How Can Online Support Impact Your 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
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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
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.
Practice relaxation techniques
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.
Be aware of sexual stress
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.
Physical activity
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.
Communicate
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.
Stay informed
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.
Takeaway
How do I start a fertility journey?
In most cases, the best way to start a fertility journey is to speak to a medical professional. These professionals typically include your primary care physician, a gynecologist, or a fertility specialist. Depending on which type of doctor you visit, you will likely undergo a series of tests to assess your fertility. These tests can vary depending on a variety of factors, including an individual’s age and medical history. Some examples of fertility tests include the following:
- Semen level analysis
- Hormone level analysis
- Imaging tests
- Genetic tests
- Ovarian health analysis
- Fallopian health analysis
- Uterine function tests
- Thyroid function tests
What is the first step in the infertility journey?
The first step to determining whether a person is infertile is typically to speak with your primary care doctor or gynecologist, who may refer you to a reproductive endocrinologist (a doctor specializing in fertility.) They will often perform a physical examination and ask a series of questions concerning family medical history and current reproductive health. Once the initial infertility evaluation is complete, a fertility specialist will attempt to determine whether any infertility issues are present before determining a treatment plan. These infertility treatments may vary but may involve surgery, medication, or procedures like in vitro fertilization (IVF) or intrauterine insemination (IUI).
What is a fertility trip?
The fertility trip (more commonly referred to as the fertility journey) typically refers to a process individuals go through when they are trying to become pregnant. The fertility trip may involve discovering that one or both partners are experiencing infertility or an inability to conceive. There may be several components to infertility, including a failure to produce healthy sperm or eggs. These fertility challenges may relate to struggles with ovulation or spermatogenesis. In addition, infertility may occur at the fertilization stage (where the egg unites with the sperm), the implantation stage (where a fertilized egg bonds with the uterine lining), or any other part of the pregnancy.
What is the timeline of fertility?
In healthy individuals, the fertility timeline can often be matched up with that of a person’s menstrual cycle. While the length of a menstrual cycle can vary, the UK National Health Service estimates that the average cycle is 28 days long. Using this average as a guideline, a sample fertility timeline may look like the following.
- Day 1-7: Menstruation or a “period (where the lining of the uterus is shed).
- Day 13-15: Ovulation (where eggs are released from the ovaries).
- 5-6 Days After Egg is Fertilized: Once fertilized, an egg will become implanted into the lining of the uterus.
Once the egg implants in the uterine lining, pregnancy will officially occur around six days after (often around day 20-22 in a cycle.) In many cases, a pregnancy test will be able to confirm this within the next seven days.
How do I help myself get pregnant?
There are a variety of techniques that may help a person become pregnant at a faster rate, including:
- Cease Contraception: While it may seem obvious, one step that some individuals forget to take is stopping the use of contraception. Contraception can include (but aren’t limited to) condoms, birth control pills, injections, intrauterine devices (IUDs), cervical caps, implants, and patches. The use of contraceptive techniques can dramatically reduce the chances of getting pregnant.
- Maintain a Healthy Diet: Maintaining proper nutrition can be beneficial for all individuals, including those who are trying to become pregnant. In addition, certain foods may also be harmful to existing pregnancies, such as those that may carry a higher chance of food-borne illness or those that contain high levels of certain vitamins (like vitamin A.)
- Have Sex During Ovulation: In order to increase the chances that pregnancy will occur, it is important to have intercourse during ovulation. This is the stage in a person’s menstrual cycle where their ovaries release eggs. In order to identify and utilize this fertility window, a person may use Devices like an ovulation predictor kit in order to find out when they are ovulating.
Can you get pregnant before fertility?
Typically, it is only possible to get pregnant during ovulation, which is the central component of what is known as the “fertility window.” The average lifespan of an egg that has left the ovaries is 24 hours, during which it needs to find a sperm in order to go through the process of fertilization. Because sperm can live for up to five days within the body, egg fertilization and pregnancy could be possible if you have intercourse anywhere from five days before ovulation to 24 hours after ovulation ends. So, it is possible to get pregnant before your fertility window, though it may be significantly less likely.
How long to try before infertility?
While there may not be a set time before one seeks professional help for infertility, the University of Utah recommends that couples under the age of 35 try to conceive for at least one year without the use of any contraceptives before seeking a fertility specialist. For those who are over the age of 35, it may be helpful to seek a specialist after six months of unsuccessful attempts to get pregnant, while those over 40 may want to start their pregnancy journey by speaking with their doctor. In addition, several other factors may require someone to seek the support of a specialist earlier, including:
- A history of miscarriage
- A history of sexually transmitted infections
- You or your partner is experiencing erectile dysfunction
- You or your partner is experiencing a chronic medical condition like polycystic ovary syndrome (PCOS)
- You or your partner are experiencing menstruation irregularities
How does fertility fall?
One way that fertility may decrease is through the aging process. According to the American College of Obstetricians and Gynecologists, the peak years for female reproductive health are between their late teens and late 20s. Once these individuals turn 30, fertility levels may start to fall; this decline often increases in pace as a person passes the age of 35. For males, fertility often begins to decrease between the ages of 40 and 45 as sperm quality is reduced. As males continue to age, the chances of getting a person pregnant go down as the risk of complications like miscarriage may increase.
How is fertility done?
The procedure that specific fertility techniques often vary. For example, in vitro fertilization (IVF) typically begins with sedation followed by the placement of a catheter through a person’s cervix into their uterus. Fluid containing embryonic matter is then injected through the catheter into the uterus, where it will attempt to attach to the uterine lining after egg retrieval. If the procedure is successful, a person will become pregnant, which is often confirmed via blood tests. Whether IVF is successful can depend on a variety of factors, including age, medical history, and the health of the embryos used during the procedure.
What to expect during fertile days?
There are several symptoms one may experience during fertile days, specifically during ovulation. While often associated with menstruation, ovulation may cause a person to have abdominal cramps, headaches, nausea, and discharge. In addition, individuals may experience changes in body temperature, cervical mucus, breast sensitivity, and senses like smell or taste. Some individuals also experience an increase in sex drive during ovulation, though this may also be influenced by other factors.
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