“So that recognition that you're only human and that you have to step back sometimes…but you have to, because that's what you have to do”. - Dr. Crystal Chan
In this episode, we chat with Dr. Crystal Chan, an OB/GYN and REI specialist. We talk about how she pivoted her career from academia to private practice, the unexpected challenges of parenthood and the importance of taking care of yourself.
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Dr. Crystal Chan, MSc., M.D.
Dr. Crystal Chan is a physician trained in Obstetrics and Gynecology & Reproductive Endocrinology and Infertility. She is currently a co-owner and scientific director of Markham Fertility Center.
Radha Sharma: Welcome to Season 1 episode 11 of Family Planning for Docs - Thriving or Surviving. This podcast is an extension of our platform at www.familyplanningfordocs.com, a website created for Canadian medical trainees to highlight useful information about family planning in a medical career. Our group has a mission to inform medical trainees about their options regarding family planning while navigating training, career, and personal life. Our research has demonstrated that personal stories are highly impactful, and we hope to provide access to a diverse number of stories, to current trainees. On our podcast we hope to capture the stories of medical professionals who have navigated the training process and a medical career while planning, parenthood parenting and the supports that they had along the way.
Radha Sharma: In this episode, we have Dr. Crystal Chan, We are thrilled to have you on our podcast today. And again, thank you on behalf of the entire fFamily Planning for Docs team for taking the time to share your story with us.
Crystal Chan: Thanks, Radha, yeah, this is definitely an important topic, and I'm very glad to share my story. If it inspires anyone or there's any advisory warnings, you know what not to do. I'm happy to help with that.
Radha Sharma: and I'm sure our listeners will appreciate that as well. So thank you. What does a day in the life of Dr. Chan look like?
Crystal Chan: Okay, so I'm currently a private practice-based fertility specialist. I do have an academic part time appointment at the University of Toronto. But my main job really is clinical. I'm currently the scientific director and co-owner of Markham Fertility Center, which is a busy fertility clinic in the northeast GTA region. So a scientific director. I direct the scientific activities at the clinic. But I'm also a very busy clinician. So I was thinking about this question, what does the day in the life look like, and I guess I would start by saying, I have probably 70 hour weeks, so probably working 12 hours a day you know, 6 days a week. The majority of that, probably 80-90% of that time is seen with direct and direct-patient care, seeing patients doing egg retrievals, embryo transfers. So no histograms. So a lot of patient consultations as well as hands on procedures, and then maybe 10 to 20% is running the business as well as scientific direction for the clinic. So a lot of administrative work, leadership committees and things like that after hours. So I see patients from maybe 7 to 6, and then sometimes 7 pm to 9 PM doing meetings and things like that. So it's a pretty busy life.
Radha Sharma: Yeah, I was going to say it sounds very jam-packed. How did you know that you wanted to be a fertility specialist? Was that something that you figured out early on in your training, or something after residency?
Crystal Chan: That's a good question. I think I was an OB/GYN keener from the start, you know.
After I delivered my first baby I was hooked, or the first delivery I was hooked, so I really loved female/women's health. You know women's health and reproductive health. I fell in love with the science of IVF and reproductive medicine early on so I wouldn't say that it was because I love babies or loved the idea of having kids. I actually fell in love with the science of IVF in medical school, and did everything that I could to work towards an obedient residency and reproductive medicine fellowship. It wasn't until I had kids myself that I realized that fertility medicine is really my calling, because then I fell in love with the idea of starting family, having children, you know, seeing what it does to a family to have have children, how it bonds the family, and then really fell in love with the subject matter along with the science of it.
Radha Sharma: That's awesome. And for our listeners that may be interested in pursuing fertility medicine, or maybe just want to know what the training looks like. Can you walk us through how many years of training it to be where you are now?
Crystal Chan: Yeah. So I trained to be an academic fertility specialist. So what I did was medical school, followed by my OB/GYN residency. Within OB/GYN residency I did the Royal College Clinician Investigator Program. So that added on an extra year to my training, I obtained a Master's degree very much in the subject matter of reproductive medicine.
And then, after that I did a fellowship at UofT. A little bit of my fellowship I spent at the University of California in San Francisco, UCSF where I did a little bit more research. And then I started on staff at Mount Sinai Hospital as a clinician investigator for actually quite a few years, and then went on to private practice. So I trained to be an academic clinician investigator, and at some point in my life decided to go into private practice. Overall the training - how many years of training? I don't know what that that is - 166 years or something?
Radha Sharma: Yeah, we'll let the listeners add up the numbers. Yeah, awesome. as you know, our goal is to chat about how you and other individuals have fit family planning while also having this amazing medical career. what inspired you to start a family? yeah, what was your motivation?
Crystal Chan: As I previously mentioned, I wasn't, you know - It wasn't always my goal to be a mother. I was so career-focused for so long. And then, honestly, it's the biological clock that's set in.And I was all career career career, school, school, school, work, work, work until probably the age of 35, 36, where it actually hit me like a MAC truck, like the biological clock, and that desire to have a child before it's too late. Yeah, that's what kind of happened to me. And around that time I guess I should talk a little bit about my family planning, which is really defined by lack of planning. So, I'm previously divorced. So I was in a marriage to another physician, both of us really prioritized career. And so I got divorced, at probably age 36, something like that. In the midst of my biological clock clicking in, and I never had kids in my previous marriage. So really there was a huge sense of anxiety to, you know, meet somebody and have kids at that point.
It felt a little bit like a hot mess at the time. But when that clock set in, really, you know, it didn't ever.
Radha Sharma: And so when you were kind of navigating, you know, knowing that you have this biological clock ticking, what sorts of resources did you access? What support systems did you have at that time to figure you if you wanted to have kids, or you know what that journey would look like?
Crystal Chan: Okay, the ironic thing is, of course, I'm a fertility specialist. So I have all the resources and colleagues at my disposal. If I wanted to freeze eggs, if I wanted to freeze embryos, if I wanted to do fertility testing, it was all at my disposal, but there was a lot of anxiety around being, you know, recently divorced, and what that meant for me. So I would say that at the time it was very paralyzing, and no matter how many supports and resources and knowledge I had on paper, it wasn't that helpful. Luckily I did meet someone. I have a male partner, I did meet someone, and we were able to have kids. I definitely pushed or deferred my fertility till quiet late. So I'm sure this will come up soon. But I had 3 kids at age 37, 39, and 41.
Radha Sharma: What did sort of maternity leave, or planning to have kids at that time look like? We have episodes where you know, people have kids in residency, so I'm hoping you can shed some light on what your experience was having kids in your practice.
Crystal Chan: Yeah. So I had my first kid in practice as a clinician-investigator/clinician researcher in a highly academic setting. So the first thing I will say is, thank goodness for my amazing colleagues. I had, and still have, amazing, amazing colleagues that really shouldered a lot of my patient care when I was away on mat leave. They were very kind, very supportive, and that's key, like, you know, no matter where you work, look for a good team. So I was able to take a mat leave - not long mat leaves probably 2-3 months for each kid. So that that's definitely key to have that support system, and I also am lucky to have a supportive partner, and parents who live with me and help take care of the children. Those are integral to success as well in my, in my kind of framework. One of the things that I realized after my first child is as an academic, I didn't have time for anything. I didn't feel like I had time to be a good present, mother. I didn't feel like I had the time to be a good doctor to my patients. I didn't feel like I had enough time to be a good investigator and researcher. I thought that I was being pulled in many, many directions, and there were certain things that I was doing, administratively or otherwise on the academic side that I felt were giving me less and less joy. So that was part of the decision making to leave academia, although I love so many things about it. I love the research. I love the people I love, the teaching. I had to make a difficult choice which was to transition away from academics and really focus on family and patient care.
Radha Sharma: Thank you for talking about that role strain, because I feel like a lot of trainees that might be listening to this definitely feel that they may be pulled in different directions, and you're wearing so many hats at all times. So thank you for talking a little bit about your you know difficult decisions about what you want your career to look like while also being a mom.
Crystal Chan: I do want to say one more thing about that, because I don't want to deter people from an amazing academic career either. There are some amazing people that are able to have children and thrive in the academic setting. I've seen so many of my colleagues really thrive and enjoy that life. But I think again, you know, I was looking at what things brought me joy and what things didn't, and patient care for me I think it always won over academic duties a little bit. So I really you know, decides to focus on that.
Radha Sharma: I know you talked a little bit about having a partner, and then also having such supportive colleagues sort of in your circle, and I'm sure that made the world of a difference when you were having your children. Did you have any mentors in the field, or anyone you could kind of go to at that time, or maybe even now, when navigating this journey?
Crystal Chan: Many, many, I would say. You know when I was at my academic clinic. It was a group of 6 people, and they all had kids, they were all very supportive. They all encouraged me to take even longer Mat leave, than I was planning to. So I see all of them as mentors. They were there for me, you know. They modeled good practice, you know. They showed me how you could thrive in Academia, you know, despite having children, children, and children. I had my third child recently. He's only 2 and a half months old, so I had my third kid while working in this private clinic with my 2 partners and they’ve always been private fertility specialists with no interest in Academia, and they also have been extremely supportive, encouraging me to take a long for that leave, being willing to cover for my patients. And you know they're also mentors in that context.
Radha Sharma: Amazing. Yeah, mentorship is so important in so many arenas of medicine. So that's great to hear that you've had that support as well.
Radha Sharma: I know you mentioned that you had 3 children, and one of them is 2 and a half months old. How old are the other 2?
Crystal Chan: Yeah. So I have 3 children. One is 3 and a half, the other is 2 and a half years, and the other is 2 and a half months old. They're all in diapers still, wheel the oldest one is being trained, and he's almost out of diapers, but it's tough. But it's beautiful at the same time to see them interact. And you know, bring that joy and energy into the household. Yeah, it's a blessing and a curse to have a very tight birth spacing is a blessing, but a curse.
Radha Sharma: What were some unexpected challenges of being a parent that maybe you didn't plan for and have kind of been navigating?
Crystal Chan: I think it's normal to feel. I think you know, when you're in medicine and health care, and just in a profession you you sort of you encounter challenges, and you eat challenges big enough for breakfast. Right like you should be superhuman and your patients and your staff and your colleagues should not sense weakness. Yeah. So the unexpected challenge of being a parent is that you will have many episodes of “weakness”. You know the kid gets sick in the middle of night, and you have to cancel clinic. Your kid gets sick and you can't take the call, and you have to ask your colleague. There's all these things that you would never imagine before having kids that you would have to ask people to help you with.
Crystal Chan: So that recognition that you're only human and that you have to step back sometimes. That's what I guess you know it's coming, but it's still a little bit unexpected, and it's painful to have to, you know make those sacrifices. Yeah.
Radha Sharma: What's been the best thing about being a parent? I'm sure there's so many amazing things that you encounter. But what do you look forward to when you finish a work day and get to see your kids?
Crystal Chan: The smell of the baby, you know, the sounds of the kids running around screaming. Those things are really precious.
Radha Sharma: I'm sure you'll have to update us on when they get older, and the newborn snuggles. Crystal, if you had a magic wand and could go back and change anything about your journey thus far would you go back and change anything? If so, why?
Crystal Chan: I've always been a you know, everything happens for a reason type of person. So I have no regrets about any choice that I made in life. In fact, I think everything led me to where I am now, and I'm thankful. The one thing and this now I feel like I need to wear my fertility specialist hat. The one thing you know, egg freezing, I'm sure, has come up a lot in your interviews and on your website. The one thing that egg-freezing - I didn't do it - but the one thing it would have afforded me is better birth spacing. I think you know, I always wanted 2 or 3 children. And so when you start at 37, tick, tick, tick, tick to tick. So my insane birth spacing was a result of that. So perhaps - hindsight is 2020 - but perhaps if I froze eggs it would have given me a little bit more breathing room, so it wouldn't be rapid fire birth spacing. Why didn’t I egg freeze when I had it at my disposal and I worked at a fertility clinic again. I think it was just massive anxiety and paralysis from the drama in my life for a few years. So I just didn't have a head space to think about doing it, but that, perhaps, is a somewhat regret, not not regret, but something I could have done differently.
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Radha Sharma: And actually on Episode 3 we chat with Dr. Maxime Billick and Dr. Joseph about egg freezing so we’ll link that in the show notes. We'll also link some resources on our website for anyone who's interested in learning more about egg freezing. I'm curious as a fertility specialist - because I know there's a lot of media hype about egg freezing, and there is a lot of misinformation that's out there about it. If someone is interested in egg freezing - can you talk to us about how important it is to kind of seek the resources, talk to a physician, etc?
Crystal Chan: Yeah. So egg freezing is an imperfect technology. It doesn't guarantee a baby at the end of it. As you know, it doesn't always work, but it is the best and only way we know how to take a detour from that biological clock, and the diminishment of the eggs with increasing age. It is the only way you can save or preserve your fertility at a certain age. So I would say, every fertility clinic I know of does egg freezing. Some are in higher volume than other clinics, but certainly it is standard of care at this point. So it would be as simple as asking for a referral or self referring yourself to a fertility clinic, getting an assessment of Ovarian reserve or egg supply quantification that can be done by ultrasound and a blood test called an AMH. And then, based on those levels a fertility specialist would be able to give you a pretty accurate estimation of how many eggs you could yield in an egg freezing attempt, and then it is a pretty streamlined approach, so it will be a week and a half on average of daily fertility drug injections, followed by an egg retrieval under sedation. My clinic does the egg retrievals under full deep sedation. So people are asleep for the retrieval, it's painless. And then the eggs come out and mature eggs are frozen for future use. If the eggs are required in the future, those eggs have to be thawed. They have to be injected with sperm in the future by a process called intra-cytoplasmic sperm, injection or ICSI, and then embryos developed, and then sometimes we genetically screen the embryo, sometimes we don't, and then we would transfer the embryo in the future to the uterus and hope for pregnancy. Now, not everybody, as you know, that freezes eggs, needs to use those eggs. That's one thing to be aware of. But it is, you know, a good technology that's available and should be considered by people that know that they're going to defer their fertility to later years.
Crystal Chan: And is there a stage that maybe not just medical trainees, but individuals, should start thinking about freezing eggs? Is there a right time to do that in your opinion I think a lot of people are interviewed and then give a number. I don't think I think everything at life is. It depends. And this is general.
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Crystal Chan: A general statement is you? If you freeze too young, you might. You have less likelihood of meeting the eggs, so it might be less cost-effect.
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Crystal Chan: it might be less necessary if you freeze when you're too old. The quality of the at the eggs are, you know, as lower, and the chances of pregnancy from those eggs is lower.
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Crystal Chan: So the sweet spot of you know, balancing need to use as well as efficacy would probably be in the 28 to 35 years of age range. That's a very broad range, and the thing about these things is that
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Crystal Chan: you know that nothing's ever perfect. I mean, you know, speaking to my own experience, it's not like you can plan or over plan everything. Sometimes people wake up and realize they want to freeze eggs at 36. Is that okay? That not okay. Well, that's something to be discuss with the fertility specialist.
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Crystal Chan: it's definitely doable. But you know that that's just a general general statement. 28 to 35 would be a nice time to consider
Radha Sharma: Amazing. Thank you so much for sharing your wisdom and expertise on that. Even in medicine there's a lot of stigma and misinformation about fertility, especially with things like egg freezing and IVF, so thank you for sharing that.
Radha Sharma: Crystal as you reflect on your own journey here. Is there any piece of advice you would give to your younger self?
Crystal Chan: A lot. I would say to my younger self to give yourself grace, to be kind to yourself, to not have such high expectations, that everything is going to turn out as planned, or you know.
At some point in my life I never thought I could leave Academia, at some point in my life I never thought I could carve out time to be a mother at some point in my life I never thought I would meet the right person to do this with, and then and then things kind of, you know, figured themselves out with a perfect no, but that's the piece of advice. Expect imperfection and be okay with it.
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Radha Sharma: Is there any advice that you have for other medical trainees, perhaps echoing some of what you've told your younger self that you could tell other medical trainees whether they be medical students, maybe residents or physicians, early in their career.
Crystal Chan: Same thing. I have the archetypal medical training reality which is hard on myself and type A and controlling, and all those things, and it's the same thing like, be kind to yourself.
Self-care, you know kindness and grace to yourself.
Radha Sharma: Amazing and Crystal, we have one last question for you. It's in the name of our podcast. Are you thriving or surviving?
Crystal Chan: It depends when you ask me. Today, I feel like I'm thriving. It's a nice weekend. I'm going back to my kids after this interview. You know, things are pretty well controlled. My patients are doing well. So today I'm thriving. Some days when kids are all sick and the baby's crying, and I have to get off to work it feels like barely surviving, but that's the joy of life is to manage those 2 opposing feelings, and it's always going to be a balance of those 2 things. I think
Radha Sharma: Definitely, I think in order to appreciate the thriving, you need to have a little bit of that surviving to keep you going.
Crystal Chan: Exactly
Radha Sharma: We just want to give you another thank you. Crystal, it was an absolute joy just talking to you today and hearing about your story and what you went through. Thank you for being vulnerable on our show. You can find our guest’s contact information in the notes from today's show, as well as any subject matter that was talked about and resources that align with those. This is Radhaa and Crystal signing off.