Coping with Infertility

When getting pregnant doesn't happen easily, it may come as a surprise. But when pregnancy is unattainable after repeated fertility treatments, the stress can precipitate a crisis among even the most loving couples.

Each time a treatment is unsuccessful, many couples begin to doubt the value of going through further procedures, especially if they are expensive, as in vitro fertilization (IVF) can be.

A woman or her partner are considered to be infertile if they have tried unsuccessfully for a year to create a pregnancy. If they're in their 30s or older, the couple may need to be evaluated by a fertility specialist after trying diligently for six months. Infertility doesn't mean there won't ever be a pregnancy just that there's a problem that could warrant intervention.

"Couples dealing with infertility often have a horrific time," says Alice Domar, PhD, founder and director of the Mind/Body Center for Women's Health at Boston IVF and author of Conquering Infertility. Domar says it may be the first time that a couple has dealt with a crisis, and many don't know how to face it.

That stress of infertility is one of the reasons why the American Society of Reproductive Medicine calls it "one of the most distressing life crises that a couple has ever experienced together."

It's also the reason why many fertility clinics like Boston IVF also have mental health services to respond to the depression that can come with infertility. Many of the clinics offer psychological counseling, yoga, stress management, and other relaxation techniques that can lessen the strain.

What signs should you watch for?

Many of the feelings that infertility brings on can be similar to depression. They include:

• loss of interest in usual activities
• depression that doesn't lift
• strained interpersonal relationships (with partner, family, friends and/or colleagues)
• difficulty thinking of anything other than having a baby
• high levels of anxiety
• diminished ability to accomplish tasks
• difficulty with concentration
• change in sleep patterns (difficulty falling asleep or staying asleep or sleeping more than usual)
• change in appetite or weight
• increased use of drugs or alcohol
• thoughts about death or suicide
• social isolation
• persistent feelings of bitterness or anger
• persistent feelings of pessimism, guilt, or worthlessness

People should also examine whether they can handle the financial sacrifices that are necessary. Many who turn to fertility treatments are straining their bank accounts and don't know when to stop. The average IVF cycle, for example, costs about $12,400, and many women undergo multiple treatments before they give up.

Even when insurance is available for medical services, "studies show that 50 percent of insured couples undergoing infertility treatment drop out before completing the number of cycles they're covered for," according to Domar.

What can you do to lessen the strain?

Think realistically about how much you're willing to pay for fertility treatments. If you have to go through two or three cycles of IVF, how much will it strain your budget? Do you have to mortgage your house? Can you turn to savings or relatives to help with the effort?

Many clinics offer financial counselors who can set up long-term payment plans that do not involve large payments every month.

Experts suggest that patients should take advantage of fertility clinics offering mental health services for people going through treatments.

Domar, for example, teaches patients at the Boston IVF clinic a number of strategies to help minimize stress, including relaxation techniques and deep breathing exercises that minimize their anxiety at night. Domar counsels them not to fall prey to the cycle of hope and despair that comes with each cycle of infertility treatment.

Not only do these programs alleviate the mental strain, they also seem to help with the medical success of treatment. A small, ground-breaking Harvard study showed that infertile women who participated in a relaxation program became significantly less anxious and depressed, and 34 percent became pregnant within six months of completing the program. Since then, other researchers have also noted the connection between stress levels and pregnancy. According to another study of 151 women undergoing in vitro fertilization, those with higher stress levels produced fewer eggs for retrieval and had fewer embryos transferred than women feeling less stress. Finally, experts say, don't think of fertility treatments as the last chance to have a child in your life. Many couples consider adoption when treatments are unsuccessful.

"I was in despair when I was unable to get pregnant," said one woman in Palo Alto, who preferred not to be named. "But once I decided to adopt, those feelings receded and were replaced by joy, hope and excitement. Now that I have my daughter, I feel complete."

Domar urges her patients to join a support group, where they can share their feelings and find understanding among men and women who also face infertility. Sharing these thoughts among others can banish the sense of isolation and discourage negative thinking.

"You look around the room and realize you're not the only one," she says.

References

Interview with Sara Rosenquist, PhD, Sara Rosenquist, a psychologist in Chapel Hill, North Carolina

Interview with, Alice Domar, PhD, director of the Mind/Body Center for Women's Health at Boston IVF and author of Conquering Infertility .

American Society for Reproductive Medicine. Infertility: An Overview.

American Society for Reproductive Medicine. Frequently Asked Questions: The Psychological Component of Infertility.

Domar AD. Impact of psychological factors on dropout rates in insured infertility patients. Fertility and Sterility; 81(2).

Domar AD, et al. The mind/body program for infertility: a new behavioral treatment approach for women with infertility. Fertility and Sterility; 53(2):246-9.

Klonoff-Cohen H, et al. A prospective study of stress among women undergoing in vitro fertilization or gamete intrafallopian transfer. Fertility and Sterility;76(4):675-87.
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