Today, women are having babies later and later in life, as there are now more professional women in the workforce than ever before. As you have most likely heard, a woman’s fertility drops due to egg deterioration by the time she’s in her late twenties and drops faster and faster every year past the age of 35. Infertility is, in the majority of cases, due to a woman’s age, but there are other causes such as the quality of the man’s sperm. In some cases, the woman’s eggs are fine but either deteriorate after fertilization occurs or fail to implant, thrive and develop into a fetus that carries to term. Repeated attempts to conceive over one, two or more years and then having your OB/GYN recommend you see an infertility specialist is disappointing and truly devastating for any parent who has always had dreams of having a family. The disappointment and feelings of failure can become all-consuming, especially for the woman who feels this is a reflection of failure on her part to have a baby while all her friends and colleagues seem to be having babies left and right.
The steady ticking of my “biological clock” kept reminding me that time was running out for me to have a baby. Counting days and using a thermometer to figure out my “window of fertility” each month felt like a science experiment, or math exercise, that we kept failing at. Then, after months and months of trying to conceive, we succeeded in early 2003 only to discover that it was an ectopic pregnancy that had to be terminated by way of 2 injections of methotrexate, a drug used for cancer patients.
We were never able to conceive again after the ectopic pregnancy, probably due to my high anxiety/stress/distress levels. I’ve heard many people say, including doctors, that stress and anxiety affect fertility. Some couples will find, just as my husband and I found, that the harder you try to get pregnant, the more stressed out you get. As each month goes by and with every unsuccessful attempt, the couple gets more and more stressed out and distressed. As each month went by, I became more and more desperate to have a baby. With each period and each negative home pregnancy test, there was this overwhelming disappointment. Each period symbolized yet another month of failure, and a step farther away from the likelihood of ever having a baby. You would be surprised to hear stories of couples adopting or having a baby through IVF, and afterwards actually succeeding in conceiving naturally! It’s logical to assume that, with the focus no longer on trying to get pregnant, the stress levels are down and voila, an unexpected pregnancy! I have at least 2 friends who experienced this unexpected and wonderful surprise.
During the summer of 2003 we attempted our first IVF cycle at an IVF facility nearby. That was honestly a nightmarish experience, mostly due to the way they made me feel like a number, a guinea pig for their research statistics. Other factors that doomed my first cycle included the stress from not being familiar with the treatment protocol and the cold, unfriendly, and disorganized environment of the facility. In general, I felt the facility was managed poorly. They even did a terrible job with the handling of my billing. No one who needs to go through IVF should be subjected to this additional stress. A facility with their reputation should be run in a much more patient-friendly manner. That facility left a lot to be desired. Never did the staff make me feel like I was a person with feelings, particularly my very own doctor. After the end of the cycle, when they told me that I could not change doctors, I told them I would not be coming back.
After that, it was by chance discussion with a colleague that introduced me to the RMA of New York. My husband and I started our first IVF cycle the following March (2004). Less than 9 months later, we had a healthy baby girl. The whole IVF process was a pleasure compared to the previous experience. Every staff member there was professional, efficient, courteous and friendly, giving me a warm and comfortable feeling every time I was there (which was quite often). What a contrast between this place and the last!
I must mention with sadness, however, that I had originally started off with twins but was in a car accident during my first trimester (May) where someone went through a red blinking light without stopping. Her car forced mine into the metal pole holding the blinking light up at that intersection, knocking it completely over. Thank God, I was not hurt. Since her car broadsided mine, had she been traveling any faster than she was–which could not have been very slow if she was able to push my car into the traffic light pole at the opposite side of the intersection, knocking it completely over–I could’ve been badly hurt. I shudder at the thought. Needless to say, I was extremely shaken. Within a few hours of the accident, I started spotting. Fearing for the worst, I went in to RMA the next day to get an ultrasound done to make sure my twins were okay. The doctor told me that, unfortunately, the heart in the smaller of the two fetuses had stopped beating and the dead fetus would be reabsorbed by my body with little if any bleeding. That was a truly sad day for me. I felt so devastated that I wanted to go after the girl that crashed into me and make her pay for the loss of one of my babies. But my doctor explained that in many cases, the strongest of two fetuses, or twins, would survive, taking most of the nutrients coming through the placenta; there was no way to prove that the car accident caused the fetus to die.
Despite my feelings of loss and sadness that I would not be having twins like I thought I would, I was able to cope without spiraling into depression. How do I know for sure? I did experience a great deal of anxiety, stress and even distress over failing to get pregnant after nearly 2 years of trying on our own and then with our first IVF cycle, but I can say for sure I wasn’t depressed back then because I now know what it’s like to be depressed. I did feel sad and cry a lot, but that’s a natural reaction to feeling bad about not being able to have the one thing your heart so desires. There were no changes in my eating and sleeping patterns. I didn’t feel hopeless or unable to function. I was able to go to work and handle other day-to-day activities.
During each IVF cycle, a woman is subjected to a number of infertility drugs to regulate her hormones to induce changes in her body to create the maximum number of viable eggs for fertilization. Her body is then subjected to the egg retrieval process where she is actually given anesthesia so she is not conscious during the process, followed by the egg transfer process where she receives at least one viable egg that has successfully been fertilized and multiplied. Next, her body is primed with progesterone in preparation to receive at least one egg for implantation into the uterine lining. Ultimately, she carries the baby (hopefully) to term.
Since hormone changes lead to mood changes in some women who are predisposed to react to these types of changes, infertility drugs used to regulate hormones like estrogen and progesterone may also cause mood changes. Even the pill has been linked to depression. Women who have experienced mood changes from being on the pill may also experience mood changes from infertility drugs. Just think of it this way. Menstruation happens from estrogen levels dropping due to the lack of a fertilized egg implanting in the uterine lining. Women who are sensitive to drops in estrogen tend to experience mood disturbances such as irritability (like me)-i.e., premenstrual syndrome (PMS)-and in more serious cases anxiety, insomnia and depression (i.e., premenstrual dysphoric disorder or PMDD). All this is further evidence that hormonal changes affect mood for some women, and absolutely not a mind over matter thing for them. Had I been predisposed to depression due to hormonal changes, I more than likely would have developed symptoms from being subjected to the multitide of hormone-influencing substances (e.g., the pill, Pergonal, Follistim, Repronex, Gonal F, Lupron, progesterone) . Note: Different combinations of these were used during my two IVF cycles.
Unresolved Grief & Anxiety Built Up During IVF Cycles and Years of Trying to Have a Baby are Risk Factors for Depression During Pregnancy & Postpartum
Depression is more common among women with infertility issues, since more is at stake for those who have gone through many months and sometimes years of failed attempts at getting pregnant and failed attempts at IVF. Most women do not succeed in getting pregnant on the very first IVF cycle. I fall into this category, but I feel blessed to have succeeded with my second cycle. Repeated failed attempts are bound to take a toll on the couple. Each time you complete a cycle only to have your period appear is such a disheartening experience that, if repeated numerous times, can leave you vulnerable to depression. With each additional cycle you endure and fail, you feel more and more hopeless and desperate. All the more reason why I am so grateful to this day that we succeeded on our second try.
Many women who successfully become pregnant through IVF cannot help but be anxious the entire duration of their pregnancy, fearful that something will jeopardize the pregnancy (e.g., miscarriage, stillbirth, pre-term birth, preeclampsia, or some other complication). Optimism is not the typical outlook of a woman who has experienced infertility, miscarriage(s) and other complications. Realizing this is more than likely their only shot at having a baby, it is natural for them to feel anxious all through pregnancy (in terms of spotting and other complications) and through the first year of the baby’s life (with every health concern from SIDS to fevers, weight, colic, etc.).
This is why I would encourage you, if you’re undergoing IVF, to avoid trying to cope with all your anxiety, stress and distress yourself, and instead see a therapist–one who is experienced in working with women undergoing infertility treatments–if you find that you’re spending most of your time feeling down and crying, you’re unable to function at work and at home, and your relationship with your husband is suffering. Talking to a non-judgmental and understanding professional experienced in dealing with infertility issues can help with working out issues that–over time compounds and if unresolved–can reach a point where the body and psyche become vulnerable to depression. In between IVF cycles–whether there is a miscarriage or not–it would be in your best interests to give some time in-between cycles to give your body the rest it needs both physically and emotionally. Try to resist the urge to subject yourself to one cycle after another–of course to the extent allowed by your financial situation and health insurance–despite your “biological clock” that is ticking, reminding you that time is of the essence. If you do successfully become pregnant, you will be bringing with you on your pregnancy journey any unresolved grief and heightened anxiety. It won’t take much for the huge changes in hormone levels to push your already-vulnerable situation into depression.
Your IVF facility can more than likely refer you to a mental health professional(s) specializing in infertility. Otherwise, you can contact RESOLVE, an organization that provides a listing of mental health professionals who specialize in infertility. Just as I found it hard to share my PPD experience with others because they didn’t understand how badly I felt, not having experienced PPD before, I found it hard to share my infertility and IVF experience with others because they hadn’t experienced infertility and IVF before. I felt the need to stay away from others who were pregnant or had young children because seeing them only served as a painful reminder of what I so desperately wanted but couldn’t have. But staying away from other people caused me to feel further removed from everything and everyone. I felt like someone who didn’t belong to the mother crowd because I couldn’t be one myself. I felt I was being deprived of being able to have a family like I’ve always dreamed of having. I had nothing to show for having gone through countless painful (and pain-in-the-neck) menstrual periods. I endured all of that for nothing. In retrospect, it probably would have been beneficial for me to give the mental health professional that my husband and I went to after our first failed IVF cycle more than just one shot at helping me get beyond my grief. But my personality–stubbornness, pride or what have you–didn’t want to have to deal with it. I was able to move on and within a few months I started my second cycle with a different IVF facility, and I managed to do just fine there. They say that sometimes the best thing to do is start with a clean slate. Especially if your gut tells you to do so.
All that it took for us to get pregnant and have a baby has made my husband and me all the more aware that the daughter to whom we gave birth is a miracle baby whom we will always treasure and never take for granted.