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.
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 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.
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?
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.
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:
There are also some apps (e.g., Headspace, Calm) that can be useful and are very good at helping with managing stress.
I worked as a reflexologist before I moved into EFT. Personally, as a reflexologist, giving that perspective, I didn’t feel comfortable reading the feet and saying, this is what I feel is going on because there are so many reasons why an imbalance may be showing up in the feet. Not necessarily that would be a stress response.
Sometimes we don’t notice the symptoms, and others give us that feedback, either a reflexologist, a doctor, a family member or a friend. That might mean we are on autopilot or don’t have enough self-knowledge to notice our triggers or stress levels. Some people go beyond their limits, and they are not aware of that. At least in Portugal, 36% of emergency cases in psychiatry are events related to anxiety and panic attacks because people don’t know how to manage them. They always give us signals before they start showing in our body, but everybody has different symptoms. Some people get more activated in the breathing system, in the intestines. Some have emotional, some have sleep problems. I think it’s good to see a psychologist and have an assessment. I don’t recommend people to go through IVF without psychological support.
I don’t know your history, but when we have a very stressful job, and we are enduring IVF, sometimes I recommend people to go on medical or psychological leave during the treatment. I don’t know if this is possible in your country, but in many countries, it is possible without having your salary affected. Sometimes it’s self-protection to be away from your job during IVF, and psychologists and psychiatrists can give a report about your mental state and advise that you should go on medical leave.
We should first assess you, it would be good to do some psychological tests as well. When patients come to me and say, my job is very stressful, it is very hard to manage IVF and my job, I would possibly recommend taking some time off your job because IVF is stressful enough.
Exercise can be a good stress management technique. Exercise can be your go-to that helps you manage stress. If you feel good, if you feel that it’s helping you manage your stress, then it’s perfect. If you are doing it because you want specific exercises to get pregnant, I wouldn’t recommend it. If your body is used to it, it’s okay. If you are doing stimulation, if you are undergoing medication, you could ask your doctor if it is too much.
We have to learn how to accept those negative thoughts as part of your path. They are inevitable after 22 years of attempts. Since you don’t have support from your family, I believe you must have a lot of negative thoughts, social isolation and insecurity, as you said. I think that it is an adjusted reaction to what is happening to you. There’s nothing wrong with that. The first thing to do is to accept whatever you are feeling to get a better assessment and protocol of treatment. I would recommend having a psychological appointment, but what you are referring to is very natural in such a situation.
I think accepting and acknowledging what we are experiencing is important. Then get the support in place if it can’t be found directly in your family and friends to make sure you do have support in place.
This is very important during IVF because people are very isolated, and sometimes they don’t even talk with their partners or families and friends about it. Therefore, an individual psychology appointment is very significant, but the group approach has a very big efficacy on this kind of patient too. That will make you feel connected, you feel related to each other, which is very different from the work we do during the consultations with the psychologist. It’s great that you found people in the same situation, and they are helping you because you do not always find this kind of group you can relate to.
EFT stands for emotional freedom techniques, and it is sometimes just called tapping or Meridian tapping. It’s tapping on the Meridian points on the face of the upper body and the hands, it’s using the same energy system as acupuncture, but differently. It is focusing on the emotional well-being and the emotional side of our well-being rather than the physical side, typically, although we know that they’re both interlinked. Instead of needles, you can use a tapping technique with your fingertips. It’s very easy for you to apply by yourself as well as use it in a therapeutic session.
Some people start using it by themselves, and they want to see how it works as a self-help tool. It’s when you use it by yourself, that it’s very important that you learn all the steps and that you apply it correctly because I’ve had so many people say that EFT didn’t work for them. When I ask, how they were using it, they were kind of missing out on some crucial steps and just doing it in the middle bit, the tapping bit and ignoring the other parts of EFT and how it works.
As long as you’re following the steps correctly, it can be used very well as a self-help tool. It can also be used as a more deeply kind of therapeutic tool within one-to-one sessions with a practitioner like myself to get started. Free resources can be found in a free Facebook group called The Fertile Mindset café. You’ll just need to request to join, once you are in that group, none of your friends will be able to see you are there, it’s a private group, but I have a section under the guide section, which is all free fertility EFT resources. YouTube is also a great resource just to watch some videos.