When you’re trying to conceive and it’s not happening, the potential for stress is endless.
From finances to friendships, from planning a career to managing your emotions, the impact of infertility is wide ranging.
Fertility counsellor and cognitive behavioural psychotherapist Ann Bracken is author of Mind Body Baby, a book written as an antidote to the stresses of trying to conceive.
It highlights the importance of first looking after your own health, offers practical ways to banish stress and anxiety, as well as clear information on assisted reproduction.
Bracken has worked at Ireland’s largest fertility clinic, Sims IVF, and is currently based at the Lister Fertility Clinic in London.
She’s well-placed to talk about the stresses of infertility, which affects one in six couples and is defined as an inability to conceive after 12 months of unprotected sexual intercourse.
Ask her about the extensive fallout of repeatedly trying and failing to get pregnant and you quickly get a sense of the ‘where do I start/where does it end’ scope of the problem.
Bracken has met couples who have remortgaged their home to pay for assisted reproduction.
She has met women — who needed lots of fertility treatment — who have lost jobs because of taking time off for appointments and scans.
She has seen many women put their career on pause and others struggle with the grief of miscarriage, while trying to work.
And then there’s the impact on the couple’s relationship.
“There’s nothing romantic about coming into a fertility clinic, about timed sexual intercourse. It can bring couples really close or it can rupture the relationship.”
She has listened to women embarking on sperm donation who feel they’re being unfaithful to their husbands.
“They find it challenging. They want to support their husband but they feel guilty.”
As the fertility journey proceeds, couples may find themselves in different places emotionally.
One might experience grief around repeated failed cycles — the other might be more accepting and thinking about the next course of action.
“This can cause conflict in a relationship.”
And there are ramifications for friendships. A woman struggling with infertility may feel she has nothing in common with friends who are having babies. She may feel jealous when friends get pregnant, and guilty about the jealousy.
“Women face the problem daily. A woman could be sitting at lunch, listening to colleagues planning family holidays or discussing a pregnancy, and she may be invested in double figures of IVF cycles,” says Bracken.
Little wonder that up to 38% of women going through fertility treatment meet the criteria for either clinical anxiety or depression, compared with 4% in the general population.
“They’ve assessed people going through fertility treatment and found it affects them to the same extent as people going through cancer and HIV — it affects ability to plan, to work and it affects family and social relationships,” says Bracken.
While stress is understandable, it’s not going to help a woman conceive. Admittedly, there are fertility problems for which stress reduction isn’t a solution.
“If your fertility problem is blocked fallopian tubes, reducing stress won’t help,” she says.
But the fact remains: stress impacts on the reproductive system, on hormones.
“It causes changes in GNRH secretion and decreased FSH and LH secretions.
"It causes hormonal imbalance — oestrogen dominance and progesterone deficiency.
"It can decrease thyroid function and cause irregular menstruation.”
Stress also reduces sexual drive, explains Bracken.
“With decreased dopamine and serotonin, you’ll have more worrying thoughts so you’re trying to deal with those. Stress reduces oxytocin, the bonding hormone — leading to feeling disconnected and detached from your partner.”
She points to research involving saliva tests to measure the stress hormone.
“In the case of women with very high levels, it took longer for them to get pregnant.”
In males, stress causes loss of libido, testosterone imbalance, lower sperm production and erectile dysfunction.
Even communicating with fertility consultants can be stressful and Bracken’s book gives guidance on how to manage this.
“A client might think ‘I don’t want to do another IVF’ or ‘why this approach, why not change the protocol?’ They might think it but not say it because they feel they shouldn’t be challenging the consultant.”
Others can feel overwhelmed by the language of fertility, yet might not stop the doctor to ask ‘what does that mean?’
And some others might be feeling very distressed, but not mention it to the consultant in case he’d recommend discontinuing the treatment.
Anyone going through fertility treatment ideally needs “to get to a place of resilience so they can make informed, balanced, wise decisions based on emotional wellbeing”, she says.
Her book contains stress reduction techniques and cognitive behavioural therapy (CBT) skills, scientifically proven to reduce stress and anxiety associated with fertility problems.
Research presented to the European Society for Human Reproduction and Embryology stated that women who received CBT experienced increases in self-esteem — ovulation was restored in 80% of the women.
Bracken recommends asking yourself, ‘what kind of fertility thinking do I have?’ Are you thinking, ‘I absolutely must get pregnant and this must work for me’, without considering other options like adoption or egg donation?
“How you think about a situation affects what you do, what choices you make. Your aim should be to become more compassionate towards yourself.”
Mind Body Baby: How to Overcome Stress & Enhance your Fertility with CBT, Mindfulness & Good Nutrition by Ann Bracken is published by Hodder & Stoughton at €19.99.
* Take charge of your mind/body fertility health.
Women undergoing fertility treatment, with repeated injections and internal scans, can feel disconnected from their body. Reconnect with your body by doing some restorative yoga.
* Keep a journal. It’s a non- judgemental space in which to express difficult/repeated thoughts and emotions.
* Complementary therapies — acupuncture, aromatherapy, naturopathy or biodynamic massage — have been shown to promote overall fertility health.
* Bear in mind the short- and long-term implications of each treatment and how to gain the most from it.
* Use nutrition and supplements to boost fertility.
* Cognitive behavioural therapy, an evidence-based therapeutic approach, can help you recognise and change any thoughts/beliefs that don’t support you on your fertility journey.
* Nurture yourself and communicate your needs effectively.
Taking care of your emotional wellbeing will give you resources to move through your fertility issues with more ease and self-compassion.
It’s easy to get lost in appointments, injections and planning.
So it’s important to refocus on other areas of your life.