How Can Online Support Impact Your Personal Fertility Journey?

Globally, 15% of couples experience infertility. In the United States, that rate increases to 19% of women who cannot become pregnant after trying for at least a year. In a heterosexual relationship, infertility can be caused by factors relating to anyone in the relationship.

The challenges of infertility are numerous. Fertility treatments can be costly, time-consuming, and physically demanding. Couples may feel a strain on their relationship. Partners can feel discouraged as each month passes without pregnancy. Statistics further reveal the emotional toll of infertility.

An internet-based intervention to decrease distress in women experiencing infertility

Although the rate of infertility-related emotional distress is high, only 9-21% of women receiving fertility treatments seek treatment from a mental health professional. The barriers that prevent more women from seeking treatment during this time mirror barriers that keep others from seeking professional support. Due to the stigma of mental health treatment, some women may fear that seeking help will lead to dismissal from fertility treatments. Transportation, time, and cost also play a role.

Internet-based treatment has provided promising results in the delivery of therapy. The goal of one study was to convert a successful face-to-face intervention into an online program. As the first of its kind, the authors sought to discern whether they could find enough eligible candidates to complete the study and determine if participants completed the intervention and assessments and were satisfied with the online program.

Participants

Participants were recruited through flyers in doctors' offices, social media, posts on infertility-related websites, and a crowdsourcing website. 160 individuals were assessed for eligibility, and ultimately 71 were randomized into the intervention and waitlist groups.

Inclusion criteria included:

• 18 years or older
• Have not given birth to a live baby
• Having internet connection
• English speaking
• No psychotropic medication changes in the last month
• No current or past involvement in a fertility mind/body program
• No substance use, psychotic disorder, eating disorder, or suicidal thoughts

The average age of participants was 33 years old, and the average length of time trying to conceive was around 31.5 months, or almost three years. The majority were college-educated women who had full-time employment; 95% of participants lived in the U.S., 38% saw a therapist because of reproductive-related stress, and 39% completed at least 70 minutes of relaxation exercises a week.

Methods

The intervention was a 10-week virtual program. It included ten modules that provided information content and applicable homework exercises. The modules covered mindfulness, assertiveness training, goal-setting skills, stress reduction strategies, cognitive restructuring, relaxation techniques, and the relationship between stress, lifestyle, and fertility. Each was designed to be completed in less than an hour and included homework assignments to track health-related information, participate in relaxation exercises, and apply cognitive behavior therapy (CBT) tools.

A therapist provided feedback to participants after each module and could be reached by email for any questions or concerns. A therapist spent approximately six hours reviewing module responses and providing feedback via email for those who finished all of the modules.

Participants of the waitlist group were provided entry to the intervention after completing their final assessment.

Results

Three outcomes were measured: (1) retention, adherence, and satisfaction, (2) psychological distress, and (3) pregnancy rates.

97% of the intervention group completed module one, but this completion rate progressively decreased, with just 39% of them completing module ten. The average number of modules completed was four. While they were encouraged to complete one module each week, most participants waited three weeks to complete the first module. This pattern continued throughout the study, so the intervention ultimately lasted an average of 6 months.

82% of those who completed the treatment were satisfied with the program, and 60% of the intervention group thought the modules were moderate to very helpful. Relaxation exercises, therapist feedback, and partner communication exercises were listed as the most helpful parts of the program.

Participants completed a baseline questionnaire at the beginning of the trial, a mid-assessment at five weeks, and a post-assessment, which was at ten weeks for the control group and at the end of the program for the intervention group. These results revealed that several positive outcomes occurred for the intervention group.

• Anxiety and depression measures decreased significantly.
• A larger portion of the intervention group became pregnant compared to the control group.
• Conception happened in a shorter time frame for those in the intervention group who became pregnant than for those in the control group.

By the end of the study, 20% of participants on the waitlist were pregnant. This was more than doubled for the intervention group, as 53% of those participants became pregnant by the end of the study. For those who became pregnant, it took 97 days for the waitlist group and 79 days for the intervention group.

Results from the study reflected what similar research has shown. People with infertility often experience increased distress, but those who participate in therapy can see improvements in their mental health.

In summary, what did this study entail?

Seventy-one women experiencing infertility participated in a trial study of an online intervention to reduce the mental distress of fertility treatments. Even though few participants in the intervention group completed the entire treatment, they still had notable results that included decreased anxiety and depression and overall high satisfaction with the program. By the end of the study, pregnancy rates for the intervention were more than double those of the control group, and pregnancy occurred an average of 18 days sooner for the intervention group.

Future research

This intervention was designed to take approximately ten weeks to complete. However, participants took six months to finish the program, and only a small portion completed all ten lessons. Future research could consider the impact of a shorter or more tailored intervention program. As virtual one-on-one therapy grows in popularity and impact, studies can also examine its role in decreasing emotional distress caused by infertility.

The majority of current literature and research focuses on infertility from a woman’s perspective. However, infertility can also impact men mentally and emotionally, often without the ability to openly discuss it in the same manner as women. Future research can also consider the support offered to men whose partners are experiencing infertility challenges.

Online therapy for the emotional distress of infertility

Therapy is a powerful tool in decreasing the stress of women experiencing infertility. In one study, women who completed an online intervention experienced significant declines in their general stress thanks to the cognitive-behavioral approach of the program. In another study that tested the impact of mindfulness on infertility distress, the intervention group saw a significant decline in their symptoms of depression and feelings of shame and defeat.

If you’re experiencing infertility and all of the worries that come along with it, a licensed therapist from BetterHelp can provide the help you’ve been looking for. Sign up, and you’ll be matched with a therapist who fits your specific situation, preferences, and needs. BetterHelp is affordable and convenient. Schedule sessions at a time that works for you and meet with your therapist wherever you have an electronic device and an internet connection.

Decreasing infertility-related stress

If you are experiencing infertility-related stress, there are a few things you can do to reduce its impact on your life.

What relaxation techniques can help manage stress during fertility treatments?

Force your body to slow down through relaxation techniques such as meditation, progressive muscle relaxation, and deep breathing. You can decrease your heart rate and blood pressure, eliminating or greatly reducing the physical impact of the “fight or flight” mode that stress can trigger. You also allow your mind to slow down and focus on the present moment. This state of deep rest is beneficial mentally, emotionally, and physically.

Can you experience sexual stress during infertility?

When you’re dealing with infertility, the pressure to conceive can intensify sexual stress and strain your relationship. When you’re trying so hard to become pregnant, sex can feel more like an obligation than a fun activity. When sex becomes just another item on your daily to-do list, brainstorm ways you can bring the spark back to your relationship. Take a month off from trying to conceive, plan a romantic date, or talk to your partner about how you’re feeling.

How can physical activity result in better mental health during your fertility journey?

Taking part in regular physical activity can significantly improve mental health, helping to alleviate the stress and anxiety often experienced during a fertility journey. Take a break from focusing on what you want your body to do to appreciate what it is capable of doing right now. Take a hike, practice yoga, or complete light aerobic exercise. The benefits of physical activity are almost endless. The American Society for Reproductive Medicine notes that these are just a few popular stress-reduction methods recommended to fertility patients.

How can communication help you deal with infertility?

Talk to your partner about physical and emotional changes. Let them know how you plan to move forward and what you’re learning. Prompt – but don’t force – them to express how they’re feeling. Conversely, don’t center all of your communication around trying to conceive, either. Talk about work and friends, tell funny stories, and relish in the joyous moments that your life currently offers.

In addition, recognize that your partner may not completely understand how you’re impacted by infertility. Build community with other people in a similar situation, whether it’s through in-person meetings, chat boards, or social media groups.

Is it important to stay informed on how online support can impact your fertility journey?

Exploring online support groups, forums, and expert webinars can provide valuable and helpful insights and emotional support during your fertility journey. Talk to your doctor about what’s going on with your body. Read, listen, and watch fertility-related content. Learn more about your options and what alternative plans you might consider besides going the traditional pregnancy route. A deep wealth of knowledge will empower you to make the best decisions for your body and fertility journey, allowing you to be more confident in those decisions.