Expert Voices: Interview with Natalie Burger, M.D., Reproductive Endocrinologist

Editor Sharon had the opportunity to interview Natalie Burger, M.D. about her work with couples.
Natalie Burger, M.D.

Natalie Burger, M.D.

Sharon: What services do you provide to women?

Dr. Burger: I am a reproductive endocrinologist — most people know us as fertility specialists.  My primary practice is taking care of women and men who wish to become parents.  However, I also have specialized surgical and hormonal training to take care of patients with other kinds of reproductive health problems (e.g. endometriosis, premature ovarian failure, polycystic ovarian syndrome (PCOS)).

 

 

Sharon: Is there some bit of information that you find women tend not to know that you wish they had known prior to coming to see you?

Dr. Burger: Probably the most common misperception that we see is that we have overcome the challenge of ovarian aging.  Because there are more and more women in the news who appear to be having children in their 40s and even 50s, it may appear that we can overcome ‘tired ovaries’.  We can overcome many things (e.g. blocked fallopian tubes, low sperm count, etc.) but we cannot reverse aging of the ovaries.  Many of the older women in the media who seem to be achieving pregnancy are actually using donor eggs (eggs harvested from a young donor in place of their own.).  This certainly is a very private decision — and understandably one that many people may not want to reveal to the general public.  However, it is important to understand that ovarian function continues to decline with time, no matter how healthy or fit an individual is.

Sharon: Do you find yourself giving advice to women experiencing infertility to complement their diagnosis and treatment plan? What are some examples (e.g,. supportive words)?

Dr. Burger: Dealing with infertility can be incredibly challenging.  People often think first about the financial stresses, but even more important are the psychological ones.  Going through infertility (with or without treatment) can place huge emotional pressure on women and their relationships.  Men and women often approach the struggle of infertility differently, and we try to help them understand each others perspective.

After I discuss medical aspects of infertility, I try to also address some of the emotional aspects as well.  

First and foremost, it is important for my patients to understand that they are not alone.  

Fortunately, it is becoming more commonplace for people to talk more openly about their fertility struggles — but there are many, many people who are dealing with infertility who are not necessarily disclosing their challenges.

We are lucky to have many counselors in the area who work with a lot of our patients — and who understand some of the more specific issues our patients are dealing with.  This is especially helpful if someone is not yet ready to talk in a more public forum.  We also have an infertility support group that is run by a nurse at our clinic — it can be very cathartic to talk face-to-face with someone who understands the monthly highs and lows that an infertility patient faces.

Strengthening emotional health can give patients the stamina they need to get through the infertility journey successfully.

Sharon: Is there any advise that you routinely share with your patient’s partners?

Dr. Burger: Men and women commonly deal with infertility differently.  I think it’s important to recognize that even though your partner is not dealing with the situation the same way you are, it doesn’t mean that they don’t care.  They may just not understand your perspective.  If a couple is really struggling, I would highly recommend talking to a counselor or other third party.  It can prevent or at least mitigate some of the hurt and anger that can occur when it seems like your partner doesn’t understand.

Sharon: Approximately, how many of the women who come see you (%) have been older than age 35 and trying to conceive their first child?

Dr. Burger: As it is more common these days for women to defer childbearing to focus on career, it is very common for us to see women in their later 30s and 40s.  I would estimate that about 25% of the patients I see are women over the age of 35 who are trying for their first child.

Sharon: How often do you see women experiencing secondary infertility, even if they have conceived successfully after age 35?

Dr. Burger: Secondary infertility is very common.  As ovarian function continues to decline with time, what might have been easy a few years ago can turn into a real struggle with time.  In addition to the ovaries getting older, other medical issues can become more common with age (e.g., fibroids) and these things can also thwart fertility.

Sharon: What, if anything do you see as different about the older mothers? This could be about their health or attitudes toward health and pregnancy.

Dr. Burger: Older mothers have the benefit of life experience.  Mature women tend to be especially motivated and committed to the success of the process.  They are prepared to do what it takes to get to the end goal. 

 I would say that there is also a certain strength and resilience that I see in this group of (AMA) women.


Sharon: Thinking about the questions that they ask you in person (or by phone or e-mail), what if anything is unique or thoughtful about their questions? Is there any wisdom in advanced maternal age?

Dr. Burger: I think that many of the questions are similar no matter what age of patient I am working with.  Oftentimes more mature patients have already done their homework so to speak — and come especially prepared to discuss infertility evaluation and treatment.


Sharon: What else can you share about your observations and interactions with women of age 35 or better?

Dr. Burger: I would tell my current and future patients that their journey to motherhood may not happen in the way that they initially felt it would — however it will happen the way it was meant to be.  Be open to the different paths that can lead to you becoming a parent.

Natalie and Sons

Dr. Burger is married with 2 kids and a Board Certified Reproductive Endocrinologist with Texas Fertility Center in Austin.  

Expert Voices: Christina G. Hibbert, Psy.D. on Pregnancy & Postpartum Mood & Anxiety Disorders: Are Women of Advanced Maternal Age at higher risk?

Dr. Christina Hibbert

Dr. Christina Hibbert

As mentioned in my previous contributions to The Advanced Maternal Age Project, Perinatal Mood and Anxiety Disorders (PMADs) are caused by a combination of biological and psychological factors:

  • Hormone changes in pregnancy and postpartum, coupled with sleep deprivation and the physical and psychological demands of becoming a parent can lead to depression or anxiety.
  • Genetics is also key, including previous sensitivity to hormone changes, and a personal or family history of mental illness. In fact, the most documented risk factors for postpartum depression include: a history of depression, depression or anxiety in pregnancy, poor social support, and stressful life events during pregnancy or just after the baby is born.

Are women of advanced maternal age at an increased risk for developing a perinatal mood or anxiety disorder? The short answer is “No,” at least not because of their age.

PMAD’s affect women the same regardless of age, culture, or socioeconomic status. Some research, in fact, has found that women of advanced maternal age may have more protective factors than younger mothers, including psychological advantages like greater resilience and more stable interpersonal relationships#.

 

However, a history of infertility does increase the risk of a Perinatal Mood or Anxiety Disorder. Since women of advanced maternal age tend to have a greater incidence of infertility, this puts them at a higher risk.

It is however well-documented that women struggling with infertility and undergoing Assisted Reproductive Technologies like In Vitro Fertilization have rates of depression almost twice the norm. 

Considering the extreme shifts in hormones, the cycle of rising and falling hopes and expectations, and the experience of multiple pregnancy loss, physically and psychologically these women have been “put through the ringer” (for more on the psychological impact of these experiences, read “Women’s Emotions: The Emotional Earthquake” article). This means that, once they finally do conceive, many  are entering pregnancy with depression or anxiety, increasing their risk for PMADs.

Once the baby is safely delivered, women who have previously struggled with infertility may also feel tremendous pressure for everything to be “great,” to feel like the “perfect mother” with a “perfect love” for their baby.

These pressures can actually lead to increased levels of depression or anxiety, which can lead to increased guilt about that depression. “I’ve always dreamed of having this baby. Now I’m not even happy. What is wrong with me?” many women tell themselves, and shame themselves over feelings that are beyond their control.

The Benefits of Knowing You’re At Risk

But just because a mother is at risk doesn’t mean she needs to panic. In fact, knowing you are at risk for a Perinatal Mood or Anxiety Disorder can be a huge benefit: It can motivate you to do the following:

  1. Get prepared for the possibility of a PMAD (see Part 1 of this series), and
  2. To seek support and treatment early (see Part 2).

The most important thing you can remember is this: You are not alone. You are not to blame. With help, you will be well. As a 4-time postpartum survivor myself, trust me as I repeat: You will be well.

For information on PMAD Treatment, visit my site.

Dr. Christina Hibbert is a Clinical Psychologist, Founder of the AZ Postpartum Wellness Coalition and Producer of the DVD Postpartum Couples. A 4-time Postpartum Depression survivor, Christina had her most trying experience in 2007, when her sister and brother-in-law died, she and her husband inherited their two children, and she gave birth to their fourth baby, going from 3 to 6 kids practically overnight (an experience she shares in her forthcoming book, This Is How We Grow) A speaker, blogger, and singer-songwriter, Dr. Hibbert keeps her practice, her family, and her heart in Flagstaff, AZ. Visit Dr. Hibbert at www.drchristinahibbert.com or www.postpartumcouples.com.
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