By Keiko Zoll, a contributor to the Seleni Institute, a nonprofit mental health and wellness center for women and mothers in New York City.
Anyone who has gone through infertility knows the conversation too well. It begins at a family holiday gathering, a girls' night out or even in the checkout line, with some variation of, "So, when are you going to have kids?" Stifling your frustration and embarrassment, you choke out a response about how getting pregnant has taken longer than you'd hoped. And then they hit you with it: "Just relax! It will happen."
For women struggling with infertility, "just relax" is perhaps the worst -- and most commonly given -- unsolicited advice. It's an attempt to be helpful, but it's based on common misconceptions about the relationship between stress and infertility, and it adds a far greater burden than it relieves.
The complicated relationship between stress and infertility
"Just relax" is rooted in a misunderstanding about basic human biology -- the assumption that if a couple could only stop worrying, they would increase their chances of getting pregnant. The truth is that women have only a 20 percent chance of getting pregnant in any given cycle*, and it depends on impeccable timing after ovulation.
The other belief underlying this response is that stress itself is an obstacle to a woman's ability to conceive. Here, the data gets more complicated. It seems that for every study that finds stress can be a barrier to conception, another one says otherwise.
"My take is that the research about the relationship where stress causes infertility is really inconsistent," says Elisabeth Morray, PhD, a consulting psychologist for the Harvard Vanguard Center for Fertility and Reproductive Health in Boston. Morray warns against rushing to find a causal relationship between stress and infertility based on the conflicting current research. Instead, she encourages her patients to focus on using stress-relief techniques as a way to deal with the inherent stresses of a lengthy treatment process.
Complementary therapies that help relieve stress can be beneficial emotionally and may possibly help with conception. In her widely-cited study published in Fertility and Sterility, Alice Domar, PhD, director of the Domar Center for Mind-Body Health in Boston, studied three groups of women experiencing infertility:
- One group participated in a 10-week mind-body group program that incorporated relaxation training including meditation, guided imagery, progressive muscle relaxation, cognitive behavioral therapy and even yoga.
- Another group participated in a support group with no complementary treatments.
- The control group didn't participate in any kind of support group.
The women who participated in some kind of group psychological interventions -- especially those in the mind-body program -- experienced increased rates of pregnancy during their fertility treatments compared to the control group who did not participate in any stress-relief support groups.
But there is a big difference between trying research-based approaches to stress reduction, such as cognitive behavioral therapy, to manage the stress of infertility (with the possible benefit of making conception more likely) and merely trying to "just relax." To date, no study has been done on whether following this specious advice actually increases your chance of getting pregnant.
The importance of listening to someone struggling with infertility
Besides lacking any supporting evidence, suggesting that all someone has to do is relax completely invalidates how emotionally challenging infertility can be. It's "disrespectful and degrading," says Bonnie Cochran, a psychotherapist in Denver who works with infertility patients. "Saying 'just relax' shows that you're not really listening, that you're not validating what this person is going through."
Maybe it's too much to expect emotional validation from a stranger in a grocery store, but Cochran says that many of her patients have been told to just relax when they open up to their closest girlfriends, or even their mothers about their fertility struggles. "It's heartbreaking."
It's heartbreaking because it means that the people you depend on for support are not listening to what you are going through and what you need.
Implying infertility is your fault
Even worse, the expression transforms infertility from a medical disease into a goal someone hasn't tried hard enough to achieve. "Telling someone to 'just relax' implies that they're doing something wrong," says Kristen Darcy, a fertility coach, motivational speaker and author of Love and Infertility: Survival Strategies for Balancing Infertility, Marriage, and Life. Ultimately, even if the comment came from a place of compassion and is meant to comfort someone, it usually does exactly the opposite.
Ways to respond to unhelpful advice
"It's incredibly painful for women hearing this to try and figure out how to respond," says Morray. She suggests that her patients think about when they may want to engage with people who offer this advice and when it will be easier to let it go.
When Darcy was on her own journey to build a family, she practiced what she calls "elevator speeches" to have at the ready. For her, a few witty comebacks were helpful such as, "Babies come when babies come," or "I have a whole team of experts working on that."
Cochran encourages couples to come up with responses together, so neither partner is caught off guard. She also recommends determining ahead of time who will respond, so you're able to work together as a team.
For example, when faced with the dreaded but often socially inevitable "So, when are you having kids?" couples can take different approaches. "We're too busy having fun trying!" is one playful approach. If that's not comfortable for you, deflection and changing the subject is another tactic couples can use: "Not yet, but we'll keep you posted."
Or, depending on your relationship to the person asking, you might take the opportunity to seek support by disclosing your fertility issues with them.
Finding people who understand your infertility experience
As a society, we are not comfortable talking about infertility, so there is abundant misinformation and few established ways to respond and help. That often leaves the burden of educating the public about infertility etiquette with the women and men experiencing it.
That's why Darcy suggests that couples carefully consider who they want to talk to about their fertility challenges. Although mothers, sisters or close girlfriends may seem like natural avenues of support, Darcy recommends connecting with people who intimately understand the infertility experience.
Couples struggling with infertility can find support through RESOLVE: The National Infertility Association. This organization offers peer-led support groups around the United States. Many fertility clinics also offer their own support groups, led by mental health professionals.
Surrounding yourself with people who truly "get it" (meaning the emotional, financial, and physical stresses of infertility) not only validates your experiences, but it also helps you manage it all.
And reducing stress during infertility through peer support isn't about getting you pregnant faster: It's about making the infertility journey a little less painful, a little less isolating, and a lot more empowered, assured, and whole.
*Average for fertile, 30-year-old woman, according to ASRM.org
This article was originally published on the Seleni Institute website. Seleni is a nonprofit mental health and wellness center providing clinical services, research funding, and online information and support for women and mothers. You can share your stories and learn more about Keiko at The Infertility Voice.
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