Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back To Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine. I'm Melanie Cole. And today, our discussion focuses on the emotional, mental, and psychological impacts of infertility.

Joining me is Dr. Elizabeth Anne Grill. She's the Director of Psychological Services at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine. And she's an Associate Professor of Clinical Psychology in the Departments of Obstetrics and Gynecology Reproductive Medicine and Psychiatry at Weill Cornell Medical College Cornell University.

Dr. Grill, thank you so much for joining us today. Before we get into this topic, because we don't talk that much about the emotional aspects, the psychological aspects of infertility, we talk about the medical aspects, but this is a really tough time and it's a lot of up and down for couples that are trying to get pregnant. What motivated you to go into this particular specialty?

Elizabeth Anne Grill, Psy.D: Yeah. First, thanks for having me. It's such a pleasure to talk about this important topic. And I'm so thrilled you're covering the emotional aspects of some of these medical issues and illnesses. Interestingly enough, I was at an internship at the VA and one of the neuropsych interns was actually going through her own struggles with infertility at Cornell. And so, we became close. And I really started to hear the stories and the struggles, and I really wasn't privy to that in the past. I didn't really understand or have any insight into the emotional aspects of family building when people were struggling to conceive. And so, I became really interested. I always knew I wanted to go into women's health. And so, this became an outlet that felt really interesting to me.

So, I wound up doing my postdoctoral training at Weill Cornell and never left, then went on to do more postdoctoral training at the Human Sexuality Program at Cornell when I realized that I was asking the tough questions to couples and patients about intimacy and sexuality as they go through this process, but had no clue how to help them when they gave me the very private and intimate answers that they needed help with. So, I went and got additional training at the Human Sexuality Program at Cornell so I could bring that back to my patients. And that was 25 years ago, and I'm still here and loving it.

Melanie Cole, MS: Wow, that's a long time, and thank you for sharing that. That's an interesting way for you to have segued really into this unique field because it is unique, and again, I say it's not something we always think about. Tell us a little bit about how patients typically react emotionally when they receive that diagnosis of infertility, whether it's the man or the woman in the couple. What happens? What are some of those primary mental health concerns that you would have for couples going through this?

Elizabeth Anne Grill, Psy.D: Yeah. So, it's not just a medical diagnosis. I think that's the important thing to realize. It really affects every aspect of a person in a couple's lives. There's the emotional aspect. There's the physical piece of it. There's the relational piece. And then, there's the social cultural piece.

Unlike so many other diagnoses, this really impacts every single aspect of a person's life, from their identity to their sexuality to their relationship with their partners, if they have one, to their relationships with family and friends and their social circles and their workplace. And so, I think it's unique in that sense that you really see this. It's like an all-encompassing diagnosis.

I think, you know, it varies like any reaction that humans will have to a diagnosis. Some of the most common themes I think are grief and loss and a sense of feeling very out of control. We live in a world where we're used to sort of being in control, at least, you know, in Manhattan where I practice. People are used to being in control of their lives. If they prepare for a test, they hope to do well. If they interview well for a job, they hope to get it. And when they apply those coping strategies to the family building, the infertility world and the treatment for infertility, it doesn't always apply. They may take their medications properly, they may do everything they're supposed to do, and they may still not get pregnant, or they may miscarry that pregnancy. And so, it really wreaks havocs on people's sense of being able to control. So, there's a lot of grief, a lot of loss, a lot of sadness and anger, some stigma and shame. So, you really get a very wide range of emotions that people will experience.

Melanie Cole, MS: That makes so much sense. And I imagine it is very difficult because, as you say, it's about control and sometimes within a family shame, because everybody else got pregnant. So, I can see where that would happen and it can be such a difficult time. So, what's your advice to couples that are navigating the world of infertility and that emotional roller coaster of fertility treatments?

Elizabeth Anne Grill, Psy.D: Yeah. It's often referred to as the emotional rollercoaster, those sort of rising hopes, and then the falling into despair. It's a long term treatment for many. I mean, people sometimes will get pregnant the first time during an IUI or an IVF cycle, in vitro fertilization cycle. But oftentimes, it can take several cycles. And so, it's more of a long distance run or marathon than it is a sprint. And I think sometimes people don't realize that there's a lot of psychoeducation that needs to go into place when people first start about setting expectations and really understanding what they're about to cope with. Because I think people feel like they're going to take the best looking egg, the best looking sperm, they're going to put it together, they're going to create the best looking embryo, and then they're going to put that back into the uterus and transfer it back into the uterus during the very best time, or with the preparation of medication to support the uterus. And so, they expect it will work. And when it doesn't, it's absolutely devastating. Or when they have a miscarry or pregnancy loss, absolutely devastating. So, I think just normalizing it is the first piece for individuals and couples. This is really hard. There's a very high incidence of depression and anxiety.

Out of a study, I think it was UCSF, by a colleague of mine, Lauri Pasch, they said that, during an IVF cycle, 76% of people experience anxiety and 56% experience depression. This isn't just having a bad day. You know, this isn't having the blues when you wake up and feeling a little gloomy. This is really clinical ranges of depression and anxiety that people experience as they go through this.

Melanie Cole, MS: Do you see a difference, Dr. Grill, when you are working with couples in how each member of the couple deals with it, whether we're talking same sex couples or male and female. Do you see a difference in how the one trying to get pregnant versus the one supporting them go through this rollercoaster?

Elizabeth Anne Grill, Psy.D: Absolutely. I mean, communication is key, and you see a lot of communication breakdown in couples as they go through this. I think one of the biggest pieces, yes, they experience it differently, but one of the biggest pieces is how they cope with it. So, you often have one partner being sort of the cheerleader and the optimist, and it's going to happen this time, and that can be really irritating to the person who's having this cautiously optimistic approach to going through it. You have grief feeling very different for people, right? So, sometimes one partner deals with grief in one way, and the other partner feels like You must not care. This didn't matter to you, that we lost this pregnancy. You don't care that this cycle didn't turn out. We got negative results, which isn't always the case. So, having couples communicate together and realizing there isn't one way to cope with this, there isn't one right way to grieve, but really sharing empathy with each other.

And also, respecting differences. You often stereotypically have one partner, sometimes the female partner who's going through procedures, not wanting to socialize as much, pulling away from baby namings or christenings, or visiting that friend in the hospital with the newborn. And oftentimes you'll have the other partner saying "What's wrong with you? Why are you so jealous? Why can't we still see our friends?" And really having that respect and empathy and understanding for each person's needs, and allowing each person to get what they need in the relationship to cope with this very, very stressful time.

Melanie Cole, MS: Dr. Grill, how do you tailor your approach to counseling based on those individual patient circumstances?

Elizabeth Anne Grill, Psy.D: A lot of coping strategies and techniques, a lot of communication. If I'm, you know, working with a couple, you have to talk about empathy, communication, setting time aside, usually daily or weekly to really touch base with each other and have time to talk about what's going on.

Another common theme you have is the person going through the treatment eats breathes, sleeps, dreams, this stuff 24 hours a day. And the person who's going off into the world who's not getting poked and prodded with injections and taking hormones can go off into the world and sort of escape it for a while. Go to work, talk to friends. And so, there's this real divide. So, getting people to connect every night or once a week where the person going through treatment has a space to really talk about what's going on, or having the other partner send a text once or three times a day, you know, "How are you doing? How are you feeling? How was the doctor's appointment?" So, just getting people to sync up around communicating.

Boundaries, really, really important, boundaries with oneself in how much you turn to the internet and the blogs to seek out information versus really relying on moderated support groups, moderated blogs, or your doctors or your therapists.

And then, boundaries with other people who may not be as supportive as you had hoped they would be. It may not be your best friend you grew up with, or your mom or your mother-in-law that can support you through this. You may need to seek out other people. So, really setting very clear boundaries is key, and then distraction. I think, you know, the two-week wait is one of the most stressful parts we talk about after transfer, waiting for pregnancy results, and that's because people are used to constant information being given to them by the doctors every day that they're being monitored in a cycle. Then, suddenly, they're left on their own for two weeks. And they've got nothing to do. Distraction with self-care and routines and bringing back pleasure and joy. So, some common things that people don't often think about that you have to sort of reinstate in their lives.

Melanie Cole, MS: Really great advice, Dr. Grill. I can just tell that your patients are very, very lucky to have you. And I can hear the compassion in your voice and your passion for what you do and this unique field that you're in. As we wrap up, what is your best advice? First of all, for couples going through this and the emotionality of fertility treatments, which as you say can be pretty harsh, they're expensive, they can take a long time. There's a lot of waiting. There's all kinds of things involved. But also, I'd like you to speak to other providers, to their primary care, their obstetrician-gynecologists, anybody else listening that is working with these patients as they go through this in raising awareness on the emotional toll that fertility treatments can take.

Elizabeth Anne Grill, Psy.D: Absolutely. Well, I could go on and on answering that question. I'll try and summarize it as succinctly as I can. I mean, we know that one in six people are suffering. So, no matter what kind of physician you are, no matter who you are out there, you have a loved one going through this, you have a patient who's gone through this. So it's important to really acknowledge and validate that this is real and it's a very painful part of people's lives.

We know from the research that people going through IVF experience the same level of distress as people who are diagnosed with a terminal illness. I think the one major difference is when someone's diagnosed with, let's say cancer, you feel this community support wrap around them, where someone's arranging the spreadsheet with who's going to provide dinners on what night, and who's going to take this person to chemotherapy, and who's going to create the care page with updates for loved ones when you have infertility diagnosis, which we know has the same level of distress as cancer patients, you don't have anything. It's like radio silence. And so, really understanding that the shame and isolation and the lack of support for these people who are going through this is really there, and we need to wrap around them more with support, ask the right questions, offer them therapy, provide information on your website or in your waiting room on how people can reach out to mental health professionals. Resolve.org is a great place for support groups. But really acknowledging that these people are grieving, experiencing loss, sometimes trauma, right? And provide trauma-informed care and compassion and sensitivity to this population of people.

Melanie Cole, MS: Thank you so much Dr. Grill, for joining us today and sharing your incredible expertise for patients that are going through this difficult time, but what can be a very, very happy and rewarding time. So, thank you so much for joining us.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on Apple Podcast, Spotify, iHeart, and Pandora. For more health tips, please visit weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast, there's so many great podcasts there. I'm Melanie Cole. Thanks so much for joining us today.

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