Courtney Collen (Host): Hi there and welcome to ‘Her Kind of Healthy’, a health podcast series brought to you by Sanford Women’s. I’m your host, Courtney Collen, with Sanford Health News. We want to start brand new conversations about age old topics from fertility and postpartum depression to managing stress, healthy living, and so much more. Her Kind of Healthy is designed to bring you honest conversations about self-care, happiness and your overall well-being with our Sanford Health experts. We’re glad you’re here.
Our topic today is all about infertility to raise awareness about the challenges many couples face when trying to grow their family. I want to welcome Allison ‘Alli’ Harrison. She’s a nurse practitioner in reproductive medicine at Sanford Health in Fargo. Alli, welcome to the conversation.
Alli Harrison: Thank you. Thanks for having me.
Host: The National Infertility Association recognizes National Infertility Awareness Week in late April. I want to ask you this, first, what is the recognition all about?
Alli Harrison: Well, we know that infertility is definitely increasing. We’re currently seeing that one in eight couples have troubles with achieving a pregnancy, whether that’s their first pregnancy, their second, recurrent pregnancy loss, or knowing where to go to get help if there had been trying to achieve a pregnancy and haven’t been able to. I think what happens is people are usually keep this information to themselves. It’s kind of personal. They have people around them that want to support them, but maybe don’t know what they’re going through. This week is just here to recognize those people that are struggling to get pregnant and find ways that we can help them through that journey.
Host: I want to learn more about your role. So, tell us what you do as a reproductive medicine nurse practitioner in Fargo.
Alli Harrison: Yeah. So at our clinic here in Fargo, we have five providers. Currently we have three reproductive endocrinologist and two nurse practitioners that have a little bit more training in women’s health and reproductive medicine. And what we do is we kind of work as a team approach here. We bring patients in and we get a good health history on the patient and try to understand what they’ve been going through, what they’ve tried along their pregnancy journey. The initial workup of figuring out where we need to go with this is done by the doctors at the clinic. Then, the nurse practitioners have that supportive role where we see the patients throughout that process, as well, for ultrasounds, visits and restart appointments and kind of getting them all set up for things like IVF if they need that route.
Host: What do you enjoy most about the work that you do?
Alli Harrison: This area is challenging. It’s challenging for patients it’s challenging for providers because we’re working really hard to help someone make a family. And so the most challenging part is that obviously heartbreak when you’re not able to achieve a pregnancy. But the best part about it is really supporting them along the way and then hopefully being with them as they navigate that first part of a healthy pregnancy.
Host: You mentioned one in eight struggle with infertility. That’s a lot… more than a lot of us might think, isn’t it?
Alli Harrison: It is a lot. And, and we usually say, you know, women struggle with infertility one and eight women, but we really know that it’s a two-sided deal. So we see a lot of female infertility, but we also see a lot of male infertility as well.
Host: What might contribute to somebody having trouble getting pregnant?
Alli Harrison: That’s a great question. There’s several things that can contribute to difficulties in getting pregnant. The first things are obviously structural things. So is there anything going on in the woman’s uterus that could be preventing a pregnancy … or maybe being a contributing factor to repeat miscarriages? So the first thing we kind of look at is what’s the uterus like? What are the ovaries like? What are the fallopian tubes like? Another thing that contributes could be the male portion of it. So really taking a good look at the semen analysis and looking at the sperm counts the shape of the sperm, how fast they move and then we know that sometimes there’s some hormonal issues that you know, hormones within the body that maybe aren’t lining up correctly. And so therefore people aren’t getting regular menstrual cycles or aren’t obviating when they’re supposed to. And so all of those can really contribute to difficulty with achieving a pregnancy.
Host: So let’s talk about the care that Sanford Health provides, what does that patient journey look like? If couples are trying to get pregnant, having a tough time when and how should they start reaching out?
Alli Harrison: Yeah. So some people will start by going to their primary care provider and just starting with that conversation saying, you know, we’ve been trying to get pregnant now for quite some time. And we’re just wondering, is there anything else that we can do to increase our chances? And that’s what we see a lot on the, you know, the primary care provider side. So there is some initial workup that can be done with our primary care provider. However, we do see a lot of people that come right over to the reproductive medicine clinic. That’s something that a lot of people don’t know for our clinic: you don’t actually need a referral to be seen. Anybody can call our clinic and just ask to be set up for a new patient consult. Others will do some initial workup maybe with their OB/GYN provider or primary care provider. Then maybe they want to put a referral in, or maybe your insurance requires a referral. So if that’s the case, they’ll just put that referral in and then we call them to get them set up for that a first appointment. As a general guideline, females that are under the age of 35, we’d recommend that you try it for pregnancy for about a year. If after that first year, you don’t get pregnant, then that’s time to reach out to someone and see if there’s anything else that should be done to help with that. Then women that are over 35, the rule switches down to about six months of trying. And that’s just because we know that women throughout their lifetime, eggs are going to deplete. And so we know that if you’re 35 or older, we don’t really want you to wait that full year before reaching out if that’s not what you want to do.
Host: Great information. Thank you. Talk about the fertility services that are offered at Sanford Health.
Alli Harrison: Yeah. So when you come for that first appointment, it’s going to be just a really good look at your overall health. Are there any health conditions that could be contributing to your fertility? We also look at some basic labs. We want to make sure you’re immune to certain things that could affect a pregnancy such as chicken pox. Did you have chicken pox when you’re younger? Do we need to give you a booster shot before you start trying? Are you immune to rubella? What are your thyroid levels like? What are your blood counts look like? And then looking at your overall ovarian function… checking some hormones, that’s kind of the background lab work that we do. Another thing that we like to look at is the uterus. So we would start by some initial workup by looking inside the uterus, maybe putting a little bit of water inside that uterine cavity and checking to see, is there anything inside the uterus that’s causing some issues?
We can also check your fallopian tubes. That’s the tube that lets the egg come down into the uterus and we want to make sure that there’s nothing blocking those tubes. We also look at again, the partner. Is there normal sperm counts? Is there no sperm? So that kind of helps guide us on what route we need to take for your treatment. Other things services that we offer include oral medications, medications to help you ovulate. We do, what’s called IUI which is an insemination in the clinic where we actually put sperm into the uterus and that helps increase the chances of pregnancy. We can do things like IVF. So we are actually one of the only clinics across a large area in the tristate area that does IVF. So that’s actually, you know, making embryos outside of the body and putting them back into the uterus to carry that pregnancy. Some other services that people maybe don’t know that we do is third party reproduction. So that would be using things like donor sperm, donor eggs, or maybe using a gestational carrier. So utilizing someone else’s body, someone else’s uterus, to actually carry the pregnancy for an intended parent.
Host: There are so many option aren’t there?
Alli Harrison: There is. And we are currently working on some processes too with the oncology unit. So working on a smooth process for people that may have found out that they have cancer or need, and trying to find ways where we can get them over to our clinic quickly to preserve some eggs or sperm before starting those treatments, because we know that those treatments can affect fertility as well.
Host: When does IVF or in vitro fertilization come in as an option? It just seems to be one of the more common types of reproductive technology, if you will, that I hear about.
Alli Harrison: Right and some people think that, ‘Oh, I’m being sent over to the infertility clinic. That means I have to do IVF’. And I know that that’s expensive and I can’t afford that, but that’s not necessarily something that everybody needs to do. It could be just as basic as maybe you’re not obviating. And so we can give you a medication to help you ovulate, and maybe you have intercourse at home and you achieve a pregnancy. Other things, you know, maybe you hadn’t had your fallopian tubes looked at and we checked them and we figured out they’re blocked. Well, we don’t want to give you medication to try on your own because we know that the eggs can’t get to where they need to be. So, those types of people maybe would go right to IVF. So there’s definitely lots of different routes in an infertility journey and IVF tends to be kind of that last route, but it’s definitely something that we don’t jump to if it’s not needed.
Host: And I know a lot of these services can be costly. What financial assistance might be available for couples who might be going down one of these roads?
Alli Harrison: Unfortunately, a lot of insurance providers don’t give a lot of coverage for infertility and they are these services are pretty expensive for many women and men. There are some bundles that we do through some outline companies that help kind of finance things so you don’t have to pay so much upfront. We have a financial counselor at our clinic as well, that will look into insurance, see what we need to do see if they apply or if they can do any of those like bundle packages that might help them afford these processes.
Host: Oh, wow. Well, that’s convenient to have somebody right in the clinic.
Alli Harrison: Yes, she’s one of the first people they see when they walk in, because we know that’s probably one of your initial questions when you come here, is ‘can I afford this? Is this something that we can do?’
Host: How much is it going to cost me? And I know that this could be a stressful process for a lot of couples. Are there other services that provide support along this journey, whatever the couple may choose to do?
Alli Harrison: Yeah. We definitely recognize that any kind of infertility that patients have can be, it can be mentally taxing for people. They go through a lot of physical changes throughout it, and then we know that emotions behind it. I mean, if you think about every month that someone tries to get pregnant and they don’t, that’s just like a monthly reminder that it’s another month that it didn’t work. And so we do see a lot of anxiety and depression with our patients. So we do have some psychologists that we work with through Sanford. We also have some psychologists outside of that have worked with patients going through infertility. We really encourage people to consider some counseling. We also have medications that have some pretty good research behind them, that state that you can use them when you’re trying to conceive and you can use them throughout pregnancy as well. So, those are counseling and medication is available for patients if they need it.
Host: Yeah, great. When visiting a primary care provider or a specialist, should the patient go alone? Should they bring their partner? What do you recommend?
Alli Harrison: With those initial longer appointments where we’re really trying to is dive deep into the history and try to figure out what could be contributing to this? I think it’s definitely helpful to have both partners there. Like I said, it takes two to make a baby. And so if they can be there and answer some questions about their health history especially when you come to our clinic, a lot of our patients will meet with a genetic counselor and look into, you know, the genetics of each side and try to figure out if there’s anything that could be a contributing factor. So not only for getting the medical information that we need, but also for just supporting each other throughout this journey, we know that it’s difficult. Sometimes, sitting in that exam room alone is it’s uncomfortable. And so it’s nice if you have someone there for support, whether that’s your partner or a friend or a family member that can be there with you.
Host: One in eight struggling with fertility means there are a lot of people out there going through this. Do support groups exist? How would somebody find resources or community for support?
Alli Harrison: Yeah, we definitely have some support groups within our region. Most people will just, you know, go to Google and Google “support groups within North Dakota for infertility”. There’s definitely some good groups out there. I think too, the more, even though it’s difficult, the more people that are honest about what they’re going through, they will start to see that friends kind of mentioned ‘yeah, I actually went through that or I’ve had a miscarriage two, or we really struggled to get pregnant as well’. And sometimes the first step is just kind of acknowledging it and opening up to some people. And it’s hard because people don’t always know how to support you in the best way. And so you will see that people maybe make comments that didn’t help or made it made you feel worse. For many people, I think they can connect with some friends and family that probably have gone through a similar situation. And for them to be able to reach out to them is, is super helpful. We have a lot of patients even that, you know, they see each other all the time in the lobby and they start to talk and end up being friends because they went through this journey together.
Host: Obviously it would be hard for someone to relate if they have not gone through infertility or might be struggling with getting pregnant … but they’re our friend or our loved one part of our family. If we want to be for them, how would you recommend ways that we can still show our support?
Alli Harrison: That’s a question we get a lot from family members trying to support like their loved ones that are going through this. I think the biggest thing is just to be there and listen. They probably don’t need you to give them advice on what to do or probably don’t need to say, ‘oh, you should try this because this worked for us’. It’s more so just saying, ‘I’m here for you. I can’t imagine what you’re going through right now. I’m sure you’re so frustrated’. And then just letting them open up to you. And it’s hard for women to tell people what they need. But if you’re there to listen and you’re checking in on them once a month, ‘Hey, you thinking of you. Anything I can do for you?’, or ‘is there anything I can help you with?’ that is super helpful for patients.
There’s also those difficult situations that if you know someone going through in fertility and say you’re at a baby shower for someone and you see them there, you know, just kind of checking in with them before saying, ‘I’m sure this isn’t the easiest, but if you need me for anything, let me know’. Cause those are those scenarios. We don’t really think about, you know, getting together with friends and maybe everybody else has kids about you or going to a baby shower to celebrate someone and they want to be there and they maybe did show up and they’re there, but it’s probably pretty painful for them. I think really being that open ear and just saying, ‘I’m here, if you need me and what can I do for you’ is probably the most beneficial.
Host: Acknowledging that it’s not always going to be easy for everybody to do those things that you think would be easy, like going to a baby shower. If somebody is listening that is struggling on their journey to become pregnant, what would you want them to know about the care that you provide at Sanford and really the whole team of fertility and reproductive medicine?
Alli Harrison: I think the first thing would be is if you’re concerned about getting pregnant, you have questions about getting pregnant, is just reaching out. So instead of sitting there and just saying, ‘Oh, should I do this? Should I not?’ Just come see us, we’d love to do an initial evaluation and just try to get some more information on how we can help you. You know, it’s a difficult thing to go through, but we clearly work here because we want you to be successful and we want you to have that healthy family. Many of us have our own kids so we just, we try to put ourselves in their shoes and just say, gosh, like, ‘I can’t imagine if this is what I wanted and I wasn’t able to achieve it. Like they must be really, really hurting’. And so, yeah, it’s hard because it doesn’t always work the first month or it doesn’t always work the way we want it to, but we really are on their side and working to do whatever we can to help them achieve that family.
Host: Wonderful. Well, we are so grateful for the work that you do and all that your team does to care for men and women who are along this journey. Is there anything else that you wanted to add, Alli, on this topic?
Alli Harrison: There’s a lot of stuff to talk about when it comes to infertility, but it’s kind of taking it step-by-step and so if we can help in any way, please reach out to our clinic or, you know, send, call our clinics, send us a message and we can try to get those questions answered.
Host: You have been such a great resource. Alli Harrison nurse practitioner in reproductive medicine for Sanford Health in Fargo. We really appreciate your expertise on this topic and all that you do for Sanford. Thank you for being a part of this.
Alli Harrison: Thanks so much.
Host: I’m Courtney Collen with Sanford Health News. Be on the lookout for our next episode of Her Kind of Healthy… coming soon!