The Unique Burden of the OBGYN on the Fertility Journey

You spend your day catching babies. Managing high-risk pregnancies. Reassuring patients who didn't plan this and aren't sure they want it.

And you go home to another negative test.

This week's episode is solo –– just me –– because this one is personal. I'm an OBGYN and REI who's lived the fertility journey from both sides of the stirrups, and I'm talking directly to one of the hardest intersections I know: being the OBGYN who desperately wants what her patients have.

This is part of a series on why certain specialties make infertility uniquely painful. OB/GYN might be at the top of that list.

In this episode:

• The cognitive dissonance of managing unplanned and complicated OB patients when you'd give anything to be in their position

• Why being surrounded by pregnant patients all day is genuinely triggering and what one OBGYN client did about it

• The realities of the schedule: 24-hour call, no 80-hour cap once you're attending, disrupted sleep, and the burnout that compounds

• The advice I got as a pregnant fellow that changed everything: be the patient, don't scan yourself

• The privacy paradox of wanting separation between your personal and professional life when your colleagues are also your doctors

If you want more on this series, I also sat down with Dr. Dympna Weil on a related specialty-specific episode- worth a listen if this one resonates.

If this is your situation, I see you. And I want you to know: you don't have to find your way through it alone. Give it a listen. I made this one for you.

With Love and Science,
💜 Dr. Erica

P.S. If you're an OBGYN sitting in this exact tension right now, caring for everyone else's pregnancy while yours hasn't happened yet, I'd love to put my eyes on your situation. Book a consult here. I'd love to connect.

Also, be sure to check out our website: loveandsciencefertility.com

Follow us on social media:

IG: www.instagram.com/loveandsciencefertility

FB: www.facebook.com/profile.php?id=61553692167183

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.

• Transcript:

  EB Healing Arts (00:03)

  Hello, my loves. I have realized that we have had so many successful people on the fertility journey through love and science, And I think, One of the hardest parts about the journey is feeling so alone and feeling like it's never gonna work. And so I am going to share de-identified stories with you to understand the kinds of ways that we help people and the kind of success stories that are possible.

  All right, let's dig in. So I had my very first client who came to me saying that she thought IVF was going to be the solution to her problems. And unfortunately, she still had not been successful. So I will say most of my clients have done IVF, it's not working, and they're really starting to get threatened with not being a parent. So she had already had two losses before IVF. She had actually generated several euploid embryos, thankfully.

  And came to me having a diagnosis of a prior fibroid which had been removed, adenomyiosis, and recurrent pregnancy loss. She thought, you know, getting to the upload embryos is going to be the thing that will fix everything. But unfortunately, her first transfer ended in a miscarriage. And her second transfer, she was not pregnant. She joined Love and Science. She coached for three months while she was doing her lupron actually, because they were trying to suppress the adenomyiosis. And her next frozen embryo transfer, which was about six weeks into the program, it was successful.

  And now she has a child. And so, you know, I think that that's a story to say that I think it's really disheartening when IVF is not working and it's like, I just have to do the most aggressive thing. I have to do the most successful thing. But when the science isn't working, it can be very terrifying. And so, you know, she said to me, she was like, I'm concerned that IVF is not going to work for me. And I'm also concerned that I'm blocking my own chance of success because I truly don't believe it's possible at this point.

  So we worked together, you know, very, very closely to help her uncover her limiting beliefs. We helped to challenge the idea that it wasn't possible and we just cracked open the door to possibility. I remember seeing her energy shift and you know, again, I remember seeing her on the Zoom call and I was like, my goodness, this transfer is gonna work because I knew it because I knew she was ready and everything was aligned scientifically. And so if you're in that space where, say you have embryos or say you've got a treatment plan.

  And your body is just so shut down because of obviously self protection, right? It's like, how could this ever work for me? Or I don't even want to hope because I've just gotten so much bad news in the past. Love and science really is for you because we make sure the science is sound and then we work on the emotional piece of it to improve the physiology, to be open to successful outcomes. And what I do is I bridge people to parenthood. So wanted to share that story. Thanks for listening and support is yours if you'd like it.

  Erica Bove, MD (02:53)

  Hello, my loves, and welcome back to the Love and Zions podcast.

  Erica Bove, MD (02:57)

  Today we're gonna talk about the first of our series of the different kinds of physicians and why certain specialties are really hard on the fertility process.

  Erica Bove, MD (03:07)

  This podcast is a sensitive one for me to talk about because I am an OBGYN and I have had a number of fertility and loss struggles myself.

  And I think that being an OBGYN, again, this is not to compare, but it is one of the hardest specialties to be in while navigating the fertility journey because I just get so angsty about this when I think about it. Like we are surrounded by pregnant people all day, every day. Sometimes people who have desired pregnancies and are, you know, glowing.

  Complaining, like whatever it is, like we just don't want to hear it, right? When we're in the thick of it. Sometimes it's unplanned pregnancies, and you know, people are living their lives in ways that really are like, what sick joke is this that this person who is using cocaine and abrupting with this unplanned pregnancy, you know, is is in the situation. Like, again, this is a no judgment zone. I know that people have their different struggles, but I I just remember thinking, like,

  All the unplanned pregnancies I saw as a resident, now I'm in fertility and people have very desired pregnancies. But all these unplanned pregnancies that I saw in residency, I just thought like, and that's when I was, you know, going through a lot of what I went through. It was like, what what sick joke is this that this is who I have to take care of when I highly desire a pregnancy and this is not my story. So again, I just think that those sort of

  That cognitive dissonance that like I'm the one who has to take care of this patient and like this just feels like some really unjust situation. I I we can't talk about being an OBGYN in the fertility world that without talking about that that paradox. I did record a podcast once with this a woman who is an OBGYN named Dr. Dimna Weill. we can link her episode in the show notes as well. But she shares her personal story of being an OBGYN going through IVF and

  like pregnancy complications and everything and what that was like for her. And so even though I'm gonna talk about what I'm gonna talk about today, I, you know, couldn't talk about it without r you know, highlighting that episode because there's just so many pearls of wisdom and beautiful moments of sharing that she so generously gave to us from that episode. Okay. So let's think about it like on a very practical level. So OBGYNs have like terrible schedules. We we know this. There's

  twenty-four hour, thirty-six hour, seventy-two hour call. Like again, depending on your setting, there's no eighty hour work week in attending life. And so sometimes people are on call for just like days on end without relief, especially in more rural settings. so there's altered sleep schedules. Sometimes, you know, you're on call for a whole night and maybe you've done two C sections and then you go to the clinic and you see an entire clinic panel. Like it goes on and on and on. And I know people criticize the laborist model. I actually think it's really helpful that we have

  The ability to have people who do shift work, but even laborists, you know, can have altered sleep schedules as well because of the nature of being on call at night and switching from days to nights and all those sorts of things. So as my father says, there is truly no utopia, but I think the the schedule of an OBGYN, I don't know many OBGYNs who have what I consider a reasonable schedule, and most are extremely tired, extremely stressed out, and the burnout rates and the early retirement is just super high for a reason. Okay, so we talk about the schedule, the stress.

  My own grandfather was an OBGYN. I never met him because he died so young, maybe partially related to the stress of the work, who knows? But I was the first grandchild not to be delivered by him. And you know, in some cultures they believe that that person's spirit enters that new baby, and and that those two souls are always connected. And I I've always just felt that way with my papa. he went to medical school, I went to medical school, as in my father actually. And so many times and I I work at the University of Vermont right now, so I can like go down the hall and see their pictures and

  Like Papa's with me in the OR, you know, again, believe what you wanna believe, but I I really do feel his spirit with me, and that's quite powerful. But I think that he would say, I mean, again, I heard this because I never knew him directly. He said that obstetrics is ninety five percent routine and five percent terror. And maybe maybe since he practiced in the nineteen forties and fifties, maybe he might have a different perspective on that now. you know, given that our patients are sicker and sicker and

  Maybe it's even more than 5% terror, probably a lot of the times, but everything that we know now about fetal monitoring and medical legal stuff and how things can change, how quickly things can change. I do think that, I mean, and I did my residency in New York City at Columbia Presbyterian, which was a highly acute environment. I just remember like I would go to my L and D shifts and there were like we were on the 10th floor, right? Choney 10 tower.

  And I would pray the serenity prayer on the way up and then recite the post-partum hemorrhage protocol, and then the elevator would ding, and I would get, you know, leave, get off the elevator for my shifts. And and that's how I started every single day or night, because it's the only way I survived. And so I think about that, like I think about the stress of the work, the high acuity, the you know, the pressure on keeping mom and baby healthy, and sometimes that's not always possible.

  And you know, I know, because I like work in an academic environment right now, I know that my journalist colleagues are incredibly stressed and there are bad outcomes. And, you know, you know, many of them are are not even preventable. It's it's a really stressful field. And so just thinking about the cumulative effects, you know, on people over time when the work is so stressful, when there's the labor and delivery dynamics, some environments are more supportive than others. I know that well from being in different places, and so just recognizing that.

  you know, it is a stressful job in terms of trying to do your best for the mom and the baby, having, you know, akretas and AFEs and and, you know, we all know that there can be really tragically like maternal deaths and all these different things. Like it's really, really stressful work. So I just wanna call that out. I think it's also really stressful to be surrounded by pregnant people all the time when it's like, okay, when is this gonna happen for me? And

  You know, I do know people like one of my coaching clients right now, she's an OBGYN, and she actually like took several months off from LD call because she said this is just affecting my mental health. Like I will do GYN only for a bit and then return to it. And that's that's what she needed to do. And I'm unfortunate, you fortunately, she worked in a work environment that granted that request. I know not everybody can do that, but I do think that for her, that was one of the key pieces to kind of getting that mental space because it was so triggering. Triggering is really the right word to use.

  So triggering to be around pregnant people all day, every day. And I I felt that way too in my residency. I was like, I don't want to see another single pregnant person ever again. But my whole clinic panel and my whole LD, like, it's just full of pregnant people everywhere. It was terrible. So I want to call that out that you know being around people who are pregnant is really triggering. And then some of them are having unplanned pregnancies and in terrible situations. Some people are

  you know, having desired pregnancies but come with their like list of five million complications that I'm I'm not say or complaints, not complications. I'm not saying that we should never complain or never be able to welcome the complaints of our patients, but sometimes when when we hear the complaints of our pregnant patients and we would do anything, we would give our left kidney to be in their situation with that same like host of of complaints, quote unquote complaints, I think it's really, really

  hard to find the well of compassion in those situations to be able to get through the day. And it's emotionally exhausting for us because at some level we have to be inauthentic because we have to somehow like listen to the people and find something somewhere to take care of their the you know complaints and their issues. But I think that it's also when we're out of alignment, when we are h being inauthentic, I'm not saying we should be, but at at some level we have to take care of the people.

  It just becomes emotionally draining, it becomes moral injury. And, you know, that's when you know, I've heard of my own clients and patients have gotten like people have complained about their lack of compassion. They've claimed, you know, complained about their snappiness or their again, if we were all men, I think this would we would be handled differently. But again, there are all these standards for women physicians that again, gender bias is real. But again, how do we do that? How do we listen to the people who have the back pain and the

  swelling and the insomnia and all those things, like and the nausea, like how can we do that when we want nothing more than for that to be our list of complaints and it hasn't happened yet? I think that that deserves to be called out. also I think that when we are in the field of obstetrics and gynecology, when it does finally happen for us, we can only imagine a bad outcome. So I will say like for me, I had a nectopic pregnancy until proven otherwise.

  I had a horrible fetal anomaly until proven otherwise. I was gonna have a 23-week perify periviable delivery until proven otherwise. And like I just feel like as a pregnant person, once I finally got pregnant, I feel like I was living in this horrible space of not imagining that I could have anything even close to a normal pregnancy without complications. And so what I find is that when I do help my OBGYN clients and patients get pregnant.

  There is a lot of pregnancy anxiety that we have to work through to say, just because you have helped people with all these issues does not mean it's gonna happen to you in your pregnancy. And a lot of like it is more likely to go well than not at this point, and like taking off the milestones and the NIPT test and the first trimester ultrasound, you know, and then the second trimester ultrasound and all those things, like.

  It's really, really hard to navigate through those things because again, all we can see is the complications and it's like, gosh, I work so hard for this pregnancy. What you know, it would really, really be terrible if that happened. And like to the point where we even believe that that's gonna be our fate until we're surprised that we have a normal ultrasound or something similar. So I want to call that out too, that I think even being pregnant as an OBGYN is harder than being a non-OBGYN because we know all the things. We we know too much, we can't unsee what we've seen.

  And it just becomes this recipe for fear and and I'm not saying we should necessarily like relax into pregnancy ever, but I think that like again, not being able to unsee the things that we have seen creates even more hypervigilance, creates even more tension, creates even more that feeling of like when is the other shoe gonna drop? And it's important to call that out. Okay.

  Also, having ultrasounds around everywhere. So I will tell you when I was a fellow and I was pregnant with my second son, my doctor, who wasn't a hyeroscopy doctor, said, You know, Erica, I know you work in a fertility clinic and there's ultrasounds everywhere, but I am going to encourage you to be the patient. Because, you know, what would happen if you were scanning yourself and there was no heartbeat or something else similar happened? Like, how would you handle that situation? And that was actually brilliant advice because I

  I don't you know, I think we are so mired in the doctor role and like I don't know, like it's almost like this control thing. We talk about this with the home fetal monitors, we talk about this with the ultrasound access in clinics and L and D and everything. Like it is a really interesting question. Like, what would happen if I were to be doing the ultrasound and I were completely unsupported? Actually, I did interview somebody else from my podcast, her name is Dr. Robin Tiger.

  Who shared how her friend, you know, was like, come to my clinic after hours and we're gonna like enroll you in this study about nuclear translucency. And then, you know, once they were like in their I mean, it wasn't Dr. Robin like scanning herself, but it was Robin and her husband and this OBGYN MFM friend of hers, and lo and behold, there was like a significant brain anomaly. And Dr. Robin Tiger as a radiologist and her MFM friend, you know, in that moment, I mean it was thankfully she had her MFM friend support, but it was not what they expected, and I thought

  Gosh, if she had done that scan by herself, like she would have been completely unsupported. And so, you know, I was able to make the decision based on my MFM's advice, like, don't look, be the patient, come to your regular ultrasounds. It's just gonna be better that way. And I I did embrace that. You know, I think it is part of the surrender that I talk about so much at Love and Science, is like relinquishing the control. I had one client say once to me, you know, Erica, like the the more control I give up, the more control I actually feel like I have because

  you realize that control was never ours to begin with. And so this this paradox of like being like, okay, I'm gonna be the patient. I'm gonna be, you know, supported, I'm gonna be taken care of, I'm gonna make sure that I'm doing what I should do from a patient perspective, but I'm not gonna do more than that because, you know, that would not be good. So just think about that for yourself. And not that everybody has to do the exact same thing, but what would happen if something came up unexpectedly and you were by yourself? Like it's a pretty, pretty important thing to talk

  To think through. Okay. Let's talk about colleagues. And this is something that came up a lot in the Dr. Dip No Wild episode, which I, you know, she talks about how nobody knew she was going through it and she was like running around like a maniac trying like be on L and D and then get to her IVF clinic for monitoring and then the retrieval, you know, you never know what days it that's gonna be, and like how hard it was for her to like suffer in silence and to bear this alone, and how she really didn't feel like she could talk to her colleagues about this. And then, you know, let's just talk about.

  Then, you know, as a pregnant person, then your your colleagues are your doctors, and like a lot of us like some semblance of separation between our personal lives and our professional lives, but it is really vulnerable when all of a sudden your whole medical history is, you know, in your own EMR and you know, I know people aren't supposed to look, but maybe they might happen to take care of you and they see your, you know, mental health history and they see like all these other things. And you know, it's it's just it's a very

  weird situation when you want that level of privacy, you want that boundary, that separation, but then by necessity the people who you work with are the people who are taking care of you. And I mean I've even found that in a much lower stakes situation with my own perimenopause care. Like as much as I love my colleagues, like I don't know, there's something about just wanting to have like a little semblance of privacy, a little semblance of like autonomy that where people aren't like up in your stuff.

  But I think, you know, especially if it's like, you know, you end up delivering in your own L and D rooms and like, you know, OBGYNs pretty much never have an uncomplicated pregnancy. I don't know what it is. We talked about that in the episode as well. But like there's usually some sort of like complication or bad outcome or something, which is really terrible. And a lot a lot of people, especially OBGYNs, have like their birth trauma experience because things haven't gone according to plans. And I also think we have to talk about that again.

  Not saying my intention is for every single one of my patients and my clients who are OBGY and that they have the most smooth sailing, uncomplicated, uninteresting labor and delivery, et cetera. But again, we all know that sometimes things happen and so how to be the patient in in that situation when it's our line of work, it's a very, very terrifying situation. And, you know, we tend to like judge ourselves and I don't know.

  again, I I think you get what I'm saying, but it's just it's a it's a bad situation and I think somewhat unique to OBGYNs. also, I also wanna call out that not every colleague is super supportive. Like I will say that I think that sometimes women are the worst to other women and there seems to be a subset of OBGYNs who either like are of a different generation and had it quote unquote worse and so they feel like things shouldn't change in the next generation.

  Or maybe it's people who have like decided not to reproduce themselves and they think that this is all an elective thing or that people are complaining. Like I actually got a lot of flack when I was a pregnant resident. and even when I tried to breastfeed, I remember like some of the child child-free MFMs making really horrible comments that I was pumping every six hours. Again, very, very grateful to have had

  You know, a healthy child and and the ability to pump every six hours, I did not take that for granted at all. But then to have to like explain myself and to these people who understood the physiology, they were just nasty and I'm gonna call that out. And it was really hard. It like added a whole other layer to it. And so I think that we also like have to think about the colleagues that we have, to think about who's in our corner, who's not in our corner, protect ourselves fiercely for the people who may not be so supportive and also

  To call out bad behavior when we see it. You know, maybe it's like, hey, you understand the physiology, you know what this is like. you know, I I really would appreciate a different tone right now. Or maybe it's like, ouch, that hurt, you know, like whate whatever it is, whatever your way of I mean, I'm not particularly funny in these situations. I tend to like react or whatever. But I do think that like being aware that a lot of times our own colleagues are some are like sometimes our our least supportive people and what that looks like and just really

  being prepared for those sorts of situations as they arise, because I think those things can be insidious, they can take us by surprise and they can also kind of rock our confidence and induce self-doubt, which is never great. So I could say so much more about this, but I will wrap up. I think that being an OBGYN is one of the worst, worst fields to be in as a person on the fertility journey on so many levels, on the work stress, work schedule, being around pregnant people, knowing all the bad outcomes, assuming they will happen to us.

  And every single one of them. and I I know from personal experience what it's like. And so if you are an OBG UN on this journey, I see you, I am you, I know what it's like, and it is one of the most painful things. And so sometimes it takes a tailored approach. Sometimes it takes, you what, I need to step away from L and D call. Maybe it's I need to not take night call for a certain amount of time. Maybe it's I need to do something different entirely. Well until I can sort of figure this piece out, or or maybe it's

  Bolstering the mindset piece. You know, I had one client one time who said when she saw a pregnant person, she I adopted the mantra I am them. Like I am them, just not yet in this moment in time. And I thought that was incredibly powerful. So with that, there are ways forward, there are ways to tweak the job, there are ways to tweak the mindset, there are ways to

  garner more support. There are ways to tune out the the negative support, the the the haters, if you will. and there is a way through. And so like I said, if this is you and your situation, let's have a conversation. I feel passionately about changing the culture from the inside out and arming you with what you need to get through your days and to get through to this journey on the other side. and not just pregnant but delivered and happy and healthy and all those things. So you know how much I love you. Until the next time. Bye.