"Just relax and you'll get pregnant!"
This advice is given liberally to most infertile couples by friends, family, acquaintances — and unfortunately even healthcare workers.
Although the words are well-meant, their effect is far from positive. Implicit in this well-intentioned advice is both blame and pressure. Blame, because the couple is obviously not relaxed, and it is assumed that this is the reason for their infertility. Pressure, because if they do as they're told, the couple should be able to conceive.
Most experts agree that although there is an association between stress and infertility, there is no evidence that stress causes infertility.[1][2] But the reverse is true. Infertility in a couple who want to conceive can create high levels of stress.
Persistent stress can, in turn, trigger depression. One study shows that the levels of anxiety and depression experienced by some infertile women are comparable to those of women with cancer or hypertension or to women patients undergoing cardiac rehabilitation.[3] Further, the stress of infertility is rated second only to the stress of divorce or death of a family member.[4]
For these reasons, infertile couples need access to counseling and mental health services.
The depression associated with infertility can either be transient — brought on by failed treatment, for example — or chronic — a result of repeated failures and the attendant strain on the couple's marriage, work, and social life. Differentiating between these types of depression is crucial in helping a couple deal with infertility and its emotional consequences.
Counseling can be helpful, too, as a couple begin to explores their options, from in vitro fertilization and donor sperm or eggs to adoption and surrogacy. Couples may feel differently about these alternatives, and their disagreement can be the source of added stress.
The benefits of support groups
Looming large on the long list of infertility stressors is a feeling of isolation. Infertile couples may be a minority — roughly 10 percent of the population — but they are still a substantial group. According to the American Society for Reproductive Medicine (ASRM), infertility, defined as the inability to conceive after one year of unprotected intercourse, affects about 6.1 million people in the U.S.
Support groups such as the American Infertility Association (AIA) and RESOLVE can reduce this sense of isolation by putting infertile couples in touch with one another and creating a venue to discuss similar problems.
Another hurdle for infertile couples is loss of control. This is especially hard to accept in American culture. We are shaped by the notion that if we try hard enough, we will succeed — but when it comes to infertility, there are no extra credits or ways to get ahead.
In this context, comments about relaxing can do more harm than good because they feed the couple's false belief that they have some control of the situation.
Many patients want desperately to believe that they have some control over whether they get pregnant — because it is too hard feel powerless. Rather than focusing on ways to cope with these feelings of loss of control, they fight them, often spending a good deal of time and energy on as yet unproven remedies such as herbs or acupuncture.
Why women are more stressed
Regardless of the cause of the infertility (male or female physiology, or both), research suggests that the woman shoulders the heavier emotional burden.[4][5][6]
Men and women cope with the stress of infertility very differently,[7] and these differences can be the source of intense marital strain. Although women tend to be more open to psychological counseling than men, the importance of this intervention remains largely unrecognized by patients and possibly by physicians as well.[8]
Red Flags in "The Fertility Game"
The American Society for Reproductive Medicine lists these signs that an individual dealing with infertility could benefit from counseling:
- Loss of interest in usual activities
- Depression that doesn't lift
- Strained interpersonal relationships
- Difficulty thinking of anything other than infertility
- High levels of anxiety
- Diminished ability to accomplish tasks
- Difficulty concentrating
- Change in sleep patterns
- Change in appetite or weight
- Increased use of drugs or alcohol
- Thoughts about death or suicide
- Social isolation
- Persistent feelings of pessimism, guilt, or worthlessness
- Persistent feelings of bitterness or anger
Individuals or couples can find qualified infertility counselors in their region by checking the web sites of AIA, ASRM, or RESOLVE.
Couples counseling can help men and women bridge the gap that is often created by gender-specific coping styles and polarized attitudes; however, research suggests it is more effective in alleviating personal depression.[9]
One word of caution: Psychological intervention is invaluable in the treatment of infertility, but it should not be promoted as a means of improving pregnancy rates.
While some research suggests that high stress levels during infertility treatment are associated with lower pregnancy rates,[10] other research indicates that psychosocial intervention does not improve the outcome.[9]
The bottom line is this: Psychological counseling can help couples function normally through the stress of diagnosis and infertility treatments and have a positive impact on their lives — regardless of the outcome.
Notes
1 Sheiner E 2003.
2 Hjollund NH 2004.
3 Domar AD 1993.
4 Baram D et al 1988.
5 Koropatnick S et al 1993.
6 Berg BJ et al 1991.
7 Jordan C 1999.
8 Schmidt L 2003.
9 Boivin J 2003.
10 Boivin J 1995.
This article is for educational purposes only and is not intended as a substitute for medical advice. Please consult with a clinician to review any current symptoms and address your medical concerns.
