Ep 15: Behind The Scenes at a Fertility Clinic - Real Talk with Margaret Daneyko
Fertility Forward Episode 15:
Margaret Daneyko currently serves as our Director of Nursing and Clinical Services at RMA of New York. With her 25 years of experience in women’s health, she is an expert voice when it comes to fertility-related operations and care. In this episode, we look behind the scenes at a fertility clinic, discussing empathic burnout and other challenges fertility nurses face; improving patient care; and the awkward waiting room setting. Almost every little girl dreams about becoming a mother one day and never questions whether that would be possible, yet fertility clinics help countless women who face the reality of infertility. This process can be overwhelming, but patients must remain open to all possible avenues that may lead to the desired result.
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: Margaret Daneyko currently serves as our director of nursing in clinical services, at RMA of New York. She has spent 25 years in the field of women's health. In this episode, we look behind the scenes at a fertility clinic, we talk about empathic burnout and other challenges fertility nurses face and we talk about how to improve patient care and the awkward waiting room.
Rena: Okay, so thanks for tuning in again this week and we're so happy to have Margaret Daneyko here who full disclosure is my boss here at RMA so I’m a little bit nervous.
Margaret: No need, no need to be nervous.
Rena: Margaret is our director of nursing and clinical services, and I think you know she's gonna share a lot of awesome, useful information today about kind of what goes on behind the scenes as an infertility nurse.
Dara: So let's get it started.
Margaret: Okay, so this is great. Thank you for inviting me. This my first podcast.
Dara: There’s a first for everything.
Margaret: Should be fun. So, yeah, just a little bit about meI have been in the fertility world for almost 20 years. Oh, my gosh.
Rena: Well it doesn’t look like a day over 5.
Margaret: And I've always been a women's health nurse. I started on labor and delivery. So, childbirth, you know anything to do with women's health I've been extremely interested and passionate about. And about 19 years ago, I made the switch over to fertility. Started out from the bottom, kind of worked my way up to where I am now. And I have to tell you, it's one of the most rewarding things that I get to do in my life. You know, working with all of you is an amazing experience, because what we're looking to do here is to provide you with that experience of bringing home a baby. So...
Rena: So when you say you you mean patients?
Magaret: Meaning the patients, yes.
Rena: Not the staff.
Margaret: Not the staff. No, I’m talking about all of you, the patients out there who are hopefully listening in. So So
Rena: So you find it really rewarding?
Margaret: I do, I do. And you know one of the things that I always have spoken to my patients about is that you know, as little girls on this even goes for our men out there as little girls. You know, when you're growing up, you know, one of the things that you think about is growing up and having babies, right? Never did we ever think that you would be in this position and have to really work hard at it. And when someone tells you that you can't do it the way you always thought you could, it becomes very stressful, and that's why we're here. I mean, that's why Rena’s here. And that's why Dara’s here. Because we want to make this an experience for you that you will be able to handle appropriately and make sure that you have all the tools that you need. You know, one of the things that I like to hammer home with my staff is that you know, be that patient, be that person and understand everything that you can about her and know what she's going through and help her along that journey.
Dara: I love that. I think that as a nurse the way I view nurses, they’re like the heart of everything. They show, the love, and the care, and compassion. Um, that I think is so important.
Margaret: It is. It's one of the main things that when you're in nursing school that they do want you to bring home. Is that you know you are the patient advocate. You're the one who's here to hold your hand and take you through this process. And the nurses here I find are phenomenal that way. Many of them keep pictures that you send of your babies that they've helped you through this journey. And I love looking at all these pictures. And I always love hearing the, you know, the success stories, but also the stories that weren't so successful because now we want to make sure that we're gonna focus, you know, maybe do something different. Or maybe and, you know, bring in services that we have to offer here, you know, see what we can do to make you be part of that, that story.
Dara: That's great. Margaret, I feel like it must be so challenging to you know, I'm sure you take home a lot of the stories and the experiences with you at the end of the day. How do you deal with it?
Margaret: You know, it's very it's very hard to when you asked me that question because I have over the years dealt with many, many women, all ages, you know, at all different stages of the process. I mean, just one story that I always love to tell is that, you know, I spent a lot of my time in third party. So I worked with a lot of the patients who needed a donor egg or a gestational carrier or donor sperm through the process. And, you know, that is a whole nother level to the whole fertility journey that you’re all on
Rena: Sure and I’m sorry I just want to interrupt incase our listeners didn’t get that. So we call our at RMA we call Third Party, you know, the team that works with donors, so donor egg, donor sperm. So when we say Third Party that’s what we’re talking about.
Margaret: Yeah. Thanks, Rena. So I had this one woman who she was 46 and she had finally with donor egg she had a beautiful baby girl, just she was so excited. And this was a woman was a career woman, worked hard every day and she called me and said, I want to come and bring the baby to show you and that that's the best part is when is when you come and you show us the baby and it's just like you know, it still brings tears to my eyes, you know? So she came into the waiting room and the waiting room was crowded and I went out and I'm looking for her and I didn't see her until finally she stood up and she waved at me and she was not in her career clothes. She was like in sweat pants and sweats. And she comes over to me and she says, I just want to thank you so much, she said, for bringing you know, this little bundle here she goes. But I have to tell you, why didn't anybody tell me how hard it was? And I looked at her and I said, Yeah, it's hard, she goes. But I wouldn't change anything for the world. And, you know, just seeing that expression in her face and, you know, seeing her with her child. It just really meant so much to me because we had worked so hard to get her there. So there's so many different avenues to take in this process. And I think it's important that everybody be open to the different…
Dara: To their own journey.
Margaret: Exactly. You know, there's nothing set in stone, and you know there's there's definitely many ways to get to that end result. So you want to keep open minded.
Rena: Sure, sure. I think you know, we've talked about that, you know with some of our other guests before about, you know, everyone kind of grows up, and I think, Margaret, as you touched upon, you know, women feel they grow up, they want to have kids, and that's their picture. And sometimes it's about reframing that if you see you know it's not gonna get there with, you know, the picture you saw, you know, with a partner in the biological child, whatever it is, you know, some people get there by themselves with a doner and it's about refraining and being open and shifting your your thinking. And you know this process can be really hard, but they're always there's so many options, and could take you in ways that you never really thought
Dara: Margaret, take us through a typical day. What do you do?
Rena: Well I can say I know that Margaret gets up at 3 in the morning to come to work.
Dara: Oh wow!
Margaret: Actually 3:30. 3:30.
Dara: So you start early?
Margaret: Yeah, I live far away, so I want to be here at seven o'clock when the doors open so that I can be here to address any one of the patients that come through that may have questions. And then to also be here for the staff to make sure that if they have questions, they need help with anything. You know, I like to do rounds through the office, say good morning to everybody. So, you know, if you're in our waiting room, you may see me walking around saying good morning. And if there's anything anybody ever needs I’m pretty much always here at seven in the morning and then once monitoring is over, you know I am, you know, working on different projects, things that are gonna help make your experience a little bit better here I will work with the recovery room and the O R. Nurses to make sure that your experience in the O. R is nothing short of exceptional. We really like to pride ourselves on excellent patient care. So that's my main goal throughout the course of the day is what can I do to help make your experience better? You know, I do, I do a lot of work with the physicians. I do work with all our complimentary services with Rena with Dara, with Dr Witkin. You know, I, uh, speak with all the teams, all the make sure if they have any questions about anything, so I kind of do a little bit of everything.
Rena: I feel like Margaret is like the wizard of Oz.
Margaret: But I enjoy it, it’s definitely a lot of fun.
Rena: And I think it’s great and I think one of the things that I think RMA does so beautifully is how you know each doctor really has a team. So if you're with a doctor, you have one consistent nurse, a coordinator and I don't know a lot of other clinics that are run like that. And I see you know, as I collaborate with teams and my patients, they really they really they really respond to that. And people get very attached to their nurses. You know, you come in every day for blood draws, you know, it's a comfort thing. You see a familiar face. You know, our nurses are so great at responding. Everyone here, really, you know, doesn't really work 9 to 5. It's really kind of, you get to know someone, you become involved. And, you know, I think we're all very responsive out of the office too. And you know, Margaret, I'm wondering, too, how is that gonna play a role in what you do? Also, you know, managing kind of staff burnout because it does become a lot to be compassionate all the time. And is that a big part of your job too? Managing staff and, you know, empathic burn out. Do you see a lot of that, too?
Margaret: Yes, of course. A lot of my nurses will come to me and say, you know, they're they're been working with, you know, a lot of patients who are having a difficult time and a lot of the times the nurses will then, what’s the word I'm looking for…
Margaret: Internalize, exactly, what's happening, and they bring it home so they'll come to me and, you know, we usually sit down, we talk about it. I'll tell you know, maybe you should take a little bit of a bright go for a walk, clear your head, do things like that. Because at the end of the day, you know they do want to be able to get back there and give you, um, the patient, what you need from them and, you know, they will smile with you, they'll laugh with you, they'll cry with you. They go through the whole journey with you and that same holds true for the coordinators. I'm sure the IVF coordinators, they are the ones who are prepping you for this journey. And they are the ones who are holding your hand up until the time you do start to take your medications. And so those are things that I like to work with the team with and making sure that they have the tools that they need so they can give you what you need. So I mean, it can be difficult at times, but, uh, you know, we figure out ways to to get.
Dara: Support each other.
Margaret: Exactly. That's the big key and what Rena was talking about about the team approach, what I like to say about that is that each physician does have their own team, but we also have the global team which is RMA. And so you're underneath that umbrella. So if for some reason your nurse is on vacation or away there's always somebody there who's going to be a backup, who's going to be able to follow up for you. Same thing with the coordinators or the physicians. We’re also very collaborative. You know, we work with, um, you know, Dara from the nutrition aspect and we work with Rena. If you know you need some extra support we work with, you know, outside vendors. If there's something piece of equipment that we think is gonna help your journey be better, we'll work with that. I mean, it's just it's an extremely collaborative environment. We have our fellowship program where the fellows who are, you know, very involved with research and that research helps us provide better care for you. So I think overall we have the global team, but then you have the individual teams as well.
Dara: The collaboration and communication is so essential and myself being a patient here years back, I got to experience that from the other side and I never felt like I was a number. I felt like I had a name and people knew who I was and yes, working closely with one or a couple specific nurses really helped ease some of my worries, know that someone was on my team to support me which was nice.
Margaret: That's good to hear. And that's so important. Because if you think about it, you know anything that we do that we're not familiar with that you know, we need someone who's gonna guide us through that and make sure that we understand everything every step of the way. And, a lot of what happens when you're going through this process is that you lose control. You know, many women, most of us, I think, are very much people that like to be in control of things. You know, we're trying to do six different things at once in our lives and now we've taken that that piece has been taken away from us, so we have no control. And so I think that's why sometimes it's important that that team just be there a little bit more to help guide you through the process, because we want to make sure that you are feeling some sort of control over your care on. And that's one of the things that I like to also work with the nurses on is, you know, it should be a joint process where the patient and the nurse work together. There's accountability on both sides, you know, and as providers of healthcare, we want to make sure that the patient that we're accountable, but also too, we want to make sure that our patients are accountable for their care. You know, they definitely have a voice. And we want to we want to hear from you. We want to hear that, you know, that you're taking control of part of what's going on because in the end, you know, the outcome is what it's gonna be.
Rena: Sure and that’s something you know, I work with patients on a lot, is coming up with plans, you know, option a option B, option C and I say, Okay, you you come up with your your plan and your options. You know that's in your control. Come up with a column, come up with a viable plan to go through everything down to how you're gonna afford it, how it's gonna fit into your lifestyle. You have a trip coming up. What is the timing, and that really helps people to feel more in control and helps them take a step back and say, OK, sure. This is my choice, you know, tell my nursing team look, you know these dates and these dates, I'm going on this trip. It's non- negotiable. I'm not going to be here. How could we work around this? What is my timing? And to help people see, You know, they do have a voice in this process.
Dara: And it's okay to ask questions.
Dara: And if anything, I feel like the nurses really do encourage
Rena: Oh sure.
Dara: Anything that you're that you don't know about or have any concerns, let us know. Because if that's gonna help decrease those stress levels, we want that.
Margaret: Absolutely, you know, questions. In my book, you can ask a million questions, a million different questions. That just means that you're engaged, you’re focused, that you really want to know all about this process, you know? And then, you know you turn the tables. If you keep asking us the same question that I need to go back to my staff and say, Hey, why aren't you communicating this information to the patient that they understand it you know, the first time that you say it? Why are they needing to ask this question over and over again? So it definitely is a joint process.
Rena: Yeah, I think it’s great here, the email access is wonderful and you know, I get a lot of patients who say, Oh, I wanted to ask this, but I was scared. I don’t want to bother anyone, and I say, No, no, it's not a bother this is so helpful, you know, that's what we're here for.
Dara: This is what we wanted to do.
Rena: Yes. We want to hear from you, ask questions, or we won't know. But I think it's so important. And, you know, I think I'm thinking back to my time and treatment, and I always wondered. Okay, where do these nurses go? You know, they come out, they get you there in the white coat. What? Where did they disappear too? And I think it might be helpful for our listeners to hear….
Dara: Behind the scenes.
Rena: Our nurses here, you know, they sit there in cubicles. You know, some people have standing desks. We're all next to each other, you know, they're taking calls. They're wearing regular clothes, talking about shoes. You know, if they're not on the phone, if they need a little break and they're they're real people, you know, they sit. It's an office setting. And it, you know, they're on the computer looking at charts and results, and that's where they go, you know, And I think it's so funny, at least to me, to think that's where they're sitting in a real kind of office setting.
Margaret: Right. I mean, the thing about it is, what's the type of setting that they're in is that they are able to turn to their coworker and say, Oh, you know what? I have this patient and she's not responding to, you know this medication, What do you think? And, you know, we always bounce things off of each other as well as the physicians. The physicians are very accessible in the sense that they are there, you know, they come in to where all the nurses are sitting, and they're you know very much about teaching they’re very much about making sure that they’re understanding everything that they're telling the patient and it just creates a very nice environment and then, you know, hopefully you know, now in turn rubs off on what they're talking to you about it and making sure that you understand. You know why we're doing the things that we're doing. But that's that's a good question. Cause sometimes I think about that when I go to other offices, you know, like where are they going?
Rena: Right. You know, it's just, you know, kind of an office and, you know, collaborating. The doctors are there, real people.
Margaret: You know, it is it can be really scary. There's no question, you know, you walk in, there's a ton of people in the waiting room and it's overwhelming.
Dara: It can be for sure.
Margaret: Absolutely. But we want to make sure that we're making it as not overwhelming as possible, you know.
Rena: And you know, that's something I’d love to hear, you know, listener feedback too. You know, write in, DM us on Instagram, email us. What would make it a better experience or less overwhelming for you to come sit in the waiting room? You know what would you like to see? What would make that better…
Dara: Or on the flip side, what does worry you? What’s the first thing that worries you when you come to an office and how can things be different?
Margaret: Feedback is so important.
Rena: Yeah we’d love to hear that, really curious to hear your responses on that.
Margaret: A lot of the times, you know, we send out surveys and our patients give us feedback. And when I call the patients, one of the first things I say to them is, You know, I really appreciate your feedback because your feedback enables me to go back to my staff and see how we can do things better for you.
Dara: Make those changes.
Margaret: Make those Changes, so you know, don't don't hesitate. You know, if you think that maybe we can do something better.
Dara: We're here for the patients to make their experiences as positive as possible.
Margaret: Absolutely no, it's, uh it definitely gives me a lot of pleasure and happiness, to see, people get discharged to their OBGYN and they're so excited and they walk around with their pictures, and you know, that's the ultimate goal here, and whatever we can do to make that happen and we're going to do that.
Dara: So, Margaret, it's changed. You've been here for quite some time. You've been at RMA. You've been a nurse in this realm for quite some time. How have things changed over the years and also, what would you like to see change down the road?
Margaret: That's a good question. Well, what I've seen change obviously when I first started in the fertility field, you know, we were doing day three fresh transfers. You know, there was no day five blastocyst there was no such thing as PGT. There was no such thing as, you know, freezing all your embryos.
Rena: Just for our, can you just tell our listeners what’s a day 3 vs a day 5?
Margaret: Sure so a day three embryo is, um, the third day after the egg is retrieved and fertilized. On Day three is when we would put the embryo back and do a transfer. And And when I first started, 99% of them were fresh. I want to say 99.9% of them were fresh. So you had your retrieval and..
Dara: It was always day 3?
Margaret: Right. Always day three. And then over time, we moved to day five and then over time, we moved to being able to test the embryos. And that technology has changed tremendously over the years. It's you know become very sophisticated, and it continues to become very sophisticated. You know, we’re able to take just a few cells from the embryo, send them off to a lab to be analyzed and we can determine if that embryo is a normal chromosomal embryo.
Dara: And what day is that usually that they do that?
Margaret: It’s usually day five or six. Sometimes sometimes they will go to day seven. But it's usually day five or six where they will take a look at the embryos. They will biopsy just a few cells. And I think some of the misconceptions that the patients have is that they take the whole embryo and they send it to this lab.
Dara: And hope everything is OK.
Margaret: What happens is there are you know, tremendous embryology staff who are just, you know, very skilled technicians are able to just biopsy a few cells off of the embryo not doing any harm to the embryo. And they send those cells off to the lab and then they freeze the embryo. So it is there, and it stays in our facility. Those cells go to the lab, the lab will then test them, and then send a report back and let us know which ones are euploid , which means that they're chromosomally normal or aneuploid, which is they’re chromosomally abnormal. And when they come back, then your physician or your physician team will let you know how many of your embryos are normal versus abnormal. And then they'll set up a plan for you now to do a transfer and you will do a frozen embryo transfer cycle. But that's one of the main questions I get is Well, what do you mean? My Where's my embryo?
Dara: It’s frozen!
Margaret: And it doesn't leave our facility. It’s safe here in our lab until you're ready to use them.
Dara: So frozen on day seven approximately?
Margaret: Well, day usually day five or six. Yeah, sometimes day seven, but day five or six, yeah,
Rena: So what are the stats on that? You know, I get patients. You know, I'm sending out 10 embryos. How many are gonna come back?
Margaret: Well, that totally depends on a number of criteria. It has to do with the patient age. It has to do with the quality of the egg, the quality of the sperm. Those are all factors that your physician will speak to you about. And there's always attrition. It doesn't matter how old or how young you are. You know you can be 30 years old and send out 10 embryos for biopsy, and only four or five of them are normal. If you're 40 years old, you may only have three embryos to send out. Maybe one of them is normal, but maybe all three of them are abnormal. And then there's everything in between, and there's no given formula for that. Each person is individual, and their outcome is gonna be individual. And those are all things that your physician will speak to you about based on your results.
Dara: And also, for each cycle, it would be different for each patient.
Margaret: Absolutely every cycle. You can have one cycle where you have 12 eggs and one cycle when you have 4. So you know you have to remember we’re dealing with human bodies. It's not an exact science. Would we love it to be an exact science, of course, but it's not so that's why there's different protocols, different ways of doing things, because if something doesn't work one time than our physicians, you know, they're always researching, always looking at maybe a different way to do something. So that's why it's so important that you keep the communication with your physician.
Rena: Oh sure. And I know you know, for myself. You know, I, you know, did IVF and I went through back then called PDT testing, or no when I did it it was PGS when I did it a long time ago not that long but science you know moves very quickly. But, you know, waiting for the results on that was very difficult, you know, waiting for the call, How many embryos do you have? And I, that my patients now and that wait time is very tough, you know, just waiting. You know you go through the process you do everything, all the injections, the retrieval and then well am I still gonna have anything at the end? And that's a really, really tough time mentally because you sort of feel like there's nothing you can be doing. You're really just waiting. That’s a very, very tough time in the process.
Margaret: It is and that's where you usually encourage people to, you know, go do something that is gonna hopefully take your mind off it. You know, maybe this is a good time to take a vacation. Maybe you want to you know, go visit that museum or something you want you've been wanting to do like don't put your life on hold. Try and do some things to keep your mind off of it until that time frame comes. And the same holds true for that time frame between the transfer and the pregnancy test. That two weeks can be the longest two weeks of your life. But if you try and focus on doing something that will keep your mind off of it, then we definitely encourage it instead of just like...
Rena: You know, a lot of people always say, Well, I think I have to be doing something. I don't know how to kind of live without feeling like I'm doing something for this process. And I say, Listen, you know, say you’re in school. You have a free period. You know you have a free period. You're still in school. Take the free period. You're still here. You're still in the process. Think of this as you’re free period. You haven't left school. You haven't left the process but who doesn't want a free period, you know. Go, take this time, do anything. And people sometimes you know it's hard for them to do that and so I try to encourage people. You're still here. You're not not doing something. But, you know, take this, you know, given break. It's a gift.
Margaret: Right. Enjoy the time where maybe you don't have to really think about it too much because there's really nothing you can do. It's out of your hands. It's out of our hands, you know? So definitely it's a good analogy. Free period.
Rena: Free period, spring break, lunch, whatever.
Dara: So, talking about things to take your mind off of you know, things to do that make you happy, what do you do on your day off that brings you joy?
Margaret: My dogs! I love my dogs. I have two dogs. And my grandson and then soon to be second grandchild. They give me happiness, but yeah, I mean, you know.
Rena: She answers my text messages on the weekend. Margaret I’m really sorry to text you on Saturday but I just have this question.
Dara: Here I’m thinking you wake up so early, I hope you go to bed...do you go to bed at a…
Margaret: No. I go, it's really hard because by the time I get home and then, you know, I want to unwind and if I want to try and work out, which, you know, I try and do. And then, you gotta clean and then, you know, gotta spend some time with the husband so…
Dara: Not enough hours.
Margaret: Never enough hours in the day but yeah, but I enjoy I love going home to my dogs, and they are definitely happy all the time. So they keep you uplifted for those you who are dog people.
Rena: Well, you know, I have to say I think for so many people here, Margaret really is kind of this, like Mama Bear figure. She is the most caring, warm, person. She takes care of so many people, and I think, you know, RMA, the patients, the staff, everyone is so lucky to have Margaret. I think, you know, really never, you know, come across someone who really genuinely cares so much about people's well being. And I think it's so wonderful. And, you know, I always love finding other people in the world that really, truly, genuinely care. I think it's hard to find.
Margaret: Thank you.
Dara: Care about the staff, care about the patients. We're very lucky to have you.
Margaret: Well, thank you. I'm lucky to be here because it's a great place and we really strive to do really good things for our patients.
Dara: So Margaret, we typically end our podcast with a gratitude. So going around, just letting everyone know what you are grateful for today at this very moment.
Margaret: Oh, wow. I don’t have enough time.
Dara: It can be something simple.
Margaret: I just think I'm grateful for good health of myself, my family and my friends. You know, I think that's the most important thing that you can you can have in life right now. So...
Dara: What about you, Rena?
Rena: You know, I think it goes back to sort of what I said about Margaret and being grateful to find other people in the world who really are just so genuinely kind and doing that. You know, I really try and practice, you know, random acts of love and kindness. And someday I’m better at that than others. If I’m cranky I won't hold the elevator for you. But I think you know just being grateful for really kind, good people and finding that in the world. Dara?
Dara: I am, there's lots that I'm grateful for. But at this very moment, as Margaret mentioned about collaboration here, I am so lucky and fortunate to be here to be able to collaborate. I worked by myself before in private practice. But there's something to be said about working in a team, bouncing ideas off each other,having Rena right next door if I ever have any questions. Or need to take my mind off of what I'm doing. Just having that really good support system here. It's great for the patients, but selfishly, it's great for me as well. Thanks for being here, Margaret.
Margaret: Thanks, ladies. This was fun. Thank you.
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 www.rmany.com and tune in next week for more Fertility Forward.