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49 - Do the Psychological Effects of Infertility Dictate Patient Decisions? An Interview with Amira Posner

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It’s easy to feel like the patient’s journey is confined to the four walls of your clinic, but their journeys extend deep into their lives. Because of this, providing support services, either in your clinic or outside of it, is so important to the mental health of the families you serve. On this episode of Inside Reproductive Health, Griffin talks to Amira Posner, founder of Healing Infertility and the Mind-Body Fertility Group in Toronto, Ontario. With her background in social work and her experience with secondary infertility, Amira set out on a mission to help women going through a similar experience and provide them with the mental health support they need. Together, Griffin and Amira discuss what she does to support her clients and offers advice to providers and support staff on how they can best provide mental health support in their clinics.

Learn more about Amira and Healing Infertility at healinginfertility.ca.

Get started on a marketing plan for your company by visiting FertilityBridge.com and completing the Goal and Competitive Diagnostic.

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Welcome to Inside Reproductive Health, the shoptalk of the fertility field. Here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field.

Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit fertilitybridge.com to learn about the first piece of building a Fertility Marketing System--The Goal and Competitive Diagnostic. Now, here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones.

GRIFFIN JONES: Today my guest on Inside Reproductive Health is Amira Posner. Amira's a clinical social worker with private practice in Toronto, Ontario. Amira has a bachelor's and master's degree in Social Work from University of Manitoba and developed and now facilitates Mind-Body Fertility Group and Fab Fertile Mindfulness Fertility Series. Amira also has had her children after several failed IUIs, conceiving her twins through IVF after a journey with secondary infertility. She shares her personal experience with infertility and that was the catalyst for HealingInfertility.ca, her venture. Amira Posner, welcome to Inside Reproductive Health.

AMIRA POSNER: Thanks so much, Griffin. It’s so good to be here!

JONES: I’ve known you for a long time via social media because you shared your journey so much. I think I met you at the CFAS in Halifax, which would have been four or five years ago.

POSNER: Yes, we did! I remember you. It was 2014 and I was actually presenting, talking about the Mind-Body Fertility crew. I remember you very clearly because you were wearing red pants.

JONES: Might be the 10th person on the show to mention the red pants, but I keep adding colors and pants in my repertoire and I've since replaced the red pants with another pair of red pants. I’ve got green, I've got pink now--

POSNER: Awesome!

JONES: It’s good to be remembered!

POSNER: I remember so clearly because--I think back to 2014 and I think, like, both you and I were sort of at the beginning of---starting our careers and so we stayed connected through social media. And I've seen your stuff grow and it's so good to reconnect with you!

JONES: I remember your passion and if I recall correctly you were speaking at that event as well. But what was the impetus? I mean, you are a social worker, but you could have practiced in any number of disciplines. You went through infertility, at what point did you make the connection that this is how I want to dedicate my professional practice as well?

POSNER: I was always a social worker. That was my career of choice, helping people. And my husband and I, we went through our own journey 10 years ago. And so I just remember sitting at the fertility clinic and seeing all these women and feeling so afraid and so scared about our treatment and just knowing really deeply inside that if I get through this--and I wasn't sure I was going to get through it--but I would hope others also get through it. And that's what happened! My journey was successful and we went through IVF and conceived a set of twins--they're 9 today. But when they were 2, I started to step into this area and I ran this very grassroot support crew. It was out of my parents’ condominium amenity room and I thought--we had seven women come and I could just see the benefits of bringing these women together to talk about their journeys. And I also provided coping techniques to help them to channel some of their anxiety and relationship to the uncertainties of infertility. And from there, I started running the group at a hospital here in Toronto, which I continue to do today. So that's kind of how it all got started! It was really my own journey with secondary infertility. And for those of you who don't know what secondary infertility is, it’s when the couple is able to conceive a child and have problems the second time around and it's very common.

JONES: So what about the idea that people don't want to talk about their experience? They don't want to share this with others? That infertility is something that they want to keep--I still hear people saying this in our field. And if I'm being honest, just anecdotally, in my own experience, I hear it even more in Toronto and in Canada, of people don't want to--well, maybe Americans, they'll put things on social media, and they’ll go to groups and they'll talk to people. but we Canadians are conservative people--people don't want to share things like that. And what about that notion?

POSNER: So, yeah. It’s a very private issue. And, the thing is, when you get a group of women together that are all experiencing it, they’ll talk. And they’ll find solace and comfort in hearing the other stories and recognizing that they're not alone. And that's why it's such a lonely place is because people don't talk about it. But I think that people are starting to talk about it a little bit more now. It's becoming more, like, widely talked about in various ways.

JONES: Someone has to go first, it sounds like. If sharing is what allows other people to participate and to feel included, but people don't want to share. It sounds like somebody has to go first, talk about that then Amira.

POSNER: Yeah, once you start talking, once you open up the room, like people will talk!

JONES: And I don’t just mean in a group. I just mean if you're going to attract people with your group and you're gonna let people know that this exists, this support network exists, an online community, these resources--somebody has to say this is what I’m dealing with. I get the impression that was you, but talk about, maybe you can talk about that dynamic?

POSNER: I think, you know, a lot of us don't feel a lot of shame associated with not being able to get pregnant in whatever journey we’re experiencing and so we hold it inside and it gets bigger and then we want to isolate ourselves. And then we're looking for the problem. Why isn't it working? And then our sense of self is dominating the problem. And this is when we're heading down a road of, like, isolation and feeling depleted, right? And so bringing ourselves back and becoming vulnerable and that's what it's really about. And everyone in the world--and this is one of the themes I talk about in my group--is we're all experiencing problems at each stage of our lives and this is one that, generally, it's a very common experience from ages 30 to 40 or sometimes younger.

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JONES: And when you go to CFAS and you're going to programming that is designed for practitioners, providers, clinics, what is it that you hope to build--in terms of relationships, in terms of what clinics offer, in terms of what patients might need from clinics--what is it that you're hoping to establish with and from providers?

POSNER: At CFAS, they have a counselor’s workshops and speakers geared towards the counselors and how we can best support patients through their journeys. And so that's all I want to be there for, is to sort of guide my clients through the system, whatever way they're going whether they're trying naturally, or whether they're just starting out treatment and helping them sort of navigate the system. And not only help them cope with the emotional impact, but also just navigating some different supports, if they are using donor conception and putting them in touch with those resources, and making sure that they're informed so that they can make the best decisions for themselves.

JONES: When I first got into the field and I started contacting people from different support groups in the United States, what almost everyone told me was that they found out about their support resources on their own. They didn’t get something from the clinic that said go to this group, check out this network. Do you see the same thing happening in Toronto?

POSNER: So there are some clinics here in Toronto that do have the counselors in house, it's not common. I believe there's only one or two clinics or three maybe that have that. There's a number of counselors in Toronto that specialize in this area and many of them are affiliated with each clinic. But I feel like having in-house is really productive, to have somebody there, right? There at the time of the crisis, if there’s a loss. You know someone that you can refer the client directly to as it’s happening.

JONES: And I think it wasn't, even if not, at least have--here are some support groups, here are some forums, here is RESOLVE, here is Fertility Matters. I feel like a lot of people are still finding that on their own.

POSNER: I must say, to your point, I find it amazing when I do get a call from a new client often and they're like, I found you online, right? So people are looking for support in the area clearly. But I do believe some of the clinics here in Toronto do have that pamphlet where they have the list of the resources that the patients can access. That's really important.

JONES: What are the resources that they should have or some of the coping techniques that mental health professionals can help with? And are there coping techniques that staff can help with in some way even if they're not mental health professionals? So let's break that into two questions. One is what are the coping techniques that mental health professionals can help with? And two, what are coping techniques and methods of support that non-mental health professionals can help with?

POSNER: I think they’re actually the same. One of the most important techniques is really just listening and using your ears and your heart to hear what’s happening and to be present for whatever is unfolding. And just like listening with compassion and if you're a nurse in the clinic or a doctor, normalize the experiences, right? And providing some hope in some way, not false hope, but just helping the patient see it from a different perspective. But often times, in times of crisis, patients can be very reactive or aroused and I guess a coping technique is to try to help them calm down, just so that they can breathe and bring themselves back to feeling calm so that then they can go on to make the decisions that they need to make. So helping them see that maybe you need to go home and just take the afternoon off work. You know, what can you do for yourself now to help yourself feel a little bit more balanced? Like this isn't the time to make a decision or go to the next treatment.

JONES: There would be a vested interest in doing that from clinics, it seems, as well because one of the things that stops people from pursuing the treatment that they need, they’re so overwhelmed and there's so many freaking decisions to make! There's micro decisions and macro decisions and they’re tangled into each other like Christmas tree lights that have been thrown back in the box for a few decades. And it's really hard, very often, for people to move from one phase of treatment to the next even when it's in their very best interest to do so because they have so many decisions to make. So to the extent that someone can help make it easier to process so that they can move on to the next phase of decision making would be beneficial for both the clinic and the patient.

POSNER: Yeah, it’s like time, the essence of time is such a huge component in the lives of people struggling with infertility. Time is of the essence for most of them, or so they feel. And so helping them just slow down and to take a step back so a bigger picture can emerge as opposed to go, go, go, and reacting from a place of fear.

JONES: So Amira, how would you want to conclude? Most of our audience is practice managers and providers, what would you want to conclude about what you hope for this space, the message that you want to promote regarding support, regarding patient advocacy. How would you want to leave the audience?

POSNER: I think just helping them understand that this is a booming area that has a lot of different facets. And, as a counselor, my goal is to help clients feel better and to make their fertility experience not as devastating or difficult as most feel. So, to shift experience and to provide different tools that aren’t just tools related to this, but tools for life, because oftentimes these same client will go on to get pregnant, and then the same sort of pattern emerges during the pregnancy. You know, is my body capable? Will I be able to get through these 9 months, 10 months, right? And then the same as when you become a parent. So helping them understand this trajectory and to feel more confident and capable and calm. And when they can work from that way, and not demeanor, then everything feels a lot easier.

JONES: And easier for both the patient, but as well as the provider and the support staff. Amira Posner, thank you very much for coming on Inside Reproductive Health.

POSNER: Thank you, Griffin!

You’ve been listening to the Inside Reproductive Health Podcast with Griffin Jones. If you're ready to take action to make sure that your practice drives beyond the revolutionary changes that are happening in our field and in society, visit fertiltybridge.com to begin the first piece of the Fertility Marketing System, the Goal and Competitive Diagnostic. Thank you for listening to Inside Reproductive Health.