How to Take Care of Your Mental Health During Fertility Treatment with Dr. Linda Kim

Welcome to the Egg Whisperer Show. I’m your host, Dr. Aimee, and I’m so excited to have Dr. Linda Kim on with me today. Dr. Linda Kim is a Harvard trained psychiatrist with many years of clinical and leadership experience.

Listen to this interview on The Egg Whisperer Podcast

Dr. Aimee: Linda and I have known each other since I was in Boston as a resident and she was a medical student. So that’s how far back we go. So it’s really awesome to reunite on today’s show and to talk about something that’s near and dear to my heart, and I know to yours too. And the title of today’s show is the most important part of your fertility journey, and that is taking care of your mental health. There is no one better to talk about this topic than her.

Welcome to the show, Linda. Would you tell us about yourself?

Dr. Linda Kim: I am so glad to be here. Thanks so much for inviting me. I did my training back in Boston. And since finishing my training, I came out to California, and I immediately began practicing within a large healthcare organization. And I have served and have been so privileged to work with thousands of patients for over 10 years now. And over that time, I have gotten to learn quite a bit.

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Photo by Ethan Dow on Unsplash

Hearing people’s stories, hearing their pain points, seeing people get better, and what has been helpful, and what has been really challenging. I really started to build this whole treasure chest of wisdom and tools and learning together. It has been wonderful. In addition to my clinical practice, I started to do more and more leadership administrative roles, and I loved that aspect too.

I started to see how challenging it can be for women in terms of maintaining busy households, or a childcare family responsibility, busy, busy career, and so forth. And so that ultimately led me to really wanting to follow my passion and say, “You know what? Actually there is this gap, right, in terms of how we think about mental health care, especially for women in their lives.”

Watch our interview on YouTube

And so I knew that I had to branch out and create LuvLuk Health, so that I could really start to be really specific and intentional in terms of thinking about mental health issues for a woman and the different challenges that they go through.

Dr. Aimee: I love the name LuvLuk. L-U-V-L-U-k.com. It is a great model because people do not need to leave their homes to get access to great psychiatric care.

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Dr. Linda Kim: Exactly. Especially for busy professional women with a lot of demands, childcare, school, homeschooling. And especially in this time of COVID too, women have been asking for easier and more seamless ways of getting care so that they do not have to leave their houses. Before COVID, it involved getting parking, get childcare that kind of thing. And so, by having a very easy and accessible virtual practice, has been really impactful I think for the woman that I care for.

Dr. Aimee: And then what made you go into psychiatry and focus on women’s health?

Dr. Linda Kim: The psychiatry issue is an interesting one. I actually thought I was going to become a surgeon. I loved being in the OR in medical school days and it was really … I love the thrill of it and that instant gratification, say, in terms of surgery. And I loved being given the opportunity to hear stories and enter someone’s life in a very personal way.

I am an avid reader, and I feel like every time I meet with someone and I can share their experiences when they tell me their backgrounds. I feel like I am being invited into another person’s life. And so that has just been one main reason why I entered psychiatry.

And I see that people get better. And so that was another really important thing for … It might not happen overnight, but it happens over time. I love being able to have a true impact on people’s lives. So that’s why psychiatry.

For women mental health, I have to say that it is a really personal thing. I am coming from a family with three girls. I have two older sisters, I have three daughters. So, you can imagine any get togethers are all women running around the house.

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For infertility, both of my sisters struggled. They both went through IVF. One sister was successful in terms of getting pregnant, she has two beautiful boys now. And my other sister, she ultimately did not end up getting pregnant or having a baby. And now she’s the favorite aunt. And my daughters actually prefer being with her at all times, rather than with me. So happy endings, everyone found their joy.

I saw and witnessed how challenging this process of trying to conceive is, and I saw the toll that infertility can take on someone. That’s why I really wanted to create some resources and support mechanisms for women going through this.

Dr. Aimee: And you have definitely helped my patients. And I just love everything that you’re sharing with us. What are some of the common mental health issues that you see in women?

Dr. Linda Kim: It spans the entire spectrum. Obviously the most common mental health issues are things like depression and anxiety. I also see bipolar disorder, PTSD, schizophrenia, ADHD, everything in women. I know (based on statistics) that women are more commonly affected.

So, for depression, women are two times more affected during their lifetime than men. It is the same for anxiety, it is one and a half times more common in women. We see that clinically.

We are trying to understand why and have a hypothesis around it. There has been a lot of research into figuring that out. And a lot goes back to the fact that we have different hormones as well.

We have our menstrual cycles, we have these really huge shifts in estrogen, progesterone, LH, FSH, whatever it may be, in pregnancy and in menopause. And that hormonal contribution is something that is quite significant in terms of mental health issues.

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Dr. Aimee: How would anyone who is reading this know if they need support, or if they need something like an antidepressant?

Dr. Linda Kim: I love that you asked that because I get asked that all the time. A lot of times woman sit at home and they suffer alone. There have been studies done that tell us that the average wait time before someone gets help for something like depression can be eight years.

So imagine that someone is suffering by themselves without getting the treatment, when they can feel better. First, I am not here to pathologize anything in terms of the normal ups and downs of life. We all get hardships, we all feel sad, we all feel stressed in relation to normal life circumstances.

The thing to monitor is if those feelings do not go away. These would be feelings of being “off,” or sad, or immensely irritable, or anxious. The way it’s generally monitored is in a two week period of time.

Let’s say you’re starting to feel really sad, or have poor energy, or you just don’t feel excitement or joy from anything. If you feel that way for either more than half the days or nearly every day for a period of two weeks or more, that really is a tip off that maybe you should reach out to someone and consider getting help.

Another to consider is if it starts to impact your functioning. So you’re either not as productive at work, you can’t concentrate. You might have your supervisor to come and say, “Linda is something off? I’m starting to notice something.” Or you might even find at home that your loved one, your partner is saying, “I’m noticing something different about you.” So we do at that in terms of if it’s affecting your functioning too.

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Dr. Aimee: It can be confusing for fertility patients because you might have some of those feelings all of the time. I find that some of my patients think that those feelings can cause infertility, and then they feel stressed. And then they think that stress is causing their infertility. What do you think about that?

Does stress really cause infertility?

Dr. Linda Kim: That is such a myth. People might say, “Oh my gosh, I’m so stressed out! That’s the reason why I’m having these fertility issues.” And it is not the case. We know that stress does not cause infertility.

If someone wants to know what is causing their infertility, that’s why they seek out your help, or the help of a doctor to take a look at anatomy, their age, and all of the other markers for the reasons why they’re struggling with infertility.

We do know that infertility does impact the way you feel, and it causes stress. Some studies show that women undergoing infertility treatments have as much stress as someone who just had a heart attack or someone who is facing cancer. I mean, it can cause that much level of stress.

Things are so intermixed and you’re feeling so overwhelmed that you might think that, but it’s not something that is causing your infertility. We know that stress can impact and influence how emotionally well you feel during your infertility treatments. And that is something that is absolutely treatable. We want you feeling as best as you can, and managing your stress, so it’s lowered as much as you can so that you increase your emotional wellness. And maybe that also can increase the outcomes of how you are feeling during that time.

I don’t want you to go away thinking that you shouldn’t be proactive in your approach in terms of managing the stress while you’re going through infertility treatments. You absolutely should be proactive in doing that.

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Photo by Victoria Heath on Unsplash

Dr. Aimee: You just mentioned managing the stress. So what are your recommendations to people who are listening and watching, as to how we can best manage our stress during fertility treatment?

Dr. Linda Kim: It’s interesting because the women that I work with come to me and the first thing that they say is, “People tell me I should not be stressed, and people tell me I should be relaxed or to relax.” And they say, “How do I do that? No one ever tells me how.”

It’s like, “It would be lovely if I could turn on that on and off switch and just say, poof, I’m just relaxed now. Great, I can start.” And that’s the kicker.

That’s really why I’ve taken all these different experiences in my past, working with thousands of women to create just a new way of looking at things. Because it’s not something that’s pathologic. You’re not seeing me for depression or for generalized anxiety disorder. You’re seeing me or getting help because we know that you’re going through a really challenging and stressful time.

I like to encourage patients to think about an athlete who is going to the Olympics. We know that she is training. We know that she is excited to be there. We know that this is a life event, something that she has worked for her whole life. And we know that there is a huge amount of stress, a huge amount of pressure, and huge amount of expectations that she is putting on herself and others are putting on her. Even her whole country has their expectations set on this one athlete.

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Photo by Quino Al on Unsplash

I like to liken the process of going through infertility treatments to that of an elite athlete, who’s going up to the Olympics because of all these different really high stakes, high hopes, high dreams, factors that are at play.

When you start to think about stress reduction in that way, I like to ask, “Okay. So, what do we know, and what can we use in this really complex arena that women are in during fertility treatments?”

The first thing is going back to the basics. In my model, I created a way to systematize this and which I call the LuvLuk Method

That L is the love yourself. Love yourself by doing self-care and by creating your core network of folks. This is your coaching squad, your team, your people who are behind you, and rooting for you. It is important because self-care is actually evidence-based in terms of stress reduction techniques (healthy diets, exercise, mindfulness, those types of things).

For the U: I like to think of it in terms of: you’re going to take care of yourself, you’re going to love yourself, and you’re also going to make sure you have those loving supports around you. Who’s your team? We know that there are people who are actually really good for you and going to be your cheerleaders, and we also know that there are some people who might not be the most positive factor in your life. Some people ask a lot of questions that feel overly critical. You want to start identifying who those people are, and then choosing who is going to be on your team.

I also to believe in the amazing power of your mind. In terms of the visualization, the imagery of what you can do for yourself. We see a lot of that in sports psychology, where elite athletes are training and using visualizations to make sure that they are mentally prepared for some of these different challenges.

The V is for Variability. So, the heart rate variability and utilizing your vagus nerve. This is super easy for you to do. It’s about the breath and abdominal breathing. There is a huge amount of evidence behind this, in terms of specific abdominal breathing supporting health. It helps you utilize the vagus nerve which is so interesting in terms of its anatomy and how that can control your parasympathetic nervous response, which is the exact opposite of your sympathetic nervous response. It helps you bring down your stress levels. And there is a burgeoning wealth of knowledge around how you can use that to affect your heart rate variability, which is to actually counteract that stress response that you might be facing.

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The next L is something we talk about in mental health, it’s the logical methods. It’s the CBT, it’s the DBT, it’s knowing what the negative thoughts are in your mind and how to reframe them and shift them so that it actually lets you look at the situation in a different way and find different types of solutions. If some things are unchangeable or out of your control, how do you find ways to actually decrease your distress or stress around them?

All of these things are very doable and tangible. It is so interesting to me that we’ve never really captured them all into one package and taught women how to do it. It’s very accessible and it can help you feel your emotional best while you’re going through this really challenging process.

Dr. Aimee: Well, thank you for that explanation. Because as you were speaking, I was doing my abdominal breathing and you were reminding me, I already feel much more relaxed.

One of the hardest parts of my job is calling people with a negative pregnancy test. I feel like I want to go to their homes, wrapped them in something soft and just give them a huge hug and just tell them everything is going to be okay. But I know that not everyone has a provider that can show and give as much empathy and compassion.

Sometimes people get calls from other staff members, sometimes it is a voicemail, sometimes it’s an email, sometimes it’s days later without a plan. And that can be really challenging for people.

I would love for you to talk through what can someone do to cope with a negative outcome. Even if they have someone supportive on their team, it’s going to be hard.

Dr. Linda Kim: It is one of the hardest things a woman can face.. The first thing is to practice self-compassion, give yourself the time to grieve. It really is a grieving period. It is filled with sadness or loss or disappointment.

Some women have told me that one of the hardest things for them is that they feel like their body has failed them in some way. Maybe they have been successful in life, doing things like running marathons or being the CEO of a company. Maybe they can multitask and do 20 things at one time. And they really struggle with the question of, “How come I can’t get pregnant?” There is this sense of failure that can hit, too. And it can go full gamut in terms of the emotions and how hard that can feel.

Photo by Ben White on Unsplash

The first step is to give yourself the time to grieve, and we know that there is a grieving process. In terms of Elisabeth Kübler-Ross’s grieving stages and getting to the acceptance stage takes time, and it is a process.

The second thing is something that I recommend while going through the process, and it is setting up a practice of checking in with yourself and checking in with your emotional barometer. You will not know where you are in terms of that barometer unless you start to understand emotionally where you are each day. Take note each day about how you are feeling, emotionally. Maybe a day after or two days after, or seven days after (whatever it may be), you are starting to feel better. You are starting to interact a little bit more and starting to get your funny side back a little bit. And then the next day, boom, you are back in feeling depressed, and sad and crying, and that’s okay.

You want to make sure that you’re checking in with yourself and don’t have the expectations that, “Oh, once I pass that stage, I’m happy, I’m good now, and you won’t go back.” By checking in you have a sense of progress being made and seeing how each day unfolds. So, it is just this practice and this habit of checking in with yourself and noting what your emotional barometer is.

The third thing I would recommend for people is this notion of trying not to get stuck. When you start to notice negative thoughts, self-doubt, worries, and anticipatory anxiety crowd other things out of your mind: take notice. Sometimes those negative thoughts push other things out of your mind and get louder. You do not want to get stuck in that pattern.

Once you identify that you are getting stuck this is a time to get help. That is when you might want to reach out to your loved one or to a family member or friend and just let them know, “Today I’m not doing so well. I can’t shake this.” Start the process of getting help so that you do not get stuck.

The next thing too is being proactive in terms of what your plan is going to be like. When you start to think about the next steps, I encourage you to have a very proactive plan about what is next. If it’s A, you’re going to try again, and this is what it’s going to look like, great. If it’s B, you actually feel like you’re done trying, you are good with moving on to some other option or whatever it may be, then this is what the plan is going to look like.

It can be a proactive process where you take the steps to make sure that you are feeling the best that you can. That is one of the important pieces of moving forward.

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Photo by Mathilde Langevin on Unsplash

I know that some people are resistant to anything that is perceived as too “woo-woo,” and want to speak to that: While something like gratitude journaling is a good practice (and might be considered “woo-woo,” these practice are evidence based, and there’s good solid evidence for them being helpful. When you do something like journaling or meditation, it is not just about the act in the moment of doing it, it is training. It is exercising for your mind for the future. It helps you train to hold two dual emotions at the same time.

That is important for when you are going through a really challenging time, and when you are feeling so down or devastated, and processing grief. As you start to journal, whatever it may be, your mind develops the muscle to hold both a difficult emotion (pain or sadness or grief) and another thing (beauty and wonder and joy) at the same time. So, if you do that, it’s training your mind for any type of possibility in the future.

I encourage patients to visualize (much like that Olympic athlete in training) what the next cycle or procedure will be like. For example, on the day of the embryo transfer I asked people, what time are you going to wake up? What are you going to have for breakfast? What is going to be your mantra? Have you visualized what the room looks like? After you visualize the procedure, what is going to be your celebratory thing you are going to do for yourself going to be? Is it going to be the flowers? Is it going to be music?

We plan it out step by step so that you can visualize. And then there are less surprises during that time. It is all about being proactive and knowing how to empower yourself during whatever you choose to engage in.

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Dr. Aimee: What you are sharing with us is so helpful. In your own mind, it can just feel like it is in chaos. And if you take control, your mind is so powerful. And it is the same stuff that I talked to my patients about.

I see a lot of patients who are coming in and they are on antidepressants, and then suddenly they even stop them without even asking. They think that that is what they’re supposed to do based on a Google search. What recommendations do you have for people who are already on antidepressants, starting IVF treatment, who are scared that maybe somehow it’s going to hurt their IVF success?

Dr. Linda Kim: It is a one on one conversation that you should have with your clinician. Even with moms who are pregnant and are on medications, they can be on multiple cocktails of medications. Fundamentally the way that we approach things now (which is different from a few years ago) is that we want the woman to feel the best as she can. This means feeling as good as she can from an emotional standpoint during preconception, pregnancy and postpartum, because that is the best for everyone, mother, child, family, everyone.

When I work with women, I see that the anti-depressant is often helping them feel less depressed. It is helping them exercise more. It is helping them not go to the alcohol or other unhealthy behaviors. It is reducing their stress. It is allowing them to make choices to eat better, it covers all those different things that people do not think about.

If anti-depressants are helping you with your mood and anxiety, they can help with how your body responds to stress when you are undergoing these treatments; especially considering the amount of stress hormones that get released. The fundamental rule is we want the woman to feel as emotionally well as possible, throughout the whole process.

Dr. Aimee: And I want the experience of being a fertility patient to always be a positive one. And if my patients are waking up in the middle of the night with panic attacks, or they are not sleeping well at night and their circadian rhythm is disrupted, that could affect their outcome.

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Photo by Christopher Jolly on Unsplash

This feels like the big take-away for people from this interview: Dr. Linda Kim, a psychiatrist trained at Harvard, is telling all of us that it is okay to still be on antidepressants while undergoing fertility treatment. And, of course, talk to your physician about what is right for you.

Dr. Linda Kim: I can’t impress upon all of you enough that for the most part, if taking an antidepressant is helping you feel well, it’s very rare that I would recommend someone to get off of it just to undergo IVF. It is dependent on everyone’s comfort level, so you will want to speak with your doctor. But the goal is to have you enjoy the process as much as possible and feel well.

Dr. Aimee: Thank you for coming on today, Linda. For those listeners who would love to be a patient of yours, where can they find you?

Dr. Linda Kim: You can find me on www.LuvLuk.com. I provide individual therapy and psychiatric services. But I am also developing more group programs, especially for women who want to maximize their emotional wellness during infertility. I have a newsletter, that you can sign up for on the website where I send out updates in terms of women’s mental health issues and overall wellness issues. So please do sign up and you can also find me on psychology times as well.

I just really love being on this program Aimee, so thanks again for inviting me.

Dr. Aimee: Thank you Linda for joining us today. I can only imagine how much the information you provided has helped those who are reading this. I appreciate all the work that you do, and mental health is the most important thing to me, to make sure that my patients feel emotionally well during their journey. So thank you for providing all this great advice.

Tune into our follow up Q&A on The Egg Whisperer Podcast

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Fertility Doctor, Reproductive Endocrinologist, Egg Whisperer: www.eggwhisperer.com

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