How to deal with stress during your IVF journey?

In this webinar session, Dr Margarida Fonseca, Psychologist at Ferticentro, Portugal shared some tips for handling the emotional stress of IVF and explained how stress is affecting your journey. The event was hosted by Sarah Holland, The Fertile Mindset Coach, Host of the Fertile Mindset Podcast, and mum to 2 boys after fertility treatment & adoption.

Stress – definition

It is a physiological brain response to a stimulus or situation which demands our attention, energy, effort, or performance. The hormone responsible for regulating the heart rate blood pressure, and breathing is called cortisol. Without cortisol, we wouldn’t be able to react quickly or make decisions, comply with deadlines or even get up in the morning. Stress can be healthy and functional, but high levels can lead to discomfort, anxiety and depressive symptoms, called distress. The point at which we might start to struggle with stress is very personal because everyone’s response to stress is different.

Stress & its impact on fertility

Stress has a clear impact on fertility. There are many kinds of stressors, such as environmental, ecological, emotional, and physical, which might activate our hypothalamic-pituitary-adrenal axis or HPA axis. It is responsible for triggering cortisol, but when it comes to emotional stressors themselves, we cannot establish a relationship between emotional stress and infertility. All these kinds of stressors might be connected, but little is yet known about stress and infertility. When it comes to emotional stress at the moment, there is no clear evidence that supports the theory of stress as a biological cause of infertility or even a link between emotional distress and treatment failure in assisted reproductive technology.

The majority of patients are highly distressed, and they can still get pregnant, so we cannot say that stress might be causing infertility. However, stress might have a non-biological role in fertility by contributing to poor lifestyle choices and emotional suffering, which might make it difficult to conceive. There is not a direct link, but there might be an indirect link because when we feel stressed, we smoke, we drink more alcohol, we might take drugs, we isolate more from our social environment, and these can have a big impact on our fertility.

It is more useful not to make them accountable for their difficulties conceiving. It is much better to focus on helping them cope and accept their stress as an adaptive reaction to their infertility, despite whether there is, or no evidence of the link between distress and IVF success. Helping patients learn to manage their stress is beneficial for their emotional regulation, well-being, quality of life, and potentially the reproduction, but it shouldn’t be done to help them get pregnant but to help them feel better and so they can see themselves achieving a better quality of life, and emotional regulation. The focus should be on psychological well-being, in a humanistic and holistic approach.

Mindfulness

Nowadays, mindfulness is considered to be one of the best approaches to dealing with stress. It has its roots in Buddhism, and it was brought by Jon Kabat-Zinn, an American psychiatrist who brought this approach to modern psychology in the 70s. Since that time, mindfulness has been studied and applied to many fields, such as infertility. Mindfulness is ‘the awareness that arises through paying attention, in a particular way with purpose, in the present moment and non-judgmentally. This is the original definition by Jon Kabat-Zinn, which has some key components such as intention to practice mindfulness, curiosity about what is happening inside and outside us, present moment and the absence of judgment. Mindfulness is a treatment that activates our parasympathetic nervous system through the vagus nerves, which are responsible for triggering our relaxed and calm state.

Why do we need mindfulness in infertility?

• infertility is perceived as a major life threat by our brain
• we are rarely alone with ourselves and with our thoughts, and our brain gets overwhelmed in autopilot mode during an infertility journey
• IVF generates not only a tremendous amount of stress, frustration, and discomfort but also feeling of being out of control and not being able to manage things
• we will never be able to control external stressors, but we can, at least, manage the way we respond to them, rather than reacting
• the human brain is not designed to make us a happy, but to make us survive
• data suggest that psychological interventions such as mindfulness are effective in reducing stress in women experiencing infertility

Mindfulness appears in the first speech of Buddha, more than 2,500 years ago. It’s the anchor of Buddhist meditation and teachings (Dharma), which is known for its comprehensive vision of human nature. In Buddhism, the practice of Mindfulness is a way of living or a way of being with suffering as an inevitable part of life and human growth. Modern and Western psychology adapted Mindfulness as a treatment to reduce the suffering associated with distress and psychological discomfort.

Many people try to practice mindfulness, but they feel that they can’t feel relaxed, and they do quit. However, mindfulness is not relaxation, distraction, focusing on positive thoughts, or making the mind blank, it’s not a religion or hypnosis. Mindfulness is all about being present. Everybody can do it, it takes a lot of patience and practice, but eventually, everyone can do it.

So how can we learn to practice mindfulness? We can start by learning about it in psychotherapy, there are also mindfulness-based stress reduction programs (MBSR) that are widely known. There are programs of 8 weeks applied all over the world. There is also mindfulness-based cognitive therapy (MBCT), which is similar to the MBSR, but more directed to prevent depression and relapse. There is also the Mindkindful program, which is a mix of compassion and mindfulness programs.

Other therapies & techniques

There are some other therapies and techniques that might be more suitable for you and your circumstances. A professional assessment by a psychiatrist or psychologist is required to assess what kind of therapy is most suitable for you. Many techniques and therapies can be helpful, such as:

• Compassion-Focused Therapy (CFT)
• The Acceptance and Commitment Therapy (ACT)
• Cognitive-behavioural group approaches
• Probiotics (Lactobacillus helveticus)
• Physical exercise (moderate level)
• Contact with nature
• Activities that provide the feeling of pleasure and achievement (e.g., acupuncture, a specific diet, starting a new hobby)
• Reducing caffeine
• Sleep
• Psychiatric medication when necessary

There are also some apps (e.g., Headspace, Calm) that can be useful and are very good at helping with managing stress.

Take-home messages

• there is no rigorous evidence that indicates stress can cause infertility, but it can contribute to difficulties in conceiving
• interventions should focus on helping patients cope and accept their stress or distress as an adaptive reaction to their infertility, despite whether there is, or there is no evidence of the link between distress and IVF success
• data suggest that psychological interventions such as Mindfulness are effective in reducing stress in women experiencing infertility, as a way of taking care of their bodies and minds, but independently of the re-reproductive outcome
• an assessment by a trained psychologist or psychiatrist should be performed beforehand to indicate the best therapy for your case