When the COVID-19 pandemic was starting to take off, Alice Domar, Ph.D., had a hunch her clients with infertility were still more stressed about getting pregnant than the deadly virus that was spreading around. She was right.
“We did a study of about 3,000 patients and they said that infertility was harder for them [to manage] than COVID,” says Domar, an expert in mind-body medicine, author, professor and chief compassion officer at Inception Fertility, an fertility services provider. “We know that infertility causes a tremendous amount of stress, so the question becomes does stress cause infertility? With most species, if you stress them out, they stop reproducing. So it intuitively makes sense that stress would decrease fertility.”
That particular scenario was nearly four years ago and, unfortunately, not much has changed since then. Although there have been studies on the correlation between stress and infertility, it’s difficult to paint a complete picture for a variety of reasons, according to Domar.
“Women who go into an IVF cycle with a good prognosis—they’re 22 and they have blocked [fallopian] tubes—are going to be less stressed when they start compared to a 43-year-old who has a very low AMH [anti-mullerian hormone, which is used to predict ovarian mass],” she says. “So you really can’t trust self-reported information, per se, in terms of predicting IVF outcomes.”
However, research has shown that the more stressed women are before they start an IVF cycle, the less likely they are to get pregnant. Alternatively, if infertility patients undergo a psychological intervention, such as therapy, they have higher pregnancy rates than those who don't—something Domar believed when she created the Mind/Body Program for Fertility back in 1987.
“The women who went through the mind/body group had a 55% take-home baby rate and the women who were randomized to the control group had either a 20 or 22% take-home baby rate,” she says. “That’s a massive difference.”
Psychological interventions and infertility
Even though infertility is fairly commonplace (roughly 1 in 6 people worldwide will have trouble getting pregnant), many people suffer in silence. In fact, research has shown that depression and anxiety levels in people with infertility is equivalent to those of people who have been diagnosed with cancer. And, as if that weren’t enough, women are more often blamed even though male infertility accounts for more than 50% of issues conceiving in heterosexual couples.
“I’ve probably seen about 10,000 patients in my career and I’ve never had a patient report to me that someone hasn’t said some version of the following: ‘oh, just relax and you’ll get pregnant,’ or 'lose weight, gain weight, quit your job, start your job' … and the basis of all of this is you’re doing something wrong and your stress level is clearly causing your infertility, which is offensive,” says Domar.
The mental health impact can be devastating. A 2016 study revealed that a significant number of patients undergoing infertility treatment have clinical levels of depression and anxiety, specifically 56.5% of women and 32.1% of men in the study scored in the clinical range for depression.
“Infertility in humans impacts every area of their life,” says Domar. “It affects their relationship with their partners, it affects their sex life. It affects their relationship with family and friends. It affects their job, it affects their financial security and it affects their relationship with God.”
But there are ways to take back your power and gain some control over your mental health. Below are some of the mindfulness strategies Domar employs in her Mind/Body Program for Fertility:
1. Introduce a relaxation strategy to your daily routine. “Whether it’s yoga, meditation or progressive muscle relaxation, I recommend some form of relaxation to bring down the level of day-to-day anxiety,” says Domar.
2. Learn some cognitive strategies to help combat depression and anxiety. “It’s about learning to challenge negative thought patterns,” she says. “So, as opposed to thinking, ‘infertility is all my fault’ and have that play over and over in your head, instead you could try saying, ‘I’m doing everything I can to try to get pregnant.’
3. Join a support group. Infertility is incredibly isolating, so it can be beneficial to find community with other people going through similar circumstances, whether it’s online or in-person.
4. Consider the impact of lifestyle habits on fertility and mood. “I can teach a patient every cognitive strategy there is, but if she’s smoking cigarettes, running marathons, drinking a ton of alcohol, then she’s got to change her habits to enhance her chance [of getting pregnant,” says Domar.
As for healthcare practitioners, Domar emphasizes the need for and importance of patient-centered care.
“We have to remember that the vast majority of our patients are anxious and depressed … this is what infertility has done to them,” says Domar. “We have to treat them kindly, compassionately and empathically because it’s really hard to go through this.”
And if you’re currently struggling with infertility, Domar wants to remind you that all of your feelings are valid.
“If you’re feeling depressed, anxious, hopeless, tired, jealous that just means one thing: you’re normal,” she says. “I was talking to a patient yesterday and she was saying she’s never been jealous a day in her life. Now, when someone says they’re pregnant, she loses her mind. I’m like yep, 100%. Every patient feels that way.”
