Managing Infertility Through mind/Body Techniques
By Barbara Blitzer, LCSW-C
(Previously published in RESOLVE and Washington Woman)

As anyone who has experienced infertility can attest, what happens to our bodies directly affects our sense of well-being, security, and optimism. Often the challenges of infertility and infertility treatment shake our belief that we can create the lives we want, as hope is followed by monthly disappointment.

Once in treatment, our bodies feel unfamiliar, uncomfortable, no longer our own. Our privacy, life routines, and intimate relationships are disrupted. Hearing of the pregnancies of friends, we may feel angry or envious. And these reactions can make us uncomfortable with ourselves. We look healthy, even prosperous, but deep inside, we’re struggling, and no one knows. We feel isolated from our peers—different and alone.

As treatment progresses with uncertain outcome, our lives may go on hold. We may postpone decisions about career and home-buying. Finances are strained. Never have we been asked to commit so much of ourselves with so little assurance of success. And yet we must be optimistic enough to proceed—to go through treatment, to advocate for ourselves in the medical system, to make difficult decisions about treatment, and sometimes proceed into a complex adoption system.

If well-meaning friends or relatives tell us to just relax, we often become outraged. Don't they know this is a medical condition as well as a tremendous physical, emotional, and spiritual challenge? How could relaxation help, and even if it did, how could relaxation be possible given the number of challenges infertility presents?

Mind/Body Medicine:
More than Relaxation

Mind/Body approaches learned in the context of a fertility problem offer much more than a relaxation program. Unlike a meditation or a yoga class, the mind/body approach allows us to focus on the specific issues related to infertility and then to draw from a wide range of techniques. Some of the major mind/body techniques include emotional support and connection with others, imagery, self-hypnosis, biofeedback, autogenic training, breathing techniques, meditative techniques, drawing, journaling, and energy work. Combining a number of techniques, we are able to craft an individual program that fits the unique needs and temperament of a given individual.

Mind/body medicine is a relatively new phenomenon in the West and measuring its effectiveness using Western scientific methods has been difficult. What has been well established in the scientific literature is that emotional states impact our health.

We all know this from experience. When we are frightened or angry, our breathing changes, our hearts race, and our digestion can shut down. Our bodies are flooded with adrenaline as we prepare to fight or flee. When we are frightened we might say we are “scared stiff” or that we have “cold feet.”

These common expressions reflect a physical reality. Our bodies are wired to respond to the type of physical dangers encountered by our ancestors who fought wild animals in order to survive. Even though the dangers we now encounter are generally products of our minds, our bodies react in such a way as to prepare us for physical encounter. Our muscles tense and our blood vessels contract, causing our hands and feet to grow cooler. While these reactions were helpful when energy was needed to fight a tiger, they can be less than helpful in fighting our inner emotional tigers.

Mind/body research suggests that our minds are powerful tools that can be used to help us regain control, reduce the effects of stress on the body, and perhaps influence our chances of conception. It also has been well documented that mind/body approaches can reduce stress-related physical problems lowering blood pressure, relieving certain types of GI tract disorders, backaches, headaches, and muscular tensions. In recent years the field of psychoneuroimmunology has conducted research on the way that the brain connects with the immune system.

Several studies have indicated that cancer patients using various types of mind/body approaches have survived longer than those receiving standard medical treatment alone. Emotional support and release, specific applications of imagery, feelings of being connected, loved and part of a community have all been shown to have health benefits in numerous studies.

There are also studies indicating that the mind can affect the body in very specific ways. In one study, groups of students were asked to visualize white blood cells. One group was shown pictures of lymphocytes and asked to visualize them; the other was shown neutrophils and asked to visualize them. Blood was draw from both groups before and after the visualization sessions. Remarkably, the group that visualized neutrophils had a decrease in neutrophils while the group that visualized lymphocytes had a decrease of these cells.

Every couple who seeks mind/body psychotherapy wonders if learning and practicing the techniques will enhance the possibility of conception. Recent research is beginning to shed some light on this question.

Alice Domar at Harvard's Deaconess Hospital conducts groups and individual sessions for people with medical problems. In her mind/body groups, she administered questionnaires, which measure the depression levels of group participants. She found that infertility patients' rates of depression were comparable to those of patients with cancer, HIV and heart disease, a striking fact in and of itself. She also noted that after completing the mind/body program, depression was significantly reduced. She then compared conception rates of those participating in the group program with those receiving standard medical care.

She found the following: Patients receiving standard medical care conceived at the rate of 24%. What was striking was that those who at the outset of the group had the highest scores on the depression inventory conceived at the highest rates--60-80%. The suggestion was that the group alleviated the depression and also the effects of that depression on the body. The question of whether depression can contribute to some types of infertility was raised.

In the Bodymind,
Everything Is Connected

While we don't know for certain why the higher rate of conception occurred among the most depressed women, we can look to what we know about how the mind and body connect physiologically and what we suspect may be at issue.

The brain is divided into sections with various functions. The cortex, or outer layer of the brain handles our logical functions. It is this part of the brain that allows us to think rationally. Deeper within the brain lies the limbic system and the hypothalamus. The limbic system is the section of the brain where emotions are processed. The hypothalamus acts as a relay station which connects our emotions with the endocrine, or hormonal system. It is the connection between emotions and physiology, mediated by the endocrine system, that is significant.

Stress can alter the flow of reproductive hormones affecting estrogen (needed for ovulation) and progesterone (necessary for an embryo to implant). Emotional upset has also been shown to cause tubal spasms, irregular ovulations, and hormonal shifts. For men, stress has been associated with significant drops in sperm counts and quality of the sperm.

Crafting an Individual
mind/Body Program

As a mind/body psychotherapist, I am often called upon to explain mind/body medicine and its application to infertility. I try to take a careful tact, discussing what we don't know as well as what we do know--or what we suspect.

In my work with fertility patients using a combination of support and mind/body skill instruction, patients virtually uniformly report an increased calm, a reduction of physical stress symptoms, greater ease tolerating procedures, and an overall brighter mood. The emotional roller coaster ride so often described by fertility patients becomes somewhat less hair-raising. It is not unusual for a client seeking help with a fertility problem to report that stress-related symptoms, such as headaches, stomach aches, TMJ, backaches, and muscular tensions, have disappeared. For me, this has always seemed a sufficiently worthy outcome.

More recently, I have become excited about the number of pregnancies I’ve been observing. Although it is impossible to establish whether, or to what extent, mind/body stress reduction techniques have contributed to this outcome, I suspect they have had a positive impact in many instances.

In my practice I work with individuals, couples, and groups. Each format provides distinct advantages and disadvantages. At the outset, I interview individuals to determine what would be best, at least initially. Some people come with high levels of emotional distress and for them, I become the primary therapist using mind/body techniques as part of the sessions.

Others are looking for group support or would like to arrange for a number of sessions to learn mind/body skills, while continuing to work with their own therapist. We determine the agenda together. Regardless of format, sessions involve some discussion of pertinent issues plus instruction in techniques. Clients are encouraged to practice the techniques at home.

The use of mind/body medicine with fertility issues is an exciting new frontier. Many more studies are needed to determine its efficacy. Until then, we can look at the work now being done in the field and evaluate for ourselves what our level of comfort and involvement can be. For some it may be important to learn relaxation techniques to reduce the stress of infertility.

And that's a worthy goal. Others might believe that the mind can actually alter outcomes. That is okay too. The important thing is to be true to oneself and to remember we are always investigating and changing our belief systems.

The world was still round well before the time that Columbus proved it to be so. We face our difficulties now, and must choose now based on limited, imperfect knowledge. Deep within us, we chart our own course with half-veiled eyes.

Barbara Blitzer, LCSW-C, M.Ed. is a psychotherapist with over 25 years experience working with mind/body techniques including imagery, meditation and hypnosis. She has special interest in fertility issues and works with individuals, couples and groups to minimize the stress associated with infertility. Ms. Blitzer combines talk with instruction in mind/body techniques to create a unique whole person approach. She maintains a private practice in Bethesda, MD.

For information, call 301-588-6461 or email barbarablitzer@mac.com