First comes love, then comes marriage… we all know what comes next, right? But, what happens when it is not so easy to conceive?
Somehow, it seems everyone around you is pregnant or has a new baby; your inbox is flooded with invitations to baby showers, and it seems everywhere you look there is a pregnant woman. Yet, despite months of trying, pregnancy has not happened for you. Sound familiar? If so, you are not alone.
Infertility is defined as failure to conceive after 12 consecutive months trying, or 6 months for women over age 35. Feeling overwhelmed and out of control is a common, understandable response to infertility. Not only does a woman’s mental health and sense of self worth suffer, but often marriages can similarly be negatively impacted by repeated inability to conceive. Here we address common questions surrounding the role of mental healthy in fertility.
Is It My Fault? The Self-Blame Game Of Infertility
No, it is not your fault. Nor is it your partner’s fault. Up to 15% of couples experience difficulty with conception, and this often heralds an intensely difficult, stressful time for a couple. On average, women are often more negatively impacted emotionally and physically by infertility than men, though men can and often do similarly have a sense of failure and inadequacy.
Does Infertility Cause Mental Health Problems?
Infertility is associated with and often causes many different emotional and behavioral changes. The most common changes include:
- Marital problems
- Sexual dysfunction
- Social isolation
- Sense of loss
- Decreased self-esteem
Depression and anxiety are relatively common results of infertility; up to over 50% of couples presenting for infertility treatment suffer from symptoms of depression, and roughly 25% begin infertility treatment with active symptoms of anxiety.
Does Mood Impact Fertility?
We now clearly see that inability to conceive may lead to poor mental health. But, is the opposite true? Do depression and anxiety negatively impact fertility?
There is significant debate on this topic, but overall research indicates that poor mood can impair a couple’s chance of conception. Stress, anxiety and depression may modify physiologic functioning, including altering levels of various hormones associated with ovulation and eventual conception such as cortisol, luteinizing hormone, and prolactin.
Women with elevated biomarkers for stress, specifically cortisol and alpha amylase, and those with a history of depressive symptoms have twice the risk of infertility as compared to women without mood symptoms. Multiple studies have shown a correlation between increased sense of distress during infertility treatment and lower likelihood of conception.
What’s A Girl To Do? How To Improve Mood In The Face Of Infertility
If you are experiencing symptoms of depression and/or anxiety while trying to conceive, the first thing to do is to prioritize your mental and physical health. Addressing symptoms of depression and anxiety through various modes of psychotherapy can often improve your mental state during infertility treatment and thus increase the likelihood of successful conception and pregnancy.
Many women find group therapy beneficial as it can allow for a sense of camaraderie and may decrease the feeling of isolation and loneliness often experienced during this difficult time. Individual therapy is another option, and may be effective in one of many forms, including but not limited to Psychodynamic, Psychoanalytic, Cognitive Behavioral or Supportive therapies.
Online supports exist in abundance for women struggling with conception; there are blogs, chat rooms, email lists, newsletters, and social media-based forums. As with anywhere else online, it is important to be cautious with providing too much personal information and to remember that your story may not be the same as someone else’s, so always check with your doctor rather than believing what you read.
A few of the many online support options include:
- Baby Bump
- Fertile Thoughts
- Fertility Ties
- iVillage’s Infertility Support Board
- What to Expect – Trying to Conceive
Women with more moderate to severe symptoms may require treatment by a psychiatrist. Often women are hesitant to consider pharmacotherapy for depression or anxiety while trying to conceive due to fears about safety of a medication once pregnant. However, research has failed to connect use of antidepressants with a decrease in fertility, and there are medications that are generally considered safe for use in pregnancy. Future articles will address use of medication in pregnancy, so stay tuned.
Obstetricians and Reproductive Endocrinologists may be an initial source for a referral to a specialized mental health provider. RESOLVE, the national support group for women experiencing infertility, has a professional services directory available on their website with names of appropriate mental health providers.
In addition to addressing mood symptoms online and/or with a professional, women can also improve their chance of fertility by making healthy life choices.
- Eating a well-balanced, healthy diet full of fruits and vegetables
- Avoiding tobacco and alcohol
- Exercising regularly
- Trying alternative methods such as acupuncture, meditation and massage
Take care of yourself. Try not to isolate from your partner, rely on support from family and friends, and consider, prioritize and nurture your emotional health during this difficult time. Almost any habit that can enhance your physical health and wellbeing will likely improve the likelihood of successful conception and pregnancy.
Carly Snyder, M.D. is a Psychiatrist in New York City with a focus and expertise in Reproductive Psychiatry. Dr. Snyder is the Clinical Course Director for the Reproductive and Perinatal Psychiatry Program at Beth Israel Medical Center. She holds faculty appointments in Psychiatry and Obstetrics and Gynecology at Beth Israel Medical Center, and a teaching appointment at Mount Sinai Medical Center. Dr. Snyder serves on the Board of Directors for Postpartum Support International, and is a member of the Women’s Mental Health Consortium in NYC. Dr. Snyder also sees patients in her private practice located on the Upper East Side of New York City. She received her undergraduate degree from Emory University, attended NYU School of Medicine and completed residency at Beth Israel Medical Center, with additional sub-specialized elective training at Weill Cornell’s Payne Whitney Women’s Program.
Dr. Snyder treats women experiencing emotional and psychiatric challenges at any age. Her approach uses a combination of traditional psychiatric methods with integrative medicine-based treatments to optimize the whole body, mind and well-being. Dr. Snyder provides individualized treatment that focus on improving a woman’s physical and emotional health. In addition to more traditional psychiatric modalities, she has extensive experience treating patients with natural supplements, either alone or in combination with pharmacotherapy. For more information, visit Dr. Snyder’s website or follow her Twitter.