When couples dealing with infertility first meet with Helen Adrienne, they often start with a simple question.
"Is this our fault?" Rather than answering, Dr. Adrienne, a social worker who leads stress reduction groups at NYU Fertility Center and the author of On Fertile Ground: Healing Infertility, asks them to consider their own question, "Why did you ask me that?" Most likely, the answer is that they’ve heard that stress prevents conception. The woman has probably been told that she’s doing too much and to "just relax," so that her in vitro fertilization treatments will work and the baby will come.
The trouble is, it may not. No matter how many hours she spends with her feet up.
"When you talk about IVF, the level of stress [of the patient] has no impact on whether or not the treatment will be successful," said Dr. Alan Copperman, the director of reproductive endocrinology and infertility at RMA of New York and the vice-chairman of obstetrics, gynecology and reproductive science at the Mount Sinai School of Medicine.
As evidence, Dr. Copperman cited a largescale review of research on the topic, published in the British Medical Journal this past February. The meta-analysis examined data from 14 studies with more than 3,500 participating women, and concluded that emotional distress was not related to the likelihood of pregnancy.
Despite this review, many people still blame infertility on stress. Dr. Georgia Witkin, a clinical psychologist at RMA of New York and an assistant professor and director of the Stress Research Program at Mount Sinai Medical Center, explained that this usually comes from the fact that the couple and their well-meaning family and friends are searching for explanations to regain their sense of control.
"It makes you feel like you can do something about it," she said. "You say, ‘I can get this under control, it’s just stress.’" Dr. Witkin also said that since highpowered, business-oriented women tend to wait longer to have children, people might attribute childbearing issues to their intensely busy lives rather than to the most likely reason for their infertility: age.
The real issue to consider is that while stress may not cause infertility, to say that infertility causes stress is a serious understatement. One widely cited study published by researchers at Harvard Medical School in 1993 showed that the psychological symptoms associated with infertility are similar to those associated with other serious medical conditions, such as cancer and cardiac rehabilitation.
"It’s a bio, psycho, social and spiritual crisis," said Adrienne. "I’m sure you can imagine that when it’s a crisis of that proportion, there’s nothing that’s untouched."
Psychologically, the turmoil associated with a lack of control over the outcome of a situation can be incredibly hard to bear, and in most cases, there’s no definite endpoint to the turmoil.
The hormones involved with IVF affect the woman’s emotions, and the couple’s relationship is tested by a series of difficult decisions and a process that can easily unravel a healthy sex life.
Socially, the couple may feel isolated, resentful and unable to relate to friends and family with new babies and their own judgments about the process the couple is undertaking.
In her individual and group sessions with women and couples, Adrienne seeks to shift the focus from self-blame and guilt to address all of the possible issues they may be confronting.
In the end, coping with the stress of the process may not influence the results, but it will certainly create a healthy, happier couple.
"I want them to feel like they’re in control," Adrienne said, "not of being fertile, but of how they navigate through the journey, whether it’s to pregnancy, adoption or child-free living."