When I first saw the description of The Retrievals, a podcast from the New York Times, I was horrified…but I wasn’t exactly shocked.

The podcast details the stories of patients who sought out IVF treatments but experienced excruciating pain during their egg retrievals. The pain persisted after these patients went home…and for a while, no one could understand why.

As it turns out, a nurse at the clinic was stealing fentanyl and replacing it with saline. This is a specific story with a particular culprit. It happened for a simple reason: Someone tampered with the narcotic that was meant to control patients’ pain, and as a result, patients suffered unnecessarily.

But this story is emblematic of something much bigger: How our society views and treats women’s pain, and how that affects the way women are treated during medical procedures. This societal normalization of women’s pain isn’t the direct cause for what these patients endured at this particular clinic — but it does likely play a role in how it all unfolded, how the affected women navigated their experiences, and why this all could have happened in the first place.

We live in a world that consistently undervalues the experiences of women, especially as it relates to their pain. This is especially true when that pain is related to their sexual, reproductive, and menstrual health — and because those topics are still considered culturally taboo, many women aren’t able to untangle expected discomfort from unnecessary pain. 

In many ways, the IVF process feels like the “perfect” time for women to suffer undue pain. Our cultural understanding of what fertility treatments really involve is poor. People who have undergone these treatments rarely discuss the nuances of their experience, which leaves patients wholly unprepared for what it really entails. 

On top of that, there’s the deeply emotional nature of IVF. Often, we desperately want to become parents, so we become singularly focused on the outcome that we neglect our own needs in the process — so maybe, when we feel excessive pain, we keep it to ourselves. 

But this needs to end. Women shouldn’t bear unnecessary pain, and the medical community needs to better account for the underlying biases we hold when listening to them describe their symptoms. There’s inherent danger involved if this doesn’t shift.

With the release of this podcast, there’s a real opportunity to bring awareness to the issue of normalization of women’s pain, both in and out of medical settings. There’s also an opportunity to make women aware of what’s normal — and what’s not — when it comes to pain experienced during IVF and egg freezing. 

We’ve asked Sara Twogood, MD, an OB/GYN and medical board expert at Flo, to weigh in on these issues — and shed light on how patients can better advocate for themselves.

Why is women’s pain so often dismissed or downplayed?

According to Dr. Twogood, there are a lot of reasons for this — and some stem from long-held gendered stereotypes.

“Part of this is that women as a group have been labeled ‘dramatic’ or have been thought to overreact (both of which are not true),” she says. “But if these labels are in place, then any time women are vocal or have concerns people will think they are not valid.”

“There can be a lack of empathy in regards to female pain related to reproductive issues specifically,” Dr. Twogood continues. “This can be from males because they don’t have the same system and any personal reference. The severity of pain varies greatly from one person to another so even women may have a hard time being empathetic when they themselves don’t have the same severity of pain.”

Should fertility treatments like IVF be painful?

“Individuals who are usually more sensitive to pain or have pain with pelvic exams may be more likely to feel pain during the IVF process, specifically the egg retrieval procedure,” says Dr. Twogood. “IVF egg retrieval without adequate sedation and pain relief is painful, which is one of the reasons why sedation and pain medication is typically a part of the procedure.”

There shouldn’t be significant pain if everything is done correctly (in the stories detailed in The Retrievals, patients weren’t getting pain medication, which is why they were experiencing so much pain). 

“During egg retrieval procedure, patients are typically sedated but not asleep, so if patients are not feeling sedated when they should be - they should tell their doctor something like ‘I’m not feeling sedated, I don’t think this medicine was enough or I don’t think this medicine helped’,” says Dr. Twogood. 

How can women find healthcare providers who will listen to them?

Should they “interview” physicians before starting something like egg freezing or IVF to make sure they find someone who won’t minimize their discomfort?

Dr. Twogood advises anyone who is navigating the healthcare system to seek out a second opinion or a new provider if they feel uncomfortable or invalidated. 

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A provider who won’t participate in conversations about pain could be a red flag. “It’s very reasonable to tell a physician you’re worried about pain and want to discuss it in more detail - they will almost always be willing to have this conversation,” says Dr. Twogood. “I suggest patients use their consultation visit (or any doctor visit) as a way to get information AND to assess if the doctor-patient relationship feels right for them. 

What are some red flags women may notice in healthcare providers?

Your gut is your best guide here. “Always trust your instinct - how do you feel there? Taken care of or dismissed? Do they treat you like a person with individualized needs or as just another number? Some offices are under quite a bit of pressure to increase volume, and unfortunately, this can lead to a lack of personalization as well,” says Dr. Twogood. 

But ultimately, your comfort matters — without it, you may be less likely to voice your concerns or speak up about anything that doesn’t feel right.

“When looking for providers, ask your other doctors, friends, and family for referrals if they have personal experience as well,” suggests Dr. Twogood. “I always encourage people to get a second opinion, especially if they are not 100% happy with their experience with any provider.”

How can women advocate for themselves if they’re in pain during a medical procedure?

The first step is getting a good sense of what is expected during any procedure. Information is power, and knowing what’s happening to your body — and how it should feel — is vital in advocating for yourself.

“I would always recommend asking: ‘If I'm experiencing unexpected pain, what do I do?’,” says Dr. Twogood. “Having this conversation beforehand can help ease anxiety and give you and your provider a game plan if the procedure doesn’t go as planned. Also, if you expect you will have trouble with pain control, discuss that ahead of time too.”

Advocate for yourself before, during, and after your procedure. “If you ever feel uncomfortable or uneasy during a procedure, describe what you are feeling, the intensity of it, and that you want better pain control with your provider before the procedure continues,” says Dr. Twogood.

Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, Marie Claire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.