Stress and Infertility - Managing Relationship, Family and Work
The webinar is hosted by Lisa Schuman, Director of the Center for Family Building and Director of Mental Health Services at Reproductive Medicine Associates of Connecticut. According to the saying ‘You don’t know that you don’t know’, she and her group (www.familybuilding.net) offer a lot of information to people undergoing fertility treatment. They lead many counselling projects and have a whole program created for patients in order to make the fertility journey easier for them.
Lisa has worked at several fertility clinics for over 23 years and during this time (as well as during her own fertility journey) she’s made some valuable observations. She admits that there are many things that have changed for the better in terms of fertility treatment: medical procedures and processes that are much more automated and more patients’ friendly than 20 years ago.
But unfortunately there are still some holes in the industry and patients do not get enough information and psychological support they need. Like, for example, is there a relationship between anxiety and depression and infertility? Does stress cause infertility?And, on the other hand, does infertility cause depression/stress? Answers to all these questions are really anticipated by patients and during the webinar, Lisa proceeds to dive into them in details.
Myths to be dealt with
First of all, Lisa starts with dealing with some harmful myths. No matter how many times doctors tell people they’re not responsible for their infertility, women still do feel guilty and responsible for it. That’s the biggest misconception and it has never been proven that any type of anxiety or depression influences a person’s infertility. However, infertility and infertility treatment are associated with stress. Going through the treatment unsuccessfully can feel equal to going through chemotherapy as they’re at the same level of depression. As you go through the treatment you get more and more depressed. It triggers the so-called ‘Fight or Flight’ response – a psychological reaction in our body that occurs to an actual or potential threat or danger. As a result, the cortisol levels (the stress hormone) build up in our system and we experience different symptoms of stress.
Lisa differentiates three types of stress-related symptoms: physical, psychological or behavioral. Typically people have physical symptoms such as: insomnia, headaches, back pain and neck pain, fatigue, abdominal pain, gastrointestinal symptoms, shortness of breath, etc. Psychological symptoms are: irritability, worry, sadness, hopelessness, confusion, anger, forgetfulness. As all these symptoms go on, we have all these related health problems, like for example increased risk of hypertension, coronary heart disease, decreased immune function and hastened aging. When you know what your own stress-related symptoms are, you can start to work on some strategies to help yourself.
According to Lisa, men and women react differently to stressful situations in their life. When men are stressed, they tend to watch TV more and drink alcohol more. They always try to fix things, get a diagnosis and move on, in other words – do things they need to do in order to help themselves. Women, on the other hand, are very different. They tend to exercise less, eat more junk food and plan for every possible scenario around the corner. All of this above is not healthy for any relationship. Couples may feel out of step with each other. They don’t understand each other anymore and don’t work as a team. They don’t have the same perception of the world anymore.
But just because people are experiencing different things, it doesn’t mean that they do not love each other. Lisa assures that it is completely normal that you do not always see eye to eye on everything. But still, you have to accept your different points of view and make efforts to understand each other’s needs and remain close. It’s good to do enjoyable activities together, go for walk regularly, try to stay connected. Couples should not let this experience pull them apart but they should try to schedule pleasurable activities together. And when it comes to fertility treatment discussions, they should not last longer than 20 minutes. This way it is possible to minimise the way this experience influences the whole life and poisons everything.
Response to the outside world
Lisa all the time highlights the basics: we cannot control the external world, we can only control what’s going inside of us and how we are going to respond to the outside world. In fact, there are a lot of things you can do to help yourself in this one of the most stressful periods of your life.
First of all, there is counselling. It is highly important as you have regular opportunity and place to process all the information about the treatment, its next steps and possible ways to manage your relationship-related problems. A person should not isolate themselves with depression. You should get out to the world, talk with others and be open.
You can also start to train your mind with meditation, yoga and relaxation exercises in order not be ‘hijacked’ by your emotions. There are a lot short meditation techniques that are easy. In fact, there are a lot of helpful apps, like FertiCalm, HeadSpace or Calm. They are all guided and easy to use mediations. Lisa suggests to try them to feel a sense of relaxation and and overall wellbeing. If you feel that meditation is too hard for you, can turn to yoga, called moving meditation. It is also a good idea to start journalling – in this way get all the feelings out of your body and put it down on paper. Find a solution that works for you and don’t get down on yourself. Always respect yourself, that’s the most important rule.
Lisa also gives us some practical tips to use in everyday life. During a fertility treatment, patients are just passengers – these are doctors who prescribe a protocol and have control over the treatment. Of course it may feel frustrating because you cannot do anything about it.
That’s why it is so important to find rules and activities that are within your control and make them part of your weekly plan. When you start to incorporate them into your daily schedule, they may make you feel a little more empowered, like you’re taking your life back a little bit.
Discard, delegate or delay – when you feel your life is crazy and you have so much going on, just start discarding, delegating and delaying your responsibilities. Simply take some of them of your ‘to do’ list and delay them to the next month.
Find 5 things to feel good about every day – write them down in your journal to make them even more effective. The feeling of gratitude will help your attitude. The good things may be simple: sunshine, heart speeding at your chest, best friend you can talk to, job you love, etc.
Put a lot of good in your life – schedule some enjoyable activities along with the protocol of your treatment: theatre visit once a week, hiking, new language class twice a week, etc. It’s good to put those things in your calendar because they may motivate you lo leave home and meet people.
Follow 80/20 rule of eating well – in other words, try to eat well at least 80% of the time. Remember that little bit is better than nothing. It’s helpful not just to your body but also to your state of mind.
Do more exercise – and do it in any way you can: you can walk, swim, work in your garden. Just do something to get outside and help yourself just a little during the treatment process. Generally, it’s good to find enjoyable ways to feel productive and not isolate yourself.
Strategy for dealing with friends and family
Finally, Lisa advises how to successfully ‘manage the damage’ with friends and family and keep relationships in tact. It may happen that people who just want to be helpful, say hurtful or intrusive things to you. The reason for this is that they simply do not understand what you’re going through and how hard this experience might be. Simply because they haven’t been there.
Lisa suggests to always tell people what you need – give them some directions, especially to those who really care about you and whom you may want to have in your life later. Tell them you’re going through a lot at the moment and you do not want to go into details right now. However, if you have the news, you will tell them. Think carefully about what you want to disclose to others – and remember that if you tell many people about your egg donation experience, you have to make sure to tell your babies early in life about their birth story. You don’t want others to do it for you, do you?
According to Lisa, you should never hesitate to share your real feelings with your friends and family. Tell them openly that you are not able now to e.g. attend baby showers or others’ kids’ birthday parties, but you love all of them and wish them all the best. Then people will not feel offended, they will know it’s nothing personal.
Summing up, always remember that you have more control that you think. Although you feel helpless, you should use all the skills and methods that can help improve your treatment experience, your relationship and help you feel better overall. All of these activities will not only make you healthier and happier but they can also help you get through treatment and achieve your most important goal.
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Questions and Answers from the event
I work 12 hour shifts both day and nights, I struggle with the lack of sleep and I am a carer for my mother. There is a lot of research which states that sleep is vital for IVF egg donation. Do you have any strategies that I can use to help myself with this? My job is very demanding and I worry about the pressure. I feel like I have too much pressure all around which I stress about then so it’s a vicious circle. Can you suggest any strategies please?
I don’t know about the research that says sleep is vital for IVF. I’ve been in this industry for 23 years, I work for clinics, I’m very active in the American Society for Reproductive Medicine and I see a lot of research relating to infertility and stress. But I’ve never seen that so I don’t know if it’s a respective piece of research. I think that being sleep deprived is not good for your health. As I said, I know that people got pregnant in Holocaust and they were starving and sleep deprived and under the hugest stress you can imagine. So I think it is important not to put that pressure on yourself. But having said that, it’s also important to try to find ways to relax and be able to get a little bit better sleep. Some people will try to get their sleep on a better sleep cycle and as they do it, that would continue to get better and better. So some would take Benadryl, Dramamine or something else just to start sleeping. If you’re starting your treatment, you may not be able to do that. So it’s worth incorporating some of the things that I am suggesting into your daily practice, like meditation or yoga practice, or getting outside and doing things that make you feel invigorated and a little more tired at night. All of this can help you.I would definitely try as many of those things as you can. I know you work a long day and I completely appreciate that, but these things don’t take more than 10 minutes. And if you’re able to get some help with your mother, it would be also great. Some people, if they feel they’ve had too much, just go to talk to their boss and say, e.g. “For the next 2 weeks I need to leave work early” . Try some of these strategies, incorporate them in your life, give yourself 10 days with breathing exercises and see if they help you feel a little bit better. And definitely get outside and move your body round so that you would be a little more tired at night.
I’ve been just wondering about embryo transfer and the time just before the procedure. Is there anything we could do to ‘calm down’ as I read that stress may impact the embryo implantation. Obviously the same question concerns the time after the embryo transfer.
Again you have to talk to your doctor first. But 20 years ago it used to be said a lot that after embryo transfer, you should go home, lie down and relax, watch movies, don’t get up and just be in a horizontal position. Now a lot of research is showing that it is not really helpful to do that. You don’t want to be jumping up and running around after the transfer but they say it’s better to stand up and take relaxing walks. Take it easy but don’t be horizontal, be more in a vertical position. And when it comes to calming down, I definitely think it could be really helpful to do some of these meditations ahead of time and see what works for you. Because if you find something that’s working for you, then you can do it before the transfer. I don’t think that being stressed is going to change your implantation. Remember that there are people who have been raped and get pregnant, people who got pregnant in Holocaust. So even in the tremendously stressful situations in this world, people got pregnant. I don’t think that if you were stressed in that moment, it’s going to impact implantation but I do think you’re going to feel badly about it, which I don’t want. So just try to experiment with some different types of breathing exercises, or like some people, do acupuncture before the transfer to calm your body. There is some old research saying that maybe it helps with blood flow. So if you want to do something like that and experiment with things like that before your transfer, then you’ll know what works best for you. And remember: even if you are relaxing a tiny bit, maybe 10%, it’s still better than nothing. Just remember you don’t have much control over it. I want you to do this because I don’t want you to beat yourself up about not doing everything you can. But ultimately it’s not going to affect you. You need to know that it’s not your fault if it doesn’t work and it’s not your responsibility. The doctors are going to give you the best protocol they know and give you the best opportunity to get pregnant and you just need to be a passenger.
Do you have any recommendation or maybe there is some practice you can use on the fly when dealing with, for example, an annoying auntie who’s asking you when you will be having children. What to do when you don’t have time to do meditation or yoga and just somehow survive this situation?
I’d say stress is like a wave. If you want to surf on a wave , it’s always better to get onto the wave when it’s small. When you wait and the wave is too high, it’s just going to crush down on you. Like in the question asked by that woman before, when you’ve been through so much that is seems almost impossible to dig yourself out of that. I think that with enough support and strategy she will start to feel better. But when you feel so depleted and so horrible, you’re going to snap at your auntie. Or you’re going to feel really upset and go home crying. You might feel that way anyway with fertility treatment but if you haven’t been doing all these things I’m suggesting on regular basis, your stress level would be very high. So if you take some of those tips and incorporate them into your life, your stress level is down. And when your auntie makes a negative comment, it’s easier to respond to her in a calmer way. Specifically with the auntie situation, I really think it’s helpful to say: “You know what auntie, I really love you, but I’m going through a lot right now and I just don’t want to talk about it. If I do have news for you, I’ll let you know. So now can we talk about what our plans are for, let’s say, Christmas? Or tell me what happened on your vacation last month.” So I think giving people instructions is really helpful because it usually shuts them down.
I’ve gone through over 10 IVF procedures and two egg donation transfers, many stimulations, also heavy ones and took a lot of different medicines, also one for the cancer. Took everything as the doctors said. Now I get stressed already when I only need to take medicine. How to cope if I already get stressed so much at the beginning now?
Oh my gosh, I’m so sorry. You have really had some bad luck in all of this. My heart goes at you, this is really hard. You’ve been through so much. I really think that counselling would be helpful. I think all of those things you’ve been through, the cancer treatment and all these IVF procedures, egg donation and disappointment at that, all of this results in tremendous amount of emotional trauma and stress on your body, mind and spirit I think it’s really hard when all of these insults are happening to body and they’re kind of chipping away your body little by little. It’s very hard to have any resource left in you to manage the next day. It feels like you’re operating on empty. And you can’t drive your car just on fumes, you have to fill up your gas tank. You need to start to feel a little bit better so you can move forward if that’s what you want to do. So I really think that counselling will be helpful. You may have had counselling at the cancer centre, they often offer that. But it’s often just for cancer treatment so I would suggest to find a specialist in fertility and have some sessions with them to work through what you’ve been through. And get to a place where you would feel a little bit better so you could start to move forward.
How much the partner should get involved when dealing with stress during the IVF cycle? Obviously woman is a person involved more into the treatment from “medical” point of view than the partner. I mean dealing with the stress alone or with the partner together.
Some women feel like they just want to talk to their girlfriends, because their husbands don’t understand this and they don’t even feel like talking to them about it. But if you feel that you’d like your partner to be there for you, then I think it’s good to educate him on how stressful this situation is. Maybe you can give him a link to this video. Also I think there is RESOLVE, the National Infertility Association in the US and you can look at their website online. They’ve got a lot of fact sheets about depression and infertility. And if men take a look at that, very often they say: “Oh my God, it’s not just my wife who is crazy, everybody goes through this level of stress during this.” And then it usually helps them to be more emphatic. So I think that at that point the two of you can talk about what would be helpful to you. You can say: “I’d really like to talk to you every night and could tell you about what’s going on and what I’m stressed about.” Or “If I cry, please don’t give me answers, I just don’t want you to fix it, I just want you to hug me or I just want you to listen.” Or you might say: “ At the end of the day I really feel stressed out and I want you to start cooking dinner for two weeks when I’m taking medication.” Or “ I would really like you to rub my feet when we’re watching TV.” I think being direct is really the best answer. Everyone is different and it’s really hard to anticipate their feelings, particularly because your partner is not going to know what’s going inside of you and how to make you feel better. They’re just going to see you’re struggling and really not get it. So I really think it’s better to let them know. This is what happens, people get depressed and stressed through this. It could be really helpful to say “I’d like you to come to an appointment/ultrasound with me, I’d like you to do this or that.” So it would give him a job to do and make him feel like he’s really doing something to be helpful. And I would really let him know that you appreciate it because positive reinforcement always helps. I think it is really good to be direct and always let him know what you need.
After 2 failed egg donation IVF, we’re taking a break and I’ve started doing yoga and meditation and aiming to do the 3rd and final cycle at the end of the year. I’ve read conflicting info about whether you can continue with yoga during the cycle before transfer or not. When should you stop?
I think number one thing to do is to talk to your doctor. Every person is different. For example, if your body is full of fluid and let’s say you’re really stimulated and you’ve got 20 eggs, then it may not be wise to do any sort of experience when you’re jumping. For example, when you’re doing a downward dog and you’ve got to jump to standing, this may not be great because you might be kind of jostling your ovaries. A lot of people say that downward dog position, like any upside down pose, is not great after implantation. So you have to ask your doctor about that first and then also consider what type of yoga you’re doing. Of course the Ashtanga yoga is much more aggressive, much more meditative than relaxing. Restorative yoga is wonderful, it can really help your mood and is also very gentle. And there is also this fertile yoga, which some clinics have and sometimes you can access it online as well. And that you can do in any state of, even if you’re semi bed rest, you can do it in a chair. I think it really depends upon how stimulated you are and what shape your body is in. If you really don’t feel comfortable because your ovaries are full of eggs and your body is full of fluid, you don’t want to be jumping around and doing any upside down poses, I would talk to your doctor about that and really consider what type of yoga you’re using.
The Ferticalm app is not available in the UK. Could you please recommend another?
So then I would try one of the other two. Either Headspace or Calm.
Could you please repeat the meditation apps?
One is a fertility app with some breathing exercises and advice – it is called FertiCalm. My good friends and colleagues developed that app, they have tremendous experience and did a great job putting this all together. The next one I would recommend is Headspace and it’s not a fertility app. It’s a meditation app. They have short meditations you can do, 2- or 5-minute long, and it’s all guided and there are lots of cute cartoons. They kind of guide you around the meditation experience and it’s really fun to listen to and makes it all a lot of easier. So I would recommend them. And the third one is Calm. It also gives you an opportunity to have a guided meditation and it’s kind of entertaining and all of that. There are also lots of cartoons and other things. And they also have different background sounds you can listen to, like beach sounds or falling rain in the forest or wind. So you can listen to any of these relaxing sounds while you’re doing the meditation. I think anyone of those three would be terrific to get started with. But you know, feel free to try them all, I wouldn’t abandon your effort if one doesn’t work. I would say: Try one and if it doesn’t work, try something else.