Feel Good In Your Own Skin During IVF with Dermatologist Dr. Laura McGevna

Have you ever done an IVF cycle and lost a good amount of your hair? Or suffered from adult acne which you don't remember ever having before? Or how about noticing new wrinkles and gray hair and being told you can't use certain products like Botox, Retin A or hair dye? How can you feel good in your own skin while going through this process? 

In this episode we discuss:

• hair loss and strategies to prevent it

• hormonal acne and safe and effective treatments

• Botox and fillers 

• Melasma 

• Seeing yourself with love and self compassion

Don't miss this high yield and relevant episode.

Guest Details

Dr. Laura McGevna is a board certified dermatologist and owner of SWAE Skin. After attending Yale University and moving on to medical school, Dr. McGevna fell in love with dermatology. She became a teacher of dermatology, and went on to establish her own practice after she learned how much needs to be done at home for prevention instead of treatment.

www.swaeskin.com

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.

I am so excited to have a distinguished guest today.

This is Dr. Laura McGevna.

She is a board certified dermatologist, our first dermatologist to be on the Love and Science show, and she is an amazing human.

She's actually my personal dermatologist.

She is also a friend from medical school and we know how deep those connections run and she is going to elucidate for us today.

A lot of the questions we have about skincare and hair care, right?

As we are undergoing fertility treatments.

So she is the CEO and founder of Sway Skin Dermatology, which is dedicated to enhancing self health outcomes.

Um, and it's a holistic approach, right?

So, and that's why I love going to her so much is because it's really a whole person approach to care.

And if, as we think about all aspects of health at Love and Science, it's really, let's get to the root.

Let's figure out how we can integrate to have the best outcomes.

So welcome, Dr.

Laura.

It's so wonderful to have you here today.

Thank you so much for having me, my beautiful, wonderful friend.

It's so nice to connect and I feel honored to be on your show.

Thank you for having me.

Thank you so much.

I can't wait.

I mean, and I pulled the people, people have questions, let me tell you.

So, you know, I would love to ask you the question, even though I know like your dermatology and I think dermatologists and skin and everything, people have so many questions about hair.

I would do it.

And I can talk about that too, from my perspective as an REI, but you know, you go through an IVF cycle, you'll lose 40% of your hair.

Like, what is that about?

What can be done?

Because, you know, it's, it's, you know, it's not that we're vain, but I think we have a certain like concept of our self image and that often involves the hair that we have on our heads.

And so, you know, we know that hair follicles have life cycles and that oftentimes the hair follicles are kind of intentionally out of sync with each other, but the hormones, they just put everything in sync so that that phase of the hair follicles and the hair falling out, that all happens at once.

Is there anything we can do to help with that, to accelerate the regrowth?

What are your thoughts about that?

I wonder, sure.

Well, yeah, you know, the hard part about it is that it is true despite any, you know, you want to put your thoughts on your image aside and you know, a lot of the time we try to say, you know, divorce ourselves from that aspect of life.

Knowing that it's so separate from, um, and not the, obviously the important part of the work that we do, but it is so hard.

It's human nature to kind of think about hair and link it to health.

And so when we see this happen to us and to our patients and our friends, it can be, um, really unsettling and it can be really hard as you're going through it.

So yes, there are things that we can do fortunately.

And you know, the hard part is there are actually a few different types of hair loss, and so I think it's really important to not minimize it and talk about the type of hair, or the past thing that's happening to us.

And then that way we can kind of investigate and see, well, what is the thing that's causing it?

Despite the fact that, you know, we try to, when you're going through something like this process and it's so hard on your body, you try to take such good care of yourself as you're going through the process of the fertility journey.

It can be such a struggle and in that struggle, our stress levels go up.

And unfortunately, when the stress levels go up, it is, it's really, it's, it's rough on the body and it's rough on the delicate hair.

And that can really catapult people from a growing phase of hair into a rapidly shedding phase of hair, just like you see, you know, after, you know, sometimes people lose their hair after, you know, a significant surgery or car accident, it really is a lot for the body to kind of take in a short period of time.

And the hair follicle, which is one of our most rapidly turning over cells, it really takes the hit.

So it pushes us into that telogen cycle.

For many people, that's the kind of type of hair loss, which the good part about it is fortunately, it's a non-scarring loss and the hair is going to come back.

It doesn't feel any better sometimes to know that, but you can try to take heart knowing, okay, this hair is going to come back just to rewind a little bit.

So if we're losing our hair in the process of telogen effluvium and the stress of the, stress of the cycle, then one of the things we can do, the most important thing we can do is really take care of the hair itself and take care of our bodies, do our best to kind of minimize our stress levels as hard as that can be.

That's actually really helpful if you can do that and kind of, you know, if you can, if you meditate or go for a walk or do anything you can to take care of yourself as a human, that will ultimately make its way to the hair follicle.

And you'll have, you'll get through that process a little bit easier.

The other thing you can do for telogen effluvium is really just supportive care.

So you want to make sure that you're not using, you know, hot combs, hot irons, hot hair, you know, hot, you know, blow, blowing cycles.

If you're, you know, doing blow, blow styling and you want to try to minimize things that put pressure on the hair follicle itself too.

So like if you're, you know, sometimes we wear hair in a kind of a tight style.

So you want to try to make sure that you're not pulling your hair back too tight and you're being really gentle with the whole process, gentle on yourself and gentle on your hair.

That can help.

There are lots of things that people try to as they're going through a hair loss process.

Sometimes shampoos that have, that are good for the scalp, that have things like tea tree oil, if you're not allergic or rosemary oil, those things can be helpful for hair growth.

Sometimes people can try if it's really, you're feeling desperate and you want to try something else, you can try a little ketoconazole shampoo.

You can get that over the counter or you can ask your provider for a prescription.

You leave it on for a few minutes and it can really, you leave it more as a treatment for the hair follicle and you use it more as a scalp treatment than an actual shampoo.

Because it can be a little drying to the tresses.

So you leave it on the top part of your scalp for a few minutes and rinse it off.

And that simple use of ketoconazole shampoo, weaving it into your hair care procedures that can grow that, that extends the cycle of antigen.

So that can really help the growing phase of hair.

Oh, I didn't know that.

That's so interesting.

Yeah.

And it's a nice thing.

It's just, you know, it's a nice low risk intervention and, you know, it's good for people who sometimes, you know, when we're going through these hormonal changes, we also get a flare of seborrheic dermatitis, a dandruff that's on the scalp.

The scalp texture can change or feel a little bit different.

You get a greasy, thick scale and ketoconazole is a great treatment for that too.

And it's extending the growth phase of our hair.

So I think it's an excellent thing to make part of the practice of your styling, you know, protocols that you, that we all use.

Yeah.

And maybe even preventatively, I mean, it's really hard to regrow the hair once it falls out, right.

But like to kind of keep that antigen phase going longer, that seems to be something that could really make a difference, right.

And especially say somebody's gone through IVF before it's happened to them, probably more likely to happen again.

You know, that maybe is something very practical that people could incorporate in that safe and effective.

That's a great idea.

Yeah.

And, you know, I don't, for a telogen effluvium, for the type of loss that happens, you know, with kind of these stressful times, I don't tend to recommend other products or interventions that are either more procedural or therapies like minoxidil.

I don't recommend those products because you have to remember this is a short period of time and those aren't the greatest to use in that time.

And honestly, the hair is going to come back.

You just have to remind yourself that the hair is going to come back on the other side.

What I'm also hearing you say is like, you know, so many of us, myself included, I'm raising my hand over here, like we don't love the hair that we were born with, right.

And we're like, oh, but I need to straighten it.

Oh, but I need to blow dry it.

Oh, but I need to like do XYZ.

And, you know, there was a period over the summer where I just, I don't know, it was like humid and I was busy and like, I just kind of like let my hair like naturally be its natural self.

And I got so many compliments and I was like, well, this is what you see right now is not, this is straightened hair for the record.

It was beautiful also.

Yeah.

You're so kind.

I love your hair too.

But it's, it's so funny that like so many of us don't embrace what we actually have.

So we then go through this rigmarole of like changing and all those regimens actually make this problem worse.

And so maybe for a time, especially since fertility treatments are so time consuming and we're trying to be doctors and patients and running all over creations of the fertility clinics, like what if we just said, you know, for this period of time, I'm going to embrace my natural wave.

I'm going to less is more, you know, I'm just going to see how that goes.

I think that might be something to consider because, you know, it's the grass is always greener when it comes to hair, I think, but I think if we can start with that, that might also be a benefit.

What do you think?

I think that's a great idea.

And I really encourage all of my loved ones and patients alike to do that very thing and really be gentle with their hair care and try to kind of go back to basics and, you know, really take care of their themselves and take care of their scalp and their scalp hair.

And a lot of the things that we do you as, you know, either heat or, you know, personal care products with, you know, things like moses or hair straighteners or relaxers or dyes, those things aren't great for the hair follicle anyway.

Ideally, they're not great to use certainly in excess during the fertility journey anyway.

So if we can kind of pair those back, then I think people will start to get into it.

We'll see that we all start to get into a little bit better rhythm and then you'll start to gently notice the hair starting to come back.

And that's just a beautiful thing.

How soon would you say, so say somebody does lose their hair, like how soon would you expect that they would have like their full head of hair back again with this problem?

And the hard part is it does take a little bit of time.

It, you know, is months.

It is months.

It is months.

And so that is, that is hard as you're going through it.

It really, it can be many months.

And an average we tell, we counsel our patients between six to 12 months really it to, before you see your hair kind of come back to its full luster.

But we embrace what is right.

Yeah, but it does come back.

It does come back.

And sometimes the things that you do or that are available aren't the right thing as especially for a hair loss that happens in a stressful time.

Now, obviously there are other types of hair loss.

There's hormone based hair loss, certain, you know, medications or supplements can induce other types of loss with scarring and that type of thing.

That's really quite rare, but you know, it's important if you're noticing these things, talk to your provider about them.

You know, look, you know, there are great resources nowadays.

Thankfully people are, women are talking about their health more and we're starting to kind of get a little bit more, more and more data in terms of, you know, women's health and, and these things that affect our unique to our experience.

So, you know, I do look for resources and I would definitely always encourage people to talk to their providers about it because you do want to pay attention.

If it is something that does need more attention, do you intervene sooner or is it something that you have to, you sit back and you say, okay, this is, this is normal. It is part of this process and it's going to settle down down the line.

Well, that makes so much sense.

Thank you for helping.

I think a lot of our listeners are going to take some practical tips from what you just said.

Another question that we get commonly is about acne and, you know, acne can happen for so many reasons, but so many people who have infertility have the PCOS version of infertility and, you know, years of, of sort of treating the acne with a birth control pill or maybe people don't even realize how much acne they have until they finally go off.

And they're like, oh my gosh, adult acne, what is happening?

And it's just really pesky and annoying.

But we also know that, you know, the, the red and A's right.

Are not recommended during.

For pregnancy or pregnancy at all.

Cause they're true.

I had a, right.

So what, what do you tell people?

How do you help people with acne in a way that is both compatible with fertility treatments and an early pregnancy?

Sure.

Sure.

Great question.

And it is one that I do get a lot, um, from the wonderful women I see part of the problem is acne can be, um, so stubborn sometimes.

And, and especially if people have the type of skin that tans easily or you've got darker skin types, a small bump can lead to lasting pigment changes down the line so it can, a little spot can kind of morph into something bigger, um, pretty quickly.

And also sometimes we see these things on our skin and we say, what, that's not supposed to be there in life.

I have a tendency to pick at them.

I know I do that myself too.

It's one of those things.

So, you know, sometimes the, this scratching cycle is worse than actual acne itself.

And there are lots of reasons that we get acne during these fertility treatments.

Um, you know, we are, our hormones are, we're constantly going through this, um, cycle of treatment and timing and, um, and our stress levels are high.

So our cortisol is up and when cortisol is up, it's going to lead to acne on the skin, it's going to increase your oil production.

And then there you go.

You get acne form bumps from that.

And then also at the hormonal changes, the cycles in fluctuations.

So then we see acne in that setting.

So it can be tricky to manage there.

I do think it's important to gauge what type of acne a person is having or experiencing kind of early on.

Um, and you can just look at that by looking to see, are they are more like blackheads and whiteheads?

Are there more inflamed pus bumps or are there deep cystic nodules?

And that kind of helps me categorize, okay, well, where am I going to go from here?

There are lots of topicals that are great for mild to moderate acne and are really safe in pregnancy.

A personal favorite of mine is azelaic acid.

It's a great drug.

Uh, it's from a cereal grain.

It's a naturally occurring compound and it's great for hyperpigmentation and it's great for acne.

It's available in two strengths, I think.

And then you can get, of course, it over the version of it over the counter, but two prescription strengths.

One is a 15 and one is a 20.

The 20% has been shown to be safe in the fertility journey.

So I, that's one of my immediate go-tos and I usually have the person do it two times a day, um, you know, on a clean skin.

So using azelaic acid is a great, um, that's a great first step.

You can also use products like clindamycin or erythromycin, which are also really readily available.

So I'm hearing you say to people, should see a dermatologist, right?

To kind of assess what kind of acne they have.

And then, um, and then the azelaic acid is safe, safe while people are undergoing the fertility journey, which is, I think really important because, Oh, some people, even in the group that I polled, their doctors told them that retin-A is safe, you know, on during this process in pregnancy.

And I was like, Oh gosh, that goes counter to everything I've ever read as a, you know, as a board certified dermatologist, would you say that, as, that, um, retin-A is safe or unsafe in pregnancy?

Well, so heart, a little bit tricky question in that, you know, um, probably in limited doses and in small surface areas, it probably is safe, but truthfully, we don't have great data on it.

Some of the, there are case reports of bad outcomes.

Um, but those have not been shown in bigger studies.

So that's where the rub is.

Right?

So, and we know that some of the other products like tizeratine and isotretinoin, which are other retinoids are really quite frankly dangerous, um, in the fertility journey and should be totally avoided.

So that's the hard part.

We have this, these case reports of, of, um, you know, rare bad outcomes with tretinoin and then, but bigger studies really haven't shown it.

That's very, very different for tizeratine for, you know, taserac, the product is tizeratine or isotretinoin where the really frankly is danger.

But because there is danger, we know with the higher strength and different isomers of those vitamin A derivatives, we tend to say, just try to avoid them.

There are nice safe products that you can feel really good about using like azelaic acid or clindamycin or benzoyl peroxide, which is really great for, you know, comedogenic or, uh, comedonal acne.

I think that makes sense.

I mean, some people have gone through like five plus IVF cycles to get to their baby finally, and it's like, okay, like going this time without the retin-A versus like the, even the very small chance of harm, you know, in my mind, it's like risk benefit.

You're right.

Like so many other safe products to, to consider.

So yeah, it's hard.

I feel the same way, but the GLP ones, I don't exactly know how to counsel people at this moment in time in the data-free zone or posity data zone, you know, but it's like, I think we just have to do our best and say, well, there's biological plausibility that this might not be good and, uh, and, and do the best we can with the alternatives.

Yeah, exactly.

Okay.

On, on a similar topic.

So people ask me all the time about Botox fillers, laser treatments, laser peels.

I can't tell you how much time I personally spent on PubMed trying to find out the answers to these questions.

Cause I want to help my people, but it's not always clear.

What are your, no.

So what are your thoughts about somebody who is either like, you know, on the journey, going through IVF or newly pregnant, uh, you know, what, how do you counsel them in the absence of data?

Sure.

Well, you know, that's the hard part.

There really isn't great data for it.

I would say that, you know, as you're going through the fertility journey, um, there isn't great data for harm for Botox.

So that's pretty good.

And that's pretty reassuring.

Once a person is, you know, you are relatively immunocompromised though, once you're in the early stages of pregnancy and it is toxin.

So it's not something that there, you know, we, uh, it's not something that I think I could recommend to a patient.

It doesn't, it doesn't feel, um, the data isn't there to say that it's safe.

So I would say absolutely in that time, just avoid it completely.

Um, but in the fertility journey, you know, if you know that you're going to a person or a provider who you trust and has beautiful technique, a septic technique, and you're not going to, you know, contract another infection or have other, um, complications, which then might lead to further procedures.

Right.

Um, and not necessarily with Botox, but certainly sometimes that can happen with filler and people can get paradoxical immune reactions with filler.

So I tend to say, um, I tend to discourage people from going, uh, to those products during the fertility process, um, specifically with filler.

I feel less strong about Botox, but certainly, um, once the time of conception that I would say, then you should, but the person, it would be in their basket for us to take a break.

Yeah.

So get it all out of your system.

Yeah, exactly.

Comment as well as you can.

And then, and then, you know, abstain.

Now here's the thing.

And one reason I love going to, you know, in your practice is because when I'm like, what about this on my face?

What about this on my face?

You're like, your face is perfect.

Like just, it's okay.

Like, you know, it's okay.

Like, like, love your face.

Um, I hear all the time.

I mean, I think, you know, many people on the fertility journey, not everybody, but especially female physicians, oftentimes like late thirties, early forties, mid forties, um, you know, already have complexes about age and wrinkles and hair turning gray and like not feeling cute, you know, not feeling like young and think of all these things that we do, right?

Botox and expensive hair, you know, face products and hair dye and all that.

That's kind of in an effort to like, Make us keep looking younger, right?

We're, we're trying to kind of maintain this image of maybe not being our current age or whatever that is this sort of youthful grow growth or expression.

What, what do you think?

What would you say to somebody who, where you're like, okay, you're on a fertility journey, maybe you have a few more wrinkles, maybe you have like some gray hair, maybe you can't do all the things you used to do to maintain your sort of model ask appearance, like what would you tell them to just like, how would you help them love themselves?

Even in the absence of the products that maybe bolstered their identity previously.

I think that's kind of the hard of us really.

It is so hard and it gets harder every day.

Number one, as we age and number two, as the world is less kind to us as we age.

Um, and we see younger and younger people wanting to look younger and younger and younger and these products being marketed and procedures being marketed to the, to the young, young, young people.

So, so it can be discouraging and it can be hard.

And already as you're going through the fertility journey, isn't incredibly hard in and of itself.

It can be hard on ourselves.

And I think the best advice I could give to, you know, a loved one going through the process is to talk to themselves like they would talk to a friend because inevitably a person would say, if you look at somebody with love and you know, respect, you're going to see all the beautiful things that the person earns.

And you're going to remind them of all of those things.

And then the wrinkles, you know, they become part of what makes a person that beautiful and all the experiences, and it is such a delicate time in life.

But it's also a very finite time as you're going through the journey.

You know, it can seem like forever, but really in the end, it is a finite time.

And so I do tend to discourage people from doing things that number one could put them at risk, number two could make them not feel like themselves.

And number three could add stress to the process.

And I just say, you know, embrace the beauty that you are and shine through.

And then if there are things that you want to fix or that they bother you, let's look for ways to do it that are going to be supportive to you through the process.

Not going to potentially detract.

And that's where those players like azelaic acid or hyaluronic acid or vitamin C serum, or just a good self-care routine, they're going to really start to make people feel a little bit better in their skin.

And I think at the end of the day, that is a hugely important process in and of itself, and probably the thing that we need to all, you know, work to master every day.

Well, that's so beautiful.

And I mean, it comes back to mindful self-compassion, doesn't it?

Right.

When we can look at our friend and see them in their entirety as so beautiful, but then it's like, aren't we our own worst critics?

We look in the mirror and we see this and that and the other that like is wrong or needs to be changed.

But, but like that Photoshop version of ourself, that's not really what, what I'm going for really, but what any of us, you know, would go for to talk to a friend.

And so I think just embracing ourselves at this life stage, this finite life stage, looking what options are available, keeping the skin moisturized, wearing sunscreen, you know, maybe there's like a fun face mask you could do to kind of spice things up, you know, but just really saying, okay, this is finite and I'm me and, you know, younger, looking younger isn't necessarily better, right?

Like, and, and, um, thinking ourselves, like looking at ourselves, like we would look at a friend and talking at ourselves, even in the mirror as we would a friend, and I think that's so beautiful.

My goodness.

Well, I can't think of any other way, better way to, to end our conversation than on that note, is there any other thing that you would like our listeners to know about, I mean, you know, we had some questions about melasma and we had some questions about like laser hair removal and safety of that.

Like, um, but we covered so many of the questions that our listeners really wanted to, um, be answered.

Is there any other thing from your dermatology perspective that you see commonly, you know, in, in people in this population that you wanted to like reiterate or educate or empower?

Cause that's what we're all about here.

I love on science.

Well, I love that.

And that's what makes this podcast so beautiful and exciting to be a part of.

Um, I have to say, I do think melasma is really a fascinating thing.

That at the end of the day, one of the most important things we can do for melasma is really just sun protection.

There is good data that you can spend money on fractionated, you know, lasers and, um, you know, procedures like IPL, these big deal, uh, procedures.

But then you step outside and you go in the sun and the, it comes right back, you know, and there is good data for tinted sunscreens.

For melasma, because women with melasma are really sensitive even to visible light and visible light really can augment the effects of UV when you're in, if you have a tinted sunscreen, it's got an iron oxide pigment, so you get the second barrier on top and that's actually really great for melasma just right there.

Well, you introduced me to my lovely LaRoche, Posey, uh, you know, tinted sunscreen, which I still use.

And I get coupons like all the time in my.

I love that one.

Oh, I'm glad.

I'm glad.

Yeah, I do love that one.

It's a nice, it's a really great product.

I mean, environmental working group, EWG.org is a great place to try out your products and you can just type the name of your product into EWG.org and they rate products and then you can see if, okay, is the sunscreen one I want to use now, or is this one I want to save for, you know, the next part of life, you know?

Um, so yeah, I would say tinted, tinted, uh, mineral sunscreens are great for melasma, vitamin C serums, and again, there's that as a lake acid, but otherwise, um, yeah, I just feel so honored to have been here and thank you for having me.

Thank you so much.

I know this is not, these are not all the last dermatological questions we will have.

And so I would love to have you on again.

And you know, it's just our community.

I think people are so curious to know, you know, what's out there and what's, what's safe, what's not safe.

And there's so much conflicting information.

So just to share your experience, to share your ideas and also your perspective on, you know, how we, you know, why we want these things and, and, and sort of what does that mean and how can we reframe and, um, see ourselves in a different light too.

I think that's really powerful as well.

And I think, you know, I tried Botox once.

And like, I don't know, you know, I'm, this is not to say anything sweeping against Botox, but like my face hurt.

It was felt really heavy.

And I was like, I just put a toxin inside and it was so expensive.

I thought like of all the other things I could have spent my money on, right.

Um, Sometimes people don't feel like themselves after Botox or filler.

That's hard.

If you look at yourself and you don't see yourself in the mirror, that is sometimes hard for people as they're kind of.

Yeah.

Yeah.

It's so true.

And again, if people want to use Botox, that is their choice.

Everyone needs to do what's best for them.

But for me personally, I looked at like the price tag and what, how I felt and what it was, and it was like, you know what?

I think if I had this much, you know, discretionary money, I think I can think of so many other things I'd love to spend it on that will truly make me feel like a more vibrant version of myself.

And I think that's what we're going for.

So thank you for your friendship.

Thank you for taking care of me.

Thank you for sharing your wisdom with this community.

And we will share everywhere in the show notes of how people can find you.

Tell, tell our listeners though, if they're, you know, sort of curious, what's the best place to find you?

Well, you can find me on sway skin.com or, uh, I do have a page on Instagram dr.

Laura, uh, dr.

Laura.md and look for me there.

I talk a little bit about skin health and, you know, I'm happy to share.

Yes.

And just sway, just to be clear.

So sway is S w a E S K I N.

Right.

Yes, exactly.

Snow logo is super pretty.

I love it.

It's amazing.

Oh, you're lovely to say that.

Thank you.

That made me happy.

Thank you.

Yay.

Well, thanks again, dr.

Laura until the next time.

Thank you for having me.

Yes.