For some of us, anxiety feels like your brain can’t stop calculating. Calculating outcomes, calculating consequences, calculating alternatives. All bad obviously. And all meaningless. After all when does an anxious person ever think an unknown outcome is going to be positive? Never, that’s when.
There are times when I have been so, so far into my wave of anxiety, I just couldn’t see out. The triggers for my anxiety are so inconsequential that a ‘normal’ person wouldn’t understand. But if you have ever had anxiety, fertility related or not, you will get what I mean.
When your friends short text message has you obsessing all day that you have somehow offended her (when the logical part of your brain, which is taking a back seat at the moment, knows you couldn’t have), when an exchange with a colleague has you literally sick to the stomach and the thought of a team meeting has your chest tightening.
I know some people won’t know what I mean by that, but I know a lot of you will.
A barrier to IVF
Stress, anxiety, fear of uncertainty, the feeling of your life constantly being on hold, the emotional cost, having ‘had enough’ and thinking that you have a poor IVF prognosis (without doctors actually stating this) are all major reasons why women don’t continue with IVF when the issue of money has been taken out of the equation1.
A recent small study showed that for women in the US who chose not to continue with IVF despite being insured for more cycles, 39% stated that stress was the reason why they couldn’t continue treatment. Specifically, these women stated that the toll fertility treatments took on their relationship was too much as well as simply being too anxious and depressed to continue1.
In fact, stress and anxiety being the reason women do not continue with IVF when money isn’t the issue (because their cycles are funded by researchers or government programs) is likely to be higher than 39% with the authors citing a Swedish study where the number is thought to be around 65% and an Australian study where the number was thought to be around 54%.
Women don’t start IVF and fertility treatments lightly. That take home baby is very much wanted and much sacrifice and consideration has already gone into making it happen. Therefore if it is the stress and anxiety associated with fertility treatments that is making women stop it must be HUGE, unbearable. And if so, why isn’t it talked about more and more done to help women before they get to that point?
Impact of stress on IVF success rates
I know that some of the information out there looking at stress and IVF success rates talks about cortisol and the hypothalamic pituitary adrenal (HPA) axis and how this links with our ovaries. But ultimately, at the end of the day is this impacting our chance of a take home baby with IVF?
The impact of stress and anxiety on IVF success rates is mixed, to say the least. One meta analysis reports that emotional stress is unlikely to have an impact on IVF pregnancy rates2 and that feelings of tension, worry or depression experienced as a result of a woman’s fertility problems, its treatment, or other co-occurring life events are unlikely to further reduce chances of pregnancy. *phew*
On the other hand, there is a study that suggests that women who experience emotional distress and receive psychological intervention are twice as likely to become pregnant than those that do not3. Whilst there is a number of reasons to NOT take this statistic as a fact it highlights the potential untreated anxiety can possibly have. Although the authors report that the effect size of psychological treatments may not be as big as doubling success rates, they do nonetheless believe that larger reductions in anxiety are associated with improved pregnancy outcomes.
Whether or not stress and anxiety does hinder IVF success rates is yet to be determined. Personally, I think it is not as straight forward as just being ‘anxious’ or not and there are far more significant factors that possibly impact the success of an IVF cycle.
Regardless of whether or not anxiety does impact success rates, I think we are all agreed that when stress and anxiety are better managed, quality of life improves along with the quality of our relationships and just the general ability to feel a little bit ‘normal’.
To sum it up, although its impact on IVF success rates is conflicted, overall, better managing our stress and anxiety can only be a good thing.
What is the best way to manage stress and anxiety when doing IVF?
Mind body interventions, such as yoga, web based interventions, cognitive behavioral therapy, acupuncture, online support groups, education sessions, guided relaxation and mindfulness classes are just some of the ways that have been studied in an effort to try and determine what best helps women doing IVF to reduce their stress and anxiety4. On top of this there is the more traditional methods such as exercising and eating a healthy diet.
Just as we all have different triggers and symptoms of stress and anxiety the ‘best’ way to manage it is likely to be unique to everyone.
For me, and many women, mindfulness does the trick to providing that small gap to disrupt the never ending thoughts that run around and around your mind. There has been some early studies that show that women who participated in a particular mindfulness course had improved quality of life measures and also increased pregnancy rates (44% of women in the mindfulness group had a pregnancy versus 26% of women from the control group who did not do mindfulness activities)5.
Although we cannot always be lucky enough to be asked to participate in a mindfulness based study for women doing IVF (!) we can embrace the mindful way of thinking and incorporate it into our everyday lives. We can get the benefits of unwinding and slowing our mind without the need to spend hours lying down to relax or taking time to attend particular courses and classes.
Next time you are in your anxiety wave, try this. When you have a shower (or are doing the tidying or waiting for your train or any number of mundane tasks where you notice your thoughts running away from you), list five things.
Five things that you can see (such as the soap sitting on the soap dish or the tap being twisted slightly off center). Five things that you can hear (such as the water going down the drain or the exhaust fan going around) and five things that you can feel (the tiles under your feet or the water on your back). As you get more practiced at doing this you will start to notice the details in what you are doing more, becoming more absorbed in the task that is at hand and more distanced from the ruminating thoughts in your head.
Mindfulness. Try it. And if you want additional mindfulness exercises have a look at this previous post. If nothing else, at least for a couple of minutes you will have the head space to feel just a little clearer, breaking that negative thought cycle and have the weight lifted from your chest. It does for me. And who knows, it may even improve IVF success rates.
** As always though, this article is just for general information. If your feelings of stress or anxiety is preventing you from living your life and you just don’t find enjoyment in things the way that you used to or if you have ANY feelings of self-harm or harming others, speak to your health professional immediately. They will be able to help you access treatments that you didn’t even know about so it is well worth the conversation**
- Domar, A., Smith, K., Conboy, L., Iannone, M. & Alper, M. (2010). A prospective investigation into the reasons why insured United States patients drop out of in vitro fertilisation treatments. Fertility and Sterility. 94 (4) 1457 – 1459.
- Boivin, J., Griffiths, E. & Venetis, C. (2011) Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. British Medical Journal. 342:d223 doi:10.1136/bmj.d223
- Frederkisen, Y., Farver-Vestergaard, I., Skovgård, N., Ingerslev, H. & Zachariae, R. (2010) Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis. BMJ Open ;5:e006592. doi:10.1136/bmjopen-2014006592
- LoGiudice, J. & Massaro, J. (2018). The impact of complementary therapies on psychosocial factors in women undergoing in vitro fertilization (IVF): A systematic literature review. Applied Nursing Research 39 220 -228.
- Li, J., Long, L., Liu, Y., He, W. and Li, M. (2016). Effects of a mindfulness based intervention on fertility quality of life and pregnancy rates among women subjected to first in vitro fertilisation treatment. Behaviour Research and Therapy 77 96 – 104.