Stress & Infertility
The Role of Stress Levels in Infertility:
What you can do to minimize the deleterious effects
by Sheila Scharnowski, RNC, MS
Clinical Nurse Specialist, Reproductive Endocrinology
Colorado Reproductive Endocrinology
For many infertility patients, the achievement of an ongoing pregnancy is maddeningly elusive. The anguish of enduring repeated cycle failures creates overwhelming frustration. As time goes on, the prolonged cumulative effect of this stress can actually cause physiological responses counter productive to reproduction. In the paragraphs below the escalating stages of despair are described and relaxation ideas are suggested to help counteract the deleterious effects of stress. Infertility strikes one couple in six. The older a women the more likely she is to need medical intervention to conceive. In this most intimate area of a couple's life the stress of medical treatments demands escalating amounts of time, emotional investment and money. A woman, undergoing infertility therapy herself, wrote the following quote that eloquently expresses the anguish of an infertility patient.
"My infertility is a blow to my self-esteem, a violation of my privacy, an assault on my sexuality, a final exam on my ability to cope, an affront to my sense of justice, a painful reminder that nothing can be taken for granted. My infertility is a break in the continuity of life. It is above all a wound… To my body, to my psyche, to my soul."
-Jorgensen, l981. On healing. Resolve Newsletter, Dec., 1.
The "wound" to the psyche and soul that Ms. Jorgensen addreesses in her quote is the area where patients can make a difference in their own treatment and is the subject of this article. The physician is providing the very best medical care for the "body" but to treat the "wound to the psyche and soul" will require the mental participation of the patient. This article will empower the infertility client to take charge of the progressive stress levels engendered by infertility treatments by explaining:
- The progression of infertility's despair
- The consequences to reproductive function that stress can cause
- And how to utilize joyful and relaxing activities to diminish stress.
Blenner (1990) describes the predictable progression of infertility's emotional toll. There are eight stages as summarized below. The spiral depicted on the right illustrates the downward drift of emotional health and excalating despair
- Dawning of awareness: Couples plan the best time of the year to have a baby; realize it seems to be taking longer than expected, still identify with fertile population.
- Facing a new reality: Diagnosis stimulates couples to face reality of infertility. Blaming, guilt arise. Selective perception of success rates and discounting of side effects and risks of treatment. Begin to isolate themselves.
- Treatment: Hopeful, excited, high energy.
- Intensifying treatment: Infertility major focus of life, financial and time sacrifices intensify. Anger or depression occurs. Increasing isolation, avoids activities with children. Loss of control.
- Spiraling Down: Tearful, overwhelmed, enrages by the injustice of infertility
- "Letting go": Usually husbands "shut down" first, then wives. Resume social life but activities without children (backpacking). Strong desire to regain control of life, quitting is gradually OK.
- Quitting and moving out: Initial feelings of relief, followed by grief. Initiation of adoption for some.
- Shifting focus: For childless couples, peaceful resignation. For adoptive parents, focus on the child.
Adapted from: Blenner, J. (1990) Image: Journal of Nursing Scholarship. 22(3), 153-158.
In addition to the stresses of the medical regimens, overwhelming feelings of loss of control and increasing isolation as described by Blenner, there are psychosocial pressures on couples to reproduce. Erickson's "stages of development" theory describes the tasks of human development from infancy's need to establish trust, through the adolescence's search for identity to middle adulthood which includes the task of generativity. Generativity is the task of guiding and helping children. It is the next stage of a human's development, (according to Erickson), but infertility blocks the accomplishment of this task. The couple can't understand why this stage is thwarted when all of life's other developmental tasks occurred without conscious thought.
Compounding the couple's despair, is the societal stigma that accompanies infertility. The couple may feel "defective" and the inability to fulfill the role of parenthood may be regarded as a personal failure. And while the couple grapples with these unpleasant feelings the woman's biological clock continues to tick adding time pressure to their list of stressors.
Researchers have verified that infertility does cause stress. Comar (1992) reported that infertile women experience twice the level of depression when compared to their fertile counterparts. And this elevated stress does compromise reproduction. Facchinetti (1997) documented that the higher a woman's vulnerability to stress the lower her pregnancy rates. Sharma and Sharma (1992) documented double the pregnancy rates in women who took anti-anxiety pills.
Domar, a researcher who works at the Mind and Body Institute in Boston which is associated with Harvard Medical School proposes a model that explains the deleterious effects of stress on the reproductive functions. This model was published in The Wellness Book (1992) by Herbert Benson.
Cycle of Despair
No Conception / Menses
which leads to:
tubal spasm / irregular ovulation / decreased sperm production
which leads to:
frustration / anger / isolation / depression
which leads to:
emotional tension / stress
which leads to:
No Conception / Menses
Adapted from: A. Domar in The Wellness Book. by H. Benson, 1992
To break this cycle, the emotional tension must be addressed. One intuitively knows that the mind (psyche or soul) can influence physiological responses. Just think of the emotion of fear. When one feels fear, there are distinct bodily symptoms such as dry mouth, pounding heart sweaty palms, etc. that accompany this emotional feeling. Perhaps, techniques available for stress reduction could reverse the emotional stress of infertility.
Benson (1992) contends that stress and relaxation can not co-exist. Several research studies have documented the positive effect of relaxation in other fields. Stuart (1987) used relaxation to help patients reduce blood pressure without medication. Mandle (1990) documented less pain medication use and a decrease in anxiety by hospital patients who listened to a relaxation tape. Goodale (1990) was able to document decreased premenstrual symptoms in women who practiced relaxation techniques. And lastly Domar (1992) cited double the pregnancy rates for In Vitro Fertilization (IVF) patients who practiced relaxation coping techniques.
The tools for practicing relaxation are so varied, there is something for everyone. The ideas suggested below are activities that enhance relaxation. Enjoying one or more of these activities diminishes the negative effects of infertility induced stress.
Stress and relaxation can not co exist!
Everyone has a different way of reducing stress. The following are some things which can help a great deal. Try some of these techniques during your treatment:
Don't forget the value of a good friend. A friend to lend a sympathetic ear can raise one's spirits and decrease the sense of isolation. Consider friends and relatives as prospective confidantes and share the sadness of infertility's elusive goal. It is natural to resist burdening a friend with personal problems. But try reversing the situation. Wouldn't it be an honor and privilege to have a friend share a problem with you? The opportunity to help ease a friend's burden is gratifying and also an expression of the friend's high esteem for you. Give your friend the same compliment. The stress of infertility can be minimized with conscious effort to honor your emotions and utilization of techniques to counteract the effects of infertility's despair. Use of a variety of relaxation methods will restore a sense of control, decrease the sense of isolation, restore optimism and may help increase the chance of pregnancy.