In October of 2006, the esteemed journal for reproductive endocrinologists, Fertility & Sterility, published the results of a study in which a group of women going through IVF were hypnotized at the time of embryo transfer.  The transfer of embryos for the control group was done without hypnosis and without tranquilizers.  The pregnancy rates of the hypnosis group were double those of the controls.

The 2006 study had postulated that because the uterus tends to spasm when opened, the muscular contractions may have caused the embryos to be “spit out” before they had a chance to implant.  Last month (April 2013), a study was reported in The American Journal of Clinical Hypnosis comparing hypnosis at the time of embryo transfer with muscle relaxation and diazepam (valium) at the time of embryo transfer.  This took into consideration the postulation of the 2006 study therefore valium and muscle relaxation became the other protocol.

It is no surprise, then, that this research team found that pregnancy rates were the same in both the hypnosis valium groups.  The study did conclude, however, that hypnosis is as effective as valium together with muscle relaxation, remarking also that hypnosis “is less invasive, has no side effects and should be routinely available.”

I would like to zoom in on the use of hypnosis for maximizing outcome for IVF patients in ways that may tip the scales in favor of hypnosis.  Neither of the above-mentioned studies had a way of delineating the many other advantages of hypnosis which in my experience provide much more of a benefit to patients than bodily relaxation alone.

When I work hypnotically with patients, they feel strongly in control of reversing the physiology of stress—which facilitates to ability to relax deeply.  In their session, I’m sure to suggest that this bodily serenity can be transferred to the uterus, thus considering the presumption of the 2006 study.  I encourage them to have an experience in their mind’s eye of receptivity of their “womb room.”  Patients are inspired to trust their mind’s capacity to communicate with their body.

Equally important, they feel in control of their infertility—not that they are on the journey, but how they are on it.  They are relieved to be more than just medical subjects.  Participants feel that they are actively contributing to the outcome.  This is huge!  In 34 years of practice, “I feel out of control” is the universally uttered statement.

The hypnosis I do with patients to facilitate conception can go far beyond the script which is part of the hypnotic protocol which needs to be uniform for a study.  Because I’m not doing a study, I can get to know each patient and personalize a hypnotic intervention to match the reality, sticking points, hopes and dreams of each person.  As a hypnotherapist, I am trained to aim the post-hypnotic suggestions at the unconscious mind, which is where hypnosis gets its power.

In addition, I make a digital recording for everyone, allowing them to take the session home with them, so to speak, to practice the deep, total body relaxation, and to absorb the powerful suggestions for receptivity to a conception.  Both the skill of deep relaxation and optimism builds with practice.

Furthermore, some women come to me prior to the start of an IVF cycle, allowing time to use the hypnosis to potentiate the stimulating ovulation drugs, ease fears about the retrieval and envision fertilization, conception, pregnancy, birth…and parenthood!  The whole enchilada.  The disappointments of infertility sometimes result in a person who feels unable to visualize success.  Hypnosis can mitigate that problem.

I recognize that there are those who prefer to take a pill.  In that case, valium will assist the physical process of embryo transfer.  But, given the nature of stress, the mind and the body often part company.  Hypnosis fosters a unity of mind and body and an inner dialogue between the two that can be magical.

Hypnosis reconnects people with their strengths: the strength of their commitment to their goal and their inner strength, which take a beating during the infertility journey.

As a result, I see feelings of great relief and joy on the faces of those who are willing to engage in the hypnotic experience.  Hope and optimism return in anticipation of a pregnancy.  Anecdotally, I can attest that the vast majority of those in my practice who choose to complement IVF with hypnosis swear that it was the difference that made all the difference.

On December 18, 2012 the NY Times reported a story plugging the value of art.   (http://www.nytimes.com/2012/12/19/arts/design/arts-as-antidote-for-academic-ills.html?_r=0)  It told of the artist, Chuck Close, who had spoken to a group of elementary school children about how art “saved his life.”  As a child he was limited by neurological disabilities which made it difficult if not impossible to perform commensurate with his intelligence.  He became a famous artist because of his limits.  He told the children that limitations are important.

Infertility seems to limit many things beyond the difficulty of enlarging your family.  But limitations can become important if you do what Chuck Close did: “…figure out what [he] had left and make it work for [him].”

So if you’re in a fertility quest, even as you do everything in your power to conceive, you don’t have the capacity to “legislate” getting the family that you so yearn for.  You feel alienated from your friends who are in the mainstream, popping out babies left and right.  You don’t feel connected to the life you once knew.  You feel overpowered by the onslaught of stress in your life.

Procreation is the most profound form of creation.  Yet, art, or creativity of any kind, can be a life-saver when struggling with infertility (or any adversity, for that matter).  To put mental energy into creativity at a time when the goal is to create new life is a very powerful analogue—and coping mechanism.  It is “what’s left” that you can make work for you.  Women or couples with whom I have worked over the years have invested creative energy into things like refurbishing a fixer-upper.  Two women started blogs, one for fashion and the other for cooking.  Participating in or just enjoying music or any arts or crafts can provide absorption into an infertility-free zone.  Any endeavor that can distract from infertility’s frenzy opens a space to shift perspective toward joy, which has a way of getting lost.

I heard a fascinating story on Public Radio’s Weekend Edition a while back that is another example of working with what’s left.  It was about a project in which inner city kids in Los Angles were paid to come to a class on Shakespeare.  Their “job,” which gave focus and joy to their lives, was to understand what Shakespeare was saying and to re-imagine his work so it could feel relevant to their lives.  Teachers guided them through Shakespeare’s “foreign” language to the meaning of his plays, sonnets, and other works.  The kids teamed up or worked on their own to create a song, poem, rap or other work of art.  These were collected on a CD called “Urban Shakespeare.”  The consensus of the participants was about how empowered they felt at what they had created.  Empowerment is the perfect antidote to helplessness.  Helplessness is a universal feeling when dealing with infertility.

The interviewer in this story was Christine Anthony.  Mary Beth Kirchner, director of education in Los Angeles, spoke with Christine about the Shakespeare project.  What Christine said was memorable:  “War pumps up the need to create.  The opposite of war is art.”  Inner city kids feel as if they are at war.  And so do infertility patients.  Infertility patients all use the same language to describe this experience: in the heat of battle, trench warfare, war zone, battleground and the like.  Art is the opposite of war.

There’s an artist of sorts in all of us.  Find your inner artist and give him/her expression and you’ll be working with ‘what’s left,” as Chuck Close did.  This is an antidote to this temporary war.  If you can use creativity to cope with the built-in challenges of infertility, you can turn a red light to green and get your life moving toward joy while you wait for the miracle.

©January 2013

Helen Adrienne, LCSW, BCD

I’m known professionally as someone who specializes in the emotional component of infertility.  At this holiday season, I’d like to suggest that the need to have access to spiffy coping mechanisms pertains to almost all of us.  Any adversity requires extra coping skills when stress elevates as it tends to at the holidays.  And stress has a way of elevating at the holidays even if there’s not a major challenge going on.

That being said, what can one do to make sure that you stay grounded at a time when you might be feeling as if you’re touring the landscape from on high like Santa, Rudolph and company?

Part of the problem is the expectation that you’ll be bubbling like a glass of champagne when you might feel like day old club soda.  Forced gayety takes its toll; it’s emotionally costly to not be true to your feelings.

While adversity at holiday time can be hard to compartmentalize, there is one technique that is effective and simple—so simple in fact, that people forget about it.  A while back, someone called me at holiday time in a true panic because she was in no mood to fake happiness.  I asked her to find a watch or clock with a second hand.  I would be quiet on my end of the phone for 60 seconds while she took slow, deep breaths.  I suggested that she say “now I’m breathing in” and “now I’m breathing out” as a way to stay focused.  At the end of the minute, she expressed shock that her jitters had stopped and she felt able to reconnect with her inner strength and resources.  Under duress, it is easy to forget that we have a built-in tranquilizer—our breath.

So, for starters, stop if you feel overwrought, breath mindfully for 1 minute and then choose from among this list of options:

• Ask yourself what is upsetting you circumstantially.  Can you eliminate a stressor?
• Ask yourself who is upsetting you.  Is that person available for clear, honest communication from you?  If not, can you limit involvement?
• If the who and the what are immoveable objects, and even if they’re not, I recommend that you take care of yourself in anyone or more of the following ways:
  • Distract yourself by doing
    • Exercise, yoga or tai chi
    • Engage in a predictably pleasant activity
    • Reach out for social support
    • Release emotions into a journal
    • Find a way to laugh
    • Reframe the situation as the glass half-full
    • Allow a catharsis

• Distract yourself by being
  • Learn meditative techniques such as the Relaxation Response or self-hypnosis
    • Listen to guided imagery tapes
  • Dance, sing, drum or  chant (these all reverse the physiology of stress)
  • Become absorbed in creative, artistic projects
  • Experience your spirituality
  • Create affirmations, positive self-talk; repeat these as mantras

When all else fails, you should reach out for professional help.  It can make a vast difference to be able to express your feelings to someone without feeling judged; someone who could provide a perspective that might not have occurred to you but would give you relief.

It can help to remember that shit makes the flowers grow.  Adversity can be the fertilizer for growing into a new, improved version of yourself.  And the path to that new self is to learn to respond to stress rather than react to it.  It is easier to respond rather than react if you can approach the holidays, breath first, and proceed in slow motion.

Mind/body techniques take into consideration that the body is the historian. The body holds information that perhaps the mind wants to forget. In its determination to keep us honest, the body nags at us in the form of anxiety or gastrointestinal problems, head aches or muscle tension until we pay attention.  Talk therapy provides mental relief and sometimes the body lets go, too. But mind/body interventions can add another dimension to our work.

How? Good question. Many of you may recognize that the attitude of separation of mind and body is passé. And so you may already have sought training in interventions that keep “the body in mind” like Somatic Experiencing, EMDR or Hypnosis.  Others of you may have been trained in approaches to therapy in which mental health is considered mental. In either case, there are some simple but powerful and easy-to-learn ways to help people reverse the physiology of stress.

Talk therapy is the most reasonable place to start. We converse with our patients and they guide us so we can guide them through their anguish and confusions. By bringing cognitive understanding of life’s problems to awareness, and by building on their resources, there can be great relief from suffering.

But the body may not fully let go, even when there is great mental relief from our work. In addition, we need to consider that given all of the stress in life, we are all likely to arrive at a place sooner or later where our coping skills fall short of the demands of a stressful situation.  Whether left-over residue or new stressors, with mind/body techniques we can use the mind to trick the brain (body) to let go of stress—often with very few words.

We can learn ourselves, and then we can teach patients that the body, which can be as uncomfortable to live in as the mind, is our ally. We can show them how to honor the body’s demand for recognition. We can teach them tools which bring balance and homeostasis to the body-mind. The key reason to learn mind/body skills is so we can set our patients up to feel a deeper, perhaps more permanent relief from suffering.  Of most importance is our patients get to feel in the driver’s seat of their own lives. To feel empowered with mind/body skills is to have the power to heal as needed. And what can be more satisfying for us as therapists than to empower our patients?

Think of it this way: Coping can be broken down into two categories: “Problem-solving coping” is a cognitive, left brain approach to dealing with adversity. Cognitive behavioral therapy is famous for matching solutions to problems. So is seeking social support, discharging emotions into a journal, exercising and various healthy distractions such as humor or creative projects.

But another category of coping has been measured to provide empowerment in a statistically significant way.  It has been called “letting-go coping. ”This is different from problem-solving coping because it is about “being” rather than “doing.” “Letting-go coping” takes the patient under the turbulence—into their body. These techniques have in common focus on the breath.  Conscious breathing helps us use our breath to enter our body.

Yogic breath work, the field-tested Relaxation Response™, guided imagery, the Labyrinth™, Mindfulness, Self-Hypnosis, Creating Affirmations—and more—will round out your repertoire of offerings to your patients, especially if talk therapy stalls.  Join me in a two-day training seminar in New York City, co-sponsored by the Mind Body Medicine Network, LLC. You will learn how these approaches have evolved from the context of cutting edge brain science and how to apply these techniques in various circumstances.   For more information on our two-day training seminar in New York City this coming November 16th and 17th, please go to the homepage of the Mind Body Medicine Network, LLC at http://www.mindbodymedicinenetwork.com/index.html.

According to Buddhist philosophy, the cause of all suffering is craving.  They say if you desire things that you do not have, suffering will follow.  If you realize this, peace will be yours.  Suffering will disappear and contentment will reign.

Tell this to 100 couples in a fertility struggle and it would be likely that the hair on the back of everyone’s neck would be standing at attention.  Letting go of this craving would seem tantamount to giving up.  To be struggling with infertility feels synonymous with suffering, which intensifies with each passing month without a baby in your arms.  Furthermore, it is the craving that motivates and energizes the quest, providing the “oomph” used to navigate what can feel like an unending challenge.

The good news is that while suffering feels inseparable from infertility, there are coping skills that can mitigate the experience of suffering.  These coping skills ironically involve letting go of the craving for short periods of time, which allows the body and mind to recuperate from the inordinate stress that is inherent in a fertility challenge.  Paradoxically, these letting go techniques correlate positively with rates of pregnancy.

You may not think it is possible to enter an infertility-free zone, even for a minute, since infertility feels all-consuming.  Yet you can learn to dive under the turbulence of this adversity and give your body a chance to rebalance.  It’s not that suffering disappears and contentment reigns.  It is that by narrowing your attention to something like awareness of your breath, for instance, your body lets go of the grip of anxiety.  The breath is a built-in tranquilizer.  Mindful attention to cooking can be an effective distraction.  Listening to guided imagery tapes can serve this purpose.  So can a yoga class.  Hypnotic work is particularly powerful.  These are some of the letting-go techniques.

Here’s how these meditative-type activities provide release and relief: It’s all about the brain—how we are wired.  We have what is called a triune brain, comprised of 3 zones, which I’ll simplify as follows:  The brain stem controls our autonomic nervous system, which takes care of functions that are automatic such as heart rate, blood pressure, muscle tone and breathing rates.  These functions elevate with stress.  We can say that this is the body.  Structures of the neo-cortex make us aware of the world and allow us to interface with it.  We experience this as the mind.  Mental frenzy is a hallmark of infertility and is mentally stressful.  In between the two is the limbic system of the brain, sometimes called the emotional brain, which can be said to be the place where the mind and body meet.

The limbic system of the brain has some features that both hold traumatic experiences and allow us to heal from trauma.  Here’s where letting-go techniques come into the story.  The limbic system responds when you breathe as if all is right with the world.  It also responds to pleasant imaginary visions, a place out in nature where you feel most relaxed, let’s say. And it particularly loves creative endeavors, real or imagined and stories, metaphors and wordplay.

Most important, the limbic system of the brain cannot tell time.  So if you spend just a few minutes, breathing richly and fully, or absorbed in decorating a cake, listening to a guided imagery audio program, or if you learn and practice self–hypnosis—any meditative activity which lasts just a little while, may as well be hours long as far as the limbic brain is concerned.  The vice-like grip of stress loses its grip.

Overall, everyone would agree that craving a baby is about suffering until you get one.  The double-edged sword is that the suffering is also the motivator that keeps the quest going.  But unmitigated stress takes its toll on the body and the mind and is counterproductive to the pregnancy quest.  You owe it to yourself to learn how to let go for the same reason that an adventurer wouldn’t climb Mt. Everest without stopping at way stations that rejuvenate and restore energy.  My web site, my blogs and my book provide much advice and guidance as to how to let go when letting go seems counter-intuitive.