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We sit down with Lei Chu, a urologist and author of IVF Diaries: A Female Urologist Infertility Journey. Lei shares her personal journey with infertility and the heartbreak of undergoing numerous IVF cycles. She sheds light on the growing issue of infertility in the U.S. and how it disproportionately affects female physicians. Lei also shares her insights on the importance of self-education and advocacy in the IVF process and the lack of standard of care in the field of reproductive endocrinology. Lei hopes to provide much-needed patient education and encouragement to others facing infertility. Join us as we delve into the world of IVF and learn from Lei’s personal experiences.
Lei Chu is a urologist.
She shares her story and discusses her KevinMD article, “Infertility: Navigating the challenges of IVF and the importance of self-advocacy.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show we have Lei Chu. She’s a urologist. Her KevinMD article is titled “Infertility: Navigating the challenges of IVF and the importance of self-advocacy.” Lei, welcome to the show.
Lei Chu: Thank you for having me.
Kevin Pho: We’ll get into your article in a little bit, but first off, briefly share your story and journey to where you are today.
Lei Chu: Well, like a lot of physicians, I got married late in life and had children late in life. Of course, that led to a lot of challenges, so we struggled with infertility. Surprisingly, I treat male infertility day in and day out. It’s not something I expected to find, but unfortunately we had issues; both my husband and I had a problem. So we went to see a reproductive endocrinologist, and we just went through a lot of hurdles to get testing done.
With a lot of things, I just did not know what to expect. It just seemed like a mystery. I just followed directions. When I showed up, I really didn’t know what to expect. The doctor tells me, “This is what we’re going to do,” and the nurse explains to me, “The protocol is like this.” So you just follow, and then you just show up. After I started the stimulation medication, every other day I went in to get an ultrasound done and blood work done. It just seems like it’s so automatic.
The first time we did a retrieval, I did great. We got three chromosomally normal embryos. I was elated, because we really only wanted two to three kids. Since we had three embryos, we thought we were done: one retrieval, and we’re done. But unfortunately, none of the embryos implanted. We ended up having to do another retrieval, and luckily we were able to get another child out of this, which is my five-year-old daughter now. By then, I started another retrieval and several other transfers, and they all failed. This journey is just very difficult. After the pandemic started, I restarted more cycles and transfers, and I was finally able to have my second child with my family.
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Kevin Pho: All right. So you said that it was a little bit of a rushed process. You’re just shuttled from one place to another, and you were told to come back and do tests and follow up. Now, if you had to do this again, what would you like to see, what would you have liked to see done differently?
Lei Chu: When a patient comes to see me and I’m doing surgery on them, I’m going to tell them, “We’re going to position you like this. The surgery can take this long. Complications include these. Side effects of possible medicines we give you include these.” I just felt like in the fertility world, those are just skipped over. I think part of it is because women who are going through infertility are so healthy, and we’re so determined, and we have so much perseverance. We want this so desperately that we’re going to do anything to achieve that goal. And I felt like a lot of these medical practice standards are skipped over.
Kevin Pho: Now, you’re a urologist, so you obviously deal with male infertility. Has your experience with the IVF world changed anything that you’ve done as a physician treating infertility in males?
Lei Chu: For sure. I think that after going through this, I have a lot more compassion for my patients going through infertility. I share my story with them, and I know the pain they go through and the desperation. And not only do I treat my male patients with infertility with surgeries or medications, but I also try to be an advocate for their partners.
Kevin Pho: Now, when you said that you share your story, you share the pain and desperation, talk about some of those emotions as you were going through your own IVF journey. What was it like for you as you were going through all of this?
Lei Chu: I think we went through infertility; it took us about five years to have two children. Living and breathing IVF is difficult. You plan your vacations around your cycles. For me, I plan my big cases around my cycles, and I have a solo practice.
Kevin Pho: What would that look like when you say you had to plan your big cases around your cycles? Give us a story or an example of that.
Lei Chu: For example, urology is very diverse, so I do a little bit of everything. I do oncology, stones, prostate. So big cases for me are, for example, a partial nephrectomy or a radical prostatectomy. I don’t want to be on medicine when I do surgeries, right? So I tend to make sure that I’m off during this time, that I’m not on any medication for stimulation, before I do those surgeries. And also after transfers, in my experience, it’s best to be stress-free. So I tend to make sure that my cases are done after I’m done with the transfer, or before I transfer, but not during the transfer process.
Kevin Pho: So what does it feel like when you’re on medicine such that you can’t do surgeries or procedures while you’re on it? How do you feel on them?
Lei Chu: I mean, it’s individual, but I think it makes me a little bit more jittery. I’m really sensitive to caffeine, so if I drink a little coffee, I’m more jittery. But if I take the medicine, I can feel like my heart rate is a little bit faster. I feel like I talk a little bit faster, and I already talk really fast. So it just felt a little bit more jittery, and I just don’t want to do any big cases when I’m taking the medicine. Also, since we put so much money and time into the retrieval and transfer, I don’t want to have anything endanger that. So I don’t want stress involved.
Kevin Pho: I want to talk about how your IVF journey intersects with you as a solo private practice urologist, because I can only imagine how stressful your professional career is. So tell me, how did your IVF journey affect you professionally, and how did you manage everything that you had to do being a solo private practice urologist?
Lei Chu: I haven’t thought about that. I just figured every woman goes through this. I just thought that this is just normal. I didn’t really think that anything I did was super extra. I mean, I know many physicians who have gone through IVF. Several of my OB/GYN colleagues have gone through it, either at the same time or after me. I’ve seen other women at my church who’ve been through IVF too. So it just seems to me it’s a very common process.
For solo practice, the challenge for me is definitely to schedule, right? So I always try to be the first patient of the day, to get there, get my ultrasound done, and get my blood work done. I pushed out my clinic so that I’m not late for my clinic. So a lot of coordination has been involved. And the retrieval requires anesthesia, so I can’t work the whole day; I just have to take a whole day off. And that’s difficult too, right, for patients, because in Houston we have 8 million people and about 120 urologists. So I think it certainly has been very challenging schedule-wise, and then emotionally it was challenging, time-wise it was challenging. But I just figured every woman goes through that.
Kevin Pho: Now, you mentioned a few places that you went to for support, and it must have been incredibly challenging, not only physically, but mentally and emotionally. Where did you go for support so you didn’t feel like you had to go through this alone?
Lei Chu: There are some groups on Reddit for IVF. There are some groups on Facebook, social media. There are some women who went through infertility at church, and then just colleagues who have gone through it. The thing is that nobody voluntarily talks about this until you talk about your challenges. Then people open up and tell you, “Oh, I went through that too, and I had the same challenges too.”
I think when I’m at my reproductive endocrinology clinic, there are a lot of other patients there, but nobody talks to each other, right? We don’t talk to each other, get numbers, and try to meet up and support each other. It just seems like it’s such a lonely process, and it’s such a difficult process. The quest for a child is such a personal goal. It’s not something that other people can understand.
Kevin Pho: Now, you summarize your journey in a book, IVF Diaries: A Female Urologist Infertility Journey. For those other physicians who may be going through the IVF journey, tell us about some of the pieces of advice that you could share with them, some wisdom just based on your own experiences.
Lei Chu: There are a lot of women who went through this. There are women who went through 12 retrievals, 15 retrievals. They have a lot of wisdom to share with you in terms of possible side effects and alternatives to treatment. The thing about IVF is there are always alternatives. It doesn’t mean you have to go through this protocol. There are other protocols. There’s not just one transfer protocol; there are various stimulation and transfer protocols. There are always alternatives. I was lucky to have really good reproductive endocrinologists, and we were able to have two children. But I felt that a lot of times it’s difficult to be presented with different options when you’re that desperate and struggling. I felt that sometimes any chance of light, any chance of possibility, is just blindly accepted.
So I did a lot of research on social media with those women, but there are also a lot of research articles. When I first started this process five years ago, for example, PGS testing, preimplantation genetic screening, was highly promoted. And nowadays, five years later, it’s not; it’s considered more controversial. It is not necessary. The reason why is because several articles with randomized studies have shown preimplantation testing does not increase the likelihood of childbirth cumulatively. That means per woman, childbirth is not increased. Not per cycle, but per woman.
Kevin Pho: Now, you’re in solo private practice, so you have some semblance of control over your schedule. Of course, you’re able to control your schedule around your treatments. Some physicians may not be in private practice. They may work for hospitals or big medical groups, and they may not have as much control. What kind of advice do you have? How can they advocate? Because it’s very difficult, of course, to go through these treatments while having to see patients and doing procedures, and being told to have to see x amount of patients and do x amount of surgeries. How can they speak up and perhaps advocate for themselves when they work in a large group, especially if they’re undergoing IVF?
Lei Chu: Being outspoken is important. Being a self-advocate is really important. People who have not gone through infertility struggles do not understand it. If this is really important to you and you don’t have as much control over your practice, you have to make your goal well known. You have to speak with your boss with empathy and let them know how important this is for you. Retrieval and transfer are a limited time, so you can plan ahead of time and tell them, “During this time, I have to be less stressed out. I have to be less busy.” Speaking out is very important. Unfortunately, for IVF, time is of the essence, so delaying is not helpful.
Kevin Pho: Now, you said that people who haven’t gone through the IVF journey don’t understand a lot of things. So you have a platform here. A lot of medical administrators listen to this podcast, a lot of physician leaders. What do you want them to know about the IVF journey?
Lei Chu: If I could go through this again, I want my doctors to give me alternatives. For example, take my second cycle of stimulation. In the first cycle, I had a low-stimulation protocol, a very low dose, and I only got seven embryos, and three of them were normal. So when I went to the second cycle, I said, “Can I have triple the dose of stimulation so I can get more eggs and more embryos, so I can make it more worthwhile?” My doctor said, “OK, we can try it.” We went through that cycle, and I got the same number. I mean, actually, I did worse. I got the same number of embryos, but only one was normal, instead of the three that were normal the first time. And there were only two months in between, so it wasn’t like a lot of time went by.
So if I could go through this again, I would like my reproductive endocrinologist to give me options and tell me there are alternatives, different stimulation protocols; to look at me as a person; to look at my AMH, anti-Müllerian hormone, and my follicle count, that’s the number of follicles you have when you start the cycle, to have a more individualized protocol; and my race too. The results of IVF do vary based on ethnicity. Asian people tend to perform differently compared to Caucasian women versus African American women. I don’t want it to be like a cookie cutter. I want to have a more individualized protocol.
The frustrating thing is I had to consult probably about seven to eight different clinics across the country to understand there are alternatives. There are seven or eight top IVF clinics in the country, like CNY, that have really high success rates. But I felt that every doctor I went to for a consult gave me a different protocol for stimulation and a different transfer protocol. I felt that if one is best, I wish they would have told me, “For you, based on my experience, I can tell you that this is what I recommend. If this doesn’t work, I think this will be the second best.” But I don’t want it to be just, “Oh, because you’re this age and because you have this many follicles, we’re going to do this.” That’s basically the message I want.
Because this is not only expensive, it’s emotionally draining. The failures are personal. Professional women, especially doctors, take a lot of failures very personally, not only in our career but also in our personal life. So when an IVF transfer fails, I at least felt that it was my fault, that my body didn’t work. But that is not necessarily true. Maybe I wasn’t on the right protocol. Maybe my transfer wasn’t done correctly. It might be that the environment wasn’t optimal. Maybe the embryo wasn’t thawed correctly. There were a lot of mysteries around IVF, and we need to open the curtains, right, to reveal the mystery of IVF and the lab that’s involved.
I mean, at some IVF clinics, I can talk to the embryologists and talk about details of my embryos. At some other clinics, I cannot; the embryologists are completely shielded. I don’t know. I felt that since I’m spending so much effort and money and time, I should be given access to those things. For example, when a patient comes to me, I say, “There are two ways to do this surgery. You can do this or this.” And then they ask me, “What do you want to do?” I tell them, “I think, based on your case, this would be preferred. The success rate is this.” I mean, IVF has been around since the 1980s. There’s a lot of data, right? So it’s not like this is a new field with not a lot of data.
With my patients, they come to me for advice. I tell them, “Based on the literature, based on research, this is what I recommend.” But with IVF, I felt like I had to do a lot of my own research. I had to go to my doctor and say, “This is what I want to do.” That’s not right. I mean, right? I feel like the physician should be my guide.
Kevin Pho: We’re talking to Lei Chu. She’s a urologist. Her KevinMD article is titled “Infertility: Navigating the challenges of IVF and the importance of self-advocacy.” What are some of your take-home messages that you want to leave with the KevinMD audience?
Lei Chu: I lived and breathed IVF for five years. It’s an emotional process, very difficult, but we were lucky enough to have two children. I think many women have a chance of success, and I think just always know there are alternatives. There’s light in the tunnel. Advocate for yourself, do your own research, and be nice to your reproductive endocrinologist, because they do this day in and day out. It’s a lot of hard work for them as well. And I think when I got pregnant, my doctor was elated, right? So that’s basically my take-home message.
Kevin Pho: Thank you so much for sharing your story, time, and insight, and thanks again for being on the show.
Lei Chu: Thank you.
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