Managing Stress, Anxiety, Fear and Anger

Andreia Trigo, RN BSc MSc
Founder of Enhanced Fertility Programme, Enhanced Fertility Programme

Emotions and Support

Managing stress, anxiety, fear and anger
From this video you will find out:
  • How to manage stress, anxiety, anger and fear
  • How are our feelings triggered
  • Where your strength comes from
  • How to speak to yourself with compassion

Infertility - How to manage Stress, Anxiety, Fear and Anger

Andreia Trigo, Founder of Enhanced Fertility Programme, is talking about how to manage stress, anxiety fear and anger connected with infertility.

How To Deal With Stress During Your IVF Journey?

- Questions and Answers

My donor egg collection has been delayed due to Covid-19. It’s so frustrating because the clinic is not staying in touch. I have to keep chasing them. Anything I can do?

Understandably, you feel frustrated at this time. Usually, when we are facing a crisis what we expect from the clinics and the governments is to over-communicate. That’s what I have been telling all the clinics, you need to over-communicate social media, you need to call patients, email patients because that’s what people expect when it’s a crisis, people expect you to show them that you have a plan and that everything is under control and that you’re giving them hope that they can go ahead, but unfortunately, I know that a lot of clinics are still not doing that, so the best thing that I could say is to continue chasing them and calling them because if they are not calling you, that’s the only way of you getting an answer is by getting in touch with them. In terms of managing your emotions I think you can also f. e. try and keep track of the changes that are happening around Spain and around the UK, what travel restrictions are in place and when clinics might be open, so there might be ways of being aware of that through the news or through social media or by being in touch with other patients that are in that clinic or maybe even following the clinics on social media, some of them are sharing some of the news about being closed or open or running other webinars like this one. It might be a way of getting in touch with them. I would say that to manage your frustration, the best thing would be to try and keep busy and try and schedule a time to look into these topics because otherwise, it can consume all your time and all your worry if you are so focused on this topic. So, if you allow yourself f. e. half an hour a day, at the end of the day to look into it and go on social media to check the clinic, email the clinic or try and call them, just do everything you need to do in half an hour. Then allow yourself for the rest of the time to engage in other activities and other things that do allow, to continue having a life outside of these restrictions.

Do you think that prescription drugs for anxiety affect fertility? I take citalopram.

Unfortunately, these drugs do you affect fertility, it’s well known, but I mean if you have been taking them for a long time and if you talk to your general practitioner or if you have a fertility doctor does tell them that you are taking these drugs, but these do tend to affect fertility, they usually affect libido, and some anti-psychiatric drugs, like SSRIs, can also affect the quality of sperm, so I would definitely say to speak with your general practitioner or a fertility doctor if you are taking those medications to see if it’s a possible reason why you haven’t gotten pregnant yet.

Would you recommend 1mg of Melatonin before going to bed daily for better sleep and less stress?

I don’t think you need it. When we look at the evidence behind supplements, there is a very little effect on supplements apart from folic acid, and there’s mixed research on vitamin D. The most important thing for you is to have a good sleep and make sure that you’re allowing yourself a calming period before that. If you have dinner you need at least 2 or 3 hours between dinner and going to bed and before going to bed that last hour you have a cooling down period, so you can maybe do a bit of relaxing yoga, or you can do a bit of reading, but you should start toning down the lights, no artificial lights, your phone shouldn’t be near your bed, you can do a little bit of mindfulness and meditation, that will allow you to have a good sleep. Sleep is actually important for fertility, but you can achieve good melatonin levels by making this lifestyle and environment changes instead of just taking more supplements.

Is magnesium good for stress?

It’s the same situation with supplements, there isn’t any strong evidence saying that supplementing your diet with magnesium is needed or has any effect. I think the most important thing to manage stress would be trying to manage the thought. Remember, we said that the thought leads to the feeling and the feeling leads to the action. Try to identify the thoughts, manage the environment around you, reduce the stressful triggers around you, do a bit of mindfulness or meditation, try not to have a list of to-do things that is too big. I’ve done that myself over the years, I was just adding 5,6,7 things to do during my day, and it was impossible to do them, so plan the things that you’re giving yourself to do realistically and you’re able to do everything that you want to do. There are also other situations where you’re facing stress that you cannot really relieve the trigger, so I’m not quite sure what your circumstances are in particular, but and there are people who are suffering from chronic stress f. e. related to family situations, having to take care of family members who are not well, or being in job positions where it’s very stressful, very demanding, so it depends on if it’s the stress that you’re feeling in one moment or it is a stress that has been continuing for a long time, but the best way to manage stress is to remove the trigger, not take supplements to be able to cope with it. If you’re feeling stressed, your body is telling you that something isn’t quite right, so it’s all about listening to your body and adjusting what isn’t right instead of just taking something to try and hide it or manage it somehow.

I don’t take any medication, but my anxiety levels have always been high, I don’t think I really control it even when I believe I do, for instance during the 2 weeks wait after embryo transfer. Can high levels of stress really affect the outcome?

There’s a lot of studies around fertility and stress and what we tend to believe at the moment is that stress does not cause infertility, but infertility does cause stress. So if you have been trying for a long time, I’m not surprised that you’re feeling anxious or stressed a lot of the time. We know that if you’re feeling stressed, you are less likely to have intercourse f. e., so you’re less likely to get pregnant, that’s what research has shown us. In terms of the two-week-wait if you’re feeling stressed we need to think about if I’m feeling stressed what actions am I taking because that will give you the results that you’re getting. So if you’re feeling stressed, but you’re finding a way of still coping with your day-to-day, and you’re doing the things you want to do, then it won’t affect your results, but if you’re feeling stressed and it is in your taking actions that might somehow affect the treatment, that you’ve just had, it can affect it. In terms of research, what we know is that the level of stress does not affect the fertility outcome, but the outcome, can cause stress. I would say that if you want we can schedule a free consultation and we can talk about some of the strategies around anxiety and stress, and we can do a small assessment to see if that’s something that you can implement in your day-to-day life or if you do need some medication because some people will eventually need medication. I would say you need an assessment initially, and then we can talk about virtually needing medication or being able to manage it with some behavioural strategies.

Does stress affect egg quality and number of AFC?

The research doesn’t show that stress affects egg quality and follicle count. What we know is that if you are being followed in the fertility clinic and you are aware that your egg count is low or that your egg quality is low, then you might feel stressed about it, but stress does not make you infertile. We know that if you’re stressed you are less likely to have sex, so let’s say you go to the doctor, and you know that you have poor egg quality or fewer eggs and that makes you feel stressed, and then you’re less likely to have sex, so you’re like in a vicious circle. Stress does not cause infertility, but infertility may make you stressed. The biggest factors on egg quality and egg count are age, so woman’s fertility starts worsening from the age of 35, so we know that our egg quality and the number of our eggs starts reducing from that age, and after the age 40, it becomes very low, the chances of fertility treatment working over 40 are very, very low and there’s a point when you might need to consider egg donation. Apart from that, stress or any other mental health problems do not affect the quality or the number of your eggs.
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Andreia Trigo, RN BSc MSc

Andreia Trigo, RN BSc MSc

Andreia Trigo is a multi-awarded nurse consultant, author and TEDx speaker. Combining her medical experience and her own infertility journey, she developed unique strategies to help people undergoing similar challenges to achieve their reproductive goals. Her mission is to improve accessibility to fertility care and support worldwide at minimal cost to populations. She is also The Founder & Director of Enhanced Fertility Programme, the evidence-based programme that improved help for fertility, currently in use by several clinics and patients worldwide.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.