Oversharing - Baby Steps: The Real Mental Toll Of Infertility Ft. Dr. Georgia Witkin

Episode Date: December 8, 2023

Jordana returns for another Baby Steps, presented by BetterHelp, and this week she’s joined by clinical psychologist Dr. Georgia Witkin to talk all about the mental toll of infertility, and how stress and therapy play a vital role in the process of trying to get pregnant. Dr. Witkin tells us how she got involved in the field of stress research, including why so little attention was paid to the role of stress on women before she started her program at the Mount Sinai School of Medicine. She also helps clarify some of the biggest medical myths around pregnancy and infertility. Is there really any evidence to support the claim that “the minute you stop trying” you’ll get pregnant? And what’s the deal with the five stages of grief anyway? Plus, she gives tips for navigating the process of egg freezing, egg donation, IVF, miscarriages, and more. If you’re curious about stress and pregnancy, Dr. Witkin has the answers. Thanks again to our presenting sponsor, BetterHelp! Visit BetterHelp.com/BABYSTEPS today to get 10% off your first month. Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello and welcome to Baby Steps presented by BetterHelp. I'm your host, Jordana Abraham, and on Baby Steps, we're exploring the various paths to parenthood that lay ahead when starting a family doesn't come easy. With the help of weekly guests, I'm taking you on my own fertility journey and asking the questions that need to be asked. Trying to have a baby, especially when you experience obstacles, can be a huge emotional and mental challenge. And that's why I invited BetterHelp to join us as the presenting sponsor of Baby Steps.

If you're thinking of starting therapy, I recommend giving Better Help a try. It's entirely online, convenient, and suited to your schedule. Just go to BetterHelp.com slash baby steps today to get 10% off your first month. That's BetterHelp, help.com slash baby steps. Therapy can give you the tools to navigate the difficult transitions in life, and the path to parenthood is definitely one of them. My guest today is clinical psychologist, Dr. Georgia Whitkin, to talk about the mental toll of infertility and how stress and therapy play a vital role in the process of trying to get pregnant.

Before we get to Dr. Whitkin, as always, here's my sister, Dr. Naomi Bernstein. Welcome, Naomi. Thank you. I'm so excited to see what Dr. Whitkin has to say about therapy and infertility. So what's the message? I hope you don't think I'm cheating on you. Yeah, a little bit. Speaking to another therapist. No, this is not, I don't have specific training in this. So I'm always happy to learn from other clinicians that do have specific training. So I'm curious to hear what you have to say about all this. Yeah, well, I mean, a big part of what Dr. Woodkin does is she kind of like speaks to people who are on these alternative paths, people who are either like getting egg donors or sperm donors, you know, like surrogates or things like that. Like there's a lot of, I think, mental health prep that goes into choosing those paths.

Yes. Because it's, you know, it's not just it doesn't, it can feel maybe like, okay, especially when you're in the hamster wheel of fertility can feel like. can feel like, oh, just make the decision, just move forward, just do it. And like, there's so little time. But what I like about what she does is she really helps people understand just sort of like what everything means physically and how that relates to how they should think about things psychologically. Oh, interesting.

Okay. Yeah. And one of those things that you talked about was like using an egg donor if, you know, you don't have viable eggs yourselves. and the way that you should think about thinking about those things, or sperm donor or any of that stuff. Like I think people, she talks about how people think that,

you know, it doesn't feel like it's my child. And then she talks about, you know, the science of that, which is just that your body can create like trillions of different babies, some of which would not look nothing like you anyway. Like she's talking about her own daughter

and how she looks nothing like her. And that's her biological daughter. And just kind of like getting over the hump of a lot of these psychological things that can hold us back from making these decisions and creating our happy lives for ourselves. Totally. I can imagine when you're making a decision like that, that there's probably a tendency to just kind of judge it, like how you're going to feel about it or something. Like that's not an option or that's not the option that I want. When going to therapy and really kind of talking through the reality of it might help you.

kind of get unstuck from your own judgments around what it would be like to have a child that's not entirely, you know, biologically related or just to really go through the process of playing that out would be an important part of the process instead of just kind of making your snap judgment, saying this is something I do or don't want to do. There's a lot more that probably has to go into the thought process and the emotions behind it. So I'm glad that she's doing that work with people and kind of just opening the door to exploration around these alternative pathways. Right. Because I mean, we talk about it all the time.

Like, the way you think about something shapes like your reality. So if you're, you know, if you're going into something thinking like you're so upset or this child isn't going to feel like yours, that's a totally different reality than like, this is my child. It like, you know, looks as much like me as my own child might look like me. And, you know, it feels like yours. a lot of it is just like the way that you process and the way you place things mentally. 100%.

And what happens when you don't do that, when you don't do the work to sit down with someone who's knowledgeable in this area and really just explore your own, just question your thoughts and question your judgments and explore why you think and feel the way that you do so that you can kind of choose a mental pathway that is a true and B feels better than the one that. might, you know, be just as unlikely or just as not true and also make you feel kind of crappy. So there's so many different ways to look at things. And sometimes we don't see it until we actually get in there and dig through. So this is, this is great. I'm excited to hear this conversation. It's going to be great. One more thing she talked about, which I thought was really interesting,

was sort of dispelling a lot of myths that we think about mental health that are just not proven to be not true. One of them that I liked was like, you know, I asked her about, is there less shame towards like infertility and IVF than there was 20 years ago because I see it a lot more publicly. And she's like, to be honest, like the research doesn't show that like there's really, it's not about people don't have shame about pursuing alternative assisted fertility. Like that's not what they, they don't tell people not because they're ashamed because they don't want to like have to keep updating them or they don't want to like have to talk about it with them. Right, right. Which I thought was really interesting. It's like there's this whole thing is like, oh, we're not telling anyone because we're so ashamed. But it's like, no, we just don't want to have to like update your aunt on how your egg retrieval.

Totally. It's almost like why people don't tell anyone if they're like in an early stage of dating because they don't want to have to give like the constant updates about how it's going. It's kind of like it's not because I'm ashamed that I'm dating this person. It's more like I don't want to have to keep, you know, every time I see this person give them the exact exact. you know, timeline of where we're at. So right. And it can feel that way. It can, if you're going through this stuff, it can feel like, oh, like everyone's going

to want to know how the, like the more people I tell, the more people I have to tell if I miss Perry or if the transfer didn't go, go well. And it's not about, oh, I'm so ashamed that that happened. It's just that I don't physically feel like tell. Right. I want to have this conversation when I feel like having this conversation, not when you ask for an update, which is great. It's interesting because there really, there is no reason to have any.

shame behind it. It's actually something to feel, I think, once you get to the end of it, to feel really proud that you set your mind to something and you did all the things that you needed to do to get there. So I'm glad to hear that. Totally. Yeah. And she just, we talk about a bunch of other stuff, whether you should take breaks or keep trying. And she just has some really good research-based statistics on stuff. And it was a really fun conversation. I feel like she's a really funny, cool therapist, just like you. I'll have to do an additional episode. Yeah, I would love, I always love to meet, you know, fun. You know, I think therapists sometimes get a wrap of being like kind of just like dry and dry, you know, just kind of, you know, very serious.

So it is fun to meet others who can keep it light. Yeah, Dr. Wittgen definitely not like that. So let's bring her on and you guys can see for yourself. We are here with Dr. Georgia Wittgen, who is the professor of psychiatry. at Mount Sinai. At RMA, New York, you are the director of psych services at Progeny. You're the director of patient services development. And you also write a newsletter for psych today called Chronicles of Infertility. Welcome, Dr. Georgia Woodkin. Thank you, Jordana. And you can call me Georgia. Okay. Awesome. I guess first off, what I wanted to talk about was like what got you into this field

surrounding infertility? I also know you've written like several books about women and stress and all of that. So can you just take me sort of on your path to like how you became so involved in this field? You just hit on it. All my books were on women and stress because everyone else was writing about men and their type A personalities and their heart attacks. So I said, what about women? And what happened was when they formed the fertility unit at Mount Sinai in OBGYN, they said, let's get that woman from psychiatry who writes about women and stress because they thought only women, of course, have infertility problems. And so I joined OBGYN also and became involved as they started the first IVFs and the first egg donations. And I became head of the

psych services at Mount Sinai. And that became RMA of New York and now we're part of U.S. fertility. So we're, I guess, among the biggest in the world. Wow. Okay. And I mean like, In terms of like mental health and stress, how does infertility do you find, like, affect things maybe even differently than other things you've noticed? It's a great question. It's probably up there in the top rate. So I'll condense 13 of my books into one sentence and save everyone a lot of money. When your sense of control goes down, stress goes up. Right. So if something's wrong, you know, with your mother, if there's something you can't control, like what's going to on now in the Middle East, no matter what it is, if it's COVID, if there's something you, as a smart woman, can't get your hands around or fix, our brains are wired to worry, watch weight, to try to take care of it, so we're up in the middle of the night, we're still trying

to think of an answer, we're reliving the past, what should I have done, we're pre-living the future, what's going to happen. So any time our sense of control goes down, everything is triggered in the area of stress, the physical, the psychological, the mental, and so forth. Now picture infertility. Any problem with fertility. Most of us did not expect it. Sense of control plummets. Most of us spent a lot of time trying not to get pregnant until we chose it. And now suddenly we can't. Many of us chose to do education first, or have money first, or some want a partner, some don't care, some actually don't want a partner. But whatever it is, it's sorting it out, we're not having babies at 18 anymore. And that's when our eggs are right.

You know, nature thought we'd be eaten by a bear by the time with 35. So the eggs don't go on forever in top quality. And there we are, feeling young, we are young, we finally got everything under control again. And now we're trying to have a baby and is a problem. And so, again, sense of control is down. It's the unexpected. It's going to cost money. It's going to take time. We're going to be taking hormones. And on top of it, Jordana, Aunt Fannie is saying it's your own fault. You work too hard. You're too stressed. Just relax. And you'll get pregnant. And it's baloney. Listen to me. I've written 13 books on stress. Stress does not give you infertility. Infertility. gives you stress. If stress alone was enough, there'd be no humans on the face of the earth

because everyone has stress. I mean, you talk a lot. I love what you're saying about the sense of control and that being sort of like a big part of this is that you really can't control the outcome. I think there's like maybe IVF or a lot of this assisted fertility stuff gives you this maybe false sense of control. Like, oh, I can, you know, I can do this thing which feels like a guarantee or feels like, you know, like now there's so much science that, that I can control this situation. I can pick healthy babies or it's going to be, you know, I can create my own success. And I think when people don't find success in that, either they can't create enough eggs or it's hard to make embryos or, you know, they have miscarriages. Like I did with, you know, with IVF

tested embryos, there's this sense of like, what do you mean? I tried to control the whole situation and I didn't. So do you see a lot of of that, like just sort of misconception of the IVF process or the assisted fertility process? It's such a good point. I think what's happened is we all kind of see ourselves as consumers at home. I can go on in the middle of the night and put on Amazon or Instacart and, you know, by the next morning have whatever I need. So we really feel like we're consumers. As you said, out there is all this technology, assisted reproductive technology. You know, if I find the right doctor and pay the right money and get the right hormones and so forth, of course it can be fixed. Of course I can buy what I need.

And then once again, we realize as we're doing with climate, as we're doing with so many other things, that nature is really not fully under our control. I mean, what do you find are the best practices to deal with that sort of thing, the sense of like an inability to control the whole process or the success or the outcome and sort of like, because it can. feel, I think for this especially, and like you said, it's a lot of like maybe women in their 30s dealing with this who are successful, who have, you know, these careers who are used to being able to control the outcome of their lives or to steer it in the direction they want. And there's this powerless feeling. So what do you, what do you recommend to your patients? Yeah, that's the

perfect description. You know, you study hard, you get an A. I'm doing everything here. I'm not kidding, the result. A few suggestions. One, is if you look at the big play, if you want the parenting experience, if you want to build a family, there are many, many, many ways. Don't confuse pregnancy, you know, with parenting. So there are many ways to build a family and we're learning about them all and we're using them all. And, you know, same-sex couples are locked into third party. They must have an egg donor for two males. They must have, you know, a surrogate if they're two males. They must have donor sperm if they're two females. So we're learning that there are lots of elements and how to put it together.

There's also, you know, of course, adoption. As I said, if you want to parent, there's always a way of parenting. So if you look at the long run, you get back some sense of control because you say, okay, I do have choices. You know, I can also choose to change my mind and not go this route to not do this to my body or to, you know, look for embryos to adopt or to look for a child. I'm not saying it's easy and I know it's all expensive, but it's a sorting out where, again, you might not be in control of the outcome, but you can be in control of how you see things. What I've learned from some of my patients is some have said when they have an IVF that doesn't work, what they do is see it as, okay, so this is yet another opportunity to have.

the physicians try to figure out what went wrong so we'll know more about the next try. So you can see it as informational. You can see it as inconvenient rather than a disaster. You're not just playing with your head. You really are cognitive restructuring. And believe it or not, you know, for decades we thought the feelings led to all of our thoughts. Now we find out how you think leads to your feelings. And if you say to yourself, this is really inconvenient or this is really, you know,

terrible, unhappy. I'm trying not to curse on there. You can't, don't want, you can say anything. Go for it. Yeah. You know, this really sucks. Then your brain and your body will process it differently as yeah. And you'll get annoyed rather than devastated. The biggest problem I see on these journeys is that people get so down that they take time out. And every week might be important. because the younger the better in terms of DNA and so forth. So I think that we've all brought into this idea of neat stages, you know, of processing as things don't go right, that Elizabeth Kubler-Ross, you know, oh, first there's denial and then there's this. No research has ever backed that up, Jordana. Did you know that? I did not know that.

It's not true. The stages of grief, you're saying? Right. Right. That's not a, okay. I didn't know that. Sorry to tell everybody who's invested in it. And here's what worries me about it. If you really believe that, I've had people in my office saying, I'm not finished, you know, really processing this. And I haven't gone through all the stages. And I go, oh, my God, you know, you could be doing another try now. You want to use your own eggs. What are you waiting for? And they'll say, well, I haven't gone through. And listen, everybody listening.

women in particular are capable of more than one feeling at the same time. You can be disappointed, you can be a little discouraged, but still excited that it's out there and still hopeful and, you know, pushing on. You can do it all at the same time. All of this, you know, processing first is not the way human beings work or everyone would be taking years out of their life. There's so much to process and losses. Yeah.

Georgia, I love that take. do you know why? Because like as someone, you know, I've done a couple transfers and I've, you know, I've been doing fertility treatments for about or a little over a year and a half. And I feel like the, you know, when things don't go right, everyone's popular wisdom, everyone's suggestion is why don't you take a break or, you know, why don't you like try on your own? Stop stressing, like you said. And, you know, it'll just happen. That's always like the most annoying advice that you get. And I've never really wanted to do that. And it's always kind of seemed like, oh, that's, that's definitely, that's the healthiest way to go about processing or figuring this out.

Like you have to take a break to regroup. But to me, it's kind of like the thing that feels the best is to just keep going, to feel like you're doing something. So it's great to feel, at least for me personally, affirmed in my own feelings about that. A hundred percent. If you look at the real studies, when you go on Dr. Google or whatever it is,

stay off the internet. But when you go on Dr. Google, put in the word research after your search term. and you will get real studies. And what you'll see is, number one, if you work, stay at work, just as you were saying, Jordan, it gives you distraction. It gives you people to talk to her not in your family or your best friends. So it's very neutral.

You can say things to somebody at work who's a friend of yours, which is different than a social friend. It gives you another way of measuring yourself. It gives you different kinds of feedback. It reminds you that you're not the only one in the world going through things. I mean, work is, and there are studies that say work gives you a routine, it gives you a schedule, it distracts you from all these side effects, from the hormones you're taking. So absolutely, I agree, stay at work.

And as for Aunt Fannie, you tell her when she says, you know, just relax, it'll happen. you can say, you will be so happy to know that the research shows stress has nothing to do with it. In fact, Jordana, there is another myth that if you adopt, tell me if you've heard this, if you adopt, you'll relax about parenting and then you're more likely to get pregnant, that once people adopt, then they get pregnant naturally. Have you ever heard that? I feel like I've heard anecdotally of people talking about that, or even sometimes I've heard that with like a surrogate or something.

Yeah, totally not. True. Totally not true. Unfortunately, you know, if you're spontaneously getting pregnant, it has to do with egg quality. It really does, you know. And there are no stats that back up that if you adopt or you use a surrogate, then the second time you, in fact, it's a year later or two years later, you're less likely. Right. Yeah. And I think, you know what the thing is, especially with all this like fertility stuff, as you see there's so many, I feel like there's all these examples in pop culture, celebrities, you know, like, who have these success stories or even just like people, you know, you hear of a friend, you hear of a friend of a friend or you hear of Hillary Swank having

twins at 48. And you're kind of like, oh, like, it doesn't seem, you know, that difficult. Or, yeah, this person adopted and then they did that. So once they stopped stressing, it all, like, became totally fine for them. And I think that gives you a false sense of, you're like stressing about the stress. Or you're kind of like, oh, those. everyone keeps telling me just to relax and I'm not doing that. So I'm, you know, I'm creating this problem for myself. Listen, starting at 35, I'm sure, you had Dr. Lucky on, Dr. Lucky's, I'm sure that she was talking about this. Starting at 35, there really is, you know, a fertility cliff. There's really a drop. It's different for every person. And I'm not saying you wake up when you're 35 and the

next day there's a fertility problem. But, I mean, the odds of getting pregnant with your own eggs when you're close to 50, if you haven't frozen your eggs and at a time it was already good, I mean, egg freezing really has improved greatly every year. And, you know, no one froze their eggs 30 years ago. It wasn't even around. So the odds of that happening are, you know, in the National Enquirer kind of, you know, scenario. But so many people are using assisted reproductive technology. they're not sharing it necessarily, particularly if they're stars. And I don't blame them. And if they've used something like egg donation, where the baby is still theirs, every cell in that child's body was built from their body. Because you're not just an incubator when you're pregnant. The baby uses your

protein and your calcium and your sugar to build itself. It doesn't have a stomach and teeth, you know. It's building itself out of your body if you're pregnant. And if you use a donor egg for some of the DNA. We use donor sperm every day. Every woman who's pregnant used a donor who was sperm. So if they decide until the child's ready to understand, which may be in six, seven, eight years, they're not going to make it public. It's their right. So we don't know a lot about how these people got pregnant. And when they do let us know, I find responders to my columns say, oh my God, this meant so much to me. Somebody, you know, who's famous also used IVF and said so, also had a loss. And they tried again. And, you know, bravo to them. But if they're not

sharing it, I think that's their right, too. Yeah. What do you think about that? I agree. You know, I understand the right to privacy, especially the more, you know, the more famous you are, the more your privacy is probably so important to you and the privacy of your children who didn't, you know, didn't ask to be born of a famous parent. I think it's nice when like, I don't think people need to, you know, do a whole post and publicize about it, but I just think even if you're telling someone about it, that sometimes is enough or that feels like it normalizes it.

And I wonder from your point of view, just as someone who's been doing this, like you said, since basically the beginning of IVF and how, to me at least it seemed to let me know if you disagree. It seems like it's so much less stigmatized now, or especially in recent years, then I imagine it would have been 20, 30 years ago.

I remember there was one kid that I knew from college who was a child. He was the only person that I'd ever heard of who was born of IVF and he was like very wealthy and it was like kind of hush, hush. But now it feels like it's living in New York City as a woman my, or previously living in New York City as a woman in my 30s, I feel like I hear this all the time. It's like so many people that I know,

so many women freezing their own eggs. It seems to be like much less stigmatizing. And I imagine mentally, and like what you're dealing with on a psychological basis is different. And I don't know, you tell me. So glad you brought it up because I just wrote a note to myself to bring it up the same thing. There is a lot in pop culture about the shame that women feel if they have fertility problems. Right. You've heard that.

Yes, of course. I don't see that. And therefore, we did some research. and found out that most women say they don't talk about it, not because of shame, but number one, they don't want to hear everybody else's story. The minute they tell their story, they have to hear, oh, yes, and I went through and I had in my problem. Number two, they don't want everyone's recommendations. Oh, I have a doctor when you're already working with your doctor.

or you should be taking the supplement or try acupuncture so they don't want to deal with that. Number three, once they tell somebody that person now checks in with them, you know, for the next three years. And how's the most annoying thing. Right. Right. So they're really saying, look, I choose my people very carefully who, you know, won't nudge me, won't overwhelm me, and will really listen and not just tell their stories. And the other thing I hear a lot is I only want to speak to people who are going through the same thing. Because when everyone else says, oh, I understand.

I think to myself, B.S. You don't understand. Don't say I understand. But if you know someone else went through it or was going through it, then when they say they understand, as you were saying, even if it's one person, it gets normalized compared to what you think in the middle of the night when you're love. I love that. I feel like you're just dissolving all these myths about, you know, things that people popularly think. Because I do think, I kind of agree. Like, I don't feel like there's that much shame. I'm not like so embarrassed to be, you know, undergoing fertility treatments. It is much more the

things that you're saying. It's like annoying to tell everyone. You don't want everyone's opinion. You don't want to have to give updates. You don't want to have to, next time you see them, you know, wonder if you should be having a drink or not having a drink because they might think that you're pregnant or not pregnant because they know you're trying. Yeah. Yeah. So that's a great point. I really like that. Some women have actually said to me that they don't spread it around because they're single but don't want to stay single. And if the word gets out, they're going through fertility, a lot of guys don't want to be involved with that. Not that they'd be less valuable. They just don't want to be part of the hormones they already know about it from their sister or from their best friends.

So, you know, I'd never even thought about that as a dating issue. Yeah, I mean, I've seen that, you know, just anecdotally around people that I know women who are freezing their eggs, but they're dating a guy and whether they should, you know, tell that they're freezing the eggs. Is that going to scare them? But to me, that would only make them, if I could imagine if I was a man-dating woman, she's freezing her eggs, that would be an attractive thing to me because I know that it takes less of the pressure off of the relationship. You know, you're less wasting someone's time. I agree. Unless you're asking him for the money to do it, then he'd be upset. This episode of Baby Steps is sponsored by BetterHelp. It's almost the end of the year. And this time, while it can be exciting, can also be really stressful. And a lot of people feel a lot of sadness and anxiety about it. And it's not just the stress of finding gifts, but it's also the stress of seeing your family, of it starting to get cold, a little seasonal depression.

But adding something new and positive to your life can counteract some of those feelings. And therapy for me is always something I go to when I'm feeling anxiety or stress around anything, whether it's the holidays, winter, or just like things that are going on in my life that are not going as I planned. I've been to therapy for over eight years now and nothing has helped me quite as much as therapy has overcome whatever obstacles come my way. If you're thinking of starting therapy, give better help a try. It's entirely online designed to be convenient, flexible, and suited to your schedule. Just fill out a brief questionnaire to get matched with a licensed therapist and switch therapists anytime for no additional charge.

Find your bright spot this season with BetterHelp. Visit BetterHelp.com slash baby steps today to get 10% off your first month. That's BetterHelp, H-E-L-P.com slash baby steps. I think a lot of women forget that. We now know that 50%, literally one half of all infertility is male. Really? We tend to think of it as our problem. And when you see graphs of fertility, it's usually a stick figure with a skirt, you know, where the graph is building.

But 30% of the time, it's a female problem. 30% of the time, it's a male problem. And the remaining, it's either both and a small percentage, probably about 10%, is unknown. Science is not yet equipped to die. So it's not a female only problem. It's just, you know, men don't share the same way, whether it's cultural, or the way the brain is structured. It doesn't matter.

I'm not debating that. But they really process it differently. What's wrong? How do I fix it? You know, let me do that. And then I don't want to hear about it. Do you get a lot of men who come to your practice or that you guys speak to about this? I feel like there's not that much attention placed.

Like you said, it is not just a female problem. And a lot of men go through it too. 50% of the people I see are male. because at RMA, you know, USF, you, if you're going through anything third party, if you're using donor eggs, if you're using a surrogate, if you're doing oncotherapy, if you've had cancer treatment and therefore you need donation, et cetera, I am part of the process. I'm there to make sure if you're doing ovum donation, for example, you understand there's no baby in the egg.

It's just some DNA-binded donor with a similar donor. gene pool and it's a transfusion to you, not to the baby. That's not the babies anything. It's your donor. And then you build your baby. So in other words, I'm helping with clarifying because there's so much stuff out there on the internet that is really just chatter and borrowed advice for over donation is being given from adoption. It's not appropriate. You don't say to a two-year-old you know, oh, it's your journey. Let me tell you about it. You think they understand microscopic eggs and the fact that the only thing in the egg is DNA from three trillion combinations in a gene pool? No three-year-old is understanding that or cares. So it's about age appropriateness.

So that's what I talk to everybody about. So I am seeing men every single day because they're either part of a couple or they're two males or they're just themselves coming in because they need a get to it. They need an ovum donor. So, yeah, I see 50% of the people I speak to a male. Well, talk to me more about what you were just saying. That's really interesting when you're talking about like what's in the egg. Is it the way to think about it? Because I think that's like really what you're talking about here, right? Because what you said earlier, to bring it back to something you said earlier about the way that you perceive something is really your reality. Right. So if you go through the fertility treatments and you're kind of like every, every bad

test result is devastating. That's what you're going to be. If you tell yourself that that's the story, if you say, oh, it's an observation. I'll try again. That gives you an entirely different feeling about the situation. But I think that's probably nowhere as important as it is when you're talking about things like using someone else's eggs or using someone else's sperm. And the way that you think about that probably entirely shapes whether you feel like this

devastating feeling of this isn't, I don't, you know, this isn't my child or this, you know, doesn't feel as much as my child because I'm using donor eggs. So I would love to hear more about that. Sure. Sure. Well, most people don't realize is it in our eggs, in our sperm is not us. So if a woman's not using her eggs, she does feel like she lost the peace of herself. But the truth is, if you picture your great, great, great, great grandparents, having three kids, and they each have three kids, and they each have three kids. Within just five generations, you already have three trillion combinations of DNA. So my daughter looks like you, Jordana. She is dark hair. She's dark eyes. Now look at me, right? I have pale hair and pale eyes. We look nothing alike,

even though I use an egg before I lost my ovaries. So, you know, one try at this wonderful daughter. She's never been asked if she looks, if she's related to me or vice versa. And I'm talking to of that, we had the same nose job from the same doctor, and we still don't look alike, nothing alike. And she has three boys with blonde hair, blue eyes. If you remember high school, that's dominance and recession. So in our eggs and in sperm, it's all the same, is DNA that was deposited there when we were conceived by our parents and each had three trillion combinations in their gene pools. So any given egg may have great, great, great, great, great, great aunt Sally in it.

And nothing that overlaps with us at all. Right. So it's not mini me in the egg. And it's not mini donor in the egg. So many people are picking donors based on their looks and their spirituality or their hobbies. And again, you could be getting her Uncle Harry, you know, mixed with the 10% of the human population that wasn't even the person they think it was because armies marched through villages and so forth. So think of a donor as a donor to you. She's giving

you some DNA so then your body can build the baby because the DNA from the sperm and egg make up a set of instructions for another human being. And it might look nothing like you, even like my case, if it came from your own egg, it still might have been relatives you really don't know and don't look like you. And what happens is this set of instructions replicates into two cells, the two to four, the four to eight, the eight to 16, by day five or six, there's a blastocystis the same size as coming out of your fallopian tube. And if it hits your uterus, then it's your job, you know, to grow that baby.

As I said, it's your protein. it's 30% of your calcium is going to be taken by that baby. It's your flesh and blood, and for nine months you interact with it. So, Dordana, if you and I had identical twin embryos, nobody would separate them, but let's say they did. And your brain hormones were serotonin, and mine was dopamine. Different parts of the brain for nine months of being stimulated. Yours was already uniquely yours.

Mine is uniquely mine, et cetera. So it's very different than people think. no one's given you a baby. You still have to create it and it's yours and it's not adoption, which is wonderful too, but it's different. Yes. So I say if you're picking a donor, gene pool, gene pool, find one like you. This is a child's sake just so it's convenient because they won't know what you're talking about

until they're at least seven, eight, nine, ten. And make sure that you asked about gene pool. You want tall? Ask about mother, father, brother, sister, grandparents. don't get the one tall woman in a short family. Right. That's, I mean, that was going to be my next question. You're saying, because I, you know, I've had a few different people on this podcast who have

used either donor sperm or donor eggs. And the one thing that they've all said kind of consistently is that they're looking for someone attractive. So which I understand because it's like you're taking the whole personality out of it. So it's kind of like, if I don't have to live with you, I'll just pick the hottest person I can find and give my kid the best chance. But what do you? what do you think, you know, as a psychiatrist going through this and, you know, speaking to people and knowing the science behind this?

Like, what is the most important thing when you're looking for a donor anything? Yeah, I'm so glad to ask the question. Number one is gene rule because that's what they're giving you. So I ask every donor, I say, look, you're not going to be thrown out of the program. This is for matching. The rule is don't double up on pathology. If on the sperm side, whether it's donor's sperm, whether it's a mate, whether it's somebody you know, if on the sperm side there's a lot of heart disease that develops in people's 40s, you know,

or some kind of, you know, incredible allergy that makes living difficult or early Alzheimer's, make sure it's not in this gene pool of the donor. In other words, you don't want to double up on pathology for your child's sake. Right. In my family, there is so much cancer. cancer. You know, that the first thing I would do is make sure whoever the sperm donor is, you know, free of cancer. Right. Exactly right. So don't double up on pathology and do as much as possible, try to mimic your own gene pool, as they said, for the child's sake, not that we're narcissistic,

but unlike adoption, which you can explain to the youngest child, you know, when someone else's, you know, uterus or womb or belly is not my first choice. And they think if you eat, you get pregnant. But, you know, and now you're ours. You know, how special, you know, we chose you. There's a different story, you know, for egg donation. I have good news for you. You're not in line for grandma's allergies, Uncle Harry's cancer.

The doctors gave me ovum donation, but make no mistake. I threw up for 13 weeks. I was pregnant for 6,000 hours. I was in labor for a day and a half. happen. Every cell in your body comes from me. I think guilt is very important to share with children. And I'm just kidding. Don't write it in. I'm just kidding. But there are different ways of presenting it. And with ovum donation, you know, that's the presentation to the child. But picking the donor, keeping that in mind, they're going to say, who donated? And what you're going to say is,

well the donor was matched to me you lucky kid and here's what we know about the genetics and if you want more we can go on 23 and me or if it's open you know egg donation we'll find out what's happened in the past eight years with the gene pool but i keep referring to it as the gene pool it's not another family it's not another mother right it's the woman's donor if you're getting donor egg the donation is to you and then your body is building that baby i see okay yeah that's a great way to phrase it. I mean, everything you're saying is really pointing again to the same thing that I think you started with, which is how you're perceiving things, how you're talking about things, is shaping how you feel about them. And that's not only true for the way that you think of any

fertility issues, but also like the way that you explain it to the whatever child comes out of this. And that's probably the most important concern for most people. Right. You know, are they going to be angry, are they going to reject me? And that's all coming from, unfortunately, other scenarios like adoption scenarios. And that's not even the case anymore with adoption. And with Ovalon donation also, there was a study and actually, it was a government study. And 90% of children were told about third-party conception, 90% either fine with it or don't care. Right. So, And probably the 10% that get involved with it would have gotten involved with anything because there's instability in the family or they, you know, had their own.

Yeah. Yeah. And I think, again, it's best problem number is probably only going to go up given like how much more prevalent it is than five years ago, 10 years ago. Like it only seems to be getting more popular as a method of reproduction. I wanted to also talk about miscarriage. Do you find that people struggle more with having multiple. miscarriages than they do with not being able to get pregnant at all? Or do you feel like

it's really entirely person to person? It's a good question. It's probably person to person. Both are so, so difficult. Again, it's not only that control thing, but you want a family. I think that there's a double whammy with losses, with multiple losses. And that is, in addition to having had some success because you're actually pregnant and having that taken away from you. which is a shock as well as a disappointment. Bonding emotionally, even though you don't know the child yet, your body is building this child. And humans are built to bond with the baby.

It's helpless for so long. It's not like some of these animals, you know, who within hours are running around. We have to take care of this, you know, crying young thing for so long. So we bond. So that's also, you know, been taken away. way. And in addition, Jordana, you know this because you've been going through this, you've got hormones to deal with that are also beyond your control. And when progester and estrogen

drop, when a pregnancy ends or is terminated or there's a loss, that's a huge emotional crash as well. And unfortunately, I think patients are not prepared enough by the medical community. I'm not pointing anything, but just in general, for what it could feel like, you know, what the downside is, you know, what the odds are. I think the more we know going in, I'm not saying it's easy to deal with, I think we're more equipped to deal with either losses or failures because we know this is going to be a good try or, yes, I'm willing to try this. or, but the loss, for those who have studied specifically multiple pregnancy losses, have reports that it is the equivalent of getting a cancer diagnosis. And it really, it's described over and over and over again as deep depression. I'm not saying everyone, you know, is clinically depressed with the moments because they want to try again.

But as they're trying again and moving forward, you said this earlier, Moving forward turns out to be the best medicine for the losses. Really? Okay. Yeah. Again, that sense of control. But I've got to say, honestly, that if you've had a loss or even multiple losses, the excitement when you have a success is a separate emotion than the sadness about the loss. And the sadness can be there forever. But it doesn't change the happiness about the baby if you are successful or the love for the baby.

As I said, we're capable of more than one emotion. So if you think you're going to get over a loss before you move forward, that might not be the case. You might just, when you think about it, you know, live with that sadness. You would have loved to have known that person, but how excited you are about the children you have. And how they probably wouldn't be those children. if, you know, if the other previous pregnancies had worked. Such a good point. I had somebody during COVID who was debating, should I go through with another child?

Should I? I shouldn't. There were lots of reasons why she was thinking she should, she shouldn't. She finally did. She used donor egg and she did. And she had her children without donor egg. And she called me afterwards and she said, I want to tell you something because you went through this decision with me for so long.

I am so in love with this baby. I don't know. Maybe it was 14 months there. I am so in love with this child that if I could go back and use my own eggs, I wouldn't do it because it wouldn't be this child. And that's what you was saying, Jordana. Yeah. It's not, you know, each child is unique to that time and place

and maybe whatever you went through meant that that's why this is your child. Totally. I think that's, I mean, that's sort of like the most helpful thing that I've heard going through. it. And I mean, it's also, the way you just talk about DNA is just, I think the phrasing of it is really helpful. Do you ever get people who are, who feel kind of a guilt about not using embryos? Because they're like, you know, I have these embryos in the freezer and then like, is it sort of like, because if you think of them as children. And that's sort of, I think when you're going through them as part of the thing is it like, is this a child that I lost or is this just like a cluster

of cells that is not working? Like, and obviously like the stage of development is probably huge part of that, I'm sure, like someone dealing with a stillbirth is entirely different than someone who's dealt with like a six-week loss or something like that. So I would imagine that like the way you're thinking about what's growing inside you is probably a big part of, you know, the devastation that entails. So you're asking me if people are concerned with what to do with embryos, if they make more, then they're going to use. because they ripen 15 eggs and ended up with seven embryos and they don't want seven children.

Yes. Georgiana, that is the number one thing after success that everybody is concerned with. It is a fabulous question because there's no easy answers and because people can't decide. I don't want to, they'll say, for example, I don't want to give it to research, even though I know it can lead to vital, you know, discoveries because I don't want to picture in the course of research that it is destruction. I don't want to give it up for adoption because then I'm going to feel like one of my children, you know, is out there. And maybe they'll marry my other child and oh my God, what will happen? You know, I don't want to pay for it forever because I feel that's just indecision.

or, I mean, I don't know. I don't think I've ever spoken to one person who was absolutely clear on what to do about the embryos. It is the post, you know, baby question. Absolutely. Is there anything you recommend or it's kind of like you just help someone guide them to that decision? Exactly.

I don't know what I would do. I honestly don't know what I would do. Maybe pay forever. I don't know. I mean, it raises all these, like, philosophical questions, right? It kind of feels like, again, like it goes back to the perception. Like, how do you perceive this embryo? Do you perceive it as just like another, right, potential life that could be, you know,

that's like you're, you're just, if you're destroyed, if you decide to destroy them, are you destroying a child? Right. Or is it a bunch of cells? And like for me, again, like having had miscarriages, I'm kind of like, so many of them didn't work. It doesn't feel like necessarily. I don't think it feels like it would if it was a further along loss, but like where is that line?

And I guess, you know, that's the political, that's more of a political question, I guess, than something for this show. But it does, all this assisted fertility stuff does raise, you know, so many of those, those kind of questions about life and where it begins and where to place all these, these things and how you should think about them. Yeah. And that's why I say, really, I don't have an answer. Literally, I'm not being coy or political.

I don't have an answer because I don't know, as you said, how the person feels about it. Sometimes they don't know how they feel about it. So, you know, do I step on an aunt? I do. You know, my mother wouldn't. She said, no, it's living. You know, it's entitled to be there. But, you know, if it's crawling on me, I find that I do.

And so how do you mix that in with whatever your feelings are about the embryo? And I know there are a billion answers to that. And I don't, I don't have an answer. I really don't. I can, you know, help people see their way through going on a fertility journey. But once you have those extra embryos, you know, it's a, let me put it this way. It's a responsibility. And that's what people feel.

Right. I created them. It's my responsibility. Now what I do. And it's a really important question. Right. just like I guess the ones that turn into children are your responsibility, the ones that didn't also kind of feel about it.

Yeah. So this has been so helpful and such an interesting discussion. And I mean, I think I kind of know the answer. But if you could give, you know, one piece of advice for anyone going through any kind of assisted fertility or overcoming all these obstacles or it feels like they're, you know, there's just so much ahead of them in order to create a child. like what is one piece of advice that you would give? It's going to sound a bit cliche,

but you have to be there for yourself on the journey. You can't blame yourself. You can't relive the past. You can't pre-live the future. You really have to give yourself empathy and sympathy. If things are hard, don't judge yourself, observe yourself. Oh, look, I didn't think this would affect me that much. Or, hey, I'm doing better at this than I thought.

or I really am a chicken when it comes to injections or, you know, look at me, I'm furious at the doctor. You know, I didn't realize that would be my response. So observe yourself, but in the end, I think our most important relationship is with ourselves. Because if we're blaming ourselves or angry at ourselves, we're trying to second guess ourselves, it's hard to be good with everybody else. So I'm saying, you know, be there for yourself the way you are for everyone else you love. really be there, be empathetic to yourself, be sympathetic, take care of yourself. It's a hard journey. I like that a lot because it's kind of like, I think, you know, there can be, like you said,

there's a lot of this anger sometimes that like expresses itself in different ways. And sometimes it's anger at your own body for not doing, you know, what you wanted it to do and kind of what you're saying, what I found to be helpful is like taking care of your body, you know, it's like almost like, it's almost practice for having a kid. It's like, it's not. doing what you want it to do, but like, should you get angry or should you just be gentle and compassionate with it? And I think that's great advice just to like to care for yourself that way. I love that. Thank you. Where can where can they find you? Where can they find you personally? I know you have many books. I know you write a newsletter. Give the listeners everywhere where they can

go to hear more from you. Oh, okay. Through progeny.orgene is a company that manages fertility benefits for corporations. And if you go to the website, there are so many webinars and, you know, interviews I've done with experts and so forth. I have the column Chronicles of Infertility that runs online in sight today. The books, as I said, buy them used or just listen to one of my podcasts like this one and save your money. You can reach me personally through our May of New York, which is part of U.S. fertility, and you can get in touch with me there. Great. Thank you so much for coming on. This was so helpful. I'm sure you said a lot of things that people listening really needed to hear. This is so helpful, even myself. So I, you know,

I loved having you. Thanks again to our presenting sponsor BetterHelp. We hope this episode has been a help to you on your path to parenthood. If you want to get started with therapy, I highly recommend trying Better Help. Just fill out a brief questionnaire to get matched with the licensed therapist and switch therapists anytime for no additional charge. Visit betterhelp.com slash baby steps today to get 10% off your first month. That's BetterHelp, H-E-L-P.com slash baby steps. Betches.