Introduction

Conquering Infertility: Dr. Alice Domar's Mind/Body Guide to Enhancing Fertility and Coping With Infertility
by Alice D. Domar, Ph.D.

Infertility is a heartbreaking condition that affects nine million American couples each year. It causes tremendous stress, can trigger debilitating sadness and depression, and can tear a marriage to shreds. In Conquering Infertility, Harvard psychologist Alice Domar-whom Vogue calls the "Fertility Goddess" provides infertile couples with what they need most: stress relief, support, and hope. Using the innovative mind/body techniques she has perfected at her clinic, Domar helps infertile women not only regain control over their lives but also boost their chances of becoming pregnant.

With Conquering Infertility, women learn how to cope with infertility in a much more positive way and to carve a path toward a rich, full, happy life.

About ten years ago, at a time in my career when I was completely entrenched in infertility both in terms of the patients I was treating and the research I was conducting, a good friend called to tell me that she was going to have a baby. Without thinking, I replied, "That's wonderful! So how did you get pregnant?" My mind was on Clomid, IUI, and IVF. "What do you mean, how did I get pregnant? The same way everybody gets pregnant!" It turns out she'd conceived the old-fashioned way and was shocked thinking that I was asking about the intimate details of what position they'd used, which room of the house they'd conceived in, and so on. It hadn't occurred to my friend that someone would get pregnant any other way than by having unprotected sex. And it hadn't occurred to me, at first, that someone could actually get pregnant simply by having sex.

Does this sound familiar to you?

If it does, and if you are thinking these days that sex and pregnancy seem to be completely unrelated, you need to read this book.

If you have to get off the phone quickly so you can hide your tears when your best friend calls to say she's pregnant, you need to read this book.

If you find yourself constantly becoming angry at your mother for not "getting it," or you worry about your reaction the next time someone tells you to just relax and you'll get pregnant, or you've lost interest in your job, or you can't stand it that everyone you know is pregnant, you need to read this book.

If you feel sad more than you feel happy, if you find yourself wondering if the guy you married has a sensitive bone in his body because his life seems to go on even after you get your period, if you find you worry constantly about seeing a pregnant woman on the street or being surprised by a pregnancy announcement, if you really wonder whether you will ever be happy again, you need to read this book.

Infertility stinks. It can be an all-encompassing heartbreak that leaves you feeling isolated, depressed, angry, and hostile. But I'm here to tell you that you don't need to feel that way. You can learn to pursue infertility treatment without feeling as if your life and body have been taken over. You can learn to talk with your husband calmly and rationally and to make decisions that are best for both of you. You can learn how to decrease the stress-related symptoms such as insomnia and headaches that further decrease the quality of your life. And believe it or not, you can actually learn to laugh during infertility.

This book is designed to give you back your life. As you read along, I want you to think, "I thought I was the only one who felt like that!" or "I thought my husband and I were the only ones reacting to infertility in such an unhealthy way!" or "I feel as if you know me-my situation is being described on every page!" And I want you to come to the realization that you are going to be OK, that there are lots of things you can do to help yourself feel better. Infertility can seem like the ultimate loss of control. In this book I will teach you how to take control of your infertility, your body, your relationships, your mind, and your soul.

This book is the result of sixteen years of work on infertility. I began doing research on the impact of stress-reduction techniques on infertility in 1986, and started my first mind/body infertility group in 1987. I published my first paper summarizing my research in 1990. I published two books on stress reduction for women and cowrote, along with two physicians, a book on infertility in which one chapter is dedicated to the mind/body connection. But it really wasn't until now that I felt ready to put all those years of experience conducting research and group and individual therapy into book form. Before I wrote a book on this subject, I wanted to have conducted the research and thoroughly examined all the literature on the connection between stress and infertility. I wanted to treat as many patients as possible so that I could reference stories that would have meaning to every reader. I wanted to be able to say that I think I've heard everything-all the myths surrounding infertility, the insensitive comments people make, the desperate actions patients take, and the ins and outs of modern medical treatment.

Finally, I wanted to learn enough from my research and clinical practice to give infertility patients hope. And now I can do that. This I know for sure, based on sixteen years of research and clinical work with thousands of infertility patients:

You will be happy again. Life will become joyful again. And somehow, some way, if you want to become a parent, you will.

People often ask me why I've made infertility my life's work. It all started with my mother and the tremendous impact her infertility had on my family. In the 1950s, when my mother had trouble conceiving, her doctors were unable to tell her why she wasn't getting pregnant, and they had little to offer her in the way of treatments. These days medical science has so many more answers for infertile women. Reproductive endocrinologists can count sperm, measure its motility, determine the time of ovulation, evaluate the health of eggs, analyze hormone levels, and inspect the fallopian tubes, ovaries, and cervix for abnormalities. Once a suspected problem is uncovered, doctors can often correct it. Surgery can remove cysts and obstructive scar tissue, and drugs can boost hormone secretion and spur ovulation. If conception still fails to occur, physicians can offer infertile couples a range of assisted-reproductive technologies that the women in my mother's generation could never have dreamed of.

But with all of today's wonderland of technological treatments for infertility, something important is missing. Despite the many medical achievements of the past decades, very little progress has been made in treating the emotional side effects of infertility. When my own mother was trying to become pregnant, she felt depressed, anxious, and isolated. She was left to bear the emotional strains of infertility alone. Amazingly, that continues to be true of many infertile women today. In just about every major city in the world, you can find clinics full of doctors who can diagnose and treat infertility. But it's much harder to find a physician who will help you cope with the anger, jealousy, sadness, confusion, and profound yearning that accompany infertility.

After years of trying, my parents finally conceived my sister. Five and a half years later, after they had pretty much given up the dream of having a second child, I arrived. And although my parents certainly didn't dwell on their experience with infertility, I grew up with an acute awareness of the effect it had had on them and on us as a family. My parents frequently talked about how infertility had affected them-and about how much they treasured my sister and me because they had almost abandoned any hope of having children.

I believe that my mother's experience with infertility indirectly helped shape my career choices. As the director of the Mind/Body Center for Women's Health at Boston IVF, I design and lead mind/body workshops that have helped thousands of women cope with the stress of infertility. These programs, which have drawn participants and media attention from around the world, teach infertile women dozens of relaxation techniques, stress-management strategies, and other mind/body skills that help alleviate the strain of coping with infertility and boost pregnancy rates.

My journey into mind/body medicine started early. As a child, I always wanted to be a doctor, but as I got older, I also knew that I was particularly interested in helping people emotionally. When I finished college, I couldn't decide whether I could better reach my goal as a psychologist or as a physician. So I took two years off to make up my mind. During that time I worked for two doctors: a neurologist and a psychologist who were doing brain research at Children's Hospital in Boston. I figured that working for both a psychologist and a neurologist would help me decide which career path to take.

During those years it became very clear to me that although I was interested in medicine, what really fascinated me was the emotional aspect of disease. As I looked at brain scan after brain scan, I was drawn not to diagnosing pathology but to helping the people whose scans I was studying. I wanted to meet the patients and families who were struggling to cope with disease and help them survive its emotional punch. So I chose to become a psychologist, and I enrolled in the health psychology program at the Albert Einstein College of Medicine/Ferkauf School of Professional Psychology of Yeshiva University in the Bronx. When it came time to choose medical specialties, I picked OB/GYN. Amazingly, I was the first person in the history of my health psychology program to choose this specialty-which says a lot about how little attention had been paid to the connection between mind and body in the field of women's health.

My twin interests in women's health and health psychology led me to the Mind/Body Medical Institute in Boston, where I began working with Dr. Herbert Benson, the father of mind/body medicine. That's when everything came together for me, and I realized that I could use my medical expertise, my psychological training, my personal life lessons, and my empathy to help women to cope with both the psychological and physiological challenges presented by their medical conditions. Over the years, as I have worked on mind/body clinical programs and research projects, I have recognized something that is crucial when it comes to successfully treating women's medical conditions: Women's minds must be treated along with their bodies. That is true no matter what causes their suffering, whether it is infertility, cancer, insomnia, chronic pain, AIDS, or menopause. To separate mind from body, to treat one without attending to the other, is foolish and ineffective. When you treat a woman's mind as well as her body, almost without exception she feels better and can cope more effectively with her condition. And in some cases her symptoms and prognosis improve.

In case after case after case we find that the women who learn to use mind/body strategies to manage the stress of infertility dramatically reduce their levels of depressive symptoms, anxiety, anger, and frustration. When infertile women learn to use simple techniques that allow them to relax, transform negative thought patterns, express their emotions, and develop strong sources of social support, they begin to take control of their lives again. They feel significantly less isolated and desperate. They sleep better, their relationships with their husbands improve, and they suffer from far fewer stress-related ailments such as gastrointestinal problems or insomnia. What's more, as I have shown in a number of studies published in peer-reviewed medical journals, they are more likely to get pregnant.

But getting pregnant is not the focus of this book. This book is about how infertile women can reestablish control over their lives. What feels most threatening to women experiencing infertility is being out of control. They can't control their fertility, they can't control their emotions, and in many cases they can't even control when they're going to make love to their husbands. They feel that their lives are falling apart, their careers are in shambles, and their personal relationships have withered-all because infertility has chipped away at their emotional health. The mind/body approach that I teach in my classes and in this book helps women regain control. Sometimes it helps them get pregnant, too-but making infertile women feel better is my primary goal. Pregnancy, if it occurs, is just a happy side effect.

In this book I'll provide you with an experience that is as close as possible to actual participation in one of my ten-session mind/body infertility programs. Central to my approach is the "relaxation response," our inborn capacity to reduce internal stress. I'll explain a variety of easy-to-learn ways to elicit the relaxation response, including meditation, mindfulness, yoga, body scan, progressive muscle relaxation, and autogenic training. I'll also show you the value of dozens of lifestyle changes, thinking strategies, and social approaches that you can use to help you deal with infertility. Not all of them will be right for you, and that's okay. When it comes to mind/body coping and relaxation strategies, I like to think that I'm offering a buffet of choices. The first time you go up to the table, you try a little of everything, and the next time you take just what you like. Here's an example: For some people meditation is a godsend-several of my patients say meditation has saved their lives. But others can't quiet their minds enough to enjoy meditation, and for them a yoga class is a far more effective way to bring peace to their agitated psyches.

I'll also take a close look at the connection between depression and infertility. Evidence is mounting that not only are depressive symptoms a very common side effect of infertility, but they may also impede your chances of getting pregnant as well. I'll help you determine whether you are depressed and, if you are, give you a variety of strategies to alleviate your symptoms.

In addition, I'll discuss the many issues that can cause emotional turbulence for infertile couples, including finances, difficulties with health-care providers, the differences between male and female approaches to facing infertility, the toll infertility can take on your career, lack of understanding among family and friends, jealousy, anger, and spiritual concerns.

You'll hear the voices of many women who have struggled with infertility. These women have endured-and survived-infertility by using mind/body techniques to help bring joy back into their lives. They have worked hard to strengthen their marriages, rebuild friendships, revitalize their careers, and make peace with their situations. Some have been wonderfully successful, and others continue to struggle. Most have become parents; others are learning to accept being childless. All of them are truly inspiring, and I hope that by reading their stories you'll not only learn the power of mind/body techniques but feel less isolated as well. Perhaps you'll even feel inspired to reach out to join a support group with other infertile women.

You'll also meet individuals who have decided to take less-traveled roads to parenthood. Some of them have chosen to adopt children, from either the United States or abroad, and others have become parents with the help of donated eggs or sperm. You may think that these options aren't right for you, but I urge you to put those thoughts aside and come back to them later. Many of the women who begin my program are hell-bent against anything but genetic, biological motherhood. But as they use mind/body techniques to restructure their thinking and to open lines of communication with their spouses, they sometimes discover that those other options are more palatable than they had originally thought.

Mind/body techniques aren't a magic wand that will make you pregnant. But they are an excellent, effective way to help you take back control of your life, cope with your infertility in a much more positive way, and prepare yourself to make choices that will contribute to your happiness and good health for the rest of your life.

from Conquering Infertility: Dr. Alice Domar's Mind/Body Guide to Enhancing Fertility and Coping with Infertility by Alice Domar, Copyright © October 2002, Viking Press, a member of Penguin Putnam, Inc., used by permission

About the Author

Alice D. Domar, Ph.D. is the founder and director of the world-renowned Mind/Body Program for Infertility and author of the national bestseller, Self-Nurture. She is also Assistant Professor of Medicine at Harvard Medical School and the director of the Mind/Body Center for Women's Health at Boston IVF, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center.