Infertility, Stress, and Depression

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

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When I logged on to my computer this morning, I took a quick look at my e-mail and found the usual collection of messages: a memo from a co-worker, a meeting reminder, a note from my sister, and some junk mail peddling stock tips that could make me rich-I wish! Then I saw a message from my good friend Cathy. The subject line, bad news, jumped out at me, so I opened the message and read it immediately.

"Got my period this morning. !"

Her message was just five words-six if you include the doodad-and yet it told me so much. Even though Cathy didn't say "I feel so depressed!" or "What are we doing wrong?" or "Why is this happening to us?" I knew she was probably thinking these things. I knew that she most likely had cried her eyes out when those first few drops of blood of her period appeared, and that it probably took all the energy she could summon just to drag herself to work. And I know that if she sees a pregnant woman today, or hears a baby cry, or glimpses a picture of an infant on a co-worker's desk, her tears will return. When she gets home from work tonight, she's likely to snap at her husband, skip her workout, and spend the rest of the evening on the couch numbing herself with junk food and junk TV, trying to forget how bitterly disappointed she is that yet another month has gone by and she's still not pregnant.

I know this because I've seen it happen thousands of times.

Being unable to get pregnant is one of the most stressful things a woman can go through. Most of us, until we start trying-and failing-to get pregnant, assume that if and when we want children, we'll have them. As little girls we rock dolls in our arms and pretend to be mommies. As we grow up and become sexually active, we walk a shaky tightrope, assuming that the slightest slip could plunge us into an unwanted pregnancy. Yet we also feel completely confident that if we are smart about contraception we'll maintain complete control of when we will or won't get pregnant-we believe that it's all solidly in our own hands.

As newlyweds we think about when we'll start "trying," and we chat endlessly with girlfriends and sisters about whether it's better to give birth in spring or summer and which we'd rather have first, a girl or a boy. Then, once we finally do go off the Pill or toss aside the diaphragm or leave the condoms in the nightstand drawer and set out to make a baby, it's nothing but fun. A little champagne, some candles, some sexy lingerie, and after a few thrilling nights of unprotected lovemaking, we fully expect to be well on our way to a darling little baby. "After all, I don't shoot blanks," our husbands boast playfully. And as we wait for that first period not to arrive, we smile conspiratorially at women with babies and then march confidently off to the drugstore for a pregnancy test, happily anticipating a plus sign.

And then, for some women, nothing happens.

So you try again-but with the tiniest sliver of worry. You may pay more attention to the calendar and plan some extra midcycle sex. You nix the champagne and pop a few extra vitamins instead. But still, the next month, nothing happens. So you buy ovulation kits and cut out caffeine and ask friends for advice. You may exercise less (or more), eat less (or more), and insist that your husband wear boxers instead of briefs-and tough luck if they feel bunchy. "Deal with it," you think. You wonder whether you should make an appointment with your OB/GYN, or perhaps even a specialist. You fixate over what you could possibly be doing wrong. You have sex constantly. And yet your period keeps arriving, right on schedule.

Getting pregnant can start to become an obsession. As you fail to conceive, cycle after cycle after cycle, your anxieties may begin to haunt you, as negative thoughts loop endlessly through your mind. You blame yourself, your body, for failing, even though it may well be your husband's body that is the source of the problem. The content of those negative thoughts differs from woman to woman, but they're all related, a laundry list of should-haves and shouldn't-haves. We should have started trying earlier. I shouldn't have drunk so much in college. My husband shouldn't have experimented with pot. I shouldn't have had an abortion in my twenties. I should have taken better care of myself. Eventually your relationship with your husband starts to suffer. The thrill of frequent sex has worn off, and when your husband comes home from work exhausted on day twelve of your cycle, you tell him that you don't care how tired he is, he's doing it tonight if it kills him. You're panicked about not being able to conceive, but he's laid back. Don't worry, he tells you. It will happen. Just relax and stop obsessing about it. But you can't.

Then your best friend gets pregnant. She calls, all excited, prattling on and on about the names she's picked out and the darling crib she wants to buy and how excited her parents were to find out they're going to be grandparents. You pretend to be happy for her, but deep down inside you're insanely jealous, and you can't get off the phone fast enough. You're racked with guilt. You find yourself avoiding her and everyone else who has children. You just can't bear facing them. You are stressed out. You may feel depressed, anxious, or angry. You might have trouble concentrating at work, and you may even cry every day. You begin to wonder if you'll ever have a baby, and if you'll ever be happy again. Your whole world is falling apart-just as it did for my patients Brenda and Janine.

Brenda's Story

Brenda, thirty-five, had been trying to have a baby for three years. She conceived naturally three times, but each pregnancy ended in miscarriage. Then she couldn't even get pregnant for about a year, despite infertility-drug treatment and several intrauterine inseminations (IUI). "I was extremely depressed, although it's only in hindsight that I realize how depressed I was," Brenda says. "My husband kept telling me to see someone, to take something-but I never wanted to see anyone, because I was afraid they'd try to put me on an antidepressant, and since I was trying to get pregnant, I didn't want to do that. And I didn't want to see a therapist, because I knew what was wrong with me: If I could just have a baby, I'd be happy. I didn't need to go sit and whine in someone's office about not having a baby. I just knew that if I had a baby, I'd be happy, and if I didn't have a baby, I wouldn't be happy."

As time went on, Brenda became more depressed. "I wouldn't buy furniture or clothes, or I wouldn't plant flowers in the garden in the springtime-I wouldn't do anything I loved to do. I felt that until I had that baby, I couldn't do anything else. I was paralyzed and frozen. It was really hard for my husband to see me miserable all the time. He felt so helpless-he'd try to buy me things or do things for me, but nothing made me feel better."

Janine's Story

"I totally thought I'd get pregnant right away-my mother always got pregnant at the drop of a hat. Her nickname was 'Fertile Myrtle,'" says Janine, a now-forty-four-year-old adult-education instructor who started trying to conceive on her honeymoon. "I was so shocked that first month when I got my period." After six months Janine still was not pregnant. That's when it started to dawn on her that she might not be fertile. "I started reading, investigating, looking at my options, and talking to people."

During the following months she underwent a raft of painful tests, procedures, and treatments, including three IUIs. She tried acupuncture and changed her exercise routine, but nothing worked. "I was sad but not depressed. I would cry a lot when I talked to my husband or my mother about it. It was very emotional. But at the same time I really hated all that prodding and poking."

For Brenda and Janine, infertility was one of the worst experiences of their lives. But by joining my infertility program, by learning to relieve some of the stress of infertility, and by figuring out how to surround themselves with the love and support of family, friends, and other infertile women, Brenda and Janine conquered their infertility. That's what I'm going to help you do, whether you've been trying to get pregnant for six months or six years. With the dozens of mind/body techniques, coping strategies, and lifestyle changes in this book, I'll help you conquer infertility, too.

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.