Mind Over Matter: Battling the Fertility CrisisNew mind/body program empowers city’s infertility patients with hope

All Maryann* had ever wanted was a baby. You could take the house, the cars, the midwinter trips to the islands, even the diamond and emerald ring which had stunned her with its beauty when she found it under her pillow on the morning of their 10th wedding anniversary. "Please, please, let us get pregnant, and I promise I'll never ask for anything else in my entire life," she prayed, over and over again. After years of morning temperatures, medical tests, injections, sex on demand, and infertility treatments that were costly, disruptive and sometimes painful, she still wasn't pregnant, and the stress was taking its toll on what had been a previously happy marriage. When her mother-in-law told her that she seemed to be awfully tense these days, and her sister-in-law added that, if she wanted to get pregnant, she "just needed to relax," she choked down her anger and changed the subject as quickly as she could. Later that night, calmer, she wondered if there was any validity to their comments. Surprisingly, the answer may be yes.

Mind/body therapy increases rates of conception Several studies have shown that the use of mind/body therapies and/or relaxation training can significantly increase the odds that a previously infertile woman will be able to conceive a baby and carry it to term. A study conducted at Harvard University and published in the April 2000 Fertility & Sterility Magazine found that 55 percent of women who participated in a mind/body program had a viable pregnancy within one year, as compared to 20 percent of women who did not use a mind/body program. The interest in mind/body medicine as a possible way to treat infertility is not new. As far back as 1983, a number of unpublished pilot studies found that relaxation-based therapy appeared to increase the rates of conception in women with unexplained infertility. A 1990 study of 63 women undergoing IVF treatment found that those who attended a two-week relaxation training session were significantly more likely to become pregnant than a control group. In their 1996 book, The Healthy Mind Healthy Body Handbook, mind/body experts David S. Sobel, M.D., and Robert Ornstein, Ph.D., believing that high levels of stress can contribute to infertility by causing irregular ovulation, hormonal changes, sexual problems and a possible decrease in sperm production, suggested that the use of relaxation therapies could enhance fertility by helping to regulate some of the body's physiological processes. Alice D. Domar, Ph.D., director of the Mind/Body Center for Women's Health at Boston IVF, in Boston, Mass., found that infertile women suffer from depression and anxiety levels equivalent to those who have heart disease, cancer or AIDS, and realized that the use of mind/body therapies could help to reduce the physical and psychological symptoms of infertility-related stress while also increasing the success of medical treatment aimed at helping women to conceive. In her well-written and informative 2002 book, Conquering Infertility, Dr. Domar discusses her world-renowned clinical program, attended by thousands of women over the years, and chronicles the ways in which elicitation of the relaxation response through the use of mind/body techniques, such as deep breathing, meditation, and yoga, can enhance fertility while helping women to gain control over their lives. "Women come in and tell the group of night after night lying awake worrying that they will never have a baby, of wondering about the ability of their marriage to withstand this crisis, and of second-guessing every step of their treatment,” Dr. Domar says. “We teach a buffet of skills — ranging from relaxation techniques for use during blood tests to how to handle the anger from the 10th insensitive comment of the day. We teach skills to get one's life back, to learn how to regain the pre-infertility self. By the end of the program, the depressive symptoms, the anxiety, the insomnia, the crying and the misery are all significantly better."

NYC program a welcome boon for infertility patients Here in New York City, Dr. Elizabeth Grill, Psy.D., a clinical psychologist at New York Presbyterian Hospital/Weill Cornell's Center for Reproductive Medicine and Infertility, has developed a program for infertility patients which uses mind/body interventions, relaxation techniques, cognitive restructuring and a variety of other modalities to help participants counteract the stresses which are often an inevitable part of the infertility experience. "Infertility is a life crisis that strikes at the very core of those who are experiencing it, affecting their sense of identity, self-esteem, and sexuality as well as their relationships with others,” Dr. Grill says. “One of the most difficult aspects of infertility for many patients is the loss of control they feel. Because the experience can leave people feeling stripped of their defenses and their usual coping skills, relaxation techniques can reduce and counteract the effects of stress on their physical, mental and emotional health." "The fight-or-flight response is a series of biochemical changes which prepare us to deal with real or perceived threats, readying us to fight or run away from danger,” Dr. Grill explains. “In prehistoric times, for example, people needed to fight or flee from dangerous animals. In the modern world, everyday psychological stressors, such as waiting for pregnancy test results or preparing for invasive medical procedures, can stimulate many of the same physical symptoms." The relaxation response, in which heart and breathing rates decline, blood pressure drops, body metabolism decreases and the muscles relax, is a learned one, requiring the use of specific techniques to counteract the body's automatic stress response. Several different mechanisms can be used to elicit the relaxation response, including deep abdominal breathing, progressive muscle relaxation, meditation, yoga, repetitive physical exercise, mindfulness, imagery and prayer. Long-term practice of the relaxation response may also result in long-term physiologic changes that counteract the effects of stress. Relaxation techniques have also been shown to help reduce anxiety and decrease the compulsive worrying, self-criticism and negative thoughts that can often be overwhelming for infertility patients, Dr. Grill says. "Coping with infertility places many demands on a couple. Infertility testing and treatment can be emotionally, physically and financially stressful,” she says. “The infertility experience can also challenge intimacy, family and social relationships and career. Often, couples find that their conversations, sex lives, work responsibilities, social events, vacations and important decisions about the future begin to revolve around infertility and treatment plans." Although the majority of healthy marriages can withstand the infertility crisis, Dr. Grill says, most couples feel that the very foundation of the relationship is shaken as they are challenged to cope with stress and vulnerability, the loss of a dream, a sense of powerlessness, and feelings of guilt as well as blame. It is important for couples to maintain strong communication skills and to make time for their lives outside of the infertility experience, she adds. Says Dr. Grill: "The mind/body approach helps patients to get support and to feel more empowered as they develop the skills needed to decrease their anxiety, increase their sense of control, and restore a feeling of hope for the future. These skills transcend the infertility experience and help patients cope with all aspects of life, including pregnancy, miscarriage, parenting or other difficult life events and circumstances."

*Last name omitted upon request

Dr. Grill’s Relaxation Techniques Here are Dr. Grill's suggestions for eight simple techniques that can be used by any woman trying to conceive, as well as by anyone in need of some general relaxation and restoration.

1. Breathing - As you learn to be aware of your breathing and practice slowing and normalizing your breaths, your mind will quiet and your body will relax. Focused breathing techniques can be used anywhere, anytime, and can help to reduce tension and anxiety immediately.

2. Journal Writing - Take just 10 minutes each day to write in a journal. This form of self-reflection involves emotional catharsis and insight, and can improve physical and mental health.

3. Meditation and Relaxation - Focusing the mind continuously on one thought, phrase or prayer for a period of time, and returning there when the mind starts to wander, can induce "the relaxation response", a state of complete relaxation which is deeply restorative.

4. Mindfulness - Based on the ancient Tibetan Buddhist practice of living in the moment, this experience encourages taking time to fully focus on the here and now.

5. Taking Time for Yourself - Because women experiencing infertility often feel extra stress, it is important to add enjoyment to one's daily life by taking time for small pleasures and activities.

6. Communication - Effective communication is important in avoiding stressful situations and in resolving situations when they arise.

7. Controlling Negative Thoughts - Learning to replace negative thoughts with more positive thoughts or affirmations can positively affect mood and behavior.

8. Humor and Spirituality - Laughter can increase creativity, reduce pain, and speed healing. A sense of spiritual wellness can help in overcoming personal trials and in reaching a state of acceptance.