In this episode, I’m thrilled to welcome Dr. Anna Glezer, a renowned reproductive psychiatrist and founder of Women’s Wellness Psychiatry to the Egg Whisperer Show. Dr. Glezer has dedicated her career to supporting fertility patients, many of whom I’ve had the privilege to care for, through some of the most emotionally challenging moments of their reproductive journeys. With training from Harvard Medical School and UCSF, she brings a compassionate, integrative approach to helping people manage stress, anxiety, and depression during fertility treatment, pregnancy, and beyond.
Our conversation dives deep into the unique emotional landscape of fertility and pregnancy. Together, we explore how hormonal changes, societal pressures, and the ups and downs of the fertility journey can impact mental health. Dr. Glezer shares her expertise on building a strong foundation for emotional wellbeing, the importance of individualized care, and practical strategies for navigating grief, loss, and the rollercoaster of hope and disappointment.
In this episode, we cover:
- The unique ways stress, anxiety, and depression manifest during fertility treatment and pregnancy
- How to build a strong support system and foundation for mental health
- The role of lifestyle medicine, nutrition, and supplements in emotional wellbeing
- Coping with grief and loss after unsuccessful fertility treatments or pregnancy loss
- Strategies for managing anxiety and “what if” thinking during subsequent pregnancies
- How Dr. Glezer tailors her integrative approach to each patient’s needs
- Advice for loved ones and fertility teams on providing meaningful support
Resources:
- Women’s Wellness Psychiatry: https://annaglezermd.com/
- Resolve: The National Infertility Association: resolve.org
- Ovasitol Inositol Powder Supplement by Theralogix
Full Transcript:
Dr. Aimee: Today, I have the honor of speaking with Dr. Anna Glezer, a renowned reproductive psychiatrist who has dedicated her career to supporting patients, many of them mine, through some of the most emotionally challenging moments of their lives. Dr. Glezer is a board-certified psychologist with training from Harvard Medical School and UCSF, specializing in reproductive and perinatal mental health. She’s the founder of Women’s Wellness Psychiatry, where she helps patients manage stress, anxiety, and depression at every stage of their reproductive journey. Whether it’s coping with the emotional rollercoaster of fertility treatment, managing pregnancy after loss, or navigating the postpartum period, Dr. Glezer brings a compassionate, integrative approach that empowers her patients to take control of their mental wellbeing.
Welcome, Anna.
Dr. Anna Glezer: Thank you so much for having me.
Dr. Aimee: You work at the intersection of reproductive health and psychiatry. Can you share how stress, anxiety, and depression uniquely impact people going through fertility treatment or pregnancy?
Dr. Anna Glezer: This is a big question, and a great one. It’s true that those who are going through a fertility journey can have a lot of unique experiences in the context of emotional wellbeing, mental health, stress, anxiety, mood, sleep issues. A lot of that relates to a number of things that are unique to those who are going through a fertility journey.
The first is the hormonal load. It’s a lot of ups and downs. We know that, for many people, a fertility journey can be a prolonged experience. That rollercoaster can take a toll, both hormonally and emotionally. It’s both the biological experience with the hormonal influence on mental health, that’s the entire field of reproductive psychiatry recognizing the role of hormonal health on mental health, and then you have the psychological experience of a fertility journey. You have the challenges of navigating it in the context of society and what that means in terms of family and friends, in terms of managing grief and loss.
Dr. Aimee: What are some of the less obvious ways these feelings can manifest?
Dr. Anna Glezer: It can definitely manifest in the form of anxiety, overwhelm, mood symptoms. Mood symptoms don’t have to be depression. It doesn’t always mean that you’re feeling down. I would say that the number one way that folks present to me is they describe feeling emotionally labile. They don’t always use that word, that’s one of my words. But emotional ups and downs, and that can be anxiety, that can be overwhelm, that can be irritability, that’s a common one, and just a sense that you’re not able to engage with your world the way that you want to.
Dr. Aimee: My hope is that patients seek help before a yearlong or yearslong journey. For folks that are just starting off, what are some of the first steps that you recommend?
Dr. Anna Glezer: I recommend building a foundation. If you have a strong foundation, even if there are gale force winds, the house is not going to shake as much. I think that foundation includes a lot of important components.
The first thing that I recommend is creating a support system and a network. That might be with the people in your family, with your partner. It might not be. Not everyone is lucky enough to have that kind of support. Sometimes it might mean building that support system. Maybe that’s with a support group of those who are going through a similar experience. Maybe it’s online, there’s a lot of really good online resources, RESOLVE and many others, to bring those who are going through fertility journeys together. Building that support system and that social network is foundational.
Then I also think it’s important to think about the other components of lifestyle medicine, essentially. Thinking about nutrition, thinking about movement, thinking about sleep and making sure that you have good sleep hygiene and routine, and thinking about all of these holistic ways. Maybe it might include micronutrients, maybe it will include certain botanicals or supplements that can help you create that foundation so that things feel like they’re stable before you embark on that kind of journey, or even when you’re already in it.
Dr. Aimee: Do you have any recommended botanicals or supplements that you think help patients?
Dr. Anna Glezer: There are several. It depends on what an individual is struggling with the most. I do have my favorites. Some of the most common ones that I recommend are, for example, I like magnesium. There’s different forms of magnesium, but it can help with sleep, it can help with anxiety and mood, there’s some good evidence on that. A lot of our diets are pretty depleted in terms of magnesium. The soil that our food grows in these days just doesn’t have the nutrients. Magnesium can be really helpful.
I also like, particularly for those who might be predisposed to challenges with their blood sugar or anxiety, inositol. It’s actually been studied for mental health benefits, and has shown to be helpful, even head-to-head with some prescription options out there. Inositol can be a good option for folks.
I would say my third favorite is omega-3s, fish oil, because of its anti-inflammatory properties. We know that for a lot of folks who are embarking on a fertility journey, some of the cause of whatever is going on might include some form of inflammation. Also, inflammation can be a cause of depression and mood symptoms, so reducing that inflammation with omega-3s can be really helpful.
Dr. Aimee: I’m learning a lot.
Dr. Anna Glezer: I would say those are my three top favorites.
Dr. Aimee: Your go-tos. Okay. So many of my patients, their journey is not linear. Sometimes we have a transfer and we have the joy of it working. My hope with each transfer is that it works, and that it works the first time. Oftentimes, we feel the immense joy of a positive pregnancy test and the crashing low of finding out that the pregnancy ended up not being healthy, and that can be deeply isolating and painful. What can someone do to care for their mental health in a situation like that?
Dr. Anna Glezer: I think the thing that you mentioned is that rollercoaster that we were talking about a little bit earlier. There is a lot of hope and optimism at the start of the process, and then there can be a lot of disappointment, and who knows how many times, how often you’re on that rollercoaster. It’s important in addition to that foundation that we talked about to take the time after a disappointment and a loss to do some healing and to take care of oneself and to nurture, and to process that grief and loss. I think sometimes that piece can get lost a little bit because, depending on where someone is in their journey, they might feel like there’s time pressure and we need to just keep going to the next step, and there isn’t a moment taken to process what happened and to hold that space and experience that grief and loss in order to be able to heal from it.
I think taking that time, taking that space is an important part of it. And getting support in that context. Maybe that is with your partner, maybe that is with family, maybe that is with your therapist, wherever that support comes from, but from people around you who can help you hold that space for as long as you need it.
Dr. Aimee: Then it’s so hard to see those patients start their next transfer journey because they knew what it felt like to be so hopeful, and then for their next transfer they’re so guarded. Do you have any advice for them around that?
Dr. Anna Glezer: That’s a really big thing, especially for folks where maybe they have a successful pregnancy after a loss. There is a lot of that anxiety and that guarding, those what-if questions. I talk with a lot of my patients about that. Whenever you have a sentence in your brain that starts with what if, just pause and think about whether or not that’s going to be a helpful sentence. Things that start with what if usually aren’t the most helpful kinds of thoughts that we have.
Although, one way that I work with patients around that is if you’re going to come up with fantasy scenarios, because that’s all these are, fantasy scenarios, future tripping, if you’re going to come up with what if something negative, it’s just as possible to come up with what if something positive. These are all things that you’re making up anyway. If you’re going to make something up, wouldn’t it be interesting if you made up something positive?
I think that is a common anxiety that people have, that guardedness where they don’t necessarily want to engage with the pregnancy because what if they have another loss. One of the things that I speak with folks about is being prepared for it: you can’t really do that. You can’t really prepare for it. It’s a little bit of a misconception that being guarded and not being all-in to the pregnancy is going to help you process a loss, but it generally doesn’t.
That’s the case for any kind of loss that we try to anticipate. If you’re not going to be successful in that guardedness being something that actually helps, because if you end up experiencing another loss, you still feel the pain of that loss, then why don’t we go the other direction? Why don’t we take the time to actually be in the moment, be in the pregnancy, not in the future? If we’re in week six, let’s stay in week six. Let’s not think about week 26. Let’s think about what’s going on right now and be in it.
Dr. Aimee: I often tell patients you’re pregnant today, let’s celebrate that, let’s say that rather than thinking about the next ultrasound. Very similar advice.
You’re known for offering patients individualized care. How do you tailor your approach to treating fertility-related anxiety and depression for each patient?
Dr. Anna Glezer: The integrative part of what I do means that I take tools from the conventional world, conventional psychiatry, and that might mean for some people prescribing medications, and then also all of the other tools at my disposal, so thinking about psychotherapy techniques, thinking about mindfulness. That’s essentially what we were just talking about, being present in the moment is a form of mindfulness. Using nutritional approaches, using lifestyle medicine, and really looking at the person in front of me because every single individual’s fertility journey is different.
No two are alike, even within the same person who is going through multiple steps. Looking at where they are, what are the different things that we can do to shore up that foundation, what are the different psychological interventions, what are the different biological interventions for this particular person in front of me that can help them through this journey?
Dr. Aimee: When you’re looking at that person right in front of you, how can you tell the difference between someone having normal stress versus someone needing medications and prescription support?
Dr. Anna Glezer: The main way that I do that is based on function. Asking the person, getting a sense of how they are living in their world and are they living in their world the optimal way that they want to. If there are some functional deficits, maybe they’re not engaging with their partner the way that they want to, maybe they’re not performing at work the way that they want to, however they want to define function, if they’re not functioning the way that they would like to, then we need to think about what are some ways that we can intervene. It doesn’t have to be prescription medications. There can be so many other tools. I don’t know anyone who doesn’t benefit from psychotherapy, for example, and it’s one of those things that’s pretty side-effect-free.
Dr. Aimee: You mentioned having a support system, family, friends, partners, but sometimes those people just don’t know how to help. What do they need to know in terms of how to support someone navigating fertility challenges or pregnancy loss?
Dr. Anna Glezer: One of the main recommendations that I would give to family members, friends, etcetera, is to not necessarily respond with platitudes. I think a lot of folks going through a challenging fertility journey hear platitudes like it will all work out, or it was meant to be, or whatever platitudes people can come up with. I would encourage instead really sitting with the person, with your loved one who is going through this, and holding that space that we were talking about for them, allowing them to feel whatever they feel, and it might feel uncomfortable for you as the one who is holding that space, but really holding that for them.
There’s nothing wrong if you feel at a loss to be really open about that. Like, “I don’t know exactly how to support you. How can I do that?” Really asking what you can do or what would be most helpful, and for the person who is going through it to feel like, “I can answer that question, I can tell you how to support me.” Then the loved one has to be open-minded enough to listen and actually follow that instruction.
Dr. Aimee: The platitudes don’t just come from family members and support people. Sometimes those platitudes come from nurses in the clinic, the doctors doing the ultrasound, and those things may not be very helpful. They can be triggering and cause patients to be upset. How can a patient communicate to their fertility team about maybe being a little more sensitive if they’re actually being told things that just aren’t appropriate?
Dr. Anna Glezer: One of the things that can be helpful is if you as the patient have a support person with you going through this experience. That doesn’t have to be a partner, it could be a friend, it could be a cousin, whoever. It can be really hard at the moment to advocate for yourself and it’s helpful if there is someone else who can advocate for you. That would be my first recommendation is to have someone help you advocate.
I wish there was more education and training of medical staff and clinicians of individuals who are going through this. I think part of it is in the appointments, perhaps before the ultrasound, before something might happen, to have a conversation with the clinician that you’re working with and make sure that it’s in the chart that this is someone who has been on a journey, that this is something that they’re anxious about, making sure that those conversations happen.
Unfortunately, even if you do all of those things, it doesn’t completely make it so that you’re going to have a completely smooth experience because you’re still going to run into some folks who maybe didn’t read the chart or don’t know how to have that kind of empathetic experience and response. Part of it is being able to have that unfortunate experience and being able to shift it and move forward, move into a place where you can get back into your journey.
Dr. Aimee: Having a fertility friend is really important. I don’t think people realize egg freezers, actually, their journeys can be quite emotional. I think my patients who are freezing their eggs actually cry more than my patients who are going through IVF because they’re in that moment, they’re thinking about everything they wanted to have accomplished at that point in their life, and it’s very emotional. I especially want my egg freezers to have a fertility friend and a support person with them. I imagine that if you opened up to your network, people will show up for you, people want to be there for you.
Dr. Anna Glezer: Yes, absolutely.
Dr. Aimee: People shouldn’t be afraid to ask for help, ask for someone to come with you to those appointments. They can bring paper and pen or their phone to write notes so that you know what your diagnosis is, what your doctor said the next steps are, you can absorb it, you can talk through it over coffee after your appointment.
Dr. Anna Glezer: Yes. It’s really hard to retain that kind of medical information when you’re in it, so having that support person serve as the recorder and the advocate is really important. Also, sharing with your support network. So many of the folks that I work with mention how once they shared, so many others were able to share.
Dr. Aimee: What words of encouragement or advice would you offer someone who is feeling overwhelmed right now by the emotional ups and downs of being a fertility patient or being pregnant?
Dr. Anna Glezer: I would emphasize the fact that there are a lot of really good support systems out there and a lot of helpful treatments so that you can have the kind of journey that you would like. You can feel your best, you can function at your optimal level. It really is about reaching out for help and getting that support from clinicians, from mental health clinicians, from family, from all of the folks around you because it absolutely is something where we can intervene and you can feel good.
Dr. Aimee: Can you share with me some anonymized patients stories where patients were struggling, they worked with you, and their journeys were a much better experience after working with you?
Dr. Anna Glezer: So many stories. There are so many patients that I can think of. Some folks where the journeys are six, seven, eight years long, and so many ups and downs. At the end of that journey, it doesn’t look at all like what the expectation may have been at the beginning. Once we begin to help them create that foundation, put together those support systems, maybe use medication, then they can feel much more resilient. I’ve had some folks where after several transfers with treatment, even if it doesn’t go according to plan, so to speak, they can feel resilient. It’s that resilience that grows that’s always very rewarding to see, someone begin to feel resilient and be able to pivot and be able to feel like they’re in control of their journey.
Dr. Aimee: And their emotions. For sure. Tell us, where can people find you if they want to learn more about your work and ultimately work with you as well?
Dr. Anna Glezer: My practice is Women’s Wellness Psychiatry. We are serving patients all over the state of California, so a lot of what we do is virtual. We use that integrative approach where we incorporate conventional tools as well as complementary tools and everything in between. Folks can go directly to AnnaGlezerMD.com, that’s the website for Women’s Wellness Psychiatry, sign up for a free phone call. I speak to every single patient who signs up, I help put together a plan, and I have a great team that I’ve assembled working with me, both psychiatrists and psychotherapists, to help folks who are on this journey feel well.
Dr. Aimee: Thank you, Anna, for all the work that you do. It’s incredibly important. I tell my patients they need to build their fertility team before they start their journey, and the team includes mental health providers and doctors just like you. Thank you.
Dr. Anna Glezer: Thank you.
Dr. Aimee: All the links we discussed today, including how to connect, will be in the show notes. Don’t forget to subscribe to The Egg Whisperer Show on YouTube and Spotify so you never miss an episode. Keep sparkling, keep believing, and keep moving forward one day at a time. Thank you for joining us.
