Journey of a PPD Survivor – Q/A Series – #2

Welcome to the second of my Journey of a PPD Survivor Series!

Laura Winters, LCSW, whom I’ve had the pleasure of knowing since we met at this year’s Postpartum Support International conference in Philadelphia, is a therapist specializing in infertility and prenatal/postpartum stress.  We are both members of the recently-established PSI-New Jersey chapter.  Laura is passionate about helping women on their journeys through motherhood, offering individual and group support.  Her practice, Postpartum Health & Harmony, is located in Chatham and Mountain Lakes, NJ.  For more information or to contact Laura, please visit www.postpartumhh.com.

Thank you, Laura, for taking the time to provide my blog readers some insight into your journey as a PPD survivor!

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Question 1:
Can you please describe your journey to becoming a Licensed Clinical Social Worker and what motivated your passion to help women with infertility issues (which I experienced) and mothers suffering from a perinatal mood disorder? How long have you been helping women experiencing infertility and perinatal mood disorder?

 When I was considering careers, I wasn’t totally sure what I wanted to do, but I knew that I wanted a career that would enable me to make a difference in people’s lives.   Social work was suggested to me and it was a perfect fit!  I started out my career working with children and teens and I really enjoyed helping them through various challenges.  In 2007, I started working in private practice, primarily focusing on families.  It wasn’t until about 2011 that I first started seeing some women who were struggling with perinatal mood disorders.  At that time, it wasn’t a specialty of mine, so I only saw a few new mothers.

In 2013, I became a mother and had an entirely new appreciation for parenthood.  It was incredibly difficult in ways I never imagined.  Breastfeeding was not going well, which caused me a lot of anxiety, sadness, and added to my exhaustion.  My husband and I both felt more like roommates and our relationship was strained.  This experience inspired me to make some career changes, most notably acquiring more advanced training in perinatal mood disorders and developing this specialty in my practice.

As I began to work with more pregnant and postpartum moms, I also started getting referrals for women experiencing infertility and postpartum moms who had gone through fertility treatments.  Once again, I felt a need to learn more and was interested in adding this focus to my practice.  I see these times in women’s lives, when you’re trying to conceive or newly postpartum, as being so precious and yet such a vulnerable period.  For the most part, everyone assumes that they will get pregnant easily and that motherhood will be challenging but amazing.  When things don’t go as planned, it can completely turn your world upside down and have you questioning everything about your life.  My personal experience definitely fueled my passion for supporting moms as well as couples trying to conceive.

 

Question 2:
In your practice, have you seen a correlation between infertility and a perinatal mood disorder? Do you treat mothers who you’d also seen while they were struggling with infertility issues and ended up suffering from a perinatal mood disorder?  Have you treated women suffering from infertility issues who ended up not suffering from a perinatal mood disorder?

 Infertility treatment is a risk factor for a perinatal mood disorder and I do see this correlation in my practice, though not across the board.  There are so many factors that influence whether a mother will develop a perinatal mood disorder.  I’ve seen women who have been through infertility treatment and did not end up experiencing any perinatal mood disorders.  Support and early intervention are very helpful in protecting a mom’s mental health.

  

Question 3:
Can you provide an overview of the services you provide? I see that you help patients in person, online, and even in a support group setting. Do you find one way of seeing your patients is more helpful? 

 I offer individual, couples, and group counseling.  I see almost all of my clients in person.  I offer online and phone sessions for times when clients may not be able to come to the office, such as not having child care available or in the first few weeks after childbirth.  Online and phone sessions are a great way of continuing sessions when life gets in the way.  The support group is open, meaning that you don’t have to register and can come as often as you need.  The moms that come to the group tend to be looking for different support than those who come for individual counseling.  The group moms are often looking to connect more with other moms going through similar experiences.

  

Question 4:
In your practice, what kinds of treatments for postpartum depression do you recommend?

In addition to therapy, I will recommend medication for those that are open to it or who have tried other things and are still struggling.  I also encourage my clients to try to incorporate exercise and a healthy diet into their routine.  For clients that are interested, I may recommend meditation or teach them an acupressure technique called Emotional Freedom Technique (EFT).

 

Question 5:
Have any medical healthcare practitioners–like IVF doctors, general practitioners, OB/GYNs or pediatricians–ever refer their patients to you?

 Yes, medical healthcare practitioners are great referral sources.  I definitely get more referrals from those healthcare professionals who take the time to talk to their patients about mental health.

 

Question 6:
What do you think medical health practitioners who come in contact with new mothers, like OB/GYNs, GPs and pediatricians, can do to help prevent, detect and treat perinatal mood disorders?

I would encourage medical health practitioners to take time to talk to moms about mental health.  Ask them about their mood and stress level.  Look their patients in the eyes and ask them how they are really doing.  Normalize how challenging being a mother is.  Making comments such as “motherhood is tough” or “you have a lot on your plate now” can go a long way in helping a mother feel comfortable to open up to you.  And having referral sources on hand when their patients need more support is extremely important.  Don’t leave it up to a new mom to have to find help herself.

 

Question 7:
Is there one key piece of advice you would offer to an expecting or new mom?

For expecting moms, I would tell them to make a postpartum plan that outlines things such as who they can count on for specific types of support (baby/childcare, cooking, advice, etc), how they will protect their sleep, and where they can turn if they need support.  For new moms, I would advise them to take breaks, ask for and accept help, and know that challenges come in phases but do eventually end.

 

Question 8:
What would you want to say to women currently suffering with a postpartum mood disorder?

This is the most common complication of childbirth and not an indication of who you are as a mother.  There is a lot of support available out there including counseling, support groups, and other moms who have been there and are happy to offer encouraging words.  You will feel better once you get the support that’s right for you.  Other moms have recovered and you will too.

 

Question 9:
What advice would you offer to friends/family members of a woman who is currently suffering with a postpartum mood disorder?

Reach out to her often – call, text, stop over.  Be there for her when she’s ready to talk.  Try to listen and validate her feelings.  Consider what support you can offer her—including cooked meals, childcare, cleaning, keeping her company—and rather than asking if she wants that help, tell her that this is how you’d like to help.  Tell her when you’re available to provide that support and then let her decide when you can come over.  Most moms will turn down help initially, but when you are very specific with what you can do and when you can do it, it’s harder to turn that down.  Also, it may help you better understand what she’s going through by researching information on perinatal mood and anxiety disorders.

 

Question 10:
What do you see as the biggest challenge in helping a mother recover from a postpartum mood disorder?

Lack of support and lack of insurance coverage are big obstacles.  It’s hard enough finding a therapist or psychiatrist, let alone when you have an infant and aren’t feeling like yourself.  Whether you have insurance coverage or not can help or hinder the process.   I find that the more support a mother has around her (people who can help with certain tasks and give her breaks), the easier recovery is.  It’s really challenging when you don’t have enough support at home and are expected to do a lot of the childcare and household tasks.  It doesn’t allow enough time for moms to tend to their needs.

If Only I Had Known…..

So, if you haven’t noticed, I’ve been somewhat absent from the blogging scene…it’s been 3 weeks since my last post, the longest break from blogging I’ve taken in a long time. I have to admit I’ve been dry on ideas lately, not to mention the fact that I’m finding it tough to be back on the Twitter scene AND keeping up with my blog AND working full-time AND all the other stuff that needs to be done like spending time with my daughter, helping her with daily homework, etc.

I finally came across a tweet today from Mindy Berkson (@infertilityhope on Twitter) that said:

Did you know that adhesions can lead to #infertility or increase the chance of an ectopic #pregnancy? goo.gl/PmDdA

This tweet IMMEDIATELY grabbed my attention.  Why? Well, as some of you already know, I had had a dermoid cyst that was growing on one of my ovaries removed back in 2001, I had an ectopic pregnancy less than 2 years later, and I had to undergo two IVF cycles.

The link takes you to an article posted on the Resolve website, a great resource for those who are struggling with infertility.  Titled “Pelvic Adhesions: Impact on Your Fertility,” the article provides an overview of what adhesions are, what causes them, how they can be removed, as well as a reminder to stay well informed by asking questions prior to surgery, like whether the doctor will be employing such procedures as microsurgery or adhesion barriers to minimize the risk of adhesion formation.

Adhesions are basically scar tissue that typically forms as a result of surgical procedures. Pelvic adhesions is scar tissue that typically develops after pelvic surgery (to remove fibroids in the uterus, cysts on the ovary, ectopic pregnancies in the fallopian tube, or endometriosis).

Had I known all this (and that there were procedures that could minimize risk of adhesions), you bet I would’ve requested my OB/GYN employ one of the procedures to minimize the risk of adhesion formation, which may have or may not have led to IVF.  Or I may not even have gone through with the dermoid cyst removal altogether.  I will never know which was the lesser of two evils–leaving the dermoid cyst on the ovary or the adhesions from removing the dermoid cyst. I will never know whether leaving the dermoid cyst on the ovary would’ve led to infertility. I will never know whether adhesions from the surgery led to my infertility. I will never know whether I was inherently infertile at that point in my life–with or without the dermoid cyst, with or without the surgery.

I just know that I did have a helluva journey to motherhood, one that was paved with infertility issues, childbirth complications, and postpartum depression–and hence the title of my book.  But let me tell you….I came out of it much stronger and smarter than before!  And now I am going to do as much as I can to bring awareness to others.  The awareness I never had and which could’ve made a huge difference for me.

National Infertility Awareness Week – April 24-30, 2011

The 22nd National Infertility Awareness Week (NIAW) will be taking place from April 24th to 30th this year.  NIAW is a movement to raise awareness about the disease of infertility that affects 1 out of 8 couples.  Click here for the calendar of events taking place all over the country.

RESOLVE is a community for women and men with infertility and provides information, support and opportunities to take action.  Check out the RESOLVE website for more information on infertility and how you can make a difference for you and others experiencing infertility.    There is a wealth of information on this website–a lot more than even a year ago! 

You can find the following:

Infertility is a major cause of anxiety and depression.  With the number of individuals faced with infertility today, it is no wonder that antenatal and postpartum depression rates are as high as they are today.  As such, it is very important that you seek support in getting through this difficult and highly stressful time of your life.   Support can be in the form of family and/or friends that you feel are empathetic (i.e., have gone through this themselves) and/or non-judgmental.   

If you’re not sure whom to talk to among your circle of family/friends, visit the RESOLVE website and look up mental health professionals in your area that have experience with helping couples get through infertility and infertility treatments.  Getting this kind of support can help prevent your anxiety levels from reaching a point that– should you (and I really hope you do) get pregnant– you could be heading into pregnancy with a great risk of developing perinatal depression

The absolute worst thing you can do is keep your feelings of grief and anxiety to yourself, and in fact, doing so can put you at greater risk for developing a perinatal mood disorder!

MY ONE AND ONLY

When I spotted the July 19, 2010 edition of TIME magazine sitting on the coffee table at my in-laws’ house this past Saturday, I was instantly drawn to the cover and the title of the feature article “The Only Child: Debunking the Myths.”    The intro lines of the article really grabbed my attention, with the typical setting that for some reason seems to be a common setting that kicks off many articles, both printed and on the web.  The setting is a supermarket.  Sometimes the exchange is between two women standing on line.  Sometimes it’s between the cashier and a customer.  In this case it was the latter….a mom, minding her own business, with her adorable, pink-cheeked baby seated in a grocery cart and the cashier.   Usually, questions asked at the supermarket pertaining to babies usually have something to do with the age of the baby, and if there are no other children present, whether that is the first baby.  Well, in this article, the cashier starts off the conversation with the latter.  If the answer to that question is “Yes” as it was in this case, then sometimes, the conversation steers toward comments suggesting that she ought to work on the next baby real soon, so that this one isn’t lonely and has a little brother or sister to play with, and to avoid the “single child syndrome” — the belief that single children end up spoiled rotten because their parents lavish all their attention on the one child, lacking social skills and selfish because they don’t have any siblings with whom to interact (and therefore no “sibling rivalry” experiences) and with whom to share their toys.

In all honesty, I didn’t finish the article because I already got what I needed from it, which is inspiration to write a post and share my experience with others who care to listen.   Then, I was inspired even more to make this post a priority when, on Sunday, I saw a tweet from @ArmsOpenGrace where she was saying that she was at a BBQ and couldn’t help but to compare herself with everyone else who all had 2+children, and she’d just had her first child not that long ago.   I tweeted to her: “I can’t help but wonder what it’d be like to have 2 instead of 1. I don’t even compare myself with others anymore. No point.”  So I proceeded to tell her that the TIME article inspired me to write my next post.  And here we are.

For strangers to be prying for this kind of information is a bit much, I have to say.  And it’s all based on this societal pressure to have more than one child, all thanks to Granville Stanley Hall about 120 years ago.   But I’ve learned to come right out with the truth just to cut the exchange short.   That really stops the conversation from getting further than it really has to.

I can’t tell you how many times I’ve had to experience the following exchange, similar to the one in the TIME article, from the time my daughter was an infant til now (and she is now 5-1/2).

Acquaintance/Colleague/Stranger  (A/C/S):  “What a beautiful little girl!  How old is she?”

Me:  [I would tell them my daughter’s age at the time]

A/C/S:  “Do you have any more children?”

Me:  “No”

A/C/S:  “So, when are you going to have another?”

Me:  “I’m too old.”

A/C/S:   “Nah, you’re not that old.”

Me:  “I’m a lot older than you think.  Did you know I was lucky to have her on my 2nd IVF cycle?”

A/C/S:  “I didn’t know that!  Well, why don’t you give it another try?”

Me:  “I can’t.”

A/C/S:  “Well, you succeeded before….”

Me: “I mean, I really can’t.”

A/C/S: [not wanting to give up]: “But you’re not that old.  Why not?”

Me [just so I can stop this exchange before I start to get nasty]: “Because I’m missing a critical body part.”

A/C/S: [not getting it but curiosity has gotten the better of them]:  “Um, not sure what you mean.”

Me:  “I. Have. No. UTERUS.”

A/C/S: [face falls after a few seconds, realizing finally what I’ve been trying to say]:  “Oh, I see.  I’m sorry.”

A/C/S: [conversation taking a sudden turn]: “Well, you are blessed with this beautiful girl.  You are really lucky to have her.”

Me:  “Yes, I know.  She’s my one and only.”

A/C/S: “You can always adopt, you know.”

Me:  “Yes, I know. But I am happy with just the one.”

And then, depending on who this person is and how comfortable I am with sharing my postpartum depression (PPD) experience with him/her, I may go on to tell him/her about my childbirth complications that resulted in my lengthened hospital stay, followed by PPD that started 6 weeks later.    A couple of people asked me if they thought that it was the realization that I could no longer have children that led to PPD.  I told them it was one factor, but definitely not the only factor.

Would I have wanted another child?  Absolutely!  When I was younger, I dreamed I would have four children…one more than me and my two brothers.   As I got older, I would have settled for three.    That was, after all, more than two…and two at the time just didn’t seem enough.   But then I got married late because it took me a long time to find “the right one” (and he was worth the wait!).  Not long after we got married,  I had to get surgery to remove a dermoid cyst, which my OB/GYN recommended to prevent pregnancy issues.   We got pregnant after months of trying, but only to have it result in an ectopic pregnancy that had to be terminated.  Then, after many more months of trying to conceive, we were encouraged to undergo IVF treatments.   After our 2nd IVF cycle, which thankfully succeeded, and we were well on our way with the pregnancy, I was praying deep down inside that I would be fortunate enough to succeed just one more time.  I was willing to endure one more, just so I could provide one sibling for my child.

When I woke up from my emergency partial hysterectomy, I felt so incredibly sad.   I was sad that I could not have another child.  I was sad I couldn’t provide my daughter a sibling.  I felt unwhole.  I was essentially missing an important piece of me.  A piece of me that would enable me to bear children.  It was so final.   Before, I had all my parts but they just weren’t working quite right.  There was a breakdown somewhere in the complex process that occurs behind the scenes–starting with the sperm swimming and finding a good egg to hook up with all the way through the time that there is a viable pregnancy.  And all I needed was some help (in the form of IVF) to prime up the process and improve my chances for a viable pregnancy that would carry to term.

In the hospital, after hearing the terrible news, I couldn’t help but cry.  But I couldn’t just wallow in my grief.  I now had a baby to take care of.  Since she was my only chance at having a baby, despite my pain and exhaustion, I was determined to do the best I could at breastfeeding her, changing her and holding her.  I was fine until my first PPD symptom, insomnia, appeared during the 6th week.  But in between childbirth and that 6th week, my body and my psyche had to endure so much fatigue and anxiety.  Six weeks of non-stop fatigue and anxiety finally caused my body to shut down.  I’ve endured a lot of challenges and anxiety in the past, but nothing that could compare to such a life-altering experience as childbirth and the weeks of adjustment that go with it.  And I was already starting in the negative, after having gone through what was referred to as a life-threatening procedure in which I hemorraged and lost 4 units of blood, on top of the following chain of events:

  •  traumatic delivery experience that resulted in a partial hysterectomy resulting in loss of ability to have any more children
  • negative experience in the hospital–e.g., constant sleep interruptions in the hospital, constant moving from one room to another and changes in hospital staff, multiple attempts to replace IVs in my arms/hands, food deprivation (I only had about 2 meals the whole week I was there….otherwise what I had were ice cubes for the most part, plus an occasional broth or jello), below-par treatment of certain hospital staff, searing pain (felt like someone was burning me) in my abdomen that came & went for 2 days after the surgery
  • constant sleep interruptions from the noises the baby made throughout the night, plus night feedings
  • baby’s bad case of eczema and cradle cap
  • baby’s one week colic

National Infertility Awareness Week – April 24-May 1, 2010

This is National Infertility Awareness Week, a movement to raise awareness about the disease of infertility affecting 7.3 million Americans.  RESOLVE is a community for women and men with infertility and provides information, support and opportunities to take action.  Check out the RESOLVE website for more information on infertility and how you can make a difference for you and others experiencing infertility.    There is a wealth of information on this website–a lot more than even a year ago! 

You can find the following:

I’d like to highlight a new public awareness initiative–Project IF–that RESOLVE has recently started, one of the partners of which is Stirrup QueensClick here for more information on Project IF.

Infertility is a major cause of anxiety and depression.  With the number of individuals faced with infertility today, it is no wonder that antenatal and postpartum depression rates are as high as they are today.  As such, it is very important that you seek support in getting through this difficult and highly stressful time of your life.   Support can be in the form of family and/or friends that you feel are empathetic (i.e., have gone through this themselves) and/or non-judgmental.   

If you’re not sure whom to talk to among your circle of family/friends, visit the RESOLVE website and look up mental health professionals in your area that have experience with helping couples get through infertility and infertility treatments.  Getting this kind of support can help prevent your anxiety levels from reaching a point that– should you (and I really hope you do) get pregnant– you could be heading into pregnancy with a great risk of developing perinatal depression. 

The absolute worst thing you can do is keep your feelings of grief and anxiety to yourself, and in fact, doing so can put you at greater risk for developing a perinatal mood disorder!

Refer to my earlier post for more info on this topic.

Stress Management Techniques Can Increase Pregnancy Rates

According to a study presented on October 20, 2009 at the American Society for Reproductive Medicine’s 65th Annual Meeting:

“Women who participated in a stress management program prior to or during their second IVF cycle had a 160 percent greater pregnancy rate than women who did not participate in a program.  The study…..revealed a pregnancy rate of 52 percent among women who participated in a stress management program as compared to a 20 percent pregnancy rate for women who were not exposed to the stress management program……Pregnancy rates jumped to 67 percent for women with signs of depression at the start of the study who engaged in the stress management program versus no pregnancies for those that did not.”

Relaxation training, cognitive-behavioral strategies and group support were the specific stress management techniques employed during this study.

In short, what this study shows is that stress management may help increase pregnancy rates (including success rates of IVF procedures) by helping women cope with and minimize anxiety levels.    

BOTTOM LINE….

There is a proven correlation between stress/anxiety levels and lower pregnancy rates.  If you are trying to get pregnant, you need to do what you can to reduce your anxiety levels.  Worrying about whether your IVF cycle(s) will succeed or not will only harm your chances.  I know it’s easier said than done.  I really do.  I’ve been there.  Give yoga a try.  I did…and my IVF cycle at the time succeeded.  Coincidence or not, I may never know.  But I’m sure the yoga helped decrease my anxiety levels, as well as provided physical benefits in terms of the stretching, etc.  I went into that cycle with a much more positive attitude than during the previous cycle (ditching the IVF cycle and doctor I couldn’t stand for a facility I actually enjoyed being a patient at worked wonders as well).  Read my previous blog posts about yoga and seeking therapy with a mental health professional experienced with infertility.

Infertility and Pregnancy Loss Resources

Just a real quickie from me today….In case you hadn’t seen 2 recent posts over at Postpartum Progress, one of which is on PPD after miscarriage or stillbirth, and the other on the difference between grief and depression after pregnancy loss.   In one post, Katherine Stone links to a mother’s struggle with PPD after miscarriage.  In the post, she links to pregnancy loss/infertility websites that can help those currently struggling with the devastation caused by such experiences.  I’ve added those links to my site (under Pregnancy Loss/Infertility Websites), since as I mentioned in my previous post on my IVF experience, women who have suffered a pregnancy loss(es) and/or infertility are at greater risk for PPD after a successful pregnancy…or even adoption.  I’m highlighting this info for you because I have had to struggle with both, and want anyone going through this to know there are resources and support out there.   And of course, PLEASE feel free to reach out to me anytime you need to!

Benefits of Yoga During IVF and Pregnancy

I know I mentioned my next blog post would be my Part II advice on getting a minimum of 5 hours of uninterrupted sleep, but I had to squeeze this short one in beforehand.  It’s been on my mind ever I saw the recent post over at Postpartum Progress on the benefits of yoga. 

Researchers in Iran provided the results on their study of the benefits of yoga on anxiety and depression in women in the May 2009 issue of Complementary Therapies in Clinical Practice (Volume 15, Issue 2, Pages 102-104).  The conclusion of the abstract reads as follows: 

“Participation in a two-month yoga class can lead to significant reduction in perceived levels of anxiety in women who suffer from anxiety disorders. This study suggests that yoga can be considered as a complementary therapy or an alternative method for medical therapy in the treatment of anxiety disorders.”

 What I forgot to mention in my previous post relating to my IVF experience is that what probably made a huge difference–other than the fact that I had an excellent experience over at RMA of NY–was the fact that I took yoga lessons once a week during the IVF process and I stopped taking the lessons once implantation took place (because I was afraid some of those yoga moves might be too much for the less than handful of eggs that were just implanted inside me).  Believe me, from the time those eggs were implanted and the next 9 months, I took all manner of precaution to avoid mental and physical strain to preserve my pregnancy.   Looking back, I probably should have taken pregnancy yoga classes (or at least followed a pregnancy yoga DVD) to reduce anxiety that would rear its head every now and then when I experienced spotting and pain.  Mind you, I don’t think my anxiety levels were abnormally high during my pregnancy.  I think it was perfectly normal for me to be concerned with spotting and pain after having gone through what I’d gone through to get that far with the pregnancy.   I mean, who wouldn’t feel concerned, given the situation?

Ruta Nonacs, in her book (pg 80) A Deeper Shade of Blue: A Woman’s Guide to Recognizing and Treating Depression in Her Childbearing Years, sums up the reason why infertility is a stressful experience for women as follows: “[Infertility] is one of the most stressful experiences for a woman.  Even the strongest and most resilient may experience depression when forced to ensure such significant demands on their emotional and physical resources…..Several recent research studies indicate that women who suffer from infertility are vulnerable to significant depression or anxiety: among women who undergo infertility treatment, it is estimated that about 25 percent to 30 percent suffer from clinical depression.”   

This is why I would suggest women going through IVF treatments to do everything they can do reduce their anxiety by seeing a therapist experienced with helping IVF patients, as well as giving yoga a try.   And for those who are pregnant–whether through IVF or naturally–you should seriously consider taking pregnancy yoga classes or follow pregnancy yoga DVDs in the privacy of your home.  Yoga will not only benefit you physically, it can help reduce anxiety levels.  After my next post on sleep, I will write on how anxiety levels are also detrimental to the fetus.

National Infertility Awareness Week – April 25-May 2, 2009

This is National Infertility Awareness Week, a movement to raise awareness about the disease of infertility affecting 7.3 million Americans.  RESOLVE is a community for women and men with infertility and provides information, support and opportunities to take action.  Check out the RESOLVE website for more information on infertility and how you can make a difference for you and others experiencing infertility.   You can also find a listing of support groups and mental health professionals that specialize in infertility, as well as a calendar of events around the country.   

Infertility is a major cause of anxiety and depression.  With the number of individuals faced with infertility today, it is no wonder that antenatal and postpartum depression rates are as high as they are today.  As such, it is very important that you seek support in getting through this difficult and highly stressful time of your life.   Support can be in the form of family and/or friends that you feel are empathetic (i.e., have gone through this themselves) and/or non-judgmental.   If you’re not sure whom to talk to among your circle of family/friends, visit the RESOLVE website and look up mental health professionals in your area that have experience with helping couples get through infertility and infertility treatments.  Getting this kind of support can help prevent your anxiety levels from reaching a point that– should you (and I really hope you do) get pregnant– you could be heading into pregnancy with a great risk of developing perinatal depression.  The absolute worst thing you can do is keep your feelings of grief and anxiety to yourself, and in fact, doing so can put you at greater risk for developing a perinatal mood disorder!

Refer to my earlier post for more info on this topic.

Unresolved Grief & Anxiety from Multiple IVF Cycles and Years of Trying to Have a Baby: Risk Factors for Perinatal Depression

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.