“Being an OB with Infertility” – with Dr. Olivia Grubman

On this episode of Healthful Woman, Dr. Nathan Fox speaks with Dr. Olivia Grubman, an obstetrician/gynecologist in New York. She shares her story regarding infertility and the many steps she had to take to experience a successful pregnancy.

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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OBGYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness.

Dr. Fox: Olivia, Dr. Grubman, welcome.

Dr. Grubman: Thank you for having me.

Dr. Fox: Nice to have you on the podcast. This is exciting.

Dr. Grubman: I know.

Dr. Fox: Yeah, we just started working together recently, and now we’re podcasting together.

Dr. Grubman: It’s exciting to be here.

Dr. Fox: This is great. I think…who was it, was it Rebarber that suggested it? Or did you just volunteer? What happened? I don’t even remember.

Dr. Grubman: I think he suggested. He asked me what I wanted to talk about, but didn’t really give me an option of being on it. But I suggested the topic.

Dr. Fox: Yeah. So it’s nice to have you, to have you in studio, and to talk about this. And we decided to pivot a little bit for two doctors, we’re not going to talk about the medical side of something, but you’re going to be telling your own story.

Dr. Grubman: Yeah.

Dr. Fox: So that’s pretty cool. So just to set the stage so our listeners know who you are, give us a little bit of background, like who you are, where you’re from, you know, open-ended question, any way you want to go with that.

Dr. Grubman: It’s like an interview question for docs.

Dr. Fox: It is an interview question. Tell me your three weaknesses…

Dr. Grubman: So I grew up in New York City, I went to college at Union College in upstate New York. I didn’t know I wanted to be in medical school. In college I kind of was just exploring, taking random classes, figuring out what I wanted to do. I decided to go to medical school my last year of college, so I had to do a post-bac. So I moved back to the city, back home with my parents, what every parent loves.

Dr. Fox: On the parent side it’s great, you know?

Dr. Grubman: Yeah, it was great for me to save money. I did some classes, I did some volunteer work at Sloan Kettering, and then I moved to Miami for medical school. I did a joint MD/MPH program, which is a unique program. There’s not many in the country with the joint program.

Dr. Fox: That’s MD, and MPH is a master’s in public health.

Dr. Grubman: Public health, yes.

Dr. Fox: Thinking you would do research one day? Or just trying to save the world, or just whatever?

Dr. Grubman: Trying to save the world.

Dr. Fox: All right, good.

Dr. Grubman: Just to broaden how I think, and get to a different level. That’s just… You know, thinking about one person, population-based…

Dr. Fox: All right. How did that go?

Dr. Grubman: It was great. So I had the best time in medical school, I made amazing friends, and I found my husband.

Dr. Fox: You found him, just wandering around the state of Florida?

Dr. Grubman: Yes. We lived in the same building in medical school.

Dr. Fox: Right. Right. He’s also a…

Dr. Grubman: He’s also a doctor, yeah. It was really the only time I’ve ever lived outside of New York state, so…

Dr. Fox: Okay. Him, too?

Dr. Grubman: He’s from Florida, actually.

Dr. Fox: Oh, okay. Fantastic.

Dr. Grubman: So yes, but we had to apply to big cities, essentially, to try and match in the same city.

Dr. Fox: Right. Right.

Dr. Grubman: So he’s a urologist. Urology is… So if you’re in a couple, part of a couple that both are in medicine, you can try and couples match, but urology is a separate match from OB-GYN. So it was a little tense, applying to residency, but luckily we both ended up in New York City.

Dr. Fox: Right. Meaning, just so I understand, when you did the match, you had to each match separately, and hope that you ended up in the same city?

Dr. Grubman: So urology is on a different timeline than OB, so it’s not even an option to try and pair together.

Dr. Fox: Ah, got it. Yeah. How did you decide on OB? I never asked you this question.

Dr. Grubman: That’s a very good question.

Dr. Fox: Thank you.

Dr. Grubman: I actually thought I wanted to do…

Dr. Fox: This is a serious podcast. We’re not throwing soft balls at you. I didn’t give you the questions in advance, you’re the hot seat.

Dr. Grubman: Yeah. I thought I wanted to do pediatrics, going into medical school. And then when I was doing my OB rotation, I realized I was really excited to go in for a delivery in the middle of the night, and actually, my husband’s like, I think you’re really into this, like, being excited to like get woken up in the middle of the night to go in for a delivery? I was like, yeah, you’re right.

Dr. Fox: Did that conclude with, what the hell is wrong with you?

Dr. Grubman: Yeah, totally.

Dr. Fox: Yeah. He’s like, I’m picking a career so I don’t have to go in the middle of the night… Yeah.

Dr. Grubman: Exactly. And I never will sleep again.

Dr. Fox: Yeah.

Dr. Grubman: So I just like the action, being on labor and delivery, like, having the long-term relationships with patients, and really, you’re taking care of two patients.

Dr. Fox: Right.

Dr. Grubman: So we came to New York City, we got married right before starting residency. I was like, we have to get married now, two weeks after graduation. We had two weeks after graduation before starting residency, and I was like, if we don’t get married now, who knows when we’ll have off at the same time ever again?

Dr. Fox: Right. And urology is how long of a residency?

Dr. Grubman: A five-year residency.

Dr. Fox: So it’s one year more than yours. Okay.

Dr. Grubman: It’s one year more. And then we both are doing fellowship now, so I’m in my third year MFM fellowship, and…

Dr. Fox: Yeah. Olivia is a terrific fellow by the way.

Dr. Grubman: Thank you.

Dr. Fox: In case all our listeners are curious.

Dr. Grubman: I am nearing the end of training finally, and my husband is also in his last year of fellowship. So he’s doing a two-year fellowship for urologic oncology.

Dr. Fox: Ah, so that’s how you’re… You’re now aligned.

Dr. Grubman: So we call ourselves the Pelvic Pair. Yeah.

Dr. Fox: That’d be a great superhero duo, the Pelvic Pair.

Dr. Grubman: Yeah.

Dr. Fox: All right, good job. Good job by you guys.

Dr. Grubman: Yes.

Dr. Fox: You know, a lot of people advise doctors not to date and marry other doctors, and others say it’s great. I don’t know, what was…you know, you’re still happily married…

Dr. Grubman: Yeah, five years.

Dr. Fox: But what was your experience like, both going through training together? That’s so hard.

Dr. Grubman: I think pros and cons. It’s definitely tense, because you’re both exhausted, and you’re just tired all the time. Especially now that we have a son and we have a dog, it’s a lot of responsibility.

Dr. Fox: Right.

Dr. Grubman: Thankfully, my parents are around, and help us tremendously with babysitting.

Dr. Fox: Right. Right.

Dr. Grubman: But it’s hard, but also the other person knows what you’re going through, so, you know, he’s not getting mad at me that my phone’s ringing in the middle of the night, or that I’m getting stuck in the OR, because it could be him the next night.

Dr. Fox: Right, right. No, I think that’s fair. And it’s pretty crazy to think that you’re almost done with your training.

Dr. Grubman: I can’t believe it.

Dr. Fox: Yeah.

Dr. Grubman: I feel so old.

Dr. Fox: Yeah, no. Yeah, listen, I remember when I finished my training, we had sort of a graduation party, and if…I think I’m correct, it was grade 23 or something like that. It’s just crazy.

Dr. Grubman: Yeah. I mean, not even including college, it’s four years of medical school, four years of residency, then three years of fellowship.

Dr. Fox: It’s a long time.

Dr. Grubman: It’s a long time.

Dr. Fox: Well, congratulations in advance.

Dr. Grubman: Thank you.

Dr. Fox: I presume that on the course you’re headed, we’ll graduate you.

Dr. Grubman: Knock on wood.

Dr. Fox: Yeah, I don’t know. I can’t guarantee it. I guess it’s up to Lois and Andre, you know? I don’t make that final decision. But presumably, yes. You seem to be doing a good job.

Dr. Grubman: Good, good.

Dr. Fox: So tell us about your story. Part of it is a fertility story, right?

Dr. Grubman: Yeah.

Dr. Fox: So when did you guys think you wanted to start having kids, and how did that go?

Dr. Grubman: Yeah, so infertility has become a huge part of my identity. I think about it every day. And I’m very open about it, because I feel like if I’m an OB, and if I can’t talk about it as an OB, then I don’t understand how other women will be able to.

Dr. Fox: Right.

Dr. Grubman: So I just want to help empower people to be open, and to talk about it. And I’m an open book, and I always encourage people to ask me questions. So it was probably about one or two years into marriage that, you know, I’m delivering babies every day, I was like, let’s get the show on the road, I’m ready to start growing our family, besides having our dog.

Dr. Fox: Right. You had the dog already.

Dr. Grubman: We had the dog. We got the dog in medical school our first year, which was a dangerous decision. We’d only been dating six months. I said if anything happens, I’m getting the dog.

Dr. Fox: All right.

Dr. Grubman: So my husband was a little more hesitant. None of his friends had kids yet, and we were residents, so how were we going to afford, and how were we going to have time to take care of a kid?

Dr. Fox: Right.

Dr. Grubman: But we’re happy we tried that, and got started, because it’s been a long road. So we tried for six months, which for a young, healthy person, you really don’t have to get a workup after six months, but I’m impatient, I’m an OB, so I was like, we’re going to go to a doctor and see, like, what’s up. So we started doing all the tests, did a semen analysis, which annoyingly was perfect.

Dr. Fox: Mm-hmm. You’re like, I so wish this was your fault.

Dr. Grubman: Yeah, right? We did a saline sonogram, which looked normal, HSG, like, my tubes were fine, no reason that we could pinpoint for infertility. So we did, like, ovulation induction, and a couple of rounds of IUI, and no luck. When I started doing…I did letrozole with the ovulation induction, and they were like, oh, your endometrial lining looks a little thin, have you had any surgeries? No. I had an IUD, but I mean, we all have…like, it’s very common. That’s not going to cause a thin lining. Or it shouldn’t. So there was really no reason for me to have a thin lining. So I had a hysteroscopy, it was fine, there was nothing there.

So we said, okay, let’s…you know, I talked with my doctor about moving on to IVF. Which initially, I think it’s a hard pill to swallow just because it’s a big jump, and a lot is involved in it. But you know, we said we’d love more than one kid eventually, so, you know, if we can make some embryos, and just set ourselves up for success, hopefully in the future, we’ll do it.

Dr. Fox: Right.

Dr. Grubman: So we did an egg retrieval, and thankfully the doctor said my ovaries work a lot better than my uterus, so we got a lot of genetically-tested normal embryos. And I did two transfers with those embryos the beginning of my third year of residency, and they didn’t work. And infertility is very, very time consuming.

Dr. Fox: Yeah.

Dr. Grubman: And I was extremely lucky that my residency program, all the attendings, all my co-residents were very supportive, and my doctor’s like, we know we have to get you in first thing in the morning. I would go, like, 6:30, before sign out in the morning on labor and delivery, and before my OR cases started, and just try and get it out of the way in the morning. Or I’d go post-call.

Dr. Fox: Right. I was going to ask you about that, sort of, were you… I mean, you said you’re an open book. Were you an open book at the time? Did, like, all your co-residents know, and everyone know, like, hey, Olivia’s trying to get pregnant, and she’s doing IVF…? I mean, was everyone sort of in the know?

Dr. Grubman: Yeah. I think I’ve always been pretty open about it. For me, it just makes it easier, for me to talk about it. And it’s really impossible to hide, because why would you be going to a doctor at 6:30 in the morning, and having to miss, you know, certain aspects of your day?

Dr. Fox: Yeah, and I was going to ask about that, and also just logistically…it’s crazy.

Dr. Grubman: Yeah, I would be like, you know, bringing my medication when I was doing the stimulation for IVF, like, bring my medicine if I’m working a 24-hour shift, bring my medicine, keep it in the fridge. You have to do it at certain times, I’d be like, okay, gotta run, do my injection in the bathroom, be right back.

Dr. Fox: Right. Right. Without naming names, was there anyone else in your program sort of similarly doing this so that it was, I don’t know, like a known thing? Like, you know, we have… You know, listen, this happens. People who are residents are usually at the age that they’re trying to have kids, or frequently at that age, and so this definitely happens. Were there other people open about it at that time?

Dr. Grubman: Yeah, so there… Well, she’s still one of my best friends, someone who was a year ahead of me in residency was also doing IVF at the same time. Sometimes we even went for monitoring appointments together, which was so fun.

Dr. Fox: Wow.

Dr. Grubman: They were like, do you want different rooms, we were like, it’s okay, we’re OBs, like…and we’re best friends. We’re okay in the same room, thank you.

Dr. Fox: Yeah.

Dr. Grubman: So it would just be back-to-back, you’re ultrasound, you’re ultrasound next… So that was helpful, to have her. She actually got pregnant with her daughter on her first try, and our kids are still best friends, so that’s nice. Yes.

Dr. Fox: Oh, that’s sweet. Okay.

Dr. Grubman: So two failed transfers later, my doctor said, okay, time for you to use a surrogate. And I was like, okay, like, that seemed to escalate fast.

Dr. Fox: Right.

Dr. Grubman: And while I didn’t want to put off finding a surrogate, I also didn’t feel that I was ready to stop trying. So I made an appointment at another clinic, at Cornell, which, you know, throughout this whole process, I’d been talking to friends, and they were like, oh, I’ll put you in touch with my friends who’ve done IVF, or had infertility treatment, and I’d heard about Dr. Reichman at Cornell. So I made an appointment with him probably, like, six weeks out because it was so hard to get in with him. I remember my mom came with me, because of course my husband, Andrew, couldn’t get off of residency. You know, it’s hard for…it’s a lot. I basically went to all my appointments alone, not because he didn’t want to be there, but because as a male in residency, it’s really hard for him to get out.

Dr. Fox: Yeah.

Dr. Grubman: So my mom came with me.

Dr. Fox: Did his residency not know that they were going through this, or just like, you know, too bad?

Dr. Grubman: He’s not as open, but I think it’s also like, too bad. What are you going to do, sit and watch your wife get an ultrasound? Yeah.

Dr. Fox: Just not in the culture? Yeah. Yeah, it’s a little Neanderthal-ish.

Dr. Grubman: Yeah.

Dr. Fox: But that’s how medicine rolls. Yeah.

Dr. Grubman: So yeah, so my mom came with me. I was impressed with Dr. Reichman. He knew my whole story before I walked in, he said, I can’t guarantee you that I can get you pregnant, but we can try.

Dr. Fox: Right.

Dr. Grubman: And he put me in touch with two other people who had a thin lining, and who had success stories. Meanwhile, my husband and I started trying to look into the surrogacy route. We spoke to a few people who had children via surrogacy, or they say…I learned gestational carrier.

Dr. Fox: Yeah.

Dr. Grubman: So we interviewed a bunch of agencies, or met with a bunch of agencies to learn about them, you know, we learned about smaller agencies that might guarantee that you’ll match sooner, and might initially seem to cost less, but to us, a bigger organization seemed like a safer route, but there was about a year wait, and it’s a huge financial burden.

Dr. Fox: Yeah.

Dr. Grubman: So that heavily weighs on that. It’s not a decision we’d make lightly. But we said, okay, we will proceed with this. We’ll put our name down, and if we get pregnant, then we get…like, we had to put down a deposit, we get half of that deposit back.

Dr. Fox: Okay.

Dr. Grubman: So we went with Circle. It’s one of the big agencies. Then with Dr. Reichman, I said, you know what? I want to just try something different. I had done two frozen embryo transfers, I said let’s try a fresh embryo transfer, just because I want to try something different. And I was in my young 30s, so shouldn’t be a reason to have anything genetically abnormal.

Dr. Fox: Right.

Dr. Grubman: And that was in February of 2020. And…

Dr. Fox: Right. For those who may not recall, February 2020 is one month before March of 2020, which was…

Dr. Grubman: Yes, when the world was about to stop.

Dr. Fox: Yeah, yeah. Just setting the stage for those of our listeners who forgot that time. Okay…

Dr. Grubman: Yeah. Yeah, that was definitely an intense time. So I got pregnant with my fresh embryo transfer. And I remember I took a pregnancy test. I was on a 24-hour shift, and I just, like, felt a little off. I think my blood test was the next day, on Saturday, and I was on a Friday 24-hour shift, and I just remember, it was like, I just feel weird. And the day before I had taken a pregnancy test from the hospital, like one of the cheap ones, and it was negative, and I remember texting my husband, like, why do I even do this anymore? Like, what’s the point? I just keep getting upset. And then I had, like, one of the First Response, like, you know, a more expensive one from the drugstore, and it was positive, and I was like… I remember I was in, like, the 9th floor bathroom in the hospital, like, I know exactly where I was, and I texted my husband a picture, and he’s like, what is that? Like, what…what? And we’re like, in shock. He was in the operating room…

Dr. Fox: Did you say, like, dude, it’s pee. You’re a urologist…

Dr. Grubman: Yeah, right? Exactly. You’re a urologist…. And I remember the friend who always came with me to…you know, who was also doing IVF, she was in the operating room downstairs, and I remember exactly which OR she was in, and I, like, ran down to show her the positive pregnancy test, and we were just, like, hugging, and so excited outside the OR.

Dr. Fox: Right. Because that’s the first time you ever even had a positive test.

Dr. Grubman: Ever had a positive pregnancy test.

Dr. Fox: Were you, before you started with this fresh cycle, would you say you were optimistic, pessimistic, or just numb?

Dr. Grubman: I think a mixture. I think looking back, like, I’ve gone through so much since then that I probably felt pessimistic. But I think I feel a lot more pessimistic now than I did then, but then it seemed like, ugh, this is my third transfer, like, what are the odds this is going to work?

Dr. Fox: Right.

Dr. Grubman: But I was optimistic switching doctors, and he seemed optimistic, although he, you know, wasn’t going to promise anything, and I had heard stories of success with him.

Dr. Fox: Right, right. And how frustrating was it that it was your field?

Dr. Grubman: It is beyond frustrating.

Dr. Fox: It’s like, this is what I do… And number one, just from an intellectual standpoint, that you know that there’s no good explanation for this. And number two, and you can answer this separately, obviously, number two, seeing all these other patients of yours get pregnant, some of them who don’t want to be pregnant are getting pregnant left and right, and you’re just like… How painful is that? It’s extremely painful. And I think that’s part of why I continuously tried to get pregnant myself, even though I know surrogacy is, in a way, easier for me.

But it’s extremely frustrating. It’s like I have barely any medical problems, we see patients who are so much sicker than me, with like, a list of medical problems, and decades, almost decades older than me, and can get pregnant. I’m like, how is it possible that you can get pregnant, and I can’t get pregnant? So it is extremely frustrating, and it’s just in my face every single day at work.

Dr. Fox: Yeah. How do you keep that from your patients, that like, that feeling…you know what I’m saying?

Dr. Grubman: Yeah.

Dr. Fox: The reaction, and the feeling. I mean, you obviously do, you know? But how do you put that wall up?

Dr. Grubman: Yeah, exactly. You just… I don’t really have an option. I just have to put the wall up.

Dr. Fox: Wow.

Dr. Grubman: And just function, and go about my every day. But it is hard when patients are complaining, like, ugh, I don’t…like, I have this ache and this pain, or the baby’s moving too much, I’m like, that’s great. Like, you should just be so thankful, and really know you’re so lucky to be here in this position.

Dr. Fox: Yeah. Yeah, wow. All right, so you get the positive pregnancy test, but as everyone knows, that doesn’t mean it’s going to happen.

Dr. Grubman: It doesn’t everything…right.

Dr. Fox: Right.

Dr. Grubman: And then the problem was COVID hit.

Dr. Fox: Right.

Dr. Grubman: So then I’m like, okay, well… My husband was on a rotation at Elmhurst at the time, and that was like, ground zero for COVID.

Dr. Fox: Yeah.

Dr. Grubman: That’s where on the news you saw, like, the trucks outside, like, dead bodies, and it was just like, I cannot be living with my husband because I cannot get COVID right now. Because we didn’t know what was going to happen if you get COVID in pregnancy.

Dr. Fox: Right.

Dr. Grubman: And we had worked so hard for this pregnancy. So I moved in with my parents. I packed…

Dr. Fox: Right. And you’re a third-year resident now?

Dr. Grubman: I was a third year resident.

Dr. Fox: Yeah, and that’s like, that’s a real busy year. Yeah.

Dr. Grubman: Yeah. I was very, very fortunate that the program said I could do telehealth visits from home for the first trimester. So that was amazing, from a residency perspective. I moved in with my parents. I packed a little bag, thinking I would go there for a week, COVID would pass…and it ended up being, like, three months that I was living with my parents. My husband and I would meet sometimes like in the park, and like, wear our masks, and like, stay far apart…

Dr. Fox: Oh, my God.

Dr. Grubman: And I remember, like, going to the doctor’s office for my ultrasounds, and obviously going alone because my husband couldn’t come.

Dr. Fox: Right. Even if he could…yeah.

Dr. Grubman: Because he was a resident, and because of COVID.

Dr. Fox: Right. Even if he could come, he couldn’t come. Right.

Dr. Grubman: Right. And I remember, like, at one point I almost touched my eye, and Dr. Reichman was like, don’t touch your eye. Like, you know, because we were like, how did COVID spread…? And then like, trying to get N95 masks, and it was just a really scary time.

But life went on, and we had a really amazing pregnancy, uncomplicated, thank God. And I was going to have my 39 week induction, and my water broke at 38 weeks, and I have a Halloween baby. So my fourth year of residency, Ryan was born, and I had, you know, my very short maternity leave, and back to residency I went.

Dr. Fox: So when… As the pregnancy is progressing, right, you know, you’re out of the first trimester, like, at what point did you sort of make that mental shift to like, I can’t believe this is happening, to like, this is happening, right? I’m having a baby…

Dr. Grubman: I really don’t think until he was born. I mean, once you can see your belly moving….

Dr. Fox: Yeah, was that a fertility thing, or a COVID thing?

Dr. Grubman: I think it’s an OB thing, that we see the worst happen, and like, you know…you don’t feel safe until the baby’s out, and in your arms.

Dr. Fox: Okay. So what was that birth like?

Dr. Grubman: It was actually great. I mean, I was annoyed that he was going to be born on Halloween initially, but now I’ve embraced that.

Dr. Fox: Right. Right. It was already the time where you could have someone with you and everything, right? Yeah.

Dr. Grubman: Yes, thankfully I could, but I mean, my husband also had him outside in the IED, which was nice.

Dr. Fox: Ah, fair. Oh, so you delivered at Sinai West?

Dr. Grubman: Yeah, at Mount Sinai West. But he worked in the system, so I mean, we could have…you know.

Dr. Fox: Right, right, right.

Dr. Grubman: But it was hard. I mean, my mom also works at Mount Sinai West, so she was able to be there, which, you know, I think you were probably only allowed one partner, but she came in, and then…

Dr. Fox: Right. Right.

Dr. Grubman: It was… I mean, I think it was hard that, you know, other family members couldn’t come in, but there were so many people in and out of our room, like saying hi, and Andrew’s like, this is just exhausting. Like…

Dr. Fox: Yeah. Yeah. You had a good working epidural?

Dr. Grubman: Oh, it was amazing. Epidural was the best part.

Dr. Fox: Now, I’m curious about your decision to deliver at the hospital where you were resident. And we’ve had other OBs on talk about this, and there’s obviously pluses and minuses.

Dr. Grubman: Yeah.

Dr. Fox: How did you ultimately choose to say, you know what, again, everyone’s going to see my business…

Dr. Grubman: Exactly. Well, I think going through infertility, you’re getting ultrasounds, like, every other day for weeks at a time, and you’re like, everyone’s seeing my business anyway. And as an OB, you’re like, you know…like, you see like so much that it’s like, you don’t remember, like, what I look like versus someone else. Like, it’s just, I don’t know, part of business.

Dr. Fox: Right.

Dr. Grubman: And my program, my residency program director, Dr. Brustman, who’s now the fellowship director, like, had been through it all with me, and she’s like a second mom to me, so there was no doubt in my mind that she was going to deliver me.

Dr. Fox: Wow. Okay.

Dr. Grubman: Yeah.

Dr. Fox: Well, listen, I think that’s terrific. You know, some people want, like, anonymity when they’re delivering, and they don’t want people to know who they are, or to know, like, if something happens. Or let’s say you become a…you know, start screaming out crazy things during labor, you know, they don’t want to work with you the next day. And others are like, no, like, I want the nurses that I know, and the doctors that I know, and the anesthesiologists that I know, and I want to feel familiar, and get some special treatment even, potentially. So…yeah.

Dr. Grubman: I mean, and all my co-residents, like, were on the journey with me, so like, you know, they were all so excited.

Dr. Fox: That’s great.

Dr. Grubman: I would have loved any of them to be part of it. Yeah.

Dr. Fox: That’s great. So when did you ultimately go back to work?

Dr. Grubman: It was Christmas Eve I went back.

Dr. Fox: Yeah. Okay, so that’s…yeah.

Dr. Grubman: It was a few weeks. I mean, almost eight weeks, I think.

Dr. Fox: Okay. That’s, you know, that’s better than some, I would say.

Dr. Grubman: Better than some. I mean, my husband had maybe a week off, so…

Dr. Fox: Yeah, yeah, I…yeah. I’ve been there. Okay, so he’s born, fertility cured, right?

Dr. Grubman: Yes.

Dr. Fox: All right, done.

Dr. Grubman: Done.

Dr. Fox: So tell me about moving forward from there.

Dr. Grubman: So of course, I’m like, I’m never going to use birth control again.

Dr. Fox: Right.

Dr. Grubman: That’s ridiculous. I hated breastfeeding, so I breastfed for about a month. This is, like, something I’ll…I don’t know. I did not have a good experience breastfeeding, which is another story. But my husband was like, maybe your body just doesn’t respond to hormones, and that’s why you can’t breastfeed, and that’s why you’re infertile, because I never produced enough, and I was like, okay, let’s calm down a little, would you? Anyway, so getting regular periods for a year, not getting pregnant, not using birth control… Okay, so he turns a year, and I’m like, okay, let’s just go back, because we don’t know how long it’s going to take. So we went back to Dr. Reichman, okay, did an ultrasound, did blood work, everything looks fine. He said come back with your next period, and we’ll do a saline sonogram to make sure your uterus looks good before we do another transfer.

Dr. Fox: Right, because you had embryos.

Dr. Grubman: We had a lot of embryos, thankfully.

Dr. Fox: Yeah.

Dr. Grubman: So then we had embryos from our first batch, that was before our first ever transfer, and then from Ryan’s batch, I call it, the February 2020 batch. So we had a bunch of frozen embryos, thankfully, genetically-tested normal. So I get my period, and I call them and I said, okay, I’m ready to do my saline sonogram, and I go there and they make you do a urine pregnancy test when you get there. So I’m like, standing there naked, looking at the urine pregnancy test, I’m like, that’s positive. I’m like, how am I an OB-GYN and I didn’t know I was pregnant. Like, this is so embarrassing. And then, like, I’m standing there naked, and he knocks, and he’s like, oh, do you need more time? I’m like, Dr. Reichman, look… And he’s like, what? And the nurse…I know all the nurses very well at this point, and they’re like, oh, my God, like, you’re pregnant.

Dr. Fox: Right. He’s like, wait, how am I going to bill you for all this?

Dr. Grubman: Yeah. Yeah…awkward, awkward.

Dr. Fox: No, I’m just kidding. That’s a joke.

Dr. Grubman: And I sent Andrew a picture, and he’s like, is that a COVID test? Do you have COVID? And I’m like, do you remember where I was this morning? I’m at Dr. Reichman’s office… And I’m like, okay, should we do an ultrasound, he’s like, yeah, but I can tell there’s going to be something there. Like, that’s as strong positive. So we look, and there’s a yolk sac, and I’m all excited, and…

Dr. Fox: Oh, you’re like, legitimately pregnant and didn’t know about it. Yeah.

Dr. Grubman: Yeah, I was like, five weeks, I guess. There wasn’t a heartbeat or anything, but I was pregnant.

Dr. Fox: Right.

Dr. Grubman: So I remember I FaceTimed Dr. Brustman when I was leaving, like with the picture, and she’s like, is that you, and I’m like, yeah. Like, that’s in my uterus. And I remember we called our parents, and we were like, we had an interesting day. Like, Olivia went for a saline sonogram, and she’s pregnant.

So then we’re nervous, but we’re like, oh, this is so exciting, like, we spontaneously got pregnant. And everything’s looking great, and I’m doing an ultrasound every week because I’m anxious, and I’m around ultrasounds all the time at this point, because I am a first year fellow.

Dr. Fox: Right.

Dr. Grubman: And we see a heartbeat, and it’s growing, and everything’s exciting, and then I remember very vividly, it was a Thursday afternoon, I was in diabetes clinic with Dr. Brustman, I was like, let’s just check, you know, I want my weekly ultrasound. I want to make sure, like, everything’s looking good. And we’re in the private office, and she’s like, looking abdominally, because at that point you had been able to see it abdominally, and like, we don’t see it, and she’s like, hmm, this is weird… So we do a transvaginal ultrasound, and we still don’t see the heartbeat, and we’re like, starting to get really nervous. So we go over to the ultrasound unit where there’s better ultrasounds, and we have one of the techs meet us. And I remember Andrew was there that day, and I called him, and I was like, there’s no heartbeat, you have to come meet me. And the ultrasound tech confirmed that there was no heartbeat.

Dr. Fox: How far along were you?

Dr. Grubman: About nine weeks.

Dr. Fox: Ugh.

Dr. Grubman: So… But we’re like, you know…you know, I was like, okay, I need this over now. Like, I just want it out. I want to move on.

Dr. Fox: Right.

Dr. Grubman: This was a pregnancy that, like, we never thought would happen because we never thought we would spontaneously get pregnant, and I was feeling, like, horrible and nauseous and tired, and I was like, I just want to feel better. Like, get it out. And I called, I think I emailed him, like, Dr. Reichman in a panic, being like, we’ve got to…like, this is what happened. He’s like, are you sure? Did you scan yourself? Was this real? And I was like, yes, Dr. Reichman, someone legitimate scanned me. I wasn’t scanning myself. And he’s like, okay. Well, you can’t…I don’t want you to do a D&C because I’m worried… He’s always very worried that I’m going to get Asherman’s, or like, scar tissue because of my thin lining.

Dr. Fox: Right. Yeah.

Dr. Grubman: So he’s like, you need to do a medical EB. I’m like, okay, that’s annoying, but fine. And he’s like, you need to collect the products so we can send it for genetic testing. I’m like, okay, now you’re asking a lot.

Dr. Fox: Right.

Dr. Grubman: So I like, get the little pan that goes in the toilet from the hospital, I bring it home, and I get my medication, and Friday morning we dropped Ryan off with my…or Saturday morning we dropped Ryan off with my parents, and I’m like, okay, I’m going to do this. So they gave me half an Ativan, which is like, the best thing ever. I fell asleep. I took my medication, and I wake up, like, three hours later, it was like a great nap, and I called Dr. Brustman, I was like, nothing’s happening. Like, I feel fine. And then she’s like, are you sure, and then I stand up, and like, it just, like, pours out.

Dr. Fox: Yeah.

Dr. Grubman: And then my friend, who also…the one who had been with me, like, the whole path of our…like, through infertility, happened to live in my building at the time. So my husband’s like, hiding in our apartment, and my friends and I are, like, going through my products of conception in our bathroom, like, trying to make sure we, like, got it. And we did. And then I kept it in my fridge until Monday, which my husband was like…

Dr. Fox: Yeah.

Dr. Grubman: Just like, the whole thing was a very weird situation. But I’m very thankful I did it because it was genetically abnormal, so that made me feel better, that there was a reason for it.

Dr. Fox: Yeah.

Dr. Grubman: Then I go back for my saline sonogram, and my beta HCG isn’t going down. Something, he realized… He did an ultrasound maybe a week after, and he’s like, you know, just to make sure that it was all out, and it wasn’t. So I’m like, oh, of course, anything that can go wrong for me is going to go wrong, so I have retained products of conception. So he doesn’t want to do a blind D&C because again, he’s worried about Asherman, so he’s like, we have to remove this hysteroscopically. And I’m like, okay, great, whatever. And then he wants the… It was like, very vascular. We had never really seen anything like it.

So he’s watching the beta HCG downtrend. Every week I’m getting blood work, I’m alternating between his office and our office at the hospital, and it’s going down. And then at one point, I just start, like, hemorrhaging. Like, I’m on L&D, doing…I don’t remember if it was a 12-hour shift, or 24, whatever, during the day, and I’m doing a C-section, and I like, feel something rushing down my leg. And I’m like, wait, this isn’t the patient’s blood. Like, this is my blood, and I’m like, oh, my God, like, I’m hemorrhaging from these routine POCs now. Like, we’ve got to get this out.

So I was like, okay, I’ll deliver the baby, and then I just remember, like, looking up and I was like, I need someone to scrub me out. Like, I need to go to the bathroom… And it was Saturday, it was the weekend, and I called the resident, and I was like, I need you to bring me, like, the underwear from…the patient’s underwear, a patient pad, and a new pair of scrubs. And I finished my shift, and I was emailing him, and he was like, okay, we’ll move…we’ll get the surgery going, so we had it, like, later that week, the hysteroscopy. And then I got to walk around with a Foley balloon for 10 days to try and prevent…

Dr. Fox: In the uterus, yeah.

Dr. Grubman: In my uterus, to try and prevent Asherman’s. Which I was really worried about it, and I thought it would be extremely uncomfortable, but it wasn’t at all.

Okay, so then that’s over. So that was, I guess, June of my first year of fellowship. So I’m finishing up my first year of fellowship, starting my second year, and I’m like, all right, I’m ready to go, I want to, like, get back on it.

Dr. Fox: This was like, a year and a half ago, give or take.

Dr. Grubman: Yeah.

Dr. Fox: Okay.

Dr. Grubman: So like, I’m ready to get back on, and try again. Because I want to use my genetically-tested embryos now.

Dr. Fox: Right.

Dr. Grubman: So then we do a saline sonogram, everything looks good, and we keep doing…we do the first embryo transfer. And I remember I was like, this is going to work. Maybe my first batch of embryos was, like, botched, and I just needed these, like, Cornell embryos, and these are great embryos, and Dr. Reichman knows what to do, and this is going to work, because Ryan worked, and this should work.

Dr. Fox: Right.

Dr. Grubman: And I was, like, very optimistic, I remember, at that point, and it didn’t work. And I’m like, okay, well, it took me three times last time, like, let’s keep going. So we keep trying different protocols, like natural cycle, medicated cycle, like, this medication, this medication, different medications, and nothing’s working. So then I think it’s about embryo transfer number seven, where he’s like, I think you’re…like, we need to sit down and, like, regroup. Like, this is getting a little crazy. Like, we really should go back to surrogacy again. So I’m like, okay, they still have half of my down payment, I’m not opposed to it, we can get back on the surrogacy list, but I’m not done trying.

Dr. Fox: Right.

Dr. Grubman: And at that point, I think we agreed, and he said you could match with a gestational carrier tomorrow, and it was $15, like, it’s a no-brainer. Because it’s a much easier decision.

Dr. Fox: Right. Sure. Right.

Dr. Grubman: I was like, I 100% agree with that, you know, I’m nauseous, I’m tired during pregnancy, like, it’s not like I have this burning desire to carry my own child. It’s just the financial aspect of it is huge, and I think someone…like, trusting someone else, trusting another OB-GYN that I don’t know is going to be extremely hard for me because my gestational carrier…

Dr. Fox: Yeah. Oh, so you’re saying trusting the doctor more than trusting the carrier?

Dr. Grubman: I trust the… Yeah, I feel like the carriers are so well screened, then, you know, I have to match with them, and we have to get along… But like, not knowing who their doctor is, and they could be anywhere in the United States, and like, I know nothing about them, like, I can’t say, hey, Dr. Fox, do you know this person? Because they could be, like, in the middle of, like…in Texas. Like, you know, we might not know them.

Dr. Fox: Anywhere. Right.

Dr. Grubman: They probably won’t be seeing an MFN. So that I knew was going to be a big hurdle for me when we get there. But I’m like, okay, so we signed back with surrogacy, and I’m like, all right, but I want to keep trying. So then I’m also now studying for my oral boards, which is like, a huge deal, and it’s an extremely stressful time, but I’m like, ugh, I don’t want to put things off more, so I’m like, doing both at the same time. Which probably wasn’t the best idea, but it worked out, so that’s okay.

Dr. Fox: Yeah.

Dr. Grubman: So I am like, Dr. Reichman, let’s try another fresh transfer, because that’s how we had Ryan, and although it is scary that I could have a genetically abnormal embryo…I think I was 33 at the time, like, let’s just try it, because that’s how we got Ryan. So he’s not happy about it, but he like, begrudgingly proceeds, and we do another fresh transfer, and it doesn’t work. But now we have a lot more embryos, we got 14 from that cycle. So at this point, we have, like, over 28 genetically-tested normal embryos, which is like, unreal.

Dr. Fox: Right. Yeah.

Dr. Grubman: And that’s part of the reason why he lets me keep going, because we do have a lot of embryos.

Dr. Fox: Right, a lot of embryos.

Dr. Grubman: If we didn’t, we’d have to use them more sparingly. So then I keep begging him to try, and I’m like, I’m not… Like, I know the risks. I know…you know, but I want to keep trying, and we’re not matching with a surrogate anytime soon, so let’s go.

So then embryo transfer number 10 happens on Good Friday last year, so ending my second year of fellowship, and I remember I was in the ultrasound unit, and I like, go back and forth if I test before, if I don’t test before. I think at that point I was like, it’s probably not going to work, I’m not going to test again. What’s the point? And I remember he called me, usually his nurse calls me, and he called me and he was like, you’re pregnant. And I was like, what? Like, seriously? Like, I didn’t really believe him because…

Dr. Fox: Right. So many times it happened, yeah.

Dr. Grubman: I don’t know, yeah, so many times it happened, and I was like… And we picked a boy from Ryan’s batch. Because I had, like, transferred a few girl embryos, and I was like, I don’t care, just do whatever you want.

Dr. Fox: Right.

Dr. Grubman: I’ve gone back and forth. But this was the first time we’d used a boy from Ryan’s batch, and I was like, maybe it’s like, the boy…

Dr. Fox: Right. Yeah, good juju. Yeah.

Dr. Grubman: This is like, the good juju, exactly. So I’m like, yes, this is great. But then, of course, you know, we had the nine week loss previously, so I’m like, you know, hopeful, but nervous, of course.

Dr. Fox: Yeah. And you’re scared.

Dr. Grubman: Completely [crosstalk 00:32:44.548]

Dr. Fox: Yeah. So what ultimately happened with that pregnancy? So about nine weeks, I was going to a Reichman basically weekly because I was anxious, and he understood that, and he’s like, at nine weeks, he’s like, this looks a little weird. I’m like… Like, he couldn’t tell if it’s like edema, or like what’s behind the back, the baby’s back, and the head, or if it was just like the membrane. And he’s doing a transvaginal ultrasound, it’s not like I can really scan myself, and I’m like, I don’t know, can you, like, move it a little this way, move it a little this way, show me the head? And I’m like, I don’t know…

Dr. Fox: Yeah.

Dr. Grubman: And he’s like, I don’t love it. I’m like, I don’t love it either. So then I’m like, in a panic mode, and like, I’m running to our ultrasound unit at Mount Sinai West. I call my husband, like, you need to just, like, drop what you’re doing. And he was on a research year last year, so he was pretty flexible. I was like, you need to just drop what you’re doing, and meet me at the ultrasound unit. And of course, like, we’re so invested in this pregnancy that, I mean, you know, he came. It wasn’t like, a question. And everyone there is like, this is early, like, we don’t know… Like, it’s hard to say. And it didn’t look super abnormal at that point, but they’re like, it’s early. We don’t know.

So that was maybe early in the week, and then I remember I looked Friday, at the end of that week, and it looked okay. And then I think the following Wednesday, you know, I was like, obsessively scanning myself, it looked bad. And I remember my parents are away, because I’m very close to my parents, like, you know, I tell them everything, and I was like, this just does not look good. Like, there is edema everywhere.

Dr. Fox: Yeah. Right, that’s fluid around the embryo. Yeah.

Dr. Grubman: Yeah. And at this point, I had had my… And it was genetically tested, but I also had my NIPT, and that came back normal. And then I’m like, okay, well, we should do a CVS, but then I’m also like, what’s the point? Because I know how this is going to turn out. I should just terminate. Then I just remember, I was like, do I do the CVS? What’s the point, like, going back and forth. We decided to, because we decided if the baby died before we got to the termination, that we would want the best cells possible, so we had a CVS.

Dr. Fox: Right, for testing.

Dr. Grubman: Right. So I had a CVS Thursday of that week, and just every time I sat down for the ultrasound, I was like, please just be no heartbeat, please just be no heartbeat, because I didn’t want to, like, make the decision, I just wanted it to be made for me. And then the termination was scheduled for the Tuesday, the next week. And I remember I just, like, told my parents when they got back from their trip, and my mom was like, are you serious? Like, how are you saying this with such a straight face? And I think I just, like,, was numb, and I couldn’t even, like, show emotions at that point, and I was like, this is what it is. Like, it’s done.

And at that point, our son, like, was two, over two, so he was like, talking, and like understood. Like, you know, we kept being like, oh, here’s the embryo. Like, this is your baby brother, whatever, and so, like, he was telling people, like, oh, there’s a baby in my mom’s belly, and like…

Dr. Fox: Ugh.

Dr. Grubman: Yeah, so that was rough. But then I remember Monday, I was like, okay, let’s just look, and it was still live, and it looked horrible, and we were like, okay, well, we have to do this. So I went back to Beth Israel Family Planning where I had done my rotation, I knew everyone, and they were just like, I’m sorry. I’m like, it sucks being on the other side.

And after that, it was rough for a while. I posted on a fertility group that I’m part of, and like, has anyone been through this? Like an IVF pregnancy that I’ve worked so hard to get to, and you have to terminate for a medical reason. And I spoke to someone who went through something similar, although she lived in Texas, and had to go to Colorado, so like, I was so lucky to live in New York. And just talking to someone who’s been through it, and who understands, like, it gets easier. And now…

Dr. Fox: What are you guys doing now?

Dr. Grubman: Oh, to make…not even after that, so then he does an SIS after my D&C, and then, of course, I have retained products again. So then I have a hystereoscopy, that was July of this year, and then I have my foley balloon again…

Dr. Fox: Oh, God.

Dr. Grubman: So now Dr. Reichman is like, no, we’re done, and I’m like, no, we’re not done, Dr. Reichman. I’m like, you know I want to do it again… Because now I know I can get pregnant, it’s even more frustrating.

Dr. Fox: Right.

Dr. Grubman: Although he’s like, well, maybe your placenta didn’t…wasn’t working properly because of your thin lining.

Dr. Fox: Right. Right.

Dr. Grubman: So I don’t know. But I know it can happen, which makes me want to do it more… But now I’m just taking a break because I’m just enjoying life.

Dr. Fox: Yeah. How do you… I mean, listen, obviously you have a beautiful, wonderful son, but you also have so much heartache, you know, over the past, you know, three-plus years, going through all this.

Dr. Grubman: Yeah.

Dr. Fox: How do you stay so positive and so chipper? I mean, like, you know what I mean?

Dr. Grubman: Yeah, yeah, no…

Dr. Fox: Like, you’re talking about all these attempts, and each one is a heartbreak, but you’re…you know, you’re going to work every day, you’re taking care of people. Like you said, it’s a very, very difficult situation to sort of see them all pregnant, and you’re, at least from my observation, you’re not continually depressed. I mean, you seem…you know? You have a really positive, you know, attitude and outlook. How do you do that?

Dr. Grubman: I think a lot of it I should attribute to my son, because you just have to keep going. Like, if you have a bad appointment, or like, I have a termination, like, I can’t be upset, and you know, crying all night when he’s there. Like, you just have to kind of flip the switch around him, and like, pretend everything’s fine because you don’t want him to see you upset, you don’t want to make him upset, so you just keep going.

Dr. Fox: Right.

Dr. Grubman: And I think at this point, like, my husband and I, like, we’re lucky to just have a normal, you know, a healthy child. Because both of us see horrible things happen, so we’re like, should we even, like, push the limits, and like, try to have another kid, when like, we see so many bad things happen in pregnancy, and even when kids are born. But we really want to give him a sibling, which is like, the only reason I think we’re going to keep going.

Dr. Fox: Right.

Dr. Grubman: But I think we really just keep going for Ryan, and that’s what keeps us so upbeat. And as time, like, gets further and further out from that event, it’s definitely easier to live a day-to-day life. Initially after, it was like, all I could think about, and it just consumed me. And it was hard in certain situations when I saw an ultrasound that looked like our baby had looked, like, to not get upset by that, but now I think it just helps me, you know, understand what patients are going through more, and counsel them.

Dr. Fox: Yeah.

Dr. Grubman: I’m pretty, obviously, very open about everything, so like, I understand what they’re going through, and I can share that with them. I know what it’s like to have a CVS, and go through, like, the emotions of not knowing what the outcome’s going to be.

Dr. Fox: Yeah. Yeah, I was going to ask you, you know, a lot of what I was asking you is how does your experience affect you, like your own emotions, but I was going to ask you, how has this made you different as a doctor, taking care of women under…maybe not the exact same circumstances, but certainly the same themes, and the same sort of, you know, motifs come up, you know, in counseling, and different situations.

Dr. Grubman: I mean, I kind of read the room. I don’t want to make a patient uncomfortable by telling them what I’ve been through, and like, put it on…like, make it about me. But I think, you know, I just kind of get a vibe from them, and see if they seem receptive, and if so, I do share my story. Because again, I think it just makes it so like, they see I’m a person, I know what they’re going through, I can sympathize with them, and they can be open with me, and ask me questions about everything.

Dr. Fox: Right. Wow, Olivia. Thanks for coming on, and telling your story.

Dr. Grubman: Thank you.

Dr. Fox: It is It is hard to tell the story. And you know, as you said, you’re an open book, but I think it’s to…you know, it’s to the benefit of our listeners to know what people go through. And again, not everyone knows that people are going through this. This could all be behind the scenes sometimes for people’s friends and family, and you just don’t know what people are going through, when they’re trying to build their families.

Dr. Grubman: That’s for sure. You do.

Dr. Fox: And sometimes they’re fortunate, and it’s very easy, and other times it’s extremely difficult, if not impossible, and everything in between.

Dr. Grubman: Yeah. I mean, a thousand nurses every day in the hospital say when is the next one coming, because everyone’s so excited. I’m like, sometimes [inaudible 00:39:55] trying, it was really hard for us to have Ryan… When you find me a surrogate, where’s your next one, frozen on ice at Cornell… I start getting creative.

Dr. Fox: Yeah. You say, how’s your uterus, you know?

Dr. Grubman: Yeah. Exactly.

Dr. Fox: Can I borrow that for about 10 months?

Dr. Grubman: Sometimes I blow it off, and sometimes I just think of creative answers, because that’s all you can…

Dr. Fox: Wow. Well, thank you so much for coming on.

Dr. Grubman: Thank you for having me, Dr. Fox.

Dr. Fox: This was…I love you calling me Dr. Fox.

Dr. Grubman: Natey.

Dr. Fox: Yeah, there you go. We’re going to end with that.

Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast, or any other topic you would like us to address, please feel free to email us at HW@healthfulwoman.com. Have a great day.

The information discussed in “Healthful Woman” is intended for educational uses only, and does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health, and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.