Life On Hold

How are you feeling?


No, really, how are you feeling?


Fully vulnerable here: I’m scared. Worried. Agonized. Overwhelmed. Angry. Fearful.

The list goes on.

And I imagine you feel the same, too.

How do we keep going in a time of unprecedented uncertainty?

As you know, my own situation is layered with the fact that I was recently diagnosed with breast cancer and am undergoing chemotherapy. As the side effects of cancer treatment take hold, I add to them the very real worries of Coronoavirus infection to my immunocompromised body. I do not wish this burden to anyone.

But I worry less about myself than others: patients, our dear employees, my loved ones – many people fall into more than one of these groups – and we are all living with heavy burdens.

My heart hurts.

My brain hurts.

My body hurts.

Fertility treatment is literally on hold. We have been directed by the American Society of Reproductive Medicine and the Minnesota governor through a direct order that we must stop treatment. I will get into it later on whether fertility treatment is elective (it is not in my opinion), but our hands are tied. We can’t even do procedures that involve gloves. This effectively rules out almost everything we can do to help our patients build their families.

Super vulnerable: This morning I was feeling particularly hopeless. This is very unlike me; I am generally an optimistic person. I made a list of things I could not control. It was bleak.

I cannot control that there is a global pandemic. I cannot control that I have cancer. I cannot control that my life’s work and purpose have been – temporarily – taken away with an uncertain timeline to resume. I cannot control that patients whose own fertility timeline is limited are being forced to put their lives on hold. I cannot make this virus go away and get our lives back to normal.

And then I made a list of what I can control.

I can write in my gratitude journal every day; today’s entry was that I was safe for one more day. I can be present. I can show love to my family and pet. I can be kind. I can maintain relationships. I can eat nutritious foods when I am able due to my cancer side effects. I can hydrate as I am able. I can walk outside – alone – when energy allows. I can think and reflect. I can follow isolation guidelines to minimize my risk of infection. I can not give up hope.

And I can plan. Normally I do not have the luxury of time to think; I just do. Now I can plan. How to do better and be better. How to be a better physician, colleague, partner, parent, friend and human. As myself how I can help patients NOW. We may not be doing embryo transfers this week, but we will be back. And I can plan and be ready. We are finding ways to stay on top of the changing landscape and be able to nimbly slide back into our mission and work, only better.

Sending love and strength to all.

The Poppy Seed Sandwich

After an embryo transfer, patients often wonder the following: Is my embryo going to fall out?

I think it’s a natural fear, especially since so many hopes and dreams are riding on the outcome of the embryo transfer.

Even though an embryo transfer is a highly technical procedure, one thing is certain: You can’t cough/pee/sneeze/squeeze/jostle an embryo out of the uterus.

Nearly fifteen years ago, when I was a new Reproductive Endocrinology fellow, someone explained an embryo transfer as “Throwing a velcro ball into a shag carpet.”

While I got the analogy because I’m old enough to remember the 1970s, it didn’t resonate with me.

So I thought of my own: Placing an embryo in the uterus is like putting a poppy seed in a peanut butter sandwich.

The embryo is tiny. The lining is thick and sticky. There’s no way that poppy seed is coming out.

Over the years I’ve explained an embryo transfer this way thousands of times. If you’ve ever worked with me, heard me lecture or been a patient or trainee, you’re probably sick of hearing it.

To wit: a patient told me about a year ago that she shared this on a huge fertility support group site and now I was famous as the Peanut Butter and Poppy Seed Doctor.

I can live with that.

Stick and grow embryo.

Stick and grow.

Why the Pineapple?

To many, the pineapple has become symbolic of the fertility journey.

Why?

Here’s the science: For centuries, pineapple (Ananas comosus) has been used as a folk medicine by indigenous peoples of Central and South America.

Pineapple fruit, skin and stems can be extracted to yield bromelain, a mixture of proteolytic enzymes that can interact with pathways in the body involved in inflammation, blood clotting and the immune response.

Bromelain supplements have been commercially available since the 1950s and it has been studied as an anti-cancer agent.

But the link to fertility treatment – and specifically IVF – is weak.

The theory is that by ingesting pineapple – and hence its proteolytic enzymes – the uterine environment may have less inflammation, better blood flow and an altered immune response, one that favors implantation of an embryo.

The bottom line: Pineapple is unlikely to be harmful to an IVF cycle, but it’s also not likely to be the deciding factor for its success.

But patients, please keep wearing your lucky pineapple socks when you come for a transfer!

While I’m 99.999% Science, I’m also 0.001% Faith, Hope, Trust and Pixie Dust, and I still believe in the power of good luck – and good vibes.

So don’t worry, if you forget your lucky pineapple socks, I’ll probably still be wearing mine.

Image via Amazon