How to Cope With Stress During Infertility
When Dr. Rachael Cohen was 33 and doing her training in fertility following her OB/GYN residency, she completed several IUI cycles and noticed her hormone levels were diminished for her age. The head of her clinic sat her down and encouraged her to do fertility treatment (IVF). “You need to do this now," he told her. But like many people who have trouble getting pregnant, Dr. Cohen, now a reproductive endocrinologist, was hesitant to start the invasive and costly process. Even though she was working at a fertility clinic, and could have been treated by the staff there, she was anxious about starting on that journey. “I'd never undergone any surgical procedure and you're giving up a lot of control," she explains.
Dr. Cohen's experience is not uncommon. "Many patients are afraid of side effects and worry that the treatment is painful," she says. "In addition, there is the thought, ‘Is this something that can resolve itself eventually on its own?’”
Sources of Stress During Infertility Treatment
There are many other potential sources of stress around infertility and getting treatment, Dr. Cohen says.
The Cost of Teatment
Infertility treatments are expensive, with medical costs of one IVF cycle> ranging from $10,000 to $25,000, not including medication. “Cost is one of the biggest factors why people are hesitant about infertility treatment," says Dr. Cohen. She notes that having insurance coverage for infertility treatment helps alleviate this stress.
Access to Care
Some people have to drive far (or even fly) to find a specialist, and that delays treatment. “Now that telemedicine is more available, access to specialists has improved," Dr. Cohen says. During the pandemic, many clinics are offering telehealth introductory appointments, which can help people make more informed decisions about finding a doctor or a clinic.
Fear of Failure
Many women worry that infertility treatment is not going to work. “In the end, there's no guarantee," says Simone Hunziker, Director of Clinical Solutions at Express Scripts. During her own IVF treatment, Hunziker found that was one of the “hardest concepts" to wrap her head around. “The idea that I can go through all of this and I may not have a baby in the end—that's a really big stressor."
Worrying About Stress
Some patients worry that their infertility is caused by stress—and infertility treatment adds to this stress. But being stressed about infertility treatment is “completely normal," Dr. Cohen says. She tells her patients that IVF treatment is “unfamiliar and different, and it's normal to be uncertain about the unknown" and to remember that "everyone around them is probably feeling the same way."
Being stressed about infertility or infertility treatments, though, doesn't mean reduced chances to conceive. “We all walk around pretty stressed and yet many women conceive naturally," Dr. Cohen likes to remind patients. She also tells them that when she conceived through treatment she was actually on call, one of the most stressful and taxing assignments for a new doctor.
How to Maintain Mental Health During Treatment
Struggling with fertility can be a trying experience. “Patients going through fertility challenges can experience symptoms of depression, anxiety, or other mental health conditions," says Kelcey Blair, Vice President, Clinical Solutions at Evernorth.
As they begin their journeys, patients are typically very hopeful of successfully bringing a child to this world, "but if there's month after month of failure, that hopeful feeling can veer toward depression," she explains.
Hunziker knows firsthand the impact on mental health of infertility treatment.
“Facing infertility can feel isolating and undergoing treatments can be emotional and stressful," Hunziker says. "During my fertility journey, I experienced a range of emotions, from sadness and frustration to becoming anxious and overwhelmed."
Blair says therapy — for the woman and her partner — can help, as well as maintaining one’s overall health, and not neglecting diet and exercise. And organizations supplementing fertility benefits with mental health benefits, like those offered through Evernorth inMynd, provide whole person support for employees looking to start or expand their families.
After Hunziker joined support groups and talked with other women, she started to feel better. “I was unaware that women were going through the challenges I faced. There are a lot of ways we can support and educate women during this process," she says. Aside from joining a support group or seeing a therapist, “it's important to have a medical worker check-in on you during your journey, someone who understands what you're going through, and can talk to you about how you're dealing with anxiety and stress," Hunziker says.
Having a medical professional check-in on patients remains important during pregnancy and even post-partum, says Hunziker, as their concerns can linger. "I think we need to keep checking on women to make sure they are okay from a mental health perspective."
An Abundance of Information—Finding Reliable Sources
"Throughout our lives, most of us have focused on learning how not to get pregnant. We learn less about how to conceive, when to conceive, and what to do when it doesn't work," explains Sarah Ham, Director, New Solutions- Strategy & Innovation at Evernorth. “That is why first appointments can be so overwhelming: Women are doing their best to fill in gaps around trying to become pregnant, as well as how fertility treatments like IUI and IVF work.”
There's only so much information you can take in during an appointment, and when there are further questions, many women turn to the internet, especially at times when they can't reach out to their care team.
"Many people go down the rabbit hole of what some call 'Dr. Google.' Of course, Google is not a doctor, and the information, while copious, is often not reliable. You want to make sure that any digital information you get is reviewed by clinical experts," Ham says. “Women should have access to quality care and a reliable source of information when they need it most, and many times this happens when their provider is not with them.”
Because the use of digital tools across healthcare is on the rise, even in the area of fertility, it’s becoming increasingly difficult for employers to assess their impact on health outcomes as well as their overarching value. That’s why relying on a clinically based, expertly evaluated platform of digital health solutions like the Evernorth Digital Health Formulary can cut employers’ administrative costs and provide much needed resources to their employees.
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