Melanie Cole (Host): Infertility is a medical condition, and it can affect many aspects of your life. It can create one of the most stressful life crises that an individual or couple has ever experienced, but there are things that you can do to help you deal with those stressors. My guest today is Dr. William Ziegler. He’s a specialist in reproductive endocrinology and infertility, and he’s the medical director of the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Ziegler. What is infertility counseling? What do you tell couples that come to you and what questions do they ask?

Dr. William Ziegler (Guest): You have to understand that when a couple comes into our office, they probably have been on the internet. They’ve gotten input from friends and family, and in many cases, they have been putting off coming into the specialist’s office because they did not want to accept the fact that there could be a problem. They’re somewhat concerned about where does that problem lie?

In most cases, women, in particular, have tried to prevent getting pregnant by taking birth control pills, maybe the NuvaRing, just as well as abstinence to try to avoid getting pregnant. And then, when they try to get pregnant, by the time they come into our office – they were trying for probably around a year or year and a half before their gynecologist asks them if they’ve been trying to conceive. At that point in time, it’s an emotional breakdown of hers. They may try some oral medications like Clomid or some other medications, which are out there, to help improve their ovulation for probably around six months to a year, so by the time they come into our office they have been trying to conceive for more than two years. Our office they see as the last stop for them in that if we can’t help them get pregnant, then they don’t see any light at the end of the tunnel.

When they do come into our office, we like to have both partners there so you can appreciate the dynamics between the two and how it can be affecting their marital status. In many cases in which the relationship could be affected by the fact in which they’re arguing with infertility – one may be blaming the other. When they come into our office, we have to really take a look at the couple’s dynamics and address any concerns which we still have at that point.

Also, take a look at the psychological issue in which the female patient has just to be facing, blaming herself because maybe she had a termination in the past and she feels that’s the cause. She could be blaming the birth control pill and in many cases her coworkers, her friends are getting pregnant, and she is not. She’s having a lot of anxiety and possibly even some depression. At that point in time, we actually do advocate them seeing an infertility counselor that specifically deals with coping with their feelings regarding infertility. From that point, we actually start to look at the medical aspect, but the major fact here is, basically the psychological impact that infertility has on the patient and how it could be affecting the couple’s relationship.

Melanie: What do you do for a woman who’s feeling guilty that maybe in her 20s she was on birth control and she thinks that’s the reason? When they’re going through this infertility counseling, Dr. Ziegler, how are they reconciled with these feelings – these feelings of guilt or sadness and they think that maybe there’s not that light at the end of the tunnel that you described? What can you do for them to change their mindset?

Dr. Ziegler: A lot of it has to be reassurance. They read a lot on the internet, and there are some good websites, and there are some not good websites. We try to give them resources that they can access the good websites and get the information, which is out there from reproductive psychologists. Within our area, we have several of them in which are trained for infertility counseling to help them adjust and to help them address their concerns. There’s also like I mentioned before about coping mechanisms, and we give them reassurance that birth control pills did not have a factor, the procedure in which they had in the past – like the termination – would not have a factor. However, there are some procedures which they could have had done, which could affect their fertility. In some cases, giving them a reason for why this is occurring and that it’s a treatable cause actually gives them relief and reduces their anxiety, but in some case, we do need to have them see a psychiatrist to get medication. Sometimes it is that overwhelming.

Melanie: So, go over some of the goals of the infertility counseling for both members of this couple and what you are looking to do toward the end of it so that they can start the treatments.

Dr. Ziegler: I think the main issue is to recognize whether or not the couple are together while going through this treatment process and the evaluation process. What I mean by together is making sure they are supporting each other and that no one is blaming the other one. We’ve had cases where there’s a severe male factor issue, and he’s feeling demasculinized, and his wife is basically saying, “I’m going through all of this because of you.”

You have to change that mindset and say this is a couple’s thing. You’re going through this together. You need to be supportive of each other and talk through really what they’re feeling, and then coming up with a game plan of how – okay, this is how we are going to address this, but it is going to take both of you to support each other. If we do see there is a conflict that could really be detrimental, again, we put our medical treatment on hold until they’re psychologically stable in going through this.

The other major issue is when we go through treatment and treatment doesn’t work, you have to have that contact point with the patient that you reach out to them, and you give them the support of – okay, this cycle did not work. However, this is how we’re going to change things and improve the next cycle. At that transition point again, reassessing how they are psychologically feeling and by bluntly asking, “Are you curtailing your activities in and outside the house? Are you stopping going to family outings, or to holidays at people’s houses?” If they’re starting to change their social activity, again, that is another red flag that we need to get a psychologist involved and put the medicine part of this on the back burner.

Melanie: And Dr. Ziegler, to wrap it up, give couples listening, your best advice about the importance of infertility counseling, who might need to seek that, and what some of these goals are at the Reproductive Science Center of New Jersey.

Dr. Ziegler: I think that any couple that are going through a stressful medical intervention -- even just walking into the office and need to talk about the evaluation – if they feel as if they’re not connecting with their significant other, then it is time to take a step back and address those issues. The other aspect of this is also the stress of going through this process. Everybody deals with stress differently. Sometimes couples talk about their stress; some don’t. To help reduce stress even in someone’s own life, looking at maybe some acupuncture, massage, something like that to help take their mind off of the process in which they’re going through will definitely help decrease the stress and can improve the couple’s relationship.

Melanie: Thank you, so much, Dr. Ziegler, for being with us today. You’re listening to Fertility Talk with the Reproductive Science Center of New Jersey, and for more information, you can go to FertilityNJ.com, that’s FertilityNJ.com. This is Melanie Cole. Thanks, so much for listening.