The stress, strain, and emotional upsets that come with an infertility diagnosis and treatment are universal and have a significant impact on patients’ well being. The evidence that stress causes infertility is very mixed. The evidence that infertility causes stress is much more convincing. The American Society for Reproductive Medicine Patient Fact Sheet on Stress and Infertility (2008) states that stress is probably not a cause of infertility in most people, while the stress associated with treatment can equal the stress of patients with life-threatening diseases.
Women are affected much more powerfully, but men suffer, too, often silently. Worry about not conceiving begins early for women, who may become anxious after a few months of trying. There is a definite gender delay in couples, with men maintaining greater hope and optimism for much longer. This disparity often causes friction in a couple, when the wife is upset and feels her husband isn’t as upset, which indicates to her that he doesn’t care. Husbands, on the other hand, are often puzzled and worried about their wives’ emotional state. A lack of good communication adds stress, and many couples find it is difficult to talk productively about fertility and family-building decisions.
Most patients begin investigating fertility with a gynecologist-obstetrician, who orders appropriate tests (including a semen analysis) and may take a couple through several Clomid treatment cycles. The next step is referral to a specialist, such as the reproductive endocrinologists at Fertility Centers of Illinois. That transition is usually very stressful for patients. Their inability to conceive has now taken on a more serious tone. There are more tests, more waiting, and probably more treatment.
As time passes without success, stress and anxiety can build to agonizing levels. Our patients’ daily routines are interrupted by clinic visits and procedures, they are often taking hormones that affect emotional balance, and they may also be struggling to pay the bills for this process. All their relationships are affected — marital, family, friends, work, and church. Even perfect strangers can be hurtful, simply by asking, “Do you have children?” The unhelpful advice and comments of others pile up on our patients, who feel misunderstood and isolated. They are not in control of an extremely important process that seems to come naturally to everyone else, and they don’t know how all their efforts will turn out. RESOLVE, a national organization that offers information and support to infertile people, has a publication designed to advise the family and friends of infertile people how to support loved ones and, especially, what not to say. Topping the list is “Just relax, and you’ll get pregnant.” Equally upsetting to our patients is hearing the advice, “You have to have a positive attitude or it won’t happen.” Patients who have no diagnosis other than “unexplained” tend to be hurt the most by these bromides with no scientific underpinnings.
A major reason why the studies that examine the effect of stress on fertility are so unclear is that they fail to take into account the ways that people manage stress. There will never be a condition of no stress, because some stress is normal and expected. Human beings need a little stress to stay motivated and productive. What becomes crucially important to our well-being is how we allow ourselves to recover from stress. As FCI’s staff psychologist, I frequently counsel patients about stress reduction and management, and try to normalize their fertility-related stress, which I call “the normal-abnormal stress of infertility treatment.” It’s abnormal only because it’s not even close to average stress and it’s normal because every fertility patient has it. I tell patients that, if it were a requirement for patients to be stress-free and always upbeat in order to become successfully pregnant, we’d have a 0% pregnancy rate. The last thing I want to see is a patient taking on more pressure by developing “stress about having stress.”
There are well-documented ways for fertility patients to manage stress more effectively. We know support helps enormously, but only when it is appropriate and not somehow judgmental (as in, “stop thinking about it so much”, as if that is even possible.) Illinois RESOLVE has some local support groups and FCI offers several groups that I facilitate. The American Fertility Association (AFA) and RESOLVE both offer excellent online support and information. I counsel patients to seek contact with people who are genuinely helpful and avoid contact with people and situations that make them feel bad. They really don’t have to go to all those baby showers at this point in their lives.
Other stress reducers are taking a short break from treatment, eliminating non-essential stress (changing jobs, remodeling a bathroom), and focusing more attention on the marriage. Couples get into a rut and stop talking and even stop having sex, unless it’s scheduled for procreation. This can be very damaging if it is not addressed. Short-term counseling can be very effective.
My physician colleagues and I also recommend exploring complimentary treatment, such as acupuncture, yoga, massage, and nutritional advice. FCI has enjoyed a special partnership with Pulling Down the Moon, where many of our patients have found solace and friendship in such programs as “Yoga for Fertility”. Many patients find that learning to relax through breathing techniques or meditation makes a positive difference for them. It’s not “relax and you’ll get pregnant”, but relax and you’ll be better and stronger.
Subtle but important changes in thinking can be very useful and stress-reducing. It’s not about “just think happy thoughts”, but about examining the brutal thoughts that many patients carry around, such as, “I will never be a parent,” or “Why me? I must be being punished for something.” Alice Domar, a Boston-based psychologist, has written eloquently about the various ways fertility patients can help themselves feel better, including managing negative thoughts that have become oppressive. I often recommend her thoughtful and down-to-earth book, Conquering Infertility.
At Fertility Centers of Illinois, our entire staff tries to see our patients holistically and we recognize that fertility issues are not just medical. They affect a person’s emotional and social life profoundly. We do our best to offer our patients emotional support and tools for coping with this very challenging time in their lives.