Fertility Frontiers: Unveiling the Psychological Journey with Dr. Kinasz

Welcome to an enlightening episode of Health University, where host Dr. Kathryn Kinasz, a distinguished psychiatrist specializing in women's mental health, shares invaluable insights. With an impressive background, including a medical degree from the University of Chicago and a residency at UCSF with a focus on women's mental health, Dr. Kinasz brings a wealth of knowledge to this vital discussion.

In this episode, we delve deep into the mental health aspects of fertility challenges. Dr. Kinasz, leveraging her extensive experience in various clinics including the San Francisco VA Women's Clinic and UCSF's REI clinic, sheds light on the emotional and psychological impact of fertility treatments like IVF and egg freezing. Her expertise extends from adult to child and adolescent psychiatry, providing a comprehensive understanding of the journey from considering motherhood to raising children.

Listeners will gain a profound understanding of the complexities surrounding fertility, including the often-overlooked mental health implications. Dr. Kinasz emphasizes the importance of addressing stress, the benefits of therapy, and the crucial role of sleep in the fertility process. She offers compassionate advice and practical tips, ensuring that the journey to fertility is not only about physical treatment but also about emotional and mental well-being.

Tune in to this episode of Health University for an informative and empathetic exploration of fertility and mental health. Don't miss out on Dr. Kinasz's invaluable guidance – subscribe and listen on iTunes, Spotify, and other podcast platforms. Remember, you're not alone in your journey, and professional support can make all the difference.

Connect with Dr. Kinasz:
https://calpsychiatry.com/kathryn-kinasz/

Take the fertility quiz: https://www.healthyouniversity.co/fertility-quiz

Schedule a Fertile Health Assessment: https://www.healthyouniversity.co/your-fertile-health-call

Follow on Instagram: https://www.instagram.com/dr.susan.fox/

Transcript

Speaker 1: 0:00

Hello and welcome to today's episode of Health University, where I have the pleasure and good fortune. Thank you for joining us, dr Kate Kinage. And Dr Kinage is a psychiatrist in the San Francisco Bay Area with practices in Silicon Valley and in San Francisco. And if you wouldn't mind, dr Kate, yes I will I will ask you to share a little bit more about yourself. I'm aware, for instance, that you got your medical degree at University of Chicago and that you got your psychiatry residency through the University of San Francisco. Is that correct?

Speaker 2: 0:37

Sure, actually.

Speaker 1: 0:38

So I went to University of Chicago for medical school and then I did my psychiatric general adult residency and UCSF University of California, san Francisco, with a distinction in women's mental health which I think is yet to purely pertinent to this conversation here and now, because we're covering the conversation of how mental health is such an important consideration for people who are about to undergo any kind of fertility support, be it IVF, egg freezing or discovering that they might have, or a concern that they might have, struggles with their fertility.

Speaker 2: 1:15

Yes, correct. So I adult residency with an area of distinction in women's mental health and during that time I also worked for an extended amount of time at the women's clinic at the San Francisco VA. I also did worked at UCSF's REI clinic, so their infertility treatment clinic, and I worked in the infant parent program at San Francisco General Hospital, or Zuckerberg San Francisco General, which is a program that works with moms and infants on sometimes pregnant moms, and then I did a fellowship in child and adolescent psychiatry at Stanford.

Speaker 1: 1:54

Oh, my goodness, okay, so you, you caught, you got the gamut.

Speaker 2: 1:57

The range, the range from considering motherhood through motherhood to your children. Yes, so I'd like to think I have the full range spectrum.

Speaker 1: 2:07

Excellent, excellent. Well then, I feel confident that you will be able to answer with authority the questions that we, that we, are about to undertake. Are you ready to go? Let's do it. Okay, let's do it. So the first question, of course, is the question for every person, right? What had you get interested in the field of fertility yourself?

Speaker 2: 2:26

Yeah. So you know I wanted when I went into the field of psychiatry I wanted to serve kids, and with kids always comes serving parents and and so I think that's initially where that interest started. And then I had multiple people very close to me, as probably every single listener does, given fertility struggles are so common. But multiple people close to me struggle with fertility and just watching that emotional tax that it had on them really opened my eyes to what an important area in psychiatric care this is. And then you know, personally I I also had my own encounters with infertility struggles, and I'm purposely vague on that, because, not that I'm not open to sharing. But I think it's really important when thinking about finding a mental health provider, whether it be therapist, a psychiatrist that you you find someone that fits and that doesn't have to mean someone who has walked the exact path as you.

Speaker 1: 3:33

I couldn't agree more. I couldn't agree more that I and I think that, if I may, to that point, sometimes there is possibly the concern of, well, you've gone through yours, but yours isn't mine exactly, and it isn't is is unique. You know you have the same diagnosis, whatever your experience is unique and while it's nice to have some, some empathy, what do you want to someone who can have compassionate care?

Speaker 2: 4:00

yes, you know, I I think not to spend our whole time on this, but I really think that is where we distinguish professionals from friends and friends are great, of course, but so often when we're talking as a friend, you might say, hey, I'm going through xyz and your friend, in the most well-meaning ways, says I totally get it, I also went through xyz. And look at this great thing that happened to me, or look at this awful thing that happened to me, and responding as a friend, and that sends your mind spinning right like why can't that be me or will that have? You know, whatever the reactions are, whereas a professional should hear you, listen to you, help, you feel held and it be all about you, not about their story. So I that's why I purposely am vague in that I do have a personal understanding of the infertility journey, but that's not what my job is. When I treat someone, it's not about telling my own story, it's about thank you for saying that.

Speaker 1: 5:01

I really appreciate that and and it is. It is true that it is becoming more ubiquitous, and so you know, with, with, with. We've got the data now one in six women are struggling fertility at some level, and so it really is a catch 22 for this, for this person who's going through it and it feels so singularly existential and and it and so it's, it's helpful, but it's not always helpful to have to have the understanding that it is that it is more than than this individual experience, because it's the individual experience that needs to get healed and work through yeah, and I mean that again, another diversion, but I think that's also something to take in mind when we think about our experience with our partner, whether same-sex couples, heterosexual couples, what you know what, single mothers by choice, whatever.

Speaker 2: 5:56

It might be that we may have someone walking through this with us, but their experience is going to be so separate, and it should be separate, because they're a separate person. But that can be. I see so many people who struggle with that when their partner may not be responding in the way they expected or in a way that even feels right to them, but it is their partner's own response too, and it once again just calls to mind how lonely this journey can be for someone. Even in the healthiest relationships, it can be such a lonely struggle.

Speaker 1: 6:32

Right, right. Yes, I think that you've just hit the nail on the head there, in that we, especially in our intimate relationships, we have come to expect a certain level of support, but that just can't always be there, as hard as that person might try or as much as that person might want to. It really does behoove anyone who wants to get support to get professional support that is just for you, and then couple if that's something that is appropriate, and or that your partner having his or her own support, so that each person going through this can come out as come through the other side as a whole and healed as possible. Now you are in the San Francisco Bay area, in Silicon Valley and in San Francisco proper, and so I imagine you have a unique prism of population of patients who are, who have the benefit, if you will, of family planning benefits and therefore have consideration of you know. Do I go straight to IVF? Do I do egg freezing? Is that correct? Do I? Yeah?

Speaker 2: 7:47

I think that's correct. Unfortunately, California is not as progressive as many states when it comes to fertility benefits. So there are some states where IVF has mandated coverage. We're not quite there yet. We're kind of in this in-between zone in California where you can get some things covered, but not quite IVF. But many of the tech companies around here and you know non-tech companies as well have really wonderful family planning benefits that many people get to take advantage of and I wish it was a universal thing every company had. But yeah, Likewise, likewise.

Speaker 1: 8:24

And yet the pin I'd like to put in the conversation here at this point is that the benefits are wonderful, right, it's lovely to have the expenses paid, but these people are going through something that there's no amount of claims coverage that is going to help the process, right the time away from work population, as, I guess, a demographic that you've worked with. What might you say in general to that population, who's probably the population listening to this podcast about? Make sure you think about X.

Speaker 2: 9:05

Y Z. That's a good question. I think you're absolutely right that, when it comes down to it, all the money or insurance coverage in the world doesn't make the actual experience or lack of a better word easier. I mean, you're still biologically experiencing hormones in your system. I think that you are with the loneliness and the emotional backers of this, the sometimes excitement, disappointment, the waiting, hurry up and wait kind of attitude.

Speaker 2: 9:39

All these things are just universal experiences in this journey, regardless of insurance coverage. So I think, going in I want to balance it because I don't want to scare anyone, but going in and just taking note of where your emotional supports are, so that you're not playing catch up and you're suddenly like, oh no, I need help in this, I need to find a therapist Shoot. These therapists have, however long of wait list that you're prepared that you know this could be pretty taxing. I think no one would say that, oh, I'm just going to casually freeze my eggs or casually get IVF and as the rest of my life continues to be the rat race, you know this really does take time and energy. Again, I don't say that as a way to scare someone, but things are much easier when we have our supports in place.

Speaker 1: 10:38

And I have to presume that anyone who's listening and is interested in this conversation wouldn't be scared by it, because you know, he or she, they have an understanding that this is not just a matter of, it's not a tooth cleaning. So just right, right, and it's not just the hormones, it is here again, it's the, it is the mental health I'm going to say exercise or discipline that is required to just make that first call to the center. So thank you for saying I really appreciate that that you're you're, you're really helping people understand that it benefits to have a little checklist of you know what might be my concerns, and one of those I'm not going to. I don't have concern is the right word, but you know, some people kind of begin already on a medication, and so is there something that you would say generally speaking about if you're on a medication, you know?

Speaker 2: 11:33

I'll let you know, yes, so this is.

Speaker 2: 11:34

This is my area of expertise Expertise as a psychiatrist.

Speaker 2: 11:39

So you know, of course, not giving any medical advice, but what I think is very important is that if you're on a psychiatric medication, you know if it's prescribed by a psychiatrist or your primary care doctor, you let them know about what you're going to undergo. So, whether it be egg freezing or IVF or even just trying to conceive, I mean just as much if it's trying to conceive, because there are many medications that are very safe. There are some medications that are not safe, there are some that are in that gray zone. So we weigh risks and benefits and you don't want to be figuring this out alone and you absolutely do not just want to stop everything in the name of treatment. So this is why you once again want to have someone by your side who's going to really walk through each medication, talk about the safety profiles of them and make an informed decision that's going to help you, as the patient, feel well cared for, while also not making drastic changes right before you're about to undergo another drastic change.

Speaker 1: 12:51

And toward that end, is there a general here again we're not making prescriptive commentary but a general timeframe within which you would say, you know, think about sharing with your psychiatrist or prescribing physician one month, two months, three months, before. Sometimes it's not an option if there's an emergency situation, but if there's an, if there is an ideal situation, what might you say?

Speaker 2: 13:17

I mean, ideal is often a year before, right, six months before, and only because if, ultimately, you hear about the profile risk benefits of a medication and you make an informed decision with your doctor that that might not be something you want to stay on, well then we want to wean off and then we want to see how you do and then maybe you need to try something else, maybe you need to go back on it. We want to give time for your medications to be at a good place or tapered off of them again. So we're not playing catch up. And it makes me think about going back to your point about being in Silicon Valley and this patient population.

Speaker 2: 14:02

And I think one other factor is that so many people, when it comes to their fertility journeys, have everything planned out Okay, and that's why this can be so emotionally taxing is I'm gonna have kids at age X, y, z, I'm gonna have my house spot, whatever other the plans are, and then fertility struggles change those plans and it can be, as you know, a total crisis. But if we're willing to think about those plans, about when we wanna get pregnant, how we wanna build our family, let's also think about planning for our mental health right and all the planning, the well-roundedness of the planning, so that it's not just focused on having a child or number of children, but we're thinking about how we can be in our best place to undergo that treatment and then possibly even embark on parenthood.

Speaker 1: 15:00

Oh well, I mean, but that would be the natural and the goal Right. So it does make sense. It does behoove someone to think about this, not just for the fertility journey experience, but also a bootcamp appropriate for pregnancy, for new parenthood, all of which is brand new territory for any of us going through it. Well, I was gonna say for the first time, but sometimes it's a brand new thing all over again the second or third time, absolutely. Yeah, that is wonderful. As a medical doctor, psychiatrist, I'm presuming you also use therapy as part of your modality. Would you speak or use the benefits of therapy, the frequency of therapy that you might suggest for someone who's thinking about this? You know, either egg freezing or natural conception.

Speaker 2: 15:50

Yes, I mean I wanna shout from the rooftops therapy, therapy, therapy. I cannot speak to that benefit enough and I think it's important. I mentioned that I worked at UCSF's REI clinic and so sometimes this distinction is helpful for people to understand. Many REI clinics have a mental health practitioner embedded in the clinic and so people might get a maybe false sense of security that oh, my clinic has someone if I need someone, but it usually and of course every clinic is different but that person is often there to support for immediate questions.

Speaker 2: 16:31

That I don't wanna get into all the different indications, but there's sometimes mandated indications for when you have to see someone but they're not there to provide long-term therapy. And again, there might be unicorn clinics out there who have someone who can provide long-term therapy, but for the most part they're there for acute issues. So if you think therapy is something that you're gonna want to engage in, it's helpful to look outside the clinic and not just rely on that, because once again, with planning, we don't wanna get disappointed and realize, oh, this person's only gonna be able to provide me a few sessions and I actually want a lot more support. And when it comes to a lot more support with therapy. Of course every person's different, but usually weekly therapy is what's going to lead to the best. I don't know how to exactly frame it, but to feel supported. I mean, some people need more than weekly, but to feel supported in that journey and I'd want people to have that in place.

Speaker 1: 17:35

Yeah, yes, and I think I would like to also sort of reiterate and amplify that within you call them REI clinics and that is reproductive endocrinology, and some in the listening world might call it an IVF clinic. When they've got mental health providers on staff, oftentimes that is because they need to check off the legal requirements of is this person if going through a donor egg or single parent by choice, or there are specific things that they are intended to do and it is not necessarily how should I say comprehensive, they're exactly.

Speaker 2: 18:19

So I wouldn't really even often call it therapy.

Speaker 1: 18:22

And that's not that these aren't trained therapists, but again, they're working for the clinic In boxes that checking A CYA if you will, and it's necessary, and I'm not being at all critical that it is not, but I think it could be a little misconstrued as, oh, there's my therapist, when in fact there is not your therapist, there is the clinic's therapist.

Speaker 2: 18:43

Yeah, and I mean I can share that. I actually was speaking to someone at one point who was turned off to therapy because their experience with that mandated person was what they're like is this what therapy is? And I had to explain this is not what therapy is. This is checking boxes. That was an assessment. Yes, and your therapy journey should not feel like checking boxes. Yeah yeah.

Speaker 1: 19:12

Do you find yourself working with other professionals in the field of fertility? Is there a collaboration that you find yourself that creates a sweet spot that lets this person feel could support it in many ways?

Speaker 2: 19:27

Yes, I think that it's always ideal and as a psychiatrist, I love when my patients are also very connected to therapy. I mean ideally if you can have both and again a primary care doctor and OB-GYN REI doctors are often very busy, but in certain circumstances they can get involved. The more of a team approach, I think, the better it can be for the patient. And it's okay if the whole team is not able to necessarily collaborate at all times, but to have that team in your corner, I think, is a really great thing.

Speaker 1: 20:10

Yeah, I would agree, and regrettably it is the system right when we're in, whether it is an REI or an OB-GYN who they just don't have the time, exactly. So that's where a therapist I mean that's just the nature of the work is to spend the time that's necessary to by the end of a session. They have gotten somewhere, not gonna be. I've got three minutes for you, exactly. Good luck with that.

Speaker 2: 20:40

Right. That's why I say that caveat, because, of course, in a perfect world, I'm checking back with their OB-GYN every session, but that's not how it really works, unfortunately, and that's okay too. That doesn't mean we can't have healing.

Speaker 1: 20:54

Right, exactly, I mean we share chart notes and have communication, but we don't have grand rounds for every patient, right Exactly, it's just an impossibility.

Speaker 1: 21:05

So that's great.

Speaker 1: 21:07

And so I'm gonna put a plug in for the sort of complimentary and integrative practices as well.

Speaker 1: 21:12

Like myself, dr Bannon-Bunker, in Chinese Medicine, because, similarly, while we are not therapists and I really wanna say that loud and clear we have the time and we have a listening set of tools, because emotions are part of our intake, our diagnosis and our pattern diagnosis, and so we are able to hear, make recommendations within our, within our paradigm, and make recommendations that this sounds like something that really does need some attention. So and it doesn't have to be an acupuncturist, but I would say, if it is an acupuncturist or Dr Chinese Medicine or something like that, do find someone who is specialized, who is either board certified or specialized, because regrettably and I think this is the case in many fields there are people who just come out of school saying I specialize in such and such, when they don't yet I may they at some point would in the time and the dedication to do so, but I think it's potentially dangerous for the person who needs specialized help and I want to again personally share that.

Speaker 2: 22:22

I'm a doctor of Western medicine and in my own fertility journey it was absolutely my acupuncturist who brought me some of my coldest moments and I know you said we're not therapists, but wow, those sessions often felt the same movement as inside, internally, like a therapy session would feel, and I just acupuncture was such an important part of my journey and I do again this is a Western medicine doctor saying this I really encourage people if they haven't dabbled in that area to think about it, because it can be so healing.

Speaker 1: 23:05

Thank you thank you for that. And while I had the caveat that we're not therapists and yet it's true, the conversation, the connection is therapeutic, right, is therapeutic. I would say one thing that happens on the table almost every time the treatment table with acupuncture is stress relief. You have these needles that are helping to lower cortisol, raise endorphins, get blood flow and all of that. So on your side of the perspective, how would you say, stress is impacting fertility.

Speaker 2: 23:45

Oh gosh, oh gosh. Loaded question, loaded question, I think okay. So I think it's without a doubt it's impacting things, and I say that with such a mindful caveat because I think one of the hardest things a person can hear when they're undergoing treatment is don't stress out so much. It's as if you can just switch off the light, switch. Right, it's not a choice that someone is feeling stressed and exactly, or and I think that often people undergoing treatment then take those words of don't stress out and feel like it's their fault if things aren't going their way, and so know that stress can definitely impact things and find ways that it can actually be released, like acupuncture, like therapy, without feeling like, hey, this is one more burden that I have to check off the list, turn my stress off, and just doesn't work like that.

Speaker 1: 24:53

Sometimes it's as simple as you know. If all of these other adjunctive support systems are not accessible to you, what you're faced to, the sun you know. Take, do, do, do you can. It doesn't cost anything but a little bit of your time to take some deep breaths, listen to some music, a guided meditation, a prayer book, whatever is one's method of saying okay, this is soothing to my spirit, soul, mind, psyche.

Speaker 2: 25:24

You know we have lots of names for it, mm-hmm we spend so much time in the fertility journey going to appointments, putting medications into our body, all the drive, the commute, the park, everything. Take some of that time for yourself as well, and that meditating and all the things you just said, taking a walk these things are also just as important and I think so often we get focused on the treatment prescribed and we forget about those other ways we need to treat our body Right find ways to laugh. Even if it's laughing at ourselves.

Speaker 1: 26:03

I do it every day, yeah. Or you know, pet an animal, you know see if hug a friend any of these things and get sleep, and get sleep. Would you like to speak a little bit more to that?

Speaker 2: 26:18

Oh, yes, I mean again, I always this is a prescription for all of us. These, the missing prescription? Yeah, it's again. This isn't to say you're not getting pregnant because you're not sleeping. That would be an unfair burden to put on someone. But we cannot underestimate the importance of sleep. It is, it's just so necessary for our body to function, and so I think when people are undergoing treatment, it's really important to take a comprehensive look at how they're treating their bodies, what they're putting into it in terms of diet, how often they're exercising or even over-exercising, putting undue stress on their body, how much they're sleeping. These factors we have data to support how important they are, absolutely, and it's just, I can't tell you how often I've seen people come in and want a medication and really be suffering, but these other areas haven't been addressed, and it's really hard to find healing when we're not addressing the whole person Exactly.

Speaker 1: 27:22

So listeners think about this how well do we sleep when we're scrolling, scrolling, scrolling through Dr Google until we're so exhausted that we put the phone down or the laptop closed, the laptop cover, and then hope to get immediate restorative sleep? It just, it doesn't work that way. Whereas we are designed the same as we were a thousand years ago or more, we need the wake, sleep, the dark light cycles. They are fuel for, they are food for our bodies. And so how you know, wake up, you know, with the light, if you can. Of course, there are people for whom their work schedules don't allow it. But to the best of your ability, and go to sleep to the dark, with not the blue lights, just before you close your eyes.

Speaker 2: 28:08

In a perfect situation. I like people to have two hours of no screen time before bed. I know, not that it's pie in the sky often, but really the blue light. You know our body releases a hormone called melatonin Many people have heard of that about it when we start to get sleepy and this blue light makes us think it's still sunny outside the blue light of our screen. So we really need for our body to naturally know it is nighttime and time to get sleepy. We need time away from that blue light.

Speaker 1: 28:39

Exactly, and that is that is red light to time people. That is why you put on, you know, blue light blockers, you know at dusk to dark o'clock, so that you're telling your brain that you understand that it is dark time now, so your pineal can produce its melatonin, so you can start the detoxification and sleep inducing process. Then you've given such such great advice. Is there anything that I haven't asked about that you want to say, ah, but I really want to make sure that the listeners hear this.

Speaker 2: 29:10

I think when people hear psychiatrists they often get worried that you're going to see a doctor who's just going to push all these psychiatric medications on you and make you feel like a zombie. And I hope, I hope listeners one have not had that experience but know that they should find a doctor who is willing to hear their story and listen to what their goals and desires are. But seeing a psychiatrist doesn't have to be scary. It should really be someone who you feel held by and who wants to work with you to achieve your goals, to have a life filled with joy and filled with value and meaning, especially as you embark on the fertility journey.

Speaker 1: 29:56

Yes, and listeners, if you happen to be in the state of California, then Dr Kate is hopefully possibly available. I will have her information in the show notes. So if there's anything here that has piqued your curiosity, of course, if you're outside the state of California, I there are limitations to you know what one can, unfortunately. Yes, we practice within state lines, so so look for that, because I'm imagining that there are people really leaning in at this point saying, wow, right, this is the missing link. I need to address this because you know I'm checking off all the other boxes and still it's not happening. I'm feeling further down the rabbit hole and you know I can feel my sense of self and my ability to manage in life and then crumbling away. So I fully expect you're going to get indented and it's such a compassionate gift that you've given with this conversation and I know that you give to your patients as well.

Speaker 2: 30:56

Oh, that's kind of you. Yeah, I mean just to say to the listeners you don't have to walk the journey alone and outside of California, dr Obi-Gyn, your primary care doctor, even the REI clinic, they may have recommendations on people who you may be able to see if it feels like this is something you need.

Speaker 1: 31:13

Yes, I would second that I think that many of the clinics or the docs, they've got their own resources, but how we met through the Marin Perinatal Resources Network. So we've got professionals who cover from fertility all the way through parenting and all of what happens along that journey. So, yeah, check with your own community and if you're in the state of California and this resonates with you, please, you'll find all of the doctor's information in the show notes. I want to thank you so very much for taking this time and I hope I have the chance to get you back at another time because I have a feeling that we could continue this conversation. Absolutely. Let's add in for an item.

Speaker 2: 31:53

Yes, I couldn't agree more. Well, thank you so much for having me, thank you for the work that you do, and I would love to be back.

Speaker 1: 32:01

Okay, very good, thank you. Well, we're going to sign off for now. So students class dismissed at Health University and we'll see you next time.