Anxiety and IVF

Anxiety is our body and mind’s way of responding to threat.  Threat can take many forms, and it can be real or perceived. Feeling anxious in certain situations is highly desirable – our ‘flight or fight’ response quickly alerts us to danger, mobilises us into action, and keeps us safe. Difficulties arise however when threats are ongoing, and the anxiety response becomes a continual experience.
 

Anxiety and IVF

The relationship between stress, anxiety and infertility and its treatments is complex and no clear picture emerges from research with regards to cause and effect.   What is clear, however, is that infertility and IVF treatment involve multiple psychological, emotional and physiological stressors, or threats.  Given this, it is not surprising that studies consistently find men and women undergoing IVF report elevated levels of anxiety.

IVF treatment is comprised of a series of stages, and each must be successfully completed before moving to the next.  Men and women going through IVF typically report that their anxiety increases with each stage, with the highest level of anxiety being experienced while waiting for the outcome of treatment. Hope and anticipation of success typically increases with each passing day but so does the possibility of failure.  Successful completion of one stage doesn’t ensure success at the next, and uncertainty and low control is ever-present.  

Some people find that aspects of the treatment itself are specific anxiety triggers, such as their daily injections and hospital procedures.  Other people report side-effects of the hormone treatment can include physical symptoms of anxiety.

How to recognise the signs of anxiety

While some symptoms of anxiety are obvious, others are not always expected.

The following are some of the more common signs of anxiety:

• Psychological – excessive worry, catastrophizing, difficulty concentrating, obsessive thoughts, irritability
• Physical – increased heart rate, panic, agitation, feeling restless, difficulty falling asleep or staying asleep, muscle tension, fatigue
• Behavioural – avoiding situations that make you feel anxious

Treatment of anxiety during IVF

A level of anxiety is a very normal response to the stressful experience of IVF treatment. 

Seeking help is recommended if you experience any of the following:

• Symptoms become more frequent or persistent
• Anxiety begins to interfere with your work, socialising, or daily activities
• You develop low mood
• Your quality of life is reduced due to your anxiety symptoms
   

Self-help strategies for anxiety

Staying well, reducing stress levels, and participating in meaningful, enjoyable activities all contribute to the effective management of anxiety:

• Stress Management:  Identify your sources of stress at work, at home, in your relationships.  Look at ways of reducing the pressure.  This might include reviewing the number of commitments you take on, and learning to be more assertive about saying ‘no’.
• Lifestyle Changes – Adding exercise into your daily or weekly routine, making time for meaningful social connections, ensuring you have some downtime each day. All of these can help reduce stress as well as help manage the symptoms of anxiety.
• Support groups & internet forums – For some people, connecting with others who are going through similar experiences is enormously supportive.
• Relaxation Training – Calm your mind and reduce muscle tension with deep breathing, meditation, guided imagery and progressive muscle relaxation.
   

Psychological treatments for anxiety

Psychological therapies, often called ‘talking therapy’, can help you identify and change unhelpful thoughts and behaviours associated with your anxiety, as well create strategies to tolerate the symptoms of anxiety more effectively.
 

Cognitive Behavioural Therapies (CBT)

CBT is considered one of the most effective psychological treatments for anxiety.  It is based on the premise that our thoughts (cognitions), feelings and behaviours are all interlinked.  It recognises that some thoughts and behaviours can increase the likelihood of anxiety, or hinder recovery from it.   CBT helps identify and change those self-defeating thoughts and behaviours that contribute to anxiety.

For example, you may catastrophise about your treatment cycle, assume you won’t cope, ‘feel’ sure you’ll have difficult side-effects, or worry about letting your partner down.   CBT helps you consider each of these thoughts objectively and then focus on problem-solving.  For example, what is the evidence you won’t cope?  What is a more rational, fact-based, way of thinking?  Has something previously helped you manage difficult, unfamiliar situations?  What supports do you need to manage your distress?

The behaviour part of treatment focusses on encouraging effective, goal-directed behaviour, and limiting avoidance.  For example, your anxiety might be stopping you from attending a support group meeting or researching egg donor options.  Creating an action plan that breaks down your goals into small, more manageable steps can help the situation feel less daunting. 

Graded exposure is another treatment within CBT that can effectively treat extreme fears and phobias.  For example, needle phobias or a fear of hospitals that may be limiting your treatment options and creating a high level of distress. 
 

Mindfulness-based therapies for anxiety

Studies have found mindfulness-based therapies to be effective treatments for managing anxiety symptoms.  Unlike CBT, mindfulness techniques don’t try to change negative thinking patterns or actively reduce anxiety symptoms.  Instead, mindfulness strategies encourage non-judgmental awareness and acceptance of them. 

For example, when you are caught up in the overwhelming panic and distress of a negative pregnancy test, try and focus on what the experience feels like. Where in your body does it feel strongest? What does it feel like? Notice your thoughts, say each one out loud What happens when you stay present with your thought instead of pushing them away? 

Although it seems counter-intuitive, staying in the moment with difficult thoughts and feelings can help change your response to them, and can increase your tolerance of them.