Episode 3: Your first visit to a fertility Clinic
Guest
Dr. Nichole Barker
Hosts
Ruby Booras
Anne Judge
About This Episode
In this episode, Ruby, Anne and guest Dr. Nichole Barker demystify that first visit: when it's time to make the appointment, what will likely happen at the clinic, how you can prepare beforehand, and more.
Show Notes
It can take years before people make their first appointment at a fertility clinic. Whether that’s because they don’t know how long they “should” try before they seek medical help, or because they’re embarrassed, or because they’re afraid of what they might learn, waiting rarely makes things better.
In this episode, Ruby, Anne and guest Dr. Nichole Barker demystify that first visit: when it’s time to make the appointment, what will likely happen at the clinic, how you can prepare beforehand, and more.
If you’ve been considering seeking fertility help for starting or extending your family, give yourself the gift of greater clarity with The Whole Pineapple.
Transcripts
00:05
RUBY
Welcome to The Whole Pineapple. I’m Ruby Booras.
00:07
ANNE
And I’m Anne Judge. The Whole Pineapple is a podcast about wellness focused around fertility. We’ll talk with experts on a wide range of topics including nutrition, stress relief, sleep, mental health, etc.
00:19
RUBY
And we’ll dig into the issues that can cause fertility challenges, like PCOS, or early menopause, or cancer treatment.
00:26
ANNE
So if you’re curious about your fertility, whether you’re ready to start a family,
00:30
RUBY
Or you’re preserving your options for the future, let’s dig in. Welcome, welcome. Welcome. Welcome back to The Whole Pineapple. This is episode three. You didn’t think we were going to go away yet? Did you? <both laugh>. No, we’re just having way too much fun. But just as a reminder, I’m Ruby Booras, I’m here with my co-host and colleague, Anne Judge. Hey, Anne. Hello, hello. How’s it been? How have you been since last recording?
00:59
ANNE
You know, we’re hanging in there. I’m recording from home today. So there’s a chance there might be a dog or cat in the background. But other than that, everything else is okay.
01:07
RUBY
The more the merrier. That’s just the nature of Zoom these days. Yeah, it’s just the cameos with the pets are very entertaining. <Ruby laughs>. Oh, cool. Anything else new?
01:17
ANNE
You know, I think we’re all just interested to see what 2022 brings. And I’m so happy that our podcast is live and that we have listeners, and we’re just excited to keep having so many topics.
01:27
RUBY
Yeah, and we’re gonna have a great episode. Today, we’re talking about that first fertility visit at the fertility clinic. It’s such an important time. And it’s often very nerve wracking. And like, when should you schedule? What should you expect, how to prepare? Anne, you and I know that, and you hear from a lot of patients that it’s very challenging, it’s a hard first step to take. And just making that first appointment or even back in the day when your first appointment was physically in the clinic, like walking into the clinic can be very intimidating.
01:57
ANNE
It is. I mean, I think a lot of people, naturally to you, it’s one of those weird, you sit in the waiting room and you like, look around and you’re like, what are they here for and what’s going on? <both laugh>. And it’s, I mean, obviously, there are many medical conditions where you wish you weren’t there. But I do think fertility is unique because for some people, although it’s anxiety producing, it can also be kind of helpful, because you’re like, okay, this is something that I’ve maybe been worrying about by myself for a while and I’m actually taking that step, I’m gonna figure out what’s gonna go on, I’m gonna get some plans and ideas, so there can be something really hopeful about it, too.
02:29
RUBY
Yeah, it’s like that actionable step that you’re taking to hopefully come to an answer.
02:34
ANNE
Well, that’s part of the reason I think it’s so relevant to do this topic now because I think at the start of the year is when a lot of people are suddenly like, okay, you know what, I need to do something about this. I can’t just on my own be waiting for something to happen.
02:46
RUBY
Yeah, absolutely. So, we have a wonderful guest today. I’m very excited to introduce our guest for today’s episode. She’s a physician, a board-certified OB GYN, and board-certified in Reproductive Endocrinology and Infertility. And she’s an overall, all around lovely human. You may know her as Dr. Nichole Barker on Instagram. She is an Ohio native, and she joined our team at Seattle Reproductive Medicine just shortly before me in 2012. And we have grown to become the dream team that we are today. <both laugh>. But in all seriousness, I’m very privileged to work just two office doors down from her in our Tacoma office. She is not only a brilliant clinician, but she’s incredibly compassionate and supportive as a provider. She really does deeply care about her patients. I could go on and on, but I’ll stop talking and let her share her knowledge and expertise and awesomeness with all of you, Nichole, thank you for joining us.
03:44
NICHOLE
Oh, Ruby, I’m just, I’m gonna now wipe my tears. <all laugh>. So much love, so much love that we have for each other. I’m honored to be a part of this. I’m so excited to have the chance to talk about a very relevant topic. And I’m so excited to do it with you guys on this amazing podcast. <all laugh>
04:08
RUBY
So exciting. So Anne, do you want to get us started off?
04:11
ANNE
Sure. You know, it’s obvious, we have a lot that we can talk about. But I guess the first thing I would want to say is Nichole, like when you are seeing people, you know, what do you think is the hardest part for people about making that first step making that visit?
04:25
NICHOLE
Sure, I always think to myself, gosh, how when I’m looking at paperwork or the history that they’re filling out and seeing how long of a time that people have been trying? Yeah, it almost like breaks my heart. I’m like five years, ten years, you know, and I really think that this hurdle of getting into even talking to someone is the first big step. It is scary to maybe find out that there could be something wrong or that you might need some help. And it also is very intimidating because it’s a very personal and intimate discussion and you don’t know who the provider may be and how it’s going to go and how it’s going to flow. And so there’s always that plus, I also think that patients are really worried that it’s going to be so expensive, which is a reality, and that we have to understand. But I do want to say that, for the most part, making a call or sending that message that you want to make an appointment and talking to somebody about it, being vulnerable, and finding out the information is something that all the patients out there should do. You deserve that. And I wouldn’t necessarily avoid making an appointment for things that you’re worried about. Because all of this information is going to be empowering to you, it does not commit you to doing treatments, it just gives you information. So I really do feel like those are some of the things that patients tell me when I’m like, where have you been? It’s been 10 years, you know, and right, a lot of times, that’s what they’re saying. And it is expensive. And I realize that and we are in a state that’s not mandated, hopefully soon, but it’s not. And so most insurances will cover the first visit and some of the diagnostics, some don’t, but you should, at least where I practice, have the ability to ask that before you even make an appointment. So you’re right out there. Like if I have to pay out of pocket, how much is this going to cost? And I would encourage patients to take it a step further. And not only just make that appointment, but ask these questions so that you’re not feeling so nervous, just going and keeping my fingers crossed that insurance is going to cover, whatnot. So doing some due diligence on your own participation to look into that or ask the right questions. And hopefully those things can decrease the anxiety above that first appointment.
06:51
ANNE
You mentioned the timeframe. Can you remind listeners what the guidelines are? Because I think people are often surprised how short the window of trying before you actually think about testing.
07:01
NICHOLE
Yeah. So you know, the definition of infertility is technically a year of trying for those who the female partner is less than 35 years. And if you’re 35 years old or older, we say within six months, and it doesn’t mean that you couldn’t miraculously become pregnant on month seven or eight, it just means that you’re at least at the point where you can get some information, just because we know that time might be a little bit more limited for you.
07:31
RUBY
Yeah, and if they don’t necessarily, haven’t quite met that criteria yet, if they know they have some sort of reproductive issue, and maybe earlier might be better.
07:41
NICHOLE
Absolutely. So one of the things that I always kind of get in my, in my bones kind of like a little tight is when I see a patient who doesn’t even get regular periods. And they were told well, you have to prove that you haven’t been able to get pregnant for a year to see the infertility doctor. And that is not true. If you do not have regular periods, if you know that you have had a tube removed or both tubes removed, or maybe had some exposure to chemotherapy, or had a testicle removed, or had hernia surgery, if you have any concern, essentially, I think it’s worth getting at least some information and having a discussion.
08:23
ANNE
I think that’s so important, especially the emotional side, because Ruby and I both do a lot of work with patients that have polycystic ovaries. And the same thing, they don’t have these regular cycles, and you have people who in their minds, they think they’ve been trying for two years. And during that time frame, maybe they haven’t even ever had a dawn induced period. And so you’re having to explain that you actually are not at all a dire fertility patient, like you’ve barely had, you maybe ovulated like once last year, and you didn’t know what it was. So yeah, you know, I think people feel emotionally defeated, because they’re so fixated on timelines, and not realizing what trying can actually mean.
08:58
NICHOLE
For sure. And I think too, the other thing I hear very commonly at the first visit is, I’ve been so excited to talk with you. So this is the flip side of once you’re kind of there, because they’re so tired of not knowing what the heck is going on, you know, like, I don’t even know if I’m ovulating, I’m not sure, or I’ve been spending all this money on predictor kits at home and all these expensive monitoring devices for ovulation, and we did a home sperm kit and we’re trying all these things and taking all these supplements but yet, I still feel like I’m roaming out there not having a purpose, not having a plan, and they really just want to plan. Some people will literally tell me, please tell me what to do. I just need help.
09:43
RUBY
Yes, well, there’s so much out there too. You know, a lot of our patients have, you know, been on Facebook or blog posts or done their own research and some are even like in the medical field and have a good understanding of the reproductive system and things, but then they get here and they’re like I’m so glad I’m talking to somebody that does this day in and day out.
10:02
NICHOLE
And I think that that can be somewhat comforting to know that we’re on your side, we’re here to be on this journey with you. And although I can’t necessarily guarantee you when, or what the outcome will be, and that’s super frustrating, we’re gonna do our best to help support you through this as best as we can, and hopefully give you some options.
10:23
RUBY
Yeah, and you know, another thing to think about too, is you may not have what we call infertility, when you make your first appointment, you know, we got a lot of patients that are just inquiring about their fertility, they’re not ready to have children now. Maybe they’re in their 20s or 30s. And they’re doing their professional stuff. And they just want to see where they’re at and what their options are for the future. Or even like, maybe we have an LGBTQIA+ family couple who wants to get pregnant and they don’t want to go through the process at home. Like that’s another reason to just schedule, just to talk with a fertility specialist.
10:55
NICHOLE
Absolutely. And it’s just information. And I will say that it’s somewhat more daunting when we used to see patients consistently like in person, right. So I think that that made it a little bit more nerve wracking. Interestingly enough, I feel like since we’ve been moving more toward Zoom, and people are able to be in the comfort and safety of their own home. It gives them a little bit of protection.
11:20
ANNE
We mentioned like the pets, like that’s my favorite part of the Zoom consults. I see people’s cats jumping in, <all laugh>, their dog and you feel like you connect on a much more human level right away. You don’t have that artificial, like doctor’s office intimidating feel.
11:32
NICHOLE
Oh, yeah, that’s one of the things I love about the Zoom calls is that it gives you that, first of all, you don’t have to worry about traffic or being late or the weather, whatever, as long as you can actually get into the Zoom. <both laugh>. That’s questionable. But I feel like once that is, patients really like it. And so although I do miss seeing people in person a lot more I will say that there has had its perks, for sure. For the patient.
11:59
RUBY
Yeah, it definitely seems to be more convenient. And you’re right, there’s that, like that comfort there. So you get your like therapy animal there. And it’s a conversation starter, too. I find that really helps to ease people and like, oh, you know what, I have a golden retriever. And how old is he or she? And so it’s really fun, like the pets are often just the highlight of my Zoom visits too. <Ruby laughs>
12:19
NICHOLE
Did we ever think that pets would be so in tune to when their masters are not paying attention to them that they would then, you know, want to get into the Zoom calls? <all laugh>. And because I feel like that’s always what happens?
12:32
RUBY
Yes, the squeaky toys are fantastic. And it’s not something you think about like oh, I’m going to go on this Zoom call, like maybe I should put the squeaky toys away. <Ruby laughs>. And it’s probably a toy they haven’t paid attention to in the last two months. But now that’s fascinating. So what have you found, that is the biggest anxiety for patients when they come into the office? What are they? You kind of mentioned it a little bit.
12:54
NICHOLE
Yeah, I did. So what I was thinking about that question, I think that one, just being nervous about having a relationship with somebody and being vulnerable with their provider and giving them information and maybe getting back information. As much as you deserve, that information can be scary. If we tell you that you have no sperm or low sperm, or you have blockages of your tubes, or you have low ovarian reserve, does not mean though, I’m sorry, good luck. And, you know, hopefully, yeah, it’s not the end of the road. At that point, you know, it gives us a launching point to talk about, okay, well, can we fix it? Or can we address it? Or do we have to kind of go around it and see if there’s some options to kind of get to your goal, because there’s many different ways to build families. And a lot of times, patients are just so focused on I’d say, the more traditional route, because they’ve usually been trying on their own, the more traditional route of having sex. So I think that if that’s the case, we talk about it. And I think that that is super scary. The other thing that I would say, is transitions, right, a lot of people compare the fertility journey to a roller coaster, which being on my own fertility journey, and I know you guys too, have shared similar experiences where that’s true. You can’t get away from it. And so yeah, you might have one hurdle and be told that everything looks normal, but that doesn’t guarantee you’re gonna get pregnant, right? Or now we know that a tube is blocked, but that doesn’t mean you can’t get pregnant. Or now I’m going to start IVF and I’ve geared up to do this but yet, oh my gosh, it’s not a guarantee that that’s gonna fix everything. So it is something that is a continual process and roller coaster of emotions and for most people. I love when it’s kind of like hi, I see you for the first time as a new patient and you just become pregnant right after. That’s amazing. That’s great.
14:52
ANNE
Yes, yeah, we don’t use the magic fertility wand for everybody. We save it for some special people. <all laugh>
14:57
NICHOLE
That’s right. I always sometimes joke, well I’m just going to sprinkle my fertility dust on you, and we’re gonna hope for the best but.
15:05
ANNE
But it is that uncertainty, I’ve had patients in the past be like, if you could just tell me, it’s gonna take XYZ, or it’s going to be two years, if I just knew what was going to happen, then I could get through all of it. But it’s that uncertainty, that’s so stressful.
15:17
RUBY
And it’s surprising sometimes, because I see people a lot for like the initial diagnostic testing, and you know, like testing their tubes and stuff. And when we find something, sometimes there’s surprisingly, this sense of relief, like I know now that this is probably related to what’s been going on, or the opposite. When everything comes back normal, I’ve had people cry, because they’re almost like, they almost want just that answer. You know, they want to know what it is. And if there’s anything we could do about it, and something that they can point to and say, okay, this is my reason.
15:51
ANNE
That was the craziest thing for me back when I was in treatment and doing the support group, was realizing that flipside, because for me, we had a very clear diagnosis, and we had to do IVF. And that was hard for me, because I felt like I was so jealous of the people that were unexplained. Because I was like, it might just happen for you, like next month could just happen. And they looked at me like I was crazy, because they’re like, you are so lucky to know what’s going on. Like, I hate that roller coaster of every month getting my hopes up, and then it not happening. And if I don’t know what’s wrong, why do I think that any kind of treatment could fix it? So, you know, it’s such an individualized path for everybody.
16:24
NICHOLE
Absolutely. And those are some prime examples, I think of some frustrations of this. And, you know, I would say the other thing that is a little scary and daunting is just costs, as well as will I ever get to my goal? Right? So I think those are the main ones.
16:43
RUBY
For sure. So what happens at that new patient consult?
16:48
NICHOLE
Yeah, so by the time and this is just from my own perspective, where I work. And so it may be a little different for everybody, okay, but I’m just going to kind of tell you the general expectations, but by the time we are talking, it’s usually at this point over Zoom, where I am, okay, or by telephone, if you don’t prefer Zoom, and it usually you have had, if you had any testing already, you fill out some paperwork ahead of time, you have maybe submitted your insurance if you had some to be checked, and you’re all set to go. And at the first appointment, I have reviewed all of that stuff. And we’re just gonna have a conversation. And after we do our introductions, and I’m making sure I’m saying their name correctly, <both laugh>. And maybe talking about, you know, their animals in the background, or their art in the background, we start diving into how I can help them. And sometimes the paperwork gives me a clue, and sometimes it doesn’t, right? So sometimes it’s I’m having recurrent miscarriages, or sometimes it’s like, well, we’ve been just trying for a year or two, and it hasn’t happened. Sometimes I have patients coming to the clinic, and they haven’t had any testing. And then I have others where with a previous provider, their primary care, or ARNP, or their OB GYN, or naturopath, have had some testing already that are preliminary for fertility. And they’re already done with that. So we kind of review that too. But if let’s just say that person has not had anything, what we would talk about if they are an infertility patient, they’ve been trying for six months to a year, they haven’t gotten to their goal, we would be talking a little bit about doing some diagnostic testing. And we would also, during that time, talk about where things could go wrong, right? Because what we’re looking for is in this process of reproduction, where are the hiccups that things can happen and the diagnostic testing is to evaluate that.
18:52
ANNE
And I think that’s so key because most people’s whole education up to this point about reproduction is all about avoiding pregnancy. That like if you ever have exposure to sperm, pregnancy is there. <all laugh>
19:04
RUBY
Just stay away from sperm at all costs if you have eggs. <Nichole laughs>
19:09
NICHOLE
For sure. And that’s so frustrating, right? We’re so far removed in all of us on this podcast right now from high school, but I think to myself, like back in when we did have like sex-ed or reproduction,
19:24
ANNE
I’m pretty sure there was a Molly Ringwald movie or something. <all laugh>
19:27
NICHOLE
I’m sure everything was totally inappropriate. And but I think that it, you know, it’s so too simplistic, too simplistic and so much weighted on prevention, which is a key, yes, that’s definitely something but what about really understanding the cycle first as opposed to just putting the band aid over it, like use condoms, use barrier contraception, use birth control pills or something? So I feel like I hope, and I don’t know, because and I don’t know, Anne you have a kid maybe closer to that age, are they?
20:01
ANNE
Well, I will say because of COVID, they skipped it. I was so mad. I was like, when the year started, I was like,
20:07
RUBY
What? But they’re all staying at home. <Ruby laughs>
20:08
ANNE
I even asked, I was like, do you want to, I’d be glad to come in and speak. And they’re like, oh, no, we have a very firm state curriculum where we can only say these things. And then when it came to that week, I asked my daughter, she’s like, they sent us a video to watch about, like cigarette smoking and why that’s bad. <all laugh>. But they didn’t do anything about reproduction. So I’m hoping maybe this year. But yeah, I was not impressed so far with what they’re telling middle schoolers.
20:35
RUBY
Yeah, meanwhile, I’m just like, okay, there’s all these kids that are bored at home. Luckily, they’re back in school now. But oh goodness.
20:41
NICHOLE
So I’m not sure if back in the 90s, and I’m dating myself now, if the, you know that,
20:47
RUBY
We already did that with the Molly Ringwald, <all laugh>, and we all understood what it was, <all laugh>
20:52
ANNE
I’m pretty sure she had a teen pregnancy thing that we watched.
20:55
NICHOLE
So true. So true. But you know, I don’t know how much ‘now’ has evolved. And what would be my desire would be to have every person have some knowledge about how are eggs even like, do we just like get them every month? Or do we have them from the beginning of when we were born? Because that’s the right answer. Or if I’m on birth control pills, do they just like get saved up? Because a lot of people think that that’s what happens. And so there’s a lot of misconceptions, as well as, oh, there’s fertility treatments. Nowadays, I can use somebody else to carry my pregnancy or I could just do IVF. Okay, well, what are the success rates of that stuff? By the time you’re 45, or 46? Like, it’s just not something where you can pick up a magazine while you’re in the grocery store and learn about somebody else’s journey, who’s 49, who had twins, you have no idea how they got there, right? So I think that it’s hard. <Nichole laughs>. Because I have to maybe feel out how much the patient really understands. And sometimes we literally start from that, okay, those producing eggs, those producing sperm, biologically, were different, we have to understand that. So those producing sperm can regenerate sperm every three months, those producing eggs will not be producing any more eggs, they were born with all of them. And they utilize them, you know, every time they have a cycle, and we’re all with eggs, just kind of working our way, sadly to menopause and using them all. So I think sometimes we have to have that conversation from the beginning so that I can then lead into well, what do you mean, I’m testing my egg reserve? What is that? Is that you’re going to tell me when I’m going to go into menopause? No, is it what you’re going to tell me, I have how many eggs for the rest of my life? No, it is every month, you get a certain amount. And that is what we’re trying to capture. And for somebody at your age, how does that compare to others? Right? So if you’re 30, and we see that you have four follicles, which could be eggs per month, that would be pretty low. If you’re maybe 45, that might be average, you know? So we have to take all that into consideration. So sometimes just the basic biology is required at the first visit to talk about this as well as just doing a sperm sample and you know, kind of seeing what can affect my sperm count. If I’m doing it, you know, what am I doing? What about my health? You know, how much have I abstained before I had it. So all of those things go into consideration.
23:31
ANNE
And we’ve recorded a few small bite-size episodes about each of these topics, too. So if people want to be able to listen and learn a little more, we have one on ovarian reserve and one on semen analysis. So the same thing, we know that people aren’t necessarily getting accurate information, if they’re just reading online or doing home tests.
23:48
RUBY
Yeah, and sometimes that first appointment can be beneficial just because you learn more about your body than you ever had before, which can be enlightening.
23:56
NICHOLE
Absolutely, and you know, so one of the things would be okay, if we are evaluating your ovarian reserve, how do we do that? Well, we can do some blood work. And we can do a pelvic ultrasound to actually look at the ovaries and try to count the follicles that is a representation per month of what your ovarian reserve is. So a pelvic ultrasound, usually is going to be a vaginal ultrasound. And I do tell patients that because sometimes they’re surprised, they just think that there’s going to be something on top of their belly. But usually to see these very small structures a vaginal ultrasound is the best way to kind of get to seeing that, now, it’s not the only way. But usually I prepare them for that, as well as if they’re doing a semen analysis. What are the options? You know, it’s not that you have to come to the clinic that’s not required. You could do a home collection. I had a couple not too long ago ask can we get one of those fancy condoms, and have sex at home and take the condom off and hopefully collect the sample, bring it in? And you can do all those things. So a lot of times if somebody is dragging their feet, because they don’t want to do the semen analysis, I’m like, whoa, whoa, whoa, wait, we’ve got some ways around all those things that you’re worried about. You don’t necessarily have to come into the clinic. So we talk about what they expect.
25:13
RUBY
Yeah, and I think that brings up an important point too, because I get a lot of patients that I hear a lot of the same worries and concerns about different testing and things. And one thing I think is important for patients to notice, like, if you have a concern, just tell your provider because more than likely, we’ve heard that same concern before. Like the semen analysis thing, like, hey, would actually would a collection at home be easier for you? And sometimes that’s good to know. Because I feel like sometimes patients will withhold things or just not feel comfortable sharing, but knowing that your provider probably has heard those concerns before.
25:45
ANNE
It’s pretty hard, I think, to surprise or shock us at this point. <both laugh>
25:49
RUBY
Totally. Absolutely.
25:51
NICHOLE
I say that every day. Yeah, but and you know, I would say the last piece, well, this isn’t the very last piece, but the main piece of evaluating for the female would be the uterus and fallopian tubes. So we usually recommend a hysterosalpingogram. Also, the acronym is HSG. Most people will call it the dye test, it is a little bit more invasive, because we do put dye into the uterus. However, again, I explain that listen, this is something you could usually drive to and from the office yourself, usually we have you eat a little something and take something for menstrual cramps. So ibuprofen, maybe 30 minutes to a half an hour beforehand. The setup is kind of like a Pap smear, nobody’s favorite. But most of my patients have had one, most, not all, then we clean off the cervix, put in a little catheter, and we’re doing an x-ray on top of your abdomen while we’re putting in dye. And so you usually get the results right then and there, at least at our facility. So I make sure that they’re prepared. And they can then ask some questions about maybe their fears of all these things, or a lot of times they’re like, well, how do patients do? And then I could be like, oh, wait, when I did it. <all laugh>. I can tell you personally, how I felt, and everybody is different. There are some people who do have a lot more discomfort, but the reality is that the test is usually less than a minute or so. But as a patient, it feels like an eternity on the table. So, but I think that explaining that stuff and maybe lifting the veil off of these tests and really making sure that these patients feel comfortable asking about what to expect, and things that they should, if there’s anything they should do to prepare, I think will help them decrease their anxiety about doing the testing.
27:38
ANNE
And people are often surprised by how cool it is to know the results, like talking people through these are your ovaries, and you’re going to ovulate from the right this cycle because you see how this circle is really big. And here are the other ones. And then here is your uterus. And here are your tubes. And I feel like reproduction seems so mysterious because it’s hidden. And so being able to actually physically tangibly see what’s going on is actually a super cool thing.
28:00
RUBY
Yeah, my nerd definitely, my nerd shows through for sure. <Nichole laughs>. Because I’m like, hey, look at this. Look how cool it is, like you have the perfect textbook looking uterus. This HSG is perfect. <Ruby laughs>
28:11
NICHOLE
And usually then they follow up with me Ruby, and they’re like, she told me that my uterus was perfect, why can’t I get pregnant? <both laugh>. I will say, kind of on the coattails of what you guys were explaining. I remember having my office hysteroscopy myself, and I was just like, oh my gosh, I can’t believe that’s what the inside of my uterus looks like, you know. So I know not everybody wants to look at that stuff. But I find it fascinating too.
28:36
RUBY
Yeah, yeah. And you have the option. You don’t have to look at that stuff if you don’t want to.
28:40
ANNE
That’s the hardest thing for me. I’m such a talker. And I always ask people I’m like, I usually kind of narrate what I’m doing. And every now and then I’ll get someone who’s like, I don’t want to know anything. Let’s just chat about the weather. And I can do that, but it’s just like, oh but don’t you, it’s so hard. <Anne laughs>
28:52
RUBY
It’s hard for me to. Yeah, I had one patient she’s like, I’m not trying to be rude, it was for an HSG, she’s like, just can you not talk so much? Like, okay! <all laugh>
29:02
ANNE
But that’s fine too, I have had people who they just want to, like bring music, or they’re gonna do a meditation and whatever we can do to make it less anxiety-producing for you is totally fine, so just ask for what you want.
29:12
RUBY
Whatever you need, what you want. Yeah, just tell us what you need, and we’re happy to accommodate. So what can patients do to get the most out of their visit? Like should they do testing beforehand? What paperwork, you know, what should they do to make it worth their while?
29:27
NICHOLE
In my opinion, I do always appreciate a patient who is organized with kind of what they’ve had done, if anything, or I have some patients who’ve been tracking their cycles for years, and they’re like, ready to like, you know, give me the book of all their like, plotted temperature charts. I’m like, whoa, whoa, whoa, we’re good. We don’t, you know, I believe you, but I think that it is kind of nice to know, do you have any questions that you’re worried about? And that’s something we put right on our paperwork, which I love because that’s usually like where patients go right to. And that’s a lot of times where they’re revealing their most, they’re like deepest darkest worries like, I’m worried that I don’t have sperm or I’m worried that my tubes are blocked or I just need help with I don’t have regular cycles, and I can’t figure out my ovulation. But it’s nice to kind of think, do you feel like there’s something because you have your own intuition? No, you know your body, you’ve been living forever. So I feel like it’s okay to be like, listen, I feel like something’s off. Or I feel like I can’t really narrow down when I ovulate. I’m not sure I even ovulate. But can I have a period, like and so making some notes ahead of time, and I love, I’m a list person. So you don’t have to formally make a list. But in my opinion, I would, and but make a list and maybe say these are the main things that I want to get out of this visit with the doctor. And a lot of people just write answers, I want answers. And so that’s fine. Well, we’ll talk about some diagnostics, but other people have some theories about what their concerns are. So I do like patients who have lists or notes or concerns, and they share it with me. I also think that it’s okay, if you’ve had testing, great. If you haven’t, don’t worry about it, because we’re going to get you the testing. So I don’t want you to think that you must have testing before you talk to us, we are the place that people refer to half the time to do the testing. So that’s okay. But I know that some patients are worried about cost, and they’d rather have their primary or OB GYN do it because they can get most of the stuff, great. And you know what, sometimes if we’re not contracted with insurance, and they are with their OB, or primary care, I’m like, let’s get you with them. And they could do, as long as I get the data, we can talk about it. So however, we can help save you money, and time. That’s what our goal is. And so I think that if you have that information with you, I am a huge believer, and this is just what I do personally, as much as a patient myself, I like to have my own records in my hand, or like on my phone or something. Because you know, I’ve worked in this field long enough, realizing that it is really hard to get medical records. And so for me, I always like it when I have my own, it’s not required, okay, we’ll get them don’t worry if they don’t show up on time. But that’s why I always tell my patients, if you get a chance to get your hands on your own records, or have an EMR through your other provider, awesome. Because that will hopefully expedite us getting all that information if we’re not the ones doing it.
32:37
ANNE
And that is the challenge when people are like, oh, I had this done. And it was normal, right. And like what they were told, someone else’s normal may not be our normal, and we really want to see those actual values, right?
32:45
NICHOLE
So having that it’s not required, but it’s definitely helpful to kind of streamline the whole process. And, you know, a lot of times, I think that just pausing at the end, because a lot of times we’ll be saying a lot, right? We talk a lot during these because there’s a lot to go over and a lot to talk about that may be new to the patient, but also just pausing at the end and saying, okay, is there anything else that I haven’t brought up yet that you want to talk about? And that gives them like, a little piece of time to think about, you know what, she didn’t bring up this? And I’m worried about it, let’s talk about it, or I am on these supplements? Is that okay? Can I take these? So I like to do that after I do my normal, this is kind of what we need to do and what my thoughts are. And then I like to pause at the end and ask them it that way and phrase it that way. Because I feel like that’s a very open ended question about maybe they could ask me anything.
33:42
RUBY
Yeah, that’s great. And I like to take those breaks too. Like sometimes I’ll tell patients, I’m like, listen, I talk at you a lot at this visit. So sometimes I’ll take breaks in between, like, if it’s like between a different, especially for PCOS, it’s all talk about one section and okay, is there anything about that you have questions about but you brought up supplements? And that just reminded me of how there are certain things that sometimes patients, whether they forget, or they choose not to include in some information in their paperwork, or they don’t think it’s relevant. Is there anything that you can think of that, I’m thinking of actually as a history of like an STI, or they don’t want their partner to know about that kind of stuff? What is it that’s important for patients to disclose to us? And how are there ways around it if they want to be private about it?
34:29
NICHOLE
Yeah, that’s a great question. So because it is totally an individual’s right to have their own medical history not be shared, even with their partner, even if they’re married, those types of things. So some things that patients have done that I thought was helpful was to separately fill out paperwork if they’re coupled, right? So don’t have the wife filling out the husband, or the one partner filling out both partners’ forms, like, just do it separately, and sometimes I’ve had patients ask to be individually interviewed by me, right? Or they go to the first interview with me and say, listen, I’ve had a pregnancy that I had an abortion. And I haven’t yet, you know, shared that, I’m not sure if I’m ever going to share it. And I just don’t want that information shared with my partner, or I’ve had gonorrhea before it was treated, I’m worried that it could have an effect on my tubes, how should we test that? But hey, by the way, this is not something I want my partner to know about. So it’s something that we need to know about. We do ask a lot of kind of really invasive questions. Like, for instance, if I have a couple and I say, well, have you ever caused a pregnancy? And sometimes people haven’t even had that conversation. They’re like, yeah, you know, back in high school, I got somebody pregnant, and like, it could open up a whole can of worms. And so I think that if either partner, if you’re partnered, because that’s kind of a little bit more tricky than if you’re just an individual, single patient, right? Because then we just share it together. But sometimes you’re together. And, you know, some of these things are important, we’re going to ask, and it’s okay, if you don’t want to share. But I think that if you already know that it’s something you’re uncomfortable with, you need to at least let one of us know why. And not to share it.
36:22
ANNE
And we have, you know, I think most places have their own EMR or some way where you can have a secure communication, and that’s almost all individual. So sometimes that’s a nice way for people to send a message afterwards being like, hey, I didn’t want to talk about this there. But I think you should know, blank. Or when we are doing the HSG, because that’s an x-ray, that’s one time that we don’t have an extra body in the room. And so I’ve definitely had people, that’s where they mention a past infection or termination, just like you said, so there are opportunities to bring up things, even if you felt shy sharing it the first visit.
36:54
RUBY
And I’ve also found that those things sometimes are areas of anxiety for patients too, they think that has something to do with why they’re struggling to get pregnant. And there could be some guilt there that once you talk it through with us, we can maybe assuage some of that, those guilty feelings.
37:11
NICHOLE
Absolutely, there’s a lot of, just in infertility in general, a lot of shame, self-shame. And, you know, the reality is that infertility does not really care who, what you are, how much money you make, you know, how tall you are, what color you are, I mean, it does not matter, it does not discriminate. And so we, like Anne said before, there’s not much we haven’t heard of, and we are not here to judge anybody, we are here to help you get to your goals, and we want you to feel as comfortable as possible doing it. So I think that the more open you feel, to share these things, it’s going to hopefully allow us to maybe, like Ruby said, address those things and decrease your worries about them. Versus maybe find out we need to hone in on something a little bit more in detail just because we can maybe either fix it or correct it or address it before the next step. So I think it is important to be very open and honest about what has been done in the past.
38:17
RUBY
Yeah. And that also brings up when you mentioned that infertility doesn’t discriminate. It makes me think of, I have so many patients that are like, I am so healthy. How is this happening to me? Like I run, I eat, I think my nutrition is really good. I do all the right things. I’m taking my prenatals. I’m doing all these things, but still I’m struggling. Can you speak to that a little bit?
38:40
NICHOLE
Yeah. And like I said, infertility does not discriminate. So really, it is unfortunately, what’s happening on the inside is important. But it doesn’t always correlate with the kind of the phenotype or the outward appearance, like I always say, you know, you might look like you’re 25, but your ovaries are 45, you know, so, and sometimes I have patients where they’re young, right, they’re in their 20s or 30s. But yet they still have some evidence of insufficiency of the ovaries or low egg reserve or something like that. And the reality of this is that there’s very little that you have control over of some of these things, okay. And I know that that is a hard pill to swallow. Now, because of that, I think that it’s important for us to give patients back things that they can control and that’s where wellness comes into, right like I can nourish my body well, I can make sure I’m getting sleep, I can work on my things that make me anxious or stressed out, and I can make sure that I follow the right steps that they’re telling me but yet, at the same time I tell patients, listen, even if you’re doing doing everything right, it does not equal a baby. Okay, so I don’t want them to stress too much about that. Because it doesn’t, it’s not a direct correlation always. But it’s not a bad idea to put your best foot forward when you are trying so hard for something, right? And I feel like it’s tough because we, as humans, most of us are so obsessed with controlling everything. And this is something that literally is out of your control, how fertile, not fertile you are, sometimes is irrelevant to the things that you do, eat. So I think that that’s something that, you know, should be reassuring, though, for people, right? Yeah, I didn’t do anything to cause this to happen to me, it wasn’t my abortion or miscarriage, or my, you know, my STI that, you know, necessarily is making me do this, it may have a possible effect on it. But it’s not a guarantee that that is what’s going to be the cause. So, again, the whole thought about doing your best, but not trying to be perfect, because that’s not what we expect is going to be good. And it does not always matter how hard you work at this. It’s not like a test or getting into college or getting that job. I always compare this process to those things. You can study really hard and probably perform well. You can work really hard and put a lot of hours in and probably get the job. But sometimes if you’re doing everything perfectly, you don’t get the outcome you want in infertility.
41:36
ANNE
What are some of the other big wellness misconceptions that you think people have?
41:40
NICHOLE
You know, I think Ruby hit on some, you know, with that example that I eat well, I am healthy, I don’t have any medical problems. I’m taking all the supplements that I read online that I’m supposed to take and, you know, I ovulate every month. Sometimes, even guys will tell me, well, I’ve caused a pregnancy in the past. So clearly, I’m fertile, right? So I feel like some of those things, too, are some misconceptions.
42:07
ANNE
And I’ve definitely had people sometimes where you feel like time really is of the essence to start treatment, but they don’t want to do anything until they feel like they have perfected their lifestyle. And it’s a balance, because obviously we want people to work on this holistic aspect. But there’s also always that factor of age. And I like you said it’s a delicate balance where you want to do the best you can. But you also don’t want to just delay until you reach this perfect point because it doesn’t exist. If people are committed to being a parent, they will definitely get there. It’s just that path to get there may take them off on a branch they didn’t think they were going to explore.
42:44
RUBY
All right. Anne, do you have any other questions?
42:46
ANNE
You’re great. You’re so warm and friendly. I would come see you.
42:51
NICHOLE
You guys are so cute.
42:53
RUBY
Well, we could talk for hours and hours and hours, but we won’t keep you forever. Thank you so much for joining us, Nichole. It’s been lovely. Well, we would love to have you on again. Your knowledge and expertise are so helpful. And I think it’ll ease some nerves for some people that are maybe contemplating coming in for their first visit.
43:09
ANNE
And I think people see it as so scary, but you’re so nice. Everybody wants to come talk with you. <both laugh>
43:15
RUBY
Yes, and again, she’s @drnicholebarker on Instagram if you want to follow her very relevant and informative posts.
43:23
NICHOLE
Oh, you guys are too kind. And thank you so much for having me.
43:28
ANNE
Thanks for joining us for this week’s episode of The Whole Pineapple podcast. We hope it was helpful.
43:33
RUBY
If you know someone who could benefit from hearing the podcast. We hope you’ll share it with them.
43:37
ANNE
And don’t forget to subscribe, rate and review The Whole Pineapple on your favorite podcast app. Every rating and review makes us easier to find.
43:44
RUBY
This podcast is sponsored by Seattle Reproductive Medicine and is produced by Audiotocracy Podcast Production. We’ll see you next time. Have a delicious week.
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