Kiddipedia
A diagnosis of infertility and the commencement of and form of Assisted Reproductive Treatment (ART), be it Ovulation Induction (OI), Intrauterine Insemination (IUI), or In Vitro Fertilisation (IVF) come with a wide and varied range of emotions. Irrespective of whether the diagnosis is that of male infertility, female infertility, a combination of both, or coming to treatment due to “social” infertility, ART can be challenging physically, psychologically and emotionally.
Traditionally the focus of ART related challenges has been on the side effects and physical impacts of treatment, however we now are aware of the impacts of the psychological and emotional aspects of treatment.
The psychological and emotional impact of ART is complex, as on the one side we experience emotions of happiness, excitement, and hope. On the flip side we can feel fear, worry, anxiety, stress, and for some a sense of failure around engagement in ART.
Research and evidence over time has changed regarding the role of stress in fertility. The historical view point has been that stress CAUSES infertility, however more recent standpoint and research indicators is the ongoing difficulties and inability to conceive or carry a child when that is your goal LEADS to stress and anxiety. Whichever way you look at the link between infertility and stress, when it comes to ART, psychological and emotional impact varies widely for individuals and couples who are engaging in treatments, but there is will always be an element of stress and anxiety through treatment processes.
While there is no clear research to identify reducing stress will have a significant impact on treatment outcomes, the capacity to reduce stress, anxiety, worry, fear and other negative or unhelpful thoughts and feelings, will have an impact on treatment outcomes. This is in the context of knowledge that the primary reason for people ceasing treatment, irrespective of predicted treatment outcomes of pregnancy, is the psychological and emotional burden of fertility treatments.
During treatment focus on strategies for the psychological and emotional journey ART, becomes essential for us all. Strategies which focus on keeping a more optimistic mindset of trust, mastery, and hope can be beneficial for everyone going through ART, it can aid with reducing negative thoughts about ourselves, reduce internalised self-blame regarding fertility being a “fault” and increase the chances of ongoing engagement with treatment over an extended period of time, giving the optimal chances of ART leading to a baby.
Mindfulness is a key strategy which can have significant benefits in navigating any potential stressful event we encounter, including ART. Mindfulness is described and defined as a mental state achieved by focusing your awareness on the present moment, while calmly acknowledging accepting the feelings, thoughts, and bodily sensations which are being experienced, without judgement.
Meditation is the act of using and implement Mindfulness to create the changes we want to create, in the case of ART, an increased sense of calm, peace and/or hope as we navigate treatment. Meditation and mindfulness can be self-directed, or supported through a Meditation App.
Mindfulness/Meditation strategies which can be implemented with relative ease include:
Sensory Grounding
Sensory Grounding accessing the 5 main sense of sight, touch, sound, smell, and taste to draw us back into the present moment and away from the anxiety driven thoughts of “what if”. Sensory Grounding can be adapted to suit yourself, and overtime you may find you feel yourself drawn and settled by one sensory domain over another. A starting point for sensory ground can be as follows:
- Identify 5 things you can SEE
- Identify 4 things you can HEAR
- Identify 3 things you can FEEL
- Identify 2 things you can SMELL or TASTE
- Identify 1 thing you have done well today, or feel proud of yourself for
Parking Thoughts
Parking Thoughts which can lead to anxiety or distraction from what we are doing can also increase our capacity to be in the here and now – the core of mindfulness and mediation, being present in the moment.
The technique of parking your thoughts is done in the following way, and can also lead to improving problem solving capacity when emotional states are calmer. When intrusive or discomforting thoughts occur in the day when you are trying to do something else:
- acknowledge them and put a plan to return to them later, left them drift away or imagine you are physically lifting them up and placing them away from yourself – introspection all the time is not helpful
- Set a time to come back to these thoughts later in the day
- Give yourself 10-15 minutes to reflect on the thoughts you had put aside earlier
- Can you do anything to challenge these thoughts? Or change them? Is there evidence that tells you they are not true reflection of what is happening and about yourself?
- If you can repeat these alterative thoughts to yourself, write them down to remind yourself
- Is there something you can do to change the situation? Can you do it on your own? Do you need to ask someone else for support to create the change?
- Does it seem as if there is nothing practical you can do about these thoughts?
- Acknowledge the thoughts and the feelings associated with them, and let them drift away acknowledging the are painful.
- Try not to place judgement on your thoughts, notice them, don’t hold tight to them, let them drift away and just be.
Breathing Techniques
When we become particularly overwhelmed, stressed or anxious our fight and flight detection systems can go into overdrive, and our Autonomic Nervous System will send messages to our Sympathetic Nervous System (SNS, Fight or Flight System) to fire up. This system then drives up cortisol and adrenaline levels – great for if you need to run from a bear, not so great when you are trying to prepare your body for a pregnancy. The SNS will trigger increase in breathing and heart rates in response to the brain noticing anxiety driven thoughts or fears. However, the ANS has another arm, which is the Para-Sympathetic Nervous System (PNS, or Rest and Digest System).
We can override the SNS response with the PNS response by engaging in breathing techniques which slow the pace of breathing, sending messages back to the brain that we are not under threat or fear. Broadly speaking
- breathing in through your nose and out through your mouth, brings the biggest response to our systems, and
- ensuring your breath out is longer than your in breath is also critical to a sense of calm.
Breathing techniques might look like:
- Square Breathing – imagine you are drawing a square in the air, with a full square equating to 2 full cycles of breathing
- Slowing breathing rates to approximately 6 cycles per minute – with a breath in rate of around 4 second, pause and breath out for around 6 seconds (i.e. a 10 second repetition)
- Take a big breath in, and on the exhale, release a loud “sigh”
Progressive Muscle Relaxation (PMR) and Body Scan:
Progressive Muscle Relaxation (PMR) and Body Scans, while different, do have some overlap.
Both work by slowly scanning through your body, but focusing on different functions within the process. They both act to focus the mind on the body and away from thoughts, while also inducing or creating relaxation and calm.
Body Scanning starts at either the top of your head or at your toes and you work slowly through each body part in sequential order until you reach the opposite end of the body. It is a bit noticing each part of the body, the sensations you feel, warmth that you can extend into your body, and can be focused on accessing and showing gratitude for what your body can and does do for you on a daily basis.
PMR takes the same concepts as within Body Scan, however add purposeful resistant into the muscles through contacting and releasing tension within them. Each muscle group is worked through, slowly inputting muscle tension and breathing out through relaxation of the muscles. PMR can be an effective way of learning how you hold tension within muscles when you are feeing stressed, overwhelmed or anxious and learning to breath tension through and out.
Visualisation:
Visualisation can be a powerful form of meditation and mindfulness for some people. Visualisation is often a more active process of meditation as you are consciously bringing an image to your awareness and exploring it.
Visualisation can be used at any stage through ART, with increased use at times around potential conception in OI or IUI or at the time of embryo transfer in IVF.
Visualisation at these times might be used to grow a picture in your mind of egg and sperm coming together, of implantation in the womb, and of an embryo nestling itself into a space of warmth and growth. It can be coupled with placing your hands over your pelvis and womb as you imagine the process occurring and sending love into your body.
Journaling
Journaling is a process which can help to relieve and process anxious, or worrisome thoughts, but also help to identify ways to reframe our thoughts to support our ART moving forward.
The following steps can help you get on your way to journaling:
- Set aside a time to write every day, it only needs to be a few minutes
- Keep pen and paper, or a note pad app handy on your phone
- Write without judgement and what feels right for you, this is not meant for anyone else
- Use your journal the way YOU want to use it
Journaling can be long prose style writing, or it can be bullet points. A standard writing book is all you technically need for journaling, but you can also purchase yourself a specific note book, or a journal specific to ART to be able to record your thoughts and reflections through the process.
Meditation guidance can be useful when initially commencing mindfulness and mediations practices. Apps and websites which can be useful if you are needing guidance to establish mediations and mindfulness practices include:
- Smiling Mind
- Insight Timer
- Headspace
- Calm
- Spotify
- YouTube
Affirmations
Affirmations are another source of potential benefit when navigating ART. Affirmations are a phrase or statement which are used on a frequent basis to aid with improving self-worth and build yourself up.
Affirmations have more recently been associated with toxic positivity, which is the excessive and ineffective overgenaralisation of a happy, and optimistic state of mind across all situations, it can lead to invalidation or denial of the range of human emotional experiences.
However, affirmations may still have a significant impact and role to play in our mindset, psychological and emotional health as we navigate ART.
Affirmations can be readily found on the internet, and some will speak more to you then others. Alternatively, you might create your own affirmations, which make more sense to you, your circumstances, and what you need to remind yourself of. Affirmations may come off the back of journaling, if you make the decision to engage in journaling, or through the other acts of mindfulness and meditation explored.
Some examples of affirmations, which may act as a starting point for you include:
- I have faith in my body
- My body and science are working together
- I trust the team I working with
- I am not alone in this, my partner/friends are here to support me
- Infertility is NOT MY FAULT – Science and Medicine Still has answers to find
- It will be OK in the end, if its not OK, then it is not the end
Affirmations can be used in different ways, but ways you might want to consider use of affirmations for yourself include:
- Repeating them at set times during the day
- Writing them down on post-its and having them in key areas of your home
- Set as a screen saver on your phone
- Writing them in a journal
- Saving them to an Instagram or other social media account which you access frequently
If you continue to experience increased levels of anxiety, stress, worry, fear, or negative self-talk and self-perception through ART, despite ongoing attempts to engage in strategies such as above, reaching out and speaking with your fertility specialist, fertility nurse, GP, or self-referring to a psychologist with training and experience in working with individuals or couples navigating ART. Referrals to psychologists can be completed without a referral from you GP in Australia, however a GP referral will entitle you to rebates under Medicare. Psychologists generally offer in-person or telehealth services, so finding the right psychologist for you doesn’t have to be limited to the distance you can walk or drive.
If you would like further information or after one-to-one support I can be contacted at https://www.seedsforhope.com.au/
Lisa Ransome, Perinatal and Reproductive Psychologist and Australian and New Zealand Infertility Counsellor (ANZICA), works with individuals and couples from pre-conception through to the post-partum period. Lisa has extensive knowledge and training in the spaces of infertility, pregnancy loss, pregnancy after loss and infertility. Lisa is able to provide support and intervention for couples and individuals accessing donor-conception treatment, as well as providing support to those who are navigating childlessness-not-by choice, after fertility treatments. Appointments are available either in person, or by telehealth services.
Lisa can be contacted through the following ways:
Website seedsforhope.com.au
Email lisa@seedsforhope.com.au
Instagram: https://www.instagram.com/seeds_for_hope/
