8.) KP: You’ve already woven several useful examples into the interview already, but could briefly walk me through your treatment process, so others can get a feel for how you work?
Diane: The thing about infertility is that it is a bit tough to generalize. It’s really case specific. I have patients as young as 32 years old who have premature ovarian failure, which is pretty devastating if you’ve been trying to get pregnant since you were thirty and you get this diagnosis that you’re coming to menopause at a young age.
Then I have patients of an advanced maternal age. Women who have been divorced, who have left a bad relationship, years go by, they work on their career and then they finally find a partner again. One of my clients just turned fifty and she trying to get pregnant using an egg donor with her wonderful partner that she finally found 4 years ago. So, she’s in a different place from somebody who is 32 years old.
Somebody in their late forties who knows that the only way they’re going to get pregnant and have a child is through egg donation has a different mindset. They may still grieve past losses but they are more readily able to move forward with a donor and they are perhaps more grateful that this option is available to them. Now, they have to deal with other issues, such as societal judgment about the “older parent,” although the mature parent is becoming more and more prevalent. The rise in women age 42-48 having children has increased 500% in the last five years. So, that’s a whole other arena in dealing with people’s emotions around “Is this natural?” “Will people judge me?” Dealing with the double standard around men being fathers at very advanced ages with younger women. But, this technology is available and egg donation is successful up to 75% of the time. So, that’s a very, very high number compared to when the doctor says you have a 2-3% chance of success with your own egg.
Back to your question about the treatment process, there are lots of different scenarios. Generally, people come to me when they’ve had at least one IVF or several miscarriages. They have experienced some pretty dramatic failure at this point. These would not be people who would be trying for 6 months and haven’t gotten pregnant.
They would come and see me, I would do an assessment and we would talk about their goals, we would talk about all the different options, whether it’s continuing IVF, moving to donor, adoption, using a surrogate, etc. I have had some patients with a genetic disease and they don’t want to pass it along, so the way they get around that is by using a healthy donor. Surrogacy, if that’s necessary, because sometimes it’s an egg issue, sometimes it’s a carrying issue, where the woman cannot hold a pregnancy. There’s also embryo donation. Parents who do conceive through IVF sometimes have leftover embryos. They have their one or two kids and they decide to donate their extra embryos. We talk about all the different options that might be available to them.
I like to work with the concept of some kind of timeline and milestones because it’s really, really critical for people going through this process to have milestones. We chunk it out into short, attainable goal, whether that’s changing clinics, or deciding to adopt, or whatever their next step. It means they need a plan for doing their homework, data gathering, how long things will take, etc.
We have a timeline, that includes goals around when is “enough” – when will they decide that they’re not going to keep pursuing one course and move to the next option, or coming to a point where they decide not to have children. Of course, you can’t decide all of that in the beginning, but I like to map out this framework for people in the beginning. This is helpful because I believe it reduces anxiety and gives people a sense of mastery over their destiny.
Usually, when a patient who has had fertility issues becomes pregnant, they want to stay working with me until they have that baby, because often times they have had multiple losses. I’ll work with them through the pregnancy and through the post-partum depression, because that’s very common for most women.
There are also major shifts in identity when they get pregnant and have their first child. This is something they have wanted so desperately for so long and then they get it and say “oh my gosh, be careful what you wish for” because you know, they’re sleep deprived, they can’t do their career as well…everything is turned upside down once they have their baby. So, I’ll help them work on these changes, the identity shifts, and the parenting issues they might face. I refer them to so many of the great resources that are in the San Francisco Bay Area for new parents. Usually, by then they’re on their way.
But, some people have really struggled for years. I have patients that have been dealing with infertility for 5+ years and they still don’t have a child one way or another and they continue to work with me. Hopefully, it’s not that long for most people, but it can be anywhere from 1 to 5 years before they’re able to somehow create their family.
KP: That’s great that you can provide that continuity of care when it’s needed. Once your client establishes that relationship with you, where you help them with the psychological and practical matters associated with infertility, you are able to help them through the next stages as well, with things like parenting issues or post-partum depression, if those arise.