🎧 Episode 13: Shame, Blame & Loss of Identity in Fertility: Coping with Emotional Challenges with Dr. Glezer
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Introduction
In this episode of the WOVA Circle Podcast, we explore the emotional complexities of fertility, including shame, self-blame, and the loss of identity. Dr. Anna Glezer, a psychiatrist and founder of Women’s Wellness Psychiatry, shares her expertise on how stress, grief, and relationship dynamics can impact reproductive health. She offers evidence-based guidance and practical strategies to help navigate the emotional side of trying to conceive (TTC) while integrating holistic approaches with medical treatment.
You’ll gain a deeper understanding of how your mental and emotional health affects fertility, learn tools to manage stress and self-shame, and discover ways to protect your sense of self and your relationship throughout the journey. Whether you’re just starting to try to conceive or have been on this path for some time, this episode provides support, insight, and empowerment.
What You’ll Learn in This Episode
How shame, self-blame, and identity loss show up during fertility struggles
The mind-body connection: how emotional stress can impact reproductive health
Navigating relationship dynamics and creating space for both partners’ emotional experiences
Recognizing when stress has reached a clinical level and seeking professional support
Practical tools: communication strategies, coping techniques, and boundaries with friends and family
How to integrate mental health support with fertility treatments, including IVF
Insights into male factor infertility and supporting masculinity and identity during TTC
⏱ Listen time: 53 minutes
🎧 Format: Video & Audio
📍 Best for: Individuals and couples trying to conceive, those exploring holistic fertility approaches, and anyone navigating the emotional side of reproductive health
👉 Explore Personalized Support with WOVA Health
👉 Learn More About Gabie’s Story
Podcast Transcript
Gabie: Hi everyone. I'm Gabie, founder of WOVA Health and your host. Today I am honored to be joined by Dr. Anna Glezer. She's a psychiatrist and founder of Women's Wellness Psychiatry, which she launched to provide thoughtful, evidence-based, and compassionate psychiatric care to women navigating reproductive and emotional transitions.
Her practice covers a wide range of areas, including perinatal and postpartum mood disorders, infertility, pregnancy loss, anxiety, depression, bipolar disorder, and perimenopausal emotional health. She draws from evidence-based treatments and integrates lifestyle, hormonal, and psychological tools to address the full picture of each woman's emotional wellbeing.
She went to University of Massachusetts Medical School and did her residency at Harvard and fellowship at UCSF. So very honored to have you with us today. Welcome.
Dr. Glezer: Thank you so much for having me. I'm so delighted and excited about this time for us to have together.
Gabie: Amazing. Before we dive in, if you haven't already, make sure to hit subscribe so you don't miss any of our episodes. Today we're going to dive into fertility, stress, relationships, grief, and all the emotional complexities of reproductive health.
So I'm going to start with something that's very common: stress. You often hear that stress doesn't affect fertility, but you also hear stress affects fertility. So which is true?
Understanding Stress and Fertility
Dr. Glezer: I think they're both true, and I think sometimes we don't always understand what we mean when we say "stress," because two different people could use the same word in very different ways.
When we're talking about stress, stress is not in and of itself a bad thing. Evolutionarily and biologically speaking, stress is supposed to be something that activates your nervous system. And then your nervous system also notices a resolution of that stress and is able to come back down. So stress is something that evolutionarily we're made to address, and something that is actually beneficial because it helps with resilience and strength in the long run.
The challenge is when stress is not something that's episodic and occasional, especially in the context of something like a prolonged fertility journey. That's something where you have elevated arousal of your nervous system and you may or may not have resolution before the next experience. And so if that's how we're going to define stress, that's something that definitely can take a toll—takes a toll on the nervous system, can lead to things like mood symptoms, anxiety issues, sleep problems, and all of those things can be associated with challenges.
In the context of a fertility journey, it's hard to say from the kinds of studies that we have the capability to do whether there's a direct causal link, because we're not able to do randomized controlled studies of this kind of thing. So we have these associations. And there is that association between high levels of stress—whether we're talking about major depression, whether we're talking about anxiety, or whether we're talking about other kinds of stress on the nervous system that might not actually even be psychological—and the association between that and challenges with fertility.
And in some ways I think that's a really good thing that there is that association, because it really means that you can target it from either direction. You can really work on the psychological aspects and that is going to help with the experience of the fertility journey, and vice versa.
Gabie: So talking about healthy everyday stress, can you give examples?
Dr. Glezer: Sure. Healthy everyday stress is going to be something that pushes you. For example, let's say that you have something at work or maybe you're a student and you have some kind of project or task—something that maybe you haven't done before, that maybe you need to learn something. Maybe you really need to push yourself to get some teaching, to do some research, to do a novel task or a novel skill, and it's stressful because you're kind of pushing yourself to do something new.
At the end of it, you've learned something new. You're able to master something and there's a completed project, a completed exam, a completed task. And there's a resolution of that stress and your nervous system is able to come back down. That's essentially the definition of something that is a healthier stress—because it's something that is episodic and temporary and your nervous system responds to it effectively and then can come back down.
Gabie: Is exercise also considered a physical healthy stress?
Dr. Glezer: Yes. That's a great example.
Unhealthy Stress: Chronic and Traumatic
Gabie: What about unhealthy stress? Is it the chronic conditions that we have to worry about, or I assume there could be something traumatic, maybe something that happens right away and creates a very high stress to you as well?
Dr. Glezer: Either of those two would be the case, because again, it really is about how your nervous system is able to respond. There could be something that is, let's say, traumatic that happens to two people, and one person does not have the same kind of nervous system response as the other.
Someone who might have a propensity towards nervous system dysregulation is going to have a harder time coming back from that kind of trauma and allowing their nervous system to calm back down and to be resilient. And so that would be an example of a negative type of stress because their nervous system hasn't been able to process it and respond accordingly. So that would be an example of an acute trauma that can cause that kind of stress.
Or it's something that's ongoing. For example, someone who's living in an abusive situation, someone who is going through significant medical challenges—something that's ongoing and chronic can also lead to this kind of negative stress because it means that your nervous system is not getting the opportunity to calm down.
Gabie: Are there any coping strategies or techniques you can learn on how to react to stress so your nervous system can actually have a better reaction, so it doesn't affect you as badly?
Building Nervous System Resilience
Dr. Glezer: Yeah. And that's the good thing—I think our nervous systems are really resilient and we can train them the way we train our muscles if we're lifting weights or something. It's training your nervous system to have that kind of resilience.
If you're training your muscles, you're doing bicep curls so you can lift the box. You've gotten your biceps nice and strong, and then when it comes time to lift the box, you can pick it up and carry it. Similarly, with your nervous system, if you do various kinds of training—and I'll mention what I mean by that in a second—when you have that kind of practice, then when the stress is in front of you, your nervous system is prepared to carry that box, so to speak.
Those would be practices like meditation, like breathwork, like grounding exercises, like deep relaxation exercises, certain kinds of mindfulness practices. All of these things that train your ability to regulate your nervous system, to activate your parasympathetic—your restful nervous system—are all things that we can train, that we can teach, and that in the long run are going to help with nervous system resilience and overall reduced stress.
Gabie: And why is that important? Besides obviously making us feel better on a physical level, I've heard that chronic stress could affect ovulation, could affect the menstrual cycle, could have a physical impact on the body as well. And I'm assuming for men too, it probably affects sperm parameters.
Dr. Glezer: Yeah. We're not just a head and just a body. The two of those are connected. There's a brain-body, mind-body connection. And so everything that goes on in our brains is going to affect our bodies and vice versa.
That's why, for example, so many medications have a high rate of a placebo effect, because we believe that they're going to work and so they do work—even things that maybe aren't even related to mental health. And so our minds are very powerful and can definitely impact our body.
And even our nervous system is connected by the vagus nerve, which starts in our brain and goes all the way down through the neck and into our bodies as well. So definitely through our nervous system, through our hormone and endocrine systems—we have glands in our brains that release hormones that travel throughout our bodies and impact us systemically. And then there's feedback systems. So whatever our body's doing impacts our brain.
Fertility Delays and the Type-A Personality
Gabie: Amazing. That's super interesting. What about a lot of women nowadays who are delaying pregnancy? They're usually building their career, making sure they finish their graduate school, maybe. They're trying to accomplish so many things along the way before they're ready to have a baby. They're used to being that Type-A personality, accomplishing anything that they set their mind to, used to being a problem solver. And now all of a sudden you're faced with infertility. How do you navigate the tension between effort and letting go?
Dr. Glezer: Yeah, I think this is a really hard one for the exact kind of person that you just described, because it isn't something that you can just work extra hard at and get success—the way that you can if you're doing a project or something at work or even some kind of exercise. Maybe it's not something where you can just work harder and achieve a goal.
And I think it's important for those who are making plans maybe earlier on to also really be mindful and get the education about fertility. What does it mean to delay fertility? I think oftentimes these days there's a lot more advertisements, there's a lot more encouragement for, let's say, egg freezing for someone who is maybe earlier on in their career and they want to postpone. And I think that can often be encouraged without necessarily even having a conversation about, well, what are the successes of this kind of process on the other end?
So I think really being informed is an important part of it. And then when you are on the other end of it and you are going through fertility challenges, being able to—maybe with the help of a therapist or a psychologist or someone who might help you with working on that locus of control—I think that can be a really big thing. Being someone who maybe has always had a very strong sense of "I like to be in control," and what is it like to not be in control? What is it like to relinquish that control and sit with that kind of uncertainty and feeling unsettled and just kind of stay with those kinds of emotions can be very challenging and takes practice. And often the help of a mental health expert who can really guide someone through something like that.
When Stress Becomes Clinical
Gabie: Thank you. What signs indicate that stress has become really clinical—at the level where you actually have clinical anxiety or clinical depression, and you definitely need to see a professional?
Dr. Glezer: The way that I like to think about that really is based on functioning. So how are you functioning in your life? Are you noticing that these symptoms, these stressful manifestations are impacting your ability to finish your work tasks, to have a good relationship with your partner, to engage in the things that are important in your life? Is it affecting your day-to-day function?
And when it starts to affect your day-to-day function, that's usually a sign that this is something that—even if it doesn't meet the formal technical definition of, let's say, depression or generalized anxiety—it's still something that we want to intervene on.
And I think sometimes these diagnoses can be a little bit—they can pigeonhole people a little bit. They can be very strict definitions sometimes, and not everyone is going to fit into those strict definitions. And so I don't think that just because you might not necessarily meet the formal diagnostic criteria for a particular condition, it doesn't mean that you're not struggling.
And so if you are struggling and it's impacting your function in whatever facets of your life are important to you, then I think it's time to get support.
Loss of Identity During Fertility Struggles
Gabie: Let's talk about the loss of identity that oftentimes happens when you are struggling for some time. For some people it could be after a few months of trying to conceive, for other people years. And depending on how deeply you want to become a parent and how you navigate through this journey, you sometimes lose your identity. You feel like you're losing touch with your real life. You start avoiding friends, maybe even family, maybe not doing your hobbies anymore. Everything becomes so overwhelming. How does this happen, psychologically speaking?
Dr. Glezer: I think it stems from a couple of different reasons. One is that going through a fertility journey is very time intensive. There are so many appointments, so many medical appointments, just so many things that are happening that you need to coordinate and it becomes almost a part-time job. And that takes a lot of time. And so taking on that identity in some ways makes sense because you're spending so much time engaged in this effort.
I think the other piece is that it does begin to kind of overshadow some of the other things that might be really important to you. And so for someone who's going through this kind of journey—at least for those who are going through it a little bit longer, which is the vast majority of the women that I work with; it's not a few months and it's definitely years and maybe even a decade—really being mindful about sometimes taking a break, making sure that you are aware of the other aspects of your identity that are important, and recognizing some of the reasons that you might be withdrawing from other parts of your life.
So oftentimes that can happen when there might be people around you who are not struggling with fertility, who are maybe conceiving or having babies, and it's really hard to kind of see that. And so you kind of withdraw from individuals who are not having the same kinds of struggles that you are. And so making sure that if you're not feeling like you can connect with those individuals anymore, are there others with whom you can connect so that you're not isolating?
Gabie: Now, besides the social aspect, is there anything else you can do to protect your sense of self and still take fertility seriously?
Dr. Glezer: I think it's really prioritizing, because all of us have so many identity hats. We are woman, mother, sister, friend, employee, homeowner. So many. And so really just making sure that you take the time to nourish every single one of those other hats that you wear, so that you're not only wearing one hat.
Gabie: Yeah, that's good advice. Thank you. When hobbies or relationships or even work start to feel draining, what steps can we take to get back to life? Is it—besides what you said—is it a good idea sometimes to maybe avoid certain people if they're not giving you the good energy or the good support, or avoid going to certain events? Or is it better to set boundaries in a different way? Like you go and you face the reality and you find a way to respond to it?
Setting Boundaries and Building Support
Dr. Glezer: I think it really depends on the situation. I think there's definitely people who might not be a good support system when you're going through something like this. They might be folks who are full of platitudes that you don't want to hear, or try to give advice that you don't need right now. And so separating yourself from people who aren't kind of fulfilling you emotionally makes sense.
At the same time, making sure that you're not just separating—that you are kind of replacing those connections with others that are more fulfilling. And so I think part of it depends a little bit on taking the time to think about, well, what is important to me and how can I ensure that I'm continuing to do the things that are important to me, whether it's related to your job or a hobby.
And also keeping in mind that, again, oftentimes it is almost like a part-time job. So it takes a lot of energy, it takes a lot of time. And so you're not going to do everything that you were previously doing and on top of that add a part-time job. That really makes your plate overflow and then things fall off your plate and it's just hard to keep it all on there.
So then you have to kind of reassess, well, which parts of my plate do I want to keep? Since I now have this part-time job, maybe it's one hobby and these two friends and something else. And this other volunteer work is not something that I can do right now. Maybe I'm no longer going to be part of the PTA or the community club. Maybe I'm not going to be able to visit a couple of these people as often as I used to before. Maybe whatever it is that used to be on your plate. There are some things that you might need to remove in order to make room for this almost like part-time job that you now have.
Gabie: Yeah. Perfect. Prioritization is definitely important, and I like what you said about replacing. Like if you pause a certain relationship, definitely replace it because this journey is already isolating enough, lonely enough, and you want to be surrounded by people who understand and can give you the support and understanding.
Dr. Glezer: Yes. Yes.
Shame and Breaking the Silence
Gabie: Let's talk about shame, self-shame. How does shame often arise in fertility struggles?
Dr. Glezer: This is a big problem that in many ways is something that has been perpetuated by societal standards and expectations where women are sort of defined by their ability to be fertile and to mother. And those that are struggling with that struggle also with feelings of like, "What is wrong with me that this isn't something that I'm able to do?"
And unfortunately I think that often does lead to, like you said, more isolation and more feelings of shame. And honestly, what's been interesting is every single person that I've talked to that shares their journey with the people around them will then hear the stories of other people around them that they didn't know had gone through this, because everyone has sort of been keeping it hush-hush. But then it creates these relationships that are really positive and supportive when people kind of begin to talk about this, because that is the number one way to overcome shame—to speak and to have a voice and to notice some of those negative thoughts about expectations, whether they're from society or from your family of origin or what have you, and be able to reframe those thoughts.
Gabie: Any healthy ways in terms of responding to unsolicited advice or questions?
Dr. Glezer: I think the first part is to notice that the person who's asking is asking or speaking from a place where they are trying to be helpful. Like they're coming from a good place. They're not trying to—now if they're not that kind of person and they aren't coming from a good place, then maybe that's a kind of relationship that you don't want to continue, want to set some limits on.
But if they are, if you're able to kind of see that they're trying, then really just providing them with direct feedback that, "I appreciate that you're trying to help. What would be more helpful for me is A, B, C."
Gabie: So in a way, teach them, because they want to support you. They just don't know how.
Dr. Glezer: They don't know how. And that happens a lot, whether we're talking about a fertility journey. It happens a lot when someone's going through a grieving process, which is often part of a fertility journey. People don't know how to support those who are grieving. And so if you know how you would be best supported, teach the people around you how to do that.
Comments to Avoid
Gabie: I listened to your podcast earlier, and I really like what you said about certain comments, for example, "Have you considered adoption or an egg donor?" And these are definitely not comments you want people to give. Can you talk about this a little more?
Dr. Glezer: Yeah, this is something that happens a lot, and I think it's hard because as someone who's gone through a fertility process, almost everyone has considered all of the options. There's no one out there who doesn't know that adoption exists. Certainly if you're going through a fertility process, you know that something like that exists.
And so I think it's important for those who are making these kinds of comments, who know someone who's going through infertility, to recognize that their role is not to be the solutions person and to fix things. It's really to be a support, to hold space for whatever the person who is going through a fertility journey is experiencing.
And so comments like, "Did you consider this or that?" are not helpful. And if anyone is listening who is one of those support people, to be able to really take that to heart and recognize that everyone who's gone through an infertility experience has considered all of these different options and has talked about them either with their partner or with their fertility doctor or with their therapist. They have considered these things and your job is to hold space for whatever they're going through and not to fix it for them or come up with solutions that you think are novel, which unfortunately are not novel.
Gabie: Yeah.
Dr. Glezer: And so, but if you're the person who's going through it, it really depends a little bit again on, what kind of category does this person fall into? Is this someone who you want to maintain a relationship with, who you want to provide feedback to about what is going to be helpful? Or is this someone who is not going to be part of that kind of inner support circle?
And just because someone isn't part of that inner support circle right now doesn't mean that they haven't been an important part of your life in the past. And maybe they will be again in the future, but maybe not right now. And if it is someone that you do want as part of your support circle, it really is about giving them a little bit of feedback and a little bit of education so that they know, "Yes, I've considered all of the options. What I would love from you is support for this next step that I'm about to go through."
Blame Loops in Couples
Gabie: Many couples experience blame loops, and I'm going to give you an example from my own personal experience with infertility. First of all, I was completely shocked when I found out that we're dealing with infertility. I always considered myself to be a healthy woman, and I was afraid of being judged and of being seen as half of a woman..
And I didn't even want to associate myself with the word "infertility" because I didn't feel I was infertile. I couldn't accept it. And I've heard that for many, the first reaction to any diagnosis is rejection. So maybe that's what I was experiencing.
But also I somehow was looking to blame somebody else, to blame my partner because he had several chronic conditions and I think I was trying to find relief by blaming someone else. I was afraid that everyone will assume I was the infertile one, where maybe it was him. Maybe it was both of us. Maybe it was me.
And this is the first time I'm sharing this, but I'm thinking that many others probably experience the same feelings. So is that normal? Do you see this often with the couples you see and what's your advice?
Dr. Glezer: Yeah, I think it happens a lot. And infertility—first of all, the language around it, it really depends on the person. Some people are comfortable with the word "infertility." Some people prefer to use "fertility journey." I recently had a patient who said she hated the term "fertility journey" because—
Gabie: Me too.
Dr. Glezer: The word "journey" suggests you're going on an adventure or something fun, and this is not that. So every person is going to have a different sense of what language kind of resonates with them. That's the first part—figuring out what that is for yourself and using that language with the people around you so that they can begin to kind of pick up on that too.
The shame that you're describing—like, "There's something wrong with me, I'm half a woman"—a lot of that can also be really, really common. And what do we do when we're people who might be, again, kind of high-functioning, successful people? Well, we need to figure out what the problem is and fix it. So maybe the problem is with you, maybe the problem is with that. Like, let's figure out what the problem is and let's fix it. And so that can kind of lead to a lot of that blame game.
And I think the challenge is sometimes there is a female factor, sometimes there's a male factor, sometimes there's both. And a lot of the times it's undefined. But even when there is, let's say there's a female factor, that does not mean the same as saying it is the woman's fault. Those are two very, very different things. A female factor could be something genetic, biological—so many different things. A male factor, let's say low sperm count—that's not something that any male has generally done to themselves or chosen. It's not something that they can have that responsibility for. It just is.
And it's the language that we often use and I think it's confused with "It is your fault." It doesn't mean that it is your fault. It's just this is where it might originate. And I think part of it is recognizing the shame piece, the desire for fixing, and how these things often can't be immediately fixed, and kind of recognizing those psychological challenges that come up really, really often because it's really hard to sit with these kinds of diagnoses.
Partner Support and Differences in Coping
Gabie: There are situations when, probably oftentimes, when the woman feels that her partner is not as supportive or understanding. Can you talk about this a little more? I'm sure there are situations when maybe that's the case, but there's also situations when that's not the case. It's just that we were raised differently, men and women, of how we navigate through the emotions and how we express ourselves.
Dr. Glezer: Yes. And I think there's so many different aspects to that. For one thing, there's the differences between the two individuals. Let's say we're just kind of working with a heteronormative, cisgendered relationship where the two individuals, the man and the woman, come from different places in terms of even their yearning for having a child. It could be different in terms of the two individuals, so maybe starting from a different place there.
The next piece is how does each individual respond to stress? And stereotypically we often see that men are taught to fix things. And so if this is something that isn't easily fixed, there can be a sense of like withdrawal, because "I can't fix this, so what am I supposed to do? I have no other mechanism by which to engage in this. I don't know how else to engage in this and if I can't fix it, what else am I supposed to do?"
So I think learning how to hold space, provide emotional support, validate—those are all skills that need to be learned. And so there's that psychological piece. And I think for a lot of people, families of origin have different kinds of pressures and different kinds of expectations for building a family, and I think it's really important to communicate—for the two partners to really communicate and make sure that they are on the same page, not just in terms of their family goals, but what steps they want to take, what the emotional experience of that might be, what support and what kind of support each person might need in the context of this.
Gabie: What if one partner is ready to take a break and the other one isn't?
Dr. Glezer: So that's really hard. Because you also don't want to drag someone along for something that is so emotionally challenging and physically challenging as well. And I think if someone is in a place where they really need to take a step back and they need to take a break and someone else isn't necessarily ready for that, that is actually a really great example of when working with a couples therapist who has expertise in this sort of thing would be really helpful.
And couples therapy—I think some people have a lot of preconceived notions that it means that there's something wrong with our relationship or we're going to get divorced. It means none of that. It's really a way to have someone who's experienced in the language of emotional communication help two people have that kind of conversation. And when it's something really specific like this with a very specific goal—in this case, the question is "Do we take a break or do we not?"—we're not talking about a year of couples therapy. We're talking about a handful of sessions that will help the couple really figure out "How do we have this conversation? What psychological place are we each coming from and how do we get onto the same page?"
Gabie: Yeah, definitely don't wait to get support. Unfortunately, people wait too long, especially when it comes to mental health. And this is probably one of the top, if not the most important things that you have to address. And for some reason we leave it as one of the last ones.
Dr. Glezer: Yes, we do.
Gabie: Why do you think that's the case? Is it because we, for some reason, especially women, we always think that we can manage through, we're strong enough, we can figure out the relationship. Is that the case? Why is it always the last thing?
Dr. Glezer: Yeah, I think there's stigma. There's stigma associated with mental health, including getting mental health support. I think there's also expectations, like what you just described—an expectation that, "I'm just going to be able to get through it."
There's—this happens a lot in women's mental health, but in women's health as well. The number of times that women are sort of taught to just kind of grin and bear it. Whether we're talking about the pain of endometriosis, the experience of perimenopause—you could name any number of conditions where you're sort of just kind of taught to get through it from a really young age. You have your first period at, say, 11, and it's really painful and you're just told that that's the way it is for the next 40 years or something like that. And so there's that kind of expectation as well that we need to notice and just take a step back from.
Male Factor Infertility and Emotional Suppression
Gabie: Women usually go through most of the procedures, regardless of the diagnosis. And we deeply want to be a mother most of the time ever since we were children. With men, it depends. It could be the same, but they usually don't have to go through all the hormonal treatments and the journey physically and emotionally. Oftentimes, it's heavier on the woman. However, I'm sure there's situations when it's very heavy on the men too. So let's address men and how we expect them also to stay strong. But what happens psychologically when they suppress their emotions?
Dr. Glezer: Yeah, and I think this is a really important point, and one that I just also want to take a step to the side and emphasize that it's really important for the male in the relationship to get the testing, because sometimes that is overlooked. And no matter how many various interventions the woman is going to go through, if there is something that is missed because none of the testing is done on the male partner, then you're missing a big part of the picture. So first things first is making sure that all of that is taken into consideration and actually addressed and assessed.
And the second piece is more of the psychological piece. And this happens quite a bit also, for example, with things like postpartum depression, which we know can also affect men, but often does a little bit later. And so what can often happen is there is a little bit of that emotional suppression, that sort of desire to be present for my partner because they're going through a lot and not necessarily checking in with themselves and what their own needs might be, which can work for a short amount of time, but it will eventually catch up.
And so rather than waiting for it to kind of catch up and hit you over the head, really taking the time to be proactive and also making sure that, as the male partner, you're getting the support that you need.
Gabie: How can couples create space for both partners' emotional experiences?
Dr. Glezer: I think part of that is making sure that there's enough of a support system where it's not just one person supporting the other, and this is the case, not just for fertility, but for really anything. Where it's really hard if you're relying your entire emotional support system on just one individual.
And this is where it's really important to kind of speak up and break the cycles of silence and shame and get other kinds of support, whether it's professional support in the form of a therapist, whether it's peer support in the form of various groups, whether it's friends and family. But really making sure that there are other people who are involved in supporting you emotionally through this kind of experience where it's not just one individual that's carrying that burden.
Gabie: That's a very good point. I think I felt it quite a bit also when I moved to the United States, only because here you live a little bit more isolated, unfortunately, from friends and colleagues. And where I'm from, from Bulgaria, you have a lot closer of a community. So it makes it extra hard. And you have to find your support system. You are right. We cannot rely on just one person to be everything for us.
Dr. Glezer: Yes. Yes. And we have to actively find that support system. The U.S. is a really big country and people are always moving from one coast—I moved from the East Coast to the West Coast—and families are very far apart and friends could be very far apart. And so really just taking a very active, conscious step towards creating that support system.
Gabie: How does male factor infertility affect identity and masculinity, and what supportive approaches help?
Dr. Glezer: Yeah, I think it's similar to when we talk about female factor and sort of this definition of femininity and womanhood. And similarly, it's the same for male factor infertility where it's the definition of masculinity—that "I can procreate and I can, I'm a male and I have strong sperm," or—I'm being a little bit facetious, but that's sort of the general psychological outlook.
And so when that is not the case, to be able to recognize again that your individual psychological identity and what might be going on biologically do not have to completely align. They're two separate things, and just because you might have, let's say, low sperm count, really doesn't say anything about who you are as a man or a human. Just like if you have ovulation challenges as a female also doesn't define who you are as a woman.
Gabie: So in a way you have to separate the two, separate your identity from infertility.
Dr. Glezer: Yes.
Navigating Information Overload
Gabie: Okay. Yeah, that's helpful. Many people also feel very paralyzed by the volume of fertility information—online, friends, family, experts. Everywhere you turn around, there's so much information. How can you make decisions without feeling overwhelmed?
Dr. Glezer: Yes. I think the first part is making sure that you feel a good rapport and connection with whomever is helping guide you. Maybe that's your REI or whoever's kind of helping to guide you through the journey—making sure that you feel heard by the person, that you've gotten your questions answered.
And that's not going to happen probably in the initial diagnostic assessment and consultation, because you're getting information and it's probably going in one ear and out the other because you're hearing words for the first time and it's all kind of paralyzing. So recognizing that you might miss a lot of that information. So maybe you bring someone that's going to take some notes for you, and then coming back and relearning that information and having the opportunity to ask your questions.
And if for whatever reason you're not feeling like your questions are being addressed or you're not feeling heard, or the relationship doesn't feel like it's working, then maybe you get a second opinion or a third opinion in order to be able to kind of put the information together. And none of it has to be decided same day, same week, or same month. This is all something that you can take the time to process, take the time to get additional information, to hear about the experience of other people if that's something that would be helpful to you, to take the time to maybe work with your therapist and outline, "Well, what are my underlying values? How am I going to make this decision?" So really kind of taking the time to process it all.
Gabie: What about coping strategies? I don't know if you've heard this question before, but I was thinking today, if you're an introvert versus an extrovert, are there different coping strategies when you are in the fertility journey, when it comes to maybe even surrounding yourself with friends? If you're an introvert, is it more likely that you get more isolated?
Dr. Glezer: I think so. The way that a lot of—different people might define introvert/extrovert in different ways. One way that I think is helpful is an introvert isn't someone who doesn't like to be with other people, but it's someone who gets energy from being potentially on their own, versus an extrovert who gets energy from being with other people.
And both of those individuals might enjoy being with other people, but the introvert in order to then recharge will need to have some time by themselves. And so just kind of being mindful of what helps you feel more energetic, what helps kind of strengthen you, and making sure that you're doing those things. And the introvert is still going to have close connections and want to get that support. And maybe it's not a group of six people, maybe it's one-on-one with people that are important and having those supports and conversations. But then also recognizing, "Hey, I'm going to need to recharge on my own as well."
So just kind of being mindful of what helps you recharge and making sure that you're doing that in addition to connecting with others and getting that support.
Integrative Approach to Mental Health
Gabie: Super helpful. In terms of your practice, it offers an integrative approach. Can you talk about that? Like a lot of people think of mental health strictly as mental health—like you're thinking about the therapy, maybe medication, couples therapy, different really mental health-focused approaches. But there's other things in lifestyle, maybe nutrition, that are also important in affecting mental health. Correct?
Dr. Glezer: Yes, and psychiatry—kind of conventional psychiatry—you often think about medication and medication support, which is something that integrative really just means that you're taking all of the pieces and you're putting them together.
So you can take the pieces around medication, you can take the pieces around lifestyle medicine—so how to optimize your sleep, how to think about exercise, how to think about nutrition and the gut-brain connection and micronutrients, how to think about the different styles of psychotherapy and which ones are going to be most helpful. How to think about different nervous system resilience exercises—grounding, breathwork, mindfulness, the things that we talked about at the beginning. How to kind of take all of these really important things and integrate them into a cohesive treatment plan.
And that's what my team and I like to do—is to take all of those pieces and put them together rather than rely on just one branch.
Gabie: Can you mention a few, maybe like the top three or the top five that you include in your practice?
Dr. Glezer: We certainly prescribe medication. We certainly do a lot of different kinds of therapy. We certainly focus on micronutrients, so making sure that patients aren't low in their vitamin Ds or in their vitamin Bs, making sure their micronutrients, their minerals are replete. So thinking about those kinds of things.
Sleep and thinking about ways to promote healthy sleep cycles, whether we're talking about sleep hygiene, whether we're talking about CBT-I or other interventions for sleep, the sleep environment. So that's super important and just thinking about the root causes of what someone might be going through. Was there trauma that needs to be addressed? Is there a genetic history that is part of all of this? Early childhood experiences? What is contributing to what's going on right now? So kind of thinking about origins.
Trauma and Fertility
Gabie: Talking about trauma, how is that impacting fertility? And is it possible that you've experienced trauma but you haven't processed it and you don't really come back to it because you don't want to?
Dr. Glezer: Yeah. Trauma—the process of infertility itself can be traumatic for a lot of folks. And so if someone has a history also of other kinds of trauma and now their nervous system is being asked to cope with something new and also stressful, and they haven't had the opportunity to really process past traumas, it can make it that much more challenging.
But even if you don't have a history of trauma, the experience of going through something like this can be quite traumatic and a source of trauma. And so just being mindful of how your nervous system responds is really important and kind of that resilience.
Grief: Loss of a Future
Gabie: Also in your podcast you talked about grief when you're losing someone versus grief in the fertility journey, for example, when you have a miscarriage or even a failed cycle, and I really liked how you differentiated between the two. Can you talk about this?
Dr. Glezer: Yeah. The way that I think about that is—and it's not completely black and white, it's not just one or the other—but oftentimes when we're talking about grief, let's say in the loss of a grandparent that lived a long life, when you're going through the grieving process, you often have memories that you're thinking about and you're thinking about your relationship and things that are tangible that you can kind of connect to.
When you're talking about a loss, like the loss of an unborn child, what you've lost is a future and the hopes that are associated with that future, all of the things that you had envisioned and hoped for and planned. And so it's a little bit less tangible. That sometimes can make it harder to grieve because you can't remember, "Oh, that wonderful time that we spent in the park," or what have you. You're kind of thinking about the loss of a hope and future.
And there's also grief where it's both of those together. Maybe you lose a partner in midlife. And there was future, but there was also past. So it's not black and white. But those are sort of the two kind of big categories that I think it can be helpful to think about this in. And it's that loss of future—because it's less tangible—it can be harder in some ways to grieve.
Secondary Infertility
Gabie: How does secondary infertility differ emotionally from primary infertility?
Dr. Glezer: It's very individual because—so secondary infertility for those who aren't familiar with it is someone has previously had a child and now they would like to expand their family further and they're going through fertility challenges. And there's the psychology of, "I did it before. Why can't I do it now? What's wrong now?"
And sometimes when you're trying to get support, you might feel like, "Well, I don't fit in with this group because here, people haven't had a child before, so they're in a different place than I am. So how do I connect with the right people? How do I think about myself and my identity in this context since I was able to have a child, I don't know, three years ago, but I'm not able to have a child now?"
So it's a little bit different psychologically, both in terms of how you think about your identity and the people that you can connect with. But it still does involve a lot of the same kinds of mental cycles around shame and identity and the fact that it's really emotionally challenging, whether it's primary or secondary infertility.
PMDD: Premenstrual Dysphoric Disorder
Gabie: I see that you also treat premenstrual dysphoric disorder. Why do some women experience those severe mood swings before their period starts?
Dr. Glezer: Yeah, so premenstrual dysphoric disorder is basically a constellation of symptoms where there's physical, psychological, and emotional and functional symptoms that really happen at the very tail end of the luteal phase. So whether that's 3, 5, 7, 10 days premenstrually depending on the length of someone's cycle.
And it really is related to a sensitivity to the hormonal changes. So I often get the question, "Should I check my hormones?" They're not going to tell you anything because they're probably all going to be normal. And the real issue—the issue is how does your body respond to the deltas, to the change in hormones?
Because what happens in the female menstrual cycle is after the midway point, which is the ovulation point, you have a peak of estrogen and then it kind of comes down and then there's a second bump in the luteal phase. Progesterone starts to rise in the luteal phase, and they both drop off in time for menstruation. And in some individuals, there's a really strong sensitivity to those changes and that can lead to those symptoms.
Gabie: What are those symptoms? How do you distinguish between normal mood swings around the cycle versus PMDD?
Dr. Glezer: Yeah, these are often really, really severe. So sometimes my patients describe suicidal thoughts and really severe mood swings and irritability to the point where it's, again, impacting their functioning. They can't—it impacts their relationship, it impacts their work. And when it's that kind of functionally impactful, then we start to think maybe this is something that needs to be addressed clinically.
Gabie: What's usually the root cause, and can someone not having it—maybe going through infertility and putting so much stress onto themselves physically and emotionally—now also experience this disorder?
Dr. Glezer: Going through any kind of hormonal transition can change the way that your body and mind respond to future hormonal changes. So whether that's infertility, whether that's pregnancy, whether that's perimenopause, these are all changes in how your body is using hormones. And any of those changes can then in the future lead to a difference in your body's sensitivity to future hormonal changes.
Gabie: Okay. Makes sense.
Dr. Glezer: The majority of those who suffer from PMDD have suffered from it from a very young age.
Gabie: Okay, that's helpful. So before we finalize, I'm going to ask you a few short questions. So if you have one grounding tool for a tough day, what would it be?
Quick-Fire Questions
Dr. Glezer: Breathing. I think there's so many there and there's so many different ways to breathe. There's so many ways depending on whether you like to count, whether you like to use your senses. There's so many. If you Google breathing exercises, you'll get dozens and dozens of examples, and I think it can be really helpful to just pick one that resonates with you and then you can take a minute in the morning, you can take a minute after lunch, you can take a minute before bed and incorporate that. And I think that can really help with grounding, with nervous system regulation. It can make a big difference.
Gabie: What is one communication tip you would give couples who are navigating through this journey?
Dr. Glezer: I think one of the most important parts of communication is not the speaking, but the listening and really hearing what the other person is trying to tell you.
Gabie: I love this. And lastly, one sign that someone should not ignore emotionally?
Dr. Glezer: When you're not able to experience the world around you—whether it's your relationships, your work, what have you—in the way that allows you to feel fulfilled and is different. When there's a change, when you're functionally impacted by what's going on for you emotionally, that's a red flag.
Gabie: Awesome. Thank you. Thank you so much for sharing your insights and your practice guidance. I really love the conversation today.
Dr. Glezer: Thank you so much for having me.
Gabie: Yeah, I think these conversations really help people feel seen and understood and supported during one of the most isolating and hardest journeys of their life—it was definitely the hardest journey that I've experienced in my life.
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This transcript has been lightly edited for clarity and readability.
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