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“I realized that maybe I won’t get pregnant, but if I want a child I can have it [in other ways],” says Carrie, a marketing manager in Danville, Calif. “Before I’d talked to the women in the class, I had no concept of surviving it if it didn’t work, but hearing them helped me know I could survive it.”

Carrie, 36, started facing fertility problems after having a procedure called cone biopsy. Her doctor had found suspicious cells on her cervix and the doctor removed a cone-shaped wedge from the cervix. Unfortunately, Carrie experienced a rare side effect in which her cervical canal narrowed. Then she started having symptoms of endometriosis. As a result, she and her husband learned that IVF would be the only way to get pregnant.

Carrie and her husband took Donnelly’s advice during a recent Thanksgiving when they knew they’d be around relatives who might ask them about their progress with having children. Donnelly calls this self-inoculation, or planning ahead for difficult situations. Carrie told the in-laws that they were planning to try IVF again, but they were going to be selective about who’d they’d share this information with.

Donnelly also believes it’s important to coach couples about the different ways men and women cope with infertility.

“Most women find infertility to be very emotionally painful and all-consuming and they have a tough time managing their emotions,” Donnelly says. “Men are much more able to compartmentalize and they don’t feel it wherever they go, but they can overcompensate in other areas. They are often less emotional and very much into problem solving.”

Slowing down

Like Donnelly, Patty Bottari, RN, BSN, believes one of the keys to treating emotional pain is teaching patients to unlearn the natural fight-flight response to distressing situations.

“A lot of what happens is that we are so conditioned to respond in certain ways,” says Bottari, who teaches in the Mind/Body Medicine Program for Infertility at Kaiser Permanente in San Francisco. “I teach them to pay attention to the things their minds are telling them and to question what they are hearing: Is that thought even true or accurate?”

Before couples can hope to be more aware of their thought patterns, they must often put the brakes on their rushed lifestyles. Couples learn to use meditation and movement techniques — such as yoga and stretching — to slow down. Bottari also asks participants to examine the way they eat to find out whether they have slipped into habits of hurrying.

Once they start slowing down, participants often discover that they default to negative thoughts about themselves when they confront a distressing situation — and these self-criticisms are often not true. Women have confessed to believing that they are infertile because God is punishing them for a previous abortion or that they are not a “proper woman,” says Ken Farber, MA, the behavioral health program instructor at Kaiser Permanente in San Francisco.

Once women learn to catch these thoughts early, they start to squarely face the sadness that is fueling the negative thoughts. Farber and Bottari encourage them to accept these underlying feelings of disappointment about their infertility. Once women do this, they often feel the emotional pain for a couple of hours rather than a couple of days.

“We don’t teach them to get rid of the feeling, just accept that they have it,” Farber says. “As you accept who you are, you experience relaxation. It’s a core fundamental skill to pay attention to your body with tolerance.”

If women in the program cultivate this acceptance, they have a better chance of responding well when a painful situation arises. For example, Farber says it’s common to see infertile women criticize themselves for being insensitive if they feel sad when seeing other children or when they are invited to a baby shower. Instead, they learn to open themselves to feeling this sadness without disparaging themselves.

As women start doing this, Farber consistently observes a striking result. Many of the physical maladies reported at the beginning of the class — gastrointestinal pain, headaches, menstrual problems, and sleep difficulties — disappear. Some women even get pregnant.

Bottari admits that although she loves seeing couples heal physically and emotionally, it’s difficult to be a nurse and not have the power to promise pregnancy. “When I see so much pain, I want to make it better.”

At the same time, she knows she is giving them tools that can last the rest of their lives.

“I tell them this is a phase in life rather than a [lifelong] sentence,” Bottari says. “They are used to focusing on whether they got their period and doing sex on demand to get pregnant. I tell them not to think about getting pregnant. This program is about giving their lives back to them.”

Heather Stringer is a staff writer for NurseWeek.

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