Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (WHO 2017).
There are, of course, many physical and emotional factors that can cause infertility. It can be caused by problems in either partner and may be primary or secondary in nature.
Primary infertility refers to couples who have not become pregnant after at least one year of having intercourse without using contraception. Whereas secondary infertility refers to couples who have been able to get pregnant at least once, but who are now unable to conceive.
Additionally, the cause of infertility may be explainable and treatable. Or it may be unexplainable, stress-related, or linked to other psychosomatic factors.
One aspect of infertility care that is causing increasing concern in developed countries, is age-related infertility. This is due to the rise in so-called ‘eleventh-hour mothers’ waiting until their 30s or later, to begin families.
With increasing maternal age, not only does it take longer to conceive but the risk of miscarriage, together with complications in pregnancy and childbirth, also increases. Likewise, assisted reproductive technologies (ART), including in vitro fertilisation and intracytoplasmic sperm injection, also become less successful as age increases.
This decline in maternal fertility with age is an entirely natural process. As with ageing, the number and quality of eggs that remain in a woman’s ovaries naturally declines after the age of 30, no matter how healthy she may be overall.
It is this mismatch between overall health and the ability to conceive that catches many women out, and it’s one of the most common reasons for otherwise healthy women to seek fertility treatment.
Currently, in the UK approximately one in seven couples have difficulty conceiving. This equates to about 3.5 million people seeking help to start or grow their family (NHS 2017).
Taking all these factors into consideration, the mind-body approach to infertility has a great deal to offer, especially for women over 30 years of age.
How can Mind-Body Therapies Help Infertile Couples?
To date, there is currently relatively little high-quality research to support the use of mind-body therapies in fertility care. However, what research does exist is encouraging and backed up by overwhelming anecdotal evidence that the mind-body approach can increase a woman’s chances of conception. Or, if pregnancy isn’t possible, to help couples come to terms with remaining childless.
Stress Inhibits Fertility
When the body is in a state of stress, it’s the reproductive system that is the most expendable. Unhealthy levels of stress can inhibit conception by suppressing luteinising hormone, increasing serum cortisol levels and inhibiting hypothalamic GnRH (gonadotropin-releasing hormone) function.
These factors can reduce egg quality, delay the release of eggs and inhibit implantation of a fertilised egg – all of which make the chances of conception and a healthy pregnancy less likely (Lynch et al. 2014).
The stress of infertility often leaves couples overwhelmed with negative emotions, feelings of powerlessness and high levels of psychological distress. Many couples are left wondering if they haven’t conceived because they are stressed or if they are stressed because they haven’t conceived. As a result, they can quickly find themselves in a vicious circle of negative emotions that can be difficult to break out of without professional help.
Whilst further research is clearly needed, there are numerous passionate testimonies from women who claim that learning to release stress and relax deeply was incredibly helpful in assisting them to conceive.
What Does the Mind-Body Approach Have to Offer?
Mind-body therapies are techniques that address the health of both mind and body together. They are usually techniques that can be easily learnt and used as self-help tools to back up the therapeutic work done within the consultation.
They are also invariably deeply relaxing and excellent stress management tools in themselves. The theory supporting these techniques is that in all cases, learning to treat the body as an ally is an integral aspect of successful fertility treatment.
Mind-Body Techniques Beneficial in Stress Release Include:
- Progressive relaxation exercises.
- Body scan meditations.
- Emotional Freedom Techniques.
- Therapeutic imagery and visualisation exercises.
- Mindfulness techniques.
Key Benefits for Patients
- Deep relaxation and stress release.
- Skilled support to work through any emotional factors inhibiting fertility.
- Mental and emotional preparation for physical examinations and treatments.
- An increase in self-confidence and positive mental attitude.
- An integrated approach to treatment within a single care package.
As Eastburn (2006) reminds us, everything, including a baby, starts with an idea that is energised into life by our emotions. Sometimes, however, those same emotions can suppress or block the chances of successful conception. This is why techniques such as stress release, mindfulness and meditation are so useful.
Cognitive-behavioural therapies have also proven to be invaluable in reducing the psychological distress of infertility. They work by offering a gentle way to help patients identify and release any suppressed emotions that might be blocking conception.
Yoon et al. (2014) endorse this idea by suggesting that psychosocial interventions for couples in treatment for infertility, in particular, cognitive behavioural therapies, could be helpful both in reducing psychological distress and in improving conception rates.
Increasing mindfulness and acceptance skills, as well as cognitive decentering from unhelpful thoughts and feelings, can help women to experience negative inner states in new ways. By decreasing their entanglement with any negative emotions, it allows them a greater opportunity to experience inner peace and reduced distress (Galhardo et.al. 2013).
In cases where the woman’s past obstetric history includes termination of pregnancy, miscarriage, stillbirth or neonatal death, the trauma of these events may be deeply imprinted within the subconscious mind. Consequently, techniques that assist with the release of powerful emotions such as guilt, grief and sadness may be needed before going on to build up the woman’s confidence and trust in her body to help her conceive again.
Fertility Nursing and the Mind-Body Approach
Whilst the goal of all treatment programs is to help a couple achieve a healthy pregnancy, fertility nurses may also be required to help a couple come to terms with the emotional toll of infertility. The pain of loss and grief, and occasionally the final acceptance that they may not be able to have children.
The current nursing and midwifery literature, however, lacks an in-depth exploration of the psychological and emotional consequences of infertility (Alan 2013). A fact supported by Kim et al. (2014) who suggests that as the number of infertile couples is steadily increasing, so more effective nursing strategies are needed to help women overcome the psychological conflicts that accompany being childless.
Whilst mind-body therapies may not be able to cure infertility, there is a growing awareness that they may be able to help build resilience and significantly lower the stress that so often accompanies fertility treatment.
Integrated care plans alongside better quality research are urgently needed to raise the profile of the mind-body approach in fertility care. With this, the option of evidence-based integrated fertility care could soon become a reality.
- Allan, HT 2013, ‘The anxiety of infertility: The role of the nurses in the fertility clinic’, Human Fertility (Cambridge, England), vol. 16, no. 1, pp. 17-21, viewed 25 January 2018, https://www.ncbi.nlm.nih.gov/pubmed/23548092
- Eastburn, L 2006, ‘It’s Conceivable! Hypnosis For Fertility’, The American Journal of Clinical Hypnosis, vol. 52, no. 2, p. 147.
- Galhardo, A, Cunha, M, Pinto-Gouveia, J 2013, ‘Mindfulness-Based Program for Infertility: efficacy study’, Fertility and Sterility, vol. 100, no. 4, pp. 1059-67, viewed 25 January 2018, https://www.sciencedirect.com/science/article/pii/S0015028213006468
- Kim, M, Kim, S, Chang, SB, Yoo, JS, Kim, HK & Cho, JH 2014, ‘Effect of a Mind-Body Therapeutic Program for Infertile Women Repeating In Vitro Fertilization Treatment on Uncertainty, Anxiety, and Implantation Rate’, Asian Nursing Research, vol. 8, no. 1, pp. 49-56, viewed 25 January 2018, https://www.ncbi.nlm.nih.gov/pubmed/25030493
- Lynch, CD, Sundaram, R, Maisog, JM, Sweeney, AM & Buck Louis, GM 2014, ‘Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study—the LIFE study’, Human Reproduction (Cambridge, England), vol. 29, no. 5, pp. 1067-75, viewed 25 January 2018, https://www.ncbi.nlm.nih.gov/pubmed/24664130
- National Health Service 2017, Infertility, NHS Choices, viewed 25 January 2018, https://www.nhs.uk/conditions/infertility/
- World Health Organization 2018, Sexual and Reproductive Health, WHO, Geneva, viewed 25 January 2018, http://www.who.int/reproductivehealth/topics/infertility/definitions/en/
- Yoon, F, Farver-Vestergaard, I, Skovgård, NG, Ingerslev, HJ & Zachariae, R 2014, ‘Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis‘, BMJ Open, viewed 25 January 2018, http://bmjopen.bmj.com/content/5/1/e006592