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Learn more about the impact infertility can have on mental health.
Nancy: Whatever happens to be going on in our personal lives, most of us try to keep it separate from our day to day at work, at least until happy hour comes around. But fertility journeys are different. They're time consuming and physically and emotionally exhausting research shows that the depression levels in patients with infertility are comparable to patients who've been diagnosed with cancer. And in a lot of cases, someone going through these journeys has to tell their manager or HR something about what's going on because they likely need to miss work for appointments. Those conversations can be stressful. And that's just one part of what makes a fertility journey, such an emotional experience.
[00:00:45] This is Baby Steps, a podcast from carrot fertility on the intersection of work and fertility health. Today, I'm talking with two experts who share advice on how HR leaders can support employees both logistically and emotionally. [00:01:00] We'll also learn about what not to say when someone discloses that they're going through something fertility related, this isn't legal advice, just as a warning. You'll need to talk with your company's lawyers if you have questions about that topic. But our guests do share useful guidance for anyone looking to approach these moments with compassion. To get us started. Let's hear from Farah Ali, a clinical psychologist and expert here at Carrot.
[00:01:28] Nancy: Hey Farah.
Farah: Hi Nancy. How are you this morning?
Nancy: I'm doing well. Thanks so much for joining us. Thank you for having me. I'm looking forward to this conversation. Can we
[00:01:37] Nancy: just start off by you saying your name and your title here at carrot?
[00:01:41] Farah: Yeah. So my name is Farah Ali, and I'm an emotional support expert at Carrot.
[00:01:46] Nancy:And what inspired you to become a psychologist?
[00:01:50] Farah: So the story starts so long ago. Sometimes I forget. But apparently when I was in high school, I did an interview with like our school [00:02:00] reporter and said that I wanted to be a psychologist, which I had totally forgotten about until my mom who keeps everything, showed me the clip like 20 years later.
[00:02:09] But I was always really interested in people's stories. I'm an introvert. So I definitely like to listen more than I like to talk. I like to get in deep rather than, you know, stay surface level. And so my friends always gave me the feedback that I was very helpful to them. I kind of naturally funneled me into a career in psychology and I love it.
[00:02:30] Nancy: How did you first come to Carrot as one of our experts?
[00:02:34] Farah: So I was actually at a networking event for a medical practice. And I overheard Dr. Asima Ahmad talking to some colleagues about being a reproductive endocrinologist. And so I told her that I'm a psychologist and fertility is one of my clinical interests.
[00:02:53] And she told me about Carrot. I started off doing chats one hour. And then as the need grew, my time [00:03:00] with Carrot grew as well. And that's how I came to be there. And I really enjoy that because my private practice, I see a lot of different things, but with Carrot, it's just focused on family forming journeys, which is definitely something that I have a lot of interest and passion. And so it's been a good fit so far.
[00:03:18] Nancy: That's great. So you were already interested in supporting people on family farming journeys before you even had ever heard about Carrot.
[00:03:25] Farah: Yeah. And that came about a little bit accidentally. I had maybe about eight years ago or so I had just by chance, about 20% of my caseload at the practice I was at was comprised of mostly women that were going through some fertility issues of one form or another. And it's something that I became really interested in. And then I went through my own fertility journey, I got to experience some of what they were going through firsthand as well. And I've been connected to that field ever [00:04:00] since.
[00:04:00] Nancy: And in your private practice and with Carrot, what are some of the problems or situations that you talked to people about?
[00:04:08] Farah: Mostly, I would say things fall within the bucket of anxiety or depression, but the reasons that people are experiencing that can come from different areas of their life, usually it's related to family or relationships.
[00:04:22] You know, the pandemic was a big one that contributed to a lot of anxiousness and some depression. So that tends to be the majority of what I end up seeing, but just what gets them there and maybe something different.
[00:04:35] Nancy: You know, this podcast is really focused a lot on sort of the intersection of trying to have a full-time job or trying to work and going through these family forming journeys.
[00:04:45] So is that something you hear about a lot of people kind of struggling to balance those two things?
[00:04:51] Farah: Yes. Yes, because both are consuming, like people's works are usually consuming and then fertility treatments are usually very consuming. There is [00:05:00] definitely an overlap that creates a lot of stress and a lot of anxiety for the patients that I see.
[00:05:08] And there are some common themes that come up for people that are at work.
[00:05:11] Nancy: What are some of those teams that you typically see?
[00:05:14] Farah: One of them is the issue of taking time off for people who have gone through fertility treatments. They are very aware that there is a lot of monitoring. There are a lot of appointments.
[00:05:24] There's a lot of having to go in usually sometimes multiple times a week. And so trying to fit those appointments in our round of work, Workday can be really challenging. So some of the things that we try to come up with is how to minimize the impact of that when possible. And most fertility clinics, they do offer really early morning appointments.
[00:05:47] And so sometimes my patients will try to snag early morning appointments before they go to work. And so that way they can get in their monitoring, but also be at their desk, whether that is [00:06:00] in a physical office space or at home in time. And it creates a lot of stress that creates a lot of rushed feelings in the morning, which is not always necessarily the best way to start your day.
[00:06:09] So we just try to do the best that we can given the situation that they're in and knowing that it's not necessarily going to be stressed free. It's not what we're aiming for, but just trying to minimize the impact and recognize that what we have control over and what we don't..
[00:06:24] Nancy: There are definitely those kinds of logistical things that people can do that can just make that process easier.
[00:06:30] What advice do you commonly share to help with managing that anxiety? side?
[00:06:36] Farah: So it's so much of the fertility process is out of one's control. Certainly there are some things that people feel like they have control over such as taking their medications properly and getting to their appointments. Other than that, the outcome is certainly out of one's control.
[00:06:52] And so we really try to focus on some healthy ways to access a sense of control and empowerment. And sometimes that's as [00:07:00] simple as just paying attention to other parts of your routine and engaging in them very mindfully. You know, if you typically have breakfast every morning, like going into that activity, knowing that this is something that grounds you, that sets you up for a good day, and then intentionally stepping into that process.
[00:07:15] A lot of times, people who are going particularly through assisted reproduction treatments are not able to engage in some of their typical coping skills, exercise, being a big one. We try to find some creative ways to modify that knowing that's going to be temporary. Sometimes a lower intensity workouts can also provide a lot of relief and might foster a little bit more relaxation then some of that physical release, which can also be really helpful. And then I'm also a huge proponent of meditation. It just helps foster this practice of having thoughts and feelings, which there are going to be a lot of, but creating some distance between yourself and them and not attaching to them too strongly.
[00:07:54] Nancy: Do you hear a lot from people who are stressed about whether or not to tell their boss or [00:08:00] talk to HR about what they're going through?
[00:08:02] Yes. So that's usually a pretty big question. Do I disclose, or do I not disclose? And what I have found is that people who choose to disclose typically have some trust in their boss or supervisor or the people that they work with, which is important because that sets a foundation for having a better experience and sharing something so personal. Surprisingly, a lot of patients have told me when they tell their supervisor or the people that they're working with, regardless of whether they identify as male or female, a lot of them have some experience or exposure to fertility treatments either with themselves or through a partner or someone who is close to them.
[00:08:39] And so they have some understanding of how intense the process can be. We evaluate the costs and benefits of telling versus not telling. I will say that sharing even just a little bit can help alleviate the burden of trying to go to appointments or take medications at work. It reduces the stress a little bit.
[00:08:59] It's [00:09:00] really very common. You know, we say I cared a lot. One in eight heterosexual couples do experience infertility. So chances are they know someone or maybe they've been through it themselves.
[00:09:12] Farah: There's already so much that a person is carrying when they have to go through treatments. And so if you're able to clear your plate a little bit, by telling someone at work, that can be really helpful, but not everyone is in that position.
[00:09:24] And that's totally their individual person's choice of what they're comfortable sharing or not. If they're not comfortable sharing, but need to say something, then usually we just decide that they might disclose that they're going through some medical treatments or procedures that might take them away from work at times.
[00:09:40] Around that, so we'll try to figure out how a person can be proactive and talking to their team or their boss or supervisor about the work that they need to do and developing a plan around making sure that work gets done so that there's not conflict at work about [00:10:00] deadlines being missed or projects not being finished.
[00:10:02] Nancy: Yeah, it sounds like flexibility is really such a powerful way for managers and employers to support employees going through these
[00:10:09] Farah: journeys.
[00:10:10] Yes, but the last couple of years, my hope is that there has been a little bit more understanding and how helpful flexibility can be and that people need that in their lives.
[00:10:22] Nancy: Yeah. And that it is possible to get your work done, even if you're not physically sitting at a desk for eight hours.
[00:10:28] Farah: Exactly. Yeah.
[00:10:30] Nancy: Would you feel comfortable sharing anything about your personal experience with a
[00:10:35] fertility journey?
[00:10:36] Farah: Yeah, sure. Let's see. I was in my early thirties when my husband and I decided that maybe we would start trying to have kids.
[00:10:44] And so I went off of birth control. We tried for a year on our own, since that's usually the recommendation since I was under 35, I think most people's journeys that I've heard of started off this way is that they're very casual about it in the beginning. But then you get like really [00:11:00] involved in trying to track your cycles and take your temperature every morning.
[00:11:04] So I did try to do that on my own. And then I went to go see my doctor, just my regular OB GYN. And she did some blood work and said that I likely had low ovarian reserve and that she would refer me to a fertility clinic. And so I did probably around like four rounds of IUI. We decided that our limit would be one round of IVF.
[00:11:26] And if it didn't work that we were going to lay that journey to rest in terms of going through treatment. We did one round of IVF. It did not result in a pregnancy. And so then we decided to just move on from there that we might try, continue to try on our own, but we also found our lives to be pretty satisfying the way that they were without children, which I feel very fortunate about, that both my husband and I felt that way we were on the same page. We do not currently have children and it's going okay so far.
[00:11:55] Nancy: Thanks so much for sharing that experience. Is that something that [00:12:00] you talk about with patients to just setting those boundaries and maybe that helps people feel at least a little control in terms of, you get to choose how many rounds of IUI or IVF you want to pursue.
[00:12:11] Farah: Right. And it can be a spiral that you end up getting sucked in. That's another place that we also practice a lot of flexibility is that sometimes patients will say, okay, I'm going to do three rounds and then I'm done. But once the third round comes around, they realize that they're not ready to be done, which is completely okay.
[00:12:28] What I tell them is that when you first made that deadline, you didn't have all of the information that you do now, and that it's okay to reassess and to change that plan and to come up with a new one. And self-compassion and that flexibility, even with one's self is really important.
[00:12:42] Nancy: When you were going through this experience yourself, where you working at a clinic, or was there any kind of professional work you had to balance?
[00:12:50] Farah: Yeah. So I was at a group practice at the time. And so I know what some of these challenges can be like in terms of incorporating [00:13:00] fertility treatments into the workday. Some of the things that I talk about with patients are definitely ones that I've experienced as well in terms of taking that time off for appointments or procedures.
[00:13:10] My fertility clinic, they did offer to be somewhat flexible with, especially the procedures. And so they said that they could try to time it so that it felt close to a weekend because I had weekends off. That was helpful. If possible. I do encourage my patients to take that time off after procedure, if they can, their body is going through a lot.
[00:13:29] And so if they have the opportunity to just rest or relax a little bit, even more so for their mental wellbeing, then even their physical wellbeing, that is something that I try to tell them to plan around if they can. Another issue that I ran into was taking the medications while I was at work. The injections I was fortunate enough to be able to do them at home, both in the morning and the evening, but there were some like supplements that you have to take during the day. That can be a little bit tricky to plan [00:14:00] around. And that's another time where it can be helpful for at least someone on your team to know that you have to step away and take a little bit of time to take these medications and to not be in your office.
[00:14:12] I think when you're forced into that situation, you just find a way to make it work. And that's often what I tell patients as well.
[00:14:19] Nancy: It sounds like too, from the employer perspective, if you are someone who maybe you're not familiar with the process, just trying to familiarize yourself a little bit with what's involved because there are these daily medications and injections, and then a lot of doctor's appointments and it can go on for years even.
[00:14:37] Yeah. So
[00:14:37] Farah: even though all of these things that you have to consider and deal with are temporary to some point they're not necessarily short-lived and that can be tough.
[00:14:46] Nancy: What have you found helps people with that side of it, with that uncertainty?
[00:14:51] Farah: Well, that is a huge skill, like sitting in uncertainty and tolerating, the discomfort of that.
[00:14:56] We kind of frame the fertility process, that way [00:15:00] that they're building this incredibly useful life skill of tolerating, the discomfort of the unknown. That's where again, focusing on the aspects of your routine and developing a structure that you do have a little bit of control over, can be really helpful.
[00:15:14] And definitely trying to pay attention to still connect with those areas of your life that are not related to fertility, trying to still keep in touch with friends and, you know, identifying the friends in your life who really help support you during this journey. And sometimes that might mean making the very difficult decision to step away from some friendships are not be as close to some people who you're not feeling supported by, and really identifying that team of people around you, who will support you through this and maintaining some type of physical activity.
[00:15:47] Even if it's a modified version of what you're used to. Some people ask me whether they should take time off, like an extended time off of period from work during this time. Depending on the person's situation I don't always recommend that because of [00:16:00] work provides a lot of structure and routine and some healthy distraction at times.
[00:16:04] And so being able to engage in a part of your everyday routine that really takes your attention and really captivates it, that can be very helpful during this time. Otherwise, it's pretty easy to keep thinking about the fertility process and to ruminate and to dwell and work can provide a way to channel some of that energy towards something different than the fertility process.
[00:16:25] Nancy: Sometimes a manager might have this expectation that someone doesn't want to work on a big project, but it can be the opposite. Some people want that as a distraction.
[00:16:36] Farah: Yeah, there's no right or wrong way. And so whatever tends to be the best fit for the person, that's what we go with. But it's interesting because a lot of people don't think they'll have the bandwidth for work, but then they'll end up saying, like, I don't know what I would do if I wasn't working right now.
[00:16:50] And for individuals who are not working, um, during the time that they're going through fertility treatments, trying to establish some other kind of structure or routines for their day is going to be helpful. [00:17:00]
[00:17:00] Nancy: Well, great. I think this has been a great conversation.
[00:17:02] Farah: Thank you so much.
[00:17:04] Thank you.
[00:17:09] Nancy: If you've ever had someone come to you about something personal like this, or if you've been on the other side, you could probably relate to what Farah has said about feeling stress and anxiety. In those moments. It can be really hard to know what to say. So for help on this, I called Emma Menzies. She's a fertility coach who started her career as a lawyer.
[00:17:30] She works with both individuals looking for help navigating work and fertility, as well as with employers who want to become more supportive.
[00:17:38] Emma, thanks so much for joining
[00:17:39] Emma: us.
[00:17:39] Us. Thank you very much for having me.
[00:17:42] Nancy: I'd love to start by hearing a little bit about your prior career in law. I know that now you're a fertility coach, but what kind of inspired you to initially pursue law?
[00:17:52] Emma: To be honest, I think it was following a path. So, you know, it did what in the UK, we call daily levels before you go to [00:18:00] university and I chose law to study. I'm not sure I would say I necessarily had a burning desire to be a lawyer. I was a little bit undecided about what to do, but it was a good degree.
[00:18:11] And in some ways I think that's linked to why ultimately I decided to leave it as well, I think at the point at which I decided to move on, it was the sense that it wasn't true to me, or at least not anymore, whether or not it ever had been, it was a good job that's for sure. It was a good job with a good company earning good money.
[00:18:34] And that I was good at and knew what I was doing, but it didn't feel right anymore. And I think for me, it was the time to think what really does feel true to who I am. And that was very much linked to me making a change.
[00:18:47] Nancy: I know, you had some fertility experiences that inspired your, you move into being a coach. Can you share some of those experience?
[00:18:57] Emma: While I was doing my legal career [00:19:00] it's while I was in house my fertility journey started and, you know, I was advising every day on work in career matters. So probably in a better position than a lot of people are to understand your rights and your entitlements as a worker.
[00:19:14] But I still found trying to manage my fertility journey alongside my career extremely difficult. It was like a difficult juggling act for me, practically, logistically, particularly in the throws of fertility treatment when you have a lot of appointments. But outside of that, the emotional weight was a real difficult thing to juggle and felt always like a full-time job that I had on top of my job.
[00:19:41] And I know that's something I come across with my clients a lot as well, and I struggled to know when to push forward in my career and when to pull back, there was lots of times I did pull back and then when I wasn't getting anywhere on the fertility journey, that sense of live stuck and on-hold [00:20:00] was really intense and really exacerbated.
[00:20:03] That was difficult as well. And again, I do find that with clients I work with that often they hold back or they even feel compelled to resign or reduce their hours evening or take sideways or downward moves. It's just a real knock-on confidence. I think as well, I definitely felt I became a shadow of my former self and I come across that an awful lot as well.
[00:20:26] It impacts how you connect with other things in your life, including other people being able to just self-manage and various environments, including the working environment. They were all of the ways that I was really struggling at the time and didn't have any support for it. And that was an interesting thing for me as an employment lawyer to think, hang on, what is anybody doing about this?
[00:20:50] This seems to be a gap here, but also as somebody who was going through that myself, I really felt the absence of any conversation about, did any support about it [00:21:00] personally as well.
[00:21:01] Nancy: At the time, did you talk to any colleagues or your manager about what you were going.
[00:21:07] Emma: I did talk to my manager and some really close colleagues in my team.
[00:21:13] I spoke to my manager so that she would understand what I was going through in terms of it also been able to get some support for treatment. And really I wanted the closer team members to understand why I was disappearing, perhaps why things weren't quite the same. It's interesting because some people make the decision not to ask for support or not to mention it at all.
[00:21:35] And, and I did that, but I still found accepting it really difficult, which again is not unique to me. And I think there's such a lot of insecurity on a fertility journey. I think employers are missing a trick really in terms of providing that psychologically safe space for people who are going through fertility treatment to feel that they can talk about it.
[00:21:59] [00:22:00] And when they do, they can have their needs met.
[00:22:04] Nancy: What do you think employers can do to help create more of a safe environment for these conversations?
[00:22:11] Emma: For me, it comes back to acknowledgement, understanding, and support. I think employers need to start by acknowledging that fertility is a workplace issue.
[00:22:23] Just getting that out there makes a big difference to people to know that they are taking this into account and seeing it as something that is happening in people's own lives that they want to support. And then on an individual basis, again, it's important to acknowledge each individual experience in terms of understanding.
[00:22:43] I think if employers can take steps to understand what it means to have fertility challenges, what that can look like, how prevalent is, how people are impacted by it, and just be better aware of what can be going on underneath their noses [00:23:00] and their workplaces. And then on an individual basis, be able to seek to understand individual experiences because they are all different. And then the final point being the support, I think again, from an organizational level, that's about what can you put into place to support your workforce? And that might be things like fertility benefits. And then it's also on a one to one level of what does this particular individual need and their circumstances, and understanding that from my point of view, education policy strategy that underpins all of those things.
[00:23:40] And that's the sort of things that I try and help organizations with as well as providing the coaching, which helps the individuals be able to take responsibility as well as they go through it. Because I do think it's not all employers and it's not all on employees either. There's a personal responsibility [00:24:00] and there's a corporate responsibility as well to be able to manage fertility at work.
[00:24:05] Nancy: I'm sure you hear from clients about things that their managers said or that colleague said, or did. Do you have any general advice for employers on how to talk about these sensitive topics or even how to respond? If someone brings something up to them, like, let's say someone does decide, they want to tell their employer about going through fertility treatments.
[00:24:26] Emma: I think three things that employers should do, are acknowledge would be the first one, be open and curious and be flexible. The acknowledgement part of it. It's as simple as, I'm sorry to hear, that must be difficult for you. That kind of statement that just enables somebody to feel heard. And it sounds so simple, but it isn't often done and it can mean a huge amount to people.
[00:24:54] They do just want to be heard. Then being open and [00:25:00] curious, seeking to understand their experience. What is it they're thinking, feeling? What is it that they're looking for? What are their needs? The last thing is flexibility. That is the cornerstone of managing anybody on a fertility journey because every fertility journey is different.
[00:25:19] We're working with a human body. So it's calling all of the shots and it would be lovely if it was black and white and we could map it all out on a diary and have it all sorted, but it just doesn't work like that. It's throwing curve balls all of the time. So flexibility really is important. And keeping the conversations going as well.
[00:25:37] I think that's the other thing I would mention for employers once you've had an initial conversation with employee, that's not the end of it. This needs to be an ongoing dialogue because things are changing all of the time. Their experience is changing all the time and therefore their needs are likely changing all of the time.
[00:25:53] Again, flexibility and patience really required to go on that journey with them.
[00:25:58] Nancy: Yeah, I think those are [00:26:00] all really great points. What would you say to someone who is anxious about saying the wrong thing? What are some things that employers and managers should stay away from?
[00:26:10] Emma: I think three things that employers shouldn't do are make assumptions, be judgmental and try and fix. With making assumptions, it's can be really dangerous to assume what somebody is experiencing or what they need based on perhaps what even that individual's experienced before. If they've been on a fertility journey, they might've come to you for support on a number of occasions and as I mentioned earlier, it's never the same one.
[00:26:39] IVF is not the same as the next IVF and so on, but also not making assumptions based on what other people you've managed might have experienced. Assuming that, because they're trying for a family they're not interested in the career. Just, just being careful to let go of these assumptions that we can make and judgements as well, which is the next point.[00:27:00]
[00:27:00] It's a human nature to judge, but really that's just going to block you, being able to support somebody. Which is why, again, I come back to being open and being curious. The last point was around not being the fixer. If you go into something trying to fix that tends to lead to unsolicited advice and comments like just relax. Have you thought about adoption? These sorts of things are the things that come up the most and are rarely well received. Also, not just unsolicited advice, but the kind of platitudes that are so well-meaning that are intended to make somebody feel better, but actually diminished their experience.
[00:27:39] And that looks like at least you can get pregnant. If somebody had a miscarriage, at least you're still young, if they failed the treatment, anything really that starts with at least look on the bright side. I would always say stay away from those things, because even though it's meant, well, it can leave somebody feeling that there's not a respect [00:28:00] for the suffering that, or the pain that they are in.
[00:28:03] Nancy: I love what you said about curiosity. It sounds like that's really at the core, you know, I've heard that sometimes there are assumptions for managers that someone going through these journeys. Oh, well, we won't put them on this project or they probably want to work fewer hours, but that's not always the case. Some people do want work as this distraction.
[00:28:23] Emma: Yeah. And sometimes people don't know straight away and sometimes it varies. I mentioned, that was my experience. It was times where I felt I just wanted to pull back. And then there was times where I wanted to push forward. So you can't make those assumptions based on what you think you might want in that set of circumstances or even what that individual has wanted before.
[00:28:45] Emma: It does need to be an ongoing dialogue. And there's a responsibility on both parties that make sure that that dialogue is happening.
[00:28:54] Nancy: This has been a great conversation. Thanks so much.
[00:28:57] Emma: It's been great talking to you. Thank you. [00:29:00]
[00:29:00] Nancy: If you're looking for more resources on fertility and mental health or on how to be a supportive manager and leader for employees going through this, we've included helpful links in our show notes. To learn more Carrot,
[00:29:12] visit carrotfertility.Com. Baby Steps is produced and edited by Eric Montgomery and Christopher Olin. To get notified when new episodes are released, subscribe to Baby Steps on Apple, Spotify, or wherever you get your podcasts. Thanks for listening.