Mind/body Approach May Conquer Infertility: Target Depression
Walsh, Nancy, Clinical Psychiatry News
Stopping the downward spiral of emotions associated with infertility can be a key factor to successfully overcoming the condition, according to Alice D. Domar, Ph.D.
Research throughout the world during the past 10-15 years has made it clear that distress, especially in the form of depression, can hamper fertility, said Dr. Domar, director of the Mind/Body Center for Women's Health at Boston IVF.
Conventional wisdom held that women's anxiety-related stress exerted negative effects on fertility, and that this became progressively worse with continuing failure to conceive. But during the past decade a shift in thinking has occurred, with the focus on depression rather than anxiety as central to the distress / infertility dyad.
Most of the literature to date has looked at stress and depression as resulting from infertility, said Dr. Diana Dell of Duke University, Durham, N.C.
"An underrepresented part of that whole picture is the extent to which antecedent depression may contribute to otherwise unexplained infertility," Dr. Dell explained.
Linking depression with infertility makes sense evolutionarily, Dr. Domar told this newspaper. "If a woman is really depressed she can't take care of herself, let alone a baby, so it makes sense for the body to shut down for awhile until things get better," she said.
And intervention clearly can help, as Dr. Domar has demonstrated during the 17 years she and her colleagues have offered a program combining mind/body and cognitive-behavioral techniques to women with infertility.
"Most of the women in the program are about 35 and have been trying to become pregnant for 3 to 3 1/2 years and about half are undergoing high tech treatments like in vitro fertilization," she said. "At this point between 40% and 50% of the participants get pregnant within 6 months," she said.
Women in the program learn a variety of relaxation techniques, including imagery, progressive muscle relaxation, yoga, and meditation.
They also learn cognitive restructuring to help eliminate self-recriminatory and recurrent negative thought patterns. For example, they are encouraged to challenge thoughts such as "I will never have a baby" and restructure them as "I am doing all I can to try to get pregnant."
The efficacy of this type of intervention has been confirmed in a prospective study that included 184 women with infertility who had been trying to become pregnant for 1-2 years. Participants were randomized to participate in the mind/body cognitive-behavioral program, a support group, or a routine care control group for 10 weeks. …