Fertility Week 2020

At this time, the global COVID-19 pandemic continues to have a huge impact on our emotional wellbeing and mental health. This is an anxious and stressful time for everyone, not least those who are also struggling with infertility or the stress of fertility treatment.

To help raise awareness of fertility and mental health, we continue our multi-part series from Prof Wingfield’s ‘Fertility Handbook’ (Gill Press). 

In the second installment of our Fertility Week series, MFC Clinic Director Prof Mary Wingfield discusses the complex relationship between stress and infertility and offers advice on ways to cope with stress during treatment and in everyday life.

Emotional Wellbeing

It is being increasingly recognised at all levels in our society that emotional wellbeing contributes to overall health. A useful definition of emotional wellbeing is ‘a positive sense of wellbeing’ that enables an individual to be able to function in society and meet the demands of everyday life. Reduced emotional wellbeing can lead to stress, depression and anxiety; enhanced emotional wellbeing seems to contribute to increased coping ability, better self-esteem, better performance and productivity at work, and it even helps one to live longer.

There is absolutely no doubt but difficulty in conceiving can be one of the most distressing events in anyone’s life. However, the relationship between stress and fertility is extremely complex and certainly not black and white. There are two big questions:

1) Does infertility cause stress?

2) Does stress cause infertility?

The role of stress related to fertility treatment is also extremely important. While most of the studies on emotional wellbeing and fertility centre on heterosexual couples, the general concepts apply to all.

Many people spend years using contraception and actively trying not to conceive. Then they may decide it is time to start a family. Even if they try not to think about it, it is only natural that thoughts will come into their minds of what they will and won’t do when they have a baby, how they will cope with work, is their house suitable, will they still be able to continue doing sports, will they have time to meet friends, won’t their parents be delighted, etc. Couples start out on this new venture together and it’s fun!

But just imagine how it feels when a few months go by and nothing is happening. Then a few more months. They try to remain positive and not panic, try to think positively. They try another month, and another month, and another month and another… Maybe they change their diet, reduce their alcohol intake, start taking vitamins, try to be more healthy. They start wondering if there’s something ‘wrong’ with one or both of them.

Will they need treatment? Will they be able to cope?

Meanwhile their family and friends may be asking them about their family plans or even making jokes. They may be surrounded by friends who are pregnant and having babies. And those babies look so cute and so vulnerable and so adorable.

Who would not be stressed in these situations?

Yet many couples have to just battle on, continue working and socialising as if everything’s hunky dory. In addition, they have all the other stresses that anyone else has – work, money, relationships, family, etc.

Multitudes of studies have been done on stress levels and the emotional wellbeing of couples with fertility problems. However, the results can be conflicting. This is not surprising given that emotional wellbeing in itself is a variable thing and varies from person to person. Different people have different coping mechanisms. Despite differences between the studies, however, the overall conclusion is that infertility and fertility treatment are extremely stressful.

While women may seem more vulnerable than men to developing emotional problems as a result of infertility and IVF, research shows that men also experience significant distress. A recent study that summarised 12 studies involving over 2,500 men showed that, one year following their first fertility appointment, many men demonstrated evidence of psychological distress.1 This was less likely to happen if men were able to access information about fertility and were able to communicate openly with their partner or others about their problems. While there are fewer studies on men’s emotional wellbeing and fertility than women’s, men report higher social isolation than women during an IVF treatment cycle, probably because, in general, men discuss their emotions less with friends and colleagues than women do.

We can forget that men find some of the procedures associated with reproduction embarrassing or painful (the pressure to ejaculate through masturbation on demand and pain following testicular biopsy). We also know that many men feel a bit excluded from the whole fertility process as many of the interventions and treatments are focused on the female side of things. This can, on the one hand, lead men to feel that they are ‘just sperm providers’ and, on the other, leave them worrying about and feeling guilty over the fact that their partner needs to undergo invasive treatments. This is particularly the case for men who have sperm issues – the treatment is ICSI, which necessitates their partner taking injections, having an egg collection, etc. Interestingly, though, one study showed that women whose partner had male factor infertility experienced higher anxiety than women with female factor.

I see this type of thing often and it shows the heartbreak of infertility – each person in the relationship is not only distressed for themselves but they have the additional burden of worry about their partner’s wellbeing. For those with secondary infertility who may have a child already, there is the additional burden of worrying about their child and wanting a sibling for that child.

References:

  1. Veloso Martins, M., Basto-Pereira, M., Pedro, J., Peterson, B., Almeida, V., Schmidt, L. and Costa, M. E. (2016) ‘Male psychological adaptation to unsuccessful medically assisted reproduction treatments: a systematic review’. Human Reproduction Update 22(4): 466–78.

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