Doctor, Heal Thyself: Making Fertility Appointments as a Female Physician
Have you ever looked at an IVF calendar and wondered how you are going to make it all work?
In today's episode, we discuss:
The typical appointment schedule for oral cycles, IVF, and frozen embryo transfer protocols
Creative solutions for getting to all of your appointments while still working as a physician
The champion's mindset which is the real driver to make this all possible
Hopefully this episode will help you to believe you are worth it, come up with creative solutions, and bridge you to your goal of parenthood.
As always, please keep in mind that this is my perspective and nothing in this podcast is medical advice.
If you found this conversation valuable, book a consult call with me using this link:
https://calendly.com/loveandsciencefertility/discovery-call
Also, be sure to check out our website: loveandsciencefertility.com
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Please don’t let infertility have the final word. We are here to take the burden from you so that you can achieve your goal of building your family with confidence and compassion. I’m rooting for you always.
In Gratitude,
Dr. Erica Bove
Transcript:
Hello, my loves and welcome back to the love and science podcast. Today, we're going to talk about how to make it all work in terms of being a physician or another busy professional and making it to all the IVF appointments if IVF is what you're doing.
And I think, you know, one piece of this is understanding like what does an IVF cycle even involve and if you're new to the journey, then I will go through some of those things. And if you're more of a veteran, of course, you can fast forward through.
And I also think understanding like the mindset piece is super important because I can give so many practical tips and tricks of like what people have done.
But I think until we truly say like, this is the most important thing right now, I have given so much of my life to medicine or, you know, insert whatever field you are in listening to this podcast.
And now is my time. You know, I say if I had an appendicitis, this would take two weeks. Guess how long an IVF cycle takes? Two weeks. This is not elective.
So I truly think unless we can get our mindset like, you know, this is a priority. This is a medical condition. I need to do this only then will we find the most creative solutions to make it work, right? Because we value ourselves and we know it's not optional.
So let's see. So, you know, an IVF cycle generally from start to finish is about two to two and a half weeks. What does it require? Somewhere between four to six ultrasounds with blood work, right?
In the beginning, it's just blood work, but then we add in ultrasounds towards the end so that we can monitor the follicles, like the ovarian follicles, and see how they are growing, see what the cohort size is doing, see what the corresponding estrogen level is.
Sometimes we also check progesterone and LH to see kind of understand if LH is rising or progesterone's rising. And so really what we're doing is we are trying to understand the physiology of an ideal IVF cycle.
An ideal IVF cycle has a cohort of follicles, right? As a reminder, we're not stealing eggs from the future. These eggs you would have gone through anyway. But we're basically capturing the eggs you would have lost to attrition, plus the egg you would have ovulated if you do ovulate.
And that comes up as a cohort so that we can get as many mature eggs as is safe for you, fertilize those eggs with sperm if you're doing a fertilization cycle, and then either freeze those embryos or do a transfer and freeze anything else that looks like it could make a baby.
So, you know, that process from start to finish is about two weeks. If you have a transfer, you can tag on another three to five days to the end.
But really having some relative flexibility can be helpful during that time because the appointments are somewhat frequent. Like I said, it's about four to six appointments over two weeks, which culminates in an egg retrieval for which you need anesthesia and a driver.
And you really should not return to work on that day because the anesthesia makes you kind of loopy. As you know, it's propofol, fentanyl, or some combination thereof.
A frozen embryo transfer cycle often is not quite as intensive, but it does involve a lot of appointments. A medicated cycle is or a program cycle as some people call it, that's probably the least amount of appointments.
We typically start with a transfer date and then work backwards because we are growing uterine lining. So say, you know, I know that I want to have an embryo transfer in about four weeks, I would pick a date, and then, you know, a few days before that appointment, I would have an ultrasound to see, make sure that the lining was thick enough. So that happens typically before we start progesterone. And then maybe a lining check like a week before that, and then maybe a baseline ultrasound with blood work to make sure everything looks good.
Now, every clinic does it a little differently. So it's like, oh my clinic doesn't do it this way, you know, like there's some flexibility. There's many right ways to do IVF. But I would say a frozen embryo transfer is usually, let's see, two to three monitoring appointments leading up to the transfer. And, you know, typically with a program cycle, you start with a transfer date and you work backwards. So people are often worried about like travel and things like usually you can navigate around that with a program cycle.
Now, a natural cycle or a modified natural cycle for a frozen embryo transfer, that is a little bit more labor intensive because we're trying to stimulate a menstrual cycle. So say you take a lectures all and we're monitoring the follicles.
Again, follicle monitoring, you got to be, you know, present for more ultrasounds with blood work. So looking to see how big the follicle is, looking to see what the estuarone is doing, looking to see if the progesterone is starting to rise, if somebody is surging, like all those things are important.
So that typically requires a baseline ultrasound with blood work and then maybe starting lectures all or FSH or whatever your concoction is, sometimes even just monitoring your cycle.
And then another ultrasound roughly mid cycle, but kind of on the shy side of that because you don't want to miss the window.
So you might come in on like cycle day 10, even if you normally ovulate on day 14 because your REI doesn't want to miss it. So, you know, say not too much is going on on day 10, you've got like some 12s.
Your lining is getting there, but not quite. Now I might say in that situation, okay, come back in a couple of days, see what's going on.
But if you've got a 16 millimeter follicle and your lining is thick and your progesterone is like 0.8, I'm going to say, you know what, like, I don't want you to wait two more days.
I want you to come back tomorrow. And that's where the relative flexibility comes in.
Typically, people have a transfer about a week after they're ready in the context of a modified natural cycle.
So, you know, again, different clinics have different protocols, but you can sort of expect that around when you would normally, you know, sort of ovulate.
That's when you are triggered. And then a week later you have a transfer because if you think about it, that's when the embryo would be making its way into the uterus.
And then, you know, then you have your weight to find out if you're pregnant, of course, which is a long wait.
But that's the typical rhythm of a frozen embryo transfer cycle. That's a modified natural.
If you're doing something less involved like letrozole or colomaphene, that's going to be less monitoring, but still that like slight unpredictability.
So, for instance, like, you know, many clinics do ask for a baseline ultrasound with blood work, some just blood work.
Then you start those meds and then come in mid cycle for, you know, an ultrasound plus minus blood work.
Then you may be triggered and it's like, oh, you need to come in in two days for an IUI.
OK, you know, get your spouse on board or, you know, get that that donor sperm frozen, whatever, you know, thought, whatever it is.
And sometimes you don't have too much lead notice on these things. So even though those cycles are less intensive, you still do need some flexibility to make it happen.
So, you know, I think those are kind of the main things. So what have people tried? Let's see.
So, you know, I think there are different kinds of work as a physician.
You know, I have a lot of patients and clients who are doctors and so sometimes going to per diem can be helpful to limit the number of shifts to create a little bit more flexibility with the scheduling.
Also, people who remain full time, you know, it helps if there's like a decent sized group where there's a culture of trading shifts.
I know sometimes that's harder to come by, but that has been successful for some of my people.
If you work nights that even though it's brutal to do this, you know, you can actually work a night shift and then come to the REI clinic.
Different clinics have different times when they start their monitoring. Like 6 a.m. is very early.
I would say most clinics don't start that early, but some do. So as you are deciding where you want to receive your fertility care, just ask like what their monitoring is like.
And that can be helpful as you start to think about how to actually make this work.
I would say most clinics start around 7 or 7 30 or so. And so just sort of factoring in, okay, what time do I need to be at work or get off of work and can they sort of pre schedule my appointments just understanding I'm a physician and my schedule is a little more restricted.
You know, so that can work like if you're on nights and then you just roll into the fertility clinic and then go to bed for the day and just have them send you a portal message so they don't wake you up with a phone call in the afternoon.
I've seen that work pretty well. I mean, it's tricky though. Like say you're an internal medicine doctor and your job is to do rounds or say you're a surgeon and you know, you're trying to block your schedule and you're trying to make sure that you don't have a busy OR day when you're trying to get your IV upset.
I mean, I think many of my patients and clients have heard my story when I froze my eggs of how I was triggered earlier than I thought. And I had a full OR day on the day that was my retrieval.
And I said to my REI, I was like, oh, like I didn't anticipate this. Can I just like trigger the next day? And she was like, look, you're ready. And I was like, yeah, yeah, I am ready. So thankfully, and by the grace of somebody, there was OR time the following day and all my patients had flexibility to move.
But you can see that was quite disruptive, right? Like even as an REI, I could not plan my own schedule in life in a way that didn't require flexibility on everybody's part.
So I just wanted to share that because it can be tricky. I think that some people will block their schedule until 9 a.m. Like some people have the flexibility to take PTO.
And so they say, OK, well, I'm going to start my clinic day at 9 instead of 8 so that I can have time. So obviously, it depends on where you live and where the fertility office is and where your actual place of work is.
So trying to factor those things in as well. But I think, you know, especially if you're doing like a modified natural cycle and you know that there's going to be some variability there, like just maybe taking a week or two and starting at 9 a.m.
Instead of eight, those days can be really helpful with the caveat that on the day of the actual transfer, you need a little bit more flexibility.
Also, just to speak, you know, I know that a lot of places do not have REI clinics nearby. So I practice at the University of Vermont. I know that people come from hours away to be able to make this work.
And so, you know, we do remote monitoring as much as possible. So if somebody lives like, you know, in the far corner of the state and they really only need blood work, then we will accept outside labs.
The caveat is that the lab really does have to get to your REI that same day so they can make decisions. If it's crossing time zones, that can be really tricky.
Like, you know, for my West Coast patients, like, you know, we're sort of wrapping up our day and then the blood work may not have come in yet from the West Coast.
And so, you know, that all gets kind of tricky. But I think, you know, just thinking about, OK, you know, where do I live? Where do I work? Where is my REI's office? What kind of work do I do?
What flexibility is there? Do I need to take intermittent FMLA? Do I need to take intermittent PTO? Do I need to talk with my supervisor and just say, hey, I'm going to be undergoing some medical procedures and I need some flexibility?
Or maybe you talk with your colleagues and you say, I promise I'll pay you back. And this is going on. I mean, it's hard because, you know, you can give different levels of detail.
But I do think that for people who do say, like, I mean, it's like either you have cancer and you're getting chemo or you're undergoing something like IVF is super rigorous.
So it's not just like popping in for one doctor's appointment. It's like something that happens over and over again.
So figuring out what level of vulnerability and sharing you feel comfortable with, but at some point figuring out how you're going to get what you need in the context of your cycle.
So I think I've said all I need to say about that. Like I said, like you can you can go to work after an embryo transfer.
I personally think just like taking the rest that were so hard on ourselves. Right. It's like that's a procedure and just giving yourself grace to take that time and rest and relax.
Like, I think that is a very human thing to do. We don't think of ourselves as human.
So you could go back to work afterwards. I tell my patients and clients to take the day if they can and just do some visualizations and meditate and let it all settle in.
But you really cannot go back to work on the day of the retrieval. That's like a must.
And you really can't drive home. You need a driver because you've had anesthesia.
And so just know that that is one day that you will need not to work.
And what else? Yeah. So let's talk about mindset.
I think so many of us as female physicians have been raised essentially in our training never to put ourselves first. Right.
It's always somebody else and always somebody else. You know, take care of the patient first and don't ever disappoint anybody and neglect your own needs and everything.
And, you know, for so many people, I mean, like many people thought about freezing their eggs or doing IVF, but it's like, oh, it's not convenient or oh, it's going to put somebody else.
It's going to put somebody else out and years go by. And so what I would say is there is no convenient time to do fertility treatment, just like there's no convenient time to be pregnant or deliver a baby.
This is just the way it is. And, you know, if we are going to support each other in the full spectrum of having professional and personal lives which are full and rich and vibrant and beautiful. Right.
We need to have a culture which supports this aspect of our lives as well. Like it cannot be deferred any longer. It has to take priority if other people are, you know, upset about it.
Well, you know, like I said in the beginning, like if this were an appendicitis, there'd be no choice. And our fertility care is not elective. It just is not.
You know, I'm fortunate to work in a place where we're all very supportive and we make these things happen for each other. So that's great. But I will say, you know, like I said, I froze my eggs when I was a new attending.
When I was getting a divorce, like I probably would have frozen my eggs again if I had felt comfortable in that culture. But I really did not feel like I could speak up.
I did not feel like it was really a safe space for me to do this. And so I deferred. And I mean, truly, like years go by without thinking about it.
So I just mentioned that to say that, like, even those of us as REI struggle to figure this out because maybe our people pleasing nature because we don't want to inconvenience anybody else.
But at the end of the day, we really do need to acknowledge that time is important. We are important and we deserve for this to happen. And so if we start like coaching always says there's the circumstance, right?
Like desiring fertility and then there's a thought about that. And then that thought leads to a feeling that feeling leads to an action that action leads to results.
So if we start with the circumstance of like, you know, trying to build a family or fertility preservation or something that's very neutral and we think to ourselves, like, this is going to negatively affect a lot of people, right?
Then we might feel like burdensome. We might feel shameful. We might feel, you know, less than whatever.
Selfish even, you know, I hear that a lot. Oh, it's just so selfish. So then what do we do from that space, right?
Then we like shut down. We put other people's needs before our own. We may sort of chastise ourselves for like being quote unquote selfish. Right.
And the result is that, you know, we really don't get to do what we need to do because we feel like we don't deserve it and we don't claim that we don't figure out a way. Right.
So if we think to ourselves, you know, I deserve to build my family, right? Like this is my pathway to parenthood. I deserve to build my family.
Then how does that make us feel? Right. Makes us feel empowered. It makes us feel worthy. It makes us feel, you know, aligned. Right.
I love that word because when our, when we're making value space decisions, we're actually aligned. This is like coaching one on one.
So from an aligned space, what do I then do? I think of outside the box solutions. I figure out what paid time off looks like in my institution.
I figure out what flexibility there is. Maybe, you know, we keep a flex half day for people who need to be canceled due to various things.
And, you know, maybe there's like another surgeon who wants our block time during this. And then we do a trade for later.
I don't know what the answer is, but all I know is when we ask ourselves better questions and we start with better thoughts, we come up with better solutions.
And so from a space of saying, I deserve this, like this is my right to build my family. We feel empowered. We feel aligned. We feel strong.
And then we come up with the solutions we need to solve the problem because I believe if there's a will, there's a way.
And if we're shut down and feeling guilty and feeling like we're hurting other people and we're burdened with, oh, how's this going to negatively affect my patients?
And, you know, again, we have to take this for ourselves. And I coach women all the time, like, oh, my goodness, but my breast cancer patients, what are they going to do?
Oh, my goodness, this, it always works out. I promise you, it always works out. Right. And it becomes a win-win. Right.
I would not want a doctor who I knew was disavowing herself of her own needs and her own family building and her own whatever to meet my needs. Right.
There's this like self-sacrificial, oh, you know, that she never thinks of anybody else. She's so selfless. Right.
No, I want somebody who can do both, who is an example. And then I know that that person is going to be a better doctor in the long run because I know that they value themselves.
I know they value me and we figure it out together. Right. When somebody models giving themselves permission, it also gives us permission to do similar things.
So the result is we come up with better solutions and we deserve to do this and it actually happens because we find a way and maybe it's not the first cycle, but we really prioritize this part of our lives in a way that, you know, maybe it's not fun.
Maybe we're truly getting up at 5 a.m. to go to the fertility clinic. Like, I don't know what the solution is, but if our, if we have a deep why and our thoughts are thoughts that serve us and get us to high vibration places, then it's much more likely that we're going to be able to do what we need to make this happen.
So yes, practical tips and tricks that's helpful to understand the rhythm of IVF, the rhythm of fertility treatments and what we generally need to make it all happen.
And also, of course, the mental space to be like, do I have all the meds I need? Like, did I did my clinic at the prior auth? Like, you know, did I block my schedule?
Like, all that stuff is not to be minimized because it takes a lot of mental energy to plan. But then also, I think, like I said before, unless our mindset is right, the rest really does not matter.
We need to start with the right mindset so that we can make all these things happen. And I think also, as an aside, when we're in community and we can encourage each other for, you know, using our authentic voices, for asking for what we need, for making creative trades, for maybe going per diem, you know, for a short bit until all this is kind of settled, you know, I think we can all empower each other to do what we need so that, yes, the patients will get what they need. But also, it doesn't steal from us that which is the most important thing to us.
So I think you get my point. I love helping people with mindset. So if that's something you struggle with, you would find a home at Love and Science.
But we can do hard things. We can do hard things like fertility treatment alongside working as a physician or a busy professional. We just got to be creative. We need to believe in ourselves.
And I really think it helps to have a community of like-minded people who are making it happen as well. So with that, hope this helped to clarify, and I'm rooting for you guys always. Bye.
Bye.
