Posted on March 12th, 2020by RMANY

Ep 10: Psychology, Mental Health, and the TTC Journey with Dr. Georgia Witkin

Fertility Forward Episode 10:

The links between stress and fertility that seem to be so commonly believed in are very misleading. Dr. Georgia Witkin is the Director of Psychological Services at RMA and has written thirteen books about stress and she joins us on the show today to remind us that infertility causes stress, not the other way around! We get to hear from Dr. Witkin about her journey in psychology and how she made her way into the fertility field and ultimately landed at Mount Sinai and RMA.

Transcript of Episode 10

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: We're so excited to welcome to Fertility Forward today, the fabulous Dr. Georgia Witkin. Thank you so much for joining us and for taking time out of your crazy schedule.
Dara: We are thrilled. We don't get to see you too often in the office so it’s nice to have you. have you in today.
Dr. Georgia Witkin: So the minute we finish, let's go to lunch.
Dara: Done and done. So you've been here since the beginning?
Dr. Georgia Witkin: Yeah it feels like since the ark landed.
Dara: And how many years has it been now at RMA since you've been here?
Dr. Georgia Witkin: We were all at Mount Sinai as reproductive endocrinology, and the technology at RMA was so much better that it was Alan Copperman’s idea that we move all of the reproductive science part of OBGYN at Sinai to RMA. So that happened about 11 years ago, and the team moved and the technology is wonderful. The numbers are wonderful. And we grew, and we grew, and we grew. It was very exciting.
Rena: So tell us what you do here since you’re not a reproductive endocrinologist you’re a little bit different for our show today.
Dr. Georgia Witkin: Right I just
Dara: You’re a very important part of the team. Super important.
Rena: So unique.
Dr. Georgia Witkin: So this is a bit of the history of how I came to do what it is I'll tell you in a minute I do. In psychiatry at Mount Sinai I researched women and stress at a time where everyone else was talking about men and stress. They're talking about type A men and their heart attacks. And I said, I think that women probably have different stresses and their body probably handles it differently. And I did that research, and I wrote a book called The Female Stress Survival Guide and it was the first book for women about stress. First program I ever did was Oprah. She was still in Washington. She wasn't even national yet and it ended up a best seller. And when OBGYN said we're going to do IVF we're gonna do ovum donation, let's get an expert on women and stress. Somebody said, well, in psychiatry there’s this woman who wrote a book about women and stress. So I got a call, would I come down to meet with OBGYN and starting then and there and we're talking about 25 years ago,I joined OBGYN also and started doing all of the psych services for the part of OBGYN that was doing fertility. So when RMA was formed, I came over as head of psych services and wellness for fertility.
Rena: Wow.
Dara: But it all went back to stress I had no idea which is something that we talk about. I know. I'm sure Rena deals with a lot and I deal with a lot but really does go back to stress.
Dr. Georgia Witkin: It does and I’ve written 13 books since then on stress. You want to know about stress, you come to me and in fact, I blog for Psych Today it's called Chronicles of Infertility, and most of it is about the stress of going through the fertility journey. So stress and fertility are inseparable
Dara: 100% and I think even in this day and age. I think stress has increased that much more so in our current environment
Dr. Georgia Witkin: Even before you start in fertility.
Dara: Even before, just I mean and also I guess we're based in Manhattan and I feel there's a an extra level of stress and anxiety in Manhattan. But I think in general, with what's going on in this world today, there's that added level. So fertility aside, we have lots of things and lots of factors that are compounding that stress.
Dr. Georgia Witkin: So here's 13 books condensed into one sentence. Are you ready for this? Particularly if you're a woman. When your sense of control goes down, stress goes up.
Rena: And that’s what
Dr. Georgia Witkin: That’s it. That's what fertility is. You didn't expect it. You didn't predict it. You don't have a choice about it. You don't have control over it. Your used to studying and getting good grades. Here you're reading and you're reading you’re studying and you’re studying and you're learning and you're trying and you're trying this and you're trying that. And your Aunt Fanny is telling you if you just relax you know, it'll all be fine.
Dara: which means more stress.
Dr. Georgia Witkin: Of course. And here is the secret that I have to tell everybody, and this is really my polemic - there is a myth out there that stress causes infertility, and that is a cruel myth because it leads people to blame themselves. You know if you only relax, there’s a myth that if you adopt and relax about parenting you’ll then get pregnant. The statistics do not bear that out. There are women who, unfortunately, were in war time and got pregnant. There are women who against their will get raped and get pregnant when a good egg meets a good sperm nature wants reproduction and, if you are stressed, can it interfere with your menses? Of course, but it is time limited and self correcting. If you run a marathon, could it interfere temporarily with your hormones? Of course, but it's time limited and self correcting. There is nothing that anybody did inadvertently unless it caused bodily harm that is creating their infertility. So here's my mantra - infertility causes stress. Stress does not cause infertility.
Rena: That’s what I say to my patients all the time too. And they say wait what? And I have to say it again and again because for some reason it's out there in society that stress and fertility. And I think it's all those Aunt Fannys out there who say you know, just relax. You'll get pregnant. It'll happen.
Dara: That does not help.
Rena: No, nothing is worse than that, right? And then, as you said, patients blame themselves. Oh, it's my fault because I was stressed. Then I go back to our mantra.
Dr. Georgia Witkin: 100% and here’s the second half of the mantra - nobody out there seems to know that 1/3 of the time infertility is female, but 1/3 of the time it's male. And the remaining 30% it's both or unknown. So we are not the problem. And all these women who are blaming themselves, go have your partner tested. You might find that it's not just you or it's not you at all.
Rena: Or I always work with them to reframe and say It's not anyone's problem. It's not anyone's fault. It just is, you know, it's a disease
Dr. Georgia Witkin: Love it.
Rena: So okay, so then the question is to say you have a patient and you tell them this lovely information. It's not your fault. You know, stress doesn't cause infertility and they say okay, well, how do I get unstressed? What do you say?
Dr. Georgia Witkin: Everything works. You know, I have books filled with tips. I've got to tell you there's no secret. Everything works. Nature gave us a 1,000,000 ways of de-stressing. Anything rhythmic is distressing because the brain know what's coming next. Remember, I said stress goes up when you can’t predict so dancing works. Rocking a baby puts them to sleep. It'll put you to sleep, too. Listening to music slower than your heartbeat works. Anything rhythmic anything boring works you know find the most boring book on tape that you can and you will be asleep. Your brain is trying to solve problems that's generally what you know keeps you up if you’re stressed, so solve some problems. Clean your wallet. The brain doesn't know if you've solved your problem in your uterus. But if you've just straightened up the drawer in the kitchen, it will feel packaged again. If you enjoy exercise great, it burns up all the adrenaline that your body is putting out so you can fight in flight when there's no one to fight and there's nowhere to run, it works. Everything works. But what happens to people as you both know who are going through fertility problems is they feel they want to first take care of everything they have to do during the day, then they're going to take care of everything related to this journey, and then the left over time is gonna be for them. And there's no leftover time.
Dara: I see that so often that especially the people that I find struggle that most are the ones that are givers. They give, give, give, give, give their time, their energy, their love and support to everyone around them, and they're such sweet people. But what they forget about is themselves, and it doesn't have to be super time consuming. It could be something small and simple as giving 60 seconds to yourself to breathe. Deep breaths.
Rena: Self care is not selfish. How can you give to everyone else if you don't take care of yourself? You’re gonna burn out.
Dr. Georgia Witkin: So what I say is, don't put yourself in front of anybody else. Just include yourself. Treat yourself as well as you’d treat anyone else who you love and love yourself. Besides, if you don't, it's gonna give other people ideas. Use yourself as cheap labor, so will everybody else in the family
Rena: Treat yourself how you want to be treated.
Dr. Georgia Witkin: Here’s something that I think really changed my life. I read that Herb Benson who's at Harvard, and he researches stress that the 20 minutes a day of downtime of pausing to do whatever you want. You know, cup a tea, of course, word puzzle, you know, humming a tune. Whatever you want to do 20 minutes a day reduces stress symptoms by 50%. And here's what's even more interesting. You don't have to do the 20 minutes all at once. You can do 5 minutes before you get up in the morning. Just relax, starting with your toes to your head. You could get in the middle of the day instead of sitting at your desk, get up, take a walk. You know, do something you love, buy a lipstick. I believe in retail therapy. That’s very important.
Rena: Me too.
Dr. Georgia Witkin: Total of 20 minutes a day. We can all squeeze that in even if it’s in five, four minute blocks.
Rena: Totally. That’s what everyone says oh I don't have time. Yes, you do. Come on, make time, right 20 minutes?
Dara: And once you do it, you realize the value and then you keep doing it, make it a habit. Rena and I always say it takes what, 21 days to create a habit, you have to stick with it. You don't even know you're stressed until you de-stress cause you get so used to being stressed and to live here in New York.
Rena: Yeah it’s a constant state. Sure, you just get used to right this constant state of stress, uncertainty especially with infertility, waiting for the phone to ring, waiting for your results to come. And you don't realize you're on edge all the time until you work to get off that edge and be calm and then you say, Whoa, I had no idea I was you know on such edge.
Dara: But for me, it's the baseline stress that I think that's already more elevated now than ever. Dr. Georgia Witkin: Yeah, when you think about living in any big city, the amount that you don't have control over it just starts with traffic in the morning,
Rena: Right or navigating a sidewalk, you know, crowded sidewalk walking somewhere.
Dara: I have to tell you, I took a short trip outside of the city this weekend in nature, and wow I mean someone who lives in New York
Dr. Georgia Witkin: Nature? What?
Dara: I know
Dr. Georgia Witkin: Remind me what that is?
Dara: Trees
Dr. Georgia Witkin: Green
Dara: And actually seeing the stars at night. But just the simplicity of looking up at the stars being in nature, hearing the birds, chirp or whatever weird cricket sounds something as simple as that really was a great way to help rejuvenate my myself and make me appreciate the world that I live in a little bit more. So it doesn't have to be also something that you need to go overnight. You know, take a day trip, a train ride somewhere, appreciate nature, something as simple as that can also be helpful.
Dr. Georgia Witkin: Remember that what makes you feel stressed is the body on alert and the brain on alert cause something is coming at you that you didn't expect, which is every day in a big city or even if you're not in a big city if you're in suburbia, you're still in your car and you don't know who's gonna be coming out of the parking lot and you don't know if you gonna be late to pick up your kids and so forth. When you're in nature, the reason you can relax, is nothing's coming at you.
Dara: Well, even technology, I think the technology boom, is a big contributor to that increased baseline.
Rena: Yeah, and always people are always waiting for their phone to ding or vibrate or this or that. I turned off a lot of social media and I turn my phone off, and it's really calmed me down because I'm not an edge anymore. I put it away. I don't need that. It's too much noise.
Dara: There’s great apps now that can help, you know, remind you how much time you're on or actually self shut off or, you know, turn on. I know my husband uses it in the morning. If he goes on this phone in the morning, it will buzz and also at a certain time at night if he tries to check his phone again it won’t work. So I think there are ways to - I gotta get the name of it, which I could leave in our show notes. But I do think that at least nowadays there are ways, but I think you need to make that conscious effort to... And I think that's at least what I see with my patients. A lot of people are not getting good quality sleep, and I think part of it goes back to being on our computer and our phone and watching TV, and that's
Dr. Georgia Witkin: Stimulating us instead of relaxing.
Rena: Or I think, you know, I have a lot of patients say they fall asleep, but then they wake up in the night because they're just so anxious about, you know, wherever it is in the process, and they can't fall back asleep so they don't get the consecutive hours of sleep. And I think that's really disruptive.
Dara: Or that deep REM sleep.
Rena: Yeah, and I have to say recently, I think I have the marathon coming up in two weeks now and usually I have no trouble sleeping. But I think I'm really nervous because I've been waking up in the night. I’ve been having these horrible nightmares, and I find that I'm not getting good consecutive sleep and it's very disruptive. I’m on my like third coffee of the day which is very unlike me because I'm so tired and it's so disruptive.
Dr. Georgia Witkin: Well, you know, we come to wakefulness about three or four times during the night. We go to deep sleep and then as you’re waking that's when you dream, cause the dream is supposed to keep you asleep. The dream takes all the noises and everything around you and weaves it into some kind of story to fool your brain, you know, and then you go back into sleep. So what happens is when you come in your wakefulness, if your brain is really filled with adrenaline the dreaming won't work. It won't keep you asleep. And then you not only had a dream that was half awake, half asleep, full of the anxiety whatever’s going on. But now you're awake and the adrenaline is pouring out.
Rena: Yeah. I find so many of my patients in this process, they have that kind of disrupted sleep. And I had someone yesterday who came in and she said, I can't take this anymore. You know, it's been a month of this and I fall asleep. But I wake up every night, my husband’s snoring beside me, and I just I can't fall back asleep. I’ve seen so many patients
Dr. Georgia Witkin: It’s the falling back because the brain is going. That's why you used to count sheep to bore yourself. It’s rhythmic. It really works
Rena: I count cavalier king charles spaniels
Dara: I used recently so 10% happier. There's many apps, but I recently bought 10% happier as a podcast, and I used it recently to I was having trouble sleeping, and it is something as simple as giving you a couple mantras to repeat, doing certain breath where it doesn't have to something you have to pay for, but whether it's, you know, using that as ah, for a week just to test it out and get some ideas. I think it could be great and useful. Just to have those tools and or even get up. Read a book, Do something, take your mind and then go back to sleep.
Dr. Georgia Witkin: So let's talk about breath because that really is important. Think about it when you're anxious, your heart beats more quickly, you’re having more adrenaline flow out. Your muscles intense because they're busy, you know, trying to get ready for fight and flight running from a bear. And there's no bear, and it's supposed to be for 10 minutes, and now you're stressed for 10 weeks. You don't have control over most of your autonomic nervous system. That's a part of your body that keeps you alive. The breathing, the blood pressure, the heart rate and so forth. The only part of that system that you have control over is breathing voluntary control. And if you breathe like you’re a baby with no worries asleep, the rest of the body says everything must be okay. In fact, that's what a lot of tranquilizers do. They relax your muscles so much, the brain says everything must be fine. So if you haven't looked at yoga breathing or you haven't practiced because you're not a singer this kind of breathing, let me tell you how a baby breathes when they're relaxed and asleep. If you put one hand on your belly and one on your chest, and as you breathe, you make sure it's only the hand on your belly that's moving. It's not the top hand on your chest, because when we're anxious, we're taking deep breaths and our whole chest cavity is moving. That's not relaxed breathing. If only a diaphragm is working your belly should go in, out, pause, not deep breaths, just gentle. In, out, pause and then picture your breath, your favorite color blue or green or pink. So every time you breathe out, give more and more of a mist of that color. Count back from 10 to 1. Take a breath on each count. Gently pause. Picture your breath as the color float in that mist. In one minute. If you had a biofeedback machine on, you would find that all of the hyperventilation, the hypervigilance and the hyperactivity diminished to normal levels. It's amazing. Try that a few times a day.
Dara: Doctor Witkin we are gonna try that. You are a wealth of information.
Dr. Georgia Witkin: In the dental chair it really helps!
Rena: What color do you pick?
Dr. Georgia Witkin: Pink. I always choose pink. Because I like cotton candy.
Rena: I love, yeah, breathing is so powerful. Or box breathing, which I know navy seals do? I learned that from Renee Brown. So that's where you breathe in for four, out for four, in for four out for four and four times. And that sequence should really help to calm you down. And I know that navy seals do it a lot out in the field.
Dara: I've done it with the holding for four. Sometimes that holding for four can help too.
Rena: Yeah so in for four you hold for four out for four.
Dara: And it takes a while in the beginning to like I can actually hold it in for four seconds after I've already breathed for four. But the more you do it, the easier it gets
Dr. Georgia Witkin: And the more you do it gently the more it works.
Dara: The less pressure you put on it
Dr. Georgia Witkin: Exactly.
Dara: Doesn't need to be perfect. No one knows
Rena: No
Dr. Georgia Witkin: Just to signal to the rest of your body that if the breathing is fine, everything must be fine it's just wonderful to know about.
Rena: Yeah breathing is powerful. I think a lot of people think oh a deep breath, you know, that’s so basic, but it really works for anxiety.
Dr. Georgia Witkin: It doesn't have to be deep.
Rena: No
Dr. Georgia Witkin: It just has to be rhythmic.
Dara: I think it's a great start and a great intro into meditation. So people think meditation I need to chant I need a mantra I need to do something so fancy. And it could be something as simple as starting with breath work.
Rena: Yeah absolutely.
Dr. Georgia Witkin: Again, it's taking control so you're not waiting for the world to bring you anything. You're kind of going inside. Almost like sleeping while you’re awake and saying right now I'm not gonna let anything come at me.
Dara: And you said the right word -now - being in the moment right now. Not thinking about the past, not thinking about the future being in the moment.
Dr. Georgia Witkin: Don't relive. Don't pre-live
Rena: I like that.
Dara: Relive or pre-live.
Dr. Georgia Witkin: You don't have control of either one.
Rena: All we have is right now to be grateful for where we are at right now. And how do you frame your thinking to be ok in this moment? And what can you find around you to be happy about now in this moment. You know, every experience is new, every second is a new experience. You've never been there before. So how do you you know find gratitude for that?
Dr. Georgia Witkin: We forget I think that thinking is a behavior. It used to be, I would say the turn of the century when Freudian thinking was part of how most people thought about emotions. That first you had feelings and the thoughts flowed from that. Now we've learned you can have thoughts and choose thoughts and direct your thoughts, and the feelings can flow from your thoughts. It's not just feelings to thoughts it could be thoughts to feelings and behavior to boat. So I remember watching on TV somebody's house was totally destroyed by fire, and she was saying on air, I feel so blessed and I remember thinking she feels blessed? You know, total destruction was behind her on this newsreel and she said Yes, because my neighbors really came and helped me and nobody was injured in the fire and even the pet was there. And I remember thinking as a therapist, My goodness, she's using cognitive behavioral therapy. She's really choosing her thoughts. She's choosing what she's focusing on and isn't that fantastic? And it totally changed my life and it changed How I choose to think as well.
Dara: Positive thinking is paramount.
Dr. Georgia Witkin: We have much more power than we think.
Rena: Yeah, absolutely. I think it's hard you know I think a lot of people in this process, you know, I see them think from sort of a victim mentality. You know why me? This is so unfair. What did I do? And I really work with people to help them find their strength and resilience to say no, you're not a victim. You know, find your power. You are so brave. You're so strong. And I think it's really working with people to help them sort of shift that thinking.
Dr. Georgia Witkin: That’s great.
Rena: You know, when I went through it myself I was certainly a victim for the first year I would say. Just why me this is so unfair and then I really, you know, worked to change my thinking because that wasn't serving me. And I don't think that it serves you and in life we have to find our power and our strength and what can we control. You know, is we're talking so much about what is out of our control. But what can we control? Starting with the small things like our breath. You know, I'm so grateful. I can sit here breathing and control my breath. So I think...
Dr. Georgia Witkin: I find a male female difference. You tell me what you think. I know the research says that by the time kids are five or six when something good happens, girls say they got lucky, boys take credit. When something bad happens, girls say, what did I do wrong? And boys say, inconvenient.
Dara: Never thought of it that way but it’s true.
Rena: Yeah.
Dr. Georgia Witkin: And when we see patients, guys come in and if there’s infertility it's inconvenient And the question is ok, so what do we do about it?
Dara: That’s so true!
Dr. Georgia Witkin: And the women are coming in: What did I do? What should I have done? What could I have done? What’s gonna
Dara: That has blown my mind. That’s so true. Men: tell me what I need to do. I’ll do it. Women. At least for me, I see women. Oh, my gosh. I could have done something wrong. I'm horrible. Why did I do that? Did I ruin my cycle, and it's usually focusing on one or two things. The negative, almost always the negative, as opposed to all the wonderful things that they have done.
Dr. Georgia Witkin: So I and you'll join me in this. I try to teach women to see infertility or anything that happens that wasn't what they would want as inconvenient. Not as a punishment but inconvenient. Which leads you to - So what do I do about it? Which is a different focus.
Dara: Yes.
Dr. Georgia Witkin: So they become consumers. They're spending money on fertility treatment. Don't see yourself as a victim or even a patient. See yourself as a consumer. You're choosing to spend money this way and let's see what we can get out of it. Even if it doesn't work, what's the information we can get out of it that can help next? It's so much more empowering to again get because you don't feel like you've lost choice or control.
Rena: Yeah, but I find it interesting that both of you guys say you see men say it's inconvenient. I find in my practice men that come in here to see me are very much usually victims. If it's male factor. Why me? This is so horrible. You know I let my partner down I let myself down. So I don't know if that’s...
Dr. Georgia Witkin: I think men confuse fertility with virility.
Rena: Yes, that's true for sure.
Dr. Georgia Witkin: And I think the ones that come to you, I would say more men are less likely to go to counseling.
Dara: Yes
Dr. Georgia Witkin:Than women in general
Rena: Oh sure. They suffer in silence because they’re embarrassed.
Dr. Georgia Witkin: So you’re seeing that small percentage….
Dara: Percentage that may not be representative of the whole.
Dr. Georgia Witkin: Exactly.
Rena: Right. I mean, yes, my male patient population is small because very few men come to see me for counseling.
Dr. Georgia Witkin: And those are the ones who are probably feeling the way women are feeling.
Rena: Women tell me their partner really needs to go. But men, you know, suffer in silence because they’re so they’re ashamed for women in their cycles. So much more shame than men.
Dr. Georgia Witkin: I also, tell me what you think, I also think men are raised or by nature to compartmentalize more than women. And so if they have this problem, when they're at work, they're not thinking about the problem. And they keep play in their life. They might have, you know, their basketball team you know for 20 years or other kinds of play, or going to movies or, you know, card games or whatever. And play is also a wonderful way to de-stress because you’re not in the past you’re not in the future. I
Rena: Yeah, yeah I don’t know if compartmentalize or just to say Okay. Well, there's nothing, really I can do about this so I’m just gonna live my life.
Dr. Georgia Witkin: Exactly.
Dara: Yes.
Rena: Whereas women say,
Dr. Georgia Witkin: They’re trying to solve the problem.
Dara: They’re helping other people and finding the answer
Rena: Or they isolate.
Dr. Georgia Witkin: Should I call a different doctor?
Rena: I see a lot of women isolating, too, you know, they don't want to be with friends. They don't want to socialize whereas men are kind of like what can I do so I’m just gonna go still hang out my friends and live my life
Dara: That's a good thought. That is true. A lot of women, when they're suffering, instead of reaching out to people who can actually support them, they feel shamed, and they feel like the only ones going through it and often do the opposite and retract when they really should be reaching out for support, whether it's through their friends, family or other people who can provide that support.
Dr. Georgia Witkin: So you’re kind of saying what I'm saying. I think women have a lot to learn from men. I don't think we're necessarily the same, and it's not about better or worse. It's just about different kinds of strategies. Some of it may be because of the way we come to the world. Some of that is nurturing and socializing. But I wrote a whole book on it called you know It's Not You, It's Him. We're trying to help women approach dating the way men do, because I really think men have it easier. If a couple breaks up, the woman typically comes in and goes, what did I do? What should I do next time? The men come in and they say, basically, I have to find somebody who appreciates me the way I am. They own it. Right. If I say to my husband something like, Oh my God, you're really clueless about A, B, or C. His answer is yeah. It's so smart. I mean what do I say to that? He goes yeah. No argument. Embraces it. It is what it is. It may be inconvenient for you but it is what it is. And I think that when it comes to handling stress, men have a lot to learn from us because we tend to be more empathetic we put ourselves in other people's positions.
Rena: We want to fix for them too.
Dara: Yes.
Rena: Let me fix this for you.
Dr. Georgia Witkin: Right. Whereas this sympathetic? Tell me what's wrong. I'll tell you what to do but we’re empathetic. I'll figure out what to do by putting my...So we’re different that way. And I'm not saying that it's better to be one way or the other.
Dara: We have to learn from each other.
Dr. Georgia Witkin: That's right, but there are times where they have to learn just be sympathetic. You know, start putting yourself in everyone else’s shoes.
Rena: Right it’s so hard right I see it for so many of my women. You know they want to fix everything. They want to be everything to everyone. They’re putting so much on themselves and nobody can do that. It's too much. You crack.
Dr. Georgia Witkin And then they say to you and to me to all of us they say, but that's the way I am. And we’re here to say: You can choose your thoughts, you can choose your behaviors.
Dara: Doesn’t have to define you.
Dr. Georgia Witkin: Right. So just include yourself among your loved ones. Take time out. You know, don't wait for leftover time. My grandmother taught me some very important lessons. One is an unmade bed is airing out. That’s very important. You don't have to. You can always find reasons why you take time for yourself. You don't have to do everything else first.
Rena: It's a hard lesson to learn. It's hard. It's hard to learn how to you know, love yourself, cut yourself a break. It's something I’ve actually been working on and it’s an ongoing process and I think especially as working women, mothers, whatever, all the hats you wear wear it’s hard but you know it's important because you don't take care of yourself you can't take care of anybody else and if you don't take care of yourself in this process, you're not gonna last. It’s hard.
Dr. Georgia Witkin: You can't last for the long run If you really using up everything for the short run.
Rena: Right. And you know I work with people Dr. Witkin I don’t know if you sort of do the same on how do you kind of live your life in parallel? How do you go through this process go through the stress go through the you know all the time it takes out everything but also live your life?
Dara: Be social.
Rena: You know, Right? Go to work, see your friends.
Dr. Georgia Witkin: It’s a perfect question because we are built for daily life. Think about it as a species we're built for interacting we’re built for you know gathering food or making money to buy food depending whether you're living now or 2000 years ago. But we're built for daily life. And that's the secret to getting through the fertility journey. You can't give up your daily life people come in and say so I'm gonna quit my job so that I can and I go oh please don’t!
Rena: No that’s what I say.
Dr. Georgia Witkin: You need your schedule. You need your co-workers, you need those emails with jokes. You need to feel valuable to something other than just your uterus, you know?
Rena: Right. People always say I feel like my life is on hold in this process. You know and a lot of times it does feel that way but it doesn’t have to. You can figure out tools and mechanisms how do you live in parallel? Right. You need all those things.
Dr. Georgia Witkin: Stop holding your breath. Start breathing again. And yes, and throw yourself into daily life. And you can't jinx this. You've seen this too, I'm sure. People who feel that they must feel positive or it's not gonna work. As if magical thinking.
Rena: If you believe, it will happen.
Dr. Georgia Witkin: And then the other 50% are coming in going
Dara: All negative.
Dr. Georgia Witkin: Right. I will not have hope.
Dara: It’s never gonna happen
Dr. Georgia Witkin: Because then I'll jinx it
Rena: Right. What do you say to those people that say, you know, I don't believe in the process. They don't have hope. What do you tell them?
Dr. Georgia Witkin: I say that if our thinking was that powerful, first of all, I would have been struck dead for some of my thoughts or I would have won the lottery for all my praying. We don't have control over our lives moment to moment which creates stress but is the reality. So you have to keep yourself company. As you said, you have to be there for yourself as any friend would. You have to pat yourself on the back you have to remember, yeah you really have to be there for yourself.
Rena: I like that. Right. Value yourself. And as you said, you know, retail therapy, whatever works for you.
Dr. Georgia Witkin: Cinematherapy.
Rena: Yeah. Get a manicure, a massage. Take yourself for a walk. Just love yourself at the end of the day
Dr. Georgia Witkin: And if you want the parenting experience, there's always a way.
Rena: That’s what I say too.
Dr. Georgia Witkin: Don’t equate it with pregnancy necessarily.
Rena: It may not be a straight line, and it may not be the path you thought but there's always a way to get where you want to go. And it might be that reframing your thinking, recalibrating, there's always a way to get where you want to go.
Dr. Georgia Witkin: Might be ovum donation, might be adoption it might be foster care it might be pets. It might be, you know, finding other projects, but that nurturing and that parenting, if you want to do it there’s always a way. Such a need in the world and the myth that our eggs are a piece of us if you really can't use them, it's not. We have gene pools of over three trillion combinations. Talk about aunt Fanny we have great, great, great, great, great aunt Fannies we never met who could be in that pool and it's not literally a piece of us and there are gene pools that overlap with ours and nurturing and parenting is not about, you know, a piece of your genetic pool necessarily.
Rena: No I agree. I think for a lot of people, I'm sure you know this, too, that it's about it's mourning a loss, and it's that sort of intangible loss that you know, we think it's our innate biological right to have a child, and when that's taken away from us again without our choosing it’s about mourning that loss and saying Okay, I don't have that so I'm gonna mourn that because it was something I pictured. So let me go through that process and then figure out or in parallel figure out okay, how can I still get where I want to go? I mean, I think to sort of say that it's not a loss and something to mourn and acknowledge, You know that's not honoring that, too. It's certainly again, is something so tough but as you said, there are so many different ways to nurture and be a parent, and sometimes it's about reframing your thinking, but it's hard obviously.
Dr. Georgia Witkin: Here’s what I also think feeds into some of the problem about moving on. There is this myth of the neat stages of recovery from any shock. And if you've ever taken psych 101 at any school you heard about Elizabeth Kubler Ross’ stages of recovery from you know a loss like a death and so forth. First there's denial and then you're supposed to. And it's not true. She made it up sitting in her office. There has been at least 30 years of attempts to replicate that in research, and it doesn’t exist.
Rena: I know people say ok I felt anger now what comes next?
Dr. Georgia Witkin: Exactly.
Rena: No it’s not like that.
Dr. Georgia Witkin: Again, it’s back to I’d like to control and predict what’s coming next.
Rena: Every stage is ok I felt this one tell me what’s next.
Dr. Georgia Witkin: Right. Oh at the end there’s a light at the...But here's the wonderful news. First of all, everyone has their own pattern. You can feel whatever you want. It's all legitimate. Some people get angry. Some get sad some get, you know, activated. Some get deactivated. It's all fine. But what's so interesting to me is that women can have more than one feeling at the same time.
Rena: Yes.
Dr. Georgia Witkin: And nobody talks about that.
Dara: Really?
Rena: People get very confused about them. Yeah they say how can I feel happy and sad? Happy about moving forward with ovum donation
Dr. Georgia Witkin: Exactly
Rena: But sad that I just had a miscarriage?
Dr. Georgia Witkin: Exactly.
Rena: You Absolutely can have opposing emotions.
Dr. Georgia Witkin: We have more than one feeling every day.
Rena: Yes, all the time.
Dr. Georgia Witkin: I don't like that woman. She's a..but on the other hand she has really good luncheons. Dara: So you can have that dichotomy.
Rena: They feel they can’t. They say, How can I feel excited about moving forward? You know, But I feel like I should also mourn this loss I just had.
Dr. Georgia Witkin: You can. Exactly right. You don't have to wait for one, this idea of working through?
Rena: No, no, no,
Dr. Georgia Witkin: No. You know, sometimes you move forward and that helps you give up some of the past.
Rena: Yes, yes.
Dr. Georgia Witkin: So don't think that you have to waste precious time moving through stages. You really can move forward to try to make things better.
Rena: Right.
Dr. Georgia Witkin: Without being finished with being disappointed.
Rena: Right. And it's okay to move forward and be excited about whatever your next step in your path is. Well, also maybe you had a late term miscarriage, and you you know you need to honor that and mourn that. You can do both things. And I think a lot of the time people feel a lot of guilt about that. But no, there's no right or wrong. And as you said, you know a lot of time this is very time sensitive and you can't, you know, sit around and say, ok, it's been an appropriate period of time now and now.
Dara: Who knows what that is.
Rena: Right. There’s no recipe for this. It's so personal.
Dr. Georgia Witkin: Exactly, exactly.
Dara: So I'm interested in learning more about you. You do a lot of research here. Is there any research that you've done that you feel, I'm sure there's so much that you feel proud of, but anything, whether it's in the past, currently, or that you're looking to the future, that you really feel there's a void or something that you that we found that you found super interesting that you're really proud of?
Dr. Georgia Witkin: I've done a lot of research.
Dara: A lot.
Dr. Georgia Witkin: Yes, I think 62 different topics in the fertility area, you know, in the stress area. And I found it all very interesting. The most interesting in the stress area is that female symptoms of stress are different than male, and no one had identified that before. And for us, it tends to be the four D's. Number one disorganization because there's a myth that we can multitask. The brain does not do two things at once, so when you're multitasking, it's switching back and forth, back and forth, back and forth. So if you're multitasking anyway, which I am, I'm driving and listening to a book on tape and putting on mascara in the rear view mirror. Don’t tell anybody that. But if you're doing that and then you add fertility journeys to it now there are three things your brain is thinking about, and then you add hormones. And then there's a fourth level, you know of interruption and the fact that you can't remember where you put the pen or you know the name of your mailman is not surprising. So D Number one is disorganization, and that's
Dara: Disorganization
Dr. Georgia Witkin: A female symptom. D. Number two is decision making difficulties. I mean, not who you want to be president, but what you want for lunch, because again the brain is so busy trying to digest
Dara: The day to day routine.
Dr. Georgia Witkin: People say oh my God, you know, I’m only 32 and I think I have Alzheimer's. Now some of it is being on overload this is the way females go. Number three is depression. Not the kind where you can't eat and sleep. But the kind where all you want to do is eat and sleep. You want to get into bed you want to binge watch something. Right, because you've just run out of energy you’ve used up all your serotonin, which keeps you mood steady. And what helps your body make more Serotonin are carbs. And You know about that, Dara. So you start craving carbs without even knowing why. And you just want to eat your carbs watch TV and go to bed because your on overload and, um and the fourth D is, um, if I can remember it. Decision making difficulty, disorganization depression... Oh, yes, I forgot it. Because it's the one I’m least comfortable with for women it’s dependency fantasies. And I remember my mother when she would go on overload, would wish for a week in the hospital for nothing very serious. It’s like I want to be taken care of. As we were saying before, women are so busy taking care of everyone you know is it my turn? Now my mother I want you to know I had a mastectomy in her 30s, hysterectomy in her forties, mastectomy in her 50s, thyroidectomy in her 60s, stomach cancer in her 70s...she beat them all.
Dara: Fighter.
Dr. Georgia Witkin: She felt like the luckiest person on earth. And every time she recovered, she did more and more to reclaim her life. And she worked with women who had mastectomies. So she was in fact, doing family and sex therapy with couples where they had been cancer. And I was teaching with somebody at Lehman College who wanted to be trained as a sex therapist. And I sent her to my mother at Cornell to be trained. And I can actually say I'm the only woman in America whose mother taught Dr. Ruth everything she knows.
Rena: Very cool.
Dr. Georgia Witkin: Exactly.
Dara: You learn something new every day.
Dr. Georgia Witkin: So I learned from my mother that number one when she said, You know, I'd like for a week in the hospital for nothing very serious she really knew what she was talking about because she had been in the hospital. But she said as bad as all of those cancers and surgeries were those maybe were the only times in her life the way she had been living her life where she really felt taken care of instead of taking care of everybody else. So I'm saying to everyone, you don't need a week in the hospital, you know, take care of yourself. As we've been saying now, before you feel like Oh my God, I Just have nothing left. Four Ds.
Dara: We've kept on going back into self care, and I think it's really so challenging for women. And remember, it doesn't have to be anything that you know, a lengthy of a stay but taking time for yourself.
Rena: So important.
Dr. Georgia Witkin: You know how when you get good news, you say, I'm never gonna sweat the small stuff again, right?
Dara: And then you sweat the small stuff?
Dr. Georgia Witkin: Oh my God, I’m never, never gonna let little things bother me and then generally yeah it takes about 40 minutes, the research says before you're letting little things bother you again.
Rena: That’s it?
Dara: That makes me so sad.
Dr. Georgia Witkin: So my family with all my mother's cancers you know, she really did not sweat the small stuff because she really learned. And I'm saying, if you're going through anything like a fertility journey, that part of the good thing you're taking away from it be your perspective that there really is a hierarchy of things that matter and If you're going through a journey like this, don't let the small stuff also come at you. And don't sweat the small stuff.
Rena: No and I think in life in general, right?
Dr. Georgia Witkin: Yeah.
Rena: Try and not let you know that the small stuff right? Bother you. Just big picture. I think try and you know be grateful and it goes back to mindfulness and gratitudes and in the moment, you know, life is too short to sweat the small stuff. So I guess I mean there’s so many things I could talk to you about and I think we will definitely have you back on.
Dara: We have to have you back.
Rena: To discuss more. There’s so much we could go all day.
Dara: You have all these books we need to discuss. Each one of them.
Rena: I Know. All 13.
Dara: And your blog.
Rena: Yes. So much. But I think for today we’ve covered so much we want to have the listener digest everything and write in with questions and everything. So normally how we end our podcast it to go around and do a gratitude. So what are you grateful for today in your life in general, so tell us, Dr. Witkin, what you are grateful for?
Dr. Georgia Witkin: I am grateful to be here with the two of you and being surrounded by so many women in this practice in my life, my research and the two of you who really make it clear that as human beings we are special.
Dara: You took the words right...
Rena: I feel like every session everyone’s gratitude is similar
Dara: I think we’re also all on the same page.
Rena: Yes, grateful for women. But I love that.
Dara: Like, women in my life and, you know, I always was close with my mother, my grandmother. But to you know, the older I get, the more I realize there's so many wonderful people surrounding me. You know, whether it's in work, whether it's in my social life, with my Children's lives and the power of women and uniting and supporting each other and reminding ourselves to enjoy ourselves. Whether it's in a group or by ourself,
Dr. Georgia Witkin: No play, play together, which is great. We can laugh together. We email each other jokes guys wouldn't even get. It's just so special.
Rena: Yeah, yeah, same similar vein. You know I'm so, you know, raising a daughter. And you know, my mom is a huge part of my life and my daughter's life. And just being grateful for strong, powerful women and to show my daughter you know, I want her to grow up and believe she can do anything.
Dara: She will.
Rena: So so grateful for that. And Dara and Dr. Witkin thank you so much
Dara: Lots of love
Dr. Georgia Witkin: Thank you for inviting me. I love it.
Dara: So happy to have you.
Rena: Yes we will have you back for sure.
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 @fertility_forward. And if you're looking for more support, visit us at and tune in next week for more Fertility Forward.

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