Marie Atallah, Ph.D. Talks Managing Your Mental Health and Fertility

Though an exciting time for many people, the topic of fertility is a complex one. Women often face many challenges and societal pressures, which can take an emotional toll and have an impact on their mental health and wellbeing. From the stigma of infertility to external pressure from friends and family, the prospect of starting a family can be both incredibly fulfilling and incredibly overwhelming.

Our Director of Therapy, Marie Atallah, Ph.D., is here to discuss some of these challenges and provide tips for coping and managing your mental health while trying to conceive.

Common challenges women face

From the stigma of infertility to the external pressure from loved ones, the fertility and conception journey can take a toll on many women.

The stigma of infertility
Your social media feeds may be flooded with pregnancy photoshoots, gender reveals, and birth announcements depending on your age and peer group. These public proclamations of starting a family can generate shared excitement but also may further the internal or external pressure to conceive quickly. We often forget that those photos are only one part of the story and leave much of the fertility and conception journey unknown.

According to our Director of Therapy, Marie Atallah, Ph.D.,

“Trying to conceive and struggling with infertility can feel incredibly isolating. You may find it hard to share in others’ joy or feel alone in your emotional pain. Even today, when we know that so many different factors can impact fertility, many women still have internalized beliefs that they are “broken” or “inadequate” if their conception journey is not going as planned. When women do share their conception or fertility struggles, even seemingly innocuous comments, like being told to “just relax and it will happen,” can completely negate the financial, emotional, and relational strain someone may be feeling. Worse, it reinforces the false notion that infertility is solely a matter of a woman’s mind rather than a medical condition.”

With more public figures and celebrities opening up about their journey through conception, miscarriage, and fertility treatment, we have seen a trend towards sharing more about the overall process. However, for many women, these topics are still not discussed in their homes, in their peer groups, or in their community at large. The struggle to open up about these topics can be due to myriad factors, including perceived shame and stigma or cultural beliefs and expectations around fertility and offspring. Religious or cultural beliefs around the use of Western medicine can also be challenging to navigate. For example, while spirituality and faith can be a strong source of coping for women struggling with infertility, some fertility treatments may be “off-limits” in one’s religious community but still pursued in secret, which understandably can be quite stressful.

The stigma surrounding infertility also affects the mental health of many, including those trying to conceive. Women struggling with infertility can experience distress at many stages of their journey. Initially, if a woman’s internal expectations of her conception timeline are not aligning with what’s happening, she may experience fear and anxiety around what’s to come. Taking monthly pregnancy tests or getting her period while trying to conceive can vacillate between feeling like a minor letdown to feeling intense grief and loss. Over time, this distress can make women more susceptible to things like depression and anxiety.

Several studies^1,2 show that women with infertility have higher rates of anxiety and depression compared to their fertile counterparts. Higher rates of distress and symptoms of depression can indirectly impact conception outcomes. For example, higher scores of depressive symptoms have been linked to early drop out of fertility treatment. Fertility treatments can put tremendous emotional, financial, and relational strain on a couple. More than half the women in an infertility study of 200 couples described the experience as the “most upsetting of their lives.” Similarly, a large study of women with various health conditions found that those struggling with infertility had similar amounts of distress compared to cancer and cardiac rehab patients.²

External pressure from friends and family
Many women experience increased stress and pressure from family and friends³ about if or when they are having children during their childbearing years. The pressure only seems to grow when it takes longer than expected to conceive. In addition to external pressure, studies have shown that women often endure more of the social and medical burden around conception. For example, a study in 2016 showed that roughly 80% of education on conception was delivered to females even though conception and fertility are impacted by both males and females. This pattern is also seen in society, where many turn their focus to the woman when difficulty with conception arises. This can impact the extremely personal decision for a woman to open up about her journey to conceive.

According to Dr. Atallah,

“Women are often faced with overt and covert messaging from family, friends, media, and society at large about having children. It’s not uncommon for in-laws or extended family members to inquire about a woman’s timeline or even weigh-in with their own opinions. Even though it all can be well-intentioned or stem from excitement, it can also create a great deal of pressure on those trying to conceive.

Sharing where you are in the conception journey is a very vulnerable experience; it can make well-intentioned but poorly informed or poorly timed comments tough to endure. Use this as a time to find your voice around setting boundaries that work for you. These boundaries may include using humor, assertively communicating your needs, or recruiting others to assist in the conversation.”

It is important to remember that this is your journey. By setting boundaries and communicating your needs, you can mitigate stressful or uncomfortable conversations, and set the tone for future questions from friends and family.

Navigating mental health conditions while trying to conceive
Pregnancy and having a baby can be both an exciting and highly demanding time for women. If you suffer from a mental health condition, that comes with its own set of challenges. It is important to note that you may be at a higher risk of relapse during this time than at other times.

According to Dr. Atallah,

“Anxiety and depression impact the way we think, feel, and behave. Even without depression and anxiety on board, the addition of the physical and hormonal changes associated with pregnancy cause expecting mothers to experience a normative but high amount of worry about their pregnancy, their birth preparation, their delivery, and their future in general.

When you struggle with anxiety or depression, these fears and worries intensify. For example, those with anxiety tend to overestimate the likelihood of something terrible happening and underestimate their ability to manage or cope with the bad things. Given that there is always some level of risk in pregnancy and delivery, an expecting mother with anxiety may overfocus on the probability of adverse outcomes occurring.”

Those suffering from depression often tend to have negative views about themselves, the world, and the future. If an expecting mother already suffers from depression, she may experience intense doubts about her ability to raise a child or have a bleak outlook.

Left unmanaged, depression and anxiety can certainly make the conception and pregnancy journey that much more challenging and can even impact the mother’s ability to have a healthy attachment with her baby. However, with the proper resources and support, depression and anxiety can be well-managed.

This journey can also weigh heavily on a couple. The conception journey can be a positive shared experience within a relationship. Still, it can be a significant source of distress. The emotional experience can vary depending on a couple’s emotional foundation, communication style, and overall relationship.

Tips for managing your mental health while trying to conceive

Here are psychologist Dr. Marie Atallah’s tips for managing your mental health while on your journey to conceive.

Communicate and create boundaries. Whenever possible, use assertive communication to establish your boundaries around what you do and do not want to discuss about your fertility and conception journey. If you are conceiving with a partner, you may rehearse together how you want to respond and who will respond in what circumstances. For example, your partner may take the lead in conversations with your in-laws. If assertive communication is not possible (or appropriate), there are ways to change the subject or divert the attention. Rehearse these different ways with a close friend or partner.

Provide feedback. If you are open to giving someone feedback, focus on the specific thing that is said or the behavior, rather than making global remarks. For example, try saying something like, “I know you are invested in this journey with me, but when you continuously ask if I’m pregnant, it makes me feel overwhelmed and stressed.” Tying a specific statement or behavior to how it makes you feel allows the recipient to hone in on their language and behavior to (hopefully) make a change.

Find your people. To the best of your ability, find a supportive community or group of friends. This community can be an online support group, a close friend, or a group of individuals. Stigma is primarily maintained by staying quiet. The more we can normalize this process and provide support for one another, the better the odds of reducing the stigma surrounding infertility and the conception journey.

Have a game plan. If you’ve struggled with anxiety or depression, know your warning signs when your symptoms are coming back. Then, develop a game plan for what you are going to do about it. For example, you may notice that you start isolating yourself and withdrawing from loved ones. Plan to have a friend on call for when this happens.

Practice self-care and compassion. As you go through physical and hormonal changes, it’s essential to practice self-care and self-compassion. Journaling, meditating, and gentle movement are all great ways to take care of yourself during this time.

Connect (or reconnect) with a therapist. Begin researching therapy options. If you engaged in therapy in the past, this might be a great time to reach out to your therapist for a follow-up session or let them know that you may contact them to make space in their practice.

Evaluate medication options. If you currently take or are thinking about taking medication to manage the symptoms of depression and anxiety, talk to your OBGYN about your options and continue to monitor your symptoms.

Set realistic expectations for yourself. Try to have open and honest conversations with new or expecting moms. They may provide some much-needed guidance or wisdom that ease your worries and fears.

Don’t try to change too many things at once. Your mind and body are going through a lot, and changing behavior is hard work. If you are working towards a healthier lifestyle, focus on progress over perfection.

Ask for and accept help. As humans, we are tribal by nature. We were never meant to have these experiences alone. Ask family, friends, and your partner for support. Remember the adage, “It takes a village.”

Sources:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016043/
2. https://www.health.harvard.edu/newsletter_article/The-psychological-impact-of-infertility-and-its-treatment
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5379123/