The Effects of Stress on Infertility -- Jean Benward, LCSW -- 09/25/02

WebMD Live Events Transcript

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Infertility is a major life crisis for many couples. What are some effective stress-reduction tips for couples? As part of National Infertility Awareness Week, WebMD joined with RESOLVE: The National Infertility Association to bring you the Trying to Conceive Cyber Conference. Jean Benward, LCSW, joined us to discuss handling stress while trying to conceive.

Moderator: Welcome to psychotherapist Jean Benward, LCSW, the current chair-elect of the American Society of Reproductive Medicine Mental Health Professional Group. Thanks for being our guest at this late hour.

Member: I've been TTC for two years. How do I avoid the stress caused by infertility? I'm becoming depressed more and more with each cycle that goes by.

Benward: Your reaction is common. The more time that goes on and people don't get pregnant, the worse they feel. There are a number of reasons for this, including feeling like you are living life in limbo, loss of self-esteem, loss of sexual intimacy, financial stresses, and the cumulative physical stress of MD visits, injections, and the hormonal effects of medications.

First of all, don't blame yourself for feeling this way and for not getting pregnant. This is easier said than done. Some things that help include getting emotional support, having some people you can talk to about feelings of anger, despair, and hopelessness. Support is so important, and sometimes people don't get the support they need from friends and family.

But it's really important to find someone to support you. Try to keep the communication open in the relationship with your spouse. Find ways to enjoy each other and don't focus all your time on infertility. Identify what your particular triggers are -- what particularly gets to you. And then try and come up with some strategies to physically relax.

People are helped by physical exercise, relaxation skills, and another helpful thing for many is to try and gain some sense of control over what's going on, such as learning as much as you can about your own infertility and treatment options available.

Member: What do you suggest we do to lessen our anxiety and remain hopeful?

Benward: Despair is one of the most painful parts of infertility and it's difficult for most to remain hopeful. The danger is people start to feel that their negative feelings will influence whether or not they get pregnant. There is no proven connection between stress and infertility. And while common sense says you want to do things to feel better, positive thinking does not ensure pregnancy.

Moderator: Isn't one of the worst things you can say to someone who is TTC "Relax and you'll get pregnant?"

Benward: Yes. One of the myths often put forth to infertile people is if they just relax and don't try so hard, then they will get pregnant. The truth is that relaxing will not change a physical problem if you have it, nor a genetic problem if you have it. And it will not change age-related infertility. We would all be rich if we had a dollar for every time someone just said to relax.

The other thing I want to add is that you should stay focused on your goal to become a parent. It has been my experience that most everybody who seeks to be a parent can achieve that goal in one way or another. It may not be in the way you originally thought it was going to happen, like in the biological child or pregnancy, BUT you still can become a parent.

Member: Any suggestions for a constant feeling of unfairness because of infertility?

Benward: Infertility is unfair. It's really frustrating because no one expects it to happen. No one grows up thinking they will deal with infertility. People expect to control their choices around fertility. And sometimes the people around us have a difficult time accepting our feelings of anger, hurt, and jealousy of other people's pregnancy.

Friends and family can tell you to just be positive, but just suppressing feelings of anger and hurt will not really change the fact that infertility really does hurt. Also, you should give yourself permission to not be in situations you know will be hurtful such as a baby shower.

Member: All of my friends are either pregnant or have kids of their own. How do I maintain these friendships while keeping my own sanity and not feel jealous or envious all of the time?

Benward: Jealousy and envy is to be expected in these situations. One thing you can do with good friends is talk to them about how hard it is for you to be around them while pregnant or to see them with their children, and ask them to try and understand if sometimes you are distant or tearful around them.

If you can talk about it to friends, there is a much better chance the feelings will not disrupt the friendship. Although there are relationships you may have to put on the back burner for a while if you cannot get the support you need from the relationship.

Member: How do you put intimacy back into your life?

Benward: Infertility has a way of taking over people's relationships so they don't have a life. Instead, they have infertility. It can take the fun out of sex, because it's now sex on a schedule. Try to find ways to do things together, not necessarily sexual, that you enjoy and that make you feel close.

Another issue that comes up is that men and women often have different reactions to infertility. Men tend to lose themselves in work and want some distance from the infertility, which makes their wives feel hurt and not supported. One thing that's helped some couples is to put a limit on how much time you spend talking about infertility. Limit the talk, for example, to 20 minutes at a time.

The other issue I hear a lot from women is feeling their husbands are not involved in treatment planning and the treatment. It sometimes looks as if they have the easy part. Often the husbands do not realize the kind of physical stress that comes from injections, invasive medical procedures, and feeling exposed and vulnerable.

It's really important that you ask for what you need. Tell your husband he needs to go to an appointment with you and take some time off work to support you in doing something. Women often feel guilty and feel like failures and forget that this is a partnership, and each of you has the right to ask for what you need from the other.

Member: How do you respond to friends and family who always have stories about how they got pregnant when they stopped thinking about it or how their sister got pregnant when they went on holiday and relaxed? There's also always the story that once you adopt and stop wanting to get pregnant, you will conceive. I don't know what to say when I get this advice.

Benward: Exactly what to say to people will somewhat depend on your relationship with them. Some can be educated about what infertility is like and how even well-meaning advice can be hurtful. Or you can say something like, "Thank you for your positive thoughts and wishes. We are working with a doctor and following his advice." Sometimes you are going to find yourself being angry and telling the person to just not do this anymore.

Member: Why does it seem there are more women/couples with infertility problems today? Is it the chemicals we eat and breathe? Why didn't June Cleaver have any conception problems?

Benward: Good question. There are clearly more couples in active infertility treatment than 20 or 30 years ago. Look at the number of IVF programs across the U.S. In the day of June Cleaver, there was very little that doctors could do. With the advent of IVF couples were offered new hope and new opportunities for getting pregnant.

The other reason why there are more women in treatment is that for the most part there are a larger number of people PERIOD in the post-war baby boom. So even if the percentage of people did not change, the number of people needing help would change.

Also, couples have postponed marriage and childbearing until they are older and then discover that their fertility has become impaired. We know a lot more about fertility than we used to, so there are many more treatment options available. Just 10 years ago hardly anyone did donor eggs. And now it's a much more common solution.

One of the issues that go along with this is that it's hard to know when to stop medical treatment. When do you get off the IVF treadmill? There are also more treatment programs available, hence more patients, in the states that have mandated health insurance coverage. In the past, most people who could not get pregnant moved relatively soon into adoption. That is no longer the case. People stay in medical treatment longer and pursue many more treatments before they will move to adoption. And there are fewer American babies to adopt than there were 20 years ago.

Member: Any suggestions for someone who will do their first IVF cycle, but is extremely afraid of needles and painful medical procedures?

Benward: Needle phobia is extremely common. I would ask your nurse if she has any suggestions, techniques, etc. to help people deal with this. For a first cycle, I think it's easier to have someone give you the injections. That way you don't have to look at it. If your husband does it, it makes it more of a partnership.

There is a kind of desensitization that takes place over time. Even people who were terrified of needles find themselves mixing up the medications and giving themselves shots. It's amazing what you get used to. In a first cycle it will all seem incredibly strange, scary, and overwhelming. Try to connect with someone who has already done an IVF cycle or who is going through it also.

Member: I find that my wife is having the hardest time dealing with the fact that our closest friends are both pregnant right now and we have been trying for over two years. I think the frustration is the hardest part. Plus when I have spoken to other couples in same situation, sex isn't sex anymore; it has become a chore during ovulation and a giant waiting game, which kills the romance.

Benward: Infertility has a huge negative impact on a couple's sexual relationship, and especially so for the woman. Try to remember that sex is not just intercourse. It's touching, caressing, holding, and words of love and affection. And you can maintain intimacy. Most of all, remember that it may be very emotionally painful to have intercourse -- emotionally painful -- because it has so often failed to create a pregnancy. And once this is past you, you can have more fun again. It is hard to imagine at this point a life after infertility.

Member: I've been TTC for four years. I'm 35 with unexplained infertility and just started IVF No. 3. How can I learn to accept the fact that I can't have my own children?

Benward: You don't know for sure that you won't. But I would imagine at this point you are exhausted by these IVF cycles. People often hit the bottom and feel like they just cannot do it anymore. This is a sign you need to take time off from treatment. Time to replenish yourself. Time to grieve. And time to make decisions.

Though the thought of not having your own genetic child seems too much to tolerate or live through, after a while you may come to feel better, even optimistic, about your alternatives.

Member: How do you find a therapist that specializes in infertility? Seems when you call the insurance company, they give you a family or stress therapist. What is the specialty I should be asking for?

Benward: You want a therapist who has specific experience and expertise in infertility. The best way to get a referral is to call your local RESOLVE chapter. There are also some useful Internet sites that also include the names of therapists in different states who understand infertility.

The therapist will know whether they are on your insurance list of providers. And even if you have to pay out of pocket, it may be worth it.

Member: So what is the connection between stress and infertility?

Benward: This is a question researchers have posed. There is no research that proves that stress causes infertility. While reducing stress is helpful for coping and helps your own sense of well-being, it won't ensure pregnancy. It is possible that people who join a relaxation program or stress-reduction program will cope better, make better decisions, but it does not guarantee pregnancy.

I think the idea that stress causes infertility is a potentially negative one for couples. If you start to believe this, then you could be heading down the path to blame yourself for all of this. Although we understand from holistic health that there is a mind-body connection, none of us has the power to cure ourselves with positive thinking.

Moderator: We are just about out of time. Do you have any final comments for us, Ms. Benward?

Benward: Infertility treatment is like having a chronic illness or even a life-threatening illness. It's very difficult. Try and be kind to yourself and not berate yourself for feeling stressed.

Moderator: We are out of time. Thanks to Jean Benward, LCSW, for joining us tonight. For more information about this and other fertility issues, be sure to explore all the TTC info here at WebMD, including our message boards and regular live chats with Dr. Amos Grunebaum.

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