Andrea McCarthy is delighted with her new baby. That is not an unusual reaction, but for Andrea, the birth of Timothy Paul followed four years of frustration, doubt and depression-four years of trying for a baby, and
”failing.” Four years of unexplained infertility.
”I always thought of myself as a `nice` person, but during that time I evolved into a monster,” confesses McCarthy, 32. ”I became neurotic-living in fear of a pregnancy announcement. If it wasn`t me, I didn`t want to know.” She felt isolated, but McCarthy is not alone. One in six couples has problems with infertility, and while physical causes often can be found, a significant percentage of cases remain unresolved.
”There are many, many options for the infertile couple,” says Dr. Melvin Cohen, director of The Fertility Center in Chicago, which offers in vitro fertilization among other medical alternatives.
But finding out what`s wrong can be as complex as correcting the problem. Frequent physical checkups, constant monitoring, and open, explicit detailing of sexual activity for medical analysis often make the severe psychological trauma of infertility even worse.
”After a while, I began to feel like a lab specimen,” says McCarthy.
”Every time we had intercourse I had to run off for tests-it was humiliating, demoralizing: I felt sexually exploited. Then the doctor said there was nothing wrong with me, and I should just go home and have a glass of wine!”
Helene, 30, has been trying to become pregnant for six years. She says:
”I was a superstar with a career-I wanted a profession. I thought I could have children when I liked.”
There is no apparent reason why Helene and her husband cannot conceive.
”I always believed that if you work hard and try with all your might, you`ll get what you want,” she adds. ”With infertility, it`s just the opposite.”
Cohen says, ”The type of patients I see are often the more or less successful entrepreneurs, with a high degree of intelligence-and of stress. But it is not practical to tell them to get out of high stress employment.”
Both McCarthy and Helene took steps toward reducing their level of anxiety by enrolling in a pioneer clinical program offered by the Section on Behavioral Medicine at New England Deaconess Hospital in Boston, Mass., a Harvard University affiliate.
The hospital`s Mind/Body Program for Infertility is the first of its kind in the U.S. Its aim is to reduce stress among women with unexplained infertility. By reducing stress, the program aims to increase the women`s chances of becoming pregnant.
Psychologist Alice Domar founded the program in September, 1987. Her approach is based on research that shows a significant link between the level of stress and the chances of conception. Specifically, it`s known that the body`s response to stress is controlled by the hypothalamus, the master gland of the brain, which regulates all hormone activities, including those that affect ovulation.
Research has shown that stress can affect progesterone levels, and can lead to an irregular menstrual cycle. Stress very probably causes Fallopian tube spasm, which can prevent an egg from reaching the uterus. It may also prevent the ovarian follicle from rupturing to release the egg.
Numerous clinical examples suggest the stress-infertility link. One study, by doctors at the Albert Einstein College of Medicine in New York, followed 19 cases of unexplained infertility over three years. Nine women
received treatment in the form of psychiatric therapy, and a third of them became pregnant. None of the other women conceived.
A similar study by doctors in two Dublin hospitals in Ireland tested (but did not treat) stress levels in 30 infertile couples over a period of time. Of the 11 couples who showed severe stress, only one became pregnant. By contrast, seven couples shown to be ”stress free” became pregrant.
When McCarthy first heard about the Mind/Body Program, she was not sure it would help. ”But nothing conventional had worked. . . and I was wondering if this could all be in my head-I was totally engulfed by everything, with not a clue how to put it back together.”
Domar has become used to an apprehensive, even hostile, approach from her patients, especially because so many have been told by well-meaning friends and relatives that if they would ”just” relax, things would take care of themselves.
”It is very offensive to tell a woman to stop worrying and she`ll get pregnant.” says Domar. ”That puts all the blame on the shoulders of the woman.”
The Mind/Body Program reduces stress scientifically. ”When most people say relax, they mean go on vacation, or have a glass of wine,” she adds.
”When I talk about relaxation, I mean to elicit the relaxation response, which produces reliable and consistent physiological changes in the body. You do not elicit this response by watching television. You do it by sitting down and following several different steps.”
The ”relaxation response” can best be described as the opposite to the
”fight or flight” response, when the adrenaline is flowing and the body is ready for action.
By contrast, the relaxation response decreases metabolism, slows down respiration, lowers blood pressure, and induces in the body a state of deep physical rest, all of which counter the effects of stress. It can be brought about by many methods, including meditation, prayer and mental imagery.
So far, the theory seems to have worked. Thirty percent of the women who have taken part in the program have become pregnant. The expected rate of pregnancy among such couples with unexplained infertility problems is around 5 percent.
Domar works out percentages for the curious with an air of resignation. She is hesitant to take credit for a 30 percent success rate. ”I don`t want that to be the emphasis. Ninety percent of women feel better after the program. That`s what I count as our real success rate.”
The women in each group of the Mind/Body Program take part in a 10-week course, with partners attending two sessions. The focus is the relaxation response, but the program also involves group discussion, stress management and gentle exercise. Participants learn how to adopt a positive attitude to regain self-respect, and receive advice on good nutrition. The aim is to decrease their anxiety and tension, while increasing their sense of energy and control over the body.
At first, McCarthy hated the group sessions. ”I just sat there looking around, listening to all the painful stories. I thought: ”So this is what a room full of infertile women looks like. Is this my future?” It scared me to death.
”The first week we had to create a mental image of something we liked to do. I was so out of touch with myself, I started asking if there was anything I liked to do. It seemed I spent all my time crying, bitching and being angry. ”One of the things recommended was that I spend at least half an hour on myself every day . . . Gradually I started to feel like a whole person again, to regain some of my pride and self-respect and to rebuild a positive frame of mind.”
By the time the program ended, McCarthy says, ”I`d been given myself back, and I was more patient and in control. Life began to look like a jigsaw puzzle-not all the pieces were in place, but at least I could see the picture.”
A short time after completing the program, she became pregnant. ”I couldn`t believe it!” she admits. ”It was the biggest affirmation I`ve ever had.”
Helene, on the other hand, didn`t conceive. ”I must admit I was disappointed. . . . But my crying spells have been reduced by about 70 percent, and whereas I used to be jealous and self-pitying around women with children, now I can feel happy at baby showers and birthday parties. I have learned to have more control in my own mind. The storminess has been quieted.”
It is impossible to estimate whether the growing number of women in high stress career positions, juggling work and family priorities, has led to an increase in infertility. Figures are unreliable. For one thing, infertility has been a closet issue. Couples often said they chose not to have children, rather than admit their inability to conceive.
What is certain is that many people are choosing to have children later in life, when time pressure intensifies the stress, and when their fertility is already on the decline.
”Age is definitely a factor,” says Cohen. ”Show me a couple who have been married 15 years, where the wife is 38 years old, and the husband maybe five years older. This is a problem situation.” He says that in terms of fertility, ”The couple who marry young, have their children young, and then go on to a career are the ideal.”
This may not be the ideal in today`s business climate. Nature has her own mommy track, and her own track rules. She will not learn to play by ours.
