Emotional Aspects of Infertility
Infertility can be such a stressful journey for a couple. From the initial diagnosis to a long pathway of oftentimes empiric therapy, infertility can create a significant amount of stress on a patient and her partner’s physical and emotional well being.
So what is stress? Stress is a challenge to our body, minds and environment when we do not have the resources to cope with this stress. For an infertile couple, this may be the stress of the diagnosis and the realization that they may not be able to conceive naturally or not having the resources available, whether emotional, physical or fiscal, to attempt conception. This may also be the stress associated with the feelings of loss after multiple miscarriages or the loss and feeling of failure after a treatment cycle when the pregnancy test is negative.
Physiologically, stress may cause a release of adrenaline which increases heart rate, blood pressure, respiratory rate as well as increasing blood flow to the major muscles in our body. In an acute event this is helpful; however, chronically, this may cause a loss in the body’s ability to regulate its inflammatory response, and in turn will lead to a variety of medical diseases—including depression. Most importantly, this may further exacerbate infertility and lengthen the overall journey to conception. The best and most thorough research to date has been on the relationship between female distress and in vitro fertilization (IVF) success rates. There have been 14 published studies that have looked at distress levels in women prior, or at the beginning of, an IVF cycle. These studies have been conducted worldwide. Ten of the studies showed that distress levels are indeed associated with decreased pregnancy rates. The more anxiety or depression the women experienced before undergoing IVF, the less likely they were to get pregnant.
Stages of the emotional journey
Emotionally, infertility encompasses a few stages that most patients will undergo, although each patient’s experience is quite different. Initially, most couples go through a process of denial. They rationalize out why - although it has been three years, they may not have truly “tried” and do not meet the diagnosis of infertility. Or why their initial treatments did not work. They are anxious to admit there may be a problem for which clinical guidance is needed.
There are also feelings of anger. Many patients are angry because they may feel vulnerable, helpless or both, often projecting that anger onto friends who offer helpful advice or friends who are pregnant. They may have anger related to their partner or family, resulting in patients distancing themselves from family or friends, or events which remind them of children or their fertility, thereby weakening the support system they truly need.
Some patients will go through a stage of bargaining or looking for hope, whether this is with a provider or with a particular aspect of therapy or promises of pregnancy, and could stem from guilt or shame. Ultimately, most patients enter a stage of acceptance where they will understand and embrace their diagnosis, their treatment plan and the possible outcomes.
Coping with emotional challenges of infertility
Having the knowledge that both stress and the infertility journey in and of itself can be an overwhelming process, it is helpful to know there are tools in the armamentarium of every patient to help them deal with the emotional challenges of infertility.
1. Relaxation response therapy – relaxation response is a state of deep rest and will counteract the impact of stress on the body. The relaxation response can be induced through a wide variety of relaxation techniques, including progressive muscle relaxation, deep breathing, meditation and imagery. Progressive muscle relaxation involves progressively tightening and then relaxing your muscles, either from head to toe or vice versa. Deep breathing involves breathing slowly from your belly, like sighing deeply. Meditation requires focusing on a word or phrase as you breathe. Finally, imagery can mean a variety of things, ranging from imagining a pleasant safe spot to focusing on your body.
2. Mind Body Program – An integrated program focusing holistically on the patient and originally penned by Dr. Alice Domar. Mind/body techniques include both physical and psychological skills. Physical skills include relaxation techniques, “mini” relaxation techniques and information on lifestyle habits which can impact fertility. Psychological techniques include cognitive restructuring, social support, coping with negative emotions such as anger and guilt, and self-nurturance.
3. Acupuncture – Acupuncture has been shown to help fertility by reducing the effects of stress and balancing the hormones. Some purported benefits include increasing blood flow to the uterus and ovaries, increasing the uterine lining, and decreasing uterine contractility. Most, if not all, the studies of acupuncture's effects on fertility have been looking at the effects of acupuncture on IVF patients. These studies suggest there may be positive effects, although this data is not conclusive.
4. Nutritional/Exercise therapy – Diet is an important aspect of stress management. It is best to cut down on or eliminate sugar, salt, saturated fats, white flour, chemical additives, alcohol and caffeine. Caffeine is a particularly strong offender, and you may be amazed how much more peaceful you’ll feel when you give it up, or at least cut down, on colas and coffee.
Other important nutritional and exercise tips include:
a) Get plenty of sleep – many people need eight hours.
b) Allow time in your life for rest and recreation.
c) Get plenty of exercise. Not only does it relieve physical tension, but if it’s aerobic exercise like running or swimming you will actually metabolize norepinephrine and serotonin, the substances your body produces when you’re under stress. You will truly get rid of stress. Consider taking a yoga, exercise, or dance class.
5. Coping techniques – These may be varied depending upon a patient’s personality. However, some examples include:
a) Getting more information about infertility, therapy, and options
b) Give yourself the opportunity to cry and be angry
c) Give your partner the chance to heal and mourn differently than you do
d) Teach your support system how you would like to be supported and, most importantly, take the time to care for yourself during this journey.
Ultimately, it is important to be aware of the stress infertility and its journey can cause. It is important to refocus on you and your partner. Utilize your support system when needed and train them to support you as it helps you best. Have tools such as relaxation techniques, exercise, and acupuncture available to you. Know that parenthood awaits whether naturally, through therapy or alternative means.