Carmen has decided to go through fertility preservation treatment, but feels disconcerted when loved ones aren’t as supportive as she hoped. And Milan Chavarkar, a nurse practitioner specializing in fertility care, speaks with Juleyka about what to expect during an egg retrieval, and how to prepare for the emotional and physical stress along the way.
Featured Expert: Milan Chavarkar, has been a women's health specialist for 25 years and a family nurse practitioner for 20 years. She has worked with people from all backgrounds and seen that conventional medical system has fallen short in achieving true healing. She is dedicated to helping her clients improve their health and vitality through a collaborative and integrative approach. She uses functional medicine, conventional western medicine, natural therapies, mindfulness techniques, medications, supplements, and herbal treatments to treat her patients. She firmly believes that an integrative approach is the future of healthcare. With a 25-year career in nursing, Milan Chavarkar has worked in many capacities in the health care system, nurse, nurse-practitioner, midwife, professor, and manager. Dr. Chavarkar genuinely wants to improve the health care system and is available to guide corporations and individuals as a speaker and consultant. Learn more about her work and practice here.
Milan recommends Resolve, the American Society for Reproductive Medicine, and the American College of Nurse Midwives, The National Association for Nurse Practitioners in Women's Health, as resources for anyone who wants to learn more about women's reproductive health and fertility treatments.
If you liked this show listen to Speaking About Breast Health As a Family and Telling Mamí about My IUD.
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Juleyka Lantigua:
Hi, everybody. Today we welcome Carmen. After careful consideration, Carmen decided to seek fertility treatment. It was not an easy decision, and it required a lot of emotional, physical, and financial sacrifices. So when she opened up to her loved ones about it, she was surprised and disappointed that not everyone was as supportive as she'd hoped they'd be. Let's get into it.
Carmen: My name is Carmen Cusido. I'm based in northern New Jersey. I am a mental health advocate, also a writer, communications professional. And growing up, it's interesting, so I called my dad, Papi. But I called my mother by her first name. I called her Magaly.
I initially thought about doing egg freezing, and in fact, I went for initial blood work when I was 33 years old. Obviously, I mean, look, my father was 54 when I was born. He was old-school Cuban. I wasn't going to just sit down with him and be like, Papi, I'm going to freeze my eggs. He would've been like, what the hell? What's going on? But I know that my mother, she was like the dad whisperer. She knew how to talk to him in a way that I only started to learn after she died and before he did. I think she had mentioned something to him, like she needs to make sure she's able to have kids down the line.And she needs to go to a doctor to make that happen. I want to be able to help her financially. And my dad basically was like, "Whatever you say, I'll do, it's fine." But at that moment, I just wasn't ready.
I turned my parents down partially because I was still very much afraid of what these medicines, what kind of reaction I would have to these hormones. But the other part of it too, I was still in my last serious relationship, and there was always that hope, oh, he'll get over his fear of marriage, he'll get over his fear of having kids, and we'll be able to do this the natural way. Fast-forward till I was 38, almost 39, and realized that it's really now or never, and that that relationship was never going to lead to marriage.
Carmen: That's when I really sincerely started looking into doing the round of egg freezing last year. There was a part of me that felt a little bit like a failure, to be honest, and I feel like that's society's rules that I let get to my head. I felt that doing this egg freezing was in a way like, “Congrats, Carmen, you failed. Everything you've wanted, you don't have.” It is just emotionally, physically exhausting, but for me, more so emotionally because you're literally putting all your hopes or I was putting all these hopes on these eggs. What was very upsetting to me, I had a family member that I won't name, but somebody that I had been very close to as I was explaining to them, this is something I'm thinking of doing. They were very much not supportive, not only not supportive, but kind of antagonistic to what I wanted to do with my body and with my fertility.
The lack of empathy, the lack of support was so upsetting. It was a few phone conversations that I had had with them. One of the conversations they reminded me, your mother had you at 40. This person had kids in their 40s too with their partner, and I respected their point of view, but I felt I wasn't being respected for my choices and for my perspective because I had mentioned, okay, what if I don't meet the person I'm meant to marry until I'm in my mid-40s and then I really can't have kids. I don't want to leave it to chance. So it was just a lot of frustration on my part because I felt I was being treated as a child without any agency whose feelings were irrelevant. After my first round of egg freezing, I just needed support from people, and I had reached out to this family member, and their response was so glib, and it was just so infuriating because their response, I didn't ask for their advice.
Carmen: I just shared this is what I'm going through, and it's painful. And their response was, "The cycle was lackluster. So why waste money and try it again?" I'm like, My life is my life, and my decisions are mine, and I live with those. And since then, I haven't spoken to that person, and it was very painful. That person was like a sibling to me. And this person, when I've asked for advice, has been great and has given invaluable advice. I didn't ask for advice in this case, and I didn't want it because I lived through months of rumination.
And that in of itself, when you're living in your own head and trying to make a life-altering decision, that is punishment enough. I think a woman or a person's decision about what kind of family they want to have and how they go about it is such a personal and important decision. And until I was in these shoes, I didn't know how painful and just how much you're investing. You're on this emotional roller coaster while you're doing, certainly while I was doing it. And I will say that other than losing my parents, this has been one of the most impactful things in my life that has really changed me.
Lantigua:
Carmen's willingness to open up and speak so vulnerably about such a deeply personal decision really touched me. It is such a gift to the rest of us because, as many of us have experienced, there is so much shame and secrecy among some of our families about women's health and about our decisions. Her story made me think about the judgment that many women experience when they share their parenting decisions, whether if and how to start a family, how to parent their children, how to be in partnership with their spouses around child-rearing. All of these topics invite a lot of questions. As first gens, how can we discuss our fertility challenges, our options, and our decisions with loved ones in productive ways? And more importantly, are these intimate decisions something we should even be talking about with our loved ones? To help us figure it out, I called in an expert.
Milan Chavarkar:
I'm Milan Chavarkar. I'm a family nurse practitioner and doctor of nursing practice based in California. I specialize in integrative and functional medicine, specifically women's health and fertility. Supporting women in being the healthiest they can be before they enter fertility treatments. Because obviously, the more healthy you are before you enter these kind of treatments, the better outcomes you're going to get. That's the work that I do as a fertility specialist, and really understanding where are women's challenges in their reproductive health and how can we improve that before they go and do hormones and injections and see a specialist and get egg and embryo freezing. That's my specialty.
Lantigua: Well, Milan, tell me what you heard in Carmen's story.
Chavarkar: I've heard something that I've heard many times from women facing fertility decisions and issues. The emotion behind it, just how painful it is to be in the situation that they're in and making the decisions they're having to make. Also, the sense of failure, the hope. It's a painful situation to be in.
Lantigua: There must be levels to the decision-making. So there are, for me, a couple of sets of conversations that folks like Carmen encounter. One is obviously the very personal one with herself about what she wants, about how she wants to proceed. The other one is with her family. Here's someone who is obviously very linked to her family. That's another set of conversations, but then there's a broader cultural conversation about the potential of herself, a single woman embarking on this parenting journey. How do you counsel, how do you work with clients or patients to have these three separate conversations?
Chavarkar: Yeah, I mean, unfortunately, what's really happening for a lot of women, it's coming down to financial choices. I think that's the number one thing that really impacts people's ability to choose parenting at a later stage. That's a huge factor. And then also your health. Where's your health at? Are you able to get through, like she talked about how painful it was to go through egg freezing in her situation and the emotional and the physical pain? So your stamina and your resources to get the support you need, and that's where the family comes into play. I mean, her parents were very supportive when the discussion initially came up, but later on it sounds like asking for help and support from other family members, and she wasn't getting that support that she needed. And so that family context is really important because then you go into the third piece because this is just the beginning of the journey, the fertility journey, and then there's the parenting journey. So you're not only preserving your fertility, but you're thinking about “Do I want to maybe face this alone?”
Lantigua: So let's talk about expectations and a little bit of what the gender-normative idea of parenting is because I feel like part of the tension that Carmen experienced has to do with the way that people believed this ought to be done.
Chavarkar: What I really heard from her was the sense of failure. “Oh, we're supposed to do this naturally,” and I have patients who come to me for fertility work, and you can feel the sense of shame almost around, I didn't get to do this the way I'm supposed to do it, get pregnant the natural way. And I think what really resonated with me was this sort of lack of support that women get around any kind of decision-making for their bodies and the lack of respect around their decision-making for any decision we make around our bodies, whether it's maintaining pregnancy, or breastfeeding, or you talk about any women's health issue, there's always a lot of shame and guilt involved.
Lantigua: Okay, so how can someone like Carmen who has made a decision, prepare themselves to go through the process?
Chavarkar: Definitely seeking a professional who's going to support you in what process you choose. There's a lot of options in fertility. I myself do natural fertility work. We try to heal the body and prepare the body for fertility work. So natural fertility is one level, and then there's artificial reproductive technologies, and the science is really amazing. The statistics for fertility are not great. Fertility is declining around the world. So I think we do need to address fertility with science and what's available to women. There are choices, there's a lot of finances around those choices, but there are choices for women.
So seeking the right professional, I think, is the first key. And then making sure that professional is providing you the support you need. We have a lot of places where we refer to so people can get the help they need, the emotional support, because it's not just physical, it's also the emotional, which we heard from Carmen as well. I think from my perspective, the fertility journey requires a lot of time, procedures, hormonal injections, a lot of medical visits. So if you have another child and you're planning to do fertility, then you're definitely going to need help with taking care of your family. If you're a working mom, add that into the mix. And then, of course, single parenting, that's a whole nother topic.
Lantigua: Yeah. So let's talk about some of the more common types of resistance that your patients encounter culturally or from their family. And what are some of the things that you help them to realize, or what are some of the ways that you give them tools to address that resistance?
Chavarkar: Yeah, I think this topic of, “oh, I should have been able to do it naturally.” I really like to counsel people on the root cause of where maybe their fertility wasn't optimal; address it from that perspective. Because in functional medicine, we're really looking to understand: where do you need help in your health in order to improve your fertility? Also, reassure them that this is pretty common. Unfortunately, fertility issues are really common. If they're addressing their family, where are their parents coming from? I mean, right now we're on the cusp of having some of the most incredible scientific knowledge to help people overcome fertility issues. And we didn't have that 20, 30, 40, 50 years ago. So you're addressing a cultural gap. We don't always see parents understanding the new science because they didn't have those options at their time.
Lantigua: All right, so what is the question that I don't know to ask you that you think has to be asked and answered by someone who's making these types of considerations?
Chavarkar: This is good because I feel like I get asked everything under the sun.
Lantigua: Good, good.
Chavarkar: I think that around fertility, I think patients, they're scared of the artificial reproductive technologies and the impact on their health. I think that's one question that I get asked a lot, or maybe not asked enough. There's a lot of medical procedures that are going to be done to you that have risk, and I think that is an important question to ask. What is the risk in maintaining my fertility and doing egg freezing and doing embryo freezing? What do I have to go through? What are the steps I need to take? What are the hormones I have to take? What are the risks of those hormones? How much time is this going to take? And then also the emotional impact this is going to have on me and my family if it doesn't work out because I'm investing a lot of money in a hope of having a child. There's no guarantee at the end of this process that you will have a child. So when approaching fertility treatment, you really need to understand how big a decision this is, and how this is going to impact you, and that you may not get all the outcomes that you want to get.
Lantigua: That's hard to hear.
Chavarkar: Yeah, it is.
Lantigua: Actually, that makes me think about the fact of whether someone like Carmen should even consider confiding in someone close. She talked about a sibling-like person in her life who was not supportive of her choice. And so if the risks are high, if it's going to be a long process, if it's inherently such a high-stakes situation, should patients just keep it to themselves until they know for sure?
Chavarkar: We all need support in our lives. And unfortunately, for her, she thought this person, we all make that mistake. We think this person's going to be supportive, and we don't understand their own specific opinions. We don't know. I think that person said it's a waste of money, and that's so harsh because you've not only made a judgment on this person's fertility, you've made a judgment on this person, Carmen's choices on how to spend her money and what's important to her. I think it was the mistake of this person who she assumed would be supportive and was not.
And it doesn't mean that we shouldn't share our difficulties. I think we do need to express a lot more about the fertility journey. A lot of women don't talk about their miscarriages. They don't talk about how difficult it is to get pregnant. They don't talk about how difficult it is to be a mom. The more we hide that, we make it seem that all of this is easy and we don't need the support. We do need the support. And so the more we share, the more support we will get, and the more the community, our families, our parents, they'll understand our women's journey.
Lantigua: Thank you so, so, so much for being here today.
Chavarkar: Thank you so much for letting me participate. I really appreciate it.
Lantigua: All right. Here's what Milan taught us today.
Prepare holistically. Fertility treatments will likely impact different aspects of your life. As you plan, consider financial costs, health impacts, as well as the emotional and physical needs you may have, depending on your own life and family circumstances.
Be discerning, but open up. It may be hard to talk about your fertility journey, but opening up to people you trust can help you get the emotional support you need. If you cannot confide in family or friends, reach out to a mental health professional who can support you the way you deserve.
And remember, manage your expectations. The science has advanced tremendously, and we have more options today than any other generation. Still, there are no guarantees that investing in treatment will yield the outcomes you expect. Keep this in mind as you plan ahead. We've linked the resources Milan recommended in our episode notes.
Thank you for listening and thank you for sharing us. How to Talk to [Mamí & Papí] about Anything is an original production of LWC Studios. Virginia Lora is the show's producer, Tren Lightburn mixed this episode. I'm the creator and host, Juleyka Lantigua. On Twitter and Instagram we're @talktomamipapi. Bye everybody. Talk to you soon.
CITATION:
Lantigua, Juleyka, host. “Seeking Support for Her Egg-Freezing Journey”
How to Talk to [Mamí & Papí] about Anything,
LWC Studio. October 23, 2023. TalkToMamiPapi.com.