Stress and infertility, a meeting of the mind

by Jennifer Palumbo

Yes. We’re having THAT conversation. Does stress impact your fertility?

There’s been endless conversations around it, articles written about it, research done on it, and debate on whether or not a mind/body approach would help you conceive.

When I was deep in the trenches, I tried it all. Acupuncture, journaling, hypnotism, visualization, and drinking herbs looked like someone just put dirt in a jar and handed it to me. Once I became pregnant, I got asked, “what worked.” From my own patient experience, I can only say that while I don’t know for sure if working on my stress levels helped, I will say it bought me at least five minutes of sanity here and there, and when you’re jacked up on hormones, those five minutes are needed.

But enough about me. Let’s talk to some experts on this topic and see if we can settle this once and for all. Below, I spoke with:

Dr. Alice Domar, Ph.D., is the Executive Director of the Domar Center for Mind/Body Health and the Director of Mind/Body Services at Boston IVF. She established the first-ever Mind/Body Center for Women’s Health.

Rena Gower, a Licensed Clinical Social Worker (LCSW), brings personal and professional experience to social worker’s role at RMA. As a former infertility patient, she understands that the process can be stressful and overwhelming and believes that having a support system and access to resources can make this difficult time a bit more manageable.

Marc Sherman founded Organic Conceptions after a decade long struggle with primary and secondary infertility. The passion came after he and his wife Erin struggled with infertility, decided to adopt, and then unexpectedly found themselves pregnant. They conducted the first-ever research project to understand better the insights, patterns, and commonalities from similar stories. Their findings and the wisdom uncovered in this research are now empowering couples to achieve clarity, connection, and certainly in their paths forward.

They shared their perspective on this hotly debated topic.

JAY: What is the effect you have experienced or seen from infertility on relationships?

DOMAR: “The impact of infertility on relationships can be profound. Sometimes it can bring a couple closer together since there is comfort in coping with a crisis together, and the divorce rate in infertile couples is lower than in couples with children. However, most individuals and couples experiencing infertility report a lot of friction as part of the process.

Some reasons include that women tend to want to talk about it more than men. The vast amount of the physical impact of treatment falls on the women even if the diagnosis is a male-factor. Women experience far more jealousy of pregnant women than men, and research shows that women report a higher prevalence of anxiety and depressive symptoms than men. Women tend to want to move on to the next stage of trying while men often hold back, so she feels as if he is preventing her from conceiving, and he feels as if she is pushing him to make decisions he isn’t ready to make.”

SHERMAN: “We believe that the most important part of this journey is your relationship with your partner/spouse (only second to yourself). The challenge, however, is that after time your relationship becomes consumed by your fertility struggle. Our research uncovered a significant difference in how women and men interpret and give meaning to their circumstances. There is no right or wrong answer. However, when there is a difference in interpretation, it can lead to a lack of validation. And men struggle as well. Many tell us that they are unsure of their role and how to support their partners best. They want to remain supportive and positive, but they are grieving as well.”

GOWER: “Infertility can be extremely stressful on relationships –financially, emotionally, or physically. The partner whose body is going through everything may feel alone and isolated, despite the other partner’s best efforts to be supportive. The partner who is witnessing their other half put their body through all treatments may feel powerless and aren’t contributing. Intimacy may start to feel like a chore or a homework assignment instead of something for joy and pleasure. Day to day life may begin to feel as though it is inundated by stressors- doctor appointments, phone call, dealing with insurance. It’s easy to let the process take over your life and your relationship.”

JAY: What would you say to couples who feel that strain and are considering emotional or psychological resources?

SHERMAN:Acknowledging the strain becomes the opportunity. A strain can lead to tension, which can disrupt your quality of life and your reproductive health. Couples need to view emotional support not as a sign that things are not going well but a proactive investment in each other.”

DOMAR:I may be biased here, but I think couples’ therapy can be incredibly helpful, especially now that most therapists are offering sessions online. Many couples find that having an impartial individual can help them navigate the challenges. When I see heterosexual couples, we talk about how to communicate so that the female partner gets heard effectively, but the male partner does not feel that it is the only thing they talk about. Also, both members of the couple tend to feel that they are coping in the right way. If only their partner switched to their method of coping, it would be ok. I steer them to the realization that their partner is coping the best way for them, even if it is different. Learning that they are coping in similar ways to other couples can be very comforting.”

GOWER: “It is normal for this process to bring up stress and strain in a relationship. Reaching out to a professional to help you navigate this is important – let this be an opportunity to strengthen and build a stronger foundation for your relationship. For instance- try to involve your partner even if they aren’t using their body for injections or pregnancy- for example- give them an action plan to help with injections – maybe it’s their job to set everything up or manage to get the medications. Delegate your partner to be the one to receive communication from the clinic or manage dealing with insurance.  Finding proactive ways to involve the other partner is important in helping them to feel a part of their process.

Communication is crucial. It’s important not to let this dialogue take over your relationship as you will start to associate these stressors or negative thoughts with your partner. Unless you are in the middle of a cycle, I like the 30-minute rule- make a date with your partner to discuss the trying to conceive journey once a week. Please put it on your calendar and cap it at 30 minutes (45 max). Try and make it fun- i.e., “Fertility French fry Fridays” or “cupcakes, conversation, and conceiving”…something to make you laugh. 

JAY: It is time for the million-dollar question! Do you think there is a mind/body connection to conceiving?

DOMAR:I do, but there are many people who disagree with me. I wrote an opinion piece in Fertility and Sterility, which was published last spring. In it, I explained that we are not helping patients by continuing to argue about whether or not stress impacts fertility. We will never truly know the answer. The only way to research it is to see if stress management strategies lead to higher pregnancy rates in women undergoing infertility treatment, which it does appear to do. Three of my large randomized controlled trials showed a huge increase in pregnancy rates in women who participated in a mind/body group (more than double)”.

GOWER: Infertility causes stress, but stress doesn’t cause infertility. It’s important to differentiate because many people put undue pressure on themselves and think it’s their fault they aren’t conceiving. After all, they are stressed. I take the perspective that my goal with working with patients is to help them feel better in mind and body for THEM because I want them to feel as good as possible and improve their quality of life, not because I think that their stress is harming their ability to conceive”.

SHERMAN: “The data is undeniable in terms of the connection between our minds and bodies. However, the challenge is that when you find yourself in a state of uncertainty, it’s normal to control the situation. Many people feel as if they are in a race against time. Therefore, they find themselves consumed with finding a solution and answering why this is taking so long. When we don’t conceive as quickly as we expected, we begin to experience worry and concern, which can then morph into anxiety, fear, and even panic. The facts are our bodies can sense danger. For many, we are operating in a survival/emergency mode, which is flooding our bodies with stress hormones that are creating an unhealthy internal environment. Our emotional health and reproductive health are not mutually exclusive. They need to be aligned to maximize success regardless of whether you are in treatment or looking for an alternative approach. 

While their answers varied on the big question, it’s clear they all still believe investing in your mental and emotional health is a smart move

To read more from Jennifer Palumbo, click here


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