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, February 24, 2011

The role of anxiety in infertility treatment

Anxiety is an unavoidable part of infertility treatment, and it is probably one of the main reasons that the process often is so traumatizing. After all, there are so many opportunities for worry during every treatment cycle, from successfully being cleared to begin treatment, response during treatment, embryo fertilization and survival, and of course, the outcome of the pregnancy test. Many of these things are out of our realm of control, and worrying about how it will all turn out is sometimes all we have left to "do". In addition, treatment cycles usually stretch out over a month or more, with long periods of time in which we must simply wait to get more information. Thus, much of the time, we look at the anxiety we experience during infertility treatment as something we must manage and work around, rather than something to which we need to directly respond.

However, there are times when anxiety can play a positive role in infertility treatment. Anxiety can function as an important signal that there is something in the situation that is not safe or good for us. In such cases, if we don't respond to our anxiety, we can be missing opportunities to improve our situation.

From an evolutionary perspective, anxiety functions as a protective mechanism. Because we must take in a large amount of information from our environment quickly, we often respond to threats on an emotional, rather than a cognitive basis. As soon as a threat is perceived, our emotional response of anxiety and fear, such as "Oh no! Hungry tiger over there!" quickly helps our bodies respond to the situation, providing the energy to do what must be done to ensure our survival (in this case, running away).

Although most of us no longer spend lots of time in the jungle keeping our eyes out for tigers, the protective mechanism remains the same. Thus, if during the course of your infertility treatment, you suddenly find yourself experiencing intense anxiety, I think it is important to take some time to figure out why. Did something just happen with your treatment that you found concerning, even if your doctor or nurse didn't? If so, it may be important to investigate this further--it has been my experience that even the best of medical professionals can occasionally miss a detail that might turn out to be very important in the case. For example, a friend of mine became anxious during her IVF cycle when she noticed that the time of retrieval, her lining was only 5.5 mm. She raised this issue with her RE, but he wasn't concerned about her lining and did the transfer anyway, which resulted in a chemical pregnancy. Her anxiety about her lining persisted, and she decided to get a second opinion. During that consultation, the new RE agreed with her concerns about her lining. As she pursued treatment with him, it turned out that she indeed had huge lining problems--causing her cycle to be canceled twice until they finally figured out the winning combination of medications to get her lining to the proper thickness. However, once her lining was good, she was able to get pregnant and carry her baby to term.

I think another important type of anxiety that often goes overlooked is rooted in the physical, body sensations that women often have during infertility treatment. Although I think most doctors don't put much stock in these perceptions, I have found that women who are infertility treatment tend to be so aware of their bodies they can often tell that something is awry before it appears in lab results or on a medical exam. For instance, they may be able to discern that their bodies aren't responding to medication in the desired way. Also, on several occasions I have observed that women have been able to sense when an early pregnancy isn't going well, even before their HCG levels start dropping. If you are in treatment and you have anxiety due to the persistent sense that your body is just not feeling right, I would encourage you to report that to your doctor and investigate it further if need be.

In sum, although anxiety during infertility treatment is usually never pleasant, it can sometimes provide us with useful information. Learning to discern whether or not an anxiety signal is a response to a potentially threatening situation, or whether it is in response to merely feeling out of control, is an important aspect of managing--and surviving--infertility treatment.


  1. during our first IVF back in September, I ended up with a TON of anxiety because there was a BRAND new ultrasound tech at the RE --who I got stuck with during TWO crucial ultrasounds, and I didn't think that she should have been alone yet. Prior to those 2 ultrasounds, she was in training and couldn't find my left ovary -- she looked for it for what felt like a good 7 minutes before finally calling in the other girl. Her digging HURT too. I had never been told prior to that day that my left ovary was a little high--the experienced techs have never had a problem. So you can imagine my woes when the following ultrasounds were done by her with NO one to back her up. I was SO incredibly afraid that she was measuring my follicles wrong or didn't know how to count them (because to me, I never understand how they distinguish one from another, when there are so many), and that my med doses and EVERYTHING really was based on what she said (with my bloodwork to back it up, of course). I actually expressed my concern to the nurse after the 2nd u/s by new girl, and she said they are going by blood work too, so I shouldn't worry.

    I felt like there was just too much at stake to have this brand new girl who couldn't even find my left ovary doing my IVF monitoring ultrasounds. By the way, I was donating half of my eggs to my friend who has none, so we were trying to get the maximum that my body would produce (and I only had about 12 follicles). So I kept thinking "Of all times for this new girl to start, it just has to be now, on ME, when there are TWO women at stake in this situation".

    I wondered if my fears were valid or if I was just too stressed out from everything. What do you think? (and sorry this comment turned out so long)

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  2. great post. I had some counselling after my 2nd mc and brought up the behavioural responses I had found following this, around other babies and preggy ladies/talk. I felt like a fraud beforehand, couldn't understand why I was reacting so strongly. The counsellor I saw said pretty much as you have above, about the limbic system and the jungle.
    Result: felt like less of a fraud. I have read in online forums about other women feeling similarly . . . its quite common after mc/during IF

  3. The anxiety doesn't go away after the baby is born. I didn't go through IF treatments, but after two miscarraiges, I am finding that I am still waiting for the other shoe to drop, even though we have a perfectly healthy baby girl. I know it's irrational but I sometimes find myself fearing the worst.

  4. It is so easy to forget that the anxiety can serve such a good purpose. Thanks for the reminder to pay attention to it.

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