Stress and Infertility: Why Am I So Stressed And What Can I Do To Feel Better?

By Alice D. Domar, Ph,D

These are things I hear every day from my patients: “I have never felt this sad and anxious," “if I see another pregnancy announcement on social media, I will scream," "why doesn’t anyone including my partner seem to get it?" “what did I do to cause this?," “I feel that I have to attend this baby shower, but I just don’t want to go,” and “infertility is all I ever think about; I can’t get it out of my mind." If you recognize any or even all of these thoughts, my guess is that you are having a normal reaction to infertility. 

Research shows that the majority of women feel anxious and/or depressed while they are experiencing infertility, and their levels of distress are equivalent to those of women with cancer, HIV+, or heart disease. Even at the height of the Covid surge in Boston, our patients at Boston IVF reported that infertility was a more frequent stressor than the pandemic! 

We know that infertility causes a lot of stress and it makes sense why: it has the potential to impact every aspect of your life. Your relationship with your partner, your sex life, your relationships with your family and friends, your financial security, your job/career, your relationship with God, and your own body image/self-esteem. Those of us who work every day with infertility patients truly understand the emotional burden that infertility represents. 

I have spent my whole career not only counseling individuals and couples and running mind/body groups but also researching how to make the whole infertility journey less emotionally painful. The psychological burden of infertility is now more widely recognized worldwide, but there is a severe shortage of trained therapists to provide counseling. In addition, many individuals don’t have the time, money, or opportunity to seek out a therapist.

Research has shown over and over that women and men who participate in psychological interventions experience significant decreases in anxiety and depression as well as higher pregnancy rates, and the most effective interventions include mind/body and relaxation strategies. So the dilemma is how can we get these valuable interventions to the people who need them the most? 

Two new options!

The first option is a mobile app that Liz Grill, PsyD, the Director of Psychological Services at the Weill Cornell Center for Reproduction, and I co-wrote. FertiCalm (now FertiCalm Pro in the app stores). This app is the culmination of our 50+ years of experience working with individuals and couples who are struggling with infertility. We came up with the idea several years ago when it became obvious that our patients needed the equivalent of a therapist on their phones.

What do you do when you are at a family dinner and your younger sister unexpectedly announces that she is pregnant? How do you cope when you are at work and the clinic calls with a negative pregnancy test? How do you NOT fall apart when you go to the bathroom on day 27 of your cycle and see blood? So Liz and I identified the 50 situations which we believe cause the most stress, and FertiCalm offers cognitive, behavioral, and social solutions for each one. In addition, it offers ten relaxations, advice for how to self-nurture, and how to see humor in some of the most stressful situations.

Here is an example of how it works: the first thing you see is a flower, and each petal has a different label: Work, Family, Friends, Your Partner, Sex, Difficult Emotions, Running Out of Options, Holidays, Baby Functions, Social Events, Fertility Treatment, the Two Week Wait, and Pregnancy. Let’s say you are waiting to see if you are pregnant and are at the end of your cycle, i.e. in the Two Week Wait. You press that petal and a new flower appears with four new petals: Waiting for Lab Results, Bathroom, Waiting for Pregnancy Results, and Negative Pregnancy Test. You need to go to the bathroom but are really nervous. So you push the Bathroom petal. That flower has six new petals: Cognitive Techniques, Behavioral Techniques, Finding the Humor, Social Solutions, Relaxation, and Self Nurturing. 

Cognitive Techniques:

Negative Thought: “I am going to see blood."

Balanced Thought: “Bleeding or spotting does not mean I’m not pregnant. Only a blood test knows for sure. Symptoms do not equal certainty. Up to half of the pregnancies that come as a result of infertility treatment include bleeding or spotting.”

Behavioral Techniques:

Try to limit going to the bathroom except for when you really need to go.

Social Solutions:

Insensitive person: “Going to the bathroom won’t change things. Just stop. It is what it is. These constant checks are making me nuts.”

Polite response: “I know I am probably driving you crazy with my anxiety. I will go somewhere else for a while.”

Educate response: “Going to the bathroom is serving to lessen my anxiety. Every time I don’t see blood, it calms me down for a short amount of time.”

So you get the idea. For most of the situations which “push your button," there is a button to push on the app with options to help you in that very moment. Our goal is for those using the app to feel protected, informed, and armed with all the information, coping strategies, and scripts, to cope in a better way, not to feel so alone, and to feel more in control while experiencing a life crisis that tends to make one feel totally out of control. 

The second option is going to be launched later this year and is the result of a collaboration between Rescripted and me. I created the Mind/Body Program for Infertility in 1987, and several large randomized controlled studies have shown that participants experience huge decreases in distress as well as more than doubling of pregnancy rates. A recent study showed that we achieved the same results with an online program. This Fall, Rescripted is going to launch a new program, Mind-Body Fertility, which is a six-session, online program which will be available throughout the US. I just trained 16 of the best reproductive therapists to run the online groups, and we are so excited to be able to offer it in the evenings, in a very cost-effective manner. 

So to answer the question in the title of this article, there are lots of things you can do to feel better. I have outlined two of the new options that I have been involved in developing. If you are interested in individual or couples counseling, ask your infertility doctor or go to ASRM.org and look for the “find a health professional," put in your zip code, and you will get a listing of the experienced therapists in your area. For help managing fertility triggers, watch the replay of my recent event with Rescripted here

You do have the capacity to feel better, more empowered, and more in control. You just need to take the first step to better emotional health. 

Alice D. Domar, Ph.D, is the Executive Director of the Domar Centers for Mind/Body Health, the director of Integrative Care at Boston IVF, and an associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School. She is the author or co-author of eight books, including “Conquering Infertility." She is a past chair of the mental health professional group of the American Society for Reproductive Medicine, the founder of the Mind/Body Program for Infertility, and the co-creator of the FertiCalm Pro mobile app.