Today we’re joined by Amy Klein, author of “The Trying Game” in which she outlines everything she wished she’d known at the start of her fertility journey.
Amy — thank you for being here. For those that don’t know you, would you mind sharing more about who you are?
Hi. Thank you for having me. I’m a health journalist that’s been writing and editing for about twenty years.
I started my fertility journey in 2011 and I began writing about it because I just couldn’t believe the secret world that I stumbled upon. And it wasn’t really written about anywhere.
I was going to a clinic in New York and there were these women waiting for appointments early in the morning — and then going to their big office jobs. And I just thought about it as a writer and how much of a Dungeons and Dragons world it seemed. One that I’d never imagined.
I just started writing about it and my editor at The New York Times suggested I start a column on my fertility journey, which could then transition to one about pregnancy. Topics we were both super naive about.
I said yes to my editor’s suggestion. And what do you know, but over the next three years, I had nine rounds of IVF, 10 doctors, four miscarriages, and two egg donors until I finally had my daughter who is nearly five years old.
I always thought I would write a book, but I then I decided that the book was not just about me, but it was about everybody else. I couldn’t have done this book without you, Dr. Aimee! You fielded all of my last-minute questions to ensure I wasn’t speaking out of turn. I write about health and fertility a lot, but I’m no doctor!
Tell us more about how the book came about. As you mentioned the fertility column was to transition to one about pregnancy.
As a writer, I felt my fertility story (and series of failures) was beginning to sound repetitive. I think probably a year into my fertility journey it became apparent to me that it would neither be a quick or happy process to write about in a column. Around that time I know I wanted to write a book about it as I thought it may help others going through a similar journey.
Tell us more about how long it took to write the book
At first, I thought I was going to write a memoir about my own journey and I did kind of write it as I was going along for the column at The New York Times. But I realized the opportunity was bigger than my own story.
This wasn’t just about me. There were so many people going through some of the same things that I was going through.
Even though the science changes, the emotions don’t change.
It took me about six months to put together my proposal and then close to 18 months to write the entire 25 chapters of the book.
I think you’re one of the first writers to talk about your journey so openly. Now it’s more comfortable for other people. But what did it feel like for you to share about everything with such transparency and personal detail?
I mean, as a writer it’s what I do. I felt I wasn’t able to focus on anything but fertility as I was going through it. So for me personally, it felt good to just keep writing, researching, and knowing.
Also, I find when you’re going through something so crazy sometimes knowing that it might make for a good story for someone else to read — it makes it a bit easier to go through it.
It was hard to read the comments at the New York Times to the column I was writing. Sometimes there were two comments and other times more like 300 comments. It’s always challenging to read comments, but it’s extra trying when you’re on hormones.
It’s only a couple of people that have something not nice to say.
At a certain point, I actually couldn’t read the comments anymore. My editor wanted me to be informed so I had my husband read through them.
You and I both know that there’s a reputation that IVF is just for the rich, and for older white women who waited too long to start a family. And it’s true that I didn’t start any of this young, but I’m not rich. We know there are hundreds of people who are young, who are poor, or have medical issues that get IVF treatment.
In retrospect, I feel like I took one for the team with the comments.
That said, I did get hundreds of private emails from people supporting me. But I think when you put yourself out there, you really are opening yourself up to trolls and for people who don’t understand.
Right. And was there anything particularly about infertility that you learned about? Just by writing about it.
I learned that I wasn’t the smartest person when I was going through it. There weren’t resources when I was doing it. Your TUSHY method is covered in an entire chapter in the book where I go through what you can consider doing before even going to a fertility doctor.
And that kind of came out of my own experiences. Six months after doing IUI, the doctor finally suggested that we check my tubes.
I love your methodical method of outlining things that people can consider way before they get to a fertility doctor.
I didn’t do a lot of things right. For instance, I didn’t go to therapy because I thought it would be over soon. I want people to have a checklist of sorts, like the TUSHY method to avoid making some of the mistakes I did.
What are some of the things that you would tell people that you wish would’ve done sooner? Aside from just checking your tubes. Tell us more about your thoughts on that.
I think that every woman in their twenties or earlier that has painful periods should know it’s not normal.
I just spoke to a woman who never had children. She’s sixty-five, is a nutritionist, and never knew what she had, but her periods were so painful she’d have to stay home from school.
I’d love for young adults to know about their bodies — and not just how to avoid getting pregnant.
My mother mentioned to me after like my third miscarriage that she has circulation issues and has to wear compression stockings. She didn’t have trouble conceiving, but that would’ve been helpful to know. I just want us all to take charge of our reproduction and to do so by knowing about our bodies I don’t want women to get to thirty-five and then have to deal with those problems.
Amy, tell us. How did you land on the title, “The Trying Game” How to get through fertility treatment and get pregnant without losing your mind.
Well, the funny thing is, this is our third title. I was just writing. And I said, oh, you know, when you’re in this trying game, some older people know that it’s a little bit like the crying game. It’s also like Russian roulette, you know, you’re trying and it’s not a game, but it feels like it at times.
And tell us, what is the book about? I mean obviously I know, but for someone who is thinking about getting the book, what will they learn from reading it?
So the book really covers every emotion from A to Z when it comes to fertility. From the initial fear and realization that you may have fertility issues, including the panic that might set in, to becoming more of a guide. To help outline what one can do before going to a doctor.
It speaks to multiple audiences — LGBTQ, single, partnered, trans.
Then it goes into some technical stuff. Like, how to find the right doctor. How to pay for the doctor. Helping you to understand what is IUI and IVF. I make sure to interview a doctor in every chapter.
It’s clear you did a lot of research for this book. So it’s almost like a fertility educational manual for folks who are starting their journey or even people who’ve already been trying.
Yeah. I wanted it to be for everyone. My favorite section of the book is the emotional part because, you know, baby envy is real. How do I deal with my best friend who’s pregnant? Or, how do I deal with my mother in law who will not stop asking me when I’m going to have a child? Or, how do I manage my boss and work-life? What should I tell them?
I wanted to give people almost a script for what they could tell people about certain aspects of fertility treatment.
From what to tell people that suggest they just adopt or a chapter to actually cut out of the book to give to your mom that’s asking about how IVF works. I wanted people to be able to say, here — read this chapter and then you’ll be more, you’ll be smarter.
So what advice do you have for someone who has a nosy mother-in-law?
It depends on how much you want to share.
You could say we are trying and we’ll let you know if we have anything to share.
It’s very painful. You just have to believe that most people want the best for you. You know, they have their own fears and their own anxieties. As you can see right now during Coronavirus, everyone has their own stuff that’s going on, right?
So most people want to help and you know, you have to decide if you want to let people know that you’re going through fertility treatment or that you’re trying or that you don’t want to have kids — whatever it is.
You also have to decide how much information to give them. And I think the closer they are to you then the more information you can offer to them vs. a stranger on the street asking if you have kids.
Even though I was writing for the New York Times and I was out there, if people asked me about my fertility I thanked them for their support and that I’d let them know if there was news to share.
I didn’t want people asking me about how it was going.
What has it been like for you to launch a book during a pandemic? And then did you ever think that anyone would use those words in a sentence?
I know, I mean just today I keep deleting events that I forgot to remove from my calendar because they’re going into May. It’s not what I thought it was going to be. I’m both grateful to be healthy and yet disappointed in the timing as I’ve put two years of my life into this.
People can order the book on Amazon and from some bookstores. I did the audiobook as well. So that is a fun thing to do while you’re like walking around your house or circling the block during the shelter in place.
I want to get into a little bit more about your journey to becoming a mother. Can you just tell us what that looked like for you?
So for me, it was not necessarily the way that a lot of people start because I got pregnant right away. I got married, I was 41 and I got pregnant right away and then I lost that pregnancy and then we went on our honeymoon and then I lost the next pregnancy too.
I had two miscarriages and then I went to a fertility clinic. I was in the regular mode of starting IUI and when that didn’t work we moved on to IVF.
You went to your OB-GYN for your two miscarriages. Can you tell us what that was like?
I mean, if I were an OB-GYN and had a 41-year-old come to me, I may treat them differently than mine treated me.
I’m not saying that I would send her straight to a fertility clinic, but I might recognize the need to send them to a high-risk OBGYN.
Yes. Now, I imagine OB-GYNs are a little bit more in tune, especially because egg freezing is something that we talk about.
So people are a little bit more aware of age and fertility in the Bay area at least, you know, I think the OB GYNs around here do a really good job.
If someone is thirty-seven they tend to do a test, like the AMH test, and may suggest seeing a fertility doctor.
Right, my experience was ages ago — and it feels like fertility awareness and medicine has come a long way. So I’d like to believe doctors are better at recognizing needs earlier.
I had two natural miscarriages then an IVF miscarriage. Then, we did a year of IVF in New York and then we went to Israel where IVF is free because we’re Israeli citizens.
We did embryo banking for genetic testing. And I want to say I don’t recommend all these things. I’m just recounting what we did. We realized we had no normal embryos. And then I moved on to donor eggs and then I had a miscarriage with a donor egg. So I finally realized that it wasn’t my egg. Most of the time it was my body. That fourth miscarriage with a donor egg was very devastating because it was supposed to be my plan B. It was to be my backup, you know, I call it like the C or G.
Then I saw Dr. Braverman who was a reproductive immunologist. He helped regulate my immune system. Finally, four years later with the help of rigorous courses of steroids, I had my daughter.
What made him think that you needed steroids? And certainly, if you’re watching the show, it doesn’t mean that they’re for everybody, but I’m just curious. What did he diagnose you with and is it in the book for people who want to read about it?
Yes, there’s a whole chapter about it. Chapter 22 talks about repeat miscarriages. It’s tough. I had genetically normal miscarriages. So if you have genetically normal miscarriages or you have PGT tested embryos that result in miscarriage, it’s not always the egg that is the problem. Many IVF doctors don’t believe in reproductive immunology. But you didn’t have to go through nine miscarriages, like Gabrielle Union did, for instance. There are other things than the uterus that can cause them.
You should be with a doctor with expertise in what your problem is. So if you’re dealing with surrogacy, you should be with someone who has expertise in surrogacy for dealing with repeat miscarriage.
Right. Someone has to give you an explanation, a plan.
You mentioned there was little fertility support when you were going through this.
What specific support groups are there now? Are there lists of groups in the book as far as where people can go for help who are going through fertility treatment?
I mention some organizations, but I think if you just type it in Facebook, “fertility group”, you’ll find all that you need.
Also, from what I can see, most doctors or their patients have their own group. These leads to subgroups. I’m in this group called Warrior. It was started by a New York woman and there are 5,000 people in that group. But there are many subgroups. So if people start asking questions about donor eggs you may be directed by a member to try a different group. I know Dr. Braverman passed away, but now Dr. Vidali has taken over his practice. They have their group of people who are considering donor eggs. And then there’s a general reproductive immunology group because there are a lot of questions. Matt and Doree’s Eggcellent Adventure is a great podcast. But those didn’t exist when I was going through this.
I think these groups do provide a source of support for people who need it.
Sometimes sharing online is another way of getting support. The best part is that no one’s going to judge you in these groups. They’re just going to support you.
These are great suggestions. I want you to teach our listeners right now. So since it’s infertility awareness week, what advice do you have for people who are starting out on their journey right now?
My advice is, first of all, take it one step at a time. Don’t get overwhelmed. You don’t have to be an MD. You don’t have to be a fertility doctor. You don’t have to be an expert on the subject. You might buy this book and learn everything and then you get pregnant like in a month.
You don’t have to learn it all. Tell people what you need. Just tell them. Say, “I need you not to ask me questions.” Or “I need to vent to you.”. Or, “I need you to be my point person.”
One of my point persons is a gay man who doesn’t want kids, is not having kids, and I can just complain to him about the number of eggs I retrieved. He didn’t really know what that meant, but he was very supportive.
Now that we’re in a pandemic, what kind of advice would you have for people?
Well, I mean, obviously if you’re lucky, I think that treatment is going to get to start ramping up — at least that is what I hear, especially in New York. So obviously be safe and take really take care of yourself. So if you’re in New York, obviously that means, you know, wearing a mask and gloves. But it also means, re-thinking your situation. If you thought infertility was the worst thing ever then maybe with the perspective of this pandemic it doesn’t feel as bad. Or likewise, maybe fertility goals are a nice distraction from the pandemic.
I would just say take care of yourself however that is possible.
That’s great advice. What trends have you noticed over the last 10 years? And do you have any predictions for what’s to come?
When I first started writing about fertility the question was about how many embryos should be transferred.
And now the trend has been to genetically test everything, freeze everything, and only do one at a time.
I want to find doctors in every city that I can recommend. You know, obviously I have you in the Bay Area, but I’m always looking for people that I can send people to.
And I want to know that doctors are not rigid. That’s what I look for in a doctor. So when someone tells me they know best and that there’s only one way to do it, I know that’s not true. A few years ago everybody was talking about endometrial scraping and then, you know, two years later, have realized that no, that doesn’t work.
There are so many fads. You’re right.
There are so many. I guess I wish every doctor could admit that they don’t know everything.
Fertility medicine has been around for less than 50 years. We’re trying things and we don’t know all of the answers. I think that some techniques and tactics work for some people, and don’t for others. To say anything differently feels untrue.
So like I see all these women online complaining about specifics of what happened to them during their IVF cycle.
I just want these women to find a doctor that has an out of the box approach that tailors it to their specific situation because there is no one way to do it just yet. I mean, I hope in the future, I know there’s a race right now in terms of how to test embryos.
There’s definitely a race for what’s possible around genetics.
And then there’s another company that I’m sure you know called TMRW. They want to automate every single part of the process so you don’t have mistakes in the lab.
Right. And also increasing access to people by being able to provide more care at a larger scale.
So tell us, if someone wants your book, where can they find it?
They can find it at The Trying Game website and they can buy it on Amazon. They can buy it at bookshop.org, which supports independent book stores. If you need any help I’m always happy to talk to people and you can find my email in my articles.
I always promised myself when I was going through this that I would help people be aware of the right questions to help them get pregnant faster.
Absolutely. We are definitely on the same page. I don’t think it’s a coincidence that we were both named Amy (ha).
If there’s one thing that you would want to share with the room full of people about infertility, what would that one thing be?
Infertility is hard. It’s hard for the woman. It’s hard for the man. It’s hard for the marriage and it’s hard if you already have kids. It’s just not what you expected in life. It’s not the thing that you thought you would have to go through.
If it’s not you, but someone you know that’s going through it. The best way to be there for someone is just to tell them you’re going to be there for them.
So if you’re going through fertility issues, while I want other people to be kind to you, I also want you to be kind to yourself. Hopefully, you will have that baby. But it’s going to be a painful journey to get there. So be kind to yourself along the way and don’t expect too much from yourself because it’s hard.
It is really hard. I now tell people, don’t let the pandemic take away your joy. But certainly, I’ve been telling people, don’t let infertility take away your joy.
Whatever you can do to find joy in every day as much as you can, it’s super important. Just live your life to the max.
Amy, thank you for being here with me. It’s been really informative and fun. You know, I feel like when I talk to you, it invigorates me.
We definitely have the same message about diagnosis before treatment. Your journey and people who read about it will hopefully help people be more informed about the steps that they can take to empower themselves.
If you’re reading this go to Facebook, and follow Amy. She has lots of great advice. She’s always such a kind person. I see her in those Facebook groups putting up comments and giving people words of support and advice, and sometimes she turns some of these conversations around so they’re more positive and informative.
You can catch more of me and fertility topics like this through The Egg Whisperer Show. The episodes are live-streamed on YouTube, Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too! Sign up for my next class at the Egg Whisperer School.