E4: The Missing Half Of Fertility Care (ft. Gabriela Rosa)

Grief doesn’t hand out uniforms, but our systems still dress dads in silence. Gabriela Rosa joins the podcast to spotlight the missing half of fertility care and the very real ways men carry loss—often without acknowledgment, language, or a place to stand. From first ultrasounds to failed transfers, the default model treats women as the patient and men as the waiting room, and families pay for that gap with confusion and mounting shame.

Gabriela Rosa is a Harvard-trained fertility specialist and founder of the world’s first fully virtual fertility clinic. She has spent over two decades walking couples through the most fragile moments of their reproductive journeys - including loss. In her work with thousands of families across the globe, one thing has become painfully clear: men are grieving too, but almost no one is giving them space to talk about it. 

Gabriela walks us through a smarter, kinder approach: lead with diagnostics, not assumptions. She breaks down why most IVF cycles fail, where “unexplained” infertility hides solvable causes, and how overlooked factors can drive implantation failure and miscarriage. You’ll hear a powerful case study where years of failed IUIs and IVF turned into a natural conception once both partners were fully assessed and treated. The message is clear: fertility is a team sport, and strategy beats trial-and-error.

We also get practical about communication at home. We talk about pacing heavy talks, naming limits, and rebuilding self-trust after loss, especially for men taught to stay strong and say little. Along the way, we share scripts that replace platitudes with presence, and we point to resources—peer groups for men, evidence-based testing, and Gabriela’s Fertility Challenge Program—that make support real.

If you’ve felt invisible in the fertility journey, or you’re tired of guessing your way through heartbreak, this conversation offers a map.

Subscribe, share with someone who needs to feel seen, and leave a review telling us one question you’ll bring to your next conversation.

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Credits

Fertility Breakthrough (website)

Gabriela Rosa (profile)

Theme Music: "Love Letter” was created using AI as a creative tool, with lyrics and direction shaped by the personal experiences and emotional intent of the host.

Show Music from Soundstripe

• Wander
• So Tell Me

By EILOH

Transcript

Naming Men’s Hidden Grief

SPEAKER_01 0:00

Men, especially because of how they've been ingrained or trained by society, to have to be the strong ones. They don't feel that they have the permission to actually ask for the support that they need or to engage support that's available because of how they may be perceived or how they may be seen by the rest of the men in their, you know, personal experience.

SPEAKER_00 0:32

Hi, I'm Kelly Jean Fili. And welcome to Dad Always, the podcast exploring what it means to be a dad even after baby loss. Gabriela, how are you doing?

SPEAKER_01 1:02

I'm good. Thank you so much for having me.

SPEAKER_00 1:05

So Gabriela is a Harvard-trained fertility specialist and founder of the world's first fully virtual fertility clinic, uh, fertility breakthrough. She has spent over two decades walking couples through the most fragile moments of their reproductive journeys, including loss. In her work with thousands of families across the globe, one thing has become particularly clear, and that is men are grieving too, but almost no one is giving them a space to talk about it. And Gabriela believes it's time to change that. She believes that miscarriage is not just a women's issue, it's a family issue. And men need more than quiet resilience. They need to be heard, and I couldn't agree more. So Gabriela has joined me today to speak candidly about what gets missed in fertility care, how society sidelines paternal grief, and how we can begin building space for men to be part of the healing and not just the support system. So again, Gabriela, thank you so much. It is a true honor and privilege to be having this conversation with you and for you to join us on this podcast.

SPEAKER_01 2:26

Thank you. And I think it's such a wonderful thing that there is a space like this for men who are going through what is such a challenge, you know, and there's so much that we, I'm sure, are going to touch on regarding that. And, you know, in as part of your intro, one thing that caught my attention was the fact that, you know, what is it that gets missed in fertility care? And I would say that it's 50% of the fertility equation, you know, the next. So it's uh, and there's a lot more about that that we'll touch on, I'm sure. But yeah, it's uh it's a very interesting landscape when it comes to difficulty having a healthy pregnancy to term. And I'm glad that we're here discussing it.

SPEAKER_00 3:11

Absolutely. It's always fun to talk with someone from Australia because, from my vantage point, I'm speaking to you in the future and you're speaking to me in the past.

SPEAKER_01 3:25

That's my constant joke about us being in the future. Absolutely.

Building A Virtual Fertility Clinic

SPEAKER_00 3:30

Yeah. So thank you for getting up uh very early for us to have this conversation. If you don't mind, let's set the stage. I would like to hear a little bit more about your background. So, what is your own personal journey and how did that lead you to founding the first virtual, fully virtual fertility clinic?

SPEAKER_01 3:53

You know, children are always amidst mothers' choices in career and life. And starting there essentially is what made me actually decide that okay, I can't keep seeing 60 patient hours a week and face-to-face patient hours, you know, because I was about to give birth to my first son. And so this was back in tw in 2012, where there really wasn't, you know, a lot of access. I mean, these days you we get on a Zoom call like it's nothing, you know. Yeah. And uh we just think like, oh, this is this is how it always was.

SPEAKER_00 4:31

Yeah, this is normal.

SPEAKER_01 4:32

Actually, exactly. Actually, back in 2003 when I started doing telehealth. In fact, I graduated and started working in 2001. And I, but in 2001, there was a little bit of telehealth that would happen for people who essentially lived very far away from the clinic and would have check-ins on the telephone, like that corded thing on the desk, you know, that had like a full-on contraption that you put to your ear and type numbers. And that was when it was didn't have the dial, you know, going around the thing. But that that's that's that's going way back.

SPEAKER_00 5:11

Yeah, you're taking it too far back right now.

The IVF Myth And Missed Causes

SPEAKER_01 5:16

Um, so that's like my grandmother's son. Actually, I grew up, but I grew up in Brazil, you see. And so I we had the dial telephones at that point. So there you go. It's just, you know, that we we go way back. So, but anyway, let's kind of fast forward to the future again in terms of you know the future I circa 2012. At that point, uh Skype had become, you know, Skype has now been kind of like discontinued through Microsoft. It got bought by Microsoft and then got discontinued. And but it that's essentially one of the reasons that I decided I need to be able to be home. I need I need to be able to work and book appointments around times that I am able, you know, to see patients. And I didn't know really what it was going to be like in terms of how my how my child would behave when he would breastfeed, you know, all of the things that essentially you don't really know what's going to happen. As it turned out, he was a terrible sleep, but didn't actually was able to put him down until he was like a year old. And so, you know, just as well. And he had silent reflux, we didn't really know, so it was this whole thing, you know. But um, but I decided very early that you know I needed to to have some kind of a change, and I didn't want to stop doing what I was doing. By then, I had already been working for over a decade helping couples overcome infertility and miscarriage, and even when other treatments have failed. And so I knew that I wanted to continue making the contribution that I was making, I just couldn't do it in the same way. And it so happened that 50% of my patients by that stage who were my, you know, who were fertility patients, they did not live in Sydney. So I already had patients who were in Hong Kong and the US and you know, in different parts of Australia, and so in the UK. And so I thought that it made the most sense to do something that actually worked for me. And so that's how, you know, in 2013 I decided that okay, this is it. I'm gonna shut down my Bricks and Water place and really only offer the types of programs that I offer in a in a kind of telehealth setting. And it's funny because when I went to Harvard for the first time, I did my master's at Harvard and then I did my finishing my doctorate there. But when I went for my master's, I remember talking to healthcare systems professors, you know, uh at the cafeteria, and they were like so enthralled by the fact that this was way before the pandemic, like around, in fact, no, it wasn't way before, it was around 2018 through 2019. And so it was we were on the verge of what we didn't even know was going to change the world, you know. But I remember sitting with them and they were asking me all sorts of questions, like, so how do you do this thing? And you know, what what happens and all of that? And it was really interesting because when the pandemic hit and fertility clinics started to close down, and you know, it was it was a surreal time. I remember receiving, because I'm a member of a lot of ART associations, you know, like the the European and American societies of reproductive medic medicine. And I remember receiving emails with them talking about how to how clinics not how to ensure that clinics didn't go bankrupt. And I was like, what? Like I just what? Like between the me. It was just okay, this is another day in the office. And of course, yeah, there was this huge pivot of before the pandemic, I was to get people who would talk to me on the phone or on you know, kind of teleconferencing, that would say, that would literally say, so hang on a second. So you don't have a clinic that I go to? Like you like, how does this work? And so, of course, you know, you go through that whole explanation. Literally a year later, once kind of setting. No, it was really funny, it was even funnier than that. Literally a year later, people are like, So I don't have to go anywhere, right? Yeah, like I can just do this for like, oh wow, like to see that in the whole mentality of society was was really quite funny to me. But you know, it also showed that, you know, it showed that there is always what we think is the limit is never the limit.

SPEAKER_02 10:07

You know, that is so true.

A Couple’s Case: Finding The Why

SPEAKER_01 10:08

There are always, and I think this applies so much to fertility as well, because especially this the patients that I see. You see, I don't see the people at the top end of the funnel of fertility clinics, you know, where let's put it this way, it sounds horrible, but it's how it is. They haven't been able to concede for six months to a year, they're at a certain age demographic. Literally, they're just told you need to go and do IVF straight away. And they do, and they basically go and have their round, it fails because 71% of IVF cycles fail. Right. And so yeah, it's it's documented data. And so only 29% of initiated cycles end in a live birth. So, yeah, so there's a lot of misconception around the fact that you know people think that, oh, I'll go to IVF if I can't concede. Well, think again. You know, usually it's a situation where you need to understand, okay, why is this not happening? And as you can probably identify with or even understand, what happens typically is that if it hasn't happened within a certain number of cycles, in a certain number of kind of variable conditions, you're literally told you have unexplained infertility or unexplained miscarriage, just keep trying, or you need dunner egg, or you need sargacity, or you need whatever. And that takes away the power of an individual and a couple to actually understand, okay, but what is happening, first of all. Second of all, what do I need to do about it? You see, and the type of patient that I treat, they typically have got, they're not like I said, they're not the people who go into IVF and it works for the first time, the 29%. They're they're typically people who have gone through and either have tried for many years, you know, not an unusual story in my clinic is you know, uh a 10 to 15 year kind of length of infertility with multiple cycles in the world, you know. And so basically that's something that I say I often say, you know, like that's that's just another day in the office for me. So I see people who they've been told now, ah, you know, like I had one lady, her name is Shelly, and they her and her husband Dave, they had tried for eight years with just basically not using contraception. So eight years of no contraception, no contraception. Then they basically decided, okay, now we're gonna really start trying. And so in that time that they really decided to start trying, they had six IUI cycles that failed and two IBM cycles that failed. Nobody in that entire time had told Dave that he had low sperm count. His sperm count was only two million, and you know, one tenth of the 20 million that you need for a natural conception. So, of course, you know, I see that and I go, okay, let's find out what else we don't know because there's more, I'm sure. And so we start to look at everything, and to know Shelley was a pharmacist, she also had diabetes. So she was she knew that there were health concerns, there were things that were getting in the way. But as you can imagine, 14 years down the track, now she's been told, you know, your eggs are the problem. And, you know, you probably now need under egg. When obviously that wasn't the case in the beginning, you know. But what ended up happening was that as a result of the work up, we went through and identified that, well, they actually both had a silent infection that was known to cause implantation failure. And no doctor had looked at it and gone, oh, okay, maybe we should address that, you know. So of course we addressed that and everything else. We got hip spam up to 36.4 million, way above where it was before. And they were able to conceive naturally the first time that they actually tried after the treatment was complete. So, and again, you know, like I look at these stories, and to answer your question, you know, the original question, which is what is it like, what's my background that got me into this? Well, I was originally trained as a naturopathic doctor. So my focus was very holistic always. You know, then I did a master's in reproductive medicine and human genetics, did a master's in public health, you know, and kind of continuing, continued to kind of honey my skill around how do I look at fertility for what it is, which is not infertility. You see, how do we optimize, how do we uh how do we remove the obstacles so that we allow the body to do what the body normally does? The problem is that in standard therapy and IVF and so on, nobody's looking at it from that perspective. They're not looking at, okay, what are the obstacles? They just think, most doctors just think that they can bypass everything with IVF. And you can't. You can bypass certain things with IVF, but you can't, you know, when somebody has had, I had patients who I talk about in my book Fertility Breakthrough, which incidentally is available free on Spotify and also YouTube, people can listen to it. But one of the stories that I tell in the book is of a patient of mine who came to me after 20 failed IVF cycles. 20. So, you know, they basically had never been able to conceive naturally by implementing and understanding what are the obstacles, how do we address them for both partners, not just one, because it's not all about the egg, it's not all about the woman, even though, yes, there is a you know, the way that we look at fertility is 404 to 20, which is 40% male factor, 40% female factor, 20% embryonic factor and environmental, right? I.e. the receptacle, uh so to speak. But the reality is that the the embryo is a party in all of this, you know, and it does have to initiate to a certain extent self-development through that process, you know, and so it's not a situation of simply going, oh, let's just keep trying, better luck next time. That usually is what actually wastes a lot of time and fertility potential for couples. Because in that continuing to keep trying, well, guess what? They literally are losing fertility potential that is unrecoverable because of time. Female fertility is finite, male fertility also declines over time, so it is not something that we can just say, you know, just because Hugh Hefner had a baby with the Playboy Bunny that was 20 or 90, sure, it doesn't mean that it's possible for every man because most 90-year-olds are not going to be able to bet a 20-year-old because they don't have the same millions. That is a fact. I know that's a horrible thing to say. Very chauvinistic of me.

SPEAKER_00 17:29

I'm sure you're bursting a lot of people's bubbles right now.

SPEAKER_01 17:35

No, so you know, so the reality of it is that people have this concept that is completely unfounded, but you know, it's kind of blown out of proportion by the media, and men think that they're going to be fertile forever, you know, and it's like, actually, no, by the age of 45, your fertility potential has significantly decreased, and your DNA fragmentation has incredibly increased, which incidentally increases the risk of miscarriage and pregnancy loss. So, what most people don't know is that in order to have a healthy pregnancy due term and a healthy baby at the end of that, 50% of that is also 50% of miscarriages occur because of male factor. It's kind of similar to when I say 50 50%, it's that 44 to 20. You know, that 44 to 20 applies to conception and also keeping a healthy pregnancy to term. But when we look at female and male factor, both have the same equal weight when it comes to carrying a healthy pregnancy to term or taking home a healthy baby. And what happens most of the time is that when couples are going through and struggling to have a baby, you know, this couple that I was telling the story of, the 25 AVF cycles, it's literally like, okay, the woman is just like, okay, you just start the cycling this day, just start injecting yourself, we'll retrieve the eggs. The man comes in sometimes in that situation because, well, we have some frozen sperm. So it's like, well, they're kind of almost like relegated to outside of the entire, you know, process. And it's like, hang on, have we looked at the sperm quality? Have we looked beyond count with motility and morphology? Because this is one thing that a lot of people don't understand is that if we don't know the DNA fragmentation rating, if we don't know if there are infections in the semen, you know, there are so many times where we will, and we've done a meta-analysis on this, which was looking at bacterial vaginosis associated bacteria. Sounds like a big lot of names, but basically women who have BV or thrush or whatever, in terms of you know, like continuous infections or overgrowths, who then are trying to conceive of Course, they're having unprecedented intercourse with their partner. Now, if Dave has that kind of microbiome environment, what's going to happen in the vaginal environment, what's going to happen is that that is going to be passed on to the partner, right? And it may or may not overgrow in the seamant. Now it's silent, it's usually silent, right? And so you don't really notice symptoms, you don't really notice that something is not quite right, but it drastically negatively impacts sperm and sperm quality. So when we're when we know that a woman has had or has BV thrush, you know, whatever, we treat both partners for BV associated bacteria, thrush, and whatever else, because we know that that's going to be impacting his sperm, even if he's asymptomatic. And most men are, right? And so it's about looking at all of the different places that could be impacting what's going on as a whole. Because this is not something that can be achieved by improving.

SPEAKER_00 22:28

Let me explain what I mean. So I come together with my wife, and in conversation, we decide that we want to start a family. We're on the same page. We do the thing, and she tells me that she is pregnant. At that very moment, once that knowledge of the pregnancy becomes it materializes in the cosmos, her path has taken one turn, my path has taken a totally different turn. In that when we now both go to the appointment to get the pregnancy confirmed and what have you, she is obviously right, the patient. And so she is going to receive all of the medical attention. And all of the things that are important to her are going to be the things that then get treated, talked about, so far and so forth. I'm most likely outside in the waiting room, depending on the clinic that I go to or the hospital that I go to, the physician may or may not ask me about what's important to me and what have you, although both of us took that decision to conceive or at least try to conceive a life together. So that is a thing that I certainly experienced in my own journey with my wife. I'm sure many men have also experienced something similar. And I'm wondering if we can start, well, from your experience of treating the thousands of people that you've treated over your career so far, what has been one or two of those moments where maybe it's come to your attention like, oh, wait a minute, this thing is happening here, but we need to bring everyone back to the fold.

Making Fertility A Team Sport

SPEAKER_01 24:35

You know, it's interesting because for the longest time, I think since I started doing this work, I say to my patients everywhere, all the time, fertility is a team sport. And it's not enough to say it, but you have to demonstrate it, right? Yes. And so basically it's like, okay, how do we as a clinic demonstrate it? Well, for us, our program encompasses both partners throughout the entire time. And so we have this, we have women-only sessions and we have men-only sessions, and we have couple sessions, and we have, you know, all these kind of opportunities for people to decide how they want to engage with their own healing and their own self-care. And we also make very strong recommendations that they engage, you know, and so basically it's not a situation of like, oh, let's see what happens. Like we literally schedule the men into the sessions and tell them that we expect that they show up, right? Now, do they always know? No, do they do they choose to opt out? Yes. Many times, yes, many times, but do the ones who feel like they want to explore further show up as a result of it a hundred percent, you know. And uh we we have this type of session in our clinic, it's called a fireside chat. As you can imagine, it's dude sitting around the Zoom room, you know, having whatever conversations. I can't really speak directly to our conversations because I'm not allowed in there. But we do have a um, we have a peer. This is a peer support session that we run that essentially we have a whole heap of men, about five or six, who have gone through the program and who have had all sorts of different journeys within their reproductive journey. You know, some have experienced miscarriage, some have experienced foul treatment, some have experienced child loss, some have experienced, you know, a whole lot of things. So we basically have them host the other men who are currently going through the journey and you know, and to allow them to be able to have conversations around what's bothering them, what's happening for them, how things, you know, affecting them on a personal level on in many different ways, you know, and whether it's having an impact on their work, their home life, their interpersonal kind of self-concept, you know, all sorts of things like that. So I think that, you know, it's interesting because in my clinic it's a given that the man will participate, right, in in the couple if a woman is in a couple diet. Now, some come because they're actually trying to have a baby on their own. And of course, in that situation, we will guide them and support them directly and you know, singularly. But um, but yeah, I think that it's one of those things that this the healthcare system is not set up to support couples experiencing infertility and pregnancy loss. It really isn't, and you know, there is no better way of seeing that than population data, right? Because when you look at population data around how long it takes for a couple to take home a healthy baby or how long it takes even for a couple to conceive, we know from published data that we have there within two years, 93.6% of couples have gotten pregnant. Now, within three years, 96 plus percent have achieved that outcome, which leaves about 3% of people who have not, or you know, within the kind of the permutation of those people who have conceived and have then experienced miscarriages or recurrent miscarriages, obviously the number drops from the perspective of you know taking home a healthy baby, but it's the vast majority of patients who will conceive and take home a healthy baby. And so in the general population, and as a result, it reflects in the healthcare system the resources go to essentially treatment and procedural consultations and sessions and you know interventions that essentially are going to focus on the people who are pregnant and you know are going to have a baby. So, you know, the majority of healthcare systems, I mean, if you have a look at what happens in universal healthcare systems like the UK, Canada, Australia, there is a slight subsidy for fertility treatment for couples who are unable to conceive. But every one of those healthcare systems, and even in privatized healthcare systems, the guideline is you don't intervene or assess for why a miscarriage was occurring until a couple has experienced or a woman has experienced three miscarriages. And so what happens with that is that, well, first of all, who wants to have three miscarriages to if you have an experience of miscarriage, you probably don't understand that it can be one of the most traumatizing things for a couple to go through. And so the reality of it is that it's for me, I find it absurd that people would start investigating miscarriage after three miscarriages. And the reason is also that especially when we've had situations where we have an egg and a sperm meat, and we have an embryo, i.e., through IVF, right? And then we have an embryo transfer, and that embryo transfer fails. Well, guess what? At the time of transfer, a woman was pregnant. So if you don't see a positive pregnancy test, that was a miscarriage, that was implantation failure, right? Whether it you call it a chemical pregnancy, which most people who have experienced it hate it, hate that term, understandably, right? Whether you call it that, or whether you call it implantation failure, or whether you call it a miscarriage, they all end up to the same outcome. You had an embryo that did not make it to full stop, right? And in that, you know, like the couples that I was mentioning before who had 20 failed IVF cycles, within each cycle, they had multiple embryos, you know, created across that entire time, which essentially means that I don't even like they would have had way more than 40 embryos transferred in you know 20 failed cycles because they were getting a response in terms of embryos, and still they're saying they're being told, oh, it's okay, it's it's a numbers game, just keep trying. And when they came to us and we treated them as a couple, they conceived naturally. Conceived naturally. So, you know, even in a situation like that, where and mind you, I mean, you know, like then the skeptic in me kind of pipes up and you know goes, well, it is a multi-billion dollar industry, RVF. So, you know, maybe there's something to be said for the fact that is there in whose interest is it to do more cycles versus less cycles, right?

System Gaps And Delayed Testing

SPEAKER_00 32:21

Yeah, I yeah, I feel like that is a rabbit hole. Oh, we're gonna we're just gonna we're just gonna sidestep that rabbit hole right now because that that that is uh that is a feeling. That that is a genuine. I think if anything, it's an important question and a legitimate question to put on the table and to explore to some degree. But we're not we're not gonna do that right now. What I do wanna, yeah, we're not we're not gonna do that right now. What I do wanna talk for us to talk about though is this aspect of the father's grief being something almost strange if in from a societal perspective. I can tell you that for me, professionally, I am with, I'm in a healthcare setting where I support families who have critically ill children. And oftentimes I am providing support to parents who are on the verge of a bereavement or even during a bereavement. And sometimes these are parents who have had their children or their child for X amount of years, or it could literally be the child was just ushered into the world, and then the child is now deceased. So I have seen the gamut, and I can tell you, and I've been in this setting for seven years. It was not until my own journey of miscarriage that I realized that when I was in one of those patient rooms, I tend to gravitate more towards the mom as opposed to the father in the room. And so now that I was going and exploring and being impacted by my own grief of losing about four or five kiddos to miscarriage, that completely reoriented my practice. So I do remember the very first time I walked into a room and I realized there is a father there, and I felt this strong connection to him. And I know that's not the experience of a lot of men. There has been many, there have been many men who've said in that moment of loss, or in whatever iteration it's happened, that they did feel supported, they felt seen, they felt validated, and yet there is still a large population of men, particularly in the realm of miscarriage and infertility, where it just gets slapped away with these types of things like, well, it's just a numbers game. Or don't be surprised if the first pregnancy doesn't stick, or at least you get to have more sex, or whatever other thing that is said that doesn't really acknowledge, capture, validate, or even give any type of importance to the male grief. So why is it important to you to bring that and for that to be something that you want to shed light on?

Harmful Phrases And Social Pressure

SPEAKER_01 35:48

You know, it's a it's a great contextualization that you've given in terms of what happens where people go through these really challenging experiences, right? And for me personally, it has always been about easing human suffering. And human is non-gendered, right? Yes, it's like what is it that a human needs? And people will recharge all the things that they feel they need in different ways, and you know, I think that that's where gender is really interesting because there is a societal kind of almost training of boys and men that they should be a certain way, and I think that that's an upbringing situation, you know, where not only are boys trained to stuff their feelings in and not say it and just be the rock and just kind of be there and be the support and be the strong one and it and you know endure whatever it is that they are going through. You know, when we're put it in that kind of context, I think that we can see it a little bit better than when we're going through a really difficult, emotionally draining situation of a pregnancy loss, of a child loss, or you know, some kind of really difficult, challenging experience, because we then instead of verbalizing and expressing what our needs are, we kind of like suppress them, right? And we will do that in every other area of our lives if that's how we are trained to go through different challenges or different situations in our life. So to all that to say that there will be some people who will feel comfortable expressing how they feel because in other areas of their life they feel comfortable with expressing about things that are important to them and their feelings. There'll be people who will go through difficult, challenging experiences who will have the mindset that they have to be the strong one, that they can't show weakness, that they can't, you know, express how they're feeling about something, lest somebody gets upset, or you know, that they're not the one that is kind of in charge, or whatever it is. So I think that we have to look at this conversation from two different angles. And in fact, you know, there are so many. Like if we if we do a 360 on this, right, there there is certainly more than two angles, but I do like to look at it from the perspective of like, okay, there are different ways in which I can choose to show up, that I can choose to experience this very experience. What am I choosing? And I know that in the moment of bereavement, it's very difficult to just go, oh, I'm going to choose my feelings or I'm going to choose that to look at this from a different perspective. However, you can actually practice that in other areas of life. And that may serve, especially when we're feeling stuck in a really difficult, emotionally challenging situation, it may serve to kind of like give us the possibility of what if I could engage with this situation in a slightly different way, you know, because the the truth is that we will show up in different areas of our life, how we will show up in most areas of our life. So whether somebody offers support or doesn't, it does not mean that somebody can't say, I need help. Right? And sometimes I find that men, especially because of how they've been ingrained or trained by society to have to be the strong ones, they don't feel that they have the permission. To actually ask for the support that they need or to engage with the support that's available because of how they may be perceived or how they may be seen by the rest of the men in their you know personal experience. So much so that as you probably you know even experienced yourself, people in general, and this is not just men, people in general have a lot of difficulty sitting with other people's challenging emotions. Yes, and in no other place is more visible than when it comes to fertility challenges and difficulty conceiving. And what you've described before is exactly the way you're going to textualize. Oh, at least you get to have more sex. You know, or oh, it's okay, it's gonna be fine, you know, you will get there, or oh, it's a numbers game, just go on holiday, just relax, go on holidays, you get very good, lady, yeah, you're about to lose your mouth.

SPEAKER_00 41:05

Yes, yeah, yeah. Another one, another one I've heard is from from friends who have gone through that journey and are still going through that journey is well, continue enjoying your life, right? Like continue enjoying your life because you know, once you have children, then you won't be able to do X, Y, and Z anymore. So you guys are the implication is like you're actually kind of lucky that you're not able to conceive yet, right? I mean, it's it's it's all of those things.

SPEAKER_01 41:38

And look, you know, there there is there is absolutely it there is truth in everything you have.

SPEAKER_02 41:45

Yes. Yes.

SPEAKER_01 41:46

You know, like everything is hard. Having a vegan is hard, not having a baby is hard.

SPEAKER_02 41:50

Yes.

SPEAKER_01 41:51

Everything is hard. The reality is, and the the distinction here is that you want to be able to choose your heart. And when you're running through infertility, miscarriage, you know, child loss, you're not it feels like you're not actually able to choose. And I think that a lot of people, a lot of times, because they don't know how to sit with discomfort with another human suffering, they feel like saying the most crazy things. Yes, you know, is the way to approach it. You know, they feel that if they if they say this, it's gonna make them feel better, not the other person. They think it's you know, they're doing it to make the other person feel better. But actually, what they're trying to do is just make themselves feel less uncomfortable with the fact that this person is suffering and there's nothing that they can do about it. And in the moment, that person is not, excuse me, necessarily going to change it, and therefore, I want to just alleviate the the challenge here. I just want to alleviate the pressure, the discomfort that I'm feeling. The discomfort that I'm feeling, exactly.

SPEAKER_00 43:04

Yes, yeah, it's the ultimate projection of one's feelings on somebody else.

Better Support Starts With Listening

SPEAKER_01 43:10

Exactly, absolutely. So it's almost like you need to take people's words for what they are, which is a reflection of their own discomfort and not take it personally, because I think that there are so you know, so many of my patients who struggle with getting pregnant, they tell me that they dread going to family events and or you know, other things that they essentially are invited to, where there'll be families and kids, because they don't want to be asked, so when are you having a baby? It's the same thing. Like I just I I I honestly, when I hear people are getting married, I dread the conversations that are going to be. Which is like, oh, so when are you guys having kids? Oh, how many kids do I have? Ah, and then you know, a couple of years goes by and they may or may not still have to. Oh, why are we taking so long? Why are you not just you know, you're getting older, and meanwhile, that person does not know that those people have been trying way before they actually got married, yeah. You know, which I've seen so frequently, you know, and so they just decided to get married because well, the baby wasn't coming anyway, so we might as well just like take some other next step in our lives, yes, yes, and the well-meaning aunt is still going on with, you know, why are you taking so long? And it's like, oh my god. And the other thing that happens, you know, the set then you go through the first of all, you start going out with it with someone, when are you getting married? When are you getting engaged? When are you getting married? When are you having children? Then are you having one child? When are you having another one? You know, like it's like it's none of your business people. Just like stop asking those stupid questions. Like, you know, if somebody wants to come and say, we're trying, we're having difficulty, you just literally say that must be really hard. I don't know how to deal with the situation. I don't know what it is that you need from me. Like, do you need me to say something? Do you need me to not say something? I'm not gonna ask unless you come to me with it, because I don't know if you want to talk about it. Just like, you know, put out there the fact that, okay, I don't know how to handle this rather than saying some, you know, stupid thing that the other person is not going to appreciate. They're gonna be too polite to tell you that. But you just actually say, look, this must be really hard, and I don't know because I haven't experienced it, and I don't know how you need me to meet you in this. But if you tell me, I'll be there for you. Like it's that simple. Just ask the question, just express, just what it is that you want, and what it is that you want to say, and illumination.

SPEAKER_00 47:20

How to gain support from from other people or how other people can approach the person who's experiencing this this loss. It's also true between the couple, right? From from the perspective of the man who doesn't know the experience, the the implications of the inability to conceive, or we've we have this thing, and then it didn't materialize. Like I don't know what that means for my wife. I may have an idea, but the experience of it is different.

SPEAKER_01 48:01

Which is your own perception. It's not even an idea. It's just a perception of her externalization of the situation.

SPEAKER_00 48:09

Yes. And the same thing is happening uh both ways.

Venting vs Fix‑It Conversations

SPEAKER_01 48:14

100%. And so I think that you're absolutely 100% correct. This conversation needs to happen between two partners as well in a relationship. Because as a woman, you like honestly, you know how there are those memes that say, you know, women are asking, so what are you thinking? You're like, nothing. Nothing. But women are like not thinking nothing, they're thinking that you're thinking about the thing that you're not thinking, and you know, it just goes on and on. And so I think that I think that what's really interesting is that if we can approach each other with that lens, that you know what, like this is hard to pull stop. Like start there, okay. This is hard, and this is hard for me individually, and this is how I feel, and I know this is hard for you, and I don't know how you feel. I can estimate it, I can try and guess it, I can try and approximate it, but I don't really know, and I also especially don't know what you feel that you would like done about it, and how I can contribute to alleviating what's going on for you if there is anything that I can do. And so I think that asking that very open question and just really listening, like not to fill up the space, not to be able to respond, to just really to learn. So being able to have those open conversations, not taking things personally, and really opening the scope for possibility, right? Possibility of action, possibility of thinking, possibility of change, possibility of inserting something new into the whole concept is also really important because this is another thing that I often see. People will often say they've tried everything and nothing has worked. But what that really means, what that really means is that they've hit the ceiling of what they know. And they beyond that, they don't know what they don't know. And therefore, they go, Well, I've done everything. And sometimes they have done it very inconsistently, or they have not done it right at all, or they have, you know, kind of like for example, when I see couples who are either struggling or have had recurrent risk carriage, and they say to me, I've done everything and nothing has worked. And then I go and look at their labs, but they also have 80% of labs that are missing that they've never done. Right. And so with that in mind, I'm like, okay, so here's the thing: you've applied some tactics on your journey, and you have not received the outcome that you want because you are missing their whole strategy. You are missing something that's effective, that's actually going to deliver the outcome that you're looking for. And yes, you are inserting tactics here, there, and everywhere, but clearly that hasn't produced the results. So it's not that you've tried everything and nothing has worked, is that you actually don't have a proper strategy in place at this point. And that applies to communication and that applies to physical treatment.

SPEAKER_00 51:43

And I do want to acknowledge that having that kind of conversation between two partners in a relationship can be and often is, particularly in that context of loss, extremely charged with a lot of emotion, extremely difficult. Yeah, it is so fraught with complications and complexities and nuances and the whole nine. So that I do want to name and acknowledge and yet it still should be something that happens where both partners strive to have that level of honest, transparent communication with one another from the posture of seeking to understand the experience of the other and not fix it because there is no fixing something like that. However, how can I ameliorate your experience of this phase of what we're going through right now to make it bearable as much as possible for you as an individual, understanding that if it's a little bit more bearable for you, we're both gonna benefit from it, right? We're both going to find some way of staying as level-headed as possible, going through this as united as possible while acknowledging our own uh separate experiences.

Returning To Hard Talks Together

SPEAKER_01 53:20

There are two things to this, actually, just very briefly, that I wanted to point out. One is, you know, the distinction between venting conversations and fix it conversations, you know, because often men they will have a woman say something and they will find, they will, they will take it as they're being given an instruction to fix it, right? Whereas actually, most of the time, particularly when women are going through a really difficult and challenging experience, they're not actually wanting any feedback on how to do a better or improve. They literally just want to be heard. It's literally a venting conversation, you know, and the times where a man can actually stop before they say a word and ask a woman, can you just explain to me, is this a venting conversation or is this a fix-it conversation? Like, do you need me to give you feedback? Do you need ideas on how to solve this? Or do you just want me to hear you out? Because you see, here's the thing if we have that distinction at the outset of a conversation, it's harder to take something personally. If we know that it's a venting conversation and she's saying, Oh, but you do this, you do that, you don't do this, you don't do that, she's not actually wanting you to do anything about that. She's just wanting to express that this is how she sees it, this is how she feels about it. Therefore, you are under no obligation to have to change, fix it, or do something different, or even take it personally. You know, it is literally just a statement. Like it's as if she would be talking to a wall, but she wants a human to just hear the words, right? Whereas in a fixing conversation, then it becomes a little bit more of a okay, there is something here that I want from this, from you, from whatever, you know, the situation, and there are things we need to do about it. In a fixed conversation, it's really useful for women to use the eye proverb of how it is that I am feeling about this situation and how I would prefer to receive support, to receive critique, to receive whatever, right? In a way that it makes it much easier for the other person not to feel blamed or externalized onto, and therefore less likely to overreact to anything that you are saying. Not that it's not gonna happen, it may still happen, but it will be an easier conversation to be had, especially when emotions are charged and both people are feeling stretched, and both people both people are feeling challenged by the experience. So I think that distinction is something that is so valuable to keep in mind and for people to really understand that you know, if you start a conversation and that sometimes, and this is the second thing that I was gonna say, sometimes it's okay not to be able to get the entire sentence out in exactly the way which you have thought about it in your mind and to go slowly and just say, I'm hurting. Yes, I don't want to actually have a conversation about it, I'm just finding this really hard and leave it there, and then maybe the next day or the two days after or three days after, you know, have another two sentences about it until you can have a full paragraph, until you can have a full page, until you can have that entire conversation. So it's okay to just start with words, and I think that for women, it's really important to acknowledge and understand that that might be the process your partner needs to go through before they can actually use the paragraphs of words that you find easy to externalize. You know, most men they have been brought up with not actually being so communicative about their feelings like women are. You know, it's unusual for a man who's able to fully express in all colours of words, you know, in a full spectrum, how they're feeling in the moment. And you know, some women have difficulty doing that, but the reality of it is that it's okay to not look at it, whatever the it is, you know, the challenge, the difficulty, the the feelings uh that are overwhelming for long periods of time. It's okay to literally just glance at it for 30 seconds and then like, you know, turn your face and then come back to it and be able to actually look at it for maybe a minute and then go away from it again. And you know, to slowly actually uncover that whole conversation in such a way that feels like you're self-resourced, like you're able to take care of yourself within the context of having you know those conversations. It's it's really important to be able to take it at your own pace.

SPEAKER_00 58:39

The thing that I want to tease out of that is to say the commitment has to be to continuously go back to that thing from both parties. It can't be one of them, one of us is coming back to it, the other one isn't. We both have to make a commitment to each other to keep coming back to that thing and respecting each other's bandwidth when we keep coming back to it, until there is this momentum of conversation and trust and because so that we can land the plane. In a moment where we were experiencing whichever of the miscarriages that my wife and I went through, I didn't know until retrospectively looking at it, there was a loss of trust. There was a loss of trust that she expressed in herself. We didn't necessarily stop trusting each other as a couple. But that alone, in me losing trust in myself and her losing trust in herself really complicated the environment for us to even have whatever conversation, although we wanted to keep coming back to the checking in and the having that difficult conversation. And so that that's the thing that needs to be set in the middle, right? Is this commitment to keep coming back to the middle where we are absolutely because it's the shame of it.

SPEAKER_01 1:00:32

Yeah. On the conversation, the the not acknowledging the not letting it air out is what creating to bring to that shame that makes me not want to come back to my partner to have the conversation. So I think that you're absolutely 100% right. It's it's that ability to be able to go even if for little pieces of periods of time to revisit so that until you can fully expose the issue.

Resources, Book, And Next Steps

SPEAKER_00 1:01:01

Gabriela thank you so much for the time that you dedicated to the that always podcast if someone wants to find more about you the virtual clinic where can they go and how can they get uh hold of you?

SPEAKER_01 1:01:16

Sure they can go to my website which is fertilitybreakthrough.com and they can also um Google my name so Gabriella Rosa G O B R I E L A R O S A. And like I said before they can look out for fertility breakthrough the book on Spotify. It's called Fertility Breakthrough Overcoming Infertility Recovery Miscarriage When Other Treatments Are Failed. So they can look out for the book on Spotify and YouTube and also I run a free program called the Fertility Challenge that really is meant to help couples one be educated about the things that they can do to improve their fertility and their chances of taking home a healthy baby but to also implement the things that are going to help them from a physical, emotional and biochemical perspective as well to improve their chances. So that's something that we can look out for as well.

SPEAKER_00 1:02:16

Thank you for listening today this podcast episode is dedicated to the ones we hoped for but never met and the ones whose time with us was all too briefly, I think it's a lot of it