Emotions and infertility: depression can interfere with conception. Research shows that by using mind-body techniques, women can boost their odds of getting pregnant - Health

Shape, Dec, 2002 by Alice Lesch Kelly

For nine years, Tammy Seres tried to get pregnant. Seres, a 36-year-old social worker in Delmar, N.Y., tried just about everything to conceive. She and her husband saw infertility doctors and endured a long list of assisted reproductive procedures, including several in vitro fertilizations (IVF). "We were so desperate to get pregnant, I would have tried anything," Seres says.

Over the years, Seres grew increasingly depressed by her inability to become a mother. "It's a constant emotional roller coaster. If we were going through a high-tech cycle and it was unsuccessful, I'd get so upset. Then I would get all excited about the next cycle, and when that failed, I was devastated." It wasn't until Seres participated in a weekend infertility retreat sponsored by the Mind/Body Medical Institute at Beth Israel Deaconess Medical Center in Boston -- and spent most of the retreat in tears -- that she realized just how depressed she had become.

Recognizing her depression was a turning point for Seres. That weekend she vowed to take control of her emotional health. Her doctor prescribed an antidepressant. She began listening to relaxation tapes on a daily basis and doing deep-breathing exercises to reduce feelings of stress. She took part in an e-mail support network with some of the other women she met during the retreat. And she used a technique called cognitive restructuring to alter some of the negative thought patterns that looped through her mind (see "Treat Your Depression, Improve Your Odds," page 74).

A month later, Seres underwent her third IVF. This time, the procedure succeeded, and Seres became pregnant with twins! Seres isn't exactly sure why this IVF worked. Was it the deep breathing? The social support? The antidepressant (which she quit taking once she conceived)?

Alice D. Domar, Ph.D., director of the Mind/Body Center for Women's Health at Boston IVF, is pretty confident that she knows why. Domar, founder of the Mind/Body Program for Infertility that Seres attended, believes that depression contributes to infertility, and that by alleviating their depression, infertile women can boost their odds of getting pregnant, either naturally or via assisted reproductive techniques.

Infertility has been in the news quite a bit lately. The book Creating a Life: Professional Women and the Quest for Children (Talk Miramax Books, 2002) generated a buzz last spring when its author, economist Sylvia Ann Hewlett, Ph.D., alerted women that they put their chances of having children at risk if they spend too many years establishing their careers before trying to get pregnant. Statistics back Hewlett's premise: According to the American Society of Reproductive Medicine, infertility affects about 10 percent of the reproductiveage population, or about 6.1 million Americans. But infertility becomes more common as women grow older. One-third of couples whose female member is 35-39 will have problems with fertility; that number jumps to two-thirds for women over the age of 40. Even reproductively healthy women up to 30 years old have only a 20 percent chance of conceiving in any given month (compared with 5 percent for women over 40). According to Domar, depression makes conception even less likely for women of any age.

How depression affects fertility

From an evolutionary standpoint, it makes sense that a woman suffering from depression would have trouble conceiving, Domar says. 'A depressed woman is not capable of caring for herself, let alone a baby. Depression may have been a natural way of contraception during times of starvation or war." But if a woman is feeling depressed because she's not getting pregnant, that's another story.

Here's Domar's thesis: A woman who wants very much to be a mother starts trying to conceive. She doesn't get pregnant right away, and she starts to worry, particularly if she's older. After failing to get pregnant for a couple of months, depression may set in, which in turn interferes with the delicate hormonal balance required for conception. Egg quality may be reduced, the release of eggs delayed or the implantation of a fertilized egg in the uterus prevented. Each month she fails to get pregnant, her depression deepens, her hormonal fluctuation continues and her fertility is hampered further. If the woman has a pre-existing depression, as some 12.4 million American women do, infertility is even more likely.

Certainly, not all cases of infertility are triggered by depression: Many couples have specific medical conditions that contribute to their fertility problems, and not all depressed women have trouble conceiving. But some 20 percent of infertility is unexplained, and in many cases assisted reproductive techniques such as IVF should work but, for no obvious reason, don't. It is in those cases that Domar says depression may play a crucial part. "There is a very complex cascade of hormones that need to coordinate to produce a pregnancy," she says. "If even one of those is off, as happens when a woman is depressed, it can prevent conception."