Watch the webinar with Monica Moore, a women’s Health NP, where she talks about dealing with IVF failure and emotional support.
IVF treatments have their own set of challenges and consequences that can generate stress. The issue is that we don’t know how many cycles it’s going to take. The data shows that the likelihood is that we’re going to be able to have a baby and take a baby home in terms of IVF success rates, depending on how far you’re willing to go with assisted reproductive techniques. You don’t know the timing, and that’s hard.
Dr Alice Domar, PhD, a pioneer in the field of mind/body medicine, conducts ongoing ground-breaking research which focuses on the relationship between stress and fertility. She did a study on a life event scale and found that IVF failure is related equally to breast cancer, the death of a family member, and worse than divorce. That is why it is so important to realize that you are grieving. It doesn’t matter if you’ve lost a pregnancy in the early stages or at any stage; you’re grieving that loss. Even if you haven’t got pregnant so far and have had multiple IVF failures or multiple cycles that didn’t result in a pregnancy, you’re still grieving. You’re grieving the loss of a dream, maybe a dream a goal or an idea you’ve had since childhood. It is still grieving, and there are stages of grieving. There’s no wrong way to feel during this process.
Our brain has a primary goal to protect us from what it perceives as harm or stress. It sends a cascade of substances and processes to mobilize us for fight or flight. The problem is the brain doesn’t know the difference between the stress of an injection and the stress of a sabre-toothed tiger that’s going to harm us, so it puts out that same cascade, that same amount of stress hormones. It’s meant to do that, but the problem is when you experience this stress, it happens chronically and over time. The other issue is that this fight-or-flight response lives in this primitive part, this caveman part of our brain, and it shuts down the thinking and reasoning part of our brain. Only one can work at a time. So if you feel like you’re in a very acute fight-or-flight or stress activation response, and you just can’t think, can’t act reasonably, and feel like you’re being very reactive, that’s real because that part of the brain, the sort of newer part that can reason, is shut down.
Another thing is that we have a mindset continuum. Everything that happens is along this process. We have a neutral circumstance. For example, if someone has excess weight. It’s the number on a scale. Technically, that’s just data; it’s a number. However, what happens is we have thoughts that occur based on that data. If it’s a negative pregnancy test or a beta hCG level, that is not ideal. Then your thought might turn to, “I’m never going to be pregnant,” and then to, “I don’t deserve to be pregnant. Maybe somebody’s trying to tell me this is not meant to happen to me.” That creates a feeling, often fear or anger, which then generates an action or behaviour, often some form of fight or flight.
In such situations, there are two approaches in terms of coping. One is to start early on this continuum and work on our thoughts, to not let those thoughts become, and to change our self-talk. That’s a really important way to approach it, but it takes a lot of practice and time. Another approach is to go to the end of the continuum and just change our actions or behaviour and let the feelings stay there. You might examine the feelings and the thoughts. Once you’re done, you’re just going to let the feelings be there and still go toward some value-driven behaviour.
Another principle of behavioural science is a habit loop, and a habit loop is comprised of 3 things:
The reason we have these habits, which might feel annoying to us if they’re bad habits, and if we’re trying to incorporate a good habit, it’s hard, is because our brain wants to automate as much as it can to save energy. Every time you go to drive a car, you have to think about all the steps to drive a car, it would take a lot of energy and time. Our brain automates things to make it simple for you. When it’s a habit you don’t like, unravelling or undoing that habit is pretty difficult. The way we respond to a trigger, and there might be many triggers and changing that response to benefit you, is going to take a lot of time because of this.
What does it mean to cope? Coping doesn’t mean positive thinking—that doesn’t work and is quite annoying for people—or that you need to be happy. The concept of psychological flexibility is that you can still experience these difficult and uncomfortable emotions, they’re not bad, just difficult and uncomfortable, and still, move toward behaviours that lead you to your core values—who you want to be most.
More often, you can realize that if you’re able to be mindful and pause, even amid these difficult emotions, you still have a choice about how you react.
Emotions are not good or bad; they are messengers. It’s the way our body communicates with itself. For example:
When we feel bad about feeling bad, we might make it worse.
What are some coping mechanisms? It’s either a sustainable or a non-sustainable way to feel better. You can either try to avoid pain, fear, anger—or you can try to do something that leads you toward a value-driven behaviour, depending on what your values are.
Like emotions, coping mechanisms are not bad or good. We can list them as follows:
There is also a role of quick relief coping mechanisms when you’re in fight or flight or resilience more. If you feel like your fight-or-flight response or activation is particularly acute, then you need to go to an easy button because, remember, that part of the thinking brain isn’t working yet. You need to pause, do whatever you need to get yourself out of that very acute fight-or-flight mode, and then maybe get into some of the more sustainable ones.
Make a list of your core values, who or what is important to you, and then you’re going to identify behaviours that lead you to those core values. These can be a sense of humour, generosity, exercise, and a hot bath. These are what are going to be your empowering coping mechanisms.
Identify behaviours that you go to that lead you away from pain—those easy buttons. Those are a glass of wine, maybe emotional eating, blaming or complaining, a victim mentality, or making excuses. You might be feeling good at the moment, but then later on, you might feel bad or worse. Once you can identify those behaviours or actions that lead you to your core values— take a picture of it or keep it somewhere close by because you probably will need to be reminded to get into these modes until you practice them or do these behaviours that make you feel good should you become triggered or activated.
The behaviours that take us away from the core values—are called easy buttons. For many people, it’s making excuses, eating cookies, drinking wine, gossiping or being snarky, complaining, acting like a victim, and needing justification—these are just a few. But if you find yourself getting into these, these are what feels good in the moment. Remember, they’re not bad, but they are a choice, and they may not feel as good later on as the ones that lead you toward your core values.
Here are some examples: exercise, laugh and use humour, engage with a partner, read, take an Epsom salt bath, connect deeply, meditate, and stay present. Many of you, when going through all these treatments, want to be a parent, so you are then working on behaviours that lead you to that core value. If your core value is being a present parent or an authentic, engaged parent, while you’re working on the fertility part, you can still be working on the present part. You can be working on the engaged part; you can be practising that part even if you feel like the fertility stuff right now isn’t working out, even if you feel frustrated, angry, or ashamed. That’s the whole premise of this—you can feel those things but still do these coping mechanisms.
How do you identify your specific empowering coping mechanisms? Some common ones that are supported in the literature include:
Movement – there are many studies on movement and a lot of good books out there.
Another really important empowering coping mechanism is boundaries. What is a boundary? A boundary is what you will and won’t do, and it allows you to choose who or what makes you feel good versus things or people that add to your emotional burden. It is about protecting you; it’s not about another person. It’s there to protect you. Perhaps, it’s not overextending yourself because every time you say yes to something, you’re saying no to yourself or someone else.
Your job is to state and express your boundaries in a very intentional, calm, and clear-cut way. Your job is not to care how other people respond to your boundaries. People don’t like boundaries if they benefit from you not having boundaries. Your job is just to state them and to be very clear-cut, without any excuses. If that person responds poorly, it gives you valuable information about that person.
Some examples of boundaries:
Another important empowering technique is mindfulness. Mindfulness is simply noticing with curiosity and not judgment. If you are amid a dysfunctional behaviour or action ask yourself: “What am I getting out of this behaviour right now?”. It takes a lot of practice. Take self-awareness breaks throughout the day. Either set an alarm or, every hour and a half, ask yourself, “How am I feeling right now? What do I need right now?” Check in with yourself. Then consider loving-kindness meditation. There are many out there; they’re very short, and if you like them, many apps have them. It’s one of the few meditations shown in brain imaging studies to change that part of ourselves that shows self-compassion.
Words matter; our language matters. Self-compassion is the way we speak to ourselves. If you said out loud what you were thinking and heard the things you said to yourself, you would never talk that way to someone you cared about. However, that’s not how we talk to ourselves. When we bombard ourselves with negative self-talk over time, it’s like tiny little paper cuts. Every time we make ourselves not feel good, we lose our confidence and self-esteem. You need to stop yourself when you find yourself doing that. That’s the awareness and mindfulness. Self-compassion is an important component of confidence, self-esteem, and resilience.
Acknowledge your feelings and that the feeling will pass. Instead of saying, “I’m anxious; what do we do about that?” try saying, “I’m activated or triggered.” This means your fight-or-flight response is doing what it’s supposed to be doing. We can find ways to get out of being triggered or activated. When you say, “I’m anxious,” it’s really hard to get out of being anxious—like, what do we do about that? If we knew what to do about it, we probably would have already done it. Saying, “I’m activated; something’s triggering me right now,” takes the permanence away from it.
Notice that you’re feeling triggered, which is causing you to feel anxious. Be kind to yourself at this moment or acknowledge that you’re going through a hard time right now. Pay attention to what you’re feeling and respect yourself for trying, persevering, or whatever it is you’re doing. You do these things regularly, but you don’t give yourself credit for them because you weigh the things you don’t do well much more heavily than the things you do well.
Journaling is another helpful technique. It’s not about what you read or going back and reading it. It’s about getting what’s in your head out of your head and onto paper. Get everything out; don’t let the pen leave the page. Whether or not you read it later doesn’t matter. Getting it out of your head and onto paper can be incredibly freeing.
When dealing with others, assume positive intent. People are doing the best they can; they’re well-meaning but usually misguided unless they’re incredibly insightful or self-aware. They may say things you’ve heard over and over again, like, “You shouldn’t be so worried; you’re doing fine,” or, “If you just relaxed, it would happen,” or, “My friend’s cousin’s uncle’s friend went on vacation and got pregnant in Bali.” These comments don’t help us; they help the person saying them feel more comfortable because they don’t know what to say. It’s a great time to work on your boundaries.
Your relationship with long-time friends might change. It is okay to pause or take a little time away or energy from those friendships. Other people’s behaviour doesn’t hurt our feelings.
Nutrition starts with you telling yourself that you deserve to be nourished. It’s one of those self-talk things that’s so important. How you eat is just as important as what you eat. Work on eating mindfully with no distractions, with a plate a table and a chair every time you eat, as opposed to walking around. It helps when you have mindful eating to practice mindfulness, to practice being present. Food or emotional eating ends up being on that easy button thing. We’re using food to solve a problem that food can’t solve. If you find yourself headed to the pantry because you need a sense of relief, or you find yourself heading to the pantry because you’re bored and you need to increase a level of stimulation, is there anything on your nourishment menu that you can use instead?
Getting good quality sleep is incredibly important. Poor quality sleep decreases your immune system, it wreaks havoc on many of your hormones, including the stress hormones, and your hormones that tell you if you’re hungry or full. So it’s really important, and something you can practise is to get good quality sleep. There is a part of the nervous system called the parasympathetic nervous system, and the nerve that’s in charge of that is called the vagus nerve. When that gets stimulated, that tells your body to rest, digest, and connect.
Related reading:
It’s so common that partners are on different pages, and that core values exercise that I brought up is helpful in relationships too because your husband or partner may have a different core value. Theirs might be to let’s say protect you, without investigating what that is, you might think he’s not considering my feelings but he might think, you know what, going to do donor egg is going to be too stressful for you, or it’s going to be something that you didn’t think about, this is his thought to protect you. I think the first step is to find out the kind of the why behind the why.
Why are you feeling this way? You may need to do it through an objective third party. This is where it would help to have a therapist who can ask the deeper questions if he’s unwilling to do it. I did the core exercise with my husband because some things drove me crazy and what I found out is that again it’s a positive intent, so some of the ways that he went about meeting the core values that he thought were meeting my needs were so, let’s just say interesting that I didn’t get it until we had a conversation about it and it might be a good conversation starter. If you still are kind of not getting too far, you feel stuck that way, then I would ask for help with the therapist who can ask the right questions, and then if he’s willing to go to the therapist, he’s going to be receptive to talking about this a little bit more.
I think my 3rd side was that you are stressed because this is incredibly stressful looking at your situation. I can tell you what on earth is happening to your body, you’re in a fight because you are through an incredibly stressful situation. If you think about it, we are told, you study hard for a test, you do well on the test, you train for a race, and you do good on the race, you lift weights, and you get strong. Here is something that you could have done right, and it still hasn’t happened to you. It’s incredibly stressful and what it takes away is your sense of agency, and I used that word before, but I didn’t explain it, and what that word means is that what you do matters, and I think a lot of times when we go through the cycles, we feel like we’re doing everything we can and it doesn’t matter, so that’s what I think is probably happening to you and then your body is in this constant state of fight or flight.
Although I think the movement is incredibly important, and I’m glad that you do it, I also think maybe you need to explore some of your other very specific empowering coping mechanisms, I also think that maybe what I tell people is to bookend your day, so right before you go to bed maybe listen to a meditation. I love Insight Timer, I think it has like 30 000 or something free meditations and picks a meditation before you go to bed that makes you feel how you want to feel, it’s like ending your day with that, and it’s sort of like that is the thing that you’re putting into your subconscious before you go to sleep. If you wake up and you’re unable to get back to Steep, I would say to go to another meditation if you can. I tell people to frequently use that because you just need to stop that loop in your brain, which is so difficult to do from thinking what if because you’ve had at least 12 what-ifs. Your brain’s like this is not going to work for me, and you need to figure out a way to get out that loop, then when you wake up in the morning to set an intention. That intention or to do something intentionally, that could be meditative, that could be a couple of minutes of mindfulness, it could be reading an inspirational book or reading something that makes you feel good. It could be getting outside if it’s a nice day and feeling the sun, anything that’s sort of like on your mind.
I love the journaling. I’ve mentioned that before but what I find is if you decide to journal and like let’s say you do it at the end of the day, your journal, and then what you do is when you close the journal that night, that’s a signal, I’m done thinking about that because you got all those thoughts out, they have somewhere to go because you’re probably thinking like I don’t want to forget this, I don’t want to forget to think about this, or you can journal in the morning so that you start the day off like that. Then you’re thinking at night about all this stuff, and you’re like, you know what – I’m going to put my meditation app on now because when I wake up, I can journal this, so at least your thoughts will have a reservoir to go so they can get out of your brain.
Nutrition and sleep often go together when one is poor – the other one is often poor as well. Sleeping a lot is usually a sign of maybe feeling sad or depressed, and I don’t mean to say that you have a deep depression, but that’s how the body copes, the body wants to regenerate in that way. When you go to sleep, you must be thinking a certain thing, and then when you predict how you’re going to feel when you wake up, let’s say from a nap or sleep, you’re going to predict, you’re feeling a certain way. That’s your behavioral loop, your cue is maybe – I can’t take this, I just have so many things going on, I just need to close my eyes and then afterward, I’m going to feel balanced, peaceful, calm whatever the word is.
The problem is that action, the action of sleep isn’t sustainable, you can’t probably live that way, so you have to explore when you feel whatever it is that preceded the sleep, what else can you do to create that sense of calm, peace, completeness. You might write down 20 things, and you have to try them out, and it might be two or three things but I think a lot of times it just has to do with all of these things going on on your mind and feeling powerless, so getting them out of your head in some way and then finding strategies that help you feel a certain way, the perception of sleep, how you feel is going to be really important. In terms of not eating at all, that is probably, what happens when you get into the fight-or-flight response.
The blood flow goes to the brain, the heart, the lungs, and it goes away from the stomach and actually away from the reproductive organs because they’re not important quoting fight-or-flight response and so what you might feel is that you’re not feeling hungry at all, some people feel the opposite because the digestive system is not getting innervated with blood, so if you can figure out strategies that you’re not in this constant fight-or-flight and maybe it is I can bring up these meditation apps.
If you’re feeling that way and you can get out of the fight-or-flight, you can get into that rest and digest part that parasympathetic, there’s ways to activate what’s called the vagus nerve. Another great way to activate the vagus nerve is breathing, and it’s breathing from the belly as opposed to chest breathing, so if you put your hand on your belly, it’s weird to feel it first but breathing from your belly is a very quick, easy way to innervate the vagus nerve and to make your exhale longer than your inhale, that’s another important kind of aspect of it, so any way that you can get there might let the digestive enzymes go, may get you out of fight or flight. In the beginning, you’re going to have to keep telling yourself to do that until it becomes a habit, that’s where that habit loop comes in.
