Stress During and After ART (Assisted Reproductive Technology)
‘Stress and Fertility’ was one of the Expert Topics at this year’s Fertility Show Africa 2023. During a relaxed panel discussion this important issue was unpacked by renowned clinical psychologist, Dr Mandy Rodrigues from Medfem Fertility Clinic, and the CEO of the Infertility Awareness Association of South Africa (IFAASA), Saskia Williams, who raised some very pertinent questions about the role of stress during and after fertility treatment, which Dr Rodrigues answered, drawing on her 30 years of experience.
SW: Does stress play a role in the success rates of ART like IVF?
MR: The reality is that everyone going through assisted reproductive technology (ART) treatments such as in vitro fertilisation (IVF) is stressed. You can’t help but be stressed going through this, because it’s got so many implications: there are financial implications; there are relationship implications; physically, you’re going through expirations; emotionally, you’re going through the waiting. This is acute stress, certainly, but it is not the main problem.
The real culprit when it comes to affecting the success rates of ART is the stress that happens separate to IVF, the chronic, ongoing, never-ending stress. It is the stress of work deadlines, the stress home and life responsibilities, the monthly stress to pay the bills – chronic stress that has pervaded your life for months, maybe even years – this is the type of stress to be most concerned about.
Some years ago, we did a study among a group of 50 women who already had one failed IVF cycle and all of them had endometriosis. We looked at their stress levels and they all presented as what we call the Type A personality. We then helped them to better manage that stress before they underwent a subsequent IVF cycle. In this IVF cycle, two-thirds or 67% of fell pregnant! So, the only variable we managed was the chronic stress. These women were all exposed to the same IVF treatment and endured the same acute stress during the treatments. But for those who reduced their chronic stress, the fertility rate doubled in terms of the next IVF – and that is a great success rate!
SW: Should stress assessment and management be included into treatment plans?
MR: It is important that every fertility clinic offers patients the option to speak to a counsellor. Ideally, when a patient arrives at a clinic the first time, whether to meet a fertility nurse or a specialist, there should be some form of screening that will detect where a couple is very stressed and provide access to a counselling session to help them manage that stress.
SW: How do you manage the immediate stress of an upcoming IVF cycle?
MR: When you are approaching an IVF cycle, it immediately exacerbates the stress that you are usually under, almost amplifying the normal chronic stress.
One way to manage stress in your life in general – and when facing an IVF cycle – is to create predictability by planning. So, for example, if you have to be somewhere and it takes an hour to get there, you might leave 15 minutes earlier than necessary or plan ahead by checking your route and possible alternative routes before leaving, creating more certainty that you will arrive on time.
Planning ahead also creates more predictability. Look through the days ahead on your schedule, and break the journey down into its small steps, marking where difficult days can be expected. For example, mark the days that you are having stimulation, followed by a scan, followed by a few more days of stimulation before your second scan, and then there are two more days before aspiration.
If you break your IVF cycle into manageable parts like this, you can plan and you can predict. It’s very stressful to think about all of it at once, and to worry about the result at the very end, when you haven’t even started. Break it down into small, easier-to-manage steps.
You can use the same strategy for IVF or IUI or any challenge you face.
SW: What is the impact of stress on the baby?
MR: Once couples have been through infertility with all the stress that entails, and then fall pregnant, they are often stressed about the pregnancy as well, because they’re not naive anymore. They now know things can go wrong. Many have experienced loss after pregnancy through IVF.
So, for many, the experience is not just a happy pregnancy that goes ‘so quickly’ but rather a long, slow nine months seeming full of possible dangers, and it can feel like simply living from scan to scan, because they are not allowing themselves the enjoyment of pregnancy, of being occupied with baby showers and gender reveals.
In addition, many moms that are pregnant thanks to fertility treatments feel they are only supposed to be grateful, that they are not allowed to complain about pregnancy symptoms, like other moms do. They feel they are not allowed to express that pregnancy is difficult. So, mothers who first faced infertility often have postnatal depression.
This stress during and about the pregnancy could result in a baby that is a little more alert and awake. But it’s not going to impact as much on the baby as it will impact the mom’s own health. Fortunately, it is also not an insurmountable problem – it can be addressed over four or five counselling sessions.
SW: Can effective communication between partners reduce the stress during the fertility journey?
MR: Yes, effective communication certainly reduces stress, but can be difficult to achieve because men and women do cope very differently with the stress of going through fertility.
Women are more focused on the long-term plan, constantly thinking: What am I going to do if this doesn’t work? What are we going to do about the next cycle? How do I avoid going to baby showers? How do I avoid seeing pregnant women? How do I make sure my partner eats properly, doesn’t smoke, doesn’t drink? So, women tend to try to micromanage the process.
Men, on the other hand, are trained to be more optimistic. They’re the ones who look for the solution. They want to focus on this cycle and take it step by step.
I often hear husbands saying that their partners said something different just yesterday about how they feel about the journey. And that today they are saying something completely different and next week they will be angry about it! I often tell these men that it is a whole journey women go through. The best support is just to listen – they don’t need to fix it.
Sadly, what often happens is independent coping, with each partner trying to cope with their experience independently from the other.
To open the communication between partners, we have a game called Snap and Chat. It is a collection photographs of different kinds of fertility triggers, like a baby shower, pregnant women, or healthy eating. We ask couples to play just for a few minutes, looking at the images to see when they both relate to trigger. So, if they both relate to say, the restrictions on their diet, there is something they can both speak about. It opens a conversation, so the partners don’t feel alone, independently trying to dealing with how they feel.
And it’s okay for the men to express how they feel, because they are also scared, and saying that doesn’t mean they are going to fall apart.
Come and meet our fertility team
Assisted reproductive technology (ART) treatments such as in vitro fertilisation (IVF) can be very stressful – before, during and even after the treatment!
That is why, at Medfem the right fertility treatments for you are delivered with empathy and caring. We believe in helping you reach your family dream through world-class fertility treatments, available for everyone, and it is our joy and commitment to give you a positive outcome to your fertility journey.
If you would like to meet one of our fertility specialists at Medfem Fertility Clinic, simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.
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We look forward to meeting you at Medfem Fertility Clinic!