Ep 96: The Light at the End of the Tunnel with Dr. Jenna Friedenthal
Fertility Forward 96:
Welcome back to another episode of Fertility Forward. Today we are joined by a very special guest who is both a reproductive specialist and someone who has struggled with infertility, Dr. Jenna Friedenthal. Tuning in you’ll hear about Jenna’s experience with polycystic ovarian syndrome (PCOS), her biochemical pregnancy experience, and how the treatment affected her partner. She also shares how she was able to navigate her own struggles while supporting her patients going through similar journeys. Jenna tells us what it was like to work with women whose biggest dream is to be pregnant as a visibly pregnant woman and why she shared her own experiences with them. And lastly, we express gratitude for our beautiful miracle daughters. To hear all about the light at the end of the infertility tunnel, press play now!
Rena: Hi everyone. We are Rena and Dara, and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Forward podcast brings together advice for medical professionals, mental health specialists, wellness experts, and patients, because knowledge is power and you are your own best advocate.
Rena: I am so excited to welcome to the podcast today, Dr. Jenna Friedenthal, who is a wonderful, lovely, inspiring reproductive endocrinologist at RMA of New York. And I am so, so grateful to have her on, for her to share her time and to tell us her story about what it was like to go through treatment while being a reproductive endocrinologist and practicing with patients. So thank you so much, Jenna, for coming on and sharing your time and story with us.
Dr. Friedenthal: Aw, thank you for having me, Rena,I'm really excited.
Rena: So let's just dive right in. I mean, tell me sort of about your story, your journey and what it was like to try and conceive for you?
Dr. Friedenthal: Yeah, I mean, so I knew that I have a diagnosis of polycystic ovarian syndrome or PCOS. And so, you know, I sort of had a feeling that I was gonna have some degree of challenge when it came to ovulation, that I might require medication to induce ovulation. So as an REI, obviously I was sort of prepared for that in all of the ways. I think I wasn't prepared for everything that came thereafter. You know, we can talk about sort of my, what has happened subsequently. We started with good old fashioned Letrozol to try to induce ovulation. We went through at least three or four cycles of that before realizing that actually the problem was gonna be a little bit more complicated as it turns out I had a hydrosalpinx and so one of my fallopian tubes it's really dilated and probably leaking embryo toxic fluid into the uterus. And so that opened up sort of a whole new can of worms. I ended up needing surgery to remove the fallopian tube. We tried, you know, for several more cycles of ovulation induction after that, and eventually needed to convert to IVF. It was definitely even that stage of the journey was, was harder than I think I would've expected even as an REI kind of knowing what to expect on a day to day. It's hard to appreciate the passage of time and how torturous the passage of time is until you are really living it day in and day out and watching each month pass, particularly when you're anovulatory and you're just watching the time pass, even trying to recruit a follicle. And so I think even in that phase of things I was learning a lot from the patient perspective for better or worse, and then a lot more came after that, which we can talk about too.
Rena: I love that you touched upon the passage of time because I know, you know, I, myself, when I was in the journey, it always felt like I was stuck and it was sort of like two steps forward, five steps back. And I think that's what so many people struggle with emotionally is there's so much kind of like hurry up and wait in this process. And it's so frustrating and so emotionally challenging.
Dr. Friedenthal: Yeah, it really, it really, really is. You know, I think the passage of time and the lack of control were the two things that really still stick out to me from, you know, from my journey. And that's, again, even being an REI, kind of knowing all of the medical expectations, going through it is totally different. You know, in the sort of in the mix of those early ovulation induction and IUIs, I did have, like, a biochemical pregnancy and I think that's the other part of it too, right. Is understanding that even with a biochemical pregnancy as sort of, as sort of early and small as we think of it in the medical field, as a human being, when you see that positive pregnancy test, you're all of a sudden planning your life, right? You're figuring out when the due date might be, you're thinking about work and when you're gonna take off leave, you're thinking about baby names. So even when it's, you know, sort of something as simple as a biochemical, it's devastating when then you check a couple of days later and the hormones are dropping and all of a sudden it's another point that's totally out of your control. You're asking yourself what you did wrong and it's crushing, it's crushing in the, in the same way that, you know, a miscarriage is crushing. And I think that that's something that until you experience that yourself, even as an RE, it's really hard to appreciate that. And I, I definitely had a newfound appreciation for the gravity of, you know, these very early losses, which I then had to deal with subsequently, which we’ll also get into.
Rena: Hmm. Yeah. I mean, I think I had to deal with that too. And I think as hard as miscarriage is, you know, the chemical ones are hard on a different level because, you know, there's, I think such little societal understanding of miscarriage. I think people understand, okay, it's a loss, but then there's even less understanding of a chemical. And I think to sort of be given that positive data and then have it taken away, you know, and as you said, you start to build up your hopes and your dreams and your fantasies and your vision, and then when that's yanked right from under you, it's devastating.
Dr. Friedenthal: Yeah. It, it really is. And, you know, for me, look, like, the journey didn't end there, right? So I, you know, we underwent several rounds of ovulation induction. I had my laparoscopy to remove my right fallopian tube. We underwent a few more cycles of ovulation induction. And at that point we all sort of agreed that there were diminishing returns and it made the most sense to convert to IVF. I, you know, I was lucky in the sense that my polycystic ovarian syndrome meant that I did well with my first round of IVF with regard to the egg retrieval portion of things. But then when we went to the time for the transfer, you know, and I think this is something that now I understand at a new level too, right? We had a beautiful genetically tested euploid embryo. The transfer went well. And then came the struggle of the low HCG and watching the low HCG, seeing a pregnancy forming on ultrasound, seeing the gestational sac, and then checking again at seven weeks and seeing no growth and dealing with the consequences of a euploid loss, which I think is also really, really challenging in a way that is hard to appreciate this, the emotion, the emotional and psychological ramifications, right? It's you as a patient and as a woman, sort of when you have an early miscarriage or biochemical, especially as an REI, assume, there must have been something just abnormal with the pregnancy in and of itself. And if I do IVF, I'll have this normal embryo and my chances of success are gonna be, you know, as close to guaranteed as possible. And, and we know, right, that the implantation rate is, is much better, close to 70% or higher with the genetically tested embryo as compared to like 10% in the general population of just trying to get pregnant. But that's not a hundred percent, right? It means that 30% of our patients will deal with either no pregnancy or miscarriage, but until you're facing that yourself, right, it, it's hard to really appreciate the worry that comes along with that. Again, like what does it mean if I have a beautiful euploid embryo and it's still not working, what does that mean for the future? What are my odds for success? And so struggling with all that was definitely sort of like a new and unique challenge that I wasn't expecting. Honestly, it took me by surprise, but I think it's important because frankly, a lot of our patients deal with that too. So understanding what that feels like on a personal level was eye opening.
Rena: How were you able to sort of navigate this, you know, your own personal journey in the emotional ups and downs that come at it while also showing up for work every day and trying to help other people achieve their dreams? I mean, I, that must have been quite difficult?
Dr. Friedenthal: You know, listen, I think as doctors, we were trained pretty early to learn how to wear multiple hats and sort of compartmentalize. And I think that that's a skill that I, we've definitely, and I've definitely honed over the years, but I also think, listen, there's something to be said for being in the thick of it with our patients. Right? All of a sudden, I'm not just on one side of the room and the patient’s on the other side, like I'm in this journey with them in a different and unique way. And so in some ways it was like, it was kind of, it wasn't that hard to come to work because I'm facing the same struggle that they're facing, right? When they're upset about an outcome, I understand and can sort of like be there for them in, in at least in my experience that much more, because I truly understand where they're coming from in a way that I think is very hard to if you haven't gone through it yourself, as, as empathetic as we are as human beings and doctors, until you're living it yourself, it's hard to really fully understand it. And so, you know, I think in some ways this is like the best field for me to, to be in, because at least I'm helping patients that I, I know are, I can understand the struggle because I was going through the struggle too.
Rena: Were you open about what you were going through? Did you find that you started sort of identifying with patients and sharing and you know, saying like, oh, I went through that too, or I'm going through this now? Or did you really keep it separate and not bring it into work?
Dr. Friedenthal: Yeah, I, I, it was sort of a case by case basis, right? Because I think not on the one hand, I think some people are appreciative to hear about it. And on the other hand, I think I don't want my experience to take away from what patients are going through in their own journey. You know, it's not, it's not about me, it's about them, but I think as sort of things were going on, particularly after the euploid loss and having to deal with like a DNC and then a second DNC for retained products, you know, like that's a long struggle that not everybody has to go through thankfully. And so for those that were, you know, I did, I found, I felt myself more comfortable sharing because I think again, it's one of those rare occurrences that, you know, unless you've experienced, it is hard for people to really understand the, the pain that you're, you're feeling the, the loss. Right? And it's one thing to read a paper and say, that studies show that it's equivalent to the loss of a child, but like, until you're feeling that yourself, it's, it's a totally different field. So after that, after that miscarriage, I started sharing more with patients I think because my, my whole anyway, was that they would know that I really do know where they're coming from in a special way and, and, and can support them at least in a unique way, but I'm always wary because I, I really wanna make sure that we, we know that it's about the patient and their experience. It's not about me ultimately.
Rena: Sure. Did you find that people were receptive to that?
Dr. Friedenthal: Yeah, they were actually in a way that I was surprised. I was surprised by honestly. Right? Cause as I said, I really don't wanna make it. It's not about me. It's just whether or not sharing can help somebody else who's kind of going through the same thing. And I think people were really receptive to that. And I listen, I like to think of myself as someone who wears her heart on sleeve for better or worse. And so I think when I allow myself to be that person for patients, for friends, for family it tends to give positive feedback. And I, I think people were, were happy to hear that somebody on this side of things really gets what they're going through.
Rena: I found that as well, you know, I don't know about MD training, but for my own training as a mental health professional, you know, we were sort of taught, you know, you have to be a blank slate. You know, we don't share of ourselves. If people ask you about yourself, you have to kind of throw it back on and say like, why does it matter to you? But I found, you know, this work is so unique and special and niche. And it's in my bio that, you know, I went through fertility treatment myself and so I never bring it up, but a lot of people ask me about it. And a lot of people reach out and say, I wanna connect to you because I know you went through this. And so I always say, look, I'm an open book. Like, you can ask me whatever you want. I'm not gonna bring it up and I'm certainly not gonna tell you anything you don't wanna know. But I, I found that, you know, similarly it really resonates with people and I think they just like to find somebody else that's gone through it. And, you know, I know working with physicians like yourself and some of our other REs who have been open about their own family building journeys that I think it does very much resonate with patients and people appreciate it, that you're not just sort of a talking head and you understand firsthand what it's like, you know, to have experienced the side effects of medication or the ups and downs of treatment. And I think it is a sort of, you know, kind of bond between patient and practitioner, which I think is very unique to our work.
Dr. Friedenthal: Yeah, I agree. And I think I've definitely become more open even just talking about like my experience with IVF to your point, right? Like the stimulation beds, how long a cycle can take place, like the SI the bloating that can come afterwards. Right? It's little things like that, that I agree is very unique about our field. And frankly, is something that we, as a society, haven't done a great job of talking about until recently. So a lot of people still feel in the dark, you know what I mean? It was like, well, if I've gone through this experience, I might as well at least be able to share this in the hopes that like I can provide, not just the medical information, but the sort of my personal experience with it. Right? I can say, this is what I had. You know, this is what happened to me. For better or worse, I can talk about the consequences in a way that I think, you know, really resonates with people.
Rena: Sure. And I think, too, it sort of humanizes it to people, you know, just because you're a physician doesn't mean that infertility doesn't touch you. You know, infertility knows no bounds, it doesn't discriminate. And so I think for people to see like, okay, here's this person in front of me in this field, it's not like you're quote unquote safe from it. You know, we can't hide from infertility. So I think that’s so helpful for people.
Dr. Friedenthal: Yeah. Far from it. I would joke with like my friends and colleagues that, you know, between the ovulation induction IUIs, laparoscopy, IVF, embryo transfer, hysteroscopy with DNC times two and second embryo transfer. It's like, you know, I I've done the majority of what our patients will need to go through at some point. So I might as well. Right. Yeah. You really talk about all of the experiences and, you know, joking aside, I feel like that is a strength, right? It, it, it, as you say, I'm a human being still and it touched me just like it touched all of our patients. And it means something to me to be able to share that with people and to now, beyond the other side of it too, you know, there is a light at the end of the tunnel eventually.
Rena: So how long was your journey start to finish?
Dr. Friedenthal: Well, my husband and I first started trying to conceive in January of 2020. It was right before the pandemic. All said and done, our second embryo transfer that led to our successful pregnancy was March 25th, 2021. So it was about a year and three months give or take from start to finish.
Rena: Okay. And then how was the pregnancy for you? Did you find that because of, you know, everything leading up to it that you had a lot of anxiety?
Dr. Friedenthal: It did. I was gonna say, I, I think really like up all the way through the second trimester and even thereafter, it was dictated unfortunately by a lot of anxiety, especially given the miscarriages, you know, I think, and I really can empathize with patients, right? Like until you hit each big milestone, you're sort of holding your breath. And I even remember that with my husband. I was actually on call here at RMA when the first positive pregnancy test, the quantitative test, came back positive. And I actually had a good feeling that day. Like I was like, this is gonna be the one that works. I'm just gonna be positive right now. And I came home and I had like, given my husband it was Easter Sunday, and I'd given him this little Easter basket, I knew the gender of the embryo with all this pink stuff. And I was like, It worked. And he actually got to said, like, I'm not there with you yet. Like I'm not ready to get excited because we've just done. We've gone through this all before. And like, how do we get past this point? And it was like a sobering moment for both of us. And it stayed that way kind of more or less until we really graduated from RMA until we kind of got to the anatomy scan and everything was normal. It really wasn't until then. So about like halfway through the pregnancy that we looked at each other and said, like, I think this might really happen? Like, I think that this might actually lead to our child, but it took that much time and people would try to tell me, like, don't be stressed, just enjoy the pregnancy. Like don't like, don't lose that time not enjoying. To me, listen, do what you have to do to get through, like, if you're gonna be anxious, right. Like be anxious. It's okay. In my opinion, anyway, knowing that like, things are still gonna progress regardless of your anxiety and that's what happened. And eventually I was able to sort of let go and separate from, you know, everything that had come before to some degree and really just like, enjoy, enjoy the pregnancy for what it was, which is great.
Rena: So how did you cope during that time? Anything specific or you kinda just one day at a time?
Dr. Friedenthal: I, you know, I think for me, one of the nurses here, actually Jordan, even that first pregnancy test when I was nervous to get excited, because I knew it had come before, you know, she said, look, today is a victory like today in and of itself is a good day. You have a positive beta. It's a nice high number, regardless of what happens tomorrow, take the time to celebrate today. And you'll face tomorrow when tomorrow happens. And I sort of like, lived by that for a little while. It was like week to week ultrasounds. Like today's ultrasound was a good ultrasound. The hormones look good. I don't know what will happen next week, but we're gonna focus on the positive for now and know that if there's trouble next week, we will brace that and we will deal with it then. And that sort of helped carry me through for a lot of it.
Rena: Yay. Shout out to Jordan, love her but I think she said exactly what I say to people, which is like, you know, you have to go with what you know, and, you know, anxiety and, and uncertainty go hand in hand and sort of this future tripping and catastrophizing. And especially with this, I always tell someone, okay, let's look at the facts. What do you know today was a good day? Your beta is good. You know, the ultrasound was good. There's no reason to believe anything else. And so that's where you have to say, you have to stay in that moment in time, the next appointment we're gonna get the next facts, but we're not there. So today look at what, you know, stay with that and really kind of work in these smaller increments of time.
Dr. Friedenthal: Exactly.
Rena: And I think too, you know, you brought up a really good point about partners as well. And I think, you know, I see a lot when I work with couples or, you know, just hearing from individual clients that it's really important to take stock in what your partner may be experiencing. You know, it sounds like you kind of got to a point of, okay, I'm ready to celebrate, you know, here's all this stuff, all this pink stuff. And your husband was like, no, like, like I'm not there yet. I'm still processing. And so I see that a lot. And I think it's important to always sort of acknowledge and check in where the other person is, because you may be on two different parts. You know, if someone is watching their partner, put their body through this, go through all of this, you know, they may need extra time to catch up to be excited because they also have their own trauma and scarring from that experience.
Dr. Friedenthal: Yeah, you're exactly right. And I think it wasn't until that moment, actually, that I sort of acknowledged that this wasn't just happening to me. And I think it's easy to feel that way. Right. And on some level it is mostly happening to the person who's going through the treatments, the agri treatable, the embryo transfer, right. In a, in a tactile way that the partner isn't always able to experience, but to your point, right, they're still experiencing it too. It's just in a different way. And you know, one could argue that they're often sort of putting their feelings aside to be the supportive person for the person going through treatment. At least that was my experience. It sort of made me realize like, oh yes. You know, my husband has been an incredible, like rock for me as I have had the emotional ups and downs with every sort of tribulation that's happened. And I, I hadn't really checked in a whole lot with him to see like, are, are you okay? And are, you know, where are you in all of this? And it wasn't until that moment that it was like, okay, we need to pause and check in with each other and make sure that we're kind of supporting one another to get through the, you know, to get through the rest of it. And, and then life thereafter, too.
Rena: Yeah. I think that's a great point. Really great. So tell us also, I mean, what was it like for you being a visibly showing pregnant person and practicing? Did you feel sort of any shift in treatment? Did you know, because I know a lot of people as is natural, normal, you know, experience a lot of jealousy and envy when they see people that are pregnant, because that's what they want. Did you find that you sort of felt any of that? Did people talk about it or it didn't really impact your work so much?
Dr. Friedenthal: You know, I think patients sort of ran the spectrum, right, from either sort of, we, we kind of didn't acknowledge it, which was totally fine, or to acknowledging it right off the bat. And I even had patients ask me if this was an, if this was an RMA baby, which I think is an interesting question to sort of, to ask like right off the bat, sort of assuming that, you know, maybe I either wanted or needed fertility services. The answer was yes, as it turned out. And I think the more that, honestly, I sort of felt comfortable acknowledging that when patients would say congratulations, or, you know, how far along are you? I think to me, I wanted them to know that like, we're still in the same boat, right? We're still still on the same page. And like, you know, I think in a lot of the sort of fertility stories and fertility groups that you talk about, there's this feeling that once you get pregnant, you're sort of not a part of the group anymore. You're out of a club and I don't feel that way. Right? For better or worse, like I still have infertility. I am grateful and lucky that we have the technology to overcome my infertility, but like, I will always be an infertile person. And so I think for me, like acknowledging that even in the pregnancy that it's like, yes, I am however many weeks pregnant and like, just so you know, this was an RMA IVF baby. And so like, there is some, you know, there was something to be said and I think something positive to be said about sharing that with people and people seem to be really excited about it. Actually, I think seeing like front end center that somebody who went through the journey is actually there on the other side, visibly showing patients who are really like, were really, really lovely and actually supportive and would, you know, go as far as to ask me like how I'm feeling. Especially if patients, I was scanning like every week for their treatment, as I was then progressing along, we were sort of on this, on this journey together, which is really nice.
Rena: I think people love stories of strength and hope. And I think because that's what they want, you know, and they wanna see hope, they wanna see, okay, someone went through what I'm going through. They got to the other side. You know, they sort of climb this mountain. And so I can do it too. People really latch onto that.
Dr. Friedenthal: No, that's part of why I wanted to share this today. Right? Is just the understanding that, I mean, I really, you know, I, I joke about all the treatment and surgeries that it got me to, you know, where I am, but it, it was a lot, right? And I can acknowledge now how hard it was in a way that I think to when I, when you're in the thick of it, it's hard to really take a moment and reflect at how much we go through to try to, you know, on our infertility journey. And it was a lot, but my hope is that by sharing that I can at least shed some light. I can, you know, let people know that I understand what they are going through on a very personal level and that, you know, for better or worse, thankfully in a lot of our patients, including me, there is a light at the end of the tunnel. There's hope on the other side. And sometimes it takes longer than you think it's gonna take. And sometimes it takes creativity and ways of getting pregnant that you might not have expected that you would need. But I think if you focus on the end goal of having the baby, which is what, you know, what we did, there's hope there. And I want people to sort of understand that and hopefully take that in.
Rena: Well, thank you so much for coming on and sharing your story. I think it's so inspiring and brave and so good to hear your voice. As you know, especially from an RE perspective, you know, going through the journey and practicing, I think the story's gonna resonate with so many people and really inspire strength and hope. So I so appreciate you coming on and sharing and being open.
Dr. Friedenthal: My pleasure, absolutely happy to come back anytime.
Rena: Well, the way we like to conclude our episodes is by sharing gratitude. So, so something that you are grateful for today.
Dr. Friedenthal: I am grateful today and every day for my daughter and her beautiful smile and the progress that she's showing me and teaching me every day.
Rena: I love that. You took the words right outta my mouth. So I will also say, I don't think I've ever done this on here before. Say my daughter, you know, she also is an IVF baby and has taught me so much and inspires me to try and be a good human and raise a good human. And it's just a true blessing and really drives me in my work because I wanna be able to help other people get that
Dr. Friedenthal: Me too. Totally understand.
Rena: Thank you so much for coming on. It was a pleasure and an honor to have you, and we'll definitely have you come back.
Dr. Friedenthal: Aw, thank you. It was my pleasure.
Dara: Thank you so much for listening today and always remember - practice gratitude, give a little love to someone else and yourself, and remember, you are not alone. Find us on Instagram at fertility_forward and if you're looking for more support, visit us www.rmany.com and tune in next week for more Fertility Forward.