Posted on December 3rd, 2020by RMANY

Ep 40: How to Overcome Stress For the Holidays

Fertility Forward Episode 40:

Going through infertility treatment is already a stressful experience for many patients and, at the time of a global pandemic, the emotional burden is likely even more difficult. In today’s episode, host Rena Gower is joined by Dara Godfrey, nutritionist and Registered Dietician at RMA New York, and Dr. Kimberley Thornton, a reproductive endocrinologist at RMA New York, who share their perspectives on overcoming the upcoming holiday stress brought on by infertility and COVID-19. Listen in as the panel discusses some coping mechanisms for this stressful time, including having a pre-prepared cocktail conversation response, just saying no, and being kind and gentle with yourself, as well as some practical tips, such as indulging mindfully and focusing on progress rather than perfection. It’s okay to seek help when you’re overwhelmed and it’s important to listen to your body, but it’s also helpful to practice gratitude and use the holidays to rest and recharge. Rena also goes through the five main tenets of positive psychology, which have been proven to shift thought patterns and foster a more relaxed state of mind. Tune in to find out more about how to overcome holiday stress, practice self-care, and tackle the mental and emotional aspects of infertility treatment that are often the most difficult for patients – and remember, infertility causes stress. Stress does not cause infertility!

Transcript of Episode 40

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 from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.
Rena: I guess so I'll introduce myself. So I'm Rena and I am the social worker at RMA. And then on this panel, we also have Dara Godfrey who is our nutritionist.
Dara: Hi everyone!
Rena: And Dr. Kimberley Thornton who is a reproductive endocrinologist. So I'm so happy to have the three of us together to dialogue about this. I know the holidays are super stressful and hopefully this conversation will be helpful to navigate the holidays on both pandemic stress. And if you're trying to conceive on your fertility journey.
Dara: Dr. Thornton let's start with you. I'm sure you have met with a lot of patients recently. Have you noticed a lot more anxiety, especially with the pandemic?
Dr. Thornton: Yes, definitely. You know, this whole fertility journey is I think distressful at baseline. It's a lot of loss of control, a lot of not knowing what's going to come next. And that's why so many people going through infertility treatment really do suffer from stress, anxiety, even depression rates are really high. And I think then you throwing in a pandemic on top of it, it's a whole other level of stress. People are worried about, you know, what does this pandemic mean if I become pregnant? For pregnancy, what's going to happen? If the city shuts down or the country shuts down and I'm in the middle of treatment and so it's definitely really valid concerns and it's a really difficult time for, I think everybody, but I think in particularly for patients going through fertility treatment.
Dara: And then there's interesting, there's another level of anxiety over the holidays. So like on top of fertility, on top of pandemic, you know, the holiday season is often fraught with that added dose of, of stress. So that can be even more overwhelming.
Dr. Thornton: Yes, definitely. I think this year is probably a little different, although some people I'm sure are still seeing families. I know a lot of people are separate from their families, but sometimes it's really great to have that support system. And sometimes it's a lot of, you know, not. Most women going through fertility treatments still actually don't talk about it. So a lot of times their friends and family still don't know. And so it's kind of amazing that one in eight couples have trouble trying to conceive or have difficulty maintaining a pregnancy, meaning they may have recurrent miscarriages yet it's a taboo conversation. And so holidays, getting together, seeing friends, family, or even if it is just via zoom this year people may not know what's really going on and you have that, you know, aunts and cousins being like, well, when are you going to have a baby yet or not realizing that that's can be actually really hurtful statement. And so I think it's definitely a little bit more, uh, stressful time than normal. And I know we're gonna get to, you know, with Dara and Rena, all you guys later, but, it's also food, there's more sweets and desserts and you're worried about eating healthy for, you know, getting pregnant and for pregnancy. And so there's just all these temptations and all these stressful events to encounter. And it's really difficult for patients to really feel and how to navigate that.
Rena: I love that you brought up you know, friends and family, um, being together and asking when you're going to conceive, because I know that's something, my patients are always really stressed about. How do I navigate that? Um, you know, whether it's at a social situation or even on zoom, you know, I think now we've been in this sort of zoom culture for a long time now, and people are asking's permeating zoom conversations too, you know? When are you guys going to have a baby? Oh, pandemic perfect for trying, you know, you guys have been together for so long. And so I always work with my patients on having what I like to call a cocktail conversation response. So that's just a one-liner that you prepare in advance that you think about, okay, how am I going to respond? If someone asks me, um, when, when are you having a baby? Okay, what am I going to say? Is it, you're going to say, well, you know, we're taking this year to travel? Eh. Not really so much right now. But, or is it, you know, we're taking this year because we are super busy in our careers or we want to save for a house or, you know, we're just not ready yet. Whatever that answer is for you, a one-liner that you can say, you don't have to think about it, cause you've already prepared it, that kind of shuts down the conversation. And it's not running away. It's not lashing out. It's not breaking down crying, you're giving a coherent response and then that's it. You can kind of walk away with grace and dignity. So that's something that I definitely recommend to people to prepare in advance if you are nervous that you're going into a situation where someone's going to ask you when you're having a baby. I love that you brought that up.
Dara: It is. I also wonder because it's a different type of holiday season than we're used to having in some ways, if it's easier to say no to get-togethers? And in some ways it could be somewhat easier to navigate around that. Have you seen that in terms of your patients, Rena?
Rena: Well, you know, I love of course that you bring up saying no, because I feel like I've learned that from you. You give me permission to say no, be it with personal stuff, work stuff, whatever it is to have the permission to say no and realize, okay, this isn't going to serve me. And if I am there, I'm not going to be my best self. And therefore my energy is not going to be good and no one is going to benefit from that. Um, and so I love that. And I think it's really honoring that and realizing you can say, no, you don't have to show up to every zoom thing. If something isn't comfortable for you because of the pandemic, you just say no and that's okay. It definitely comes up with my patients. What I work with them on beyond the permission to say no, once we've done that is okay, you're going to say no, but again, back to this grace and dignity thing, how do you then make it acceptable so you're not burning bridges. So if you are saying, no, it's not like, no, and you're slamming the door in someone's face, catch you later. I hate you for even inviting me because that's not cool. So do you say no and then you send a gift in your absence? You know, do you say no and you make up a reason why, you know, or tell them why, even if it's just honoring your feelings and saying, Hey, I'm so sorry. I'm not going to be able to make it. I just, it's too much for me and I don't think I'm going to bring positive energy. That is totally okay to say and most times people respond really well to that authenticity. So again, definitely saying no and then making sure that you're doing it in a way that you're not going to have ramifications later because you burn a bridge. So I think that's sort of the thing to remain really mindful about.
Dara: I think also sometimes not making long convoluted excuses. Sometimes just having a very simple answer and being kind and graceful and saying, thanks so much for the invite. This is just not the year that we're going to come to, but we appreciate it. And let's, let's touch base next season and see if we can get together. Some, sometimes you don't have to have a whole long list of excuses that sometimes can actually be more hurtful.
Rena: Just say no, and that's it. End of story, you know, ownyour truth and that's okay. So I love that.
Thornton: Dara,something I keep getting asked, which is really up your alley of expertise is how, you know, what are tips for eating during this season? It's a really, really hard time. There's a lot of sweets and candies and things around, and I know everybody wants to put their best foot forward for fertility. But how do you, what kind of tips for managing that? At the same time you know, everybody deserves a little bit of a splurge, you know, to enjoy. So what, what tips do you give?
Dara: I have a lot of tips that I typically suggest, but part of it is, is not, I think it could be quite overwhelming or people think the holiday season can be quite overwhelming, but it doesn't have to be. I think part of it is not being so hard on yourself. I think when you go in thinking it's going to be not great, that can often manifest, I think going in and being open-minded and saying, this can be okay and I don't have to avoid all of those foods that are seasonal, that happen once a year and actually enjoy those foods. But I do think having some sort of a game plan, similar to Rena, like going in with a couple of ideas and, and to help set you up more so for success. And part of it going in with that game plan is number one thing that I tell all patients is do not go into any holiday event hungry. So I see this time and time again, you know, after I speak to patients, how did it go? How did the holidays go? And the first thing they say is I ate so much food. And then I, the next thing I ask is, so what did you have before you went into the event? And more often than not people say I didn't have anything because I knew what was going to be eating a lot for that meal. And I think a great strategy would be to not go hungry. Have a normal breakfast, have a normal lunch if your event starts in the afternoon. If your event starts in the evening, have a nice protein, rich afternoon snack. So you're not going into that event hungry. It's kind of like, you know, not having, not going on an empty tank and it doesn't have to be anything crazy, but I like to focus on protein and fiber rich meals leading into the holiday season. The other thing is water, hydration, which I think is such a simple thing, but it can often get lost, especially if the holidays are over the weekend or of course on the days that are less structured, you're not going to work on the holidays. And so we often forget about drinking water, drinking two cups of water for every single meal can be helpful. And, you know, depending some patients choose to drink alcohol during events and whatever their choice may be, don't forget to stay hydrated. I typically suggest one to two cups of water for every alcoholic drink. But let's talk about the actual meal, cause I think that's what people really want to know about. I'm not about avoiding those holiday foods that you really have once a year. I'm all about going for them, but surrounding those foods with other nutritious foods. So if you're going to a buffet, scan the buffet, look for some vegetables, look for some protein, fill up half of your plate with vegetables, a quarter with protein and leave that quarter for whatever you want. And I think knowing that you can and should go for those holiday foods, you know, it, you're less likely to binge. So I do think it's important to, to, to go for those foods and enjoy it, but also eat them mindfully. And that's something that, you know, Rena and I discuss all the time, the importance of mindfulness,of slowing down and realizing that sometimes we eat things out of excitement and we don't even actually, you know, sit down and enjoy each bite. So slow down, there's nowhere to be. And I, when you actually slow down and take the time to eat those foods that you like, you actually can be more satisfied a lot sooner than you would think. So the other thing is also honoring your fullness and that doesn't mean eating until you're stuffed but actually when you slow down and you actually are paying attention to the delicious food you're eating and the wonderful company, hopefully, that you're having, you can actually notice when you are satisfied. And that can mean, you know, trying to make a meal last 20 to 30 minutes because it takes about 20 to 30 minutes for your stomach to tell your brain that you're done and honor that, listen to yourself. So indulge mindfully, honor your body, listen to your fullness. And then I think if anything, people don't realize it's not usually the actual meal, the holiday meal, that's the issue. As I mentioned, it's kind of the surrounding events, it's going in really hungry, but also not taking home leftovers. It's usually the days following that can often be the most challenging. You know, instead of choosing, you know, instead of making it one meal, we typically make it a breakfast, leftovers for lunch and dinner. I mean, I, you know, people often say that they'll eat all those leftovers for a full week after as opposed to enjoying it for that one meal. Anything on your end that you guys find challenging?
Dr. Thornton: I'm definitely guilty of that leftover pie for a week after.
Dara: I'm like, give it away, give it to, you know, family members, friends, you know, someone on the street. And if anything, people often don't like to waste it. So like, they don't feel like they want to throw it in the garbage cause they feel like it's a form of waste. But what I tell patients, it's still a form of waste. It's just a waste in your body after that meal.
Rena: I like that. But what about to, you know, I'm definitely, if anyone follows my Instagram they know my big weakness is granola. I will sit there and just sometimes I'll look at a bag and just be like, okay, I'm just going to eat you right now and I'm okay with it. And so I'll have patients tell me, they’ll talk to me and - Dara, I'm so curious to know the nutritionist-take on this - and they’ll say, you know, I just sat there and I ate an entire bag of chips or I ate 20 cookies. Or, and I say, okay, well, let's talk about it because I think there's such a link between, you know, emotional eating and so, okay. So let's talk about it. What was happening before, you know, were you triggered by something, maybe you got a call with not great results and that triggered you to then, you know, you wanted to,it's a void. And so, you know, people cope in different ways and sometimes food is totally used. So, you know, whenever a patient tells me that I say you need to be kind to yourself, let's look at the why, let's look at your trigger. But you know what, that's okay. You know, ok you ate a bag of chips. You're going to be fine and let's just honor that. And it's okay. And next time, if you recognize that you're feeling triggered, try to breathe, try to drink some water, try and honor your feelings and get through it. And okay. If you eat a bag of chips, you know what, there are worse things. So I'm curious from the nutrition perspective, what you would say, that's sort of my take as a mental health person.
Dara: I wholeheartedly agree with you. I wholeheartedly agree with you that it's, it's how we react to that situation. I mean, once you've already eaten something, I think the guilt and shame associated with it isn't great. And the reason why we often turn to food when we're stressed or we're happy or often when we're sad or bored,it's because it gives us that instant gratification without anything, anyone talking back to us. So I think part of it is, is learning to reflect and be, having awareness, realizing that we can't undo the past, but we can actually look at those moments and kind of realize, okay, this may happen again. If this happens again, if I'm in a similar situation, what are things that I can do non food related that can help,help me cope with the sadness, with the, with the stress, with the boredom. So, I mean, that's where I think we go hand in hand Rena that, you know, coming up with strategies, whether it's taking a deep breath. And I think, you know, and I say this with, with all patients is it's progress, not perfection. I think sometimes it takes time to get out of those old habits, like the holiday eating habits and you know, giving yourself some grace and kindness. And, but, but reflecting, reflecting and reframing. You can, you know, tell yourself horrible. Like I'm horrible for doing that. And that was so bad and I'm a bad person, but that's just harming yourself. Instead say, okay, that may not have been my finest moment, but you know what, it happened, what can I do next time? And even if you can pick yourself up a step earlier, instead of finishing the last chip, you throw it out, that's a step in the right direction. But in life, I think we need some of those challenging moments to learn from it.
Rena: And I think too, it's about sitting with it. So I always tell people, okay, if you are feeling that next time, let yourself sit with it because what you're doing when you're, you know, whatever your coping mechanism is, is that you're eating or you're having a drink or you're going for an intense run, whatever, it’s cause you can't sit with those feelings. So I say, well sit there. They're very uncomfortable. See if you can sit with your feelings and just see, because that's where I think the work really gets done is sitting with those feelings because as humans, you know, we tend to run away from what's not comfortable. So see if you can sit there and see what comes out, because I think that's where true evolution and growth happens. And then as you said, okay, if you still need to go eat the bag of chips, just do it. But this time leave one chip, that's a win. Okay, you're breaking your pattern, leave a chip. You know? So I think that's, um, super helpful and so interesting how the nutrition and mental health are really, really intertwined. I think.
Dara: Don't you think also being okay with seeking help, you know, asking people, you know, for support whether it's friends, family, you know, therapists, doctors, dieticians, I think also just being open. If you feel like it, it may be stressful that it's okay to reach out to people to get support and ideas.
Rena: Oh, sure. Well, I think it takes a village, you know, and that's why building it out is so important, you know? So you have people, you know, you can text this person if you're feeling this or that person for that, and really building it out so you have different people in your wheelhouse to reach out to for different things. And maybe that's a support group for infertility. Maybe it’s other people who are struggling with eating things or depression for that. I mean, really it's really important I think to build it out. And then that goes back to, I think, adding tools to your toolbox so, you know, okay, in this situation, I'm going to do that. So I think that's important.
Rena: I think for the holidays, like something, especially that comes up is especially for people who are together with, let's say families and people are like, well, I made this for you. Or, oh, you didn’t eat enough of it. You know, do either of you guys have good, I guess responses or how to navigate that cause I, I mean, I know, I think that that's really common in a lot of families.
Dara: I mean, I typically say, it's important to acknowledge and say, thank you. But you shouldn't feel pressured to have to eat it at that very moment. Maybe you do want to have it, but maybe you don't, you know, you've already eaten, you know, a pumpkin pie and you're satisfied at that moment. It's okay to say thank you so much. And you can even say something like, I can't wait to have it tomorrow. Whether you have it or not. But a lot of times, I mean, I know that's so typical of like a parent, like I made it for you. It's also okay to be open and say, thank you so much. It's actually not my favorite food. Like you can say, thank you, but I'm okay. Or, you know, it's okay to say no.
Rena: Yeah. I think like Dara said, you know, the attitude of gratitude is really important. And then it's okay to say, no, you know, you're going to have it tomorrow or you don't really care for it, you know, but thank you so much. It is so kind that you went out of your way to make that for me. So I think it's more, again, sort of, you know, the attitude of gratitude and recognizing that.
Dara: I think it's weighing in, you know, if it's more insulting to say a negative comment to say, thanks and move on.But if, you know, if it's a constant every year, I'm making this for you and it's something that you really don't love or maybe you like it, but it's not your favorite thing and it's just one other thing, you know, that maybe gives you more anxiety, you could always say ahead of time. I know you typically make this...maybe can we try making something else?
Rena: Maybe this year you’re a vegetarian and family members have been making you chicken for the past 10 years, you say, actually I'm a vegetarian. I didn't want to tell you, I didn’t want to hurt your feelings but maybe we could cook cauliflower steak? You know, I think it is, you know, honoring yourself and standing up for yourself and owning who you are. I think especially these days, people, I mean, it really runs the spectrum of dietary restrictions. You know, people are always on some diet or another. One year someone's gluten-free then there’s dairy-free, keto, paleo, whatever. And I think people at this point, you’re hosting, you're used to knowing. People just eat so differently now.
Dara: That's true. So I do think in the end of the day, it's not feeling guilty and shameful for wanting those holiday foods, but going in with a game plan, you know, in terms of having the right lines to say to your friends and family, not going in hungry, seeking support and guidance if you need it and really focusing on what it really should be about family, you know, it's, it's, it's a holiday it's about spending time with the people that you want to and enjoying the season or seasons.
Rena: Yeah. Dr. Thornton, one thing I would love to talk about, we can talk about coping mechanisms that I think will be really helpful for people is I get so many patients and questions about the lab closure in December and people, they say they didn't know it sort of, they feel, they feel shocked by it. So I'd love to hear from your perspective, like right from the mouth of reproductive endocrinologist, can you tell us the rationale behind this? Why the lab closes, what is happening? And then we can talk about how people can cope with that because I know it's something that's super upsetting when people feel like their cycles need a pause.So I'd love to sort of give people the real information behind this.
Dr. Thornton: So, you know, most fertility centers do do a lab like maintenance. It's really not closure. It's really maintenance timeframe. And in typically at RMA we do do it normally, you know, early, like end of June, early July and the last couple of weeks of December. This year, things were a little different with COVID so we ended up not doing that over the summer to kind of, for all the people that got delayed in the spring, but typically that's what we do. And it, and it's really the time for embryology to do all their, you know, like quality control, equipment maintenance, all those things because our eggs and embryos that are frozen are so precious. You don't ever want anything to go wrong. You don't want anything to break down. And so it's just really not safe to go years and years without having a good check-in on everything. And you also, we don't want eggs and embryos out during that process because that’s when ideally they’re safe. And so,I know it is really disappointing for a lot of people, but it's actually really, you know, it's really for our patient's best interests. We're doing it really to keep things, you know, as top notch, you know, and to kind of continue to have the success rates that we have. I think a lot of patients put a lot of pressure on themselves. It’s almost like the end of the year seems like a deadline and I'd be interested, I think we should talk a little bit about new year's and resolutions kind of going in after this, but, I had to have some conversations, even with some people who are, you know, let's say planning an embryo transfer and if we did it the first week of January, versus if we were going to have done it the last weekend of December, I'm like is two weeks, you know, really gonna make a big difference, you know, in your life or planning? But I think people get this in their head and it has to be by the end of the year, people put this deadline of the new year, new me and it has to be done before then. And so, I think anything can be done is, you know, to try to alleviate, not put that much pressure on yourself. In reality, a month here and there in short timeframes for fertility treatments, not going to make huge differences. And we're really talking about just a couple of weeks, but it is, it is really, you know, really emotional for a lot of patients. A lot of people are in that mindset in that treatment. They want to just keep going, going, going. And I think, I mean, you probably see it more. I think having to take a pause for a few weeks, for some people waiting is really actually more anxiety provoking and has more negative psychological effects on them. And so it can be a hard time to cope. I get those really, I guess, the medical reasons for doing it. And then I, that was another thing I was gonna say is I feel like even, you know, holidays, they end with them, you get into new years. And a lot of people put a lot of pressure on these resolutions for themselves. I'm going to do this or this, or accomplish this. And,you know, sometimes, you know, life doesn't work out exactly in the picture box and timeframe they want it to. And so I think it's caused a lot of frustration or almost can make people feel worse, than if they hadn’t set such a specific timeframe. I don't know what you guys think about that or if you see patients with nutrition eating new year for like the stress aspect and emotional aspects of those things.
Dara: Yeah. In terms of new year's resolutions, I don't personally love myself setting them nor my patients because of exactly what you said. I think that there's so much pressure to accomplish a goal perfectly and you know, the research shows that most new year's resolutions after a month go down the drain. SoI, I'm all about short-term goal setting and that, you know, small, specific, actionable goals that are not too overwhelming. So instead of saying my goal is to lose 30 pounds, I would prefer someone to say, or my new year's resolution is I want to lose 30 pounds. I would much rather say, you know, I want to be more open-minded the next year to add in more protein to my diet or to, you know, take a walk three to five times a week. So something that's small, actionable, and it could be even something smaller than that. It could be, I want to walk around the block twice a week, you know, so it doesn't have to be like I'm working out at the gym for 60 minutes, but making smaller, smaller goals and kind of checking in every couple of weeks and seeing how it's going. And then if they are working well building upon that. But I find that usually those new year's resolutions are very broad and wide goals that can actually lead to more stress and anxiety. And then when there's more stress and anxiety, we often also crave,, you know, more sugars and it can kind of lead to that feedback loop of more stress, wanting to eat, you know,you know, more sugars, more stress, and then that cycle can continue. Rena, what's, what's your viewpoint on new year's resolutions?
Rena: Well, not shockingly I’m super aligned with you in terms of these smaller, manageable goals. I believe, you know, working on yourself and, and goal setting, I'm really big into the micro and I think that just sets you up for success. I, you know, really practice being in the present. So I don't love the macro goal setting and especially that carries into my work with RMA patients. So something, an analogy I like to use, you know, with my patients who are really upset or thrown for a loop about the lab closure, you know, of course, you know, I explained to them what Dr. Thornton said - it's necessary because we need to keep you safe. We need to take care of what's what's in there, we need it's in the patient's best interest. But of course, for people, it really throws them off. So I use the analogy of think of this time, you know, whenever it's a pause and your, and your treatment, you know, maybe it's cause the lab closure, or maybe you had to get a surgery, maybe you are dealing with a loss, whatever it may be. The treatment is unfortunately, oftentimes filled with a lot of kind of stops and starts. So you want to think of this as a free period. So if you're in school and you have a free period or a study hall, whatever, it doesn't mean that you're not in school. It means you have a free period. And if you're smart, you know, you'll do your work, you'll meet with your teachers, like whatever you need to do so that you don't fall behind, or you're not up until two in the morning doing your homework, whatever. And so any time off is a free period. And so it's in your best interest to take this time, you can be proactive. And I always say, this is your free period. This is your time to nurture your body, mind, and soul and take care of yourself. You want to focus on your sleep. You want to fuel yourself well. You want to do any exercise or positive psychology tenants that, you know, suit you because then when you're given the green light to go ahead, you're going to be not even just at the starting line, you'll be two steps ahead, you know, because you'll have nurtured your body, mind and soul during this time. Versus if you took this time to be upset, you filled your body with sugar. You started keeping a weird sleep cycle. You didn't move off your couch, whatever you'll be at the end of the line, and then you'd start your cycle. You wouldn't feel good. So that's no. So I also focus on in terms of any, if there's a pause in treatment such as because of the lab closure during this time, you know, this is your free period. Definitely indulge, do self-care, all of Dara's tips for eating, but make sure you really are taking care of yourself so that when the new year comes and you are given the green light to go, you're ready and you're not making up for a month of just sort of letting yourself kind of fall apart. And I love in, in these time periods, you know, work in the shorter increments of time, make yourself daily to do lists. I love setting intentions for the day. So when you wake up in the morning, the first thing you do is not take your phone, which is most people's, you know, go to, they wake up, they look at their phone, no! Lie in bed, breathe, set intentions. What do you want to do today? What kind of energy do you want to emanate? Who do you want to be? What do you want to put out in this world? I love that practice for starting the day. So I definitely recommend that.
Dara: Don't you think for a new year's resolution I think one thing I know Rena would probably be on board and I'm sure Dr. Thornton would be to is starting a gratitude practice, some form of gratitude, practice.
Rena: Thanksgiving's all that giving, you know, never to, it's a great time to put into practice your attitude of gratitude and really, really actively think of what you're grateful for. It's a really, it's a great way to end your day if you have a family to do it around a dinner table, or, you know, set up a group chat with friends, whatever. It's a great way to start your day and a great way to end your day.Think of what you're grateful for. It really sets you up for success and research shows if you do this after 21 days, it really is going to reframe your mind and shift your thinking so that you do see things more positively. And I think now more than ever, that's really important because it helps us then roll with the punches better and cope better with things instead of getting so thrown off. So I absolutely recommend actively thinking about your gratitudes every day, ideally twice a day, morning and night, really helpful.
Dara: Yeah. I think even five minute journal, whether you have your own journal or sometimes if you need it to be prompted with certain questions and intentions, the five minute journal is a great addition.
Rena: Yeah. Or affirmations, you know, write them down, put them around. Mantras, all that stuff. I think you really do have the power to be in control of your life. I think it's, it's understanding the, what capacity that is. You know, no we can't control bigger things like a global pandemic, or we can't control when your fertility treatment is going to work, but we do have the power to be in control of ourselves and how we cope with things and how we deal with what life hands us and I think, you know, my patients know the positive psychology is a big part of my practice and I really take that in there because there, there are five main tenants of positive psychology. So it's practicing gratitude which we talked about. It's meditation. There's a bunch of apps that are great for that, or you just start your own practice. Exercise is the third. So whatever that means for you. Random acts of love and kindness so that's, you know, giving someone money for food or opening the door for somebody or smiling at someone. And then journaling.So those are the five main ones in positive psychology. And if you really actively start to implement those in your daily life, again, research shows, it makes a big difference on your mindset and how you're able to frame things. So, whereas before you may have been a glass half empty person or any little thing that didn't go your way may have totally set you off. If you start to put these into practice, it's going to help you just cope with life, better, roll with things better, see the positive more so than the negative. And so I, I'm a big believer in trying to implement those.
Dara: I like using the word reframe. You know, we can look at things in various ways, but if you notice, you catch yourself with looking at things negatively, you have the, you have the power in you to reframe it into something that's more positive.
Rena: And that's a great exercise too. Do say someone, okay, so say you get the results, you know, okay, this your cycle, didn't go how you wanted. You didn't get a positive pregnancy test. Okay. How do you reframe that? You know, and it's not to be unrealistic to say, okay, you now you're going to be super happy about it and reframe it that that's actually what you wanted. No, that's unrealistic. How do you reframe it though so that instead of having that be kind of the end of your, your world and, and leave you in a funk for a week and not being able to get out of bed, you're able to reframe it to say, okay, that was so important. I got through a cycle and now my doctor and my team has information that they needed about my case and about my body to say that, you know, whatever treatment we did, whatever protocol we did, this is what happened. That's data and information that you didn't have before. So those are all pieces of your puzzle. That's drilling in to get you where you want to go. And so again, like a great practice is if you're finding that something really throws you off and you're feeling super negative about it, take a second and say, okay, how can I reframe this? How can I think about this differently? And if you're having a really hard time, sometimes it's helpful to think of if a friend came to you and they were crying and they needed advice, how would you counsel them? How would you talk your friend out of it? What would you say to them? And sometimes that's helpful if you're really struggling with your own kind of self-talk and saying, I can't find any positive in this. There is no positive. Try and back out of it a little bit and talk to yourself as though you would a friend who needed your help.
Dara: I love that.
Dr. Thornton: Yeah. I like all these kinda mindful exercises and things that you're talking about cause I would say just from the medical aspect of things it's really important for patients to try to have good coping mechanisms. I actually tell most of my patients that, you know, the medicines are not fun. Injections for IVF are not fun. All the ultrasounds, even if you're on pill medicines and all the procedures are not fun. But at the end of the day, really the hardest part of fertility treatment is the mental aspect of it. That is what eats people alive, much more than the physical tolerance for everything you're doing just from being in this field for awhile. And you know, we always kind of harp on that you know, stress infertility causes stress, stress doesn't cause infertility like, you know, I don't want anybody ever thinking, I stress myself out, this is why it's not happening. Cause that's not true. You don't control fertility. You know, you didn't make this happen to yourself. That's, you know, self blame and those aren't positive things. But there are negative things that can happen to you or make you less likely to be successful if you don't have good coping mechanisms. People who don't deal with stress or coping as well are more likely to, you know, involve in risky behaviors like smoking, drug use. People are just overall much more likely to drop out of care even people who are good prognosis who would likely be successful. It's one of the top reasons for emotional burden is for people to stop fertility treatment. And so that's obviously not getting you to that goal and you know, if you give up, you know, because it's just too much stress. I think one of the most interesting studies I have seen, was from a couple of years ago out of Boston, which is Massachusetts, is a mandated state meaning most patients actually have coverage for IVF and fertility treatment and it was actually a huge portion, it was almost 40% of patients that stopped care is that it was because of the emotional burden. And half of those people said that they were too depressed and anxious to continue on. And it was like 36% said that it had taken such a toll on their relationship with their partner that, that was, you know, another big reason they weren't continuing on. So it's really important to, you know, mindfulness doesn't come naturally for most people. It's actually something that takes work on how do I cope? How do I think about this? And it's not, you know, wrong or a bad thing iIf you need to think about it or speak with somebody or if you need, you know, write in a journal it's not intuitive. And so I think it's really important that we kind of talk about those things to deal with things.
Rena: I love that you spoke. So I want to say, I love that you said all of that and I believe in all of it and I would definitely want to reiterate what you said, which is infertility causes stress. Stress does not cause infertility. So anyone listening, infertility causes stress. Stress does not cause infertility because I think there's so many people who blame themselves and think that it's their fault. It didn't work because they were stressed or they work too hard or whatever. And that is just not the case. What I always say to people is no, but my goal for you is that you deserve a better quality of life. You know, you don't, no one deserves to go through this process and then have their lifestyle partner feel horrible about themselves. So my goal for you is how do I get you through this and still have a semblance of your normal life and be able to feel joy and happiness and life. This is 10% of your life and not 110% of your life. And the other thing I love that you said is that no, all of these things, you know, all these coping mechanisms we're talking about, you know, they take work and they take a team and it's really hard to start them and it's really hard to continue them. Asking for help I fully believe is a sign of strength. I think really life, regardless of what you're going through, whether it's just, you know, wanting to just be a better person or just sort of tolerate the site, it takes a team and it takes a village and asking for help, building out your supports is so important. These exercises are hard and when you're, especially, if you're at a place where you're already feeling kind of dark or depressed or anxious, even harder to start, it's even harder to see the light. And so it is so important to ask for help, seek help, build out your supports. You don't have to do it alone. You know, no one can get through life alone and you know, we're all here. That's why we're here. All of us, it's why we work in a collaborative and integrative team here because we believe that and you know, just how we each have separate jobs and take care of different pieces of the puzzle. So, you know, again, it's easy for us to talk about these things. This is our job. I know Dara and I, you know, have been practicing these things for, for years. I started this practice myself about four or five years ago and it completely changed my life. And so I carried it into my professional life. And I feel really lucky every day that I get to do that. But it, it absolutely came from me working on myself and implementing it in my life and seeing the concrete change. And now I see it in my patients and it's really incredible. So, but it it's a lot of work and some days are easier than others. So asking for help is super important and building out your supports.
Dara: I love that you said it's a strength asking for help. And I think that's a big thing for a lot of people. They feel like they're weak if they are seeking out support. And, um, it's the opposite. I think it's a huge strength to realize that you want some support and guidance.
Rena: Totally.
Dara: And really that's what we're here for.
Rena: Right. Right. And I think, you know, I, a lot of my patients now I'm a really big Brene Brown fan and her stuff really resonates with me. And I specifically love the, her analogy about the man in the arena. And there's this Teddy Roosevelt quote, if you just Google man in the arena will come up, but it's about, you know, if you're not in that arena, if you're not in there getting bloody, getting beat up, you know, you're not living. And how can anyone respect you? You know, life is about being in the arena. It is about taking risks. It's about failing. It's about picking yourself up. It's not about sitting on the sidelines. And so I think anyone that does ask for help, like you're, you're there, you're in the arena, you're living it. And I think that that's where true growth comes from. Otherwise, you know, what are we doing? We're sitting on the sidelines. We're not evolving and changing. Fear is a really easy place to live in, but it's not the best place and you know, it's, it's working through our fear. It's, it's conquering that, you know, it's, it's getting, it's failing, it's getting pushed down, it's getting beat up, but it's also about getting up. But again, it's not about getting up on your own. You know, sometimes you need somebody to help you. And I think that's really important. It's really important to find your tribe, find your community, you know, in the infertility world, there are so many communities out there to join, people that will welcome you with open arms. And, you know, again, it's about finding it. If you need help, that's what we're here for. Feel free to reach out anytime I have a whole bunch of resources I can send you for communities to join and people that will absolutely welcome you with open arms. You know, the, the great thing about the, all the technology we have and the online resources is, you know, you don't need to go anywhere. You can be located anywhere and it's all kind of at your fingertips, computer, phone, whatever it's right there. All you have to do is kind of sign up and, you know, just, just be there.
Dara: Fabulous. So for everyone who has tuned in to watch this and for those of you who are listening, you guys are strong. You are just for even taking this time to listen and being open-minded and hopefully getting some tips out of it.
Rena: And, you know, just to keep it really, you know, we all talk about this, but it doesn't mean every day is easy. For sure some days I have to think really hard about my gratitude or some days I forget to set my intention for the day and some days I'm just like, I, I can't wait for this day to be over, you know, I'm human too, so it's not, you know, that's just life. But really, I, I hope this was helpful. And please, if you have any comments or, you know, I think accountability is something that's really helpful. So if you need someone to email your gratitudes of the day to, or email your intentions to, email me. You can put my email out or you can find me on Instagram and you can message me there. I love when people send me that every day. I love it. I think being accountable mentally is extremely, extremely helpful. So if you need someone to be accountable to, I'm there for you. I got you.
Dara: I'm there too. And I'm sure Dr. Thorton is too.
Dr. Thornton: Yes. Yes.
Rena: So thank you guys so much. And how we love to end all of our talks is on a note of positivity and gratitude. So we’ll all kind of go around and say what we're grateful for. Dr. Thornton, do you want to go first?
Dr. Thornton: It's Thanksgiving week so it's perfect even more perfect than when you normally do it. You know, I, I have to say, you know, thinking, reflecting on the year, the thing I'm probably most thankful for it's health and family. I think that pandemic has really made you realize if you don't have your health you don’t have much. And so, you know, it can make life a lot harder. So I am just so grateful that, we've all been healthy this year at my house. And that’s my biggest grateful.
Dara: How nice. Rena?
Rena: I guess, same, for sure if you don't have your health, you know, you don't have anything. And I think when you don't have your health, you realize too how vulnerable you are. So I'm grateful right now to, to be healthy, to be here mentally sound, physically sound. I'm really grateful for that. And I'm just hoping it stays that way. So I can continue to do my job and be there for my patients. Dara?
Dara: So going to be a little bit different today. I'm usually quite deep, but I'm actually coming. You know, it's going to be Thanksgiving in a couple of days, I'm excited for my slice of pumpkin pie that I'm going to be eating. Well, it's something that I don't have all year round. And you know, being Canadian, we have Canadian Thanksgiving, but I never really celebrated it growing up. So, and pumpkin pie was never really anything I had, but I do enjoy a slice of pumpkin pie on Thanksgiving. So it's, it's something that, that I'm gonna look forward to and enjoy and not have any guilt and really savor each and every bite. And, yeah knowing it's something special that I'm looking forward to. I'm very grateful for, for pumpkin pie.
Rena: And do you make it or you’re going to buy it?
Dara: No, I'm going to, I'm going to get it. I unfortunately, yeah, I do bake, but I have yet to make my own pumpkin pie. Maybe that should be my new year's resolution.
Dr. Thornton: I have to agree with you. It is pretty good pie. It's the only time of year I eat it as well. It's a great seasonal treat.
Dara: Exactly. Well, we're so happy that we were able to do this and yes, anyone that has any questions or comments, please feel free to reach out to us at Fertility Forward on Instagram.
Rena: Thanks everyone. Happy holidays, happy season, and just try to keep that attitude of gratitude. And if you are having a hard time and you need a moment, deep breaths, walk away. Happens to everybody.
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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