The Emotional Impact of

Infertility & IVF

Marianne Tome

Counselling Manager

Melbourne IVF

Overview:

• Impact of infertility/treatment on individuals and couples

• Case egs

• Male experience

• Some stats and figures

• Role of counselling

• More serious reactions

Kate and James

• In their mid 30s, married for 3 years, ttc for 1

year

• Unexplained infertility

• 1 stim cycle – 3 embryos - unsuccessful

• Attend supportive counselling appointment

to prepare for next stim cycle

Kate:

• High level of anxiety about treatment - doubtful

IVF will work, frustrated with what she

perceives as her ‘failure’

• Frustrated/upset that James does not appear

concerned/upset enough about their situation

• Struggles with treatment – moody, teary,

anxious, feels all control has been taken from

her

• Has not found James a good support - feels he

withdraws from her when she is too emotional

James:

• Described self as optimistic about treatment and pleased

that they are doing something positive after months of

uncertainty

• Found first cycle very difficult as did not know how to help

Kate

• Found anything he said/did antagonised Kate – admits he

withdrew to avoid conflict

Counselling Intervention

- 1st time James had spoken about his

experience during treatment

- Kate had seen James’ withdrawal as

uncaring rather than not knowing what to

do/avoiding conflict

- Discussed what they had learnt about

themselves/each other during treatment –

first major stress they have experienced as a

couple

Counselling intervention

• Discussed plan for next cycle

• Mindfulness techniques for Kate

• Couple attended 2 more counselling sessions

• Undertook 2 more cycles

• Couple described feeling much more in sync

with each other and more of a team.

• Currently pregnant

Leah:

• 32 year old, 2 rounds of unsuccessful

treatment (1 embryo per cycle)

• Had stopped treatment

• ‘ I had lost my sense of peace, calmness,

hope and also my courage to give IVF

another go anytime soon’

• Joined Melbourne IVF’s Mindfulness Group

Leah:

• Learnt:

• How to identify unhelpful thoughts

• Mindful meditation

• Relaxation exercises

• Techniques for sleeping better

• How to manage stressful situations

• Made friends

Leah

• Leah practising a

mindfulness exercise

prior to laparoscopy

Leah:

• Outcome:

• Described feeling more hopeful, optimistic, calmer and less worried thoughts

• Commenced treatment again

• Not pregnant but continues to practice the techniques she learnt and experience the gains she made through the Mindfulness program and this has allowed her to continue with treatment

Impact of infertility/ART:

• Studies have shown that stress from

infertility similar to those with ca (Domar)

• Depression and anxiety highly prevalent

amongst women undertaking ART

• Study of 42000 IVF patients – 60% met criteria

for depression following a failed cycle

(Sejbaek)

• Treatment can cause depression (de Klerk)

• Milder treatment, fewer symptoms of depression

• 40% of women met criteria for psych

disorder at 1st infertility evaluation Chen et al

Impact of Psychological Factors on

ART

• Studies have showed mixed results regarding the influence of stress and distress on ART outcomes.

• Meta-analysis undertaken in 2010 showed that emotional distress (depression/anxiety) will not compromise the chance of becoming pregnant (J. Boivin)

• However emotional distress as a result of infertility/IVF treatment may reduce patients willingness to remain in treatment for the optimal number of cycles to fall pregnant (J. Boivin)

• Women with depression dx prior to ART underwent significantly fewer cycles (A. Domar)

What helps – Cognitive restructuring

• CBT (cognitive behavioural therapy)

• Exploring negative/unhelpful thoughts

• Does this thought contribute to stress?

• Where did I learn this thought?

• Is it logical?

• Is it true?

• Finding new ways of thinking about treatment

and self

• ACT (Acceptance and Commitment Therapy)

• Package of tasks during cycle

What helps – Mindfulness techniques

• Being aware of experiences with openness, receptiveness and interest rather than avoidance/judgement/controlling

• Engaging in the present

• Can increase enjoyment of life/reduce distress/enhance relationships

• Breathing/Relaxation techniques

• Yoga

• Writing techniques

• Exercise/physical activity

• Mindfulness apps

More serious reactions

• Major Depressive disorder

• Anxiety disorders

• Exacerbation of previous psychiatric issues

• PTSD

• Schizo-affective disorder

• Bi-polar

• Suicidal thoughts/behaviour

Joanne

• 40 year old single woman accessing treatment with CRSD

• No significant issues identified through counselling although

socially isolated and no previous long term relationships

• Denied any mental health history

Joanne

• Commenced treatment

• Staff noticed that she was calling frequently, highly anxious,

not able to retain information

• Behaviour escalated and staff contacted counselling –

conversations irrational and she became abusive towards

staff, not following instructions

Joanne

• FS decided to stop treatment and await assessment

• Joanne refused assessment

• Treatment did not continue

• Joanne went to another clinic

Joanne:

• Significant proportion of patients who start treatment have a

pre-existing mental health history

• More vulnerable to the stress of treatment

• May present ok initially

• Thorough pre-treatment assessment essential

More serious reactions

• Liaison with mental health professionals

• Plan in place

• Monitoring of patients and reporting any

concerns

• Earlier intervention the better

• Prevention better than cure!

Let’s end with a good news story