Experiencing, Really Experiencing In Vitro Fertilization

retrieve - transferIn Vitro Fertilization is normal these days, but it is not natural. The numbers are way up since 1985 when, according to the Center for Disease Control, 41 IVF clinics first reported how many cycles were started for the year. The average cycles started per clinic was 95.6. In 1990, with 175 clinic reporting, the average was 109.6 cycles started. By 1995, 281 clinics reported an average of 146.2 cycles started. And by 2000, 383 clinics reported an average of 261.0 cycles started. If you do the math for 2000 alone, you’ll see that there were almost 100,000 cycles started. And while some of those would be the same people returning, not all clinics reported their numbers. And now, it’s 3 years later.

Yet, when all is said and done, being in good company does not change the fact that a couple is not making a baby by making love. Making love is natural.

Stop and think about this for a minute. Wanting a child with someone you love is the point. Getting a child with someone you love by way of the sterility of a clinic with your feet in stirrups and surrounded by strangers is about as diametrically opposed to the intent as you can get.

This is not to say that the outcome is any less poignant. In fact, I think it is more so. IVF babies are miracles like any baby as well as a true miracle of modern medicine. But the IVF route to a family by way of cold speculums and hard science is far removed from the humanity of procreation. There is no beauty in it, no spontaneity, no fun, and certainly there’s no romance of a private and intimate nature.

These are the things that IVF isn’t. What it is must be endured in order to keep your sights on the goal. Endured means tolerated. Endured can also mean withstanding the physical and emotional challenges over a long time frame. In a word, it is an ordeal, which, for this audience need not be delineated further. Patients and physicians alike know intellectually how painful infertility is. But to know intellectually is very different than to know in your heart. To know in your heart is so much more intense. It is a different level of understanding that can’t help but result in a stranglehold of mind and a stranglehold of body.

Often patients work like crazy to prevent themselves from sinking to the depths of that level. This is quite understandable. What is often overlooked, is that it is desirable to sink to that level, to feel it, and to acknowledge it. Knowing the truth of what is going on in body and mind is exactly the key that gives us the ticket out. The way out of any stranglehold is through – through the pain by way of an attunement to the body’s messages.

This is an article that will look at the In Vitro Fertilization experience through the filter of the mind-body connection. And no matter how protracted the quest to become pregnant by this unnatural method, the mind-body connection is the most hopeful way to look at this experience. It is hopeful because, while you cannot control the fact of your infertility, you can, by being attuned in this way, control your experience of it.

Our bodies, including our brains, are the filtration system through which we experience the world. And our minds are the filtration system through which we experience our bodies. This is a two-way loop system by which the outside world impacts on us and creates a physical and mental awareness of that impact. The awareness comes by way of bodily feelings that “communicate” with us and which we understand with our minds. So in this instance, body language is not what we communicate to the outside world by way of our posture or facial expressions.

Body language is what we communicate to ourselves about the circumstances we are in. Part of my job as a mind/body therapist is to facilitate the awareness of bodily communication and then work with it to ameliorate the understandably stressful responses to these unwanted circumstances.

These days the mind/body connection is considered common knowledge. The landmark research that makes the connection of the mind and the body indisputable was made public in 1997 when Candace Pert, Ph.D. published her book Molecules of Emotion. In it she explains how our emotional experience of an event gets converted into neurotransmitters which travel to receptor sites in our bodies, such that we can think of our brains as actually existing in every cell of our bodies.

Let’s not forget that the ordeal of infertility takes place in the context of a demanding world. Everyone knows the expression “multitask.” So many of us are overworked and even our leisure has an urgency to it (“I must get to the gym!”). We do not have built into our society the sitting around a campfire of our ancestors. So as a rule, our neurons are always ready to fire off for the next obligation. Managing infertility in general and IVF in particular’ responds well to slowing down and respecting the extra load on your body and emotions that is entailed. I realize that this is optimum, given the way our world is, but even to aim in this direction helps.

There are two aspects to the management of, or preparation for the experience of in vitro fertilization. One aspect has to do with intellectually managing the procedure. The other has to do with managing anxiety and depression, the most common emotional reactions to the gestalt of infertility. Both can be approached from the perspective of the
mind/body connection and both have to do with self-care.

The intellectual management really concerns the things that fall in the category of what could be called how-to. There is a certain amount of common sense to this aspect of self-care such as getting plenty of rest, eating healthily, attending to the marriage, getting a massage, going to a yoga class or going to church.

The intellectual management also pertains to gathering information. For instance, I think it is important for patients to know that the ovulation-inducing drugs can cause an emotional lability that is like PMS at its worst. Patients should know that when they feel as if they are swinging from the rafters they do not blame themselves for being out of control, but understand that this could be a side effect of the drugs. It is also important for patients to know that they need not let their myriad questions go without getting satisfactory answers from their doctors or clinic staff. Information is notorious as an anxiety reducer, and a hopeful piece of information can lift one’s spirits. Sometimes patients feel hesitant to ask for what they need from the doctor or nurse because “they are so busy and they won’t treat me right if I pester them.” As a patient advocate, I encourage patients to go after what they need so that their body can let go of the grip of an unanswered question or concern.

The intellectual approach to infertility/IVF raises the option of bibliotherapy.There are many resources out there that answer your specific concerns. Books stores are filled these days with a potpourri of how-to books to meet what ever your needs are. Since whole books are written about this, I refer you to search the stacks to clarify your specific concerns. Many people search the internet for what they need, which can be a wonderful source of information as well.

Social support is part of good self care. To be isolated with a situation of this magnitude can only heighten your stress. I do understand, however, that for some people, either the cast of characters in your world are not user-friendly, or for one of many possible reasons, you do not have a blue-print for going public. Here is where a support group specific for infertility such as those run by RESOLVE can make all of the difference. Deciding to reach out is another intellectual management tool.

Keeping each of your respective families in line can sometimes be a complication. The last thing that you need now is the aggravation of family members who do not understand the situation that you are in. Rather than trying to pretend that you are fine, or avoiding the family when your insides are in a knot, it is recommended that you seek out the services of a therapist. Therapy can help you to get a perspective on who the people are, how they operate and what your options are. Most important, you would have a chance to examine if and how their styles of relating may have been incorporated in the way you and your spouse relate. Now is not the time for emotionally inherited junk to come between you; and conversely, now is a wonderful opportunity to learn where you may be on auto-pilot and how you can make a departure to your own healthy ways of relating.

Sometimes, it is residue from your respective families explains depression or anxiety. Managing the symptoms of these emotional states can be ameliorated intellectually and emotionally with the help of a well-qualified therapist. It is this aspect of IVF upon which I wish to call to your attention. Here is where a giant growth edge exists. Here is where there can be a leap toward a profound kind of empowerment. And the bonus is that since life is full of traumas, if you to learn to tune in to physical or emotional symptoms, what is learned will serve you well for the rest of your life.

Meanwhile, specific to the dominant emotions of the infertility (IVF) experience, in the 25 years I have been in practice, I have never met an infertility patient who was not at least somewhat anxious, depressed or both. This is separate and apart from the fact that people are excited that there is a procedure that can address the infertility.

This is not to say that there aren’t couples who navigate the trauma with as smooth a sail as is humanly possible. These people and those who block what they feel, do not show up in my office. The lucky couples are those whose style of coping is empathic, meaning that they are either on the same page, or they respect each others different feelings. Lucky, too, are those who can successfully deny the fact that there could be an undesirable outcome to the fertility struggle and turn up pregnant before they run out of stamina, thereby circumnavigating the emotional component. For the most part though, the issue of reproduction is so huge that it lands like a ton of bricks. And where else will it land, if not in the body? So how does a mind/body attunement help? How does it help a patient feel that while she may not be in control of becoming pregnant, she can be in control of her experience of the quest?

We’ve already seen that to put in place good physical self-care, active pursuit of answers to your questions, knowing what you need and feeling entitled to it, social support, and managing your family or setting limits to them can bring down the levels of stress that exacerbate depression and anxiety. Now it’s important to realize how much more power you have to bring the thermostat down even further.

That anxiety and depression are an intricate part of the infertility experience is a no-brainer. Both anxiety and depression are absolutely in dead center of the bell-shaped curve of normality for this condition. Sometimes psychopharmacologic interventions are appropriate, but even in cases of extreme anxiety and/or depression, mind/body techniques are extremely powerful tools. They are more powerful than most people realize at first. It is possible to learn to reduce the experience of anxiety by reducing the actuality of it. And if anxiety is reduced successfully, the body is in a steady-state that is a lot easier to live in. By steady-state I mean a kind of neutrality that is akin to “sitting around the campfire” that was built-in to the world of our ancestors. Likewise, it is entirely possible to learn to manage depression in a way that is totally empowering. This empowerment feeds on itself in a positive way.

The place to start with patients is to look at what is. What is the person’s individual experience of the infertility/in vitro process? Any individual will have her previous life experience that will shape and mediate the roller coaster ride that is infertility. Work with patients should be totally individualized. No two people are alike.

Even mind/body groups for infertility are comprised of individuals whose psychodynamics control their experience and/or the intensity of it, so answers cannot be cut and dried. While nothing cures the physical and emotional response to infertility like getting your baby, the next best thing is to be able to feel the power of your coping capacities by tuning in to how your mind/body connection lets you know where you are and what you need. If you plan to seek guidance at this difficult time, a mind/body therapist trained in mind/body techniques, including visualization or hypnosis would serve you well.

The following are just two examples of how individuals were able to be honest with themselves about the impact of the stress of infertility. Consequently, they were able to greatly smooth out the emotional wrinkles by tuning in to the present moment with various techniques such as breathing, guided imagery or hypnosis. These and other techniques elicit a kind of relaxation that truly allows the body to arrive at that place of our ancestors where, when the work and tensions of the day were over they could commune with each other or with nature and derive the physiologic benefits in which blood pressure, heart and breathing rate, and muscle tension all came down to neutral.

The names in the examples discussed below have been changed. Nora was able to tune into her body so as to get what she needed to successfully navigate the infertility journey. For Nora, the normal state of affairs before infertility was a state of anxiety (as opposed to the trait of anxiety showing up in response to the infertility). So you can imagine how hard it was for her to manage the demands of infertility. She worked with me in individual therapy and, after a while, in my mind/body group as well.

I taught her the power of breathing. Simple as that sounds, for her the following session was a landmark for her: She came in with such a tightness in her chest that she felt that she couldn’t breathe. I gently encouraged her to take in as much oxygen as she comfortably could. I then guided her in a very long exhale, as long as she could tolerate, at the end of which she had created a vacuum in her lungs and broke the muscle spasm. She began to breathe normally and realized that she now had this tool that she could use for herself.

Nora was also very nervous about the procedure called “co-culture” during which a small section of the endometrium is removed and used as the medium in which the embryos are grown. Nora had responded very well to hypnosis in prior sessions. During this session, I worked with her in trance to arrive at a state of relaxation and safety and then encouraged her to use the power of her creative imagination to visualize the piece of endometrium as the “nest” in which her babies would be safe and sound until they were implanted in her uterus. She had previously had several failed IVF attempts, but now she became pregnant and ultimately delivered twins.

Jamie also worked with me both in group and individually. Jamie not only achieved her goal of getting her family (she, too, has twins), but as an added bonus, she was so attentive to her body that she actually reclaimed her womanhood fully in the process. For her it was not only being in the grip of infertility that was the issue, but also the fact that she had been anorexic earlier in her life. That she was not menstruating on her own was to her part of the problem. As one of my referring physicians said to me years ago, “Helen, we can make a stone ovulate these days.” But for Jamie, to artificially induce ovulation was less the point than the sadness for her about feeling like less than a woman. Through her dedication to what she learned in the mind/body group, and through her hypnotic work with me individually, Jamie began to get her period on her own. Subsequently, she carried twins to term and is breast feeding, not only feeling fully like a woman, but also feeling much better qualified to manage whatever depression or anxiety pops up in the future.

It cannot be denied that key in the story is the quality of the medical procedures that patients receive. But, the achievements of these two women, or any other examples that I might give, would be rooted in a commonality that facilitates a capacity to be more receptive and more hopeful. From the chaos of the world we live in, to the specifics of anyone’s infertility struggle, each person must, as these women did, come in for a landing in the present moment with some degree of regularity. Too often we are drawn to the past or oriented to the future. Breathing in the present moment and breathing the present moment in is what stops the merry-go-round and thereby stops the physiology of stress and the experience of it, if only briefly. But to stop the stress briefly and then to expand the time that you “hang out” in neutral, is to teach both your body and your mind that you can change the rules. What a relief! What a victory!

I feel compelled to highlight what may seem like a simplistic statement: to breathe in the present moment and breathe the present moment in. In any given moment, one cannot breathe deeply and luxuriously and simultaneously be anxious. A deep breath signals the body that all is well with the world. So if one strings together a few and then many of such breaths, the stressed body literally catches a breather.

Of course, I recognize that it is not so easy to go beyond a few of the above breaths before what has been called “the monkey mind” starts swinging from trees, demanding attention, particularly to negative thoughts. There are many techniques for maintaining focus so that with practice any of us can find the approach that works for us and we can gradually learn to clear a space that really gives the body and mind some “time around the fire.” As you might imagine, there is no magic to this and a person must be motivated to practice relaxation in order to overcome the natural tendency to stay glued to the frenzy.

The patients that I described above were people who went the distance with this, in sessions with me and in their self-care when they were on their own. They both derived enormous benefit from using the relaxation that came from focused breathing to allow themselves to sink into a safe inner space where the unconscious mind opens up to the power of guided imagery or hypnotherapy. Jamie was religious about using the audiotapes that I made in the sessions on a daily basis to reinforce the positive messages and to get past the learned limitations that had staked a claim in her psyche. And Nora came to redefine herself as someone who did not have to live by the label of “the anxious one” that had been assigned to her many years ago.

Getting your family by way of the unnatural odyssey of IVF is absolutely worth the ordeal. But judging from the response of those women, men and couples with whom I’ve worked from the mind/body orientation, developing the mindfulness and discipline that enables you to stop and “breathe in the now” is also well worth the effort. Think of it – you make it through the enormous tensions of IVF and now you have the tools with which to handle the trials and tribulations of parenthood.

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About the Author:

Helen Adrienne, LCSW general psychotherapist, clinical hypnotherapist, and practitioner of mind/body therapy with a specialty in infertility. New York City