SART Fertility Experts - Your Infertility Nurse: Partner in Your Care

Infertility nurse practitioner and health coach Monica Moore explains the essential role of the infertility nurse in the IVF process. Topics include learning how to give injections but also the importance of a healthy lifestyle and self-care during the IVF process. She also offers strategies for managing stress, effective communication with your care team, and managing expectations during the IVF process.

The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and SART. These podcasts are provided as a source of general information and are not a substitute for consultation with a physician. Welcome to SART Fertility Experts, a podcast that brings you discussions on important topics for people trying to build a family.

Our experts are members of SART, the Society for Assistive Reproductive Technology, an organization dedicated to ensuring you receive quality fertility care. Hello, my name is Dr. Kelly Lynch, and I am your host today for this episode of the SART Fertility Experts podcast. My guest today is Monica Moore, a nurse practitioner and certified health coach who specializes in infertility.

She started her career in reproductive endocrinology and infertility over 20 years ago, and during that time was a nurse manager, a third party coordinator, and a PCOS specialist. Her passion lies in using her education and experience to help women with infertility thrive. Monica, thank you so much for joining us for this episode of the SART Fertility Experts podcast.

Thanks for having me. Hi, everyone. I'm super excited to be here.

I wanted to devote this episode to sharing just how much the infertility nurse helps out our patients in their treatment plan. I think sometimes patients don't realize how important the nurse is to their care and helping them achieve their goal, and so I really wanted to highlight just what it is you do and the essential role that you play on the care team for an infertility patient. Can you talk a little bit about that? Yeah, I would love to talk about that.

So first, I want to say that we are forever humbled and grateful that during your time as a patient, when you probably feel one of the most vulnerable that you've felt in your life, that you allow us to participate in your care, and we never take that lightly, and so I just want to let everyone know up front that we realize that this is, you know, a difficult time. It's a stressful time. We can talk about some of the stressors and specifics about that, but just as an underlying theme, like we feel so grateful that you kind of let us into your life, and what I see as a role of a nurse is to be an advocate, a teacher, a tour guide, a partner in some way.

You know, how can you partner with you, and honestly, sometimes a liaison. I think a lot of times liaison between you and maybe people that you don't see, like people in the lab, and really, sometimes we are your lifeline. If you're not sure who to go to, you come to us, and that's appropriate, and you know, I really hope that people will continue to do that, so we have a lot of roles, and we hope to fully kind of partake in all of them.

I know one of the most important things that you do is teach patients. You help them to understand their medications, their protocol, and help them to manage expectations. Tell me a little bit about how you adjust the way you teach patients based on what their needs are.

Yeah, you know, what I always find is that any kind of like frustration or anger is usually a result of someone's expectation not being met, right? Now, the issue is could be that the expectation was never mentioned, and that's what I find when there's a frustration with any kind of communication with a nurse patient or anyone, a nursing clinical team combo, is that you might go into an infertility center as a client and not know what you can say, not know how to advocate for yourself, not know what is normal versus not normal, so I think really the first step is, well, first of all, I always tell people to take notes and to go in, and it's just an overwhelming day. There's a lot to be said, and then to somehow rewrite the notes, so I always mention that, and it also like even, and it doesn't mean that you don't listen, but it's also just something to do or have your partner or friend go take the notes for you just to have, you know, that feeling of control, but I also just feel like in terms of expectations, what you can expect is that the doctor first of all or clinician that you're set up with is kind of maybe you heard of them, maybe you were referred to them, and I don't know what you do about this, Dr. Lynch, but sometimes there's not a great, you know, really personality match, let's say, between you and the primary physician, so I always tell people go in with a certain, you know, intent, and then if you need to, let's say, switch physicians, and I guess we're getting into the hard stuff a little bit, that is an option for all places and no hard feelings, so I'm not sure how your center handles that, but we, I always tell people like do your research, independent research, ask around, and then once you get there, kind of, you know, be open and receptive and assume positive intent on everybody else's part that we're all trying to do the best we can, but I guess the first thing is your, in terms of the clinician or physician, I know the places that I work with have protocols in place for if you want to switch physicians, and I think feeling like your physician cares about you, values you, sees you as an individual is incredibly important. Do you, do you, where you are, have protocols for that as well? I, we absolutely agree with that, not, there's not always a good fit initially between patient and physician, and you really have to make sure that you both have similar communication styles and similar expectations, and we do encourage our patients to figure out who is going to work best with them, and so we do have the ability, or we do encourage our patients to figure out who is the best match for them in terms of communication styles and coming up with a care plan, whether they prefer it to be collaborative versus just the physician makes the plan and they follow along, and I think it really comes down to what the patient wants, and so yes, we absolutely do do that, and I think patients are happier, physicians are happier if they're not struggling, and to make sure that their patients are happy.

Yeah, and while we're talking about communication styles, sorry to interrupt, I think there's two things we're talking about. One is, do you, are you just a just a fax man person? Give me, give me whatever, I don't need any extra, extra, or are you something that needs somebody who's a little warmer, you know, has a little bit more of a hand-holding? That's one style. The other thing is, do you want to know everything up front? Just give me everything, and I'll sort it out myself, or do you only want to know a little bit at a time? You may not know that on the first visit, but just know that about yourself when you go in there, because as a nurse or a physician or clinician, we might give you what we feel is the right way, but if you come into us and say, you know, hey, I'm feeling a little overwhelmed.

I know that you have a care plan for me. Is there a way that you can give me what I need to know today, and that we can make a plan for me to set up or call you or email you in the future to go over the next steps? I'm feeling overwhelmed. That's another right way to advocate for yourself.

I absolutely agree. I do think we can only handle so much at once, and I think it's easy to get overwhelmed with all of the information that we have, all the decisions that have to be made. It's easy for that to happen, so I think being able to step back and allow the patient to decide how they want to get the information and when they're ready for it and who's going to help them make the decision is really important, and actually, this is where I think nursing can be really, really helpful, because we can spell out a whole lot of options to patients, but they're not going to be able to decide immediately right away what they want.

They need to go home and mull it over and talk to their partner, and oftentimes, they'll follow up with a nurse who will be able to really help them sort out those ideas and what choice might be better for them. That's another big point is once they get home, right? So you get home, you have these papers, let's say, maybe a little overwhelmed, maybe a little unsure. What is your next step, and who is your contact? Because at some places, especially larger places, you have a contact for finance, maybe you have a different contact to schedule appointments, and maybe the third contact for the clinical stuff, like the nurse may not be the one scheduling appointments, so who is your, who are your contacts for these various things? When is the best time to contact them, and when is the best time for you to be contacted? So there's some ways in infertility cycles, there's some aspects of it that are not under our control so that we can make it under your control in terms of timing.

There's other times when we do have a little bit of flexibility, and that might be one of them. So I always tell people who are teachers, if you have a time during the day that is your free time, and it's always some weird time, like 112 to 203 or whatever, and you tell me that that's the time that you want to be contacted and how you want to be contacted, whether phone call, patient portal, email, voicemail, then I will do my best to reach you at that time if I know that in advance. But I think a lot of people don't know that that's an option, or I want to be contacted on my lunch hour, or I want a voicemail, especially with maybe potentially difficult news, to be left on my machine for when I get home.

Those are all ways that are absolutely realistic and under your control that you can advocate yourself that I think you would appreciate, and we would appreciate knowing about you in advance. I absolutely agree with you. I think having some control over how and when you're going to get the information is really important to be able to manage it.

And as you mentioned, there's lots of different ways that we can communicate, but it's best to know what works for you, whether it's via portal, via voicemail. We want to make sure that you are getting the information in the most useful way possible, and we also don't want to play phone tag with you either if we know the value of an actual live conversation with you. And so, you know, we are so, we so much rely on nurses to be able to have those conversations, but we know that you need to talk to us as well sometimes.

So that control and that being able to get the information when you want it and when you need it and how you need it is something that you should really advocate for yourself as a patient. Yeah, absolutely. And I, you know, I have a nursing education business, and so one of the things that I teach is how to deliver difficult or bad news.

I think it's an important skill that's underdeveloped in most of us, and so I would say to patients, how do you want to receive bad news, potentially bad news? We hope to not be able to give you bad news, and I'll talk about that in a second, but how do you want to receive it? If you know that you have a certain test that day, and this is an important day, when and how do you want to receive that news? You can tell them when you come in for the blood work in the morning, hey, I want to be called. I want my husband or partner to be called. I want a message to be left.

I want to be emailed. What I talk to about nurses is sometimes when we are the ones delivering bad news, we feel so bad about delivering it because we know that we're ruining your day. We are acutely aware that we're ruining your day when we give you bad news, and our discomfort can make that phone call a little abrupt, and when I teach people that, I role-play with them, nurses.

I record them, and they get up and they're like, oh my god, that was so rude. I said, hey, this isn't, you know, your pregnancy test is negative. I'm so sorry.

Call me with your next day one. Well, that doesn't mean that we didn't realize the gravity of the situation and what we just kind of put in your lap, but we need to get this information across to you. We are uncomfortable almost hearing how much that you're upset, and that just makes us human and multifaceted, but I don't love that we end up doing that, so I just want to put out there if you, in fact, when you receive difficult news from a nurse or anybody in the practice, and it's less than you expected, then that the reason is that own person's discomfort, not their incredibly deep care for you.

It's that they care for you so much that they don't know how to say it or do it differently. What I teach is then I'm going to give you this news. I'm going to let it settle with you.

I'd love to contact you in the next day or two when you're ready to talk. Would that be okay? Most people really like that, but you never know how you're going to be on the phone, and we don't expect you to be any certain way. We hope you're finding this episode of SART Fertility Experts helpful.

Remember, for more information on this and related topics, visit www.sart.org and click on the tab labeled Patients. And now, back to SART Fertility Experts. One of the things I'm hearing as you talk about is not only how hard it is to get bad news and how much we do of that and how much you as nurses are required to do that, but how to help patients cope with that news and what can we learn and how to manage those expectations.

Can you talk a little bit about that and helping patients understand that not all fertility treatment is successful, much as we would like it to be. We want people to have realistic expectations. How do you help your patients realize those expectations? It's a great question and one that I actually explore with people all the time and I learn about myself.

So, the one thing, if I can get that across to everybody, is you are not your infertility. So, I brown eyes. I don't consider myself, I wouldn't, if you asked me 50 things about myself, I wouldn't say, I am brown-eyed.

Like, I happen to have brown eyes, but that's not the essence of me. It's not something I can control. You have infertility.

You are not your infertility. It is not a character flaw. It is not a way that you're less than.

In fact, for some people, once they get through the process, they actually find ways to access inner strength that they didn't realize that they had before. Now, I'm not saying that when you go through, if you cry or you get upset or you get angry or you're reactive, that that means that you, there's something wrong with you either. Because any way that you act is appropriate at that moment.

So, with that being said, I always tell people to figure out some empowering coping mechanisms that they can use during their infertility process. Some people use rigorous exercise as a coping mechanism. Well, we kind of take that away from you or limit that.

Some people use a glass of wine every night, myself included. We take that away from you, right, with preconception stuff. And we are inadvertently giving you a little bit more stress.

So, now we need to find some empowering coping mechanism. So, what I, I'm also a health coach. And so, I work with people and I do this thing called creating like a nourishment menu.

And so, what are the things on this menu that help you create a certain feeling? So, maybe the feeling you want to create is calm. Maybe the feeling you want to create is connection. Because sometimes going through this feels very lonely.

So, if you are a day that you're feeling super lonely, you go to your menu and you say, here's what I do in order to connect with other people. If it's a day that you feel overwhelmed or out of control or helpless, these are all also common feelings, you go to your nourishment. What is it that I can do? For some people, it's organizing like a closet.

It's a simple sense of accomplishment. But knowing in advance what these, what I call empowering, because I don't think there's good or bad coping mechanisms. How we cope is what we need at the time.

Empowering coping mechanisms can I use to create a feeling that I'm trying to get. And so, to know those in advance, maybe write them down when you see it. Remember it when you go through it and then employ them.

And if at that point it doesn't work for that particular day, that's okay too. I also tell people that a lot of people say infertility is stressful. So, then you think to yourself, I'm stressed.

And then you say, what can I do to get out of stress? It's sort of too general to say I'm stressed. It'd just be like saying I'm anxious. Well, that's great.

None of us know how to deal with anxiety. But if you label specifically what you're feeling, I feel unheard. I feel lonely.

I feel helpless. All these things that we talked about, those are things we can work with. So, you label it.

You say, this is how I feel, which is different again than this is how I am. Or right now I'm feeling this. So, it feels like transient.

It doesn't feel like it's part of you. And then I need this. Right now I'm feeling lonely.

I need connection. Right now I'm feeling sad. I need comfort.

It's very different than saying right now I'm feeling stressed. I need to be unstressed. Well, what does that mean? I think it's too general and there's no actionable item we can do to sort of counter that.

So, I don't know if that made sense or helps in any way, but create your nourishment menu and strike while the iron is cool. That's the only other thing I tell people. In the heat of it, the nourishment menu goes out the window like everything else.

So, kind of formulate that and identify that stuff when you're not in the heat of the moment. Great advice for helping manage those feelings and try to be more specific about what it is that's getting to you. I think that is great.

You mentioned that you're a health coach. Can you talk a little bit about how you help patients improve their health before fertility treatment, before pregnancy? I think that's a really, it just fits really well into what you do as a nurse and nurse practitioner. So many of our patients would benefit from hearing the kinds of advice that you would recommend to patients who are planning a pregnancy.

What are some of the things that you coach patients about? You know, I got my certification to be a health coach because when I was in the throes of actually working in a practice, as you know, Dr. Lynch, there's just not a lot of time to do all the stuff we want and love to do. We're sort of confined. And now with COVID, requiring so much of our time with consent forms and blood work and all this other stuff, we even have less time because we're kind of stuck on the stuff we don't like to do.

And we have to limit the patient care, which we do like to do. So, getting my health coach certification allowed me to do this. And so, what I talk to people about all the time are these core tenets of health.

I work mostly, well, people refer to me mostly if somebody has excess weight to lose prior to a cycle. But when I talk to people, we end up talking about the nutrition part, like the third or fourth consult, because there's so many other aspects of a person. So, we talk about sleep, exercise, or movement.

I never call it exercise because that implies some sort of outfit necessary or structured time. I just think moving and less not moving is incredibly important. And by the way, the ACOG guidelines, the American College of Obstetrics and Gynecology in 2017 said people should be moving and even in the early pregnancy.

So, there's certain times and cycles that we don't want you to, but regular walks and moving is a great form of stress release. Yes. We talk about sleep, eating, drinking enough water and not drinking drinks that actually have a lot of sugar or extra stuff in it.

For me, for a long time, it was working with people who would always get coffee drinks. And a lot of it was the treat of kind of going to, let's say, Starbucks or the coffee place, but really what they needed, they were bored or frustrated or distracted. So, we have to talk about what can you do when you're bored, frustrated, or distracted instead of getting an unhealthy or not so healthy coffee drink.

And so, we talk about mostly those core tenets. Sleep is huge. And then stress release, which you and I had talked about in terms of the nourishment menu.

But really, I talk a lot about habits. And so, there's a certain cue and everybody has these triggers. It's based on our programming.

Everybody has their own story. If I said something to you that bothered you, that you feel like it's a little bit of a live wire, that particular spot, you're going to deal very differently with it than if I said something to you that wasn't. And so, it's identifying those things.

Making something in that action part be a healthier, empowering, functional, or workable habit, as opposed to emotional eating, drinking, smoking for some people, ruminating, et cetera. And then what is the feeling that you're trying to create, which we got into a little bit when we got into before. Is it peace? Is it because you're bored and you need to do something that makes you not feel bored? I find that when people go through infertility treatments, what you're doing is you're experiencing emotions that you may have never felt before in your life.

So, you and I and many people that are our clients are accomplished women who you study hard for a test and you do well on the test. And you do well in school and you get a certain degree. With infertility, you can kind of, quote unquote, work as hard as you want and not be able to achieve what you're trying to achieve.

And that's not only incredibly frustrating, it's something we've never dealt with before. I mean, we've never had to deal with it. We've never had that happen before.

And it takes away our sense of what's called agency, meaning the choice that we make can affect the outcome. And that, I think, is one of the hardest things for people to understand. And there are other ways to make choices within the process.

And that's what I talk to people about. But I just need people to know that if you are doing everything that you said you're not, you're going to do, and your outcome is not what you think, it is hard. And that you have to realize that, but that most people that go through this can do hard.

They know how to handle hard. I think that's a great point. I think there's an agency, it's the right word, that you don't, you lose some control over things and you just, you can't, no matter how hard you try, there's some things that you won't be able to control in this process.

And all you can do is handle the things you can control. And it sounds like through coaching, you're able to help people control what they can and manage their health and their emotions as much as possible. So I think that's just such great advice and such a great part of what you offer your patients and something patients can seek out as they look to try to help themselves go through this process.

Yeah, I love it. And I feel like even if I can't change the circumstances, what makes it worse is feeling ill-equipped. So if I can equip people or any of your nurse can do without necessarily being helped with some strategies or techniques that work, then that is at least arming you with some information or some, you know, retail armor in the midst of, you know, a challenging situation.

I have another question for you. How about, so many times fertility treatment involves injections and many patients have a fear of giving themselves injections or find this some, one of the more scary parts of infertility treatment. How do you help patients overcome that fear? What are some of your strategies? Very valid.

I am sure Dr. Lynch, you and I, we had a dollar for every time something like, there's no way, there's no way I'm going to be able to do an injection. We, and then they end up going on to do the injection. We would not have jobs right now.

What I find in the great majority of the time is the thought of administering or receiving an injection is worse than the actual administering or receiving an injection. 99 point something, something for some time. I've had people that I have had to help with injections, let's say for the first night.

And I go over there, they're like, there's no way. And some injections are more difficult because of where they are, because there's a little bit more of a technique, but we're talking about the subcutaneous, the small needle in the fat injections, they're usually in the belly. Maybe sometimes in the top of the thigh.

Those are absolutely doable on your own. Once you get over the initial, I don't feel like I'm going to be able to do that. So what I would tell you is that it is absolutely and completely normal.

I have maybe a handful of people that said, I can do this. I'm good. Everybody else like there's no way I can do this.

And guess what? They end up being good too. So I would say take small steps. So acknowledge that you're scared, right? That's part of the I, you know, right now I'm feeling scared right now.

I'm feeling whatever. That's okay. And acknowledge that.

And then the next step is, let me just watch the video. There's lots of great videos out there, animations and actual videos. Then the next step might be, you know, having you try it.

I always have people try it on like a chicken breast, a thawed chicken breast, which they A, don't use and B, don't use that needle. I, you don't have to say that, but that, you know, people like the, I think I can just use this chicken breast. I was like, no, but just to try it on there.

That's the next step. Then a lot of times at your center, the nurse, medical assistant or somebody else clinical is happy to watch you do your first injection if you need to. And if that time slot works or to go through with you, even right now with Zoom or other screen shares if it's a time during the day and you say to the nurse, Hey, can I give myself this pretend injection? Or can I show you what I'm thinking? Can I show you this through a screen share? Absolutely.

Somebody be willing to do it. Just make sure that you check with the timing to make sure that that timing is a time that works for both of you and that that nurse doesn't have other stuff going on. So she can really truly give her attention to you and the attention that that deserves.

The other thing I will say is just a little procedure step, let the alcohol dry before, because if not, it can sting. And then you're wondering if you're doing it wrong. And the last thing I would say, especially with subcutaneous injections is a really hard to get wrong.

They're really, really hard to get wrong. And some people will say it's done. There's a little bit of blood at the site.

There's a little bit of bruising at the site, all completely normal. And most of the videos explain that, but if you're not sure, and you and I talked about this, Dr. Lynch, we talked before, if you're not sure in the evening about to give an injection, you absolutely call your emergency line, speak to whoever's on call and go over the injection. We would much, much rather you call us and take literally two minutes to explain this to you than have you either not do the injection properly or B, worry about it all night and have sleepless nights.

It makes me so sad when somebody's like, I wanted to call last night, but I didn't know what to do. I didn't sleep all night. I feel terrible.

There's no reason to that. We absolutely are so happy to do that. What about involving the partner? Do you find partners can be helpful with injections too? Absolutely.

So if we're talking about, so there's two things. So one, we talked about agency and small steps in order to make choices. This is something you can do each day.

That is like, this is something that I can actually do. That's going to create an outcome. And then there's other ways that your partner or friend wants to be involved and always says, how can I help? I don't know how I can help.

For some people it's like, I'll go over all the financials. Let me be the financial liaison or liaison between us and the finance person. And then the other way is to help you with injections, particularly if there's some that have to be given in the butt, which are intramuscular.

There's a very, even the utmost of best injectors in the world, that's difficult to do. So that's another great way to involve your partner. And if you do involve your partner, they are nervous too, because they're like, this is the one thing I have to do and I don't want to screw it up.

So just realize that their first time they're doing it, they're nervous as well. So that's a great point. Yes.

And the other thing is there's a way to reframe, which is kind of like, let's say putting on a different set of glasses in a situation, instead of being like, this is one more thing, you can say, this is something I can actively do to achieve my goal. And there's certain days that you may need to consciously remind yourself of that. But a lot of times people put it in that framework.

It just makes you feel like you're more proactive than reactive. Thank you. We're grateful to Infertility Nurses everywhere for the work that they do in helping to take care of our patients.

And that role cannot be overstated. It's such an important part of the process is how nurses help our patients through their journey. So thank you for all that you do.

Thanks so much. Thank you for listening to SART Fertility Experts, your resource for information on IVF. If you found this podcast useful, please like us on your favorite social media platform and tell your friends about us.

For more family building resources, visit www.sart.org slash patient dash information or www.reproductivefacts.org