Anxious about when you will be able to start a family or whether you even should?
Many of the patients I work with in NYC are powerful, dynamic, successful women (and men) in their 30s and early 40s whose focus has been career-building and who have significant anxiety about whether and when they will have an opportunity to have a family of their own, or whether they even want to at all. There are just so many factors to consider, from unconscious but influential messages internalized throughout life about parenthood to rigid ideas about the “right” way to go about constructing a family to finances, and so much more. Often, the work of uncovering all of those pieces can take time – time that a person in their 30s or 40s may feel they do not have because of anxiety around an impending end to their fertility. When these questions begin to arise in therapy with me, one of my first recommendations is that the person consult with a fertility specialist as soon as possible so that they can learn about their options in reality, rather than just what they fear may be the case based on what they’ve heard from friends or family or Google. Having tangible information about one’s current reproductive capacity, as well as about what the various fertility options entail, can liberate people from a dark, scary mystery based in fantasy so they are free to explore the other pieces of the puzzle involved in making decisions about family-building.
What does an expert have to say about anxiety and fertility?
If asked for a recommendation for a fertility specialist, I always recommend my esteemed colleague: Dr. Sheeva Talebian, a founding partner of the CCRM New York Fertility Clinic. Dr. Talebian is a kind and engaging physician, a leader in her field, and was recently named to 2018 Castle Connolly Top Doctors in Reproductive Endocrinology and Infertility. She also co-produces Truly MD, a very accessible “real talk” website and e-newsletter dedicated to providing information about women’s reproductive health from the perspective of physicians.
I recently asked Dr. Talebian some of the most common questions that come up in therapy about the intersection of anxiety and fertility, and I am pleased to be able to share her thoughts in the below exchange:
Q: What effects are you seeing anxiety have on women in NYC in general?
A: I see anxiety manifest in many different ways in my patient population. In general, NYC can be a difficult place to live. There is CONSTANT activity. It is loud and busy. A simple commute to work or a social engagement can be stressful. There is also pressure financially and socially. Adding fertility struggles on top of our baseline stress can be overwhelming to put it mildly. The worst impact of stress that I see, is when it impedes women/couples from coming in to seek treatment or it leads to them stopping treatment before achieving success. I often say, resilience is the most important factor when predicting the success of fertility treatment.
Q: Is there anything about being a woman in NYC that you believe specifically impacts levels of anxiety?
A: As I describe above, I think in NYC EVERYTHING moves faster. Getting around the city can be stressful. We don't have the same access to fresh air and nature. Sometimes finding a quiet space can seem impossible. I think the constant stimulation that we face as New Yorkers adds a layer of stress that women in other cities and towns do not have to face (or at least to the same extreme).
Q: How do you see anxiety showing up in the fertility clinic/reproductive medicine office?
A: Anxiety can present as illness, weight loss, weight gain, sleep disturbance, depression, anger – I can go on…
Q: What are you looking for in your patients (or their partners) that would lead you to suggest they seek anxiety treatment?
A: When I sense that feeling of defeat in a woman/couple, I often offer referrals for additional support – specifically a mental health specialist. When women/couples are complaining of an inability to sleep well, lack of happiness, anger and frustration – I also give referrals.
Q: What specific concerns do you have about anxiety, either cause or effect, for women considering or navigating:
A: Anxiety may be the reason a woman who wants to egg freeze does not. Women who are candidates to egg freeze (not yet in a relationship but desire children) often have anxiety about their status. They often say, "I never thought that I would ever be in this situation." They tell me that it took them months to make the appointment to see me. It makes me believe that there are so many more women who want to learn about egg freezing but are too anxious to come in for the consult and as a result, never pursue this route.
Trying to Conceive (“TTC”)
A: We often spend much of our reproductive years avoiding pregnancy but once the decision is made to start a family, the desire often becomes intense and we want immediate/instant results. When pregnancy does not occur in the first few months, anxiety just continues to build with each progress[ing] month. Many women tell me "my mother says if I just relax I will get pregnant" – I hear this type of comment often. But for any of you [who] have started TTC and it doesn't happen in your expected time frame, relaxing is NOT easy. Anxiety is rarely the sole cause of infertility, but it certainly does not help and can compound other issues. So, if you are TTC – I would recommend measures to decrease anxiety (meditation, exercise, therapy, support groups).
A: Surrogacy is a process that most people know very little about. It is also stressful to "give up" the control you would have carrying the pregnancy yourself. I always recommend seeing a therapist to discuss the emotional aspect of surrogacy prior to making this decision.
A: As with surrogacy, the prospect of egg donation can be foreign and scary. I always recommend any woman/individual/couple seeking egg donation meet with a therapist well versed in this process to review all aspects surrounding egg donation. Even in couples/women who are certain this is the route for them, I still recommend at least one visit. It can only be a benefit to speak through the complexity of this process with a trained professional who has a background in "third party reproduction" (donor egg/sperm, surrogacy).
Same sex reproduction
A: Many decisions [need to be made] with same sex reproduction – whose eggs? whose uterus? and sperm? Speaking with a trained specialist can help you navigate some of these questions – along with meeting with a specialist who can do medical evaluations and provide resources to make these decisions.
A: Obviously this is an important decision that can be very anxiety provoking. A support system is imperative when making the decision and during the process of getting pregnant and postpartum. Again, I would recommend meeting with a therapist who specializes in single motherhood to help you navigate the decision and emotional aspects.
A: Each miscarriage is a loss. With each loss, stress/anxiety/depression increases. Women and couples who undergo chronic miscarriage need as much support as possible. Your doctor can help evaluate the underlying cause and recommend treatments to improve your chances. A mental health specialist can help provide the emotional support needed to continue trying.
Secondary infertility (infertility after a successful pregnancy and delivery)
A: Women who have [had] no issues conceiving in the past are often taken by surprise when they have trouble for a 2nd or 3rd child. This can add stress and anxiety to your relationship and take emotional energy away from the child(ren) you already have.
Q: What about for partners of women who are TTC (or any of the above)?
A: The partners should not be forgotten. It can be very difficult if it is not your body that may be miscarrying or failing to get that + pregnancy test. It is important for partners to also be acknowledged as the patient and offered support.
Q: How do you consider anxiety medication as part of a treatment plan when working with a woman who is TTC?
A: If you are under the care of a psychiatrist who believes you will benefit from medications, I support that plan. Most anxiety/depression medications are safe to take when TTC and even during pregnancy. Just be sure to share your pregnancy attempts/plans with your physician.
Q: Is there anything else about anxiety that is not covered above and is related to your practice of reproductive medicine that you want to discuss?
A: There is no reason to suffer. If you feel anxiety/depression are negatively impacting your quality of life, please share this with a doctor, nurse or other healthcare provider that you feel comfortable with. Treatment is available and can only help your endeavors to start a family and be a happier healthier parent.
There is no reason to suffer.
As is clear from Dr. Talebian’s perspective, anxiety can both arise in and also have an impact on many different parts of the fertility journey. Taking steps to recognize, treat, and manage your anxiety can be crucial in your family-building plan.
If you are wondering about your own anxiety and how it might intersect with your reproductive health or family plan, please contact me here to schedule a free 20-minute consultation where we can discuss whether anxiety treatment might be one of your next steps.