Q: Why did you decide to become a nurse and then work in fertility?

Actually, it was a practical decision. I wanted to travel and find interesting work, so I attended a two-year program for RN’s in my hometown of Edmonton. I thought I’d try nursing for a few years and then return to writing, which was my first love, but I have stayed on in nursing for over 30 years. It turned out to be an immensely rich experience.

I was working as an NP in gynecology and was invited to be the NP in a newly formed fertility specialty clinic. I declined, thinking my practice would become unmanageable, but the reproductive endocrinologist infertilitist (REI) began to describe the endocrinological background, which was intriguing, and I
was hooked.

Q: What do you do as an NP in your clinic?

A lot of my work revolves around the ovulation induction process. Patients are given medication that causes their ovaries to make many eggs, instead of the usual one per menstrual cycle. In some cases, the patient is not ovulating at all and takes the medication in smaller doses to produce one egg. The medication is refined from the urine of postmenopausal women and is self-injected by the patient. We do sonograms or ultrasounds of the ovaries to measure the growing eggs, deciding medication dosage and when the eggs are mature and ready to be released. When this point is reached, we counsel patients about the best time to have sex or perform intrauterine inseminations, if that is indicated.

Kaiser Fremont has just started offering in vitro fertilization (IVF). The REIs worked a long time to develop this program, which was complex, especially at a not-for-profit HMO like Kaiser.

I have a colleague, Nancy Zinn, RN, MS, NP. We cover for one another and do most of the procedures, as the clinic is open seven days a week.

Typically, patients will be seen first by the REI, who decides the type of treatment. We have a weekly fertility team meeting to plan the treatment details, such as specific medication, dosing, and timing.

Q: What do you like best and least about what you do?

First, when a patient gets pregnant, we see everyone’s hard work and efforts come to fruition. That’s always exciting for the patients and the entire fertility team. Second, I like the endless possibilities for learning. This is a complex and fast-moving field. Sometimes the treatment choices are based on one or two research papers. Many times our patients come to us with years of infertility and little time left. We have to be aggressive in our treatments.

The most difficult part of the job is to give bad news regarding chances of success. Many of our patients are in older reproductive age groups, and we occasionally see younger women whose ovaries are failing prematurely. In both cases, the ovaries don’t respond, no matter how much medication we prescribe. It’s hard to tell people they can’t have something they have dreamed of all their lives.

I want to get the message out to women who consider childbearing as part of their prescription for a happy life. My message is: Don’t wait too long. Fertility rates fall quickly as women age, and though some women will conceive and bear children in their late 30s or early 40s, they are beating the odds when they do.

Q: Any incidents that stay with you?

It’s inspiring to deal with alternative types of families. We have many lesbian and transgender couples that are truly making a success of their lives.

Q: Any special interests?

I’ve had a long-term interest in polycystic ovarian syndrome. Nancy Zinn and I are working on PCOS education, both for staff and patients. We find it takes time for these things to be realized, and it’s becoming a long-term project.