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Caitlin Whyte: So much of the fertility process focuses on the science of it, all the treatment options and the eggs and the sperm, but fertility is a deeply emotional process that can take a lot out of couples here to talk about the emotional side of infertility as always, are our doctors, Molina Dayal and Maureen Schulte, joined today by mental health specialist. Jen McCurdy. This is All Things Fertility. I'm your host, Caitlin Whyte. Maureen, tell us about how doctors and mental health specialists interact at SIRM, St. Louis?

Dr. Schulte: So interaction in the office actually is through telephones, I would say because unfortunately we don't have a mental health counselor on staff, but I think that in every consult that myself and Molina do, we are discussing mental and emotional state with our patients. Fertility is devastating the actual journey of infertility, and in my opinion, everyone needs some sort of support, and I prefer them to get professional support with a counselor. So I recommend that to all of my patients. This journey is hard enough and so finding people and professionals to support you through it I think is an excellent idea. So the discussion between the physician and counselor really occurs after seeing the patient when we make a recommendation to the patient on who we think would fit their personality best as far as from a referral base and then they go and see the counselor and then, you know, the physician and counselor can speak about the patient just so that everyone's on the same page, you know, in touch base that way.

Host: So Jen, tell us a bit from your perspective, what is the role of a mental health specialist in fertility treatments?

Dr. McCurdy: Sure. I really believe my role is to simply empower my clients to feel safe and supported along their journey. You know, as she just said infertility it's devastating. It stops you in your tracks yet life is still going on around you. So if we can help people get a little bit more grounded with all of their big fields, what to do day in and day out, they can embrace their infertility journey while also embracing.

Host: So Molina, I'll throw this next one to you. When do you refer patients for care?

Dr. Dayal: Well, oftentimes we'll recommend either patients or couples obtain care due to a variety of reasons. Sometimes it could be that couples are just struggling connecting with one another through the fertility journey. I mean, it's a very stressful process. Sometimes they've already undertaken treatment and it hasn't been successful, and this can be very stressful not to just the involved but to their relationship. So that's one time that I will recommend that they see someone. Oftentimes couples who are navigating, having had multiple miscarriages will be referred as well. And that's because many times there is a sense of stress, a sense of self blame and guilt, and again, that can not just affect the woman under going those miscarriages, but the couple as a whole. Again, just kind of helping them navigate that process because sometimes they've lost hope and part of it is just trying to find their way back onto the path so that they can continue in their journey to have a family.

Oftentimes I'll recommend patients or couples also see a mental health specialist if, let's say they've tried multiple different fertility treatments and now they have to decide to use let's say an egg donor, which means that it's someone else's eggs and oftentimes the partners sperm. But then the patient herself is carrying the pregnancy but now she's not biologically related to that child. So in those situations we oftentimes will have couples seek psychological clearance just to proceed, just to be sure that everyone involved is completely comfortable with the process. And for that matter we do that even for donor sperm. So if the, if we're not using the partner sperm, but now they're using donor sperm, same sort of idea, we want to make sure that everyone feels comfortable proceeding with that, that treatment. And then of course, if there are other people that are involved, whether it could be somebody that you know who's going to be the egg donor or somebody that you know, could be the sperm donor, then of course everybody just has to be sort of comfortable with moving forward.

Host: So Jen, tell us a bit more about how therapy helps. Where does it fit into a patient's journey?

Dr. McCurdy: So really therapy provides a space nonjudgmental platform for our clients to simply be them. It gets a field all of their fields, ask all of their questions. They're embarrassed to ask or scared to ask, feel overwhelmed with all of their thoughts while they're going through different phases of infertility, different things come up. We'll see a lot of past trauma, relationships, stress, what to do with my job. And if we can help support them on the mental health front, they're going to be more empowered to engage with their, the medical side of the infertility treatment. The one thing we do see is with therapy, as we increase the patient's access to their coping skills and we're starting to provide more multiple layers of support, anxiety decreases, depression decreases, their response to trauma changes, and they're able to engage with the treatment more, hopefully.

Host: So Jen, tell us a bit of the types of emotions you see during a fertility process during, you know, these therapy sessions.

Dr. McCurdy: Absolutely. So I see a whole bag of mixed stuff. I think anxiety would be your number one. We see a lot of anger, depression, fear, grief, stress, trauma, fatigue, you name it. It definitely comes in through the door. But I also do you want to add that I see a lot of hope and resilience with my patients. I always tell my infertility clients, they're my most favorite group of people to work with. They are remarkable. They will do anything to make this process successful. And they tried so hard with every phase of the treatment, meaning both there physical treatment, but also the mental health treatment. So it's truly a joy to work with them. So even though there's a lot of extreme emotion, there's also a lot of work that they're willing to do and try.

Host: You mentioned this before, but what type of topics do you cover in a session?

Dr. McCurdy: Typically, honestly, it's how do we present in a very, very busy world while dealing with infertility. Self care is huge. That is my number one thing. When someone walks into my office, I want them to leave my office with an idea of something to do to help take care of them. All of my patients will hear, you know, I tell them to get their journal. We're going to learn to meditate together. We want to own our own stuff and exercise. Something as simple as taking a walk for 20 minutes. You know, stuff like that. We go over in session. Infertility definitely brings people to me, but regular life typically finds its way also through the door. We go through the whys. Why is this happening? How can I make this work? How do I deal with hope? Just my partner really get it. Do they care? How do I get my people and my friends to support me? Those are big, big questions. Other big topics are about relationships and we deal with partnerships, marriages, the stress of infertility on a relationship is huge. Job stress. How do I work when I have to go get treatments and I'm going in and out for ultrasounds all the time? Do I tell my boss? Social media is a huge topic we deal with a lot. Is it okay to see all of our friends pregnancy announcements and gender reveals and how to use our social media mindfully. Also we do a lot of trauma, childhood trauma, even politics comes in, so really we get it all, but those are probably the biggest topics that I see on a daily basis.

Host: What would you suggest for people who are looking into therapy? How many sessions or times do you need to see someone?

Dr. McCurdy: It varies. Counseling is all, it's really truly about the relationship. I tell people that you should feel a connection with a therapist pretty quickly within a couple of sessions, you should feel the, Oh, I could talk to this person. I could ask these questions that I wouldn't want to normally talk to someone about. You should really feel grounded with your thoughts. So in about four to six weeks. After that, it kind of depends on, some people want to come for a very, very long time. Other people get their ideas and their coping strategies and they're on their way. I will say that most of my clients do stay connected throughout their treatment when we're dealing with infertility, it's such an intimate journey. You know, they want to tell me about their hopeful babies and I want to see the pictures and it's really a joyous celebration if we can get to that point and if not, we have to process, the loss and the grief. So whether it's weekly, biweekly, some people will rev up during their treatment and see more, especially during the two week wait. And if they pause, we look at that too.

Host: Would you rather see couples alone as individuals? Does it matter? How does that work?

Dr. McCurdy: You know, honestly it really doesn't matter. I have mostly women that come to me. Honestly, it's probably easier to get a woman to get through the door. I love when women bring their partners. They are always more than welcome, but typically the woman going through the treatment is the one who is willing and able to come to therapy more often.

Host: Do you usually see patients at the same time as they undertake treatment or is it before, after? How does that work also?

Dr. McCurdy: Yes. Yeah, so that's the goal. My goal is to see them before treatment starts so that I can help them build their coping strategies. So they're walking into treatment, feeling empowered that they have a voice, that they have their coping strategies to get through it. And then I definitely carry them through. Again, going back to that two week wait, we're talking to each other a lot during that. And then when we find out, you know, whatever treatment path they're on, we deal with and process through. How did that all go? Where do we need to go in the future?

Host: Jen, do you prescribe medications in these sessions?

Dr. McCurdy: I don't. I'm a licensed professional counselor, so I don't do medication, but I definitely recommend it if I feel it's needed. And if the client wants it.

Host: And is your therapy individualized? What type do you offer?

Dr. McCurdy: So all of the therapy I provide is individualized. So it depends on what the person needs and what they wish and how they like to process. Everything is intrinsically based. So I utilize a lot of person centered therapy and I offer cognitive behavioral therapy techniques in all of my sessions depending on what the client needs and how they best respond. I do work, I like to work in person when I can. Right now we're doing a lot on virtual therapy as well, either voice or video. I also, I actually work with a lot of people across the country who aren't even local to St. Louis and that's when we do a lot of virtual therapy sessions because it's hard to get access to mental health supports with infertility in mind. So that is something we're able to do.

Dr. Dayal: I think mental health specialists are so very important to our patients. You know, they, it's, we definitely reach out to these individuals to really provide sort of a, the best way to cope with the entire process. And it's amazing some of the work that they do. So I applaud you. Thank you for what you do.

Dr. McCurdy: Thank you. Thank you. I appreciate that.

Dr. Schulte: Yes, thank you. You're so necessary.

Dr. McCurdy: So are you guys, so it's a team of parts. I definitely, especially with infertility, this is who can do what. The more the merrier.

Host: Well, thank you all so much for your time today. That was of course our doctors, Molina Dayal and Maureen Schulte from SIRM St. Louis, joined by mental health specialist, Jen McCurdy. To learn more about the team at SIRM St. Louis, or to schedule an appointment, visit StLouisfertilitycenter.com. If you enjoyed this podcast, find more like it in our podcast library and be sure to give us a like and to follow if you do. This has been All Things Fertility. I'm your host, Caitlin Whyte. Thank you for joining us and we'll catch you next time.