Unbearable: Mental Health and Infertility
Recently, I had the pleasure of speaking on behalf of Biomed International about Managing the Mental Health Impact on the Infertile Couple at the Ontario Association of Naturopathic Doctors annual convention. The theme of the weekend was mental health, understanding the integration of mind/body, and best approaches to supporting the mindbody with natural medicine in a variety of contexts. As fertility is a topic near and dear to my heart, I jumped at the opportunity to share what our patients are experiencing at Acubalance with my naturopathic colleagues.
One of the reasons I was so excited to share what I’ve learned since working with fertility patients is that I never understood myself, before working in the field, how significant the mental health impact of infertility was. Having an initial interest in working in the field of naturopathic oncology (cancer care), I had the thought that working with fertility patients would be an emotionally ‘lighter’ field. Boy, was I wrong.
After working with my first few fertility patients, I started to see that almost all of them were struggling with intense emotional states - anxiety, depression, worry, stress, anger, frustration, resentment, guilt, shame, and low self-esteem. Being the researcher I am, I had to know more. I read books like Conquering Infertility, The Infertility Cure, The Mind-Body Fertility Connection, Taking Charge of Your Fertility, and all the pubmed articles I could find on mental health and infertility – and what emerged from my literature search was mind-blowing.
Some of the research shows:
1. between 30-50% of ‘infertile’ women, on first presentation to a medical doctor regarding their struggles to conceive, already show signs and symptoms of clinical depression
3. in couples experiencing infertility, severe depressive symptoms are seen in 11% of women and 4% of men
4. women in the highest tertile of salivary alpha-amylase (indicator of stress) have a 2-fold risk of infertility in the first few months of trying to conceive
5. the diagnosis of infertility has an emotional impact equivalent to the diagnosis of HIV positive status, cardiovascular disease, or cancer
What I expected to find in the literature was that infertility is stressful – and that stress affects fertility. I didn’t expect to find that the impact was so significant that these patients were going through life-changing emotional crises similar to patients who receive a cancer diagnosis.
What’s perhaps even more mind-blowing, is the fact that there is very little emotional support available for patients dealing with infertility. A small number of organizations hold support groups, there are some online forums where men and women can connect and share information. But in comparison to what’s available for patients with cancer or HIV, mindbody fertility support falls way short.
In general, men and women having trouble conceiving aren’t talking about their struggles with anyone. Partly, that’s because of stigma. Another issue is lack of understanding from friends and family. Other patients don’t bring it up because they feel like a burden. No wonder the emotional charge is so great – it’s not being discharged anywhere. Patients at Acubalance are encouraged to talk about this aspect of the journey, because treating those emotionally difficult states not only makes the process more bearable, it also improves the likelihood that a pregnancy will be received.
When we look to the literature we see:
1. a group of couples who saw a therapist for Cognitive Behavioural Therapy (CBT) for 18 months specifically for their issues about fertility, had a 60% conception success rate, vs 11% in the no-therapy group
2. after 9 hypnotherapy sessions, 65% of women have successful full-term pregnancies within the next 12 months, vs 34% in the control group
3. 80% of women with amenorrhea (not cycling regularly) who receive CBT start to ovulate again, vs 25% who don’t receive therapy
4. men who receive auricular therapy meant to reduce stress levels see a greater seminal volume, sperm count, and progressive motility scores than those who didn’t receive the therapy
It’s pretty clear from the research and what we see in clinic – infertility is incredibly stressful, frustrating, and emotionally charged. These emotional states also impact an individual’s ability to have children. But treating the mindbody greatly enhances fertility, as well as makes the whole journey more easy to handle.
Something to keep in mind is that in Chinese Medicine they say “the heart opens the womb.” I reminded atendees that we can help our patients to receive more healthy pregnancies and parent more healthy babies when we remember the importance of treating their hearts.
If you’re struggling with some negative emotional states and are trying to fall pregnant, know that you’re not alone. Many of these feelings are considered ‘normal’ given the circumstances, but they’re certainly not ideal. Ask your Acubalance practitioner for advice on how to discharge it, or just ask us to listen to a rant (we’re open to that too). Your team is here for you, and we want to help make this journey more bearable.
Dr. Kali MacIsaac HBSc, ND