Anxiety and Infertility

It is extremely common for people struggling with infertility to be dealing with high levels of anxiety.   In this post, I look at the relationship between anxiety and infertility from my own personal experience and suggest some coping strategies that I found helpful.  Some of this is about clinical levels of anxiety, but the suggestions included below are intended to be helpful for anyone dealing with anxiety arising from infertility.  You can skip the background and leap straight to the strategies for coping if you want. Please note I am not a doctor, I am just relating my own experiences.

1. What is anxiety?

We all know that women have the tendency to go a bit crazy during IVF cycles.  No surprise – you’ve got insane doses of hormones racing through your system, and you’re generally stressed and worried about whether the cycle will work.   Usually for me, the cycle would be a rollercoaster of hope and fear and terror and hormonal craziness, to be replaced by crushing depression afterwards.  But on my 5th cycle – the last with my own eggs – the overwhelming feelings of fear and terror and craziness never left, even after the drugs were all out of my system.  Uh-oh.

It wasn’t because I was sad it was my last cycle (with my own eggs) – I never wanted to do stims again, I think if my RE had said to me “Great news!  We have a new treatment for you that will have a 100% success rate!” I would still have turned it down, I was that worn out from the whole process.   I had accepted that things were the way they were, and was ready to move on to something new, but I was so continually agitated I wasn’t in any state to move on to anything or even to go to work (fortunately this happened conveniently close to the Christmas holidays).   I started to develop all kinds of nervous tics, which freaked me out even more.  I went to see the doctor, who told me that I was suffering from anxiety and sent me on to a therapist.

Of course, before my appointment with the therapist  I went to Dr. Google to find out what this anxiety business was all about.   Anxiety is often defined as “excessive worry.”  That didn’t sound right to me at all.  I wasn’t “worried” that I was infertile, that my IVF wouldn’t work, or that I would not be able to bear a biological child: these things were simply facts (and anyway, being ‘worried’ about not being able to achieve one of my life’s major goals didn’t seem ‘excessive’).   In any case, I didn’t feel like I was sitting around worrying about anything, I just felt agitated, keyed up, scattered, restless, jumpy, and completely unable to deal with everyday life.  But I didn’t feel anxious about anything.

Nevertheless, the therapist confirmed that, indeed, these things I were feeling were anxiety.   I think a better way to understand anxiety, at least in my case, is as an extreme version of the fight-or-flight response.  If you are continually in situations that frighten you, with no possibility for escape, then eventually you are going to get into adrenalin overload, and that is what anxiety is – worry is more of a symptom than a cause.   The cause is adrenaline overload and a nervous system that has become a hairtrigger for stress, which in turn causes agitation, racing thoughts, and worrying.

2. What is the relationship between anxiety and infertility?

My extensive, yet totally undocumented internet research has revealed a strong link between anxiety and infertility.  Here I’m not talking about the “just relax, you’ll get pregnant” crowd but rather about the fact that after seeking infertility treatment, and especially after a length of time of unsuccessful trying, there is a high rate of clinical anxiety among infertile couples.   If you think about what causes anxiety – being caught in situations that frighten you, with no escape – the reasons are pretty straightforward.  For people who want to conceive, infertility is a huge life crisis, a stressor that can easily trigger anxiety in those disposed to it.   And when you have been cycling for a while, the prospect of life without children becomes a huge, looming danger, and each failed cycle is a desperate, but eventually unfruitful, attempt to avoid that danger.  I began to feel after a while like Sisyphus, pushing a giant rock up a hill with each cycle, then watch it tumble back down again and my task start over.  I told my friends I was on the “Hamster Wheel of Doom”, running, running, running, but never getting anywhere.  It’s easy to see how your system can get overloaded and oversensitive when facing such a seemingly never-ending life crisis.

I suspect, though, that there is another link between anxiety and infertility.  People who are prone to anxiety tend to have certain personality traits in common.  On the negative side, people prone to anxiety tend to be more perfectionist; we tend to seek approval, need to be in control, and drive ourselves regardless of personal cost, ignoring signs of stress.  On the positive side, we tend also to be more creative, intuitive, sensitive, and empathic.  These personality attributes may contribute to more suffering with infertility.  Please note I’m not saying that somehow a predisposition to anxiety causes you to become infertile.  Rather, these personality traits may lead people to (a) feel the losses involved in infertility more acutely (b) to feel a strong compulsion to have children in the way we wanted and imagined or think “ought to be”, rather than in whatever way is possible (c) have difficulty handling the reality that something so important to us is not in our control, despite a strong need to be in control and a long track record of doing so and (d) continue with cycle after cycle despite it causing way too much wear and tear on our psyches and bodies (yes, I know, I am the poster child for this one).  I have friends who TTC’d for 2 months and then said “screw this, we’re adopting,” and others who adopted without any interest in trying on their own.   Although they may be infertile (quite likely, because of their age), these two couples never suffered from infertility.  And you can believe I was jealous of them; although on the surface it looked like joining them would be easy, what I was really jealous of was that they never had to grieve (at least, not about that).

3. What can help with dealing with anxiety during or after infertility?

Here’s some things I found helpful.

Something that really helped me a lot  was The Anxiety and Phobia Workbook, by Edmund Bourne.  This is a giant bible of techniques and ideas which help to mitigate anxiety.  It is really practically oriented, it’s full of concrete activities to try that help both moment-by-moment and in the long run.  I can’t recommend this enough.

One of the most helpful techniques for dealing with anxiety is cognitive-behavioral therapy – i.e. where you identify what you are telling yourself when you are upset, and practice telling yourself things that make you feel better.  You can work on this with a counselor, using the Anxiety and Phobia Workbook mentioned previously, or using the book Feeling Good: The New Mood Therapy.   The basic idea is that when you are feeling bad, stop and write down immediately the thoughts that are coming to mind (e.g. “I will never have kids” – “God must think I would not be a good mother” – “Everyone else can conceive easily.”)  Trust me, if you do this religiously for a few days you will be astonished to see the volume of negativity you are spewing at yourself.   When you have calmed down, write down more supportive and helpful statements that counter what you were saying to yourself previously (e.g. “I will have kids someday, somehow, someway” or “I will make myself a good life, no matter what happens” – “God will help me through this trial” – “Plenty of people have trouble conceiving, and they find a way to survive it”).  Note: the positive things have to be things you can really believe, “I will magically 100% for sure get pregnant on my next cycle” would be nice but you’ll probably find it hard to really believe it.   Practice saying those positive things instead when you notice yourself getting upset and notice how much better you feel.  Pretty soon the more supportive thoughts will become second nature, a way that you can take care of yourself.

It is really important when dealing with a serious emotional crisis not to feel bad about feeling bad.   Many of us carry along a lot of baggage about how we “ought” to be feeling – I “should” be able to handle this, I “should not” be so upset, I “should” behave rationally, etc.  All these shoulds just make us feel worse.  Dealing with infertility is a genuine crisis.  You don’t have to feel bad about not being able to handle it without any emotional upset.  At one point when I was dealing with infertility anxiety, I told my mom about how bad I felt, I was getting hardly any work done, etc., and my mom started saying “that is so terrible, you have to be working now, it is really important for you to be productive,” etc.  I gritted my teeth and said “Mom, that doesn’t help.”  And yet how many times have I said the same kinds of things to myself?  Recognize that you are in a major life crisis and your body is telling you that you need to take the time to deal with it.  And don’t apologize about having that need.

Since anxiety is based on a fight-or-flight reaction, what’s really going on is often that your racing thoughts, behaviors, and actions are attempts to run away from something which is too frightening to confront directly.  Sometimes it helps to sit down and take some time to consciously face the thing you fear.   Be brave and spend some time really experiencing the feelings of sadness, anger, or grief that are welling up in you.  It won’t be fun but… if you give yourself a chance to really feel them it will make it a lot easier for you to move on.   When I’ve done this successfully, I felt an intense sense of catharsis and an immediate improvement in my anxiety symptoms.

Something my counselor always emphasized – and he was right – is the importance of regular exercise.  If you’re feeling anxious you’re running around with a lot of extra adrenalin in your system, and exercise helps to burn some of that off.  If the exercise requires a lot of concentration (e.g. following an instructor in an exercise class, paying attention in sports, or intense exercise like weight training that you can’t do unless you are fully concentrated), it really helps you to get your mind off the stuff you are anxious about for a while.   And, let’s face it, infertility treatments are not kind to your body nor to your waistline, and it can feel really empowering to work on getting fit again – just ask Chicklet.  Note: if you would like to exercise and are near, in, or just after an IVF cycle please read my post on the safety of exercise during IVF first.

In any case, a lot of anxiety is “being in your head” – being preoccupied with the bad stuff that is happening to you, racing thoughts, an inability to mentally slow down.   It can really help to engage in activities that get you out of your head and back into your body again.  That includes exercise, but it can also include other kinds of physical activities, from going to the sauna to dancing to some music you love.  This might sound kind of weird, but during one of my anxiety episodes I got a lot of comfort out of going down to the local stable and scooping poop after the horses.  Whenever I got in a bad way, Mr. Nishkanu would say, “Why don’t you go down to the stable again?”  I’d always come back feeling a lot better.

When you are anxious you are carrying around a lot of muscle tension in your body, and that tension can keep you feeling anxious.  You can short-circuit some of that using progressive muscle relaxation (PMR), a technique whereby you alternately tense and relax different body parts.  There are lots of free mp3’s on line that guide you through PMR (see for example Dr. Todd Finnerty’s site), you can download some and see what works best for you.  PMR works best to lesten your overall anxiety if you do it regularly, 1 or 2 times a day.

If you are having trouble calming down because of racing thoughts, this site has an excellent description of the “Stop Sign” method of consciously blocking your racing thoughts.    Another excellent practice to get into which will help with racing thoughts is meditation.  I am terrible at this but that is why I need it so badly.  In principle meditation is pretty simple, you can just close your eyes and notice your breath going in and out.  And when I do that?  In 10 seconds I am off on the monkey-mind thought train, wallowing in my worries again.  15 minutes later I remember “oh wait, I wanted to meditate.”  What I found really helpful was the guided meditation recordings available (free) on The Meditation Podcast. Just plop one into your mp3 player, plug in your headphones, and off you go.  The ‘guided’ aspect helped to keep my mind from wandering.  The podcasts are part of a whole series that teach you to meditate.

If you are in or just coming off of treatment and/or a miscarriage, remember that your body is grappling not only with a lot of stress but also with a very strong flood of hormones. These hormones amplify any emotional reactions that you are already having to your bad situation.  It helped me when grieving a miscarriage, for example, to remember that once the HCG washed out of my system and the progesterone wore off, I would automatically start feeling a bit better.

If things are getting out of hand…

I found counseling incredibly helpful.  In my early days of counseling I went a couple of times to a counselor who specialized in infertility.  She was not very helpful, I got a lot of stories about other people who had trouble conceiving but got knocked up quickly and the classic  “you have to relax or you won’t get pregnant”.  Later I found a counselor who knew little about infertility or infertility treatments but was smart, sensitive, and experienced in dealing with anxiety.  He was happy to be educated about the treatments and their implications and ‘got’ the emotional issues instantly (unlike the fertility-experienced counselor, who seemed to get the lingo but not the emotions) and gave really practical, useful suggestions for how to feel better.

In my worst days I was very happy that my doctor had given me some medication for anxiety.   The stuff pretty much knocked me out and it was not the kind of stuff you want to be on all the time but when it got out of control and I couldn’t take it any more it was nice that I could get a brief break from it for a while.  Just knowing I had it and if I got into an emergency I could use it was already a huge comfort.

I am very sad to say this, but if you are hoping to adopt from China in the near future, before you seek a doctor or therapist you should be aware that under the current rules, you will be ineligible for adoption with a ” Current diagnosis of depression or anxiety or currently on medication for depression or anxiety. If you were previously diagnosed with depression or anxiety, you must be off medication and recovered for at least 2 years.”   In my humble opinion, you should not allow this to hold you back from treatment though if you need it.

Did I get something wrong?  Do you find other coping strategies useful?  Please add in the comments below.

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4 Comments »

  1. A topic that is heavy on mind, as you might imagine. I woke up this morning and decided that as far as I know, I am pregnant. So I am not going to torture myself all day today dreading an outcome I cannot possibly control tomorrow (my 2nd beta.) If it is positive, I welcome that. If it is negative, there is absolutely nothing I can do. So worrying is a waste of time and very harmful to me. And also to this little being (beings?) growing inside of me.

    So I have decided that I am pregnant for today, and that is enough.

    I’ll deal with tomorrow when tomorrow gets here.

    • nishkanu said

      Good for you! I often wish to have such an attitude but I find holding it a challenge. I hope and pray it goes well for you.

  2. This was wonderfully informative. However, if I ever get pregnant and stay pregnant, I think only a massive dose of “this is not my life, gimme some valium” will get me through the anxiety. It never truly leaves, even with counselling and therapy…

    I read a good article the other day published in our clinic’s newsletter about catastrophising… and making things worse than they seem, in our heads, taking one thought and developing it into something finalistic… this actually applies for the 2ww too, like “I’m convinced not pregnant” which after some time (not long, for IVF-vets like me) turns into “my life sucks I really want to give up, this is the worst life ever” etc etc etc…

  3. Phoebe said

    My trauma therapist taught me lots of stuff on how to deal with anxiety, which in my case, has a lot to do with my trauma during pregnancy.

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