Fertility Struggles
The mind/body connection
By Heather Stringer
April 11, 2005
Suiting up for work was almost unbearable for labor and delivery nurse Gretchen Sewall, RN, LICSW. She had enjoyed bringing babies into the world until she discovered she might not realize that dream herself. Now she was on the fertility Ferris wheel — spinning between the high of waiting for pregnancy results and the low of another failure. A job in obstetric nursing only intensified the swings.
After five miscarriages and two ectopic pregnancies, Sewall knew all too well the subtle — and often misunderstood — emotional trauma caused by infertility. Studies have found that infertile women have the same levels of depression and anxiety as patients with HIV, cancer, and heart disease. Those studies were conducted by a Harvard researcher who knew that these women needed more than IVF treatments. The women were desperate for emotional care to deal with the devastating realization that their bodies seemed to be failing them.
Alice Domar
In 1987 the Harvard researcher Alice Domar, PhD, designed a 10-week mind and body program to help women and their spouses learn techniques to avoid the emotional black holes that can accompany infertility. Couples who participated learned to use yoga, meditation, and communication to stop the negative thinking that fuels depression and anxiety. Sewall heard about the course and felt compelled to learn how to teach the techniques to couples in Seattle. She took Domar’s one-week intensive course four years ago and now offers the program at Seattle Reproductive Medicine.
Sewall is among a select cadre of nurses throughout the nation who are replicating Domar’s mind and body program. These nurses are teaching couples how to slow down long enough to recognize the emotional pain underneath their anxiety and depression. Then the nurses equip the couples with strategies for facing the disappointment that emerges. For the course instructors, the impact of these soul surgeries is nothing short of remarkable.
For example, many of the program leaders have found that more than 40 percent of the women who participate — and roughly half are IVF patients — get pregnant, compared to 20 percent for those who don’t join the program. These numbers support Domar’s findings from a formal study she conducted from 1994 to 1999. The course leaders suspect that this high rate of pregnancy is related to the fact that women learn new ways to manage the stress of infertility.
“Psychological distress is capable of inhibiting the hormones needed for reproduction,” says Penny Donnelly, RN, MFT, director of the support program for the Infertility Clinic at Stanford.
Donnelly had been working with infertile patients for years at Stanford and couldn’t ignore the fact that so many seemed to be depressed. Like Sewall, she wanted to offer them a course that would equip them to approach their disappointment differently, and so a year ago, she took Domar’s one-week class. In September, Donnelly started teaching the 10-week course at the Infertility Clinic in Palo Alto, Calif.
Planning ahead
Donnelly’s class of a dozen women met for two and a half hours a week for 10 weeks and husbands joined them for two of the classes and for an all-day retreat. One of the techniques she teaches is resilience training. She describes the qualities of a resilient person: being optimistic, adaptable, willing to look at situations in a new way, and good at problem solving. The women also learn how to avoid seeing a crisis as insurmountable.
For Carrie, who did not wish to use her last name, the resilience training helped her steer clear of a spiral toward despair when she discovered after the second class that her IVF treatment had been unsuccessful.
“My husband and I have had little bad news in life, so it was devastating [when we found out the treatment failed],” Carrie says. “It was all so scientific until the moment we found out it hadn’t worked. That was a dark week.”
Though she was tempted to sink into negativity, she remembered Donnelly’s discussion about the power of translating circumstances positively.
“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.