An Interview With Lucinda Koza
Taking care of yourself, mind, body and spirit are important, especially when navigating the challenges of IVF. This can look like what we discussed earlier: engaging in grounding routines and rituals, adjusting movement practices, and taking care to be gentle with yourself and with your body during IVF.
Infertility and the journey through IVF are challenges that many individuals and couples face, often accompanied by emotional, physical, and financial stress. Despite advancements in reproductive technology, the process can be isolating and fraught with uncertainty. How can we better support those navigating infertility and IVF, and what strategies can help manage the various challenges along the way? As a part of this series, I had the pleasure of interviewing Lauren Lui.
Lauren Lui is a licensed Marriage and Family Therapist in Sacramento, California, and the founder of Living Gently Therapy, a private practice offering individualized care for adults and adolescents. She specializes in anxiety, perfectionism, and childhood trauma recovery, and blends evidence-based techniques, like EMDR, and Internal Family Systems (IFS), to deliver personalized and transformative treatment. Lauren is passionate about helping women break free from perfectionism and develop lasting self-worth, and supporting individuals navigating grief and loss. She also works extensively with adults, who experienced childhood trauma, find resolution and navigate complex relationships. Lauren’s mission is to create an empowering therapy experience that helps individuals build more authentic, fulfilling lives and ditch the belief that they must be productive to have value.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” better. Can you tell us a bit about you and your backstory?
As someone who has a more sensitive disposition, I was often aware of the needs and emotions of others around me. I’m grateful to come from a very loving family, but the school environment I grew up in was very competitive. I struggled with perfectionism and basing my value on achievements during my adolescence; and, thankfully, my family helped me stay more grounded. This personal experience impressed upon me the immense impact of family dynamics on how we see ourselves.
Being a bit more shy and reserved, I found a lot of comfort in my imagination, the stories I’d think up. I loved to put on plays with my cousins and daydream. Growing up, I found myself gravitating more and more towards, and becoming more naturally curious about, people’s stories and experiences that shape them.
How did you get involved in this field?
When I reflect back, how I became a therapist was a culmination of experiences. As I shared, I have always loved writing stories. I get to experience many elements of storytelling as a therapist, whether that be how someone understands their story, learning about how the stories of our families shape us, the stories that larger systems tell us about ourselves, etc. I knew I wanted my career to be relational, and initially considered teaching. Elements of explaining concepts creatively, building personal connections, helping empower students– those were what appealed to me the most.
I realized I really wanted to work one-on-one with people, and started on my path to become a therapist. Wonderful professors and clinicians mentored me, and the more I learned about family dynamics, the power of human connection, our brains, etc. I felt called to use my relational strengths to support others in re-defining their narratives and mending relationships. After volunteering with an organization that spread awareness about human trafficking and provided practical support for survivors, and later working with underserved families at an agency in Los Angeles County, I became more interested in trauma-informed care and EMDR, a trauma modality that I now get to integrate in my own practice.
From your experience working with individuals and couples navigating infertility and IVF, what are some of the most common emotional challenges they face, and how can healthcare providers best support them in managing these emotions?
In my work with clients, I’ve found that entering the process of IVF is incredibly complex, and tends to poke at core wounds centered around not feeling good enough, capable enough, enough generally. Women in particular often express feeling this way, despite knowing intellectually that the ability to conceive is not a reflection of their worth or value. This is an unfortunate byproduct of internalized messaging and external societal pressures and constructs about the value of women and women’s bodies that we are slowly chipping away at, but is often present nonetheless.
I also think that compounding these core wounds is the accumulation of emotional and physical trauma that comes with IVF. More often than not, by the time many reach the point of pursuing IVF, months or years of grief and frustration have accumulated. What we, as providers, have to keep in mind is that a majority of the time, IVF may not be the way people hoped, or envisioned, they would have a family. The patients walking through the door are likely carrying trauma from the emotional rollercoaster of unexplained infertility, previous experience with miscarriage(s), and potentially, their own emotions surrounding a health diagnosis that led them to pursue IVF (e.g. Pursuing IVF and genetic testing of embryos due to finding out you are positive for the genetic mutations that increase risk for cancer, etc.). Further, what’s emotionally challenging and taxing is the uncertainty: from the financial side of things, to side effects of medications used to stimulate ovaries, how many embryos will be viable, success of implantation and subsequent carrying to term, how others in your life might react should you share about your IVF journey, etc.
Healthcare professionals can best provide support by integrating holistic care that takes into account IVF’s impact on mental and emotional health. When healthcare providers recognize and validate their patients’ feelings and experiences, they empower patients in what can feel like a very disempowering experience. Assessing mental health by integrating screeners for anxiety and depression at intake appointments and providing mental health resources (individual, couples, and group therapy referrals), are two practical ways healthcare providers can support their patients.
I think including mental health assessments in the intake process can really help both patients and providers have a grasp of how patients’ emotional health may be impacted by IVF, and providers can offer additional support and resources to facilitate a more comprehensive and positive patient experience. Providing education about the prevalence of IVF can help normalize the experiences and help patients feel less alone.
Additionally, when healthcare providers prioritize their mental and emotional health, this not only provides personal benefits, but it also has a trickle-down effect to positively impact their patients. We know that compassion fatigue in the healthcare setting is so real. And when you are working with patients who are struggling emotionally over long periods of time, there may be increased risk for burnout and potentially, negative impacts on patient care. By prioritizing their own mental and emotional health, providers benefit personally, but also, can positively serve patients in the long-term.
Fertility treatments often come with significant physical and hormonal impacts on the body. What strategies do you recommend to patients for managing the physical toll of IVF, and how can healthcare professionals better assist in minimizing these side effects?
The unfortunate reality is that we can’t fully escape the discomfort that IVF brings, but we can do things to mitigate and manage the physical and emotional toll.
IVF involves medications and hormones, and most women report fluctuations in emotions, physical appearance, and energy levels during various stages of treatment. Engaging in activities that ground you, such as gentle movement (yoga, stretching, etc.), prioritizing time outside, guided imagery exercises to decrease discomfort, expressive art and journaling, are just a few options for outlets that can help bring some ease to the physical impact of IVF.
Practicing self-compassion and honoring your body’s resilience are also helpful. Validating the physical and emotional toll of what has brought you to IVF, and now going through IVF itself, will help you fully process the experience as opposed to shutting down or avoiding those emotions. Research tells us that the more we suppress emotion, the more likely it will resurface in unhealthy ways. Extending yourself compassion, and honoring your body’s ability to undergo the IVF process, can help repair some feelings of shame or inadequacy around your body, which come up frequently around the ability to conceive.
At different times throughout IVF treatment, say in the phase where you are receiving hormone and medication injections to stimulate egg growth, you may have less energy. At this point in treatment, patients are usually attending multiple doctors appointments as well to monitor the medication’s effects. The combination of medication and multiple appointments can be draining. Giving yourself permission to slow down, rest when you need to, make adjustments to your exercise routine, are helpful ways of listening to your body.
Providers can provide support by providing patient-centered education on what to expect physically and emotionally. Because the IVF process is often overwhelming, providing patients with physical or digital resources about what they can expect at different stages of treatment can be especially helpful. If resources allow, providers can consider hosting workshops on what to expect physically, tools for stress management, and alternatives for physical activity that are gentler on the body.
Following through with the complete process of fertility testing and treatment can be absolutely grueling for the body for what could be years. How can someone cope with constant procedures, medications, hormones?
Because IVF can be a lengthy process, it’s important to keep in mind how you can cultivate stability and longer-term support. Your needs may shift throughout your journey and that is ok; acceptance of the fluid nature of IVF and an overall posture of curiosity towards what you need throughout treatment will help you find the best-fit support.
Generally, going off of positive coping strategies that have helped you navigate challenges in the past can be a helpful starting point in developing a toolkit of strategies and practices. I think that due to the isolating nature of IVF, prioritizing community is essential. Continuing to consistently engage with the meaningful relationships you have currently creates a sense of safety and feeling known, even in a season where a lot is changing. Having a space to share with others who are navigating IVF through support groups or friends who have experienced it can also help you feel less alone.
Additionally, if you’re partnered, IVF can also create strains in your relationship. For the most part, one person is shouldering a majority of the physical toll of treatment. It’s normal to feel disconnected at times from your partner because of this, whether you are the person undergoing the treatment, or the one primarily providing support. Share with your partner what the experience of IVF is like for you; allow them to support and take care of you, and process together any feelings that come up throughout treatment so that as challenging as it may be, it becomes something that brings you closer rather than further apart.
As I mentioned earlier, IVF is full of ups and downs. By sticking with rituals and routines that ground you, you provide yourself with a sense of normalcy in what can feel like a very daunting season. I think rituals also provide us with a sense of hope that there are certain things in life that will outlive our present circumstances. Nurturing this hope through rituals and routines can help you remember that at some point, this season will also pass.
This is relatively self-explanatory, but take into consideration the physical impact of IVF as you navigate responsibilities at work, socially, and in exercise. Perhaps you made plans to go on a hike with a friend, but your body is feeling worn out. Communicate this with that friend, and make plans to do something a bit more gentle on your body (e.g. a neighborhood walk, sitting outside and enjoying lunch or tea, etc). Consider how you can optimize your schedule at work. To the degree that you feel comfortable, express your needs around workload and remind yourself that it’s ok to be gentle with yourself during this medical journey.
Financial stress is a major factor for many couples undergoing fertility treatments. How can healthcare providers and therapists address this stress proactively, and are there any resources or advice you offer to help patients navigate the financial challenges of IVF?
The cost of IVF is debilitating for many, and can add onto the stress of treatment. Money is a topic that can bring up a lot for people emotionally. Therapists can support clients undergoing IVF by allowing individuals and couples to process their own feelings around money and the financial impact of IVF on their life. For couples, helping them work through differences in emotional associations with finances, and ultimately, pave a path forward that aligns with their values can help reduce the friction financial stress tends to create in relationships. Providing group therapy at a lower cost also be a helpful way of making therapy more accessible for those who are feeling the financial strain of IVF.
Healthcare providers can help reduce some financial stress by providing clear, transparent information regarding the costs of IVF. This looks like providing and explaining cost breakdown sheets, possible additional expenses (e.g. genetic testing of embryos, Intracytoplasmic Sperm Injection (ICSI), etc.) at the outset. Staffing financial coordinators to assist patients in understanding the financial side of things empowers patients in understanding their financial options.
Additionally, providing resources around payment plans, fertility coverage under insurance, etc. equips patients with information to help them make informed decisions around their treatment, ease the financial burden, and budget as needed. Organizations on that referral list could include those like WIN Fertility, for example, which is an organization that helps with family planning in a variety of ways, including access to fertility treatments and care by connecting people to in-network specialists, financing options, and more.
Can you please share “5 Things You Need to Navigate the Challenges of Infertility and IVF”?
- Resiliency and Adaptability:
As we’ve discussed, IVF is a taxing process, both emotionally and physically. The ability to navigate ups and downs, uncertainty, and possibly having to pivot from your initial idea of what IVF looks like are essential in caring for your well-being throughout. Emotional resilience is not acting like hard, disappointing circumstances don’t bother you, but rather honoring those feelings AND finding ways to move forward. In my work with a client whose journey with IVF was not as straightforward as she expected, much of the work started with grieving the idea of what she expected her IVF journey would look like, and exploring how to balance both honoring that loss, and being able to continue in treatment, as this was in alignment with her values and ultimate goals.
2. Strong Support System & Community:
I’ve found that IVF is not well-understood by those who haven’t experienced it, which can feel isolating. Ensuring that you have a strong relationship with your partner, and within your trusted network of family and friends, can help ease the burden of feeling like you’re doing it alone. Therapy can also be a great addition to your support system, whether that’s individual, couples, group therapy/support groups or a combination. Processing feelings around IVF in therapy can look different for each person; a few themes my clients have found helpful to explore in individual therapy around IVF have been feelings and messaging around what it means to be a woman, value and identity in and outside of motherhood, family pressures and expectations, feelings of loneliness, stress and anxiety, grief & loss, etc.
3. Advocate for your needs:
You are your best advocate when it comes to your healthcare. Within the U.S. healthcare system, much of the onus is on patients to advocate for themselves, and this can feel burdensome in an overwhelming process. With this in mind, if you can, be choosy when selecting your provider to minimize stress. IVF is a lengthy process, so consider actively seeking a provider who best aligns with your needs and goals, whether this is more clear communication or interpersonal skills, specializations around a particular infertility issue (e.g. male infertility, PCOS, endometriosis, etc), responsive staff, etc. Word of mouth referrals from friends, referrals from doctors you trust, and reading online reviews can be helpful ways to find a best-fit provider.
Additionally, ask questions about what to expect during IVF and don’t hesitate to advocate for yourself at every stage of treatment. While IVF is daunting, when you have a grasp of what each step entails, this can help reduce overall anxiety about the process. During appointments, it can be difficult to fully absorb the information due to the emotional nature of IVF. One way to advocate for yourself is to consider asking your doctor to send a brief summary of the key points of your appointment, take notes if that feels good for you or, have your partner take notes, or invite a trusted loved one to accompany you to appointments and help ask questions.
4. Self-Care and Tending to the Anxiety:
Taking care of yourself, mind, body and spirit are important, especially when navigating the challenges of IVF. This can look like what we discussed earlier: engaging in grounding routines and rituals, adjusting movement practices, and taking care to be gentle with yourself and with your body during IVF.
I’ve found that at various points in treatment, IVF can be incredibly mentally preoccupying, which makes sense given all the “what ifs” and uncertainty. Anxiety is what happens when our brain tries to solve a problem, but ruminating and fixating on treatment can be draining and unhelpful. If you find yourself caught up in cycles of rumination, consider compassionately viewing this anxiety as a part of you that is trying to help, validating its intention to solve or find answers, and asking for some space from it. A helpful way to go through this process is through journaling and imagining an inner dialogue between yourself and the anxious part of you; think Inside Out 2.
5. Communicate and Set Boundaries:
Strong communication with your support system is key. If partnered, communication between partners is particularly important in helping each person feel seen and heard throughout the IVF process. Expressing your needs to your partner and loved ones helps ensure you are getting the support you need, and that you and your partner are feeling connected. Communication also includes considerations around whom you share about your IVF journey with. Share about your journey with people you trust and make you feel safe; be mindful of what “shoulds,” may show up when it comes to sharing, and use this to discern what feels right for you when it comes to sharing.
Sometimes, you may need to take a break from talking or thinking about your IVF journey; that’s ok. As I mentioned earlier, IVF can feel all-consuming at times, and it’s perfectly normal to step back from it. Texting friends ahead, letting them know you’d rather not talk about IVF at dinner, is a way to honor and communicate your needs. Other examples of communication practices I’ve explored with clients have been how they can express their needs to their partner throughout IVF; a client who wanted more emotional support from her partner was able to practice and express this; another client role-played a conversation with her in-laws to better communicate her boundaries around sharing about the IVF process.
The isolation that often accompanies infertility can be overwhelming. What role does mental health support play in the IVF journey, and what can healthcare professionals do to create a more connected and supported experience for patients going through this process?
Mental health plays a critical role in IVF; bringing awareness to the multiple layers of emotional experiences that come with IVF is crucial to taking care of your mental health. We know now more than ever just how connected our minds and bodies are, and how our bodies can carry the impact of trauma, including the trauma that can accompany infertility and IVF. This being said, healthcare professionals who help create more opportunities for connection are really honoring the whole person’s experience, not just their physical conditions that are showing up around infertility.
Healthcare providers can help patients by providing resources for individual, couples, and group therapy, and online resources such as Resolve, which is the national infertility association. This platform includes user-friendly information about infertility, ways to advocate for fertility treatment, and find community. In addition, providing patients with referrals to therapists who have experience working with those navigating IVF can be an incredible relief. I’ve heard from many clients that the process of finding a therapist can be overwhelming, and so providing support with this can help ease that overwhelm. This could look like providing patients with information for clinics and therapists in the area. Should resources allow, consider establishing an agreement with a local therapist to facilitate support group(s) at your clinic.
Another possible avenue of support that healthcare professionals could offer would be mentorship opportunities. Emailing past patients to gauge interest around possible mentoring opportunities for folks entering IVF can both help those starting the process feel less alone, and it facilitates new ways of making meaning of their experience for those who have gone through IVF.
Wonderful. We are nearly done. Is there a person in the world, or in the US, with whom you would like to have a private breakfast or lunch, and why? He or she might just see this, especially if we tag them. :-)?
I’d love to have lunch with Dr. Gabor Maté; he has done some amazing work on trauma and addiction that is incredibly insightful! As I work with many loved ones of addicts, I would love to hear him share more on the nuances of addiction in ways that could best support and help this population.
If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
I’d love to help connect more people of different ages to promote intergenerational friendships. There is so much richness in developing friendships with and learning from those who are different from us. We know that community is integral in healthy longevity, and strengthening bonds between generations can also help with broader systemic issues such as ageism. Having positive role models who bring life experience and wisdom to younger folks can be so grounding in the rapidly changing world we live in today. There is a newer neighborhood in my city that has a senior living community in the center of a single-family housing development; what a cool way to promote relationships and connection across the lifespan right outside your door.
How can our readers follow your work online?
You can learn more about my work on my website, www.livinggentlytherapy.com
You can find me on LinkedIn here
Thank you so much for joining us. This was very inspirational.
About the Interviewer: After becoming her father’s sole caregiver at a young age, Lucinda Koza founded I-Ally, a community-based app that provides access to services and support for millennial family caregivers. Mrs. Koza has had essays published in Thought Catalog, Medium Women, Caregiving.com and Hackernoon.com. She was featured in ‘Founded by Women: Inspiration and Advice from over 100 Female Founders’ by Sydney Horton. A filmmaker, Mrs. Koza premiered short film ‘Laura Point’ at the 2015 Cannes Film Festival and recently co-directed ‘Caregivers: A Story About Them’ with Egyptian filmmaker Roshdy Ahmed. Her most notable achievement, however, has been becoming a mother to fraternal twins in 2023. Reach out to Lucinda via social media or directly by email: lucinda@i-ally.com.
Lauren Lui Of Living Gently Therapy On Navigating the Challenges of Infertility and IVF was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.