Did stress cause my failed IVF? How to manage stress to ensure successful IVF?

Explained by: Mandy Rodrigues, MA, Mandy Rodrigues, Private Practice
Category:
From this video you will find out:
  • Why is so important to deal with stress properly?
  • Stress and infertility – the link
  • The correlation between psychological assessment and endometriosis
  • How to change the habits that seem impossible to change?
  • What is TUPS?
  • What is predictable and unpredictable stress?

How to avoid excessive stress and have successful IVF?

In this webinar, Mandy Rodrigues, is talking about stress and its impact on your IVF treatment. Watch the video and learn new tips on how to manage your stress and deal with it on a daily basis.

How to avoid excessive stress and have successful IVF? - Questions and Answers

I’m in the middle of my second round of IVF. I’m easily stressed. My embryo transfer is in a week. Is it too late to start managing stress?

Not at all. We look at a 10-session program but what was very interesting is by the time people got to session four, in fact, the pregnancy rate was shooting up by session four. I could promise you just by measuring your stress and starting to manage it just by what I’ve said to you before. Session two which I’ve already done with you, I always say to people: for one week, just have a look at two triggers a day and two reactions. Write this down. You can do that in one day if you want. Then, have a look at what is real and what is self-induced. You will notice that’s a pretty hard question. The real stuff is the stuff  I don’t care if you worry about it and it is the stuff that a relaxed person would worry about.  So that’s question number one and I say to you if it’s real worry more. But you’ve got to be honest with yourself because we’re trying to create a thinking pattern that says “you know, what when this is not real, it’s no use me saying to you stop stressing about the stuff that’s not real”. So what I’m saying to you when it’s real, stress more. Second thing, I’m saying to you when any trigger over the next week is unpredictable, you just have to try and say “Could I have made it predictable?” You don’t need to change anything else and that already will reduce your stress already in one week. Beyond that managing your stress will actually help you in terms of dealing with your results going forward. No, it’s definitely not too late.

Could you please explain a bit more about endometriosis and personality type and how it relates to stress/fertility?

Our original study in 1996 and we wrote a book which if you go on to tabs.co, it is available there. What we had to look at is people with endometriosis. In South Africa, we’re pretty different because, in South Africa, we do laparoscopy if we’re worried about endometriosis. But I know some countries don’t and they don’t think that endometriosis has a big impact but we were worried about putting patients through repetitive laparoscopies because of scar tissue and, obviously, because of what it did to the womb. So we decided to grab patients with this personality type and with endometriosis and without endometriosis. 100% and I’m not lying to you, 100 % of our patients who have one symptom of endometriosis and that might simply be diarrhea with a cycle or it might be infertility and if they’re time urgent and perfectionistic, they had the test that I’ve exposed you to, all of them on laparoscopy had endometriosis. The way it relates to stress – endometriosis is an abnormal growth of tissue on the uterus. Every time you have a period, the body’s immune system is supposed to shed the uterus’ lining properly and then your room starts afresh. But if your immune system is not functioning properly what happens is the immune system doesn’t get rid of all that blood that’s going down so it starts forming this kind of plastic foam around. It is an immune problem. Indirectly, we know that stress is related to hyperinsulinemia because people eat differently. It’s related to thyroid problems. All of our patients I see have endometriosis polycystic ovaries, thyroid disease and they all have the same personality type.

Can we really say that if you manage your stress, you will be increasing your chance of success? I am talking as a counselor.

Absolutely. I can see where you come from because the research over the  years has been very sketchy in terms of stress, IVF and the impact of it. But Israel last year, specifically, when we could travel, and we started our research 24 years ago. We wrote our first book and we have seen clinically how our patients have benefited from managing this stress. But not only in terms of success but in terms of their marriages, in terms of coping with a potential negative result, in terms of taking the next step forward. I can definitely say it increases your chances. I had cancer. I had to stop my PhD  but my PhD is definitely on publishing because as we know you’ve got to publish in order to get something recognized around the  world. I can promise you, in a year or two I’ll be doing a keynote talk on how stress and the decrease of stress increase fertility success. That is our aim because I’ve seen it for 25 years in myself, in my patients.

My doctor who does acupuncture says that stress has no impact because during the war time many people got pregnant even if they didn’t want to but they didn’t reduce stress and they got babies.

So I assume that’s war you’re talking about and again if we look at real stress, look at women who are raped, look at in South Africa, especially, and I’m sure it’s around the world, we have a high teenage pregnancy rate, these girls don’t want to be pregnant. They definitely stress because they’re in poverty and they’ve been raped etc. but they fall pregnant. Remember, I’m defining stress in terms of what is real and what is not. People in war are definitely stressed but it’s real stress. If you put a relaxed person in that situation of war, COVID-19 or a rape, they will fall pregnant because in real stress we’re secreting adrenaline. In stuff that is self-induced, the chronic silly stuff that a relaxed person says but I’m not stressed about that is where people are not falling pregnant and that is the stress we can manage. So definitely if that’s war, people in war, poverty, floods, trauma, their pregnancy rates are extremely high because they’re focusing on real stress and that’s adrenaline and that does not impact the outcome.

I’m scheduled for my first IVF in a month. I’m trying not to stress. Any tips?

I think the first thing is familiarize yourself with the process so I almost want you to change your thinking and say my first IVF is a very expensive invasive investigative procedure. So at my first IVF, I produced 24 eggs back in the day but they were all useless. I was overstimulated and it didn’t work and I thought that was the end of my world. I couldn’t afford a second one going forward until much later and I knew I had to familiarize myself with the process. I had to look at almost what is my next step and it’s not saying what is the worst-case scenario but what if this IVF doesn’t work. What would be your next step? I wrote a chapter last year for um a medical textbook where they tried to say  why do parents who adopt fall pregnant and why do parents who give up fall pregnant. None of us, and I’ve been a fertility patient for many years, want to hear “relax and it’ll happen” –  that’s rubbish. But as soon as you focus on what is the next step going forward if this one doesn’t work, I promise you, you’ll cope better and if you familiarize yourself with the process, break your IVF into manageable parts and say “stims and then it’s the first scan. OK, go through that part, then that’s a few more steps and it’s next and go through that part.” So you break it up into little batches to cope.

How to manage the environment around you during the procedure? People are always giving different opinions and it’s really difficult to make others understand what you are actually feeling because with all the medicine and anxiety sometimes you really are not able to express yourself.

When I see people I often say it is not we can’t change other people, we can’t necessarily change our environment, I can’t change the fact that COVID-19 had an impact on our business or on my family but I can change the way I react to it and the way I think about it. I assume that’s about your infertility and not understanding what you’re feeling, sometimes you’ve got to have some standard response that you give them. You have got to choose with discretion who you’re going to talk to and how much you want to express. There are a lot of support groups and I know maybe that’s not what you want. You’ve got to understand people who haven’t been through this are going to give you the wrong answer not because their intentions are bad but purely because they haven’t been through it themselves. It’s like when someone passes away, they don’t know what to say so they avoid it and say the wrong things. I think it’s best to try and change the way you think about the environment as opposed to the environment which we often can’t change.

How to deal with family whom you don’t want to tell because you know they will cause more stress than support?

You’ve got to decide is it more  important to have their support or not. I was totally open with my family but my family is Catholic and very conservative so I didn’t want to give my family too much detail. They also didn’t know what aspiration is and I didn’t want to go to all that detail so I would say I’m going for an IVF and would give them a white lie about when my pregnancy result was so that I could first deal with it even if it’s a day later. You’ve got to think if you want to tell them. If you’re feeling you have to and if your partner maybe is feeling you have to. A lot of my patients are forming an admin only Whatsapp group, if that’s what you want. I’m not sure which part of the world you are in. Maybe you don’t have Whatsapp but you are able to just put a notification on that you might not be ready to talk but it’s a bit of feedback. I think with discretion you have got to choose who you’re going to tell and who you’re not and what is the benefit at the end of the day. If you’re worried about disappointing them, that’s self-induced stress. Going back to what I’m saying,  if they’re going to criticize you, if they’re going to say the wrong thing, if they’re going get so upset for you , remember how I broke the streets up – that’s a self-induced stress. A relaxed person is not going to stress about that and that’s something I want you to put into that category and say “Either I’m going to manage it differently in terms of those four cycles or I’m going to avoid it and not tell them.”

I think it is very difficult to reduce stress if you have had bad experiences. I lost two babies and do not get pregnant anymore. I go to pilates. Anything else can you recommend?

I’m sorry you’ve lost two babies. It’s extremely difficult and it’s definitely very real. I don’t know if you had primary infertility before but there’s now the secondary infertility and i don’t know if your chances are completely negative right now. That’s a very real stress but then remember what I said about  something that’s real – maybe you need to examine whether you can take this any further, whether you need to go and speak to someone. Again, in terms of something like pilates, absolutely go for it, even if it makes you feel better but if it’s a stress to go to pilates and take time out and you feel, it’s not helping you then it’s actually more of a negative than a positive. But I’m so sorry you’ve lost those two babies and I do think you need to, if you haven’t already, go for support in terms of grief counseling. Because you carry with you into the future  this complete lack of enjoyment of potentially another pregnancy and this  complete fear and this complete anxiety going forward.

How much should the partner be involved when dealing with stress during IVF? Women are more involved in the treatment from the medical side. How to talk about it with a partner/husband?

Yes, you’re right. My husband would never go to a therapist. I often have to tell a white lie to get him to come and talk to me. I would love it if clinics in South Africa or wherever around the world, would actually say every couple going through IVF or presenting to a fertility clinic gets given a counseling session, the husband doesn’t need to know, this is a counseling session on what to expect  when you’re trying to conceive but be given that and be told “this is the process that your wife is going to go through, this is what it’s going to do to your relationship”. We do know the research says that husbands that are more  involved in decision-making and more involved during the IVF, their wives have a better outcome in terms of pregnancy rates, endometriosis and healing as well. Talk to him about it or show him. I’ve got on my websites lots of podcasts or 50 second videos I post every day on relationships, infertility, IVF and I often get wives share it with their husbands and say “look, what this man went through with his wife”. Yes, I think it is important to acknowledge with him that  he is not intricately involved and is there any way you can get him more involved in it. Would like him to be with you at scans even though with COVID-19 I know this is a little bit hard. When couples come and see me I actually have a card game that I play with them, where I give the husband and the wife cards and they both got the same emotions. You can make the cards yourselves. I  get the husband share how he feels in terms of the fertility on one side and the  wife in terms of the other. They need to share them and see what they’ve got in common and it’s often very similar. But the husbands will often say to me they miss their wives in terms of this process. Their big loss is yes, the negative result, but it’s more what it does to their partner whereas the woman and the men are often “it’ll happen, it’ll happen, we’ll do it again, look, please, don’t get too upset” and they start coping independently and that’s what we don’t want. We, actually, want the wives to be able to fall apart in front of their husbands and their husbands to know that’s okay. I think just tell him maybe what is going to happen and that if you do fall apart and you do break down, it’s not that you’ve changed, it’s not the end of the world, you’re going to be okay, you just need him there in terms of support.

I’ve had IVF four times and my stress levels and fear are very high. What is the best I can do that will work?

I would suggest, firstly, having a look at the stress site and seeing how high your self-induced stress is. Four IVFs that is a lot. Maybe to get an understanding as to why they didn’t work. Is it due to low AMH levels? Is it due to something that they can possibly change? Is it due to the need of a different process in terms of going forward? When I was battling to create that peace of mind I would take a goal list, and I get my patients to do it, and write down  what are your short-, medium- and long-term goals. Write down what is your fertility plan. If we do a fifth IVF and that doesn’t work, what is your next step?  I might have to consider donor eggs or I might have to consider donor sperm, whatever it might be. We have this roadmap in our minds of a fertility plan, we have our other goals that we still focus on. Our life is not on hold and we merge them together to get some peace of mind. I would strongly suggest if your stress levels are above 100 on that stress test that is online, then I think you need to then manage your chronic stress if it’s high as a starting point.

After my last transfer my mobile died so I went to mobile shop and lost all my  four years of messages. I felt very stressed. Would this have contributed to the  embryo transfer failure?

That’s a very interesting question because when we look at chronic stress with a failed transfer, it would be deemed maybe an early miscarriage because in effect we’ve put an embryo in you. If we look at all that research, chronic stress is more involved in pregnancy loss towards the end of the pregnancy. So not as much acutely during that very moment. Also, stress is more involved in the  chronic stress leading up to the development of the eggs. So, no, I don’t think it has. If you say to me that you are still worrying about that it’s like three weeks down the line and you’re still worried about the messages, still angry that you lost your phone, still thinking I wish I had those photos on my phone – that becomes a chronic stress for the next IVF but not for that particular IVF.

Is there any evidence-based study about managing stress and IVF increased  chance of success? I would like to be able to prove what I’m saying to my clients.

Absolutely, it’s so sketchy which is why I am going to finish my PhD. If you look at the webinar of an IVF guru that is on my social media platforms; in terms of this talk I did put down some of the research that emerged out of ESHRE. I looked at the research with this recent virtual ESHRE and I didn’t find as much. If you go onto any of my social media platforms, I have posted this. Whenever I find research I make a 50-second video clip with my voice and with the research quoted. There is the intermediate research that has been published.  They’re busy doing pilot studies on but we’re waiting for publications. There are books written, anecdotal stuff, they’re subjective and qualitative studies. But science is looking for statistics and they’re looking for numerous variables. But if you look at salivary amylase and stress and if you look at Dr Alice Domar’s work on stress and infertility, you can then find evidence for that.

My husband is a doctor, a super stressful job. He can be stressed but not like me. How can I manage this stress?

Are you telling me your husband who’s the doctor is super stressed or you’re more stressed than him? OK, you’re more stressed than him. My husband is in fact a fertility specialist in South Africa. Twenty people come into his room from 6 in the morning, they queue from about 5 AM. He does back-to-back scans, aspirations, transfers and then it’s operating theater. It’s a super stressful job but, probably like your husband, he knows when to apply his stress and he deals with it and gets off it, he deals with the next patient, gets off it and deals with it and he gets home and it’s done. You’re probably someone who chronically stresses and the interesting thing is a lot of women will say to me “I’m going to give up my job. It’s all my job that’s creating stress”. And it’s not! The most stressful people I see are the ones who’ve been boarded or maybe have taken off a three-month sabbatical or are home executives so to speak. If you look at the old research about men who have heart attacks, they don’t have heart attacks in the boardroom. They have heart attacks when they are on Mauritius, when they have retired, when they’re traveling down to the coast. It’s almost like the body’s able to say “OK, there’s your husband, super stressed doctor, he needs to secrete adrenaline in this moment but he gets off it”. Then here lies the wife thinking what she is going to cook for dinner, all the house is amiss or look at these deadlines I haven’t finished or look at everything I have to attend to adminwise and the mind is able to say “but hang on a second – that is not real stuff, that is not a doctor doing an anesthetic where he needs adrenaline and that’s where the impact on the immune system. You need to learn how to manage your stress, you need to identify what is real and what is not and I can bet you he’s probably a well-functioning type A personality which I’d like to say that’s what my husband does and I’d like to think I’m that, most of the time.

I haven’t shared with my close friends about my IVF because I don’t want to  hear from those that haven’t had a hard  time. Is this causing unwanted stress as well? What are your thoughts?

Sometimes we’ve got weird stress. I can tell them and it creates a bit of stress  for me because they’re going to say the wrong things, they don’t know what I’m going through, they’re going to be dismissive and they’re going to be falling  pregnant and all of that. Or we might say that not telling them is avoiding the trigger. But if not telling them is actually stressing you more than what? We’re telling them! Then, you need to tell them. You’ve got to say “what is the benefit?” At the end of the day, I think it is stressing you. I would then look in terms of that stress cycle – it’s not real because relaxed people, believe me, will tell the whole world or they will choose certain people and not care what other friends say. But it sounds to me like it’s a perfectionism thing and then in terms of how we manage our stress, we look at that stress cycle and we say “OK, when I’m about to tell them, let me get my physical self under control and let me get my breathing under control”. We’ve got an exercise that we implement there, our self-talk is: “they’re going to say the wrong thing, they don’t know what this is about, they’ve just got married, they’re probably going to send me a message that they’re pregnant soon.” There’s a certain way we challenge your thinking and then there’s a certain way we say to you “this is how you maybe behave and this is how you articulate yourself or be assertive when you are telling them” if you’ve decided to address this. So absolutely I think if it’s worrying you, then it’s something you need to look at in terms of that stress cycle I’ve explained where you implement one of those four solutions to actually addressing the problem.

How do we go about enrolling for your salivary amylase study? What is  involved in the process?

I’ve been a bit slack on this because of COVID-19 I have been inundated with Zoom calls and meetings all over. Our stress site has been running for about 15 years. We’re busy updating the entire stress cycle, making videos and interactive virtual sessions, etc. Right now you go online and you can manage your stress or people zoom me and they manage their stress.  Once salivary amylase study, especially next year when I find out exactly what the university wants, (I sit on the board in South Africa and on various other boards) we’re going to try and get a lot of clinics involved. It would purely just be taking  possibly a level of your salivary amylase if they decide that’s a parameter they  want. Or they might want to know what is the person’s sperm count, what is their egg quality, what’s their previous IVF result like – this is their stress score. Then take the free 10-week or ten session stress management course and then we look at what the sperm looks like now, this is what the IVF result looks like. So it’s going to be very simple in terms of comparing and all that will be involved with the individual so basically we will use the bloods from the clinics or whatever results they’ve got. You can allow them to share that data  anonymously. We would keep that private and then you would just enroll yourself on the course. We would definitely let people know and I would let  MyIVFanswers know obviously when that study comes around.

I’m starting with IUI and IVF. I had to take many hormones and also my thyroid is working slower which is not good for the embryo to stick. Could stress be the factor here?

Absolutely. An underactive thyroid is definitely one of the autoimmune things that we look at. The first point of call is I would get your fertility specialist or the doctor you’re seeing to have a look at putting you on euthyrox so you would need medical treatment probably for that thyroid. I don’t know if you might need these thyroid antibodies, injections or drips – there are different protocols around the world. But definitely stress can have an influence on that as well. The first protocol is to put the patients on the measure their stress. You would also have a look at if you’ve also got a history of endometriosis, if you’ve got a history of polycystic ovaries, autoimmune problems, a whole range you’ll see on the website. There’s a whole range of symptoms – there’s often like a symptom subset related to this personality type, that if we manage the stress, it has an impact on all of those in terms of immune system, chronic depression,  insomnia, spastic colon, the old yuppie flu, the Crohn’s disease, all of those kind of illnesses.

For me, it is very stressful that you cannot change your mind easily because you wake up in the morning and think about IVF and infertility. And you cannot stop thinking about a baby the whole day? How can you reduce the stress level? I really want to think about other topics but it does not work.

I know. I’ll be honest with you and I’m not running down anyone who’s had  cancer but I had stage 2 cancer so I needed a double mastectomy, chemo and radiation and all of that kind of stuff. It was a long-term protocol but I coped far better with my cancer than I ever did with my infertility. Because my oncologist said this is what you do. I had no choice and the thing that she said “OK, if you do X, Y, Z, there’s a 95% chance you’re going to live.” That’s great! That’s a high  statistic. We don’t get that in infertility. A lot with infertility is to do with science. Science understands cancer at a large degree; it doesn’t understand all the self-worth stress.

If you believe in God, some people say that the surgeons have their hands but they don’t have the ability to create a life if it’s not meant to be. It is very hard thinking about a baby. I’d like to know if you’re working or if there’s anything else that distracts you. Because a lot of the time people, especially if they’re not working do tend to think too much and that becomes all they think about all day every day. I’m not sure if you are working because sometimes there needs to be some sort of distraction. I do exercise with patients where I have a look at everything going on in their life and I have a look at general things that they do. If they are working, what is the value attached to working? What is the value attached to their relationship at the top? What is the value attached to having a baby? Then we look at all the values attached to having a baby which is a sense of belonging, fulfillment and nurturing, etc.

Then I ask what else can we do to fulfill that value in the interim? For me, a lot of it was about nurturing. My value – about having a baby. That’s how I started working with children in a sex abuse clinic which became difficult once I did fall pregnant but that’s where my work started. We also have a million rescue dogs – that would fulfill my sense of nurturing in some way. My sense of not belonging – it would be that I found a different group of people to be with. Because when you’re battling to have a baby, there’s those that are going out all the time and there’s those that are married, settled, have kids and you don’t fit in any way. I see you say you’ve got a busy job. It’s become automatic for you to just think about the baby all the time so I think if you can break up for a week for me. What are the triggers about the baby?  What are other triggers potentially and your typical reaction? Then start  determining what is predictable and what is not because we’re getting the brain wake up and almost automatically think about a baby. We’re getting it to first think is this real or not? And then you might still stress about the baby but, eventually, the next week is this predictable? OK, it’s predictable.

Maybe I must avoid it. I can avoid it in terms of the cycle. All we’re doing is we’re getting your stress not to be automatic anymore like a Pavlovian response. We’re stopping you and saying “first, think about if the stress is beneficial or not or predictable or not”. I would strongly suggest you have a look at that and if you don’t want to register for a course, measure your stress levels go on my social media and all that advice is there for free.

I’m worried about choosing a donor. I have been offered two: one with a very good resemblance and one without such a resemblance but with proven fertility. How important is proven fertility? I could also have a mixture from both donors.

Proven fertility is either going to be proven fertility in terms of a previous donation or we determine it in terms of she’s got children herself. I don’t know  what you mean by proven fertility at this point. What I tend to see with the couples I hope choosing a donor is initially they want one who looks like them,  one whose profile they like, one who is very similar to them and the same height, etc. And then if that one doesn’t work, then suddenly they prefer a donor that’s a proven donor because they cannot take any more disappointments. Proven fertility – again, you look at myself and I actually had 24 eggs initially but then my second and third IVF I had 14 follicles and one egg. And I was young at the time. So proven fertility – yes, in that particular cycle was good. But what about the next cycle? We don’t know that it’s necessarily going to be the same. Resemblance – again, if your country allows for you to do a mixture of both, why not? If that’s important for you. I know in South Africa we’re starting to limit the number of embryos placed back so you’ve got to be more sure. You can decide which looks better at the end. Do you want to know what if the child looks like you in some way? It’s so difficult to remember that even with proven fertility if you look at the whole field of epigenetics the fact that you’re carrying the child will also have an impact on how the child looks.

Authors
Mandy Rodrigues, MA

Mandy Rodrigues, MA

Mandy Rodrigues is a Clinical Psychologist registered with the Health Professions Council of South Africa. She holds the degree BA (Honours) (SA), MA (Research) (Cum Laude) (SA), MA (Clin. Psych) (Cum Laude) (SA). Mandy has written numerous articles for popular magazines and newspapers; and have been guest speaker at numerous lectures, motivational talks and conferences. She also has made numerous television appearances in relation to the field of infertility, couples and families, and stress. Mandy consults to Medfem Fertility Clinic, working with a multidisciplinary team in relation to women’s health and infertility.
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Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is an International Patient Coordinator who has been supporting IVF patients for over 2 years. Always eager to help and provide comprehensive information based on her thorough knowledge and experience whether you are just starting or are in the middle of your IVF journey. She’s a customer care specialist with +10 years of experience, worked also in the tourism industry and dealt with international customers on a daily basis, including working abroad. When she’s not taking care of her customers and patients, you’ll find her travelling, biking, learning new things or spending time outdoors.

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