Types of support
Preparing for or going through the process of trying to become pregnant can be especially challenging and, whilst often there is a major focus on physical aspects (eg. hormones), emotional and mental health is not always given the attention it needs. The good news is there are effective ways to alleviate stress, depression and anxiety if you and/or your partner are finding it difficult to fall pregnant naturally.
Below are some types of support that may assist you if you need to seek support or treatment at this earliest pre-pregnancy stage in the perinatal journey:
This can be particularly helpful if you and your partner have conflicting views, priorities or attitudes surrounding starting a family. Relationship counselling can assist you both to understand where each of you are coming from, identify your concerns and work through these issues. Often identifying possible issues, putting them on the table and talking them through can relieve feelings of stress and tensions and help you both move forward with informed decision-making.
For those undergoing IVF treatments, relationship counselling, which includes education and addressing stress throughout their IVF cycle, can be very helpful. In fact, research shows that this can not only reduce levels of depression and anxiety but also increases the likelihood of pregnancy.
Sometimes, just having the opportunity to talk through how you are feeling and thinking with someone independent and neutral gives you the opportunity to express things that may otherwise be awkward or uncomfortable to talk about with people you know.
Whilst this may be helpful in alleviating feelings of stress, it may not be enough to provide ongoing relief, as these issues may continue to impact on your daily life and affect your ability to function from day to day. In this case, psychological and/or medical treatments can be very helpful.
Psychological therapy, often referred to as ‘talking therapy’, can help you to identify and alter negative thoughts and feelings that you may be experiencing and, in turn, change negative behaviours.
One common psychological therapy is that of cognitive behaviour therapy (“CBT”). The ‘cognitive’ component of this treatment is essentially about assisting you to identify negative thoughts and feelings that you may have and learn to challenge these thoughts.
For example, you may hold beliefs that you would not make a good parent, are never going to get pregnant or that you are being punished by being unable to fall pregnant. In these cases, it is important to look objectively at the facts about why and consider if these are rational and substantiated beliefs or thoughts. For example, why wouldn’t you make as good a parent as someone else you know? Are there practical reasons why you may have been unsuccessful in falling pregnant so far (e.g. timing, opportunity, biological reasons)? Similarly, the ‘behaviour’ part of treatment involves looking at your current behaviours and making a change. In this case, it may involve spending more time with parents you know and observe how you could similarly be a good parent or being proactive about seeking professional advice about why you haven’t fallen pregnant after a certain time period.
This type of therapy may take place in a group or individually. Studies suggest that cognitive behavioural group psychotherapy and support groups decrease stress and mood symptoms like anger, depression and anxiety, as well as increased fertility rates.
Although research into other types of psychological treatments amongst women who are unable to conceive is lacking, treatments that decrease depression, anxiety symptoms and stress in the general population are also likely to be helpful.
While there is little data regarding the treatment of patients with infertility specifically, like other times in life, medication remains an important option for women and men who may develop more severe depression and/or anxiety in the context of infertility and its treatment.
Antidepressants are effective for the treatment of conditions like depression and some types of antidepressants are also effective for treating symptoms of anxiety. In instances where symptoms are severe and significantly impacting on your ability to get through the day, antidepressants are often needed as a first step. Without this, you may not be able to get the benefits of psychological therapy, as your concentration, thinking and motivation is likely to be impaired. In these cases, it is recommended that you start with medication first, which will put you in a better position to benefit from psychological therapy.
Antidepressants will usually take up to three weeks to take effect and, during that time, you may experience some some side-effects. Unfortunately, you may need to try more than one type of medication to find the one that is best for you. Once they do start taking effect, it’s important not to stop taking them suddenly. Most people will remain on antidepressants for six -24 months or, if you have a history of depression or anxiety, this length of time may be greater or ongoing.
Whilst you may have a tendency to want to avoid medication for fear that this may reduce your fertility or may affect the outcome of your pregnancy, it’s important to note that there is currently no evidence to suggest that commonly used antidepressants negatively affect fertility. Furthermore, certain antidepressants are indicated to be safe to use during pregnancy.