Mother Talkers

Talk therapy for infertility

by NJmom

Wed Sep 05, 2007 at 10:13:43 AM PDT

The New York Times interviews Dr. Sarah L. Berga this week.  Berga investigates the relationship between a woman's chronic stress level and difficulty getting pregnant. For example, Berga showed that some women with excessive levels of cortisol, a stress hormone, were able to restore ovulation after undergoing cognitive behavioral therapy (CBT).

I get Berga's concept, but there is something about this that just irks me.  A doctor assuming that a woman who is having difficulty getting pregnant might need talk therapy strikes me as the old "It's all in your head," school of medicine, which women have been victims of far too long.  

The author of the NY Times interview, Randi Hutter Epstein M.D. asks about this issue:

Q. (Epstein): In the 1940s, Freudian analysts told infertile women that lurking antimaternal thoughts made them sterile. Feminists later attacked this theory. Do you think of yourself as a continuum of this practice, or do you feel your ideas are completely different?

A. (Berga): Back then they did not know the mechanisms and they intuited relationships, but they were not all wrong. They were closer to the truth than we’d like to believe. The truth is that if you are not in harmony with yourself and your culture, you are stressed. That is not totally different from Freud.

  • ::

I've seen so many women get blown off by their physicians when complaining of things that can't be measured with a test, like pain and fatigue. I've seen so many women receive the answer that it must be in their head.

Unfortunately, sometimes it turned out that the symptoms were very serious, sometimes even symptoms of cancer.  I don't doubt that there is a connection between stress and our bodies, but there is something about this that strikes me as troublesome.

What do you think Mothertalkers?  Do you think women who are having difficulty getting pregnant should be referred to a round of talk therapy first?

Tags: infertility (all tags)

Permalink | 47 comments

  • Small numbers... (0 / 0)

    That article mentions some of her findings.

    In a study of 16 women reported in 2003 in the journal Fertility and Sterility, Dr. Berga showed that ovulation was restored in 7 of 8 women who underwent cognitive behavioral therapy, compared with 2 of 8 who did not get therapy. In 2006, in The Journal of Clinical Endocrinology & Metabolism, she reported that women who did not ovulate had excessive levels of cortisol, a stress hormone, in the brain fluid.

    Numbers are awfully small to be drawing conclusions.  It's not impossible that there's something to it, I suppose, but I don't see therapy as the first step, personally.  Perhaps a concurrent step, but certainly not to the exclusion of medical assistance - unless that's what the patient desires.

    Katherine

    by pat of butter in a sea of grits on Wed Sep 05, 2007 at 10:15:43 AM PDT

  • Gee...wonder if that could work in (0 / 0)

    reverse?  If we could talk ourselves out of ovulating so we wouldn't get pregnant???  Then the right wingers could rightfully blame women for "letting themselves" get pregnant.

    Rubs me the wrong way, too.  Doctors do blow women off.  And the medical field does indeed have the tendency to pass off any symptom that isn't readily diagnosed or treated as being an emotional or mental problem.  We've finally gotten past the point that we don't view all reproductive health as somehow being under the woman's control...lets not go back.  I can't tell you how enraged I was when my mother in law informed me that the god-awful morning (day-long) sickness I had with my first pregnancy was all "in my head".

    by tjb22 on Wed Sep 05, 2007 at 10:21:53 AM PDT

  • Additional guilt! YEAH! (0 / 0)

    Just what a woman with fertility issues needs! When DH were trying for our year, and getting frustrated every month, I couldn't get over how stressed the process made me, and how I read I shouldn't BE stressed... talk about a cyclical issue!

    I think it's a cultural issue- we are all SO STRESSED it's no wonder the rate of infertility is higher! Hello, there are so many fricking things to be stressed about, added to a government that leads by fear. This is yet again one of those "symptoms without a diagnosis", IMO. WHY are women so stressed? WHY is this something we're having more of an issue with today?

    Adding to the topic, feministing.com recently had a post regarding a study that says women who are stressed WHILE PREGNANT may cause harm to the fetus. SO... you're too stressed to GET pregnant, and then you work it out and you're too stressed to BE pregnant in a healthy way. Oh suck it. Seriously, these studies need to SUCK IT.

    by lilianna28 on Wed Sep 05, 2007 at 11:02:22 AM PDT

    • Well, stress isn't even new. (0 / 0)

      Seriously...you wanna talk "stress"?  My great grandmother had two year old twins when she gave birth to triplets.  And these weren't her only children.  And Ofcourse, it being a hundred years ago, she lost a couple of children along the way, too.  And, I might add, she raised her children without all the conveniences such as disposable diapers, packaged baby food, washer and dryer, etc.  There is just no way I can try to convince myself that somehow, my life has been more difficult than hers was.  And you know, as stressful as the lives of women like her were, the human race continued to successfully reproduce.

      And don't let anyone fool you...women handle stress better than men.  There's been studies that back this up.  So, too all of those who keep telling us that are biggest problem is "stress", well, I agree...they can most certainly SUCK IT.

      by tjb22 on Wed Sep 05, 2007 at 11:10:22 AM PDT

      [ Parent ]

  • I agree with y'all, but.... (0 / 0)

    But how is this different than going for acupuncture to help you get pregnant?

    I know when I was trying to get pregnant after my miscarriage, I wasn't having luck until after we went to Key West for a week.  A few days later, I was pregnant.

    Just one data point, sure.  But if you believe in the mind/body connection, you have to see that there could be some inkling of truth.

    Of course, the leap from some sort of connection between stress and infertility to blaming a woman for not being able to get pregnant isn't that far, so we must always tread lightly when making summary judgments.

    Miles and His Favorites: The World As Seen By an Eight Year Old

    by Hillary on Wed Sep 05, 2007 at 11:13:08 AM PDT

    • I think we don't understand (0 / 0)

      how acupuncture works.  I think this is the reason the results are mixed for those who try it.  I think it can be beneficial in some situations, but how or why?  Who knows?  

      And there is a mind/body connection.  Truthfully, do we know of any medical condition that stress improves?  No...in fact, it worsens about any health problem out there.  However, that's quite a leap from saying that we'd all remain perfectly healthy and never encounter problems if we could just adequately "deal" with stress.  

      by tjb22 on Wed Sep 05, 2007 at 11:19:23 AM PDT

      [ Parent ]

      • mind/body connection (0 / 0)

        I really liked the midwife who attended the birth of my second baby, who was born at 34 weeks, except that during my entirely unexpected preterm labor she told me that she believed in the mind/body connection and that I should try to visualize things to stop the labor.  I remember thinking "yeah, right."  I think it can actually make stressful situations more stressful when you think your thoughts have some control over the outcome.

        by Treena on Thu Sep 06, 2007 at 03:20:55 AM PDT

        [ Parent ]

        • I had twins at 34 weeks. (0 / 0)

          I was on bedrest for two months before that and hospitalized for a month of that time.  Believe me, if I could have "thought" myself out of that, I would have.  Finally, my water broke, and at that point, there certainly wasn't anyway to "think" those membranes back into an intact state.

          I think a lot of people who carry it so far have never dealt with serious health conditions.  As someone who does, I have to admit to feeling insulted.  There's often that undertone of "you could get better if you really wanted to" or "you're not trying hard enough".  Its those attitudes, encountered daily, that lead people to need the help of a therapist!  The therapist can't help one "visualize" one's self to wellness, but he/she sure can help in dealing with idiots who believe you can.

          by tjb22 on Thu Sep 06, 2007 at 07:47:55 AM PDT

          [ Parent ]

  • Clearly, there is no statistical basis (0 / 0)

    for this study. 16 women? PLEASE. As a scientist, I'm lucky to draw a conclusion people believe off of 200 cancer patients. Don't automatically believe something because it's published-realize this isn't in any major journal either: Nature, Lancet, NEJM, Science...those I'd be more likely to believe.

    I could probably find 16 female scientists here at work who would no longer be fertile after therapy. :)

    by quiltgirl on Wed Sep 05, 2007 at 11:44:40 AM PDT

  • I call BS on this one (0 / 0)

    I have endometriosis.  It leads to fertility problems as well as extremely painful periods.  I suppose there are plenty of women suffering from infertility due to this condition if their doctors don't take the initial complaints of menstrual pain seriously.  Then wehn the infertility comes after the disease advances it's stress -not blocked tubes, right.  BS.

    by music teacher on Wed Sep 05, 2007 at 11:45:22 AM PDT

  • No amount of talking (0 / 0)

    would have opened my blocked tubes, LOL.    

    I agree w/ Katharine - it's certainly one more tool to use against unexplained infertility.  But as anyone who's BTDT will tell you, being told you should "just relax" is not very helpful, and would not be my first choice of intervention.

    by ChristineB on Wed Sep 05, 2007 at 11:56:56 AM PDT

    • sorry to reply to myself but (0 / 0)

      I'm annoyed by the whole "unexplained infertility" diagnosis (approx. 30% of all IF diagnoses).  There are many infertility docs out there who pooh-pooh any connection between IF/recurrent miscarriages and autoimmune disorders or hormone levels that are completely out of whack. (I know mine did.)  If it's not male factor, or tubal blockage, then it's "unexplained" (and no further effort is made to determine the cause).  

      I have to wonder if I'd had more comprehensive blood work done if it would have turned up something that would have enabled me to get (and stay) pregnant.

      by ChristineB on Wed Sep 05, 2007 at 12:14:21 PM PDT

      [ Parent ]

  • It's a shame that there's such a stigma (0 / 0)

    to mental health issues. It's all chemistry and neurology.

    I bet if you labelled this therapy differently, it would feel less obnoxious (I certainly agree that it feels that way). But, counselling (particularly of the cognitive therapy type) can be helpful. Many of us get it informally from friends, or even here. ;-) I've always thought it was funny to prescribe meds for someone anxious or depressed about finances, for example.

    If one is having trouble getting pregnant, it is prudent to look at stress levels, at one's everyday activities, at diet, at spouse's stress and diet. And, obviously, how often and when you are having sex. :-) It is appropriate to recognize that if the body is in fight or flight mode, it might be less fertile. I would hope all of these questions are part of the regular practice in an MD office.

    The problem is, we consider "just relax" as easy, and people who can't do it as having cooties and being generally defective in some undefined way. Sometimes it's not appropriate to just relax.

    Frankly, docs don't know what's wrong a lot of the time, and they get frustrated by that too, and tend to blame the patient.

    by shenanigans on Wed Sep 05, 2007 at 12:40:33 PM PDT

    • I've known plenty of people (0 / 0)

      who were helped by therapy when dealing with chronic health problems.  Ideally, everyone who's diagnosed with a life altering condition should have the option of seeing a therapist to help them adjust.  Infertility patients would certainly be included as those who would likely benefit.  However, I have actually known therapists who were just as frustrated as their patients by medical doctors not helping patients find proper care or treatment because they assume the problem is "mental".

      by tjb22 on Wed Sep 05, 2007 at 12:58:56 PM PDT

      [ Parent ]

      • yes! yes! yes! (0 / 0)

        My father has worked his entire life in the mental health field (beginning as an orderly in a mental instutition at 16), mostly as a social worker. I can't tell you how many horror stories I've heard from him and his clients as to physical ailments that went unnoticed and undiagnosed for years because doctors couldn't get past the fact that they were mentally ill and/or homelss. One small example - guy with schizophrenia and deaf, many years off and on the streets, in and out of mental hospitals. Well, they thought the guy was deaf from his early 20s into well into his 40s, when somebody finally got him a booking to be tested and fitted for hearing aids. As part of the fitting process, they had to clean out his ears. Turns out, the guy had bits of gauze jammed in his ears from decades before. They removed the impacted gauze, and lo and behold, the guy had perfectly normal hearing.

        by Rachel on Wed Sep 05, 2007 at 04:19:15 PM PDT

        [ Parent ]

        • As if one couldn't have a serious mental illness (0 / 0)

          and a "physical" illness, too!  

          Seriously, though, while we ourselves might not have a prejudice against mental illness, many in the traditional medical field do.  And sadly, all too often it effects the quality of care received.  I guess that's why we fight the "all in your head" labels...getting such a label can often mean that one has a very difficult time getting medical issues addressed.  

          My father in law has suffered from severe clinical depression for years.  He was hospitalized for it back in the 70's.  Since then, he's always been on medication and under care for this condition.  Well, sadly, the man almost died from heart disease about 8 years ago because all of the symptoms he was having were put down to "anxiety" and "recurring depression" by his primary care doctor.  Only after his ECG showed changes that indicated he had recently had a heart attack was anything done.  

          by tjb22 on Wed Sep 05, 2007 at 08:27:03 PM PDT

          [ Parent ]

  • Value what's 'in your head' (0 / 0)

    A doctor assuming that a woman who is having difficulty getting pregnant might need talk therapy strikes me as the old "It's all in your head," school of medicine, which women have been victims of far too long.  

    While women have been the victims of this point of view--often unfairly--I don't think a Dr. attributing a physical symptom to a mental origin is necessarily 'blowing off ' the patient. Maybe our society as a whole needs to take psychologically based phenomonae more seriously. My favorite Dr. (DH) has always maintained that psychosomatic symptoms are 100% legit. Look at panic attacks--definitely a mental process that manifests as extreme physical symptoms.

    The mind is incredibly powerful. Just because something is 'in your head' doesn't mean it's inconsequential. In fact, that may be an incredibly powerful diagnosis, which could lead us to see the connections between our mental and physical states of being.

    To quote Albus Dumledore: "Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?"

    by sangfroid on Wed Sep 05, 2007 at 12:48:00 PM PDT

    • The problem with this is (0 / 0)

      that once a doctor has determined the problem is psychologically based, it can be damned difficult to get him/her to investigate other possibilities.  And if its put in medical records, the problem can go with you, from doctor to doctor.  I might add that many doctors are making such pronouncements without being properly trained or qualified to make such complex diagnoses.  I've known women (and a few men, for that matter), who've had to have their psychologist, therapist, psychiatrist, etc., have to INSIST that their medical doctors look for a physical reason for symptoms because the problem was not mentally based.  That's a sad state of affairs and it shouldn't be that way, but it is.

      by tjb22 on Wed Sep 05, 2007 at 12:53:49 PM PDT

      [ Parent ]

      • The reality is (0 / 0)

        that your psychologist/psychiatrist is the only doctor you can see for an hour at a time, once a week.

        When I was very sick with physical symptoms and not getting better, I was about to go see a psychiatrist - just because I thought he (as an MD) might be able to help me find a regular MD who would be able to help.

        I'm reading "How Doctors Think" right now, and I'll probably review it when I'm done. His introductory case amused/saddened me, because I knew well before the punchline what the woman's real problem was.

        by shenanigans on Wed Sep 05, 2007 at 01:27:53 PM PDT

        [ Parent ]

  • Ooops! (0 / 0)

    I posted this in the wrong diary:

    I guess that women who are raped during wartime must be pretty relaxed about their whole situation.  

    I also guess that it's women's stress that cause low sperm counts in men.

    by Pastry Demon on Wed Sep 05, 2007 at 01:50:02 PM PDT

  • simultaneous treatment? (0 / 0)

    I don't think it's a good idea for women to go for talk therapy in lieu of medical treatment, because the clock is ticking, both emotionally and physically.  So I don't think it would be a good idea to try therapy first.  But since it does make sense to me that stress could be a factor, maybe therapy isn't such a bad idea.  Especially considering that, from what I understand of infertility, the whole ride is just so traumatic that you're not going to be left feeling good about it anyway.

    I have a friend who's infertility does seem to be the direct result of stress and trauma.  Fortunately for her she already has children, but her doctor really cannot find any reason why she hasn't been able to get pregnant again after a traumatic experience, and she agrees that it is probably a psychological issue.  There are so many causes, and I'll say that if I were battling infertility, I might want to try every option, including the possibility that it was "stress."

    by Erin on Wed Sep 05, 2007 at 04:35:14 PM PDT

  • yes there may be a connection but its not (0 / 0)

    necessarily a reason. Alice Domar has done a lot of work on the mind/body connection and infertility and health. I think it's important. It may help someone resolve these issues. But it doesn't 'cure' infertility. I get so frustrated with these articles that rush to a solution. What happened to gray? My reproductive endocrinologist was perplexed as to why I did not pregnant, etc. Sometimes they just don't know.

    by brave on Wed Sep 05, 2007 at 05:34:44 PM PDT

  • never one to mince words (0 / 0)

    I think this is complete horseshit.

    If infertility were caused by stress then most species never would have survived past basic evolutionary pressures.  The most stressed societies (read impoverished) have a much higher rate of pregnancy and birth than the societies (western industrialized) who best meet the basic needs of their citizens.

    Again, complete crap.

    by alh on Wed Sep 05, 2007 at 06:32:49 PM PDT

    • Yes...as I posted above, (0 / 0)

      we really don't know what "stress" is.  Our great grandmothers led stressful lives...they gave birth every couple of years and watched children die of simple childhood ailments.  I just can't get into the idea that we have harder then any women have ever had it throughout history.

      by tjb22 on Wed Sep 05, 2007 at 08:21:13 PM PDT

      [ Parent ]

    • exactly (0 / 0)

      If stress caused infertility then we would see a much lower birth rate in countries with chronic civil war, etc.  Not the case.

      by Pastry Demon on Thu Sep 06, 2007 at 07:50:59 AM PDT

      [ Parent ]

  • btw (0 / 0)

    Why hasn't there been a study to find out if stress makes men shoot blanks, pray tell?!

    by Rachel on Wed Sep 05, 2007 at 08:23:46 PM PDT

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