not doing this already that because it's.
(18:58):
Yeah. Oh, I know, I know, I as you're
talking, doctor, I was like I was guilty of that, you know,
doing all of the charts, checking everything daily, you
know, especially first thing in the morning and like tracking it
all and it was almost obsessive.It takes away from even the joy
of the journey or any part of it, right?
And it just makes it almost likeAI mean loving the control over
(19:20):
a feeling like you know, I have a sense of control over it.
But then it is, it can be and I know you know it.
It almost felt like a job after a while.
Yeah, and I think there's many reasons why intimacy can be
affected during the fertility journey.
But it when when you're looking at your your kit or your chart
(19:42):
and then you're saying, come on,honey, we need, we need to be
intimate today. That kind of takes some of the
excitement out of it also. But you get to that point like,
you know, like you try the easy way and that doesn't work.
So you want to do something different.
And I think that's that's fine, but not for a year's worth.
(20:03):
And I would say the same thing about supplements.
So there's so much out there. It's overwhelming for me as a a
doctor to vet what products are needed or helpful.
So I could only imagine how overwhelming it is when you're
the patient trying to navigate these supplements and and
(20:23):
devices. But when someone comes to see me
and they ask my advice about supplements, as long as it's not
harmful, I'll say that's fine ifyou want to give it a try.
But if you've given it 3-6 months and it really hasn't made
a difference then probably not necessary.
(20:45):
And also seeing how it makes youfeel.
Some supplements can cause side effects and not worth toughing
it out if if that's the case. No.
And it and get expensive. I mean, all of these products
will be really, really expensive.
So, you know, I think it's greatthat people, patients are
(21:08):
empowered to try, like to do their research and try these
things. And I always welcome patients to
share with me what they're doingso that I can give my $0.02 on a
supplement or a product. But most of the time, if it's
making you healthier, that's a good thing.
(21:29):
I caution patients, my, my male and female patients to avoid the
supplements or products that claim to like enhance your
vitality or like that that's more of a, a, a men's supplement
thing. But it what if they're claiming
that it's increasing your libidoor increasing your, your
(21:52):
vitality? I, it makes me wonder, is there
a plant based type of male hormone in there that actually
can be working against us? And then for female patients,
any supplement that claims to regulate your cycle, I would, I
would caution because birth control regulates your cycle
(22:13):
because it totally takes over. So you just, you know, sometimes
in an effort to try to make everything perfect, we can, you
know, do a little, you know, more harm than good.
But that's why you're never meant to do it alone.
Like there is, there are people out there who can, can help you.
So always I think remembering that is important.
(22:35):
Yes, and I think too like understanding when is it
important to make the change over from a clinician, you know,
AGP or OBGYNII know we get this a lot, you know, in support
groups or different support services.
We have infertility loss parentscoming to us and you know, they
go to their doctor. It's kind of, you know,
(22:56):
dismissed, like we said about, you know, go home, relax kind of
thing or not doing further testing or they had ADNC or a
procedure from, you know, a pregnancy loss or, you know,
have experienced endometriosis and PCOS.
And maybe, you know, it's something that a surgery can go
in. And I mean, I needed that.
(23:17):
And you know when you would seekan RE doc to talk through all of
these different things compared to staying with an OBGYN or
feeling like your answers aren'tbeing heard by a clinician?
That's a great question. I think it's never wrong to
start with your GYN or your PCP and share your your your current
(23:39):
situation and get their advice. But if you feel as though
there's kind of this like stall out and not much is happening,
anyone can self refer to an RE II would say at least at Shady
Grove. I would, you know, at my
practice, anyone can self refer and I it's not unusual.
(24:00):
I have someone who hasn't been trying, you know, probably
doesn't need to be here, but sheneeds to be here.
If she needs to hear from me that everything sounds OK and we
can do these tests to reassure you.
But like that, that's OK. That's I, I think there's,
that's why we're here to, to, you know, hopefully reassure
(24:22):
patients. But if something is up, the
sooner we know the better, right?
We're just trying to come up with putting clues together and
coming up with a road map. So I would say if, if, if ever
someone is feeling like they need just a little bit more
evaluation or listening to then then that either ask for a
(24:46):
referral or just self refer. And I will also say that your
intuition, whether you are a male or female, your intuition
is important. And so if you, if your primary
or your gynecology says now you're fine, you know, you're
young, you're healthy, relax andthat doesn't sit well with you,
(25:10):
then, then, then. Seek.
The expert care because no one knows you as well as you know
you and and so. Absolutely, Doctor.
Oh, no, that's fantastic. You know, if someone is
listening today, you know takeaways, you know from our
(25:30):
conversation, what would be the main ones that you would like
them to take away? You're not alone.
It feels like you may be the only one going through this, but
that's not true. There are resources and people
around to help you. And I really do believe there's
(25:56):
a light at the end of every tunnel.
And sometimes the tunnel's longer than we think or there's
a little more, you know, scary parts of that journey.
But I think that that getting tothat that end of that tunnel is
so amazing. And so like keeping your sights
on that is, I think, the only way we all get through it.
(26:21):
Yes. Oh, doctor, that was so
beautiful. Thank you.
It it just means so much. Thank you for sharing your
expertise with such heart and clarity today.
It means the world to have you here.
It's I thank you for having me and for everything you do.
Thanks Doctor. Oh yeah, For anyone listening,
remember that infertility is notyour fault, your questions are
(26:43):
valid and seeking help is a signof strength.
If you need support, guidance, or simply a community that
understands, Chasing the Rainbows offers a bunch of
different daily support servicesand we're here for you to walk
alongside navigate this journey with you.
Until next time, be gentle with yourself and remember that hope
is always possible. Thank you again, Doctor O.
Thank you.
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