Infertility and the physician journey [PODCAST]

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“I am a medical doctor—a hospitalist working in an environment with many talented professionals. We share our knowledge and our approach to medicine with one another in ways that profoundly affect our patients and other personnel in the hospital.

At our best, we are a community whose foundation is a willingness and openness to discuss hard facts and make difficult decisions.

So why is it that when I was first diagnosed with infertility, I felt so alone? I was 1 in 8. Where were the others? There are hundreds of thousands of female doctors; where were the thousands who shared my situation?

I didn’t know anyone else.

Because no one talks about it.”

Kate Hoppock is an internal medicine physician and can be reached at Fertility Found.

She shares her story and discusses her KevinMD article, “Normalizing infertility conversations in the workplace.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Kate Hoppock. She’s an internal medicine physician, and she wrote the KevinMD article “Normalizing infertility conversations in the workplace.” Kate, welcome to the show.

Kate Hoppock: Thank you, Kevin, so much for having me. I’m really happy to be here.

Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and your journey to where you are today?

Kate Hoppock: Yeah, absolutely. I think, like a lot of professional women, I was kind of postponing having or starting my family when it was the quote-unquote “right time.” You know, not through medical school, not through residency; make sure I’m married, have a good job, be steady in that job. And then all of a sudden, I find myself diagnosed with infertility, and now all of a sudden I’m balancing a new job, going to appointments weekly, procedures monthly, hundreds of injections, blood draws, and so forth. And the balancing act of that, and what that led to, was kind of isolation, fear of my future, and anger that this was happening to me. And I thought that I had time.

I think that emotional, physical, and financial toll that it takes on women and families, I mean men of course too, but specifically on our women, is such a struggle. And I wasn’t aware. I had no idea that this was something that could impact me at such a young age, so to speak, when I was in my 30s. And so suddenly I just found myself really struggling with the balancing act of all of it.

That kind of led me to where I am today, with just kind of waking up a bit and wanting to find ways to really help educate women, find ways to advocate for them, and going to prepare them, so they realize that they’re not alone and that there are actions you can take. You don’t have to wait until you’re going through all of this. We can start this conversation sooner.

Kevin Pho: Can you share some stories or anecdotes that really illustrate how challenging it was for you to go through infertility while practicing medicine?

Kate Hoppock: Yeah, absolutely. I mean, I think that there are a couple of big parts of it. I think there’s a lot of shame and embarrassment that can sometimes be present, even though there’s no reason for it to be, so you’re often trying to balance a lot of this on your own. And with fertility treatment and workups, you’re kind of at the mercy of them. You don’t get to just coordinate and organize a day off; you have to do it based off of what’s happening with your cycles.

And so all of a sudden, you might have a busy clinic, or, I’m a hospitalist, so I’m seeing patients, and my shifts are when they are. Suddenly I’m trying to figure out, “OK, I need to get my blood drawn, do ultrasounds, maybe I have a procedure that has to happen,” and I’m trying to do that before work, during lunch, after, trading shifts. At the time, when I was early in my journey, I wasn’t really telling people about it, so I was trying to balance all of that on my own.

Ultimately, I opened up to my colleagues, which was a huge relief for me. Not everyone feels comfortable with that. But for me, even with them knowing what was going on, I was still juggling that and trying to make sure I could get to places before seeing patients. It’s a struggle. It puts a lot of strain and a lot of overwhelm on us while we’re going through this journey.

Kevin Pho: You mentioned that you did it alone. Were there really no support services around you? And I guess my second question is, how accommodating was your workplace?

Kate Hoppock: So I think that there are support systems; we just don’t know about them because we don’t talk about it. What I found with time was that there was actually a really great online community of women, specifically some women physicians, who were going through this. But until somebody told me about it years into my struggle, I had no idea. And it’s not a conversation that comes up in medical school or residency. Sometimes you just see women having kids, and maybe they struggled, maybe they didn’t, but nobody talks about it. So there were really no obvious resources until I started digging for them.

In addition to that, it’s not something that work talks about really, either. Once I broached the topic with my colleagues, I definitely had support. I mean, we all care about each other, right? We care about our human experience. People understand the importance of wanting to have a family if that’s something you choose. But it wasn’t like there was a built-in support system for time off, or, you know, the coverage that you get with insurance. Some women don’t have that at all, and we were lucky that we had some insurance coverage. But there’s not a system that really seems to be in place to say, “Hey, this is something that’s really common.” I mean, actually, one in four women physicians go through infertility, and so it’s happening all around us, and yet we don’t talk about it.

Kevin Pho: So let’s transition now into your KevinMD article, “Normalizing infertility conversations in the workplace.” Now, for those who didn’t read that article, can you just walk my audience through it?

Kate Hoppock: Yeah. I mean, the main thing for me was just kind of bringing about that awareness that this is something that impacts a lot of women. In the general public, it’s about one in eight, and then miscarriage is one in four, and actually women physicians are finding that it’s about one in four, too. For so many of us to be struggling with it and not talk about it, it creates an environment of shame and anger and fear, and there’s really nothing to be ashamed of. You know, this is a medical diagnosis.

I think that by normalizing those conversations, it allows women to do what they need to do without having to feel like they’re asking for permission or being judged. You know, we don’t have to say why you need a day off or why you might need to be a little bit late into work that day. We should be able to do this, and I don’t want medicine to be a barrier for women to build their families if that’s what they choose to do. And so I think that when we have these conversations and it just becomes like anything else in the medical field, women will be able to start advocating for themselves more without feeling that fear of what this means for my professional life.

Kevin Pho: So what would be a hypothetical scenario that you could illustrate where we can normalize infertility conversations, either in the hospital or the clinic?

Kate Hoppock: So I would really, to highlight it, I really think that we need to start talking about it earlier. I think that this needs to be something that is part of our medical education, whether that’s in medical school or residency, ideally both. We need to know about our reproductive health and what it means, and, like, what are the statistics related to infertility, especially as it applies to women in medicine, and then what does it entail? I think talking that through so women understand what their options are, and that they’re not all of a sudden blindsided when they’re done with their training and are ready for that, you know, right time to start having a family. So I think just educating and bringing about awareness is huge.

For me, I share my specific story because that’s the way that I know. I mean, I’m not an OB, I’m not an REI, but for me, it’s important to share my story, so I feel like at least maybe that helps one other woman feel like they’re not alone. And that’s not what we have to do; people don’t have to share their specific story. So I think it’s the education part. But if you do feel comfortable, you know, you can share it, because what I found is that by sharing my story, women started reaching out to me and feeling like they at least had somewhere to go.

Kevin Pho: For those women who are going through medical school and residency, or just our young attendings, what are some of the questions they should be asking during that journey?

Kate Hoppock: I think understanding what their insurance coverage is when they’re in training, so medical school and residency. What does that entail? You know, are they able to go and see a specialist and just have kind of a workup and understand what their reproductive health is? I think that they should be asking, “What does fertility treatment look like? What does this mean for me if I choose to wait to have children?” Which is totally OK. You know, there’s no one right or wrong time to start a family. But I think that people at least need to know what that could entail, so they know how to balance it and have the right support system in place when it is time to go through that.

Kevin Pho: And from what you understand of the health insurance during medical school and residency, what is the typical coverage for infertility treatments?

Kate Hoppock: You know, I’m not sure about med school and residency in particular. I think there are a lot of differences statewide, and there are a lot of insurance providers who can actually opt out of certain things. I’m in Illinois; we have decent coverage here. But if you’re out of pocket, I mean, when you think about an IVF round, each round can cost 20,000-plus dollars. And so if you don’t have insurance coverage, that on top of your medical school loans, in particular, again, for our specialties or our field, it’s astounding, you know? And it’s not like one round gets you a child, you know.

What I think, a lot of the things when it comes to awareness and education, is understanding that even if you struggle to get pregnant on your own, when you see a specialist, IVF is not some magical answer either. I mean, this can take years. For myself, it took over five years to get my two boys, and we needed to go through multiple IVF rounds. We need to understand that this is something that, if you do not have insurance coverage, you need to figure out, “OK, how can I financially prepare for this? How do I make sure that this is not a barrier for me?” And so I think just asking those types of questions of your programs is important, and eventually continuing to advocate on a wider scale for providing appropriate coverage for women. That’ll be something that hopefully will continue to change with time.

Kevin Pho: We’re talking to Kate Hoppock. She is an internal medicine physician. She wrote the KevinMD article “Normalizing infertility conversations in the workplace.” Kate, if there’s something that you know now, after your journey, that you wish you knew back before, what would those few things be?

Kate Hoppock: I think it would be just about educating myself and educating others around me. So anytime I learned something, I would want to make sure that I shared that with my colleagues. And really understanding that you are not defined by labels, whether that’s doctor, mother, physician, you know, infertility, any of those things. You’re not defined by it. You know, there’s a lot to each of us, and I think it’s important to have the right kind of support system in place to make sure that you don’t lose yourself, that you’re not just in constant survival mode, and that you can really still live and enjoy what’s happening around you despite your fertility.

Kevin Pho: And for those who are interested in looking for more information on fertility during their residency or medical training, what are some resources that you can recommend?

Kate Hoppock: So I think reaching out to your local OB is really a great place to start, so you can understand kind of your own reproductive health. I think that that’s really the first place to start, because once you understand that, then you can start to figure out what those next steps are and where you should go next. Is that another specialist? Is it maybe just online communities? You know, there are a lot of online communities about support systems based off of different diagnoses. So really, the resources are endless, but starting with your OB is a great place to start.

Kevin Pho: And my final question: What’s your take-home message you want to leave with the KevinMD audience?

Kate Hoppock: That, you know, you’re not alone. I mean, this is something that is impacting thousands and thousands of women, and you’re not alone. You have a support system. We’re out there. You know, we just have to make sure that we continue to support each other, be kind to each other, and lift each other up as we go through this. And that’ll speak volumes, when we can make this, you know, something that everybody is aware of.

Kevin Pho: And how could people reach you?

Kate Hoppock: So my website is fertilityfound.com, and my Instagram is Fertility Found. I’m just trying to create a place where people, and women, really have just a support system, somebody who they can talk to. I’m coaching now, and so that’s something that I think can really help. But they can reach out to me anytime if they have questions about my journey or anything else.

Kevin Pho: OK. Thank you so much for sharing your story, time, and insight, and thanks again for being

Kate Hoppock: Thank you so much. I appreciate it.

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