Exploring the need for Resilience in tackling the Infertility process with Gabriela Rosa

[00:00:03] Hi, I'm Dr. Russell Thackeray and welcome to Resilience Unravelled, a podcast with new ideas, new thoughts and new thinking about resilience. Guests with remarkable stories, products and services that can really power up your own mindset and resilience. You can also go to our site for more information, to ask questions or to access some of our resources at resilienceunravelled.com. Let's get started.

[00:00:32] Hi everybody and welcome back to Resilience Unravelled. And we like to look at all facets of resilience, different places, different countries, geographies, subjects, inferences, concepts, whatever you like. And today is going to be something really different. And I'm really looking forward to it because we're talking to Gabriela Rosa, who's in front of me now from the other side of the world with a very distinctive accent. And yeah, it's going to be, I think, really interesting. First of all, hello Gabriela, how are you?

[00:01:02] Well, thank you so much for having me Russell. And so from your accent, I'll immediately assume you're in the wilds of Oz. Yes, that's it, Oz it is. But you don't live there, do you? Except that I have been living in Boston, so I feel very conflicted as to my identity. You're a nomad, aren't you? What, you're born in Brazil, did you say? I was born in Brazil, yeah, but raised in Australia. So I think I was in Brazil until the age of about 12, 13.

[00:01:32] And then after that, most of my life has been spent in Australia. But like I said, for the last three years, Boston has been home. Look, you better tell us what it is that you do. I'm a fertility specialist. So I was originally trained as a naturopathic practitioner, a naturopathic doctor, as they know, in the US.

[00:01:53] And basically, from the beginning of my career, I've helped women optimize hormones. And that transitioned very quickly within the first kind of three to five years of working in the field to helping couples overcome infertility and miscarriage, even when other treatments have failed. And that has been very much the focus of everything I do for the last 20 years or so. So yeah, it's been some time.

[00:02:23] And when you say with the naturopathic side of things, does that mean you didn't have a medical background? You just came to the subject from a different place? Absolutely. From the perspective of how I operate, the initial training that I had was in integrative medicine, naturopathy specifically. And then I did a master's in reproductive medicine and human genetics and did a master's of public health at Harvard, doing my doctorate there right now.

[00:02:48] So that's been the transition from clinical work to research and adding more, ever more, actually, I would say, the scientific kind of integrative evidence base to what it is that I do. But also that kind of leaning, cutting edge part piece where there hasn't been a lot of research in my field specifically.

[00:03:14] And so bringing more of that clarity to the conversation of what really works and how do we approach challenging, complex fertility situations? Because most of the people who come to me, they've been trying for many years. When we did, for my master's in public health at Harvard, I did a study to look at, it was a seven-year analysis of our patient cases and the types of people that we helped and the types of people who came to us.

[00:03:42] And on average, there was a four-year longstanding infertility history. And with a kind of standard deviation, plus or minus two and a half years. So many of the people who were coming to me had multiple years of infertility and miscarriage history or failed treatments that they wanted to overcome. And in that analysis for that cohort, it was 544 patients. We noted a 78.8% live birth rate.

[00:04:11] So it was enough to be able to tell us that, yeah, OK, this is an effective treatment for people who are in that specific situation. And that's how it unfolded from there. Very interesting. You'd have thought you'd be knee-deep in research. Look, I think that the research primarily, if you think about how the healthcare systems around the world are structured, and of course, in the UK, it's slightly different being a

[00:04:38] universal healthcare system compared to privatized systems. There's research for different purposes. And in reproductive medicine specifically, i.e. IVF treatment, there is an aggregate amount of minimal research that's necessary to deem the procedure as not life-threatening. And from a perspective of risk, there is research.

[00:05:05] And there is somewhat more comparisons around what is the best protocol that works in this kind of setting of scenario. But certainly not from the perspective of public health and the perspective of preventative medicine for optimization of fertility is very little research. Yeah, that's interesting. I think there's a sort of, this might be, and I'm asking you questions from a place which is, has no knowledge. I've never experienced this.

[00:05:33] I'm not particularly qualified to talk about it at all. So maybe I'll just be expressing the views of the sort of person in the street, as it were. But many of us have this perception, especially who've had kids, that having kids is quite easy. But that's not true, is it? Actually, it is true. Oh, OK. Yeah. I don't know. Elon Musk's out of you. It's a fair perception. And the reason it's a fair perception is that in the general population, the majority of people conceive without trying.

[00:06:02] Typically, it's three months time to pregnancy. It's literally have intercourse, get pregnant, have a baby done. We're no longer having this conversation. So what you said is actually not incorrect. It's very true. However, the piece of that is the flip side, is that when it hasn't been straightforward, it's not easy. And when it hasn't been straightforward, finding and understanding the reasons as to why it

[00:06:31] hasn't happened is even more difficult. And the reason is that all of our healthcare systems around the world aren't really, if you think about it, it's very disease-centered. And so the point here is how do we make sure that people are not dying from XYZ disease? And as opposed to how do we create an optimized function? So that's the distinction and that's the difference in the conversation that really

[00:07:00] transitions a average experience of it's just easy to get pregnant and have a baby to one that's very difficult, prolonged, and quite traumatizing for a lot of people. Because as you can imagine, as a human kind of drive, we want to reproduce. We want to have families, communities, all of that. And for most people, because it is easy, and as you probably will know, someone who looked

[00:07:30] at their partner and just conceived without trying or oops, accidentally, quote unquote, quote, and or people who have, on the face of it, very unhealthy lifestyles or life choices, like smoke, drink, do drugs, whatever, be able to conceive seemingly easily in those kinds of situations. The drunken one-night stand that people talk about.

[00:07:55] And other people who have very healthy lifestyles, who really desire to have a family, not being able to do it again, it creates a lot of conflict. And so people think this is easy and it should be easy. But then there are there's evidence in my life that this has not been easy. And the reason for that is that different things affect humans differentially. So we all would have heard of people who have never smoked a day in their life and died of lung cancer.

[00:08:25] And then you've got that person who's a chain smoker who has never developed cancer at all. And so that epigenetic impact of how a substance situation event affects one person versus another is essentially what changes the way in which people experience even this area of their life. And that's why sometimes people call it the heroin addict syndrome, like the person who

[00:08:53] points to the people out there who may be doing all of the wrong things. And so maybe that's what I had a patient once who literally said that to me. I was like, I was so shocked. It was early on in my career. She goes, maybe I should just shoot up heroin. Maybe then I'd have a baby. And I was like, I don't really think that's a good idea. But I asked her, I said, what makes you say that? She goes, exactly what I just said. Because for those people, it's easy. And it's actually not that it's easy.

[00:09:21] It's that their systems are affected in a different way. And so the person who smokes and doesn't develop lung cancer, they may have cardiovascular disease as a primary concern or liver dysfunction or whatever it is. And so basically, it just depends on how a person, what the susceptibilities of an individual will be as to whether an impact and exposure will affect their reproductive system or another one. Okay. So you've given me a lot to go out there.

[00:09:50] Let me just write the note. So the first thing is, I'll come back to that in a minute. And I'm guessing what's interesting is that the perception of having babies been easy is quite an important thing 200,000 years ago when we were, lots of people used to die and children used to die during childbirth, didn't they? Because at early ages, it wasn't necessarily easy in those days. And I guess the process was pretty straightforward for that reason. And also as mammals, we have our babies quite early, don't we?

[00:10:19] Because we've all got massive heads and otherwise it'd be quite a challenge. I can imagine that. But is there a correlation now, though, in the way that this works between age groups? Because actually, isn't there lots of data saying that lots of couples now are having children later on. They're having careers first. Whereas the sort of old stereotypical thing is that people were having pregnancies, forget the legal side of this, from 14 onwards, you know, at the point of past puberty. So is there something about difficulty and age and such?

[00:10:46] Yeah, there's definitely an aspect of fertility for women is finite. It's not something like for men, men are producing sperm from the day dot until they die. Whereas for women, exactly. Whereas for women, it's not the same. We're born with, this is again, the conversation of 2025, because in 20 years from now, who knows what's going to be the case with all the stem cell research and everything else that's being looked into.

[00:11:14] But at this point, women are born with all the eggs we'll ever have. And so basically what that essentially means is that because the eggs, it's almost a self perpetuating kind of prophecy is that the egg maturation creates a cycle of hormonal changes and it's a biofeedback loop and all of those things that perpetuates the cycle itself until there are no more eggs.

[00:11:43] And typically women reach menopause, which is the cessation of all of the eggs that will be there to be released by about age 50. That's an average for most women. And perimenopause, which is the years around menopause, are five to 10 years before the cessation of periods. We know that a woman at 40 to 45 or even earlier, depending on when she will go into menopause,

[00:12:13] because the average is 50, but some women go into menopause at 40, 45. So five to 10 years before is where those hormonal imbalances will begin to occur and difficulty conceive. It's not so much about difficulty to conceive, it's that sometimes what ends up happening is that the balance of hormones becomes disordered in ways that make the cycle unpredictable or

[00:12:40] make egg maturation more difficult or even the quality of the egg that's being matured and ovulated, be less than what it needs to be in order for something like a conception and a baby to take place. Not to say that you can't improve egg quality, you can improve egg quality. You can't improve or increase ovarian reserve. Because like I said, we're born with the eggs we'll have, but the quality of those eggs,

[00:13:08] they almost have a very direct correlation to the quality of our health. And so if you can improve the quality of your health and your cells and your biochemistry, which we know we can with good lifestyle habits and optimal treatments and so on, you can improve the quality of the egg. It does not mean, however, that by the time a woman reaches 40, 45 or close to 50, that's going to be enough to affect conception and deliver a healthy baby.

[00:13:38] And so this is where it then becomes, and of course, the other factor here is that male fertility and male sperm, even though there is that continuation of development of the cell itself, it will also decline in quality over time. And that's where for men over 40, sperm quality becomes worsened. And if you have a couple where both partners are over 40, just because of quality of cells

[00:14:07] or lack thereof, you end up with a more difficult time to pregnancy than you would if you would say if you were in your 20s. Right. And that's for both partners. So an older woman with a younger man is going to be able to deliver a healthier baby or healthy baby easier than an older woman with an older man or a man of her same age. Yeah. Okay.

[00:14:32] And, and of course the reverse is absolutely going to be true is that an older man with a younger woman is going to be able to affect conception in much more readily available way than in any other, in any other kind of circumstance. Yes. Age. I don't like to say age so much. It's a proxy. Age is a proxy for quality of cells. That really is what it ends up being.

[00:15:00] And so when it comes to fertility, that will certainly matter, but it's also not untrue to say that you can be older and take excellent care of your health and be in a better biochemical cellular state than somebody who is younger and doesn't. So, you know, there are some of those important considerations as well. However, in this day and age, with all of the lifestyle exposures that we all have, and then by lifestyle, it can just also be environmental.

[00:15:29] Think about drinking water from a tap as opposed to filtered water. In your tap water, if you're not filtering it with a good quality filter, you are exposed to all sorts of chemicals from industry runoff to the contraceptive pill in the water from somebody else's urine and everything in between. So, of course, that's also going to impact the way in which the body responds and is affected by the environment.

[00:15:57] So putting precautions in place that are going to help to improve and optimize health is going to be a very good way to ensure that you are also as healthy as possible for fertility down the track for a long run. And you're talking about people with reduced fertility options there, because actually we know that there are many children born in areas of conflict or extreme poverty or there's plenty of problems in the water and all that sort of stuff. So this is more the challenge. And people might be wondering why we...

[00:16:27] See, here's the thing. And I think that what you've pointed out there is exactly what I was talking about before, which is people will be affected differentially. However, when you have a situation where it has not been straightforward, you can't pick and choose what you intervene on. You have to intervene on everything. Otherwise, you run out of time to have a baby altogether. So you don't have time to disentangle specifically what is it that one person struggling to get

[00:16:55] pregnant versus another is going to benefit from the most. In some instances, yes, you can. But what happens is if you are struggling, the bottom line is do everything you possibly can to optimize every aspect. Because yes, you're right. And I say this all the time, especially when people come to me and say, does stress really affect fertility? Yes, but... And the thing is, there are people in more zones that get pregnant and have babies. So it can't be the only thing.

[00:17:22] However, when you are struggling to get pregnant, and this is the really big distinction that I think is so important for people to understand, because otherwise they end up saying things like, oh, don't worry about it, just adopt. And it's like, okay, first of all, you don't understand what adoption actually means. Because if you think it's that easy, you know, that's a problem in itself. And just be quiet, because the other person on the receiving end of this will not appreciate it. Because this is the thing, do you really think that somebody who has been trying for five years hasn't thought about adoption?

[00:17:52] Like, it's disrespectful at best to just sling out some recommendation to people that, you know, have not asked for it. If they come to you and said, I'm thinking that I'm not getting pregnant, and I'm having difficulty, what are some of the options that you think I could be implementing, then by all means, open your mouth and say whatever it is that you want. Otherwise, just be quiet.

[00:18:16] Because most people who are going through a situation like this, which is highly traumatizing and highly stigmatizing in so many ways, don't need the, oh, just relax, you get pregnant. If it was that simple, they would have already. So talk to me about the trauma. Trauma. Trauma. You mentioned trauma. So that was my, now we're at it. Here we go. Yes, absolutely.

[00:18:45] It's interesting because that's actually the topic of my doctoral project. I decided that there are so many different ways in which people are affected. But infertility related trauma and grief is really real. And just the point of going through all of those challenges. And the thing about infertility is that it happens every month, whether you like it or not.

[00:19:08] You are faced with a bloody pad or some negative pregnancy test that you just like, and you can't stop it. You can't help it. You can't just go, I don't want to see this. I don't want to be exposed to this traumatic experience. It's like, it happens. Right? And so finding ways to create new meaning around that narrative conversation, I think is a really important thing.

[00:19:38] And the reason that I say that too, is because I see it so frequently in my clinic where there's been research studies that show that women who are infertile, 20% of women, in fact, there was a study that was published some years back, but looked at this particular cohort of women with struggling with infertility and demonstrated that 20% had self-reported that they would rather be paralyzed, i.e. be a paraplegic or a quadriplegic than have infertility.

[00:20:08] So you can see from that kind of situation how highly taxing going through the experience of infertility really is. And especially when you don't know if it will ever end. You know, if you don't know if you ever will hold your baby in your arms, like your sister, your neighbor, your aunt, your cousin, your whoever, your mother before you.

[00:20:35] It's a disconcerting life event going through something like that. And that is this, the good side of reproductive challenges, because then you end up with people who have extremely traumatizing pregnancy loss or stillbirth or neonatal death of babies post delivery.

[00:20:58] And all of those things can really take a massive kind of, I don't even know the best way to describe it, but a very big kind of hit on a person who isn't necessarily expecting that. Because like you said, the expectation is as you're growing up that, especially for girls, think about girls growing up, we're told you have to be careful. You, if you have sex, you're going to get pregnant. You have to be on the pill from a certain age just to prevent blah, blah, blah.

[00:21:28] So women grow up with this sense of, okay, of course I'm going to have children. Of course I need to, if I don't want to have children, protect myself from that event. And then all of a sudden, when you decide that, okay, this is something that I really want and it doesn't happen and it doesn't happen for years. Yeah. Yeah. It becomes, you need a lot of resilience and you develop a lot of resilience from going through those situations in ways that are unexpected.

[00:21:58] So infertility is one of those, I guess, situations where most people don't quite expect how difficult it's going to be until they are in it or on the other side of it. A lot of learning and growing comes from it, but it's, it takes time. I was going to say, I must take a put a massive strain on people's relationships because see, I assume, and I might be making the assumption here that women are highly driven if they want to have children, they're highly driven to, to have them.

[00:22:28] And there must be a financial thing because I imagine it's hugely expensive, especially over where you are. And that's bad enough over here when I think it's still private, but there must come a point where there's a sort of pragmatism comes in on one side of the equation of the gender binary. And the other one is still desperate to have a child. And I suppose if you, I don't know, you do see, and again, I haven't got the right language for this, but you do see sometimes that it almost becomes all consuming, this drive. It's the only thing that matters. Almost an addictive type thing.

[00:22:58] I don't know if it's the right language. Yeah, I do. And as much as the language is quite accurate in many ways. And the reason is that, yes, women typically, it's not always just the woman who is very highly driven. Men also feel like they want to, it's a part of legacy for a lot of humans, right? And so basically, it becomes something that typically, when a man wants to have a child,

[00:23:27] it's going to be equally driving for both people, right? Sometimes, however, men are better able to disconnect from that drive and desire. And just, it doesn't, I think that the difference here, and not everyone will agree with this, but women are much more likely to self-define by having a child. Yes.

[00:23:57] Often women talk about not being part of the mummy's club or being excluded from certain societal structures because of having or not having children. And so what happens is that women are much more, and also because we're both children and we have to kind of like, we're raising them much more hands-on typically than most men.

[00:24:21] It becomes a situation where women much more likely self-identify as mothers and or have the desire to, whereas men much more likely self-identify as men than fathers necessarily. Although there is absolutely that same similar drive from a human perspective, an evolutionary perspective of procreating.

[00:24:48] But I think the meaning of the activity and the label and the societal structure and definition can be very different depending on the different sex. So that's, I think, where the difficulty comes. But I also feel like in some instances where a woman really wants to have children and a man really doesn't, that's typically where the biggest problems will occur and or vice versa.

[00:25:16] Because what happens is that will eventually impact relationships and that will make the drive of one person to fulfill that versus the inactivity or the lack of desire of another person to do the same will typically mean that there is always that discordance between the two. And that is where the blame starts.

[00:25:42] That's where the four horsemen of the apocalypse, as John Gottman talks about, raise their heads. Because then it's, okay, we don't exactly want the same thing and we're not going in the same direction, but then one person is trying to pull the other to go in that direction. The other person is trying to go the other way. It becomes a mess. And then you add to that dynamic the cost, physical, emotional, financial, and you have a real mess in your hands.

[00:26:11] And the thing I think a lot of people don't understand, because I know a couple of people who've been through IVF, is the miscarriages. And I think irrespective of IVF, women do have miscarriages and it can be extremely traumatic. Some things, some women never get over a miscarriage depending on what stage happens and whatever. But I'm understanding is that there are more miscarriages. How much she wants a baby and is struggling. Exactly.

[00:26:38] Even if we're seeing a positive pregnancy test one day and the next it's no longer there. That can be equally traumatizing for a woman who has desired, who has dreamt of being a mother for her whole life. And it is somebody who has had a late-term miscarriage. And for some people that might not make sense, but I hear this so regularly in my clinic and I've talked to thousands and thousands of people over 25 years.

[00:27:04] And so I know that it might not make sense for some people to hear that and go, no, that can't be true. It can't be true for you. It's true for the people who it's true for. Yeah, it is. Exactly. But people process death differently and it's still a death. So it's a question of where it took place in any cycle. I guess one of the things I'm thinking about when you're chatting there in terms of when we think about resilience, we often talk about being able to endure because that actually

[00:27:30] one has a sense of purpose because you understand why you are suffering because the potential outcome is so great. And I suppose that is part of what's going on here, isn't it? If you're in that process, there is always this idea. It's not a secret what having a child looks like or feels like or all those things. So it's almost the incentive is there to continually keep going.

[00:27:56] It must be very hard then for someone to disengage with the process or medically to learn that you can't do that or not even medically, whatever it might be. So what happens when you lose that sense of purpose? You must be having to deal with people in bits. Yeah, look, that's exactly right. I think that one of the biggest things that happens in this scenario of people trying to have babies when it hasn't been easy, what you're talking about is that kind of, okay, this month, this month, it's going to be the month.

[00:28:25] So there is always that anticipation that this month of this treatment cycle is going to be the one. And the cost fallacy of the fact that you just keep going just because you've already put so much into it is something that happens very frequently in reproductive medicine and fertility because people are like, okay, no, this cycle is going to work. This is the cycle that we're going to be successful.

[00:28:51] And so on the flip side of that, it's also the thing that keeps people going. It's the hope of the potential benefit or achievement of that result that drives people. What happens is that when people have had enough loss, enough challenge that they feel like, okay, I have, and that is very personal.

[00:29:20] Imagine this. I've had the longest standing case of infertility I've ever treated was 19 years. Wow. The woman was 44 by the time she came to me and the partner was close to the same age. And in 40 years, they had done multiple failed IVF cycle in 20 years, sorry, 19 years. They had done multiple failed IVF cycles. They had done multiple failed treatments of all different kinds of treatments.

[00:29:47] As you can imagine, if somebody hasn't given up by the 10th year or the 15th year and they keep going, you usually will try new things because you think maybe this thing is the thing that's going to happen or is going to help. And at this point that they came to me, the man was still not quite ready to give up. The woman was already, she had already given up probably five years before.

[00:30:12] And so you can imagine that kind of situation, what we were talking about before was definitely playing a role here. I don't want to do this. I want to do this. I want to give up. I don't want to give up. And so that took a little moment to go, okay, you guys need to make a decision here as to how this is going to go. If you decide that this is what you want to do, then this is the path that we're going to take. In the end, long story short, they both decided, okay, fine, it's worthwhile, last go. Let's do what it is that we need to do.

[00:30:40] And they did and they conceived and they had their baby. But the thing about that, you know, often is not spoken of is the fact that also in a long term kind of situation like that, sometimes you give up multiple times. And this is one of the things that she described to me. She said, like, I've given up multiple times. And then went back to it thinking with kind of, is it either because they, when you feel really tired, you've run for a really long time.

[00:31:09] And you go, I cannot keep going. I'm going to die. And then all of a sudden you stop running and you sit down or you lie down or you have a night's rest. And then the next day, okay, fine. Let me just go with this again. And that's resilience, right? It's that whole thing of, okay, I've given it a good go. Now I've rested. Now I'm going to try again. And so that journey, that process is somewhat what happens with longstanding infertility.

[00:31:36] But sometimes people then find that they're like, okay, I have given it enough. I've rested. I've tried again multiple times. It still hasn't happened. Now I'm going to give up. And even though deep down, they might still have that little tiny glimmer of hope that maybe I'm not quite done yet. They find it very difficult.

[00:32:02] So unless they put themselves into that mental mindset of, okay, I'm going to give it my everything. They find it really difficult to actually rev up again to the point of actually wanting to try something new. Because then you have no hope for the future. You have no desire, no willingness to actually keep trying. So two things starting to hit me now. The first is you're probably just going to discount straight away and just say it's a fatuous comment.

[00:32:29] But I'm going to say it anyway, which is with this massive desire, this potentially well of money, it seems ripe for unethical providers to be in there encouraging people. Oh, you're nodding. That was disappointing. I thought you were going to say, no, that never happens. We're all angels. And we don't do that. No, look, IVF is a multi-million, it's actually, in fact, it's a multi-billion dollar industry.

[00:32:52] There are anywhere where there are massive gangs, you will find sharks, you will find charlatans, you will find people who are there to take people's money. Unfortunately, that's just the reality of it. Now, it's a highly regulated industry in terms of IVF. And it's also an expensive industry to get into. You don't just decide one day that you're going to set up an IVF clinic.

[00:33:15] But because of that also, there is a high vested interest in making a return on your investment. And most clinics that are privatized and most clinics, even in the UK, like you have, sure, you have the universal healthcare system, but in the private sector, basically, they all have shareholders. These are investments. These are businesses.

[00:33:38] And so what happens is that there is definitely a drive for people continuing to do treatment. And that's one of the big things where I go, I understand the fact that IVF is a wonderful tool and it's a wonderful, miraculous scientific innovation, right? However, it was developed to help women who had blocked fallopian tubes to be able to have babies.

[00:34:05] In fact, UK was the first place in the world where IVF was available. And 1978. So the thing about it, since then, it has been used for every single possible thing you can think of, even when the indication is not great, like low ovarian reserve has a very poor prognosis for IVF. It's still recommended because you might as well, and there's money to be made.

[00:34:34] Now, it's not, and it is the interesting thing in the UK, you can see this very clearly because it is a universal healthcare system. If you go through the NHS, if you have low ovarian reserve at a certain cutoff point, they will not allow you to have an IVF cycle on the system. They will not allow it. Why? Because they know that it's very unlikely to work and you're literally taking resources away from somebody else who could actually have a better outcome.

[00:35:03] But in the private system, if you're willing to pay for it, that's where I become a little bit sceptical and agree with you. And I think couples must have a challenge with selecting people to work with, mustn't they? Because they need to check this out. So final question, because I'm just looking at your time and I'm just thinking, blimey, we said this is going to be very short and here we are, rather in a way, because it's been fascinating. I'm just wondering with the state of parenting in the Western world, if there is such a thing now, I wonder whether IVF parents parent in a different way.

[00:35:33] I think parents who have experienced infertility parent in a different way. And actually, it's one of the reasons why I got into doing the work that I do. Because in my opinion, based on my empirical evidence of observation over 24 years, 25 years,

[00:35:53] I see that people who have struggled to conceive typically are much more aware of many things that, you know, from a holistic perspective, physically, emotionally, spiritually, of reasons as to one, why they're doing this. Because if you can imagine, if it hasn't been easy, it's a deliberate choice to overcome that challenge.

[00:36:22] And so then you have to put meaning behind that, because if you don't keep going, it's that the whole conversation that we've been having up until now. And usually what that does is it helps people to clarify, why do I want a child more than what is it that I'm doing to get one? And I think that just in that process itself of having to ask myself,

[00:36:48] what is the meaning of having a child? What's the meaning of parenthood? What is the meaning of becoming a mother or a father? What do I hope for this human being that I want to create? What are my wishes and desires and dreams? And how do I want to help this child fulfill them? These are questions that people don't deliberately ask themselves for no reason, typically.

[00:37:16] You know, the idea of having a child when people are in their late teens and early 20s is a very much a societally driven thing to do. You know that, oh yeah, you grow up, you find a boyfriend, you get married, you have children. Like most people will follow that line of kind of lifeline and line of thinking. But when that hasn't happened easily, that breaks the kind of, I don't know,

[00:37:46] trance of the societal trance of this is how I need to do this, or this is how this should be done. And so then it actually adds questioning to the process. Yes. And some people choose because it hasn't been easy that, well, actually, do I really want that? Do I really want to put in the time, the effort, the energy, the money, the sleepless nights, the, and some people decide based on that. Actually, no, I don't want that. But the people who decide, actually, yes, I know the costs. I know the challenges.

[00:38:15] I know what it takes. And I still want this. Usually they, they have a higher purpose, a higher reason for wanting to do something like that. Which is to invest the entire kind of parts of themselves into the process of receiving the outcome. And of course, it's not always, I'm not saying this is a generalizable thing for across every person who has ever struggled to have babies. But I see this very frequently in my clinic for the patients I treat.

[00:38:46] It's interesting because I had this perception that an IVF child would be parented to within an inch of their lives. Avoidance of all risk. You're too precious. You can't do this. Do you realize how long it took us to have you? You can almost see a situation where over-controlling parents could produce a non-resilient, happily neurotic child. That can happen. What I also find is that that questioning of meaning usually yields results

[00:39:12] and outcomes that are not exactly anticipated easily. And so it just really does depend on the person and what I guess the person has gone through it. And I think that also the other aspect here is that, and this is going to be very unpopular, but very true. Most people going through infertility, when they're going through infertility, they think that the baby is going to solve all their problems.

[00:39:40] They think that if only I can have this baby, everything is going to be perfect and beautiful. And then they have said baby. And the child doesn't sleep for more than 20 minutes or an hour and 20 minutes all the way through the day and night. They've just gone through a very traumatic birth, ripped the entire perineum, have had to recover from that, or had gone through a cesarean section and have had heavy bleeding and almost died in childbirth or have then to go through very difficult, traumatizing,

[00:40:08] breastfeeding experiences with bleeding nipples day and night. Lots of things happen after you have a baby that aren't exactly glamorous or wonderful. And postnatal depression is real for every woman, not just women who have difficulty or easier conceptions or births and vice versa. And so what happens is that also throws another spanner in the works, which is most women feel very guilty about the fact that they're hating motherhood

[00:40:37] and their mothering experience because they've gone through so much challenge, right? Because they've gone through so much to actually have that baby, they don't feel like they can express the displeasure of certain aspects of the journey in the same way that women who conceive easily could, for example. So there's a lot, there's so much there. You know, it's funny enough, when I first started this, I thought, this is going to be nothing in this subject. There's tons!

[00:41:07] What a fantastic, huge subject. Look, we haven't even touched on the LGBTQ plus community yet, which must have its own sort of stuff as well to go with that. So let's leave that for another episode, hopefully, because I think that will be fascinating. Because there you go. But look, if people want to find out more about you, where will they find you? They can Google me, Gabriella Rosa, G-A-B-R-I-E-L-A-R-O-S-A, or they can go to my website, which is fertilitybreakthrough.com.

[00:41:34] And if they can't Google that or write that, Google will help you. So just pop in there, some kind of permutation of that, and you will be able to find me somewhere, somehow. It's been fantastic. Thank you, Gabriella. It's been a joy to meet you. And hopefully, Stage 2 will do it another time, the next version. The unusual stuff. Thanks so much for your time. You take care.

[00:42:03] I hope you found that episode useful and entertaining. If you want to support our work, please go to resilienceunravel.com, and you can become a member there as well. You can also send us a question there and even apply to do a podcast. You can also leave a review on Apple Podcasts or any of the other podcast hosts of your choice, as well as getting hold of some useful resources about resilience and a whole lot more.

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