See a therapist — This is probably the biggest tweak, but I think it has the most benefit. So many women I see are in their 20s, 30s, and 40s. They are overall healthy and rarely need to see a doctor. And for many, infertility is the first major personal struggle in their life, and the first major struggle that a couple has faced together. I think part of the stigma of infertility leads to patients feeling like they have to bear the grief and anxiety on their own. A psychologist can help a patient process their emotions, so they can deal better with the blows that come with a failed treatment cycle. I started seeing a therapist for post-partum depression and anxiety after the birth of my twins, who were born at 29 weeks after IVF. I realized how helpful a therapist could have been and wished I would have started seeing one earlier, especially when I was going through infertility.
As part of my series about “5 Lifestyle Tweaks That Will Dramatically Improve One’s Wellbeing”, I had the pleasure of interviewing Meaghan Bowling, MD, FACOG, is board-certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility. She has published articles in both basic science and clinical medicine peer reviewed journals, including Obstetrics and Gynecology. She has presented her research on estrogen receptors at national meetings including the American Society for Reproductive Medicine and the Society for Gynecologic Investigation.
Dr. Bowling has appeared on CNN to discuss issues related to reproductive technology. She was named a “Mom-Approved Doc” in Atlanta Parent magazine. She has also received multiple awards for research and excellence in teaching medical students and residents, as well as the Society for Laparoscopic Surgeons Achievement Award. Her clinical interests include in vitro fertilization (IVF), preimplantation genetic screening (PGS), oocyte cryopreservation, male infertility, polycystic ovarian syndrome, ovulation induction, intrauterine insemination (IUI), and minimally invasive surgery.
Thank you so much for doing this with us! Our readers would love to “get to know you” a bit better. Can you share with us the story about how you first got involved in fitness and wellness?
I’d love to share my story, as it has helped define who I am today as both a doctor and person. I went into the field of Reproductive Endocrinology and Infertility Fellowship training at age 30, which is the age most female physicians are when they finish residency and are able to go into practice as an independent physician. I went into the field for the reason that most of us REIs do: love of two things: 1) caring for patients during a deeply emotional time in their life and building some of the most intimate bonds with them, and 2) the amazing science behind our fertility treatments. A human embryo is about 100 cells in size. Every day I still wonder at how amazing it is that I can hold an embryo in my hands and that cluster of cells will become a baby, and eventually an adult, with a life that we can only imagine.
Cut to age 31, in my second year of fellowship, and I am struggling to conceive. I end up going through IVF myself. From a physician’s standpoint, I’d say my diagnosis was ‘poor egg quality’ due to endometriosis. As a patient, I’d tell you my eggs were crap; I had them, but they just didn’t seem to do what they needed to do. So, I ended up going through three egg retrievals over the course of five years. I have four amazing children from this process and they are all from IVF. I feel so lucky. You can imagine that this has significantly affected my understanding of what my patients are going through emotionally and physically during the fertility treatment journey, and how I approach my job.
Can you share the most interesting story that happened to you since you started your career? What were the main lessons or takeaways from that story?
I would say that the most interesting stories are those of my pregnant patients where things are not going according to plan, such as a patient who is about four weeks pregnant, and her hCG hormone levels are not rising as we would expect them to in a normal pregnancy. For example, if you ask any REI, according to textbooks and literature, the hCG level should double every 48 hours, which we monitor with blood testing. If it doesn’t double, we worry she will have a miscarriage and counsel them to expect the worse. But I can’t tell you how many times we have seen the levels not rise appropriately, and the pregnancy turns out to be fine. The most extreme story I’ve got is a patient who had made it to six weeks of pregnancy but was having very heavy bleeding. At one visit, she came in for her ultrasound appointment, and before her appointment even started, she ran into the bathroom and had a massive amount of bleeding. I have never seen so much blood, except back in the days of my OB residency. We got her into an ultrasound room assuming the worst, and there was that little fetus with a heartbeat as strong as ever. She went on to deliver a full term, healthy baby! So I tell patients, you just never know. Human life seems to find a way even when our scientific knowledge suggests a pregnancy is failing.
Can you share a story about the biggest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
As a doctor, when you start to practice independently, you begin to realize how much of the job is figuring out how to communicate with all the different types of people out there. As residents and fellows, we are so worried about making sure we have read every book and every article and know all of the medical facts that will help us give patients the best treatment.
As an infertility doctor, a lot of what I do is explain the treatment options. For each option, I describe the medications, ultrasound visits, overall time involved, and then the two big factors which are success rate and price. IVF is very expensive and often not covered by insurance in many states. However, it has the highest chance of success by far. As a patient with infertility, my statistic-oriented brain lead me to move quickly to IVF and not ‘waste time’ so to speak with less successful options like IUI. And I have to acknowledge that my privilege as someone who could afford IVF was part of the decision. Early in my career I realized how many patients are thinking about treatment in different ways. Most patients want to start with the least expensive, least invasive options and move their way through the steps. I believe that early in my career, if I could not help a patient understand that the treatment option they were choosing to go with had a very low chance of success (as low as a 5–10% chance per month!), I felt in a sense that I was failing them. I realize now that I was not failing them, but instead helping guide them through the process and allowing them to make the choices that are best for them while supporting their journey. It’s not about helping a patient conceive in the minimal amount of time, but helping them make decisions according to their priorities, and knowing that it may be a long road, but we often are able to help them have a baby at the end of that road.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?
Without a doubt, my husband has supported me and helped me the most. Barrett is also a physician, a Geriatrician at Duke University. He has been my rock during all of our struggles with infertility, having premature twins in the NICU, and supporting me in my career. So many of us have doubt about what we can achieve in our lives, and Barrett has always helped me see how successful and happy I could be in my job and in my life, even when I could not see it. I am a full-time clinical physician and mother of four. People ask me how I do it. I tell them, I can help so many women and couples have the family they want because my husband helps with every aspect of our home and family life. We are equal partners, and again, I feel so lucky.
Ok perfect. Jumping into our main focus — when it comes to health and wellness, how is the work you are doing helping to make a bigger impact in the world?
COVID-19 has affected people across the globe and many struggling with infertility have experienced unique challenges, like clinic closures and delayed or canceled treatment cycles, as a result of the virus and its impacts on daily life. I understand how difficult these changes have been for the patient community. At this time, most clinics are taking the appropriate health and safety precautions for staff and patients while prioritizing patient care, including adhering to the guidelines provided by the American Society of Reproductive Medicine (ASRM). With the rise of telemedicine due to COVID-19, virtual consultations may also be offered by many clinics.
Despite these challenging times, being an advocate for your fertility is as important as ever. I encourage women and couples who are struggling with infertility to visit myfertilitynav.com to find and speak with a Reproductive Endocrinologist, whether in-person or via telehealth options. And for those who’ve experienced treatment delays or cancelations, we encourage you to get in touch with your clinic to assess local guidance and determine appropriate next steps.
Can you share your top five “lifestyle tweaks” that you believe will help support people’s journey towards better wellbeing? Please give an example or story for each.
We all know that the struggle of infertility takes a huge toll on mental and emotional wellbeing. I encourage patients to be proactive in managing their mental health during this journey.
- See a therapist — This is probably the biggest tweak, but I think it has the most benefit. So many women I see are in their 20s, 30s, and 40s. They are overall healthy and rarely need to see a doctor. And for many, infertility is the first major personal struggle in their life, and the first major struggle that a couple has faced together. I think part of the stigma of infertility leads to patients feeling like they have to bear the grief and anxiety on their own. A psychologist can help a patient process their emotions, so they can deal better with the blows that come with a failed treatment cycle. I started seeing a therapist for post-partum depression and anxiety after the birth of my twins, who were born at 29 weeks after IVF. I realized how helpful a therapist could have been and wished I would have started seeing one earlier, especially when I was going through infertility.
- Protect yourself — If you are struggling to conceive, it seems like every single person around you is getting pregnant. This can lead to a lot of negative emotions: bitterness, anger, and jealousy come to mind. These feelings then lead to another negative emotion: guilt that you can’t be happy for a best friend or sister who is pregnant. Remember that these feelings are normal. And it’s OK to protect yourself and put yourself first. Skip the baby shower. Have answers prepared when you are asked by the well-meaning family members when you are going to have a child.
- Be healthy, but don’t go crazy. — Yes, it is important to be in your best health before pregnancy. I encourage patients who are overweight and underweight to work on achieving a normal BMI prior to pregnancy. This may not be possible for all patients but studies show that for overweight and obese patients, for every point you can lower your BMI, your chance of success with fertility treatments increases. But, there is no special diet, supplement, or exercise regimen that will improve your chances. I had one patient with a failed IVF cycle who took three months off to eliminate all processed foods from her diet. She then did another IVF cycle, and unfortunately had the same outcome. I want patients to know that they can live their lives normally and not add pressure on themselves to live a ‘perfect’ healthy life. Same thing for acupuncture. So many women ask if acupuncture will help them conceive. While some small studies have suggested a benefit, most of the literature indicates that acupuncture does not make a difference. I tell patients that if they enjoy acupuncture, then go for it. But otherwise, I think that going for a massage, a pedicure, a walk, or enjoying a good book are just as helpful for self-care. I encourage patients to do what they enjoy and take care of themselves during the infertility journey.
If you could start a movement that would bring the most amount of wellness to the most amount of people, what would that be?
So many patients who suffer from infertility never even seek care or talk to a doctor. This gets back to stigma of infertility, embarrassment, fear of failure, and fear of prices. I tell my new patients that the hardest part of the journey is walking in the doors of the infertility clinic. So many patients tell me how nervous they are at the beginning of the appointment. They are worried that I am going to tell them that they will never be able to get pregnant. People are shocked to hear that most patients never need the expensive treatments like IVF, and most get pregnant with basic changes like treating underlying conditions and helping improve ovulation with oral medications. I want women to feel empowered to seek help, and search out reproductive endocrinologists and infertility physicians to help. I want women to know that 1 in 8 couples face infertility, so even though you may feel isolated, you are not alone. When you feel brave enough to talk to people in your life about it, I guarantee that at least three other women will come forward and say, “Oh yeah, me too! I went Dr. So and So to have both of my babies! Go see her and she’ll help!”
What are your “5 Things I Wish Someone Told Me Before I Started” and why?
- Listen to the patient — Patients don’t want a doctor telling them what to do. They want to be heard and so I sit back and listen. When the doctor and patient understand each other, a beautiful partnership is formed that allows the patient to have the most satisfaction with their care.
- Have empathy — In all walks of life, you can encounter difficult personalities. When I am faced with a patient who is angry or frustrated that they are not pregnant, I now understand that the easiest outlet is for the patient to aim their anger at the doctor, nurse, clinic, or front desk staff! I remind myself and my staff that these patients are fragile and afraid, and we make sure to treat them with kindness and patience during this difficult time in their life.
- Take care of yourself — Doctors are notorious for not taking care of themselves! I think it is easy to get caught up in losing sight of your own health and wellbeing when you have spent your whole day and whole week giving everything you’ve got to your patients. Learning to say no, and learning to carve out time for myself to do things that I enjoy, like walking, journaling, reading, helps me be a better wife, parent, and doctor.
Sustainability, veganism, mental health and environmental changes are big topics at the moment. Which one of these causes is dearest to you, and why?
As I mentioned above, mental health is such a critically important piece of my work and my personal journey. I started seeing a therapist, as I mentioned before, after the birth of my twins. My twins are now nine! So I am about a decade out from when my fertility journey started. In the midst of that journey, I felt like I was in a deep dark hole that I would never get out. But then you get through it. And then that chapter closes, and you move on to the next phase of your life. I will say that in many ways infertility stays with you forever, but the passage of time makes everything easier. While at the time I would never have wished to go through infertility, I now feel lucky that I have lived that part of my life and can now help other women and couples through it.
What is the best way our readers can follow you on social media?
Follow Carolina Conceptions on Facebook (https://www.facebook.com/carolinaconceptions) and Instagram (https://www.instagram.com/carolinaconceptions/). Our website www.carolinaconceptions.com has a wealth of information and videos to help you on your journey! I encourage women and couples who are struggling with infertility to visit myfertilitynav.com to find and speak with a Reproductive Endocrinologist, whether in-person or via telehealth options.
Thank you for these fantastic insights. We wish you only continued success in your great work!