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By The American Fertility Association

You did everything you were supposed to do--quit smoking or never started, drank but moderately, ate well, exercised, crossed with the light. You were ready to have that baby--but after six months, a year, longer, it just didn’t happen. You have become one of the one-in-ten couples around the world who are trying to understand and overcome infertility--and it’s driving you crazy.

It becomes very stressful very quickly when doing what comes naturally has an unnatural result--no pregnancy. Feeling your hopes and dreams of a family start to fade can throw all kinds of emotions into stark relief--many of them painful. Says Joann Paley Galst, Ph.D., a New York City-based psychologist specializing in reproductive health issues, “We can’t say that stress causes infertility but we know that infertility causes stress.” It’s your job, as you go through this difficult process, to learn how to manage that stress.

The Breaking Point

Stress is a part of everyone’s life. But when you’re struggling with infertility, the pressures you confront are especially wearing. Our emotions are a combustible mix of anger, guilt and shame. We blame our bodies for being “inadequate,” our partners for the same reason, our parents, our doctors, our careers, even God. It’s open season. For many of us, the cultural, social and religious imperatives to bear children are so huge that we also shoulder the burden of feeling like pariahs, isolated by an unkind act of nature. Because the inability to have babies remains a taboo or, at the very least, a highly charged topic, we often find ourselves alone in our sorrow. The truth is, we all feel grief-stricken when the incontrovertible fact is that we can’t procreate without medical intervention or at all. It’s important to allow yourself to grieve the loss, to find support. After all, infertility is a disease, not an act of divine retribution.

At the same time you’re learning to surrender the idea of an easily conceived child, there are the treatments: the shots, the doctor’s visits, and the restrictions on your sex life, the mood-altering hormone treatments. Add in the usually sky-high, often-uninsured costs of the drugs, the sonograms, the blood tests, intrauterine inseminations or IVF cycles and you have a recipe for anxiety that’s foolproof. But you don’t have to become hostage to that stress. There’s plenty you can do about it.

Calm Down

It’s unclear how much stress affects fertility. The only thing that is clear is that prolonged stress can affect menstrual function. But for the most part, studies indicate there is little to no negative impact on the ability to achieve a pregnancy. So take a deep breath, expect stress to be a companion during this time and take some positive steps to alleviate it when you can.

One study conducted by Dr. Alice Domar, Director of the Mind/Body Program for Infertility at Boston IVF, found that infertile women who had specific mind/body interventions to help them deal with stress had greater success in conceiving and carrying a pregnancy to term than those who didn’t.

Says Dr. David Sable, Director of Reproductive Endocrinology at the Institute for Reproductive Medicine and Science of St. Barnabas in Livingston New Jersey, “I tell patients to be as stressed as they want and not to worry that stress is having an adverse effect on their treatment outcome but I do encourage patients to seek out forms of stress relief. Making the process more tolerable in and of itself is good regardless of whether it makes it more likely a pregnancy will be achieved.” Unchecked stress can lead to heart disease, elevated blood pressure and a host of other woes. So it’s best to deal with it openly and early.

One thing all the experts agree on is “express yourself.” Don’t try to hide or bottle up your feelings. You’re going through something very difficult and trying to just “get over it” is never going to work. While you can’t let heightened emotions rule your life, neither can you pretend they don’t exist. Give yourself a half-hour or so a day to focus on your feelings about infertility. Sometimes knowing that there’s a place and a time for these feelings will make them more manageable.

Look for safe outlets for you to explore and discuss thee complicated thoughts and emotions of infertility. Dr. Domar says that roughly half her patients haven’t told anyone that they’re infertile. They’re just carrying the pain around with them. Pain becomes so much easier to bear when it’s shared, she said and suggests joining a support group that lets you vent to someone other than your partner. Don’t forget, your other half is likely to be feeling fragile, too. Check with your fertility center to locate a reputable support group and make a point of going. Who can better identify and sympathize with you, who better to provide helpful suggestions than others suffering with infertility? These are people who can and want to identify with you. Talking candidly in a safe, caring environment acts as a pressure release valve. It allows you to take the necessary breaks from fighting down your sadness or hiding your resentment in front of pregnant friends or those who have children.

It’s also important, says Dr. Galst, simply to keep doing things that give you pleasure—things like putting flowers on your desk, getting a massage or going away with your partner to a non-family oriented place. You’re on a long road and, despite the setbacks of infertility, life still holds much that’s good. You have to treat yourself lovingly and stoke your energy and zest.

Family Ties

Of course, some of the most infuriating and tension-provoking comments can come from well-meaning family members. Their questions about why you haven’t coughed up the progeny yet can cut like a knife. But don’t cut them off. Try to educate them about what infertility is and how you’re coping with it. Tell them what you want from them. That’s no guarantee that you’ll get it--as anyone with a family knows--but if they love you and you love them, it’s worth the effort to keep the lines of communication open. Only the most insensitive won’t bend a little.

Be clear with your partner as well. Infertility taxes a couple like few other life changes, with each blaming the other or agonizing about what might be wrong at every step. Try to stand together and be open with each other about what’s going on and what you need--whether it’s more space or more closeness.

Men and women respond differently to the stress of infertility, according to Dr. Domar. It’s a waste of time trying to get your partner to feel exactly as you do and it’s why you both need supports outside each other. Keeping a journal can be very helpful, especially at times when it’s difficult to reach out to others. A journal is always there, ready to receive anything you have to say, no matter how hard—and sometimes, as you write, new ideas or insights can spring up.

At the same time, your relationship is central in this process. Don’t give it short shrift. Try to remember you are two people who love each other--not just two people who tried and failed to produce a baby. Go on dates together, spend time doing things you like to do--things that have nothing to do with having a baby or not having one.

Sexual Healing

Because infertility, fertility treatments and sex are inextricably bound, intimate relations often become the first casualty of your medical odyssey to have a biological child. What was once effortless, spontaneous and fun now becomes a chore with set times and an ardently hoped-for end product. While there’s no way to get rid of the difficulty entirely, you can remember to focus on each other in different ways. Give each other pleasure in ways that have nothing to do with sex--presents, hugs, affection, all the little things you did when you were first dating. Maybe you can add to your repertoire of little intimacies, trying to maintain physical contact that doesn’t end in intercourse. Once infertility rears its head, it’s so easy to stay focused on the baby goal that you forget why you got into this ball game at all.

Move it

You’ve heard it time and time again--exercise not only helps you live longer, it’s a great tension tamer. Even if your physical activity is restricted by your treatment, talk with your doctor about what’s OK for you to do. Consider yoga, which has the benefit of increasing flexibility, strength, and managing stress. At the very least, take a walk outside every day. Moving your body--remembering all that it does right for you--takes your focus off your reproductive system.

Deep relaxation techniques can also take the edge off. Deep breathing, visualizations, muscle relaxation and meditation are all very useful and, once you’ve learned them, can be incorporated into any part of your daily life.

You might also find that getting involved in activities--volunteer work or hobbies--that are unrelated to infertility might serve you well. Sometimes meaningful diversion is as important as acknowledging your feelings.

Information Please

Take a proactive stance. Learn about infertility, treatment possibilities, insurance, finance and your coping options. You’ll feel less out of control, less victimized by the situation. Few things are as draining as uncertainty is draining, so nail down as much information as you can. You’ll be able to make the dozens of decisions that you’ll confront in a much more rational and calm frame of mind.

Help, I Need Somebody

What if you try all this and more and nothing seems to work? What if the stress and sadness feel so overwhelming that meditating or keeping a journal sound like jokes? What do you do if infertility is compromising your career or your personal relationships and you don’t see a way out? That’s when you seek professional help. The American Fertility Association can help you find a knowledgeable counselor as well as refer you to support groups. Don’t let stress of infertility take over your life. Call toll free at (888) 917-3777 to get the help you need from the people who’ve been through it.

The American Fertility Association wishes to thank Joann Paley Galst, Ph.D., Dr. David Sable, Director, Division of Reproductive Endocrinology at the Institute for Reproductive Medicine and Science of St. Barnabas, Livingston, NJ and Dr. Alice Domar, Director of the Mind/Body Program at Boston IVF for their invaluable assistance in assembling this fact sheet.
This fact sheet was funded by an unrestricted educational grant from Unipath Diagnostics http://www.clearblueeasy.com