This blog addresses various emotional aspects of experiencing infertility. It is written by a clinical psychologist who specializes in infertility counseling. Thank you for reading, and best of luck with your journey!

Thursday, September 16, 2010

The negatives of positive thinking--denial, optimism, and pragmatism in infertility treatment

One question I am frequently asked by clients in the process of infertility treatment is what sort of attitudes and expectations they should maintain about the outcome of their treatment. In my experience, it can be common for some infertility patients to maintain a very optimistic outlook regarding their chances for success, even in light of indications to the contrary. Frequently, people with this outlook are seemingly afraid to explicitly acknowledge the possibility of problems or failure. In this post, I am going discuss some of the pitfalls of this type of thinking as it relates to infertility treatment.

Why thinking positively may not always be the best thing to do

You may be wondering what on earth could be wrong with maintaining a positive attitude in even in the face of a challenging situation. I realize that my argument does fly in the face of much conventional wisdom, but I think that having an unqualified positive attitude may give rise to two problems. The first is that it can make it difficult to acknowledge and respond to important medical and situational information. The second is that it can make it difficult to acknowledge, process, and respond to negative emotions, such as fear, anger, despair, and hopelessness, that are an all too common part of the experience of infertility.

In our culture, there has been a great deal of recent emphasis on thinking positively, as epitomized in books such as "The Secret". The fundamental gist of these beliefs is that to get a positive outcome, you must only think positive thoughts about your situation. Thinking negative thoughts is not good as it will somehow bring negative energy, and negative outcomes, your way. You have no idea how much I wish that it was really that simple, because life would be a much, much better place. But the fact is that although you can think as positively as is possible, the power of your thoughts cannot change the physical reality of the situation. I remember in my second IVF cycle, I decided to use a lot of positive imagery and visualizations as a way of improving my ovarian response. During the early part of the cycle, when we could still travel, my husband and I serendipitously came across $300 round trip tickets to Hawaii. What better place to have a positive attitude? One day as I snorkeled among the beautiful fish through the sunbeams, I imagined the warmth of the sun healing my underachieving ovaries. Then unbelievably, I was suddenly joined by a pod of spinner dolphins, who surrounded me, leaping in the air. The pod was filled with several pairs of mother and baby dolphins--what could be a better omen than that, right? Flash forward to my first big ultrasound for that cycle, and--you guessed it--there was no dolphin magic for me. Although it was an amazing experience, it didn't change the reality that my ovaries were not up to par. If I didn't accept that information and respond to it, both practically and emotionally, I would not be able to make decisions to maximize my success given my situation.

In my opinion, not accepting the possibility of a negative outcome, or believing that positive thinking can trump physical realities, really isn't positive thinking at all. Rather, it is denial. It is much more common in infertility treatment among people who tend to use denial as their main psychological defense in other areas of their life. And I've seen it have some very negative long-term effects in people's lives. So trust me, you don't want this to be you.

Secondly, I have found that some people are afraid that if they consciously acknowledge their negative feelings about their prospects, they will somehow "cause" their treatment to fail. The idea that negative thoughts or feelings by themselves can produce some sort of negative outcome is quite common and in fact is a normal part of our childhood emotional development. If we don't get the proper responses to our negative emotions as children, this belief can sometimes persist, albeit unconsciously.

However, if we deny ourselves the opportunity to acknowledge and express negative feelings as they come up (and in infertility treatment, believe me, they are going to come up sometimes) we unwittingly create more problems. In order to avoid awareness of our negative feelings, we must use up a lot of psychological energy. This can be exhausting and draining, but may lead to a more serious problem--it can chronically raise our cortisol levels, which has been linked to several negative health outcomes and may even impair our fertility--although the jury is really still out on that one. Plus, we don't get the benefit of the information about ourselves and our situation that our negative feelings are giving us. Just as thinking positively cannot transcend our medical reality, acknowledging negative feelings and working through them in a measured way can't make our medical reality worse.

The power of practical thinking

Now I am by no means suggesting that one should adopt a doom and gloom attitude when it comes to infertility treatment. I believe that positivity has its place, and that optimism is a very useful outlook. But it must be tempered with an awareness of the problems that we currently face, as well as the negative outcomes which potentially occur. As much as I've witnessed bad things happen to people in their infertility treatment, I've also witnessed true miracles. But these miracles usually happened to people who acknowledged the problems in their situation, and adapted their treatment strategy to them--often with great daring and personal sacrifice. It has taught me that true optimism and hopefulness isn't really what you think or feel--in the end, it's what you do that counts. Pushing ahead as best and as wisely as you can, being fully aware of the emotions involved and the risk of failure--to me that's optimism and bravery at its best.


  1. I just wanted to thank you for what you have been sharing through this blog. I have really appreciated the perspective you bring as a psychologist and a woman who has gone through IF. Every post has been interesting, well-written, thought provoking and enlightening. I look forward to each one!

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  2. Wow, I just did a post about that this morning! Thank you.

  3. Great article. My own therapist and I have discussed this at length. She has talked me about being cautiously optimistic. Being real about that face that this IVF is not a guaranteed thing.
    This attitude helps a lot considering people love to tell infertile people. Just Think Positive. My mother being the #1 culprit.

  4. Thanks so much for all of your comments. I am glad that some of you are finding the blog helpful. I know it helps me to write it...and it's good to know that all that suffering was not for nothing! Please let me know if you have any questions or suggestions of topics you'd like to see discussed. And best of luck to everyone!

  5. Thanks for this wonderful article. I all too often fear I will jinx myself by not thinking positive and it can be exhausting to be honest!

  6. Perhaps it's not "thinking positively" per se, but being in an open listening, loving frame of mind? Listening to and healing your body from within while calmly and non-judgmentally hearing the challenges your body has TTC.

    Not that I have any particular need to defend 'The Secret', yet it has been misunderstood. Their thing is actually about seeing positive outcomes for the ACTIONS that you take. They're are about taking action. That being said, the main producer, Rhonda, has written that she cured her short-sightedness with a "mind over matter" type visualization. And don't forget folks like Louise Hay who cured herself from cancer...

    So the more I think about it, I'm not sure I wholly agree with you, and the more confused I'm getting! How do you reconcile those mentioned above (and the scores of other stories around) with stuff that really doesn't work - like the Christian Scientist family in my daughters' school who insisted they were curing their kid's lice infestation with prayer, when in actuality our kids suffered repeated lice outbreaks (thanks to them) for the entire school year? It was brutal!

  7. wonderful post! I think it should be required reading for everyone who is telling me to think positively and not worry about the fact that I might have to deal with a stillbirth again!

  8. Great post! Thank you! First time I come in here and it was exactly what I needed to hear.

  9. I am a person who avoided starting fertility for a long time in fear that I would hear bad news. In the end, I tried fertility treatments and was eventually successful after months and months of bad news. The attitude that helped me during my fertility treatments was to see each month as a month in which I would or would not know that I had done all I could to try and get pregnant. I decided I would feel worse if I did not try than if I tried and failed. Every month was grueling, but by focusing on my choices rather than the outcome, I at least got little kudos for myself along the way.

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