In honor of national PA week, I wanted to share a little bit about my personal life – in dealing with infertility while working as an OBGYN PA.
I love my job. Most people aren’t lucky enough to feel like they found their “calling”. I knew I wanted to work in women’s health the first day I shadowed an OBGYN in college. I kept an open mind in PA school and went into every rotation with a go getter attitude. Volunteering for every procedure, every opportunity to practice and learn. But then I got to my OBGYN rotation. And it was just SO much better than the others. I tried to keep an open mind for the rest of my rotations, but I just knew that women’s health was where I was meant to be. I knew what it felt like to be a nervous teenager, wondering why my periods were so painful and made me feel so terrible – who was scared to death of a pelvic exam and hoping I wouldn’t have to get one and looking for compassion and understanding from my doctor. I wanted to be that for someone else. But to also be there for all the other anxiety provoking changes that occur in a woman’s lifetime. Pregnancy, loss, infertility, menopause.
I had my first baby at age 29. We conceived without problems. My pregnancy was uncomplicated – outside of working in healthcare during a worldwide pandemic. I had her in June of 2020, pre-covid vaccine. I labored in a mask and had no visitors and worried sick about protecting my infant from illness. It was such a stressful time but also one of the happiest too.
I remember the feeling I had when I returned to work 8 weeks postpartum. I was sad to leave my baby, but I had a renewed sense of pride. Now I knew exactly what it was like to be pregnant, to have a baby, to be postpartum. And the sympathy that I had for my patients turned to empathy – because I really could understand what they were going through. I remember seeing a postpartum patient, my first day back – and it was just the reminder I needed of why I was doing what I was doing. I love being able to help women navigate all of these crazy life changes.
Fast forward to our daughter turning two years old. We knew we wanted another and were hoping to have them about 3 years apart. So I had my IUD taken out and we thought, okay we’ll be pregnant in a couple months. We were aiming to have our baby during the summer again to ensure my teacher husband could have some extra time off. It’s crazy looking back now and how naive we were about it all. Even working in medicine, I just assumed it would go just like before.
But 3 months went by, 6 months, 10 months. And nothing. With each passing month, my medical brain kept churning. And each negative test was fueling a fast burning fire of anxiety within me. I began to notice every detail of how I felt every day, analyzing it trying to figure out if it could be a sign of what was stopping us from conceiving. I started doing testing at work, labs and imaging. All normal. I became a walking ball of anxiety.
In medicine, we are taught to compartmentalize. It’s sad, but necessary to avoid burnout. It’s how ER doctors can run a trauma code and lose a patient and still move on to the next patient without skipping a beat. It’s not always that simple, and it doesn’t always work, but it’s a skill I think we are all indirectly taught to have during medical training. My work days are filled mostly with routine pregnancy visits, but then I’ll have someone come in with an accidental pregnancy. Or maybe even an unwanted pregnancy. Or someone who is pregnant and complaining about this, that, or something else. I tried to compartmentalize. Separate my work life from my personal life. But my anxiety started growing into anger and bitterness and, honestly, sadness. I found myself crying in my car ride home several times a week. I realized I needed help and did two things. I scheduled my first REI (reproductive endocrinologist) appointment and I scheduled a therapy session.
After my first REI appointment and several therapy sessions, I was feeling so much better. The hopelessness had started to fade a little and a bit of positivity crept back in. All of our testing was normal, although with some suspicion of mild endometriosis. But I felt like we were moving forward. I had a lot of things going for me, I was still under 35 and had been pregnant before, which gave me better stats. We started with a medicated timed intercourse cycle, no luck. We then moved to IUI. We did 3 cycles – all of which failed. My hopelessness started to creep back in with each failed treatment. My anxiety started to rear its ugly head again. I was back to late night research sessions. Ordering every book I could find on infertility. Adding supplements, acupuncture, yoga, meditation, cutting out caffeine, alcohol. You name it – if there was data on it, I started doing it. But it still didn’t work.
People don’t talk much about the feelings of loss after failed fertility treatments. These 3 failed IUI treatments were some of the hardest months of my life. The waiting — is awful. The staring at the pregnancy tests, squinting and hoping maybe there’s a line there and finally accepting there’s not with tears in your eyes. Then going into work and pushing it all away. It’s so mentally exhausting and also invisible to most people.
As a Type A person – I’ve always had the mindset that if I just work hard at something, I’ll succeed. And to be honest, this strategy has worked very well for me throughout my life. But this was the first time that working harder didn’t get me what I wanted. In fact, I continued to realize that there are SO many women who work so damn *hard* at trying to get pregnant and just simply aren’t successful. And this was an incredibly painful realization for me. I thrive on control and planning. And this is just something I truly cannot control, no matter how hard I try.
We are at a big decision point. We are trying to decide between pursuing IVF or potentially having surgery for my endometriosis. This was not something we had anticipated at all. And the financial stress of it all is real. Our IUI cycles cost about $800 each. The average cost of one round of IVF in the US is $20,000 … and in the state of Texas, fertility coverage is not mandated. So my current insurance plan covers nothing. The success rate for someone in my position with 1 round of IVF is roughly 48% … so there’s a good chance I could need *several* rounds of IVF. We are fortunate enough to be in a position where we can probably manage this (not easily, but we can), but the idea of spending that much money on something that’s not even a 50% chance of working is such a scary feeling. And there are so many others who are not as fortunate as us to be able to afford this option.
Every day, I don’t think more than 10 minutes pass, without me thinking about my infertility in some way. I can’t escape it. It weighs on me. The unknown of it all. The financial burdens. The decision fatigue of what is the best next step for us. It’s exhausting. And then if one more person tells me I need to “stress less” and it’ll happen … I swear I’m going to lose it.
We don’t have our happy ending yet. I truly hope it is coming soon. But these last 15 months have changed me. I’m absolutely a different person than I was before. It has truly made me understand why you see the phrase “infertility warriors” or “IVF warriors”. Infertility is a life altering diagnosis. One that is silent and unseen and frequently not talked about. It’s so hard to understand it if you aren’t going through it. I hope reading this may help shed a little light on the things people may be going through behind closed doors. I hope it helps to rid some of the stigma surrounding talking about infertility. If you are a fellow infertility warrior and want to reach out, please do. I’d be more than happy to chat with you.
The one thing that I am SO SO thankful for is that, at the least, I’ll be able to support and help my patients going through infertility in such a better and more compassionate way than I was before. Because it’s not sympathy anymore, it’s empathy. That’s my little silver lining. And that holding my baby one day will be so much sweeter knowing what we had to go through to get to meet them.