2.) KP:  Can you talk a bit more about the “issues around fertility?” 

Diane: New studies are revealing how psychologically traumatic infertility can be.  One recent study found that for women, the emotional stress of receiving an infertility diagnosis is equal to the emotional stress of receiving a cancer diagnosis. It’s often underestimated.

Infertility is somewhat of a silent disease.  There’s a lot of shame around it and a sense of overwhelming failure so people choose not to talk about it openly with friends and family. Then they become isolated and that’s not good for their mental health.

KP:  That’s an amazing study suggesting that infertility can have the same emotional impact that a cancer diagnosis can have.  I imagine most people would be surprised to hear that, so that’s useful information to have.   The piece about it being a “silent disease” seems to make sense.

Diane: The other interesting study that has just come out is that women who have had a prolonged diagnosis of infertility start exhibiting symptoms of Post Traumatic Stress Disorder (PTSD).  I see this in my patients.  Most of my patients have been trying to conceive for at least 2 years and some even 4-6 years with no success of getting pregnant.  They can become quite traumatized by repeated medical interventions that fail.  They lose hope.  They often have the characteristic PTSD symptoms of overwhelming anxiety, intrusive thoughts, nightmares, the inability to focus, and depression.

KP:  So, you mentioned the emotional difficulties related to feelings of shame, the concept of the body failing and the possibility of past losses colluding with what’s happening in the present.  Is there anything else you can share about why struggling with infertility can be so traumatic?

Diane: There are many reasons, and it’s fairly complex.  Here is an example. I had patient who lost a parent at a fairly young age.  Her worldview was fundamentally changed at the time of that loss.  After repeated miscarriages the past loss of the parent is triggered.  This stirs up the belief systems and mental models of “things just don’t work out for me, bad things happen to me, I’m never going have a healthy child, something is going to go wrong, etc.”  This thinking leads to depression, anxiety and hopelessness.  Even though she did eventually get pregnant on the third try, she worked very closely with me during the entire pregnancy.  She was so terrified that she would have another miscarriage, have a special needs child, or experience a stillbirth. So, there was a lot of support given to her, and we discussed the past losses and how that was triggering her during her pregnancy.  I also gave her practical tools such as guided imagery and relaxation breathing techniques.  She reported that this had been extremely helpful.

Added to the complication of all that emotionality and past history, are the numerous hormones that women experience during pregnancy.  The body is completely flooded with all kinds of raging hormones.  So it’s very common for women to experience intense mood swings and lots of tearfulness during pregnancy.  That makes it even more challenging.

Then there are so many of my women patients who see everyone around them becoming pregnant so easily.  Their entire peer group is pregnant, about to give birth, have an infant or toddler or moving on to the second pregnancy or having the second baby.  It is extremely painful for these women to witness this, be invited to numerous baby showers, etc.  They often feel like an outsider and on top of it, they have to field intrusive questions about their own plans for a family or how things are going with their infertility treatments.  This again causes them to isolate leading to deeper states of depression.  There are some who feel intense anger and envy, a sense of injustice and unfairness in the world.  The “why me?” factor.

Next: Do you give guidance or recommendations regarding medical treatment options for infertility?