Poor Bedside Manner, Lack of Empathy or Self Defense Mechanisms

I launched my fertility coaching business in July 2020 and shortly thereafter created a business profile on Instagram in order to help promote my business but also to learn from the TTC community. I want to learn what people need, what support is lacking, what support is useful and what’s unhelpful. Very early on I learned that something I know I’ve said as an embryologist was in fact unhelpful to my patients. Saying “it only takes one.” After an egg collection with one egg, or when we delivered the news that one egg was fertilized, or when getting to day 5 in culture and explaining we have one blastocyst. We deliver the news, and it’s often met with a disappointed “only one?”. So, we try to be reassuring, responding “it only takes one” is meant to be encouraging. Now I realize why it’s not.

Part of my role as a coach is to help support people on their fertility journeys. But I also want to use my presence to help promote fertility education, raise infertility awareness, and feed back some of my findings to the medical professionals that I used to work with.

In order to find out what things are unhelpful to the TTC community I had to enlist some help. I approached Katy from @ivf_got_this_uk and shared previous articles I’ve written and asked if she’d be willing to help me for my next article. She kindly agreed and posted a question on her stories: “what has a fertility specialist told you that was unhelpful to you in your current situation?”, and she shared the responses with me. Over 100 responses to be exact.

What unhelpful or hurtful comments are said to those struggling to conceive? Here are some of the recurring ones:

“Why are you so worried? You’re so young!”

Most of the responses had a reference to age and worry. Why is this detrimental to someone struggling to conceive? Because if you’ve been trying to get pregnant for 2 years, it’s considered to be infertility no matter how old you are. It also invalidates any concerns the patient has. Monthly cycle after cycle, the patient is reminded of not achieving a pregnancy. Becoming more aware of the risks that something may be “wrong” and wanting to address it sooner rather than later. Medical professionals will often disregard their requests of further investigations or referral to treatment, deeming them as impatient. I want to believe that the comment is meant to be reassuring, but as no other information is given it is instead perceived as dismissive. What could they be saying instead? What response would be interpreted as thoughtful and caring? “Given your age, medical history and lack of diagnosis, you should be able to conceive naturally. I understand this must be worrisome, but I’m not concerned. Let’s look at some things you can try and if things haven’t progressed in a few months we’ll follow up and take it from there”.

“Just lose a bit of weight”

So many women have heard this response. A majority of them suffer from PCOS. PCOS is a disorder that can affect the reproductive system, but it’s also an endocrine condition that can make losing weight really hard. Some women go on extreme diets to meet BMI criteria for IVF treatment, which may in fact deplete the body of vital nutrients needed during the treatment. A more helpful approach would be to support a plan for the weight loss. There are so many wonderful dieticians and hormone dieticians that can assist with meal plans, exercise, self-care and supplements, which would enable a healthy weight loss and promote hormone balance that will have long term benefits for patients. Directing patients to these types of resources would be a more thoughtful approach rather than dismissing them.

“At least you can get pregnant”

Far too many women have heard this when they’ve suffered a pregnancy loss. Miscarriages are unfortunately very common. Most people don’t know how common they are until it happens to them. The 1 in 4 statistic isn’t helpful. Numbers don’t matter when your heart is breaking. Early pregnancy or late - what the patient is going through is not just the loss of their longed-for baby, but their future hopes, dreams and plans. From a diagnostic point of view, knowing an implantation can happen is useful for the doctor trying to help you. But “at least you can get pregnant” is not the way to convey that. And often the message is accompanied by “you can start trying again in your next cycle” but it either falls on deaf ears or is heard in disbelief by someone who will now want nothing more than to be pregnant again but is simultaneously scared of another loss.

Often in times of delivering bad news people say they don’t necessarily remember what was said, but they remember how they were made to feel. So, make sure they feel supported in this devastating time. Acknowledge their pain and sadness. Provide resources that can help them with their grief, because it is indeed grief that they’re experiencing. Do not invalidate that.

So why does medical professional say these things? My belief is that they do not understand how hurtful these comments are, as I was unaware of “it only takes one” being unhelpful. Skilled professionals providing a highly specialized service unfortunately have limited training in how to deliver bad news. Maybe that’s why we’re sometimes bad at it. Maybe that’s why after saying something that’s upsetting, we try to follow up with something that we think is encouraging. But as it’s clear that the patients aren’t the ones benefitting from the attempted uplifting comment, are we doing it for ourselves? It’s not impossible to imagine that we want to “end on a positive” because of what it will do to our mood. We know that the reality of fertility struggles, and fertility treatment is that more cycles end in a negative pregnancy test than a positive. If we truly opened our hearts to our patients, would we become too invested? And would that emotional investment affect the quality of our care? Being objective is a good way to provide equal treatment to all, but it can come off as coldhearted. The emotional impact of fertility struggles is such an important part of the journey, and we need to be learning how to address this aspect as much as we are trying to help patients get pregnant.

-Sandy Christiansen, Fertility Coach

MSc, HCPC registered clinical embryologist, ESHRE certified embryologist

Medical Disclaimer:

The information provided in this blog is intended for general informational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider or qualified medical professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this blog.