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Caitlin Whyte: The winter and holiday seasons are a time of gathering and visiting friends and family you may not have seen in a while. But for those dealing with infertility, it can be a triggering reminder of the family they are trying to start themselves. Joining us with some tips for navigating infertility this holiday season are Kristin Dillensynder, a fertility coach and former patient, as well as Dr. Johanna Von Hofe, a reproductive endocrinologist and infertility specialist.

This is Flourish, a podcast brought to you by Prisma Health. I'm Caitlin Whyte. So Dr. Von Hofe, I'll start with you. Let's begin with the basics. How common is infertility?

Johanna Von Hofe, M.D.: Infertility affects one in eight couples. So it's a fairly common diagnosis.

Caitlin Whyte: Okay. Gotcha. And doctor, at what point would you recommend someone reaching out to a fertility specialist and getting that extra help?

Johanna Von Hofe, M.D.: Sure. So for women that are younger than 35 who have regular menstrual cycles, we recommend reaching out to a fertility specialist if you've been trying to conceive for one year and have not yet been successful. If you're over 35, we actually encourage you to reach out earlier than that. So at the six-month point, we tell all women who are over 35 years old to come see us for further testing to see if there might be something that we can do to expedite your chances at becoming pregnant.

And then, if you have known risk factors for infertility like irregular menstrual cycles or a known endometriosis diagnosis, uterine fibroids or if you or your partner has had some type of medical treatment like cancer treatment or is using medications that could affect fertility, we tell you to come see us right away. And if you're one of our women that's over 40, the minute you know you want to be pregnant, we want to see you here so we can see how we can help.

Caitlin Whyte: Now, while this is a physical issue, it's also very emotional for people who are going through it. And I know Kristin, that's where you come in as a fertility

coach. So where can people turn to for support during this journey?

Kristin Dillensynder: The good news is there's lots of options out there, which means that you can find what suits you. When I went through infertility, I did all the things. I went to a local support group through my church. I also attended Resolve: The National Infertility Association, that is an advocacy group for infertility. They have local groups nationwide. So I met with those groups as well. And sometimes that's not enough for people. So that's why I became an infertility coach to give that one-on-one support. There's also therapists. You can find a therapist in general or someone who does specialize in it.

But me as a life coach who specializes in working with women going through infertility, I know what it's like. I'm not going to say the wrong thing. And I'm also not in the trenches anymore. I'm at the top of the mountain helping you walk through. There's something for everyone. The key is just to get the support you need and it's okay if you need that help.

Johanna Von Hofe, M.D.: You know, if I could add to that, infertility and the journey through it is really personal and oftentimes women are going through it with a partner. Sometimes the women that are seeking help from us are unpartnered. It's hard when you're going through something that is so emotionally charged to rely solely on your partner for the support that you need, because your partner is also going through the journey.

And so I do always encourage patients to think about finding someone outside of their partnership that they can lean on for support or reach out to for support. So I think that's where coaching, counseling, support groups really, really help because they help treat that individual as somebody who's going through the journey. And they take that reliance on partnership out of the equation, which can be helpful for both partners.

Caitlin Whyte: Gotcha. Absolutely. Having a third party, I feel like is always a good kind of neutral zone, right?

Johanna Von Hofe, M.D.: Exactly. Yeah.

Kristin Dillensynder: A thousand percent.

Caitlin Whyte: So let's dive into the meat of our topic today. Dr. Von Hofe, why are the holidays so difficult for those struggling with infertility?

Johanna Von Hofe, M.D.: Well, I'll tell you what I hear from my patients a lot. One is they are constantly exposed to triggers for them. So, holiday cards with families with pregnancy announcements. You know, our life is so intertwined with social media these days, so pictures with Santa, pregnancy announcements online during the holidays. There are lots of family-focused events that can be really hard for patients who desperately want to build families to see. So I think that's one of the reasons.

Caitlin Whyte: And Kristin, can you dive into a little bit more about the typical triggers that Dr. Von Hofe was mentioning? What do you see?

Kristin Dillensynder: Absolutely. She nailed it on the head with all those triggers. The challenge is that oftentimes we're caught off guard with those kinds of things where we're going about our day. And it's the moments when we're not actually thinking about our infertility. Because when you're going through infertility, you're thinking about everything, like what you're eating, what you're putting into your mouth, how you're spending your day and your time. It impacts every area of your life. And so when you do find pockets where you're not consumed with it, and then something outside of your control, like a pregnancy announcement comes through, it can really throw you off.

One of the other challenges of the holidays being so hard is it's almost like a measurement stick on how far you did not go. If you've been going through this, it's another year. And most people will spend the holidays thinking, "This is the last year without a baby." And if you've been in the journey for a long time, it might be the second year or the third year without a baby. And it can be really challenging to be reminded of what feels like no progress at all.

Johanna Von Hofe, M.D.: I think a third thing can just be time with family, which is precious in a lot of ways and something that we look forward to. But it can be really difficult I think for patients that are seeing us to go to family events and see family members that they maybe haven't seen in a while, particularly in the context of COVID. So now, we're getting back together and families are coming together and they're asking questions that, while they're meant to be well-meaning usually, sometimes they can feel really, really insensitive to somebody who is secretly going through this treatment.

Caitlin Whyte: Well, Dr. Von Hofe, what are some coping strategies you would recommend, especially if maybe you're heading into one of those situations? You know, your aunt's going to ask a bunch of questions or something like that, where you can prepare ahead of time.

Johanna Von Hofe, M.D.: One thing that I tell my patients is it's okay to delete the apps. It's okay to not open the Christmas cards. It's okay to say that you will go to the event, but set very strict parameters on how long you'll be there. It's also okay to say no. But I think Kristin probably has some really good, really good strategies for how to cope with the questions in particular.

Kristin Dillensynder: Yes. I'd love to answer this question. I have all of my clients prepare responses in like a bulls-eye mentality where you think of the bullseye and then the two levels outside of it, so the target. And it's important if you do have a partner to be on the same page. But think about what kind of people fit in the bullseye of this target and who are on the one level out or two levels out. So in the bullseye is usually like maybe your parents and your best friends. The one level out might be some other friends, friends you don't talk to all the time, coworkers. And the third level might be your aunts and uncles, depending on how close you are, your friend's mom, people you just know in the neighborhood. And come up with responses with how comfortable you are sharing about your story.

A lot of people hold this close to their hearts. It's really hard to share that you're going through this challenge because it isn't always guaranteed. And it's hard to share when you're in the middle of the journey. Most people feel comfortable sharing that they've gone through infertility and had to seek treatment when they're successful. So if you're in the middle of it, most people are not as open. So pick what you and your partner are comfortable sharing and with whom and be prepared with answers.

One of the things I really like to say is if I'm comfortable sharing that it's a struggle, but I don't want to necessarily say, "Oh, by the way, I have a monitoring appointment tomorrow. You know, we're trying," if somebody asks, "Hey, are you going to have kids yet? What's going on? What's taking you so long?" I might say," Hey, thanks for asking. We're actually trying. And it's a little bit harder than we thought. When we have news to share, you'll know." Because at the end of the day, that's really what the nosy aunt wants to know, that she'll know when you have news to share. And you can go as far as to say, "We'd appreciate your prayers." You can go as far as to say, and if you want to educate people and say, "You know what? A question like that can be really triggering for someone like me, who's struggling or other people. I'd really rather not talk about that." You can also just blow it off and just say, "Oh, yeah. Cool. Good question. How's the weather? Are you watching the football game?" You don't always have to answer. "Where's the bathroom?" "I need to fill up my drink."

Caitlin Whyte: Exactly. Right.

Kristin Dillensynder: The nosy questions are the hardest. But if you prepare ahead of time, you take a little bit of that sting out of it, and then you're proud of yourself for kind of nailing it, which can be really good.

The other thing is, during the holidays, it's okay to make your own traditions. You do not need a baby to celebrate the holidays. Up until this date, you haven't had a child and you've been able to enjoy, you can do that again this year. So make the gingerbread houses. Go see the Christmas lights. Take a photo with Santa if you want to, if you feel well enough for that. Send Christmas cards. And be silly if you need to. Posing with poinsettias or something. A baby is not the only reason to celebrate right now. Make your own traditions.

Caitlin Whyte: I love that. That is such a good reminder. That kind of we've always had Christmas and we can keep creating Christmas in our own way for the holidays in general. But that leads me to my next question, Kristin, what can family and friends do to help? Or another question on that is maybe what should family and friends never do or say? It sounds like we've had a couple of examples?

Kristin Dillensynder: Well, one is don't ask about people's reproductive plans. You know, it should start in the bedroom and it should stay in the bedroom and just stay out of there. And depending on how much you know, you might have an inkling. If you know a couple that's been married for a couple years and they haven't had children, they might be trying and they might be struggling. They don't need to tell you for you to be kind and supportive, but you also don't have to mention it.

Let them lead. If they feel comfortable with you to share, that's an honor. And good job for being somebody that they feel safe to share that news with, but you don't need to ask. Let them lead with the conversation.

Also, if somebody has recently had a loss or a miscarriage or you know they've been trying and they're still not out with positive news, you can let them lead. If you just ask, "Hey, what's been going on?" or "What are you looking forward to next year?" Open-ended questions like that are so much better. If they feel comfortable, they will fill it in for you. And if not, follow their lead and don't ask anything about it. Even if they open up to you, do not, do not, do not give advice unless you are a doctor.

Johanna Von Hofe, M.D.: As a doctor, I'd love to echo that. I think one of the hardest things that I hear from patients is "My friend asked me about this thing. My friend wants to know why we're not doing this test." And often my patients are already questioning things so much. They're in such a vulnerable space. That unwanted or uninvited medical advice really clouds the journey for them. And it makes our medical treatment plan harder. You know, I always appreciate questions about treatment and why we are and aren't doing things, but when it's driven by untrained lay people who just are asking probing questions, it's usually not helpful.

Caitlin Whyte: No, absolutely, absolutely. As we wrap up our episode here, Kristin, and I know that you had your own experience with infertility, which actually prompted you to become the infertility coach you are now. So can you tell us a bit about your experience and how it got you to this place?

Kristin Dillensynder: Absolutely. I went through infertility. And my journey started in 2015 and ended up doing three rounds of IVF and each round had a different outcome. The first one did not work. The second one worked and I have a four-year-old IVF miracle daughter because of it. And the third one we did did not work and it ended in a miscarriage. So I feel like I went through all of the stages and experienced all of the outcomes.

And I was under the amazing care of Dr. Von Hofe. She's now family because of it because she helped grow my own family and make me become a mom. And she is as kind and caring as she is intelligent and knowledgeable about infertility. And so I was in such good hands with her and the whole team that I saw when I was going through IVF. There was still something missing. And part of it was, I could have talked her ear off, but I knew she had other patients to go to if they had a schedule.

Johanna Von Hofe, M.D.: We always did have long and thoughtful conversations.

Kristin Dillensynder: No surprise to anybody who knows me. And I said earlier, I went to the support groups. I found other people who were going through IVF. There was still just something missing because what I found was I was either with the doctor who I love and adored, but I knew that there was a time limit or I was with other people who were in the trenches and sometimes they had good news and I didn't. And sometimes they had bad news and they didn't have enough of an emotional well-being bank to support themselves and me at the same time. And so I couldn't rely on them.

So I knew that there was a gap in the amount of emotional care, and I just knew that there was more out there. So after I was successful and had my daughter in 2017, I decided to become a life coach and get certified and specialize in supporting women going through infertility, because this is not a choice that any of us have made. It is a medical diagnosis. And it is a challenge with reminders and triggers, not just in the holidays. Every month when your cycle starts again, every time you see a friend with a child or somebody asks a personal probing question, you are reminded of what you don't have when it's all you want.

So I now am the safe space for a woman to show up exactly as she is. She doesn't have to cover up how she's feeling. She doesn't have to pretend she's stronger than she feels. Like we said earlier, she doesn't have to lean on her husband or her family who feel it differently and don't always know the right thing to say or what they need. I also have the tools and the strategies to help you not only survive, but make it better, make this experience better. Because at the end of the day, this is a part of the story of your child.

And it doesn't have to be all bad. It is consuming. It does take over, but I have the tools and the strategies to help you love your life while going through IVF. And I'm so honored to take that very messy time of my life and learn from that experience and help other women as they go through it now.

Caitlin Whyte: Oh my gosh. You all are both so inspiring. Well, my last question I'll ask to both of you. We'll start with you, Kristin. You've laid down so many good tips and just messages in that, but what are some key messages as we wrap up that you want to share with those also on this journey?

Kristin Dillensynder: My number one thing is that this is temporary and it won't always be this way. This holiday season might be really hard for you, but it is possible that next holiday season you won't be in the same place. It's okay to get help and help from a doctor, from a fertility specialist like Dr. Von Hofe or help from a counselor or help from a coach. It's okay to get help.

Johanna Von Hofe, M.D.: Yeah, I think I would say acknowledge your feelings. Feeling sad, angry, and jealous when friends and family share their pregnancy news doesn't make you a bad person. Feeling down right now doesn't mean that you can't be happy for people that you care about and still be sad about the struggle that you're having to build your family. And then I can't reiterate enough what Kristin said, reach out. Reach out to somebody that you trust. Ask for resources. Use a coach, use a counselor. But make sure that you're not trying to "handle this alone." It is hard. And it's okay that it's hard. It is temporary. And we have ways to get you through it, supportive ways to get you through it, medical ways to get you through it. So don't do it alone. Find help. Acknowledge what you're going through.

Caitlin Whyte: Well, thank you so much for this information. It's so important to remember the nuances of the holidays and we got some great tips here today. For more information, head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by Prisma Health.

I'm Caitlin Whyte. Stay well and happy holidays.