Dealing with Bad News

There are just so many data points and so many decision points along the way that in the evaluation , in the treatment , in the decisions about next steps , it's something that we all need to figure out how to deal with , and I think that part of what makes the fertility journey so difficult is that there are so many things that are out of our control .

And if you're like me , I kind of like control I like to not be surprised . I like to have a sense that my good efforts will result in some sort of an outcome that is in line with my good efforts . Right , and unfortunately , the fertility journey is just not that way .

We can do every single thing that we're asked and still we can end up with either a bad result or an unexpected result or something that really shakes us to the core . So I've been talking with a lot of my clients and my patients .

I delve in bad news every single day , which , by the way , is partly why I formed Love Science , because I realized that most of what I was doing on a daily basis in my clinic was not really the happy news , because the people who have happy news , who are very fortunate they move on to their OBGYNs pretty quickly .

But it was seeing couples after unsuccessful treatment . It was seeing individuals , maybe even after IVF that didn't work and really , in the context of that unplanned , unexpected or undesired bad news , figuring out what to do next . And so I've been asked by my favorite people to talk about some of the ways that the bad news can come Like .

For instance , some of the situations that we might not predict that can yield bad news . So if you're listening to this and you're at various points of the journey , you know , just stay tuned , because if you're at the very beginning , you might be like , oh my goodness , I didn't even know that was possible . I think knowledge is power .

So not to overwhelm but to say let's be prepared , let's just sort of have a sense of all the things that may or may not happen , and then also to give you a framework for dealing with bad news that is empowering and holistic and allows you to integrate all of the journey and move forward in the next right way for you , right ?

Which is maybe not the same as your neighbor who's going through infertility . But this is all about values based decisions and empowered choices . So let's just talk for a few minutes about where people can get bad news . So sometimes people see me for the first time and they've not ever had any fertility evaluation and no treatment .

So I listen very carefully , I get to know the person , the couple , if it's a couple , the values , how many kids they want , where they're from , how they spend their days . I just try to get a sense of like who the person or people are in front of me so I can really create a relationship and understand not just the goals but the values as well .

So once I hear their story , their situation , their medical history , then I think about okay , well , what tests are going to help me understand where things are not connecting ?

Or maybe it's somebody's had losses and you know , are there any things that we can discern that might be an explanation for the losses , such that we can then intervene and help somebody not just get pregnant but stay pregnant ? So these are the things that I do every day when I'm wearing my doctor hat .

I don't order the same test for every single person , but there are some patterns , like , say , somebody's not getting pregnant . We typically will check the fallopian tubes and make sure that those are open , because if the tubes are not open then the egg and the sperm will not meet .

If it is a couple where there is sperm exposure , I will often recommend checking the sperm as well , because at least 40% of the time there's some male factor present and we wouldn't want to miss that . So that's another data point . I will often check some reproductive hormones just to sort of understand where is a person at , especially for their age .

We do not talk enough about age-related infertility and I know we all think , okay , well , 35 is getting older . What I will say is that it's all a bell-shaped curve . We know that for most of us things start to get worse in the late 20s even , and sometimes early 30s , who are struggling with what we call diminished ovarian reserve .

So I don't take that lightly . I really want to make sure I understand what's going on and that can be very alarming . If somebody gets information that their ovaries are not acting 28 , but they're acting significantly older , of course , that can be very distressing . So those are some of the things we get .

I usually get some preconception labs just to make sure that somebody is in a good place for pregnancy , and all those things , and then , after I prescribe those tests , a person or a couple will spend about a you know month or so doing the evaluation and then what happens is then they come back to see me and we talk about those results .

So that's kind of the most pure way , the first place that things can quote , unquote go wrong , so to speak . It does depend a little bit how you look at it , because if I , you know , diagnose a couple with even mild male factor , it's like , okay , well , there's an explanation there and maybe there's some lifestyle changes that can you know , happen .

Maybe there's some other things that we can do to make the chances more likely of getting pregnant . But I do think it can be alarming Whenever we learn something that maybe is not what we expected about our bodies , it can just rock us .

So there's the data about the egg reserve , there's the data about the sperm , there's the data about the uterus and the fallopian tubes . There are opportunities , I would say , for getting bad news at any of those points and even say you're in the third of couples who comes to see me and I don't find an obvious explanation .

Even that's bad news , because you're like , wait a second . I've been trying to get pregnant for a year and a half and you're telling me that all of my tests are normal , like that doesn't make sense because I know something's wrong , otherwise it would be pregnant .

You know we're timing it , all those things , and so you know I try to reframe that and say , well , we have treatments that do treat unexplained infertility , that give you a much better chance compared to trying at home . But that can be very unsettling , right .

Or even say I have a couple with recurrent pregnancy loss and every single test that I can test is normal . There's still a problem , right , because somebody keeps having losses . But what are we gonna do about it ? And assimilating that can be , you know , just kind of tricky and challenging .

So that's really the first place is like the first visit back from getting the initial evaluation and then trying to understand the tests as they exist . I would say the next place that things can kind of go askew is once somebody is doing treatment , like what those treatments are and whether or not they're working .

So say somebody's done like three insemination cycles and they come back to see me and they're still not pregnant . I mean that's bad news , because there was a certain expectation that there was at least a reasonable chance that this would be successful .

And when somebody has invested their time , their energy , their financial resources , all these things throughout this time , it just can be very frustrating when things aren't working out and it's like , okay , well , I knew that I wasn't getting pregnant at home , but now we're intervening and why still are things not working ? And that can be very difficult .

Another way that things can go askew , especially with in vitro fertilization . For those of you who have delved in that world , you know there are so many steps and so many data points and you know I always tell my patients when you start the process expect attrition , expect drop-off of the numbers , expect all the things right .

Not every follicle necessarily has an egg inside . Not every egg is necessarily mature . Not every mature egg will fertilize with a sperm and then not every embryo will continue growing to the point where it can even make a blastocyst and not every blastocyst will make a baby , even if it's tested and shown to be euploid .

So you know there's so many different places and I think for those of us who are fairly type A , it just feels like the rug can get pulled out from under us . So say , we had 20 follicles at our ultrasound the day of trigger and we only get eight eggs . That can feel really unsettling . I always say it's the progression .

Try to take each milestone as its own and really trust the process , because somebody can have 40 eggs and no embryos and somebody can have three eggs and two children . It's very , very important the efficiency through the process , but clearly if somebody does have more eggs in general , it is more likely that that person .

Very important the efficiency through the process , but clearly you know if somebody does have more eggs in general , it is more likely that that person is gonna be successful . Also , age matters too and we don't talk about this enough . So just expecting that , especially at the older ages , there's gonna be some element of egg factors involved .

I think understanding that can prepare us when we see sometimes more than expected drop off in IVF . But just understanding that anything that is a loss feels like bad news . I will also say a lot of what I do in my clinical practice and also my coaching practice is really creating appropriate expectations for people .

So I have clients who do IVF and recently we talked at our support group on Friday night about bad news . One of our clients had a very unexpected result from IVF and it was just very , very distressing for her , for very good reasons .

And every other person in the group talked about how they also had had bad results , bad news , and that they had felt blindsided as well . And you know some things that people don't know is sometimes an IVF cycle doesn't result in any embryos that can be transferred or frozen .

Sometimes an IVF cycle results in eggs that are retrieved but aren't fertilized by sperm , and that can be very distressing .

Sometimes an IVF cycle results in even getting to the point of having blastocysts , but if those blastocysts are tested and none are shown to be normal by genetic testing , then it feels like there's nothing to show for that cycle , especially when you know many of patients , many , many clients , are paying completely out of pocket for their fertility care .

It's like whoa , I just wasted , you know , 5 , 10 , 15 , 20 , 25 , 30 grand and what do I have to show for it ? Nothing . I mean that can feel extremely distressing , and so this is not . If you're at the beginning of the process . I don't mean to scare you and say you know , nothing's ever going to go well .

But I will say again , there's usually some element of bad news or loss or decreased efficiency that needs to be navigated , and every single one of those pieces of news can feel very jarring and unsettling and frustrating .

Even if we get good news sometimes maybe somebody gets two or three good embryos out of an IVF cycle we don't really know what the outcome of those embryos is until we transfer them and see that all the milestones are happening for a normal pregnancy as well .

And so sometimes even the good news of an IVF cycle , of getting , say , a few embryos that seem potentially viable , it's like well , what if they don't work ?

Or what if I have what we tend to call a biochemical pregnancy which I don't like that word , but it seems to be used very commonly and people have been told they've had this before which is basically when there's a briefly positive pregnancy test but then the test turns negative . Maybe there's even a euploid embryo which ends up in a miscarriage , which we say .

Checking the chromosomes of the embryo usually is most of the battle , but sometimes 5% to 10% of the time , especially depending on the platform used a euploid embryo can end in a loss and that can be incredibly distressing , incredibly distressing . So there are so many you know , ways and places that bad news can come .

Like I said , sometimes it's in the initial evaluation when we're trying to figure out what's going on . Sometimes it's even the lack of a diagnosis that can be unsettling .

And other times , you know , and I'd say oftentimes , it's in the midst of fertility treatment , when there's some expectation that there's a reasonable chance that something's going to work and it just doesn't work out . And then , you know , most of us turn the eye towards ourselves and say , gosh , what did I do wrong ? Why am I not worthy ?

You know , this is my fault . I shouldn't have done X , y , z . We know that that's not the case biologically , because I'd say 99.999% of my patients and clients are doing every single thing that we ask them to and there is some element of probability here .

But really figuring out how to navigate that bad news with a sense of wholeness , a sense of humanity , a sense of self-compassion , that's really , really , really important . So let's start thinking about the bad news and how we can have a framework for dealing with it as we're on this journey .

The first step in dealing with bad news is making space to process the feelings . I always joke that I'd rather clean a toilet than feel my feelings . This is what I do , for my work is help people , day in , day out , feel their feelings , which also means that I need to be accountable myself . So I do carve out time to feel my feelings .

I don't like it because it is inherently uncomfortable . So I'm just trying to validate that it doesn't always feel good , but it's like any sort of detox , any sort of purifying sometimes the things that are good for us , like exercise and sweat , they don't always feel good in

the moment . So , allowing those feelings and the key is , without self-judgment so say , you just got news that none of the embryos are chromosomally normal .

It is so important to take time either that day or in the next few days to journal , to cry , to yell , to scream , to vent to a friend , whatever it is that's going to help you move forward in the best way possible . It is just so , so important in terms of getting that out and being able to process .

Now , you know , if we start to turn inward and say , what did I do wrong ? Or was it because I took the progesterone and oil an hour late that day , or you know all the things that we ask ourselves in terms of beating ourselves up . What I would say is that's where the self judgment comes in .

Remind yourself that everybody along this journey gets bad news at some level . This is not your fault . And the next step , really , once you process the feelings and move forward in that way , is to then meet with your REI , figure out a plan for next steps and all those things .

But in the moment , sitting down and saying , okay , what am I feeling right now ? And this is like a very embodied experience it's not like what do I think I'm feeling ? What does my brain say I should be feeling right now . It's like , okay , where do I feel this feeling in my body ? What is the sensation ? What does it feel like ? Does it have a color ?

Does it have a texture ? Is it weighing me down ? Do I feel tight ? Do I feel constricted ? Do I feel tense ? Do I feel fiery , hot , like a red poker ? All those things are super important .

And so feeling those feelings , whether it's rage , disappointment , feeling blindsided , feeling hopeless , despair , frustrated , feeling sad , sad and disappointed I think sometimes we feel anger because it's a more powerful , more accessible emotion , but when we get down to it .

Really it's the sadness and disappointment that are more vulnerable emotions that we don't maybe feel so readily . So I definitely recommend , you know , feeling the feelings without judgment , and that's not something we can do in five minutes , you know .

That usually does take like at least an hour , if not two , sometimes even half a day , which I know sounds like a big investment of time . But what I say about feelings is it's kind of like whack-a-mole at the fair .

If we just whack our feeling down and don't process it , another feeling or that same feeling is going to come up from a different spot or it's going to come out sideways , and we're just going to be playing whack-a-mole all day , every day , and even in kind of weird ways , like we're like why was I irritable with my sister ?

Oh , maybe I'm upset about my fertility journey , you know . So I really do think that feeling feelings authentically and creating space for that is super important .

And if you start to go down a shame spiral or if you start to feel guilty or if you start to feel unworthy , just acknowledge that and realize how you know this is a zone free of self-judgment and just say isn't that interesting ?

I'm judging myself right now I'm going to do my best to let that go and just focus on the feelings , because anybody in my situation would be feeling this way and see how that feels in your body . In my situation would be feeling this way and see how that feels in your body .

So , as we talk about how to process this bad news , I think a self-compassionate lens is super helpful . I adore the work of Dr Kristen Neff .

She is a psychologist who has done a lot of research on mindful self-compassion and she proposes three questions that we can ask ourselves to really help us to stay grounded in the present moment and to really figure out what we need . So the first question that she proposes is that very question what do I need ?

And I would say that sometimes I think , oh , I need a pedicure , oh , I need a snack , oh , I need , you know , something that's kind of superficial , and even on the fertility journey it's like I just really need this to work , or I need a positive pregnancy test , or I need to match with a gestational carrier , like whatever it is .

But what I would say is if you can broaden your horizons in terms of what a need actually is , the needs that I'm talking about here are more universal needs . So maybe it's the need to be seen , maybe it's the need to be loved , maybe it's the need to be understood right .

All of those things are not dependent on an external result , but it's to be validated as a human and to be loved for who . We are right . So thinking about like the universal needs that we have and not like I need a specific thing to happen .

I think that's really useful because even if we have bad news that we didn't want to have , if we can feel seen in that , if we can feel honored , if we can feel loved , if we can feel like somebody has our back , then that really makes a huge difference . So the first question is what do I need ? And remember , think of universal needs .

The second question is what do I need to hear right now ? I love this question

. Elizabeth Gilbert recently started this platform on Substack where she describes letters from love . Started this platform on Substack where she describes letters from love , and what she suggests is that we grab a pen and a paper , because , she said , this always works better when we write something down .

We grab a journal and we just ask the question to love with a capital L dear love . What do I need to know today ? What would you have me know today ? Or something like that . Maybe I'm paraphrasing , but that's the gist . And when I think about that , like there are certain things that I need to hear on a regular basis but I forget to tell myself .

Like I might tell my closest friends these things , I might tell my aunt these things , I might tell my patients these things , my neighbor , like other people in my life who are just humaning right , they're humaning .

They have good things that happen , they have bad things that happen , and as I comfort them in some of the harder things , I tend to be a pretty self-compassionate , excuse me . I tend to be a pretty compassionate person , but when it comes to the self-compassion , I forget .

And so when the things I love to hear , you know , I would love to hear from myself on the regular although I forget is you know , I am worthy for who I am . My worthiness is not attached to my productivity or my accomplishments .

I am so loved , I am strong , I am beautiful inside and out , and that can be in the first person , it can be in the second person , it just kind of depends on my mood that day and kind of how I need to hear it . If love is telling me , love usually talks to me in the second person . So , dear Erica , dear one sweet one , you are so loved .

You have everything you need . You do not have to be productive today . It is safe to rest . Those are some of the things that I need to hear . It's that discipline of sitting down and writing out that journal entry , and it doesn't have to be like five pages . Sometimes it's usually just like a couple of lines , maybe even half a page at most .

But what do I need to hear right now ? So , in the context of the bad news , it's like , what self-soothing do I need ? To be able to soothe myself , to comfort myself and to treat myself as I would treat a loved one , to treat myself what I believe as myself , what I believe as a child of God .

And so it's really , how can we hold ourselves , hold space for ourselves , nurture ourselves and stop being that inner critic , that critical voice that's like oh , you should have done this , you should have done that , you didn't do it the right way , or you could have done better , you could have tried harder .

All those things , even like , oh , you were too stressed out , that's why it didn't work . All those things are not helpful , but to really hold ourselves with love and space and grace when we ask ourselves that question what do I need to hear right now ?

Somehow and I can't explain this , but somehow our intuition knows what we need to hear and especially when we put the pen to paper , the right things just emerge . It's kind of like magic . I urge you to try it . So that's the second question is what do I need to hear right now ? The third question is what do I need to know for sure ?

So , groundedness , right . So if you're like me and you're very cerebral and you're just sort of always thinking about ways to make things better , do better , work , harder , all those things , sometimes I forget to think about . What do I need to know for sure ? And I consider that my groundedness , my grounding .

I do meditate every single morning , which I see as a big win in my life , a big shift , a big change in discipline . It's a little easier now that I'm not in training , right , but just the way my life has gone , my mornings have tended to be fairly chaotic and over the last five years or so I've meditated most days .

If I don't do it , I feel off every single day and it's really just like 10 minutes of saying in the morning my first priority is to like , be and to connect , like to plug in to my , my spiritual source .

And this is not to be religious at all , but this is to say like there is a higher power that is outside of all of us , whether it's love or whether it's a divine being or however we conceptualize it . Like we are not all there is on this earth and we are part of something that is much greater .

And so when I can calm myself and nurture myself and plug into that energy , whatever else happens that day , it just is right , because I know I'm plugged in , I'm grounded , I understand that . You know . What I believe is that there is a plan for my life , even if I don't like what's happening in the short term .

That if I lean in to my people , if I lean into love , if I trust my intuition that I will emerge stronger , more resilient , and sometimes even with a plan that I couldn't have even anticipated myself , help comes when I ask for it . So when I ask that question , what do I need to know for sure ?

Sometimes it's truly like all will be well , like if we all believe that all will be well , no matter what . How powerful would that be for us right ? And sometimes , like for fertility stuff , it's like , okay , you know , I am going to become a parent one way or another . Like I have so much to give , I am worthy of this right .

Sometimes we tell ourselves we're not deserving , especially if we've gotten bad news .

Sometimes we remind ourselves that it's okay not to have all the answers right and that , especially if we're physicians , that our doctor brain can calm down and we can trust the people that we've chosen to help us navigate this journey , namely a very trusted reproductive endocrinologist who's taking good care of you .

If you're working with me , you know that I take this role very seriously to take the burden from you so that you can calm the doctor brain and quote unquote just be a patient , right .

It's not an easy role to be a patient and also for my non-physician clients , we talk about going down the rabbit hole and how hard that is , and most of my clients I'd say pretty much all my clients are highly educated people who try to read the data and get in these rumination loops and I just say like , let me help you , let me take the burden from you

because this is too much responsibility . And so sometimes what do I need to know ? For sure is it's not entirely up to me and I can let go and let my people guide me on this path .

That might be a leap that might be kind of too far to think about right now , but I will say that when we head in a direction , sometimes it just takes like slight turns , baby steps , slight mindset shifts to come to a place where we can be more trusting , more empathetic to ourselves , more open to different possibilities , and all those things help us on our

journey to parenthood . So , to summarize the three questions that Kristen Neff talks about in her Mindful Self-Compassion Workbook , which is phenomenal . I highly recommend it the first one is what do I need ? And remember those are universal needs , not like an exact outcome . The second question is what do I need to hear right now ?

And so having love or whomever show us what we need to hear , and turning that inward on ourselves and really absorbing it . And then the third question is what do I need to hear and turning that inward on ourselves and really absorbing it .

And then the third question is what do I need to know for sure , because that grounds us in a power that's greater than ourselves and that is what allows us to surrender , to be open to the possibilities , some of which are even beyond our imagination . So that's sort of my framework from Kristen Neff for how to handle bad news .

The exercise really is to get into a cozy , comfortable space to really make room to answer these questions . I like to make myself physically comfortable , so I like to sit on like a soft chair , soft couch .

I like to have like a soft blanket , maybe my slippers , maybe a cup of tea that I like to have with me , like all those things just make me feel very tucked in by the universe and already nurtured .

One thing I've learned in my journey is that putting my hand on my heart , it's actually like two hands , so hand to heart and then your other hand goes over your hand and just pressing on my heart , on my sternum . There are data that this changes brain chemistry , so I highly recommend doing that .

I will say what it helps me do is it helps me move my brain and all the ruminating thoughts I have that can take me in whatever direction I decide . Those thoughts are going that day because I can lead myself to any conclusion .

It's a very scary place sometimes , my mind , but it really helps me drop into my body and the wisdom of my body and the intuition of my body . And when I do that , not only do I feel so loved and tucked in and cared for , but it also really helps me listen to that still small voice that's within me .

It helps me tune into how things feel inside my body . Glennon Doyle talks about going towards what's warm and going away towards what's cold . That helps me a lot as I'm trying to make values-based decisions for my own life and it just feels so darn good . Some people have variations of this .

Some people put a hand on their abdomen and one hand on their heart . Other people just put a hand on their face . Other people stroke their hair , if you have hair . Other people give themselves a hug . I actually liked that one myself .

I just like cross my hands over my chest and grab my biceps and my shoulders like from on the opposite side and just give myself a squeeze . For some reason that feels really good and sometimes I just stand up and gently rock back and forth . You know this is about intentional , purposeful movement .

That is inherently self-soothing and I think for each of us that might take a slightly different shape . So just play around with it , see what feels the best to you and nurture yourself to begin to just get into your body and open that safe space .

Then do that exercise , ask yourself three questions , especially as it pertains to the bad news that you've just received , and then come up with two to four mantras . And so the mantras generally begin with like may I be at peace with this news . May I have the courage to figure out the next right thing for me and my journey .

May I forgive myself , and maybe it's for not starting this process sooner , for not freezing my eggs when I talked to my doctor about this many years ago . All those things . That's a mantra that can serve us . Maybe it's .

May I be vulnerable and share what's actually going on in my heart with my partner , because I tend to shut down or wall myself off and I haven't really been sharing my inner world with them . If that's your situation , I know not everybody has a partner and not everybody is doing things in a certain way , but maybe it's being vulnerable with a friend .

You know , I've talked with clients recently who Maybe it's being vulnerable with a friend . I've talked with clients recently who opened up to friends recently and how even though it's a really hard thing to do sometimes it really stuff of relationships .

So , coming up with two to four mantras that really serve you and this news you've received and how you're going to support yourself on your own path , and once you have those mantras , write them down , repeat them and then let them go , just release them .

I picture a balloon that I'm letting go into the air and letting it float away , because if we're too attached to these things , it's kind of a Buddhist phenomenon . But when we're too attached to these things , sometimes it blocks the energy from them happening .

And I'm sure I know it may sound strange on the surface , but many of us have sort of experiences where maybe we're so fixated on a certain thing happening that we ignore the even better thing . That is like staring us in the face , right .

So just do that step , visualize yourself releasing the mantras and then just say , may it be so , or something even better , and then move on . Or something even better and then move on . So part of this , I think , is , as we figure out what we need , learning how to approach our loved ones with that .

So maybe it's that we need to be seen and understood and that we find a way to share our journey with our most intimate people .

Maybe it's that we need to hear that we're worthy and that the fertility journey does not define us and that we will stay committed to this pathway of becoming a parent and maybe open our minds a bit to other possibilities of parenthood . You know , everyone's story is different . There are no two people who have the same story .

But what this is really about is , you know , there will be bad news , like you know , if I think , if I think you know , oh , you know , bad news shouldn't happen , which , hey , I know it may sound a little ridiculous on the outset , but , like I think sometimes we're just like , hey , we're testing , we're intervening , things should go well .

Like , if we can normalize that there will be bad news and that we will feel socked in the gut that we will have setbacks or forks in the road , or that the journey might get a little bit longer or more expensive , or that we might have to , like , think about other ways of parenthood .

You know , not have to , but that those options may serve us if we can open our minds to those sorts of things . You know , all those things can be very difficult .

But if we can normalize that , that is part of the process and have a framework for how to do that , I think it can set us up not only for not dwelling in the bad news and not kind of being stuck in these rumination loops about it and what we're making it mean about ourselves , but saying , okay , bad news , I knew you were coming .

This is probably not going to be the last bad news either . And let me navigate this . Let me call in the supports I need . Let me listen to love and how love

is talking to me about this . Let me not block my own openness to that groundedness , that divine energy that is so healing and nurturing and supportive and clarifying right .

Sometimes we get the clarity to move forward with next steps and let me just embrace this as part of the process because I know , if I stick with it long enough , that I will figure out what is right for me and it's just figuring out that next right thing so that we can move forward in wholeness with our values , with our vulnerability , with our favorite people

, with our REI , with me . If I'm part of your story and I hope I am I love to help people with this , but with that , I hope this helps you . I hope that this helps you to up-level your relationship with yourself and your fertility journey , and may it be so , or something even greater . With that , I will leave you . I love you . Talk to you soon .

Bye .