As the saying goes, marriage takes work. In fact, all relationships are work, but in truth it is the external factors that test our most precious ties. For couples who are struggling with infertility, going through treatment can be one of the most stressful periods of their relationship. Based on a review of the literature on the psychological aspects of in vitro fertilization (IVF), IVF is physically and emotionally stressful for women and their partners; depression and anxiety are the most common psychological reactions to treatment (Eugster and Vingerhoets, 1999).
Dealing with the Emotional Toll
The stress of infertility affects the dynamic of any couple’s relationship, and it can also affect a couple’s ability to stay in treatment until they are able to start a family. The leading cause of couples terminating fertility treatment is the emotional toll it takes. Several studies have indicated that a significant number of patients drop out of infertility treatment programs voluntarily, not for financial reasons or on the advice of their doctors. Many patients seeking help with infertility drop out due to the “emotional cost” (Gleicher N, et al. 1996).
As a licensed clinical social worker (LCSW), I meet with patients to help them develop stress management skills that will assist them on their path to starting a family, as well as to maintain a healthy relationship. To counter the psychological effects of infertility treatment, I encourage my patients to maintain open communication and to find tools that minimize stress. This can be accomplished by learning about the mind-body connection, and by eliciting the relaxation response, which is capable of counteracting the physical toll of stress on the body. It also gives patients a way to feel more in control during their treatment.
Mind-Body Connection
When a person is under pressure, the body experiences a physiological or ‘fight or flight response.’ During this period, the brain is unable to tell the difference between physical danger and psychological stress and causes the body’s functions to speed up, tense and becomes very alert. The average American has approximately 50 responses a day to stress. In the short-term, this stress can lead to insomnia, headaches, back pain, stomach issues, and an increase in premenstrual syndrome (PMS) symptoms. In the long-term, excessive stress has a cumulative effect and will lead to high blood pressure, suppression of the immune system, anxiety, depression, and anger-management issues.
Patients can utilize mind-body techniques to reverse the affects of stress on the body. By training their minds to be more ‘fit,’ patients experience an immediate sense of relief. This effect deepens over time. Patients who practice mind-body exercises every day for about 15 to 20 minutes achieve long-term improvements in how their bodies handle stress. This is called the ‘carryover effect.’ In a review of literature on psychosocial interventions for infertility, educational groups that emphasized knowledge and skills training (i.e. relaxation training) within a supportive group environment were found to be most effective (Boivin 2003).
There are several different kinds of mind-body exercises, and I encourage my patients to find what works best for them. Every person has an individual preference, much like having a wide selection of ice creams to choose from. Some exercises can be done individually, while others can be done as a couple. I see the strongest results in patients who practice a combination of individual and couple exercises.
Mind-Body for the Individual
I like to think of utilizing mind-body techniques as a form of mental maintenance. For fertility patients, incorporating these techniques into their daily life can improve their treatment experience and the results. A review of psychological interventions to reduce stress related to IVF have concluded that they are generally effective, and that there is ample preliminary evidence that psychological distress can impact fertility, and thus IVF outcome (Campagne, 2006).
Breathing techniques, body scans and self-guided meditation are examples of ways to elicit the relaxation response. They take only minutes yet they have an immediate physiological affect on the body, its stress hormone production and long-term effects of stress by-products, such as high blood pressure. There are several smart-phone applications that can assist in mind-body practices; one that I recommend to patients is “Headspace.”
In addition to these exercises, there has been a lot of recent discussion in the media about practicing Mindfulness. This is less about an exercise with a definitive start and end point, and more about shifting a person’s perspective. This daily practice helps patients’ focus and appreciate the here and now, instead of becoming preoccupied with the past and the future. For an infertility patient, this means letting go of past experiences (e.g., a negative pregnancy test) as well as future expectations (e.g., tomorrow’s embryo transfer) that prevent you from enjoying the present moment. I encourage my patients to imagine putting their thoughts about their infertility treatments away in a box, for a little while, and practicing Mindfulness or “being in the moment” 15 minutes a day.
As Jon Kabat-Zinn puts it, Mindfulness is the “direct opposite of taking life for granted.” By learning to live in the moment, patients can promote peace and stillness within.
Mind-Body for Couples
I find that the most effective adaptation of the mind-body approach starts with the individual and moves to the couple. Like a couple who chooses to lose weight together through improved diet and exercise habits, mind-body approach works best when a patient has the support of her partner. Mind-body exercises can help a couple to improve their communication and manage their stress together.
Rather than allowing infertility to become all-encompassing, I encourage my patients to recapture joy. If it is hard to do that, I ask my patients to make a list of 20 things that make them happy and find a way to incorporate them into their day and/ or their week. They should find something they enjoy doing together. It is important for couples to laugh together and have fun, to live in that moment, even when infertility is taking its toll.
Couples can support each other by practicing mind-body techniques together. They can take a yoga class, do a guided meditation or even take a mindful walk together. They can also seek out support groups or counseling. For patients who are struggling with their emotions during this time, this can have significant benefits. These are safe environments where patients can share their thoughts, fears, anxieties, and disappointments. They take comfort in knowing they are not alone; after all, one in six couples experiences infertility. They may find a way to articulate their feelings. These sessions also can be a way to address emotions with a finite start and finish; allowing couples to discuss their feelings without letting those feelings encroach on every moment of the day.
Lastly, I suggest resources and reading to patients. Alice Domar, a thought-leader in using mind-body connection to improve fertility, has written Healing Mind, Healthy Women. One of her ideas for improving communication and the tone of couples’ conversations is through “new and good.” For example, when a couple comes home at the end of the day, they each share one new item and one piece of good news from their days. By restructuring their thoughts into something positive, they are changing the way they communicate and interact.
Infertility Patients are More than their Diagnosis.
An infertility diagnosis and going through treatment can be one of the most stressful experiences a couple will endure together. But it does not have to define them. It can be a learning experience with lasting benefits. By overcoming these challenges, you can learn how to cope with stress and better yet, your relationship can become even stronger.
Melissa Kelleher, LCSW works with couples and individuals at Reproductive Medicine Associates of Connecticut (RMACT), giving them the tools to emotionally handle their fertility challenges and make related decisions. Melissa earned her Master’s in Social Work from New York University and she graduated cum laude from State University of New York at Albany. She has been working as a Master Level Social Worker (MSW) since 1997, and earned her LCSW from New York State in 2006 (when it was first offered) and from Connecticut in 2013. Melissa has trained under Alice D. Domar, PhD, a pioneer in the application of mind-body medicine to men’s and women’s health issues.