Seleni Spotlight: Treating Infertility
April 2023 - This month we recognize National Infertility Awareness Week, April 23-29, which was started back in 1989. The public conversation around infertility has come a long way, with celebrities sharing their own experiences and a recent week-long series about infertility on CBS Mornings. However, infertility continues to be a silent struggle for many. A recent WHO report found 1 in 6 people globally are affected by infertility, a statistic that warrants us coming together as professionals and a society to destigmatize infertility and provide the mental and emotional health support people grappling with it need. We sat down with clinicians Erica Mindes, PhD and Evelyn Page, LCSW to share their insights on helping patients through an emotional and uncertain journey.
What are some of the ways you work with patients to help them manage the emotional challenges that come with treating infertility?
EM: The emotional response to fertility treatment is often compared to a rollercoaster: from a sense of hope and optimism to worry, anxiety, and loss of control to feelings of sadness, grief, and anger. There’s no “one size fits all” strategy to help you manage this emotional rollercoaster. It’s important to shore-up your emotional resources by identifying friends or co-workers who’ve been through fertility treatment who you can rely on, or seek out an infertility support group. Make sure to establish healthy boundaries. If there are people in your life who ask too many questions or tend to make unsupportive comments, minimize your interactions with them during a treatment cycle. Give yourself permission to avoid baby-related events or spending time with other pregnant people if it’s too difficult emotionally.
EP: Often people can feel out of control during this process and frustration that their body is not doing what they want. You’re at the whim of doctors’ and clinics’ schedules, or even at the mercy of insurance companies and their decision to cover treatment (or not). One technique I use with many people is identifying and internalizing a mantra that they can carry with them through this process. A word or short phrase that is authentic – “I can do hard things” rather than “I will have a baby” – can help you get through the tougher parts of treatments.
What about the impact of infertility on relationships?
EM: Talking about treatments may start to dominate your conversations as a couple. While one partner may find this talk helpful, the other may notice it increases their stress level. An effective strategy is for partners to limit talk about infertility and the treatment cycle to 20 minutes a day. This allows you to receive the emotional support you need from your partner but also places boundaries around the length of the discussion.
EP: While you and your partner may cope with infertility differently, communication is key, from discussing the logistics of treatment planning to sharing the emotional weight of the journey. Different ways of coping are not bad in a relationship, they are just different. Understanding how each of you manages challenging situations can help you know how to support each other through this phase of life.
People often think stress contributes to infertility. Is this true?
EM: The belief that stress contributes to infertility or unsuccessful fertility treatments, such as IVF, is a myth that’s persisted for generations. Comprehensive reviews of the research literature haven’t identified a consistent link between psychological stress and infertility or the outcomes of fertility treatment. If you think about it, women have always conceived during times of great stress, for example during periods of war. Actually, research has shown that infertility at all stages, before and during treatment, can lead to psychological stress and distress. Seeking psychological support to help manage stress and distress may not increase the chances of pregnancy or a positive treatment outcome, but it can improve your well-being and quality life as you continue to pursue your family-building goals.
What’s the best way to deal with comments from other people who ask when you will have kids?
EM: If you’re dealing with infertility, at some point you’ve likely received this or similar inappropriate questions or comments. It can feel like a gut punch – it reminds you of the emotional pain and loss of control that accompanies infertility. Research has shown they can increase psychological distress among individuals who’ve been unsuccessfully trying to conceive. It can be helpful to strategize, in advance, how you, or you and your partner, want to respond and come up with some quick comeback lines. For example, when someone asks, “When are you planning to start a family,” you could respond: “We’re past the planning stage and already working with medical professionals,” “Sometime before we send out the birth announcement,” “Someday,” or just “That’s not something we’d like to talk about.” You can’t stop people from asking the question, but you can change how you respond. And this may be enough to increase a sense of empowerment and regain a sense of control in your communications with others.
EP: It is almost inevitable to escape some form of the question “when are you having kids?” in social situations. My patients often talk about what they wished they could have said, ranging from quick polite responses to more colorful language. There is not a one-size-fits-all response that works in all situations. Rather, I work with patients in developing a few replies they are comfortable with using depending on the situation or who is asking.
