Regardless of the overused ‘relax and it will happen’ baby-making advice, no direct link has so far been found between stress and infertility. What is a fact though, is that dealing with infertility can have a significant impact on your emotional and mental well-being.

Charles from Dreaming of Baby discusses mental health and empathy to stressors of infertility with Dr. Aaron Styer, Reproductive Endocrinologist, Fertility Specialist, and Co-Medical Director of CCRM Boston.

CJ DeGuara: Hello and welcome to Dreaming of Baby where our team is dedicated to being with you on your journey to parenthood. Today we have with us Dr. Styer with whom we will be discussing mental health, empathy, and stressors that may impact fertility. Thank you for joining us today Dr. Styer, would you be so kind as to introduce yourself to our readers.

Dr. Aaron Styer: Good afternoon everyone. My name is Aaron Styer and I am a Reproductive Endocrinologist, Fertility Specialist and Co-Medical Director of CCRM Boston. I am honored to participate today.

Infertility: the emotional aspect

CJ DeGuara: We are glad to have you with us today! I’d like to start by learning a little about the impact of mental health on fertility: which are the most common conditions that may impact fertility or conversely are likely to become present or exacerbated when one is diagnosed with infertility?

Dr. Aaron Styer: The emotional component to infertility is quite significant and sometimes underestimated by many patients and medical providers. Preexisting conditions such as depression and anxiety can be worsened by the stressors of infertility. In some cases, depression and anxiety may also develop depending on a patient’s or couple’s ability to cope with the stressors of infertility. One significant factor to highlight is that the stress and anxiety associated with infertility can also affect a patient’s relationships with her/his partner, spouse, friends, family, and colleagues.

Dr. Aaron Styer: “The emotional component to infertility is quite significant and sometimes underestimated by many patients and medical providers.”

CJ DeGuara: So, if I am understanding correctly, the first and most important part of the puzzle is being aware of the impact infertility can have on one’s mental health? What are some of the signs that an individual or couple can look out for in themselves and their partners?

Dr. Aaron Styer: Yes, you are correct. It is important for a patient or couple to be aware of the direct and indirect effects of infertility on mental health. To this end, I make a point to discuss the emotional components of infertility during my first visit with a patient or couple and during each subsequent visit. I frequently “check in” with my patient and their partner (if applicable) to see how they are doing with the process of testing and treatments and I ask if they need additional emotional support from a mental health professional.

Dr. Aaron Styer: It is crucial to acknowledge and validate the emotional stressors of infertility for a patient at the early stages of infertility testing and treatment. With this approach, they are empowered to seek support if needed and they can navigate infertility more effectively.

Dr. Aaron Styer: “It is crucial to acknowledge and validate the emotional stressors of infertility for a patient at the early stages of infertility testing and treatment. With this approach, they are empowered to seek support if needed and they can navigate infertility more effectively.”

Empathy when dealing with infertility

CJ DeGuara: With regards to empathy, I believe in the case of infertility there is normally a triangle of empathy required, empathy between the partners and of course with the medical professionals such as yourself. How can we improve and bring more empathy to such a sensitive subject; what are some of the most common situations in which empathy may be lacking but can be improved?

Dr. Aaron Styer: I think the first aspect of improving empathy is to provide more personal experiences of infertility from patients to the general public. This would involve more education on the overall public health and emotional aspects of infertility to the general public and general medical community. Additional clinical studies which evaluate the prevalence of mental health disorders in patients and couples with infertility would also provide invaluable perspective and allow for greater empathy. I also recommend that more therapists and psychiatrists provide more focused care and treatment for infertility related stressors.

Fertility Treatment and Mental Health

CJ DeGuara: How important is it to a reproductive endocrinologist such as yourself to be informed early on by a patient with pre-existing mental health conditions; are there any medicines that may need to be stopped or altered? Is the approach at all different in such circumstances?

Dr. Aaron Styer: These are excellent questions and are common topics that I and my colleagues frequently encounter in our medical practices. It is essential that a reproductive endocrinologist has a complete understanding of a patient’s prior mental health history before beginning treatment. This is crucial to optimizing communication between the reproductive endocrinologist and mental health providers to give the best support. The primary goal is to ensure that the patient and/or couple are in the best emotional state possible when they become pregnant and begin raising a child. It is essential to have all care team members available to help.

Dr. Aaron Styer: “It is essential that a reproductive endocrinologist has a complete understanding of a patient’s prior mental health history before beginning treatment.”

Dr. Aaron Styer: We commonly see that patients are taking anti-depressants and anti-anxiety medications. Many medications are safe during pregnancy. I typically consult with a patient’s prescribing mental health provider to assess which medications can be continued and which may need to be stopped.

CJ DeGuara: In terms of the impact of mental health on actual fertility, have there been any studies showing sub-fertility associated with certain conditions that disrupt ovulation, sperm production etc.?

Dr. Aaron Styer: There is no consistent data which has shown a consistently negative effect on the ability to conceive. This also applies to a man’s sperm production and a woman’s ability to ovulate or release an egg.

CJ DeGuara: So if I understand correctly the most important aspect is in fact better management of the emotional aspect in terms of the treatment and working on fertility factors. What are some of the things a couple should be prepared for? To be clearer, what are some of the major stressful moments in the path to parenthood when sub-fertility is present? What should they be asking their fertility specialist?

Dr. Aaron Styer: There can be several emotional hurdles to anticipate. The first may be the early stages when fertility testing is being done. This can seem overwhelming: to have to wait to get the results and then be seen by your physician and team to be able to interpret the results with one’s fertility specialist. Also, the actual additional time of undergoing treatment can be demanding and cause stress when trying to balance time constraints in terms of one’s personal and professional life.

Dr. Aaron Styer: Most significantly, there is a waiting period of about 10 to 14 days between the end of a treatment and when it is known if pregnancy has or has not occurred. This is very difficult for many. To minimize stress, it is always good for a patient to ask their physician and medical team about logistics and times lines for testing and treatment so that expectations can be established from the onset of care.

CJ DeGuara: Do you recommend reading up on the subjects or is it best to have the fertility specialist guide you through these hurdles?

Dr. Aaron Styer: There are some unreliable sources of information on the internet or in the press. Many of these may increase anxiety, frustration, and confusion for some patients. I always advise patients to formulate a list of questions to review with their fertility physician and nurse. This may be the best means to optimize understanding of what is happening and what to expect.

What are the questions I should be asking my fertility specialist?

CJ DeGuara: I am going to ask you for a big favor which I think our parents-to-be will appreciate… especially since this will be coming directly from a leading fertility specialist! What would be the 5 to 10 top questions they should be asking their fertility specialist?

Dr. Aaron Styer: 

  1. How does my age affect my fertility?
  2. Can I improve my fertility through diet, lifestyle, or exercise modifications?
  3. Are there specific dietary supplements I should be taking to improve my chances of conception?
  4. How do I know which fertility treatment is best for me?
  5. What are the best timing methods to try to conceive naturally?

Dr. Aaron Styer: These are the most common questions patients typically ask. They provide the best general background for patients/couples who are beginning the infertility journey.

CJ DeGuara: That is very helpful, thank you so much, Dr. Styer! I do have one final question for you. If you had to give your most important piece of advice to parents-to-be on their journey through infertility, what would it be?

Dr. Aaron Styer: One of the most important points of advice would be: Always have open discussion and dialogue with your spouse, partner, family, and care providers about how you are feeling about infertility. Always reach out for help if needed. I always emphasize that the infertility journey can be difficult and that a patient/couple are not alone. There are many people who are here to help!

CJ DeGuara: Thank you for your time, Dr. Styer!

Dr. Aaron Styer: Thanks so much!

Dr. Aaron Styer is a Reproductive Endocrinologist, Fertility Specialist and Co-Medical Director of CCRM Boston.

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