The stress, strain, and emotional upsets that come with an infertility diagnosis and treatment are universal and have a significant impact on patients’ wellbeing. The evidence that stress causes infertility is mixed. The evidence that infertility causes stress is convincing. The American Society for Reproductive Medicine Patient Fact Sheet on Stress and Infertility (2014) states that it is still unclear whether high levels of stress can prevent pregnancy or affect a woman’s chances of conceiving. However, we do know that reducing stress provides a better quality of life during intense personal challenges.
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. Male partners, on the other hand, are often puzzled and worried about their female partners’ emotional state. A lack of good communication adds additional strain, 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 who may take a couple through several Ovulation induction treatment cycles. The next step is referral to a specialist, such as our 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, and work. 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, the 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 is crucially important to our wellbeing is how we allow ourselves to recover from stress. Fertility Centers of Illinois’ two on-staff behavioral health specialists frequently counsel patients about stress reduction and management, and attempt to normalize their fertility-related stress. Our goal is to prevent patients from 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. We currently offer our patients a monthly support group for couples and individuals. RESOLVE has some local support groups. Organizations such as RESOLVE and Path2Parenthood, both offer excellent online support and information. We counsel patients to seek contact with people who are genuinely helpful and avoid contact with people and situations that make them feel bad. For example, they are allowed to decline an invitation to a baby shower if it will be too painful to attend.
Other stress reducers are taking a short break from treatment, eliminating non-essential stress (changing jobs, remodeling a bathroom), and focusing more attention on their relationship. 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. We also recommend mindfulness skills, like deep breathing and meditation.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.
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.