Episode 91: Can Stress Affect Fertility? A Must-Listen for Doctor Moms with Dr. Yemi Famuyiwa

Topics Covered

• Fertility and High-Functioning Burnout in Doctor Moms
• Can Stress Affect Fertility? Cortisol, Irregular Periods, and the Reproductive Axis
• Delaying Pregnancy in Medicine: The Career and Fertility Tension
• Egg Freezing for Busy Women Physicians: Is There Really “No Time”?
• The “After This” Mindset: Why Years Slip By in Training and Practice
• The Power of Supportive Work Environments in Medicine
• Your Menstrual Cycle Is a Vital Sign: Listening Without Guilt
• Accountability, Agency, and Why It’s Never Too Late

Many doctor moms I know can tell you their next professional milestone. Fewer can tell you what their body has been trying to say lately.

There’s a question we rarely pause long enough to ask: Can stress affect fertility?

Not in a dramatic, breaking-news kind of way. It’s more subtle.

In the exhaustion that hits when you finally sit down.

In cycles that begin to feel unpredictable.

In the aches you override because the next deadline is approaching.

Today, I’m joined by Dr. Yemi Famuyiwa, a double board-certified reproductive endocrinologist and doctor mom, who explains what chronic stress actually does to the reproductive system and why your menstrual cycle is a vital sign, not an inconvenience.

This episode is about listening now, before “I’ll deal with that later” turns into years.

And it’s full of clarity and hope.

Find the full transcript and bonus resources for physician moms at inspiredmommds.com/91.

Fertility and High-Functioning Burnout in Doctor Moms

Dr. Cindy: I have a very special guest today. Her name is Dr. Yemi Famuyiwa, a double board certified reproductive endocrinologist, physician mom and founder of Montgomery Fertility Center. She's also an Associate Clinical Professor of OB-GYN at George Washington University School of Medicine.

Dr. Fam trained at the NIH and has published extensively in peer reviewed journals. She has a deep love for the science of fertility, especially oogenesis, and she's passionate about translating complex biology into knowledge that women can actually use to make informed decisions.

She founded one of the most diverse egg banks in the Northeast with a strong emphasis on donor safety and access for patients from all backgrounds. Her work centers on personalized, holistic fertility care and fertility preservation, particularly for busy professionals and cancer patients. She is recognized with multiple honors, including Castle Connolly Top Doctor for over a decade, Exceptional Women in Medicine and Top Black Doctor in 2023.

Dr. Fam, I am so grateful and glad you're here.

Dr. Famuyiwa: Thank you so much. My pleasure. It's an honor.

Dr. Cindy:

So much of your work centers on helping women understand their bodies during deeply vulnerable times of their life. And often those women sitting in front of you in the office, or virtually, are high achieving, high functioning professionals who are used to just pushing through a lot like doctor moms.

I'd love to zoom out a little from the fertility specifically and talk about that high functioning pattern that we see in physician moms. And in your experience, maybe clinically or personally, how does high functioning mask burnout or whatever term you want to use in women.

Dr. Famuyiwa: Well, one of the things, as you know, we're women, we're doctors.

We care for everyone. We care for our patients, we care for our staff. And, you know, you almost wear your emotions on your sleeve. So the last thing that people think about sometimes is themselves. I know, so, so many women doctors, even trainees I've known, the medical residents in training that have worked with me, that I always kind of pull them aside.

I say, "Hey, you need to take care of yourself. You need to think about if you want a future reproductive potential, you need to put it on your back burner. Just take two weeks off to take care."

So I'm always advocating that even for women who are still going, because I do mentor pre-med students, so I try to talk to them from every step of the way.

We don't really pay much attention to ourselves. And that's a quiet burnout where you sit down and you are exhausted to your soul and sometimes you don't even know you are exhausted. We put ourselves on the back burner so many times and it can affect us, affect reproductive potential, affect overall longevity and health.

<>Dr. Cindy: I love that you are reaching out to pre-med students. So you're getting to women before maybe they start in this possibly toxic process.

Dr. Famuyiwa: Absolutely.

Dr. Cindy: So what are some of the signs or the subtle signs that women might often get overlooked? So being exhausted I would think, sounds really obvious, but what are some subtle signs?

Can Stress Affect Fertility? Cortisol, Irregular Periods, and the Reproductive Axis

Dr. Famuyiwa: Well, you can be fatigued but you've got so much adrenaline going on that you don't really pay attention to it. Like most people don't realize that they're sleep deprived, right? You'll know it if you go to finally find a quiet place. Maybe you're invited to a family function. Or you're going to a presentation or a dinner after hours and there's no adrenaline there because, right?

There's no one dying right in front of you, or you know, birth about to happen. And the water broke, you know, 20 hours ago. So in those quiet moments, you sit down and your body just kind of sinks into the chair and you feel really exhausted.

But, even with that deep felt exhaustion, if somebody were to call you again and say, “Hey, listen, we got a stat coming in, meet me in the…” you are, you're jumping up. You're running to it again. We run pell-mell into tough situations because we've been trained that way.

There's nothing bad about it. Everybody loves medicine, otherwise you wouldn't be in it, right? I love, you know, tough, complicated cases. I love being with my patients, but you gotta take care of yourself because your body is not a machine, right? So I think that women do feel it if they take a minute to listen to their body.

Dr. Cindy: Hmm. That really resonates with me. The part where you said when you sit down and you don't have any adrenaline, or a reason for an adrenaline rush at the moment, and you just sink into the chair.

I remember so many times that happened. And it's hard to put two and two together when you're in the moment.

Dr. Famuyiwa: Yes, exactly.

Dr. Cindy: Because like you said, you can jump up and run straight to the fire and not realize anything's wrong.

Dr. Famuyiwa: Exactly. Exactly.

Dr. Cindy: If someone is staying in that high functioning mode for years, just running from fire to fire or just being so busy and they're not listening to the subtle signals and they're just pushing through, there's a cost on the body, which is what you're talking about.

And that cost is not always obvious at first. So I'd love to explore what that actually looks like, what the ramifications are. So what are those clinical consequences that happen to a woman when she just keeps overriding what her body is telling her?

Dr. Famuyiwa: So when you are that exhausted, when you run on fumes, your cortisol levels go up, right? So your body now transitions to a very high inflammatory state. I mean, cortisol is great if we're being chased down by a beer or a lion, right?

But, if there are only rabbits in the playground and we are still running like, you know, a bear's chasing us and that chase is on 24/7, it never lets up.

And when we're sleeping, we're still thinking of strategic ways of avoiding the lion or the bear that's coming after us. So then your body is perfused with cortisol all the time, and the problem with that is when you have so much cortisol in your body it disrupts your reproductive axis.

So much inflammation starts to wear on the body. So maybe your menstrual cycles are not flowing regularly as they should, right? So menstruation is off. Ovulation is off, so you're not ovulating regularly. And then when you do ovulate, you may not even be able to fertilize as well.

Because of all these stress hormones, you're living in a state of high constant cortisol levels. And that's not necessarily a good thing. And then also what makes it worse is if you are sleep deprived. That also triggers more cortisol. It affects your HPA axis, so it's not necessarily a good thing to have.

Delaying Pregnancy in Medicine: The Career and Fertility Tension

Dr. Cindy: I find it interesting that women are into medicine because we love it. We put ourselves in this situation where we have high cortisol release continuously.

And you're saying it affects menstruation, it affects fertility, and we're already spending years maybe postponing having children because of the choice of profession. It just seems like a double whammy.

So what's your opinion on women who postpone childbearing because of their profession on top of the stress?

Dr. Famuyiwa: I actually wrote an article on medium.com a few years ago. Where I stated that the best graduation gift you can give anyone who's a family member who is in medical school, don't buy them, you know, a fancy car. Don't give them money. Pay for them to go get their eggs frozen.

That's the best gift you can give someone, contribute to their GoFundMe to get their eggs frozen. For some reason women have this notion that taking some time off to freeze their eggs takes such a long time. And I tell them it depends on where the clinic you're working with.

I mean, I'm a physician too, so I am very sensitive when women come to see me who are physicians, and I do make accommodations to help them with their schedule. Because I know how hard it is. I know they're on call.

They gotta get back to the hospital. I know all that.

Talk to a clinic that's willing to work with you because as a physician your needs and time constraints may be different, right. People should be willing to help you out.

Egg Freezing for Busy Women Physicians: Is There Really “No Time”?

Dr. Famuyiwa: I had a patient who I saw who was pregnant several years ago, and she was actually a PA. No difference. They're just as busy. And I knew she worked some crazy shifts. So I told her, "I tell you what, I will wait for you, I'll accommodate."

And she was so shocked.

She goes, "You know, the other clinic I was going to would not even work with me."

What they told her was, well everyone else makes it work, so make it work, right?

So, you can work with someone who's willing to work with your schedule and you don't need that much time, right? You know, maybe a couple of weeks where you're doing the monitoring, so it's not like you're there every day, you're coming in for a five, 10 minute visit just to check on the follicles, and then the day of the retrieval, you can take that one day off.

So I always tell patients, do you have two weeks out of your life that you can do this thing? And even that two weeks, it's not the entire two weeks, the only day that they're critical is the day of the retrieval because you're going to be under. We use anesthesia in our facility. But other than that, the monitoring time, there are workarounds that can help you get through that.

It looks like you don't have the time, but you do. You do. You have a week's vacation off. You have a few days off. You can time that few days to correspond with when you are doing the retrievals, everything else can be worked out.

I talked to a physician who said that when she was considering this. Someone scared her and she said, “Oh, I don't wanna do this. I don't know.”

And she put it off and now it's a few years later and now she's over 40, but she had gone three years earlier, but she got scared and ran back. So I'm thinking, okay, we'll still do this. Yes, I would've taken 37-year-old eggs over 40-year-old eggs.

I tell you what, I'll still take 40-year-old eggs versus 43-year-old eggs, right? So still do it. Work with someone who can work with you, but don't give up. You know, I can't tell you how many of my mentees I've encouraged, and some of them when I see them later who did not, and it kind of breaks my heart.

I said I have a few people I'm training now, and they all hear it from me, trust me.

Dr. Cindy: Mm-hmm.

Dr. Famuyiwa: In a very nice, encouraging manner. And they will all tell you that, I mean, they all share their experience with my office. They love their rotation care, they love the support. And I tell them all these things.

Dr. Cindy: Wow. So women can take control.

Dr. Famuyiwa: Yes, you can.

Dr. Cindy: Over their fertility, even despite having a crazy schedule and increased cortisol and possibly disrupted cycles.

Dr. Famuyiwa: Yeah,

Dr. Cindy: There's a way to take control.

Dr. Famuyiwa: That can help to reverse that. And that's one of the things I wrote for my book coming out next month, called the Quest for Fertility. And I'm telling real life stories so people can see themselves in these stories and then use that to teach the science and then use that to explain concrete steps that you can take.

So it's not like, oh, it's all doom and gloom and it's all over. No. No, there are things you can start to do now if you know what to do.

Dr. Cindy: You are providing the education, you're providing the steps that people can take.

Dr. Famuyiwa: Absolutely.

Dr. Cindy: I love that because when you're in the moment, it's hard to know what to do.

Dr. Famuyiwa: It's really hard. So the book has information that I wish all my patients knew even before they saw me. And it's also giving practical steps, but also encouraging stories so they can see themselves and say, oh wow, you know, I can see how I can overcome this.

Dr. Cindy: Mm-hmm.

Dr. Famuyiwa: Because this patient did that and it helped. It's a conversation starter for what they can use to talk with their own physicians as well.

Dr. Cindy: Right.

The “After This” Mindset: Why Years Slip By in Training and Practice

Dr. Famuyiwa: And also, you know, if they know other friends, families that are going through this, you can give them the book. Or someone who's maybe shying away. They kind of don't wait for everybody. I can tell you so many of my female friends, doctors right now, which is – it's not denial, but it's like they know they have to do it, but it's not on the front burner, if you will.

It's on the back burner and it's going to be always someday. And it's someday and I say to them, "Okay, Are you ready now?"

No. Yeah. Well, I'll be ready after I do, and yeah. I'm working on this project and after I get, and then I'm gonna come back. And then it's been a year, two years. So I do tell the people around me and my friends that are OBGYNs, I also share, I even have family practice friends.

And so anyone who's a friend of mine, I've shared that message and I have them share it with their patients.

I want to magnify the information. You know I have a friend of mine who's an OB-GYN. The minute someone walks in her door and she thinks they need to be talking, boom, she sends them off to me.

I can't tell you how many people I see at any age, where their ovarian reserve is starting to be erased. So you've got to chase down the few eggs they may have.

Dr. Cindy: Time really slips by while you wait for the, "After this, after that".

The Power of Supportive Work Environments in Medicine

Dr. Famuyiwa: Yeah. Because, you know, we get this – I want to get past my internship, want to get my boards step three, and then I make sure I finish my application for that fellowship. And then I want to go on the interview circuit and then you know, there's always going to be a then, and then, and then.

And then another thing too, I think most medical schools are not supportive, but if you are already in a residency program or fellowship program, it's not the end. I was very fortunate that I went through a residency program at Georgetown that was extremely supportive. Now, I didn't have my kids when I was at Georgetown, but we were all supportive of our colleagues that chose to.

And it was just something we did across the board and covered so that they could have their families. And be fulfilled in it, and I don't regret one minute of it. And it was also institutionally encouraged, right?

After Georgetown, when I was an attending, I'm still an attending at Holy Cross Hospital. When I started having my kids, the hospital itself was extremely supportive. They provided resources.

They provided breastfeeding spaces if we even have the access to training staff that they gave us, complimentarily if we needed any questions on how to do certain things.

So being in a supportive organization and an environment is also extremely valuable.

Now, I know not everyone has been blessed to be in that kind of environment. Today I am extremely grateful for the support that I have had.

Dr. Cindy: Exactly. And I'm really hoping that it's becoming more commonplace as time moves on. And I remember even back 18 years ago, 19 years ago, even back then, I had support from my anesthesia group.

And I realized it at the time, how valuable that was, that they supported me.

Dr. Famuyiwa: There's a certain comradery when you are with your colleagues that are extremely supportive.

It's such a wholesome feeling that I can't explain it to people who've never experienced it.

I'm grateful for all the people that have worked with me. Another thing I do now is participate with our Montgomery County Medical Society. When we have our meetings and we come together, I just feel like I'm in that support environment all over again. We're all physicians. We all know how hard it can be, and we have nothing but support and encouragement and tips to help each other out.

So, look to your environment where you are, you know, maybe just having just a few supportive colleagues around you may be, what drives you to make those changes? You know, someone that says, "Come on Annie, let's go. You can do this. Come on, Jane. You should look into this."

And when you have that support, it's like, oh wow. You're right.

Your Menstrual Cycle Is a Vital Sign: Listening Without Guilt

Dr. Cindy: Yes. Now I want to shift gears a little bit. I'm really interested in your thoughts about women listening to their bodies without guilt. Reclaiming agency and control over our choices is clearly what we want for women, but so many of them are just in the habit of doing and doing and pushing forward and not listening to themselves.

And then when they do stop to rest or they do stop to take a break, they feel guilty.

Dr. Famuyiwa: Right.

Dr. Cindy: Why is it so difficult for women to listen to themselves?

Dr. Famuyiwa: Again, force of habit if you've not been taking the time. One of the things I totally enjoy doing is taking a few minutes at the beginning of the day and then a few minutes at the end of the day where I just go over in a grateful manner everything. Like, I'm grateful to be talking to you today. So I'll think about that.

I'll think about the wonderful people I'm grateful to be working with, the support staff, the nurses, the PAs, the nurse practitioners, my student. And you know, when you ground yourself in that gratitude, take that special minute, you have to be committed to taking a few minutes to just think about it.

It's maybe hard if people are doing it for the first time. Once you start to do it, you see all the positive things that could happen. You start to feel good about yourself taking that extra breath work.

Just wow, right? And then when you do that, your body has a minute to pause. You know, if you just go, go, go, go, go you may notice that you're not even having a menstrual cycle anymore.

That's the first scream that your body's sending out. Something is off. You know, my period sometimes gets haywire. Something is off, you know?

Track your menstrual cycles for a minute. It takes a minute. Some people use apps nowadays. I tell them to just get a regular calendar and they'll just circle period and circle when you end, and then look at it every month. And is it being regular or if it's going haywire. If you're starting to have cycles every 35 to 40 days where you used to have cycles every 28 days, how else can your body scream at you?

Your menstrual cycle is a vital sign too, just like your blood pressure.

Dr. Cindy: Mm-hmm.

Dr. Famuyiwa: It's telling you something is not right, you know? So pay attention to things like that. When you're overtly fatigue like we talked about. It's not normal to live in a state of fatigue.

So what can you do to start to change that? So, check your overall health. You know doctors, we're guilty of this. When was the last time you checked your hemoglobin A1C? You may be running so hard that you've now started to become pre-diabetic with all that cortisol and that glucose level staying high.

So what's your hemoglobin A1C? That's another number that you need to know. When was the last time you put a blood pressure cuff on yourself? Check your blood pressure. Your blood pressure is starting to go up. It's telling you something.

Dr. Cindy: Yeah.

Dr. Famuyiwa: We know this stuff, right? We tell our patients this stuff. How often do we take the time to do that for ourselves? It's hard.

Dr. Cindy: You mentioned a number of things. You mentioned you can ground yourself in gratitude.

Dr. Famuyiwa: Yes.

Dr. Cindy: …in breath work, in just taking a few minutes to pay attention.

Dr. Famuyiwa: Right.

Dr. Cindy: …to track your cycles. These are all things that don't take too much time out of the day.

Dr. Famuyiwa: Yeah.

Dr. Cindy: And I think the overall message should be that, don't feel guilty for taking two or three minutes a day to do any number or any one of these things. Two to three minutes a day can have a profound impact on your health.

Especially if you notice, like you said, “Oh my gosh, my cycles are completely haywire. What does that mean?”

And just taking two to three minutes to realize that's happening and then reach out.

Accountability, Agency, and Why It’s Never Too Late

Dr. Famuyiwa: I mean, when was the last time you saw your own gynecologist, right? Or your own internist?

Look, I'm not a saint. I used to be guilty of that. And I remember, during my pregnancy, my doc, she was a friend of mine, my OB doctor would literally have a copy of my chart in hand. So when she saw me in the hospital, she's like, okay, come on. That's how bad. But I still learn. It was the same message. And she would tell me, Yemi, come on a few minutes here and a few minutes there.

And knowing that your colleagues are rooting for you. We are here for you.

Who doesn't want to see another colleague do well. Right? Don't you know what I mean? We're here for you.

So if you want, you can even choose an accountability partner for your health. I don't know about other people, but we all did that in med school, right?

I had accountability partners for, when we completed our study, and when we completed our notes, when we finished the assignment. You know, “Hey, have you completed this?”

Set up a monthly accountability partner. “Hey Jill, how are you doing? Did you get your blood pressure checked last month? Did you blah, blah, blah.”

And sometimes when we know we're going to meet an accountability partner that pushes us, say, "Oh my gosh, you know, I gotta talk to Cindy today, so I gotta check my blood pressure before I talk to her. She's gonna ask me."

Dr. Cindy: And that's a great point . You mentioned some women are not blessed to have an environment that's very supportive, but you still have agency to create that environment by reaching out.

I could reach out to you and say, "Yemi, can you be my accountability partner?" Even though my environment doesn't have one right now? We have the ability to create an environment, even if we're not already in it, that will be supportive for ourselves and for other women. And show an example.

Dr. Famuyiwa: Yes, it's hard, but we can be there for each other.

I think there's a virtual group of female doctors where we're on WhatsApp and giving ideas and chit chatting with each other. Do something like that, but for yourself. But, it's not too late. Look into your fertility, look into your health.

It's never too late.

Dr. Cindy: It's never too late.

Dr. Famuyiwa: Never too late.

Dr. Cindy: I am so grateful that you exist in this world and are doing this work for women and helping them in this way. Where can listeners learn more about you and about your book? Tell us about that.

Dr. Famuyiwa: It's out in March.

Okay, so do send me a message. Just go onto my website, montgomeryfertilitycenter.com, and under the “contact us” button, pop a message in there. We will reach out to you.

You can also find me on LinkedIn. Search Dr. Oluyemisi Famuyiwa and sign up for my newsletter on LinkedIn.

I'm giving weekly updates about the book and when it's coming out.

We will get you on that list. We'll send you updates and you can read my newsletter. I give you every week what's going on and little excerpts from the book. And the same newsletter is also on Substack, so Dr. Yemi Famuyiwa on Substack or LinkedIn to get my newsletter or just go to my website.

All the links are there.

Dr. Cindy: Dr. Yemi, thank you for being here. I really appreciate your wisdom. Thank you so much.

Dr. Famuyiwa: Thank you so much for having me. This has been a pleasure.

Links:

• Fertility Specialist | Maryland – Montgomery Fertility Center
• Oluyemisi Famuyiwa MD, FACOG | LinkedIn
• Oluyemisi’s Substack | Oluyemisi Famuyiwa, MD FACOG | Substack