RESEARCH

1. Stress & Depression including CBT, Mind-Body & Mindfulness
Highlights:

Live birth rate 93% higher in women with positive affect.
Birth rate in infertile women treated for stress and depression – 55%; no treatment 20%
Mindfulness training revealed a significant decrease in depressive symptoms, internal and external shame, entrapment, and defeat in infertile women.
After 3.5 years of infertility, 42% of women conceived with mind-body intervention.

A Synopsis by my teacher Alice D. Domar, Ph.D.
The Mind Body Center for Women’s Health at Boston IVF

Infertility has been defined by the World Health Organization as “the inability of a couple to bring pregnancy to term after a year or more of regular unprotected intercourse”. Approximately 10-15 percent of couples of childbearing age experience infertility. The psychological impact of infertility can be profound and depressive symptoms are more common in the infertile population than in matched fertile women. Approximately 10 percent of infertile women meet the criteria for a major depressive episode, 30-50 percent report depressive symptoms, and 66 percent report feeling depressed after infertility treatment failure. The majority of infertile women report that infertility is the most upsetting experience of their lives. Infertile women report equivalent levels of anxiety and depression as women with cancer, HIV status or heart disease.

Recent research indicates that psychological distress may impair fertility and that depressive symptoms may reduce the efficacy of infertility treatment. Several studies conducted within the past three years support the theory that psychological distress can have a significant adverse impact on successive rates in vitro fertilization (IVF). In one of the studies, women with depressive symptoms were half as likely to conceive as women who were not depressed, and in the most recent study of 151 women scheduled to undergo an IVF cycle the chance of a live birth was 93 percent higher in women with the highest positive-affect score. Researchers have concluded that the success rates of high-tech infertility treatment can be adversely affected by psychological stress.

Mind-body treatment of infertility patients has been shown to both increase pregnancy rates as well as reducing psychological distress. In a recent study conducted at the MBMI, 185 women who had been trying to conceive for one to two years were randomized into either a 10 week mind-body group, a ten week support group, or a routine care control group. The birth rates during the one year follow up period were as follows: – Mind/body 55%, support 54%, and controls 20%. In addition the mind-body patients reported significantly greater psychological improvements than the support or control patients. Patients in the clinical Mind-Body Program for Infertility show benefits as well; in four published studies on several hundred women with an infertility duration of 3.5 years, 42 percent conceived within six months of completing the program and there were significant decreases in all measured psychological symptoms including depression, anxiety and anger.

Infertile women report elevated levels of psychological distress and this distress may reduce their chances of conceiving. Mind-body treatment has been shown to be effective in both significantly increasing pregnancy rates as well as reducing psychological stress.

Selected references on the relationship between stress and fertility

1. Domar, A., Clapp, D., Slawsby, E., Dusek, J., Kessel, B., Freizinger, M (2000) Impact of group psychological interventions on pregnancy rates in infertile women. Fertility and Sterility Vol. 73, no.4 April

2. Domar, A., Zuttermeister, P., Friedman, R (1999) Distress and Conception in Infertile Women: A complementary approach. Journal of the American Medical Women’s Association. Vol. 54, No.4

3. Demyttenaere K, Bonte L, Gheldof M, Veraeke M, Meuleman C, Vanderschuerem D, et al. (1998) Coping style and depression level influence outcome in vitro fertilization. Fertility and Sterility. 69:1026-1033

4. Domar, A (1996) Stress and Infertility in Women: Is there a relationship? Division of Behavioural Medicine, Deaconess Hospital Mind/Body Institute, Harvard Medical School.Psychotherapy in Practice 2/2:17-27

5. Domar, A., Zuttermeister, P., Friedman, R (1993) The Psychological impact of infertility: a comparison with patients with other medical conditions Journal of Psychosomatic Obstetric Gynaecology. 14 Special issue 45-52

6. Wasser, S., Sewal, G., & Soules, M. (1993) Psychosocial stress as a cause of infertility.Fertility & Sterility, 59, 685-689

7. Domar, A., Seibel, M., & Benson, H (1990) The Mind/Body Program for Infertility: A new treatment program for women with infertility. Fertility and Sterility, 53, 246-249

8. Pennebaker, J., Kiecolt-Glasser, J & Glasser, R. (1987) Disclosure of traumas and immune function. Health implications for psychotherapy. Journal of consulting and Clinical Psychology, 56, 239-245

Stress
1. J.M.J. Smeenk,C.M. Verhaak, A. Eugster, A. van Minnen, G.A. Zielhuis and D.D.M. Braat (2001) The effect of anxiety and depression on the outcome of in-vitro fertilization. Hum. Reprod. (2001) 16 (7): 1420-1423.

http://humrep.oxfordjournals.org/content/16/7/1420.full

FINDINGS: Pre-existing psychological factors are independently related to treatment outcome in IVF/ICSI, and should therefore be taken into account in patient counselling. Psychological factors may be improved by intervention, whereas demographic and gynaecological factors cannot. Future studies should be directed towards underlying mechanisms involved and the role of evidence-based distress reduction in order to improve treatment results.

2. Wasser, S., Sewal, G., & Soules, M. (1993) Psychosocial stress as a cause of infertility. Fertility & Sterility, 59, 685-689

http://www.ncbi.nlm.nih.gov/pubmed/8458480

FINDINGS: An adaptive model for the evolution of reproductive failure predicted psychosocial stress to increase as anatomic causes of infertility decrease. The nonanatomic infertility group in our study reported greater psychosocial stress than intermediate (P < 0.008) or anatomic groups (P < 0.0005). Controls, women with nonanatomic etiologies who were not attempting pregnancy, also reported higher psychosocial stress than the anatomic group (P < 0.007). Results are consistent with the hypothesis that psychosocial distress contributes significantly to the etiology of some forms of infertility.

3. Cousineau TM, et al. “Psychological Impact of Infertility,” Best Practice & Research: Clinical Obstetrics and Gynaecology (April 2007): Vol. 21, No. 2, pp. 293–308.

http://www.bestpracticeobgyn.com/article/S1521-6934%2806%2900161-1/abstract

FINDINGS: The inability to conceive children is experienced as a stressful situation by individuals and couples all around the world. The consequences of infertility are manifold and can include societal repercussions and personal suffering. Advances in assisted reproductive technologies, such as IVF, can offer hope to many couples where treatment is available, although barriers exist in terms of medical coverage and affordability. The medicalization of infertility has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmatization, and a disruption in the developmental trajectory of adulthood. Evidence is emerging of an association between stress of fertility treatment and patient drop-out and pregnancy rates. Fortunately, psychological interventions, especially those emphasizing stress management and coping-skills training, have been shown to have beneficial effects for infertility patients.

Depression
Grief reactions are common among infertile couples, however, these normal grief reactions may prolong into pathological grief leading to major depression. (6)

Depressed patients exhibit low mood, loss of interest or pleasure in daily activities, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration.(7) Prevalence is 5 to 12% for men and 10 to 25% in women.(8) Major depression is 2–3 times as common in women as in men.(9)

Depression may affect infertility treatment, follow-up and hope for the future; it may also influence the intensity and longevity of relationship of the affected couple.(2) Lapane et al (1995), (3) have reported that depression could also have role in the pathogenesis of infertility.

Domar et al, in 1992, (4) reported that among infertile women 37% had depressive symptoms on the Beck Depression Inventory (BDI), which was twice as common as in the control group. Results of an Iranian study in 2006 showed that depression is more common among infertile couples than fertile couples (p<0.015). (2)

Drosdzol et al in 2009 (5) found that 35.4% infertile women scored above the cut-off for severe symptoms of depression, compared with 19.47% of fertile women. They found female gender, age over 30 years, lower level of education, lack of occupational activity, diagnosed male infertility and duration of 3–6 years of infertility as risk factors leading to depression and anxiety among infertile couples. Other researchers have explored lack of self-confidence, feeling of grievance and disappointment as factors that may be related to infertility. Infertile women who have social support, positive personal characteristics, and have a satisfactory life with their spouse show fewer signs of depression. (5)

1. Demyttenaere K, Bonte L, Gheldof M, Veraeke M, Meuleman C, Vanderschuerem D, et al. (1998) Coping style and depression level influence outcome in vitro fertilization. Fertility and Sterility. 69:1026-1033

http://www.ncbi.nlm.nih.gov/pubmed/9627288

FINDINGS: The non-pregnant group reported increased expression of negative emotions. In the subgroup with a female indication for IVF, increased depressive symptomatology (correlated with increased expression of negative emotions) was associated with lower pregnancy rates (PRs). Expression of negative emotions predicts depression levels and outcome in IVF.

2. Ashkani H, Akbari A, Heydari ST. Epidemiology of depression among infertile and fertile couples in Shiraz, Southern Iran. Indian J Med Sci. 2006;60:399–406. [PubMed]http://www.ncbi.nlm.nih.gov/pubmed/17006025

FINDINGS: The BDI mean difference between infertile and fertile couples was significant (P=0.015). It was significantly more among couples with infertility from 1-3 years’ duration compared to those with infertility of 1-year duration or less. Regarding the high rate of depression among infertile couples, it seems necessary to pay more attention to infertility centers that offer psychological and psychiatric services.

3. Lapane LK, Zierler S, Lasatar TM, Stein M, Barbout MM, Hume AL. Is a history of depressive symptoms associated with an increased risk of infertility in women? Psychosom Med. 1995;57:509–513. [PubMed]http://www.ncbi.nlm.nih.gov/pubmed/8600476

FINDINGS: Women with a history of depressive symptoms were nearly twice as likely to report infertility relative to women without a history of depressive symptoms before the index age after controlling for potential confounders (90% confidence interval: 0.9-3.2). Our data suggest that depressive symptoms as well as the drugs used to treat these conditions may play an important role in the pathogenesis of infertility. The association between depressive symptoms and infertility should be explored further.

4. Domar AD, Broome A, Zuttermeister PC, Seibel MM, Friedman R. The prevalence and predictability of depression in infertile women. Fertil Steril. 1992;58:1158–1163. [PubMed]http://www.ncbi.nlm.nih.gov/pubmed/1459266

FINDINGS: The infertile women had significantly higher depression scores and twice the prevalence of depression than the controls; women with a 2- to 3-year history of infertility had significantly higher depression scores compared with women with infertility durations of < 1 year or > 6 years; women with an identified causative factor for their infertility had significantly higher depression scores than women with unexplained or undiagnosed infertility.Depressive symptoms are common in infertile women. Psychological interventions aimed at reducing depressive symptoms need to be implemented, especially for women with a definitive diagnosis and for those with durations of 2 to 3 years of infertility.

5. Drosdzol A, Skrzypulec V. Depression and anxiety among Polish infertile couples–an evaluative prevalence study. J Psychosom Obstet Gynaecol. 2009 Mar;30(1):11–20. [PubMed]http://www.ncbi.nlm.nih.gov/pubmed/19308778

FINDINGS: Infertile women (35.44%) scored above the cut-off for severe symptoms of depression, compared with 19.47% of fertile women. In the case of anxiety evaluation there was significant total prevalence among infertile women (15.53%). In the male groups there was a comparable frequency of negative results for depression and anxiety and their intensity. Among Female Infertile, depression occurred most frequently in combined infertility, whilst among Male Infertile in male infertility, with a time-frame of 3-6 years causing the creation and severity of depressive symptoms.

6. Williams KE, Zappert LN. Psychopathology a psychopharmacology in the infertile patient. In: Covington SN, Hammer Burns L, editors. Infertility Counseling. New York, USA: Cambridge University Press; 2006. pp. 97–116.

7. http://www.who.int/mental_health/management/depression/definition/en/

8. Sadock BJ, Sadock VA. Kaplan and Sadock’s pocket handbook of clinical psychiatry. 4th ed. Lippincott Williams and Wilkins; Philadelphia: 2005. pp. 145–10.

9. Kessler RC. Epidemiology of women and depression. J Affect Disord. 2003;74:5–13. [PubMed]10. Demyttenaere K, Bonte L, Gheldof M, Veraeke M, Meuleman C, Vanderschuerem D, et al. (1998) Coping style and depression level influence outcome in vitro fertilization. Fertility and Sterility. 69:1026-1033

http://www.ncbi.nlm.nih.gov/pubmed/9627288

FINDINGS: The non-pregnant group reported increased expression of negative emotions. In the subgroup with a female indication for IVF, increased depressive symptomatology (correlated with increased expression of negative emotions) was associated with lower pregnancy rates (PRs). Expression of negative emotions predicts depression levels and outcome in IVF.

Depression, SSRI’s and Infertility
The most common treatment for depression in the US is antidepressant medication, usually with a class of medications called SSRIs. However, in a recent literature review by Dr. Alice Domar, PhD, along with two infertility doctors and a high risk obstetrician, they came to the conclusion that SSRIs may well not be the best first choice line of treatment for the following reasons:

Antidepressant use during pregnancy is associated with increased risks of:
miscarriage,
birth defects,
preterm birth,
newborn behavioral syndrome,
persistent pulmonary hypertension of the newborn and possible longer term neurobehavioral effects.

There is no evidence of improved pregnancy outcomes with antidepressant use. There is some evidence that psychotherapy, including cognitive-behavioral therapy as well as physical exercise, is associated with significant decreases in depressive symptoms in the general population; research indicates that some forms of counseling are effective in treating depressive symptoms in infertile women.

http://humrep.oxfordjournals.org/content/28/1/160.full.pdf

They concluded that women who are trying to conceive who have symptoms of depression and are contemplating taking antidepressant medication should speak to their doctor about trying other non-pharmacological approaches first.

The Mindful Fertility Journal is a non-pharmacological approach to treating infertility depression.

They also recommended that women who are trying to conceive and are already taking antidepressant medication should speak to a psychiatrist or other mental health professional about the pros and cons of remaining on their medication, versus tapering off their medication after they have successfully learned other strategies to treat their depressive symptoms.

There is little evidence that infertile women benefit from taking an SSRI, therefore they should be counseled appropriately about the risks and be advised to consider alternate safer treatments to treat depressive symptoms. SSRI use is associated with possible reduced infertility treatment efficacy as well as higher rates of pregnancy loss, preterm birth, pregnancy complications, neonatal issues and long-term neurobehavioral abnormalities in offspring.

Cognitive Behavioral Therapy
Most of the research on non-medication treatments for depression has been on psychotherapy, specifically cognitive-behavioral therapy (CBT), which is a short-term form of therapy in which the patient learns to recognize and challenge automatic and distorted thought patterns (“I will never have a baby,” “the infertility is all my fault”). The goal is to move towards self talk such as “I am doing everything I can to get pregnant,” and “I didn’t do anything to cause my infertility.”

The research shows that CBT is equivalent to, or in some cases better than, antidepressant medication. In one randomized controlled study with infertile depressed women, 79% of those who received CBT reported significant decreases in depressive symptoms, compared to 50% in the antidepressant medication group and 10% of the controls. Other research on CBT delivered in a mind/body group format showed that depression scores returned to normal by the end of the 10 week program and pregnancy rates were significantly higher in the mind/body group patients when compared to the control group.

http://www.resolve.org/support/Managing-Infertility-Stress/depression-and-infertility-treatment-considerations.html

The Mindful Fertility Journal uses Mindfulness-Based Cognitive Therapy to decrease symptoms of depression.

Mind-Body Programs in the treatment of Infertility
Mind-body treatment programs for infertility patients have been shown to both increase pregnancy rates as well as reduce psychological distress. The Harvard Behavioural Medicine program for infertility has been in existence since 1987 in Boston. In studies Journal of the American Medical Women’s (1999) & Journal Fertility and Sterility (2000) conducted at Harvard Medical School, 185 women who had been trying to conceive for one to two years were randomized into either a ten week mind-body group, a ten week support group, or a routine care control group. The birth rates during the one year follow-up period were as follows: – mind body 55%, support group 54%, and controls 20%. In addition, the mind-body patients reported significantly greater psychological improvements than the support or control patients. In four other published studies on several hundred women with average infertility duration of 3.5 years, 42 percent conceived within six months of completing the program and there were significant decreases in all measured psychological symptoms including depression, anxiety, and anger.

1. Domar, A., Zuttermeister, P., Friedman, R (1999) Distress and Conception in Infertile Women: A complementary approach. Journal of the American Medical Women’s Association. Vol. 54, No.4

In this study published in 1999 in the Journal of the American Medical Women’s Association, 42 percent of the 132 infertile women in the mind-body program conceived within 6 months.

2. Domar, A., Clapp, D., Slawsby, E., Dusek, J., Kessel, B., Freizinger, M (2000) Impact of group psychological interventions on pregnancy rates in infertile women. Fertility and Sterility Vol. 73, no.4 April

Findings: In this study published in April 2000 in the Journal of Fertility and Sterility, 55 percent of the 148 infertile women in the program conceived within 6 months and actually delivered babies as did 54 percent of those participating in a support group. In the group that received no psychological help, only 20 percent conceived and gave birth.

3. Domar, A., Seibel, M., & Benson, H (1990) The Mind/Body Program for Infertility: A new treatment program for women with infertility. Fertility and Sterility, 53, 246-249

http://www.ncbi.nlm.nih.gov/pubmed/2078200

FINDINGS: There is increasing evidence that a behavioral treatment approach might be efficacious in the treatment of the emotional aspects of infertility and may lead to increased conception rates. The first 54 women to complete a behavioral treatment program based on the elicitation of the relaxation response showed statistically significant decreases in anxiety, depression, and fatigue as well as increases in vigor. In addition, 34% of these women became pregnant within 6 months of completing the program. These findings established a role for stress reduction in the long-term treatment of infertility. They further suggest that behavioral treatment should be considered for couples with infertility before or in conjunction with reproductive technologies such as intrauterine insemination and gamete intrafallopian transfer.

Mindfulness
Our emotional conflicts are mediated in the limbic brain. The limbic brain is the home of the master neuroendocrine center that regulates our hormonal processes as it works with the pituitary gland in the brain to influence the functioning of the reproductive system and the entire body. Involved in the release of cortisol, the stress hormone, this limbic region is a fundamental part of the “HPA” axis—the hypothalamic-pituitary-adrenal axis that is the core of our response to stress.  Emotional messages like ‘danger,’ ‘infertile’ and ‘there is something wrong’ cause physical responses in the limbic brain. Stress hormones surge.

Fortunately, the brain’s emotional circuits are actually connected to its thinking circuits. As a result, activity in certain cognitive regions sends signals to the emotion-generating regions. So while you can’t just order yourself “relax,” you can develop mindfulness of thoughts.

When you do, the left PFC sends inhibitory signals to the amygdalae of the limbic brain, basically telling them to quiet down. As a result, the negative feelings generated by the amygdalae peter out, and you’re not inhibited by fear, shame, defeat, resentment or hopelessness. And hormones begin to regulate.

1. Galhardo, A., Cunha, M.,Pinto-Gouveia, J (2013) Mindfulness-Based Program for Infertility: efficacy study. Fertility and Sterility. 100:1059–67.

http://www.ncbi.nlm.nih.gov/pubmed/23809500

FINDINGS: The Mindfulness-Based Program for Infertility (MBPI) group and the control group were shown to be equivalent at baseline. By the end of the MBPI, women who attended the program revealed a significant decrease in depressive symptoms, internal and external shame, entrapment, and defeat. Inversely, they presented statistically significant improvement in mindfulness skills and self-efficacy to deal with infertility. Women in the control group did not present significant changes in any of the psychological measures, except for a decrease in self-judgment. Increasing mindfulness and acceptance skills, as well as cognitive de-centering from thoughts and feelings, seem to help women to experience negative inner states in new ways, decreasing their entanglement with them and thus their psychological distress. Data suggest that the MBPI is an effective psychological intervention for women experiencing infertility.

2. Self Acupressure

These studies are done with acupuncture – the Mindful Fertility Journal helps you achieve these results using the pressure from your fingers and thumbs to stimulate the same acu-points, instead of needles. For many of my clients this is hugely advantageous because of fear of needles, the cost of acupuncture, the time it saves them and the availability of acupuncture for fertility. And because you can practice everyday – twice a day – (instead of a few times a week) the efficacy of self acupressure is profound.

Highlights:

70% pregnancy rate with acu-point stimulation vs. 25% in control group
Miscarriage rate decreased by 50% and ectopic pregnancies significantly lower.
Acu-point stimulation increased the odds of a live birth by 91% compared with the control groups

Research:

1. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilization: systematic review and meta-analysis.
Manheimer E et al. BMJ 2008;336 pg 545-549 British Medical Journal

FINDINGS: This research meta-analysis examining existing high quality acupuncture research on acupuncture and IVF. The authors found that “acupuncture increased the odds of a live birth by 91% compared with the control groups”.

2. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy
Paulus W et al, Fertil Steril 2002 Vol 77, pg 721-724 Fertility and Sterility

FINDINGS: This landmark study, was published in a prestigious reproductive medicine journal.The study found that women receiving acupuncture treatment in conjunction with ART had an increase in ongoing pregnancy rates of over 60% compared to control subjects.

3. Acupuncture & IVF poor responders: a cure?
Magarelli P,Cridennda D, Fertil Steril,2004;81 Suppl 3 S20 Fertility and Sterility

FINDINGS: This retrospective study found a 40% increase in pregnancy rates in IVF patients using acupuncture. There were no exclusion criteria for the women in this study. Of important interest in this study, patients classified as poor responders (elevated FSH, longer history of infertility and poor sperm morphology) who received acupuncture demonstrated the same pregnancy rates as normal-prognosis patients.

4. A randomized, controlled, double-blind, cross-over study evaluating acupuncture as an adjunct to IVF Quintero R et al, Fertil Steril 2004 Vol 81 Suppl 3, pg S11-12 Fertility and Sterility

FINDINGS: This study showed a significantly lower amount of gonadotropins used when IVF is combined with standard acupuncture. A 70% pregnancy rate was also achieved with standard acupuncture and IVF, compared to 25% in the control group.

5. Acupuncture in IVF linked to lower miscarriage and ectopic rates OB/Gyn News, Copyright 2005 by International Medical News Group, an Elsevier company

FINDINGS: The miscarriage rate was almost halved in the acupuncture group, and the ectopic pregnancy rate was significantly lower. Overall the live-birth rate was significantly higher in the acupuncture group than the control group.

For more research on acupuncture-point stimulation and pregnancy success, click here

3. Nutrition
1. Agarwal, A. et al, 2005, ‘Role of oxidative stress in female reproduction’, Reproductive Biology and Endocrinology, Jul 14, 3, 28.

2. Altschuler, J. et al, 2007, ‘The effect of cinnamon on A1C among adolescents with type 1 diabetes’, Diabetes Care, Apr, 30(4), 813-816.

3. Bennet, M. et al, 2001, ‘Vitamin B12 deficiency, infertility and recurrent fetal loss’, Journal of Reproductive Medicine, Mar, 46(3), 209-212.

4. Chavarro, J et al, 2007. ‘A prospective study of daily foods intake and anovulatory infertility’, Human Reproduction, may, 22(5), 1340-1347. Epub 2007 Feb 28.

5. Chavarro, J. et al, 2007, ‘Dietary fatty acid intakes and the risk of ovulatory infertility’, American Journal of Clinical Nutrition, Jan, 85(1), 231

6. Cramner, D. et al, 1994, ‘Adult hupoplasctasia, milk consumption, and age-specific fertility’, American Journal of Epidemiology, Feb 1, 139(3), 282-289.

7. Daniels, J.L. et al, 2005, ‘Fish intake during pregnancy and early cognitive development of offspring’, Obstetrical and Gynaecological Survey, 60, 80-81; 2007, ‘Experts say benefits of eating fish outweigh possible risks’, Harvard Women’s Health Watch, Feb 14(6), 6-7.

8. Del Bianco, A. et al, 2004, ‘Recurrent spontaneous miscarriages and hyperhomocysteinemia’, Minera Ginecologica, Oct, 56(5), 379-383.

9. Dixon, R et al, 2004, ‘Phytoestorgens’, Annual Review of Plant Biology, 55, 225-261.

10. Ebish, I. et al, 2007, ‘The importance of folate, zinc and antioxidants in the pathogenesis and prevention of sub fertility’, Human Reproduction, 13, 163-174.

11. Helgstrand, S. et al, 2005, ‘Maternal underweight and the risk of spontaneous abortion’, Acta Obstetrics Gynecology Scandinavia, Dec, 84(12) 1197-2011.

12. Howard, J. et al, 1994, ‘Red cell magnesium and glutathione peroxidase in infertile women – effects of oral supplementation with magnesium and selenium’, Magnesium Research, Mar, 7(1), 49-57.

13. Jescheke, U. et al, 2005, ‘Effects of phytoestrogens feinstein and daidzein on production of human chorionic gonadotropin in term trophoblast cells in vitro’, Gynecological Endocrinology, Sep, 21(3), 180-184.

14. Marsh, K. et al, 2005, ‘the optimal diet for women with polycystic ovary syndrome’, British Journal of Nutrition, Aug, 94(2), 154-165.

15. Maconochie, N. et al, 2007, ‘Risk factors for first trimester miscarriage – results from a UK – population-based case-control study’, British Journal of General Practice, Feb, 114(2), 170-186.

16. Myers, G. et al, 2007, ‘Maternal fish consumption benefits children’s development’, Lancet, Feb 17,369(9561), 537-538.

17. Nagata, C. et al, 2000, ‘Inverse association of soy product intake with serum androgen and estrogen concentrations in Japanese men’, Nutrition and Cancer, 38, 37-39.

18. Parazzini, F. et al, 2004, ‘Selected food intake and risk of endometriosis’, Human Reproduction, Aug, 19(8), 1755-1759. Pub 2004 Jul 14.

19. Rock, C.L. et al, 1996, ’Nutritional characteristics, eating pathology and hormonal states in young women,’ American Journal of Clinical Nutrition, 64(4), 566-571.

20. Wilcox, A. et al, 1989, ‘Caffeinated beverages and decreased fertility’, Lancet, Apr 15, 1(8642), 840.

21.  Xu, Y. et al, 2007, ‘Effect of placental fatty acid metabolism and regulation by peroxisome proliferator activated receptor on pregnancy and fear outcomes’, Journal of Pharmaceutical Sciences, 96(10), 2582-2606.

4. Yoga

By Natalie Engler, RYT
Director of Restorative Yoga Services
The Domar Center for Mind / Body Health at Boston IVF

Restorative yoga is a gentle and effortless form of yoga that stimulates the body’s quieting systems. I have found the practice to be an invaluable tool for learning and teaching people how to relax deeply. Restorative yoga can help to lessen the emotional pressures of the infertility process by providing tools for calming negative thoughts and enjoying a greater sense of control. Once you learn how to relax, it becomes easier to do so on a regular basis. (It reminds me of using a map to get somewhere the first few times you go — and then finding your way easily after making repeated trips). Restorative yoga helps to reduce stress, which lowers blood levels of the hormone cortisol. High levels of cortisol may interfere with reproductive hormone function. In studies, yoga and meditation have been shown to lower blood pressure, elevate brain levels of gamma-aminobutyric acid, or GABA (a brain chemical that is low in people with depression), and create significant improvements in people’s sense of wellbeing. Supported yoga postures gently stretch and relax the muscles and connective tissue, increasing blood flow to the pelvis and reproductive organs. A 2003 study (1) published in the journal Fertility and Sterility found that yoga and meditation are helpful adjuncts to fertility treatments. When women learn how to attain physical relaxation, she feels better about her body and begins to treat it with more respect. This results in healthier lifestyle choices as well as a greater sensitivity to symptoms and body processes. The same study showed that yoga produces clarity of mind, a more positive outlook, and more patience for undergoing the rigors of fertility treatments. Restorative Yoga is often used in conjunction with psychotherapy. Women who use both treatments report dramatic improvements in mood, stress reduction, and enhanced primary relationships.

Research:

1. Khalsa, HK. Yoga: an adjunct to infertility treatment. Fertility and Sterility (Oct. 2003): Vol. 80, No. 4, pp. 46-51.

http://www.ncbi.nlm.nih.gov/pubmed/14568288

FINDINGS: Yoga and meditation can help women experiencing the challenges of infertility. The practice of meditation and relaxation can help increase the clarity of the mind, maintain healthy body chemistry, and give patients the patience to undergo the rigors of infertility treatments. When one understands and can attain physical relaxation, one tends to feel better about the body itself, and begins to treat the body with more respect. This understanding can lead to healthier lifestyle habits as well as increased sensitivity regarding symptoms and body processes. This is beneficial to both doctor and patient as the patient can report with more clarity and sense cycles and physical issues more readily.

2. Pilkington K, et al. “Yoga for Depression: The Research Evidence,” Journal of Affective Disorders (Dec. 2005): Vol. 89, No. 1–3, pp. 13–24.

FINDINGS: Overall, the initial indications are of potentially beneficial effects of yoga interventions on depressive disorders.

3. sljpsyc.sljol.info/article/10.4038/sljpsyc.v3i1.4452/galley/3603/download/

FINDINGS: Yoga has been with us since ancient times and has been used by mankind to alleviate various problems. Yoga is supported by research evidence as a safe, and effective method that the patient can follow at home to reduce anxiety symptoms.

Congratulations to the Class of 2022!

#classof2022 #youarethefuture #rightofpassage #loss #bittersweet #college #movingout #legacy #goforit
When you begin the process of setting external boundaries, you will first need to learn to set internal boundaries with the part of you, called anxiety, who will want to be in authority.

When anxiety is in authority within you, it will say to you, "What If?"

"What if I represent my needs and I'm rejected?"

or 

"What if I represent my feelings and I'm ridiculed?"

When you notice anxiety in authority within you, provide for it by saying, "You're safe. It’s ok.”

And then represent your needs and feelings externally.

#mentalhealth #boundariesarehealthy #justsayno #mindfulness #mindset #therapy #ihaveneeds

Art by the talent Arla Patch
Coloring Conception - website link in Bio
Enmeshment means organizing your life around the feelings of somebody else instead of validating and responding to the needs that you have.

Creating a boundary is your willingness and ability to say no.

When you have boundaries, you have your own feelings, needs, and wants.

#mentalhealth #boundariesarehealthy #justsayno #mindfulness #mindset #therapy #ihaveneeds
When you were little, who acknowledged you when you cried?

I ask this question to all of my clients.

If someone kindly acknowledged your pain, then your nervous system knew it was secure.

You knew you were safe.

If the grown-ups around you did not acknowledge your pain, your nervous system automatically told you there must be something to be anxious about.

When the caregiver, culture, friend, and family are impartial, anxiety is the result.

Mother’s Day is a painful day for so many women.

Acknowledge their pain.

My empathy cards can help.

WEBSITE LINK IN BIO
What is unrepresented within me will show up in the form of radical behavior.

Pain and disease are one form of radical behavior.

Ask yourself:

What am I feeling that I really want to say if I wasn't at all afraid of saying what is really happening for me?

AND/OR

What truth inside am I trying to tell myself but I'm not listening to, that I'm not acknowledging or that I haven’t
been able to say to myself?
Natural Cycle Meditation Series
Online Audio Course

Course Overview

Natural Cycle Meditation Series is a 28-day mindfulness meditation program focused on well-being. This course increases your capacity for presence, safety, and connection through the difficulty of a trying to conceive cycle. It teaches you to become a working force in your health and well-being a powerful agent of change.
 
Total Course Time: 7 hours 8 minutes; 15 minutes daily.

Instructor Bio
Written and Narrated by Course Instructor: Buffy Trupp, MA, RCC, LMFT

Buffy Trupp is a somatic psychotherapist and the author of the Natural Cycle Meditation Series. She has been teaching mindfulness to women and men trying to conceive for 15 years. In this 28-day meditation series, she teaches you how to discover well-being during challenging times.

Module Descriptions

Module 1: Being Aware of Reality As It Is
Meditations 1 - 7
Learn the foundational practice of mindfulness: being aware of the breath, body, and thinking to open to the present moment. 

Module 2: Removing the Obstacles to Reality As It Is
Meditations 8 - 21
Practice skillfully and compassionately detaching from automatic patterns of thoughts and feelings.

Module 3: Accepting Reality As It Is
Meditations 22 - 28
Cultivate a deeper and deeper acceptance: a state of being spacious and receptive to things as they are. This open receptivity is the source of potential and the key to well-being while trying to conceive.

LINK IN BIO

#infertility #healinginfertility #awareness #mindfulness #mindbodymedicine #mindfulfertilityproject
Excerpt from Meditation 3: Module 1

Natural Cycle Meditation Series
Online Audio Course

Course Overview

Natural Cycle Meditation Series is a 28-day mindfulness meditation program focused on well-being. This course increases your capacity for presence, safety, and connection through the difficulty of a trying to conceive cycle. It teaches you to become a working force in your health and well-being a powerful agent of change.
 
Total Course Time: 7 hours 8 minutes; 15 minutes daily.

Instructor Bio
Written and Narrated by Course Instructor: Buffy Trupp, MA, RCC, LMFT

Buffy Trupp is a somatic psychotherapist and the author of the Natural Cycle Meditation Series. She has been teaching mindfulness to women and men trying to conceive for 15 years. In this 28-day meditation series, she teaches you how to discover well-being during challenging times.

Module Descriptions

Module 1: Being Aware of Reality As It Is
Meditations 1 - 7
Learn the foundational practice of mindfulness: being aware of the breath, body, and thinking to open to the present moment. 

Module 2: Removing the Obstacles to Reality As It Is
Meditations 8 - 21
Practice skillfully and compassionately detaching from automatic patterns of thoughts and feelings.

Module 3: Accepting Reality As It Is
Meditations 22 - 28
Cultivate a deeper and deeper acceptance: a state of being spacious and receptive to things as they are. This open receptivity is the source of potential and the key to well-being while trying to conceive.

LINK IN BIO

#infertility #healinginfertility #awareness #mindfulness #mindbodymedicine #mindfulfertilityproject
Images can be very powerful fertility tools.

When you imagine, you create.

This creation is from Day 16 of Coloring Conception, an adult coloring book for women trying to conceive.

Learn more and order here:
https://www.blurb.ca/b/7014475-coloring-conception

#infertility #healinginfertility #awareness #mindfulness #mindbodymedicine #mindfulfertilityproject #coloringconception
When our defenses become our allies we can benefit from them. 

We ask the defensive part, "How did you learn to serve me in this way?"

When we understand this part of us, why it took leadership, and we are in a relationship with its intelligence, we are in a position to agree with its advice, or not.

Growth is when we can set boundaries with the defensive parts and the authentic self is in authority.

For example, "My anger is my ally and I am in control of it."

Or,

When I feel anger, I can voice it in some way and then consider whether or not I want to eat/drink/smoke.

#mindfulness #meditation #mindful #meditate #stresstips #stressreliever #innerpeace #healingjourney #mentalhealth #selflove #mindfulnesspractice #stressfree #stressmanagement #personalgrowth #personaldevelopment #stressrelief #selfcare #dailyinspiration #stressreduction #meditationpractice #stressless #stress #healing
This fertility coloring book offers inspiring mandala designs for you to color and make your own while trying to conceive. 

Each of the beautiful images has a powerful self-relaxation exercise to enhance your well-being.

By coloring and visualizing your body's fertile health, you will prime your mind for conception.

Learn more and order here:
https://www.blurb.ca/b/7014475-coloring-conception

#infertility #healinginfertility #awareness #mindfulness #mindbodymedicine #mindfulfertilityproject #coloringconception
The only guaranteed outcome of change is RESISTANCE. 

We experience resistance at each and every stage of growth.

If you propose change, your inner defensive parts will not want to come to the therapy session!

These parts have a purpose, intelligence, and carry a need and a desire to survive. 

In the therapeutic process, we must respect them as living beings and their desire to exert their leadership as protection.

When we step into the world of the defenses and honor them, safety is established and the change process begins.

#mindfulness #meditation #mindful #meditate #stresstips #stressreliever #innerpeace #healingjourney #mentalhealth #selflove #mindfulnesspractice #stressfree #stressmanagement #personalgrowth #personaldevelopment #stressrelief #selfcare #dailyinspiration #stressreduction #meditationpractice #stressless #stress #healing
There is no healing the body or healing the mind; there is just healing. There is no separation! When you heal, you become. You become a Mom or whatever you long to be.

#infertility #healinginfertility #healing #awareness #mindfulness #mindbodymedicine #mindfulfertilityproject
"What everybody wants is to be understood; for their feelings to be acknowledged. Acknowledgment doesn't mean you have to agree. Acknowledgement means allowing what someone wants to express to be expressed." 

Meditation 13 - Removing the Obstacles to Intimacy While Trying to Conceive

Natural Cycle Mediation Series

http://mindfulfertility.thinkific.com/courses/natural-cycle-meditations

#infertility #healinginfertility #healing #awareness #mindfulness #mindbodymedicine #mindfulfertilityproject
On my decade's long journey as a somatic psychotherapist, as a patient of psychotherapy, as a meditator, as a student of various wisdom traditions, and as a human being making embodied sense of my own trauma I’ve realized that the great unifying principle to health and well being is integrity.

In a typical conversation, we think of integrity as something we have or don’t have. The same is true for dis-ease.

But if you look closely, dis-ease and integrity are not something we have or don’t have. They are an internal representation of our lives both collectively and individually.

Dis-ease is fundamental and wise. But only when we’re informed by it.

Let’s start with language.
 
When we presence, become aware of, and look at the process and language, the sentiment or thought or belief that I have a dis-ease. It looks like there is an “it” called dis-ease that happens to happen inside of my body and I don’t have any access to it nor do I have any control to change it. There is a thing, an “it” called dis-ease and I have it. Doctors say I have a dis-ease and I confirm it. And so I have coherence with authority figures and with the culture. When we think like this we invest in each other’s trauma; the belief that we are separate from our bodies.

When in actuality, I don’t have a dis-ease.

I am tightening up to suppress or compress my experience. I am actively holding my experience out of my awareness. Then I take medicine or undergo surgery to deal with the symptom that I am. So trauma becomes normalized in our world, in our language, in our body, and in our medicine.

Trauma is numb to information.

Healing trauma begins by courageously becoming informed. When we learn to let dis-ease inform us, we become a working force in our own health and well-being and a powerful agent of change.

#infertility #healinginfertility #healing #awareness #mindfulness #mindbodymedicine #mindfulfertilityproject
Reality is not good or bad, right or wrong. Reality is what's happening right now. This moment, just this moment, is the way that it is.

#infertility #healinginfertility #awareness #mindfulness #mindbodymedicine #mindfulfertilityproject
When we experience pain, our automatic tendency is to hold it outside of our awareness. We do this without knowing we do this by blaming, judging, analyzing, worrying, shaming, fixing. Not feeling pain seems so justified. But we cannot heal when we can't feel. Healing is a four step process:

1. Awareness begins the healing journey. It is the process of becoming informed, of bringing how and what we hold out of awareness, into awareness. It is the process of deactivating shame and fear so we can feel what is below them.
 
2. Acknowledgement involves compassionately greeting all that we have denied, disowned, dissociated, projected and suppressed: beginning to feel all that we have intelligently and actively held out of our awareness.
 
3. Healing is the work of opening or returning connection to these suppressed, denied, dissociated, projected parts within ourself and in our relationships. The work begins within the therapeutic relationship.
 
4. Integration is the restoration of our capacity for presence, safety and connection through any experience; a moving toward what’s happening, even if it’s painful. This is the ultimate act of the mothering and it's essential for healthy brain development in your baby and young child. 

 
My approach is rooted in awareness-based, somatic psychotherapy. Through a focused method of individual therapy and customized meditations, you will master healing.  When you do, conception is often a side effect; spontaneous conception, conception through IVF, Egg Donation or adoption or by any means you choose to create your family.

#infertility #healinginfertility #awareness #mindfulness #mindbodymedicine #mindfulfertilityproject
When you begin setting boundaries, you will have to provide for the part of you called anxiety.

Anxiety will say to you, "What If?"

"What if I represent my needs and I'm rejected?"

or 

"What if I represent my feelings and I'm ridiculed or worse, ignored?"

To begin to provide for the part of you that is anxious, say, "You're safe. I'm here for you. I won't abandon you." 

#mentalhealth #boundariesarehealthy #justsayno #mindfulness #mindset #therapy #ihaveneeds
Mindful Minute

I invite you to begin by letting your attention descend into your body, descend out of your mind and out of your head and just let your attention descend down through your chest and into your lower belly.

Allowing your breath to move in and out through your lower belly; just attending to your breath in your belly.

If you’re not trying to control anything or change the quality of your breath, if you’re just being aware of the quality of your breath in your belly you’ll notice that it has a tendency all by itself to begin to calm the nervous system. 
 
Just the act of conscious breathing resets the nervous system and calms it and allows it to return to a more natural state, to a more peaceful state.

Excerpt from Meditation 24 - Natural Cycle Meditation Series

Link In Bio

(Video is from a recent trip to Haida Gwaii)

#infertility #healinginfertility #awareness #mindfulness #mindbodymedicine #mindfulfertilityproject
Mindful Minute

Once again I invite you to allow yourself to become aware of the breath as a way of gathering your attention down into the body.

Allowing your attention to come out of your mind and allow yourself to be aware of your mind and your body relaxing.

And as your body relaxes, awareness and the energy of your body begin to come down and inward into the lower abdomen as you’re breathing.

And I want to remind you that to be aware doesn’t mean to be selectively aware. It doesn’t mean you’re trying to shut anything out, any thought, any feeling, any image.

To be aware just means that you’re putting your attention on the awareness itself and so if a thought arises, it’s just a thought and you’re only being aware so you’re not adding more commentary, you’re not judging yourself for thinking, you’re just only being aware of the thought as it arises and passes away.

So whatever arises, you’re just letting go of judging it in any way. Positively or negatively and you’re just letting go of commenting on it or analyzing it and you’re only being aware.

Awareness is the backdrop upon which ALL of our experience unfolds.

Sensations come and go in awareness, as do thoughts, as do feelings.

It seems like when we’re thinking our experience of ourselves is whatever we’re thinking. Our thinking becomes our experience of ourselves.

We think we are our thoughts.

That’s part of our habitual tendencies. That is part of our conditioning.

And yet thoughts come and go but somehow we exist whether we’re thinking or not.

So just take a moment and let yourself feel the deepest part of your being.

Because you’re not just experiencing awareness, how it feels, the quality of it, the texture of it but you’re actually being it.

Awareness is a deep aspect of who or what you are.

Meditation 3- Natural Cycle Meditation Series

Link In Bio

#infertility #healinginfertility #awareness #mindfulness #mindbodymedicine #mindfulfertilityproject
For a minute, begin settling into your body and into your breath, and just allow your attention to naturally gather into your breathing.

Notice how doing that, simply resting your attention down in the belly, starts to calm your nervous system.

You may notice your shoulders begin to relax as energy moves down from your head, down through your shoulders, down into your belly, and even now down through your feet, into the ground. 

You can begin to feel that sense of rootedness and the way in which you are always being supported by awareness. 

And you can feel how your body likes to feel what’s underneath, your body likes to feel what’s holding you.

Your body feels most comfortable when it’s held in awareness.

Your nervous system calms down and your body starts to feel at home and supported. 

And just like awareness supports your body, your body supports the breath.

The body is the space for the breathing to happen in and there’s such a great intimacy between the breath and the body and awareness. 

Meditation 7 - Natural Cycle Meditation Series

Link In Bio

#infertility #healinginfertility #awareness #mindfulness #mindbodymedicine #mindfulfertilityproject
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