Friday, August 27, 2010

Infertility and Emotional Resilience

Most people who have grappled with infertility have developed their own narratives about this experience and how it has shaped their lives. I often am amazed at how many people have found a silver lining in their infertility cloud. This past week has provided several experiences that heighten for me the connection between infertility and emotional resilience.

My first experience was with a group of about 20 women, ages 25 to 60, who conduct workshops and training sessions in their communities about issues affecting families. They had asked me to speak with them about my book When You're Not Expecting, and I encouraged them to ask questions and offer observations during the course of my presentation. Well, I had only spoken a few moments when the conversation turned quite quickly to their own personal experiences with infertility. Who would have imagined that 15 of these women had difficulties conceiving, pregnancy lossses, or lived in a childfree marriage? No matter what the experience was for each, the way in which they shared their infertility experiences ultimately came down to "It's not what I expected, but I know I am a more understanding and compassionate adult because of learning how to come to terms with my infertility." Personal examples ranged from adapting professional goals so they could be more generous in helping troubled families to ways that they redefined their own families that put them in closer touch with young nieces and nephews. The tone of the meeting was definitely upbeat, although there was a fair amount of Kleenex passed around the table as various women delved into their emotions to connect with the shared topic of infertility. What struck me very poignantly was how each person disclosing her thoughts had moved from emotional pain to resilience as she found a new way of shaping her future than the one she initially had envisioned.

My second experience this week occurred when I was interviewed live on our local public radio station about my book. Call-ins are a part of this particular radio hour and, once again, the callers shared their infertility and adoption experiences. One man expressed with zest how the pain of his infertility was eclipsed by the joy of adoption; a female caller spoke matter-of-factly about medical reasons that she could not risk a pregnancy, sharing her sadness that her husband's curly red hair wouldn't be passed along to their children, then moving on to talk about the emotional happiness her family shared 25 years ago as they adopted their two children.

In both of these experiences I was taken with how easily people could delve into their pasts and retrieve memories of unanticipated reproductive losses, the need to regroup emotionally, the capacity to find a new pathway, and the emotional growth that they now attribute to their infertility journey. I hope this can be especially heartening to any readers who are trying to make sense of your own infertility, since it is clear that emotional upheaval is expectable, but emotional resilience also can be an outcome of infertility.

Friday, August 20, 2010

New research on stress and infertility

For years there has been a dialogue between physicians and their infertile patients about whether stress is a cause of infertility or the result of infertility. Current research has shown that the stress levels of women with infertility are equivalent to women with cancer, AIDS or heart disease, so there is no question about infertility resulting in enormous stress. The breaking news published online in the journal Fertility and Sterility and summarized this week in the Science section of the New York Times, ( Old Maxim of Fertility and Stress Is Reversed ) is that women who stopped using contraceptives took longer to become pregnant if they had higher saliva levels of the enzyme alpha-amylase -- a biological indicator of stress. Specifically, women with the highest concentrations of alpha-amylase were 12 percent less likely to become pregnant each month than those with the lowest levels.

So what are the implications of this new research? The researchers say theirs is the first study to link a biomarker for stress with delayed conception in normal, healthy women, and they suggest that identifying ways to reduce or manage stress may be a low-tech solution for some couples diagnosed with infertility. Alice Domar, executive director of the Domar Center for Mind/Body Health at the fertility center Boston IVF, responded to the research findings by saying "This is one more piece of the puzzle that's adding up to the same conclusion: that stress is not necessarily a good thing for our reproductive system." Her 2004 book, Conquering Infertility, addresses the mind/body connection and suggests practices ranging from mindful meditation to yoga that can help women reduce the stress caused by their infertility.

So we are coming full circle: acknowledging the obvious, that infertility causes stress, and now addressing the scientific evidence that stress delays time of conception in healthy women. The researchers remind us that stress is the one consistent factor that shows an effect on how long it takes to get pregnant, of all the lifestyle factors studied to date. More surprising is that even low levels of stress can have an impact on conception.

Dr. Domar advocates that mind/body techniques can decrease physical symptoms of stress such as insomnia, headaches, abdominal pain and fatigue as well as psychological symptoms such as depression, anxiety, hostility and tearfulness. She cites recent research that has shown that women who participate in mind/body programs in conjunction with treatment from their physician have significantly higher pregnancy rates than women who receive medical treatment only.

With these intriguing studies, if you are a woman hoping to become pregnant (remember that the alpha-amylase study used data from 274 healthy women who had just started trying to conceive), certainly you will want to reduce your stress as much as possible in an effort to enhance conception. If you have been diagnosed with infertility, you are already in the midst of a stressful experience; seeking an infertility clinic that incorporates counseling, mind/body interventions and stress management strategies can provide you with new stress reduction techniques. In my book When You're Not Expecting, I provide information on how to locate a counselor or a support group, as well as lists of resources for help with mental health concerns, including stress.

Each of our responses to the stress of infertility is unique to our particular circumstances. Yet this recent research is a red flag that we should actively try to address our own stress levels in an effort to assist our physicians in their efforts to help us achieve a healthy pregnancy.