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Is It Really That Bad?

Just how ridiculous is it to talk about relieving stress for fertility's sake? Besides the fact that just being alive in today's world inherently means experiencing stress, infertility brings with it a whole new batch of obstacles to feeling whole. While it just seems like common sense that struggling to conceive will add up to anxiety, well-done research backs up that notion time and time again.

Fertility is in many ways a tenuous prospect. So many complex bodily systems are required to be in fine working order for the miracle of conception to occur, it makes sense that there are innumerable points along the way in which something, tiny or huge, can go awry for both women and men.

Back in the 1970's, Dr. Herbert Benson coined the term "relaxation response" to describe the body's physiological reaction to things like meditation, measured respiration, and repetitive activities like yoga, walking, even prayer. The relaxation response results in a state of mental calm with decreased blood pressure, slower respiratory rate, and lessened muscle tension. The well-documented conclusion is that the benefits of this response are life-enhancing. Later, one of Benson's protegees, psychologist Alice D. Domar, connected the relaxation response to fertility issues through her mind-body program and resulting research. The long-story-short of what she found is this: what's good for the mind is good for the body, and a healthy body and mind are more fertile ground. Dramatically, a study led by Domar and published in the journal Fertility & Sterility (April 2000) concluded that "Group psychological interventions appear to lead to increased pregnancy rates in infertile women."

The interventions referred to in Domar's study were two different kinds of in-person support groups: one with a cognitive-behavioral therapeutic focus in which participants were trained in various relaxation techniques and thought re-structuring, and the other, called a "standard support group," during which attendees spoke to each other about their personal situations and different infertility-related topics.

Final analysis of the research study's data found a "statistically significant group effect" for both types of groups. It should be noted here that women who were found through an initial screening process to be clinically depressed were not included in the study, but were referred out for appropriate professional psychiatric care.

Mary Fusillo RN, BSN, MS says that she's seen the impact of emotional support on fertility in action through the group she's founded for women using donor eggs, called simply "Donor Moms." Having served over 200 women in both Washington, DC, and Houston, Texas over the past six years, Fusillo reports that an informal survey of the group finds 100 percent of attendees have resolved their family-building issues through either donor egg, gestational surrogacy, or adoption.

"That says a lot," says Fusillo, who is the Third Party Parenting Coordinator for Center of Reproductive Medicine in Houston, "especially when you consider the intense emotional pain from arriving at the conclusion that donor egg is needed to build your family. If our goal in the end is to add a child to our lives, then all of our members have successfully grown through that pain."

Group support isn't the only means that appears to have a positive impact on fertility. The Pennsylvania researchers found that individual cognitive-behavioral therapy (CBT) sessions helped women with amenorrhea start ovulating again. In their study, the subjects were experiencing functional hypothalamic amenorrhea (FHA), the result of low levels of the hormones GnRH and luteinizing hormone and the most common cause of anovulation (lack of ovulation.) In spite of screening to rule out depression, eating disorder, or other psychiatric disorders, study subjects (as compared to women with normal menses) were found to have higher levels of perfectionism, need for social approval, and altered attitudes toward eating. With the goal of "altering problematic attitudes," participants engaged in 16 individual sessions with a dietitian, a reproductive endocrinologist, and a clinical psychologist. The study authors felt so confident about their subjects' return to normal ovulation that they suggest CBT or similar might be offered to women with FHA as an "alternative" to fertility medications.

Typically, men as a group are not as active in seeking emotional support, regarding any particular need or situation. Hence, while a growing proliferation of psychosocial services are available to women and couples, there are fewer services that are specific to men. The service dearth stems not from lack of need, but lack of demand. Still, professionals are trying to reach men where they are, so to speak. One recent study (Fertility & Sterility, January 2005) concluded that simply providing a two-page leaflet with information about the initial fertility workup seemed to have a positive impact on reported distress by men, as well as on the number of no-show's for clinic appointments.

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