While I was there, my professor got a call from one of the fertility clinics in town and signed me up. I felt extremely lucky that I was expanding my range in reproductive shittery, because I thought that I was going to be working with preemie parents.
Dr. Aimee: Did you just say reproductive shittery?
Dr. Deborah Simmons: Shittery, yes.
Dr. Aimee: What does that mean?
Dr. Deborah Simmons: It means anything that is going on when you want to have a baby and it’s not working. It could be that you’re not ovulating, it could be that you have a miscarriage, it could be that you’re doing IVF, it could be that you have a pregnancy loss, a traumatic delivery, a preemie, you name it, anything that is outside of the realm of what we’re supposed to do.
Dr. Aimee: It’s just all shit. I love it. For people who might not be familiar with what you do, what is psychoeducation? I love that term because it feels a lot better than seeing a psychologist because you have a problem. Education just feels nicer. And why is it important for fertility patients?
Dr. Deborah Simmons: Because often people don’t know much about fertility, and they don’t know much about fertility treatment necessarily. We’re not here to diagnose people in the mental health world. We’re not interested in stigmatizing. We’re interested in saying, “Did you know,” and, “Let me help with this,” and “Here’s a handout.”
In the realm of third-party reproduction, we’re talking not only about what people are going through now, but also about what it will mean in the future where there is a child.
Dr. Aimee: I almost want every single patient to have a therapist that has a booked appointment with my patient on the same day that I give them their pregnancy test results.
Dr. Deborah Simmons: Do you know how long we’ve been waiting for that?
Dr. Aimee: I know. No matter if positive or negative, because with the positive comes additional anxiety and, as you know, with the negative comes depression, sadness, trauma, and then we stop taking care of ourselves and don’t treat ourselves right. So, I’m going to do it.
Dr. Deborah Simmons: The first blood test is really nice, but then what?
Dr. Aimee: Exactly. So much can happen. Why do you feel like it’s important for patients to work with a therapist during treatment? Can you just share with us some of the benefits?
Dr. Deborah Simmons: Sure. We know that people are suffering. Normally, we would go to friends or family or coworkers or a religious person, but often what people get are like, “That’s not a big deal. You just need to relax.” A therapist who is trained in the area is able to say, “This is really hard. This is as hard as you think it is. We’re not going to dismiss your concerns.”
It’s an opportunity to also explore a little of the old stuff. When you’re feeling defective in your body, anything you’ve ever thought or felt about feeling inadequate, the not good enough monster, that will come up in fertility. So, it’s an opportunity also to say you’re a good person and you have compassion for other people, let’s have that for yourself as well.
Dr. Aimee: So true. I’ve also found that relationships are splitting up more than I’ve ever seen in my entire life, so I’ve actually introduced a new question during my new patient interview for people who are coupled. I’m just shocked by the answers and I’m so glad that I came up with this question. What’s the chance that you guys are going to be together in a year?
Dr. Deborah Simmons: That’s a great question. It scares the jeepers out of everybody.
Dr. Aimee: It does. I’ve had someone say 30%, and then the other person had no idea that person was thinking 30%. I’m just like, “Oh shit.” I’m just so glad that I brought it up. In this one situation that I’m thinking of, it actually brought them together, so they could figure things out so that they could be committed to one another and their future pregnancy. Anyway, if you’re listening to this, please ask yourself that question.
Dr. Deborah Simmons: If you were to ask that same question in an oncology clinic, what’s the chance of you being with your partner a year from now after you’ve had treatment, we would be shocked. We would feel like, “What are you talking about? Of course we’re in this.” But somehow about fertility, we don’t think of it as medicine, we don’t think of it as a medical problem, and we think of being together as optional.
My husband said to me one time, I’d read him the questions that I’ll ask. Is this your first marriage? He said, “Excuse me, this is the only marriage.” I started asking the question then, “Is this your only marriage?” I talk with people about what did you promise to each other when you got together. Did you say that if things are a little hard, we’re just going to walk away? No. We said we’re in this for better or worse, in good health or poor health. This is not, I don’t know, it’s just not that.
Dr. Aimee: You’re so right. When someone gets diagnosed with cancer, you fight together. You’re right, it shouldn’t be optional. That’s really powerful.
What are some of the important things that parents-to-be should consider, especially around the best route for them to take in becoming parents?
Dr. Deborah Simmons: Flexibility. It is important to even get your mind around the idea. If you’re wanting to go this way, this is the way you expected to go, but your route is going this way, when you want it to come back to here, as much as I understand that, it’s not going that way. So, we end up using energy to try and resist. I understand resistance, I understand why it’s there, because we don’t want the story, we want the easy story.
But I’ve learned over the course of my life that if we use the words “this is what’s happening,” we’re able to keep going with what we want. We can grieve along the way, but we also might get closer to what we want.
Dr. Aimee: Wow. I’m learning so much from you, Deborah. Flexibility is a word that I think that everyone needs to use as a physician, as a fertility doctor, when talking to patients about being flexible. It’s not about this is the plan, this is how it’s going to happen, and you have this guarantee. It’s about being flexible around what you might learn and how you’re going to pivot around those things.
Dr. Deborah Simmons: And we don’t have to like it. We may be flexible to do plan B, but we don’t have to like it if we don’t want to.
Dr. Aimee: That’s true. My patients sometimes don’t like the other plans, but later on they look back and they’re happy.
You do a lot of work, obviously, we’ve talked about relationships and how they play into the fertility journey and parenthood. I would love for you to teach us a little bit more about how to navigate each of these and what our listeners need to know. Let’s start with the relationship with yourself.
Dr. Deborah Simmons: I said before to please be compassionate with yourself. You would not say ugly things to your neighbor who was going through the same issue. Please be kind to yourself.
The fact that you may be having a fertility problem doesn’t make you a bad person or a less-than person. It makes you a person. I think addressing shame and guilt, and whatever inadequacy you may think you have, good, let’s do that.
Then there’s also the flexibility of the mind. I like positive neutral. When we’re going through procedures, I like to say, “This might not suck.” I’m not going to say it’s going to work or it might not work. This might not be as awful as I thought it would be.
Dr. Aimee: Oh my god, I love you. This might not suck.
Dr. Deborah Simmons: Right. That one came up from one of my patients. Ever since, that’s the first one that I’ll offer, and people laugh and they’re like, “Yeah, it might not suck.”
Dr. Aimee: Dr. Deborah Simmons, “It might not suck.”
Dr. Deborah Simmons: Put it on a billboard.
Dr. Aimee: I can just see the t-shirt and the hat. What about the relationship, if partnered, how to navigate the relationship with your partner?
Dr. Deborah Simmons: To look to one another, not past one another. If you are in a place of absolute distress, and your partner is feeling helpless, which is often how it goes, acknowledge that the partner feels helpless. For the one who feels helpless, acknowledge that this one is in distress. We don’t have to judge it. We don’t have to do anything about it. We do have to remember that each person is having feelings.
I often hear, “My husband (or my partner) just doesn’t ever think about this.” I’ve countered that. I was just at the Jefferson Infertility Counseling Conference about a week ago, and Dr. Brendon Peterson who studies male infertility said men are having all kinds of thoughts and feelings, they just don’t express it out loud necessarily. I often have to tell women please know that your partner is feeling all kinds of things.
There’s also a way that we can invite partners in to provide psychoeducation, because they can take information. We don’t have to talk about all of our feelings necessarily, although I’ll tell you that it comes up a lot.
I remember I used to work in a fertility clinic, and I sat down with a couple, and a woman said, “My husband has been great for me. He’s listened to me and he’s been there for me.” I said, “That’s wonderful.” I turned to the gentleman who happened to be a police officer, and I said, “I hear you’re a great guy. Who has been there for you?” and he burst into tears. So, I know that he was having all kinds of feelings. He told me later that being acknowledged was hugely helpful, just to know that there was somebody on his team, too.
Dr. Aimee: Right. What about relationships with your friends, any tips about how to navigate that?
Dr. Deborah Simmons: Oof, that one is a rough one. Normally, you look to go and take your thoughts and feelings to your friends, and they’re great. Except on this one, what they often have is advice or they say, “I don’t know what to do. How about we go shopping?” It’s like a complete dismissal of all of it.
Sometimes we have to train other people to say, “I’m going to tell you something, and I just need you to listen.” Then friends can hear it. Sometimes you invite a friend to the clinic because they really don’t know. How could they know? They’re not in it.
Sometimes, if you were to draw a target with you in the middle, you would normally expect those friends to be right smack in the middle with you, but often the friends are way out on the outside. It will reorder friendship sometimes, especially if your friends are popping out babies like popcorn and they want you to be a part of it, which I understand, they want you to share in their joy. But if you can’t, you just can’t. You look for the things in your friend that you can get and the things that you can give.
Dr. Aimee: Right. Popping them out like popcorn. Those damn popcorn machines.
Dr. Deborah Simmons: You hear them all the time.
Dr. Aimee: All the time, that’s so true. It’s so loud in the ears of my patients, and it’s so hard for me to see that. I have a rule in my practice that the only baby shower that you’re allowed to plan or go to is your own. As women, we force ourselves to do things because we feel like people are going to be upset with us. No man would go to a baby shower if they don’t want to. Right?
Dr. Deborah Simmons: Do you know my special word for that?
Dr. Aimee: What?
Dr. Deborah Simmons: Diarrhea. If you go to the baby shower, because maybe that morning you think you can, but then it becomes too much, you go in the bathroom and you sit there for a while and you tell yourself, “I’m having diarrhea. I don’t have to explain that to anybody. I just don’t have to be out there right now. I need to be right here.”
Dr. Aimee: Right. That’s true. You don’t tell people you have diarrhea when you have diarrhea. You just say, “I’m just not feeling so hot.”
Dr. Deborah Simmons: Yes.
Dr. Aimee: What about relationships with coworkers, what kind of tips do you have for us about navigating those?
Dr. Deborah Simmons: That one is tricky. People have such a good work ethic, they don’t want to put extra work on their coworkers. They don’t really want to tell their coworkers because they don’t want to hear the same stuff they hear from their friends. They don’t necessarily want to tell their boss because the boss says, “You still have to be here to do XYZ.” Some of that is also fear, it’s anticipatory fear that they’re going to get a bad response and they really are afraid of losing their jobs. I don’t think that they will, but the fear of it is what drives a lot of this.
When people have in fact told their supervisors, for example, “I’m having some medical problems, I’m going to need to be away from the office,” vague truth goes a long way. The employer doesn’t have a right to ask, and it gives you a little bit of room. With coworkers who are like, “You’re away so often,” the answer is, “Yes, I am. I’m having some medical problems. Kindness goes a long way.”
Dr. Aimee: That’s nice. Kindness goes a long way. Or you just tell them that you’re having diarrhea. No, I’m just kidding.
Dr. Deborah Simmons: Exactly. A lot.
Dr. Aimee: Frequent diarrhea.
Thank you for those tips, they’re great. We’ve been through so much in the last couple of years, and I’m sure you see that with your patients and the experiences they share about the amount of stress that they’re under. I feel like tip two on your list, 10 tips to survive infertility, which is “infertility is as difficult as you think it is, you are not making this up” is so relevant right now.
What do people need to know now that we’re living during a more stressful time?
Dr. Deborah Simmons: That kindness goes a long way. That the last few years have been awful in lots of different ways; COVID, people getting sick, people dying, people being closed out of clinics in May 2020 who felt like they were running out of time, feeling set back or another hurdle.
Remember what I said about this is what’s happening? That would be another way to go about it, too. We’re not going to fix what’s on the television. We’re not going to fix what’s in the world. We can only take care of ourselves and control whatever we can control. I think that helps a huge amount to set expectations in a way that can be dealt with.
It may be three months until you get your treatment. It may. The world is not ending, and the world is not going to end, at least not because of the fertility journey. The rest of the stuff that’s going on in the world, maybe. But keep it local, keep it within yourself, keep it within your partnership, keep it within your household, because that’s where you have some control.
I’ll tell you what. There have been days over the last couple of years where at the end of the day I lay down on the carpet in my room and I do savasana, last pose in yoga, and I get grounded again, because I don’t know that I can get out of the building. I have to get my resources back to be able to let go of what I can let go of, and then also to keep going.
In the fertility world, you need to get your resources back in order to cope with stuff. Maybe you take a month off from your treatment even though it might feel like a year. Maybe you do something silly like go to a B&B and sit quietly. Maybe you read a book. Maybe do something that is bringing you something.
Dr. Aimee: I listen to trance music when I need to recenter myself, literally. My husband laughs at me like, “How is that relaxing?” I don’t know why, but it’s relaxing.
Dr. Deborah Simmons: I’m a stress baker. The people in my family are very fortunate.
Dr. Aimee: Thank you, Deborah. I could literally sit here and talk to you all day long. I can totally see why people love you. Thank you for contributing so much with the work that you’ve done, the research, and your books as well. Is there anything else that you would like to share with our listeners?
Dr. Deborah Simmons: Keep going. If you don’t feel that you can, that’s okay too. Just remember you’re a beautiful human being in a difficult circumstance and that things will be okay. I don’t know what okay means yet, but things will be okay.
Dr. Aimee: Beautifully said. Where can people find you and learn more from you and read your 10 tips?
Dr. Deborah Simmons: PartnersInFertility.net
Dr. Aimee: Wonderful. Thank you so much, Dr. Simmons. Such a pleasure having you on, such an honor. Thank you. Have a wonderful day.
Dr. Deborah Simmons: Thank you so much, Dr. Aimee. Thank you for the beautiful things you do.
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