Trying to Conceive (TTC) and Infertility
Difficulty with getting pregnant is emotionally challenging, and our clinician’s goal is to equip you with the knowledge and skills you need to stay emotionally balanced on your journey to having a baby. We are dedicated to helping women who are experiencing infertility. We provide individual psychiatry (link to page) and psychotherapy (link to page) care and offer a Mind Body Fertility Program.
Getting in the right frame of mind is crucial when dealing with infertility to help you make a plan for getting pregnant and to implement it. A growing research evidence base documents the benefit of mind body programs and counseling for improving mental wellness while TTC and likelihood of conceiving.
It can be shocking for someone to realize that after spending half of their life trying not to get pregnant, they may need to spend the next part of their life trying even harder to get pregnant. Many women are surprised when they experience difficulty getting pregnant, yet infertility is quite common and affects between 80 million and 168 million people worldwide.[i]
Among married women in the United States, the rates of infertility are under ten percent for those under 35 and jump up to about a quarter for those over 35 years of age.[ii] The rates of secondary infertility (trouble having another child) are even higher than for primary infertility (trouble having your first child). While infertility can feel isolating, you are not alone!
Here in New York City, many women push their biological clock to its limits—so it’s probably not a coincidence that the “city that never sleeps” is also home to a number of fertility centers. More and more women delay having babies to their 30s and 40s as they pursue their education and career[iii], yet many of us run into fertility complications as we push our natural reproductive ability to extremes.
Infertility, coupled with its difficult and expensive treatments, is painful in many ways, and can trigger anxiety or depression. According to one research study[iv], women undergoing infertility treatments show levels of anxiety and depression equal to people with serious medical conditions such as cancer, heart disease, and HIV. Another study[v] showed that 49% of women and 15% of men described infertility as the most upsetting event of their lives. More than half of individuals with infertility experience some psychological problems.
We can provide an orientation to topics that are important to consider when dealing with infertility and practical tools and advice for tackling various infertility related issues. Our aim is to reduce your stress and increase your odds of having a child. Many people’s stress is only intensified by headlines about the dangers of stress for health, and half-baked advice from friends and family to “think positively” and “just relax.” Women who think they have to relax to get pregnant often just end up even more frazzled than they were before. How can one relax and use positive thinking to get pregnant, while at the same time going through month after month of disappointment, medical tests, hormonal drugs, invasive procedures, enormous financial costs, and devastating losses? In the mid-twentieth century, half of infertility was considered unexplainable or attributed to psychological causes, while today 90% of infertility cases have a known biological explanation. Nevertheless, it’s surprisingly common to hear that challenges with getting pregnant are “psychological” or caused by a “negative attitude.” This notion is harmful, because it places blame on the woman, instead of offering her the support she needs.
While infertility is not caused by your mind, your mind does play an important role in achieving your goal of having a baby, while keeping your emotions on an even keel. The mind and the body are connected, yet that connection is multi-layered and complex—instead of worrying about the harm of stress, consider how you can use the mind-body connection to optimize your health. Bodies are resilient and a certain amount of stress is normal and manageable. We work to help you tap into the power of the mind to heal the body, and to keep you emotionally well enough to stick with the fertility process for as long as it feels right for you.
Couples experiencing infertility need support. A survey of couples undergoing infertility treatments identified the need for couple-centered treatment, emotional support, and professional psychological help.[vi] Little research exists to tell us which therapies are most useful. Reasonable approaches to getting psychological help during the infertility process include Cognitive Behavioral Therapy (CBT) [link to page], Acceptance and Commitment Therapy (ACT), couples counseling, and group therapy. Some research shows that group interventions emphasizing education and skills, such as mind body relaxations skills, are more effective in improving anxiety, depression, and interpersonal functioning than counseling interventions that focus on emotional expression and support.[vii]
A number of research studies suggested that psychotherapy may actually increase the odds of getting pregnant, yet more research is needed to sort out what works and for whom.[viii] Since addressing psychological concerns may increase your chances of getting pregnant and arm you against depression and anxiety, you may get a great return on your investment into your mental health.
Whether you have been TTC for only a few months, or you have been trying for years, we are here to support you on your journey to fertility.
Pregnancy can be a time of incredible happiness as well as emotional turmoil. Pregnancy can bring up complicated issues such as difficult relationships, insecurities about career and achievement, and concerns about a big life change. The transition to being a mother is a huge life change and it is important to acknowledge the shadow side of pregnancy. In order for a new self of a new mother to be born the old self and old childfree lifestyle is lost. It is natural to go through an emotionally challenging period of mourning the loss of the old self, old body and old lifestyle. Each woman will also go through a personal process of questioning her life up to the point of pregnancy and wondering about what will happen once the baby is born. How will having a baby affect her relationships, work and lifestyle? How will she feel as a mother? Will she be a good mother? Is she prepared for the new responsibility in her life?
The hormonal changes of pregnancy may add intensity to this process of psychological transition and adjustment. As estrogen and progesterone levels increase some women may experience an increase in irritability, sensitivity and mood swings. Some women are lucky and instead feel less anxious because of the high levels of progesterone, which is an anti-anxiety hormone.
Some of the common emotions a woman may experience during pregnancy include anxiety and worry, mood swings, fear, tearfulness, increased irritability and “brain fog.”
Women with history of anxiety, depression and other conditions, are at an increased risk for developing problematic psychiatric symptoms in pregnancy. It is a good idea to reach out for help early to prevent worsening of symptoms. Anxiety and depression are treatable and it is important to take care of yourself for your benefit as well as your baby’s. There are non-medication options for treatment, such as cognitive behavioral therapy, nutritional supplements, mind-body practices and lifestyle changes, and medications are also an option in pregnancy when necessary.
The first few months after having a baby are a challenging time! Luckily things get much better about three to six months later, once babies start to sleep through the night and their tummies work better. It is important to be informed about the impact of the new baby on both new mom and new dad and to plan in advance for how you could get support in case you need it.
“Baby blues” is a very common experience, with up to 80% of new moms going through a few days to a few weeks of feeling overwhelmed, sad, anxious and weepy. When these symptoms are severe or persist more than two weeks, it is important to consider the possibility of postpartum depression and to reach out for help. Some signs that you may be experiencing postpartum depression are:
Feeling sad or numb more than half of the time
Feeling angry or irritable
Not feeling interested in your baby
Having intrusive thoughts about not wanting to live or wanting to hurt the baby
Lack of appetite
Lots of negative thoughts and feelings of guilt
If you are experiencing even a few of these symptoms, it is important to reach out for help. New moms need time for self-care, sleep, exercise and therapy if needed. You can always come in for a session with your baby if you do not have anyone who can stay with your baby at home.
Dr. Beata Lewis, MD specializes in women’s health treatment.
References:[i] Vayena, E., Rowe, P. & Peterson, H. (2002). Assisted reproductive technologies in developing countries: Why should we care. Fertility and Sterility, 78, 13-15.[ii] Centers for Disease Control and Prevention. (2015). National survey of family growth. Retrieved from http://www.cdc.gov/nchs/nsfg/key_statistics/i.htm#infertility[iii] Martin, J., Bradley, H., Osterman, M., Curtis, S. & Mathews, T. (2015). Births: Final data for 2013. National Vital Statistics Reports, 64(1). Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_01.pdf[iv] Domar, A. (2007). Coping with the stress of infertility. Resolve Fact Sheet Series, 15. Retrieved from http://www.resolve.org/resources/fact-sheets.html[v] Freeman, M., Toth, T. & Cohen, L. (2013). Assisted reproduction and risk of depressive relapse: Considerations for treatment. Annals of Clinical Psychiatry, 25(4), 283–288.[vi] Souter, V., Penney, G., Hopton, J. & Templeton, A. (1998). Patient satisfaction with the management of infertility. Human Reproduction, 13,1831–1836.[vii] Boivin, J. (2003). A review of psychosocial interventions in infertility. Social Science & Medicine, 57, 2325–2341.[viii] Hammerli, K., Znoj, H. & Barth, J. (2009). The efficacy of psychological interventions for infertile patients: A meta-analysis examining mental health and pregnancy rate. Human Reproduction Update, 15(3), 279-295. doi:10.1093/humupd/dmp002