Author: Michelle Bourke | Published 21st March 2021
These offhand comments from well meaning friends and family members might seem pretty innocuous at first glance, but for the Infertile Initiate they can feel utterly devastating. Like some thug kicked you in the guts and you’re gasping for air looking for an answer, or a crevice to fall down between the couch cushions, or a shadow in the curtain to fade away into.
While their intentions are almost always good and they’re just trying to help - they’re usually blissfully unaware of the meta messages they’re delivering to you at the same time.
Meta message: maybe you need to unlock your femininity by looking after something and once your “inner mother” is out, perhaps Mother Nature will trust you with a human child. Cos right now you’re practically a caveman.”
I’ll admit that I tried this one. After 11 months of no dice I was back in country Victoria visiting my family, when I watched the Netflix documentary “Pick of the Litter”. It got me thinking about puppies and 1 month later, we had a gorgeous toy poodle crying herself to sleep and peeing all over our beautiful hardwood floors.
The first two nights as I set my alarm to wake myself at 11pm, 1am, 3am and 5am to take this precious little soul outside for a pee and then gently put her back in her crate and soothe her until she stopped crying...sllloooowly stepping away from the crate and then waiting another hour to fall asleep again while she cried, I genuinely considered calling in the post-sale guarantee and sending her back to the breeder.
But three months in I was a full blown Fur Mum, dressing her up in pink booties for winter morning walks, spending hours in the dog park so she could play with her fur-friends and telling everyone that she had my eyes and her father’s face. To be fair, this is true:
As a now fully converted fur parent, let me just say that while it’s true that raising a puppy in particular has the power to bring out your mothering side, they should never be prescribed as a cure for infertility. At best, they distract you from your infertility while you train them how to be well behaved little fur-humans.
Because hint: puppies don’t come “life-ready” you actually have to teach them how to do things like...walk. Oh how little I knew. In the meantime we carried her around in this if we needed to:
Meta message: this is really a subcategory of the “stop stressing” comment. If you’re rooting in the comfort of your own bed, then perhaps it’s all too same-same, boring and stressful. Switch it up and magic will happen.
I’ve tried this one too. Obviously. And no, it didn’t cure me either. Have you ever heard of the logical causal fallacy called a post hoc fallacy? Post hoc is short for post hoc ergo propter hoc ("after this, therefore because of this").
This fallacy happens when you mistake something for the cause just because it came after. For example, “One of my friends went on holiday after they were trying for a while and bam, they got pregnant”. Just because the holiday came before the pregnancy, doesn’t mean it was the reason. 82% of people aged 35-39 are pregnant within a year, and 90% after 2 years. It is likely just a statistical probability that they fell pregnant when they did.
Other more likely causes could include the fact that by having time off work, they somehow fluked their way into having sex at the optimal time of the month - which is a significant reason why many people don’t get pregnant as quickly as they otherwise might, as strange as that sounds (turns out human females aren’t hideously fertile throughout the entire month as our high school Sex-Ed teachers led us believe).
So how does that help all the rest of us cycle-tracking nerds who are rooting away based on OPKs (Ovulation Predictor Kits) and well timed sex at home? It does not. Not one bit.
Interestingly the other thing people often get on holidays is sunshine. Sunshine gives people vitamin D3 (which is only otherwise available from supplements – humans can’t get it from food). One UK study released in 2019 showed that having vitamin D levels of 75 nmoL or above significantly improved pregnancy rates by 67%. In fact this study is one of the most compelling pieces of support for any fertility supplement with the exception of Folate and DHA/EPA fatty acids. So it’s possible that is an associated factor.
Again, what does that mean for us nerds with our Vitamin D supplements over winter and checked blood levels with picture perfect results? Nothing. Nada. Zip. Zilch. Extra sun is always nice, but it won’t be the baby maker.
Meta message: All the energy you’re spending to bring a beautiful child into this world is wasted. If you just “gave up” and “let go” it’d happen. So why don’t you just forget about this silly little ‘kids thing’ of yours.
This is the biggest crock of bullshit that ever lived. Seriously. It must be said. You cannot try too hard for a baby. We aren’t all living in the Matrix trying to “be the spoon” in order to bend reality to our will.
There are some organisations who claim it is true. In fact I have done their courses - and they were even helpful from a psychological coping point of view. The problem is, their research isn't published in any journals, and proper research to determine whether “giving up” legitimately improved outcomes (verses improving simply your emotional experience of the excruciating wait for a child), would require much larger sample sizes and the ability to properly define and separate people into “trying” and “not trying” groups, as well as a placebo if it made sense.
Plus...how exactly do you know when you’re “not trying” anymore? If you’re bonking your partner without a condom or other birth control and they’re not pulling out...my friend I’ll let you in on a secret...that is called trying.
In the months leading up to when I did get pregnant naturally (although it ended in an ectopic), I couldn’t possibly have been doing MORE trying. Meditation, a buttload of supplements, red light therapy, acupuncture, Chinese Medicine and naturopathy. I basically tried everything except a 30 day juice cleanse and an orgy 🤣
In reality, people will always have stories that support both sides because after a certain amount of time, pregnancy is basically a lottery. One story doesn’t make a statistically significant truth.
And the reason people get spontaneously pregnant is because that's the roll of the dice. We only get 12 rolls a year, or 360 across the entirety of our reproductive lifespan – 15 years of which many women haven't even started baby making – and the final 5 of which are much more difficult, so that leaves about 120 good rolls of the dice for many of us.
Meta message: The very fact you’re upset about your infertility and sharing your frustration or sadness with me leads me to the immediate conclusion that you are stressed. Without any other evidence or understanding of your prior medical history.
Ugh. I have a special kind of hatred for this one. Especially because I run a business and I work hard and when I speak I get passionate about stuff. Guess what. All that does not make me medically stressed! I know women who run billion dollar businesses or are right in the middle of growing startups who are popping babies out like skittles.
To clarify, this one does have some medical evidence behind it. For instance, some very small studies in Guatemala have found that women who have high levels of cortisol are more likely to have an early natural pregnancy loss before 6 weeks - which is often before the average woman is aware she is pregnant.
The kinds of contributing factors though, are not what the people who make this comment would generally mean when they say “stress”.
For instance, extreme levels of exercise or lack of food and nutrients can cause the reduction of a woman’s body fat to the point where her periods stop...i.e she stops ovulating! And you can't get preggers if the egg doesn’t show up for her date with the sperm.
Alternatively, severe stress and anxiety – like the type where you feel like you need a Valium to chill out – can lead to the steroidal hormone “Pregnenolone” to prioritise making Cortisol instead of Progesterone. And in the second major phase (luteal phase) of a woman’s cycle, not enough progesterone could mean your uterine lining may not get thick enough for a fertilised embryo to implant – especially in a natural cycle where you may not be being supplemented with progesterone as you would be in an IVF cycle. Or alternatively, progesterone struggles to continue to be produced after implantation has already occurred.
Then again, lots of cortisol can also suppress your over-active immune system, and if you have high levels of Uterine Natural Killer (uNK) cells, this might actually improve outcomes for you especially if you’re doing IVF where progesterone is already supplemented!
This could be one reason why a 2014 systematic review of evidence of the link between cortisol levels and IVF outcomes has found mixed results from studies to date. Some have found higher than normal levels of cortisol reduced the number of oocytes retrieved and fertilised, others have found the opposite or no association at all.
Here's another way to look at it. If an average-person amount of stress caused infertility - then PMS would be a leading factor in fertility issues (which it is not), because no woman is more stressed than in the second half of her cycle when she’s PMSing her head off but needs her progesterone the most!
If neither of those things are a problem for you, if you’re uterine lining is lush as hell (above 6mm or more at the time of egg retrieval if you're doing IVF) and you know you’re ovulating regularly through OPKs or a transvaginal ultrasound from your fertility specialist, then no. Stress is not what’s stopping you from bringing a baby into your life.
The only logical thing you could possibly ask someone is “have you checked your cortisol levels to see if they’re higher than they should be?”
Meta message: you are causing your own pain by creating your own infertility with the power of your thoughts.
Woah. This one is super harsh on the soul. And so, so not true.
You cannot negatively think yourself out of a pregnancy either before or after it happens. If you could, teen pregnancy, sexual assault pregnancy and other unwanted pregnancies wouldn’t exist. Abortions wouldn’t exist. So just NO. Ok?
There’s a great book by Joe Dispenza called “Breaking The Habit of Being Yourself”, and in it he tells the story of a class where the lecturer asked everyone to really meditate on and start wishing cancer on their own bodies. Of course no one did it because they were much too afraid of even the smallest possibility it would play out.
The point he made with the story was that, if you believe it’s possible to hypnotise your subconscious mind into creating cancer, why wouldn’t you believe it’s possible to hypnotise yourself out of any number of other physical or psychological ailments.
That said, there are a few studies such as one with 194 total women in Israel – 98 of whom were placed in the test hypnosis group – which showed that hypnosis can basically double implantation rates! But it was not powered to address the most important outcome: live birth rates. And good luck to you finding a commercially sound IVF clinic that will do 20 minutes of hypnotic induction for you on what is otherwise a five minute procedure when they have hundreds of patients to deal with. That study was only useful to 98 people. The people who were in the test group of the study.
There are also other fairly small studies, one of which was carried out on 499 women in San Francisco. The study showed that those who scored higher levels of pessimism on the 12-item Life Orientation Test, and higher Trait negative affect using the 23-item neuroticism subscale of the Eysenck Personality Questionnaire (EPQ) were associated with a 66.0% increased odds of failing their first IVF treatment cycle. This was independent of all other factors such as age, infertility reason and more.
But unless you fall within the parameters of either of these tests please don’t worry. It absolutely 100% does not apply to you. And if you find it does, good news! You can visit a psychologist and actually do something about it.
True to form, I did both tests and found I was very much a positive thinker, and not depressed. Even though I wallowed in a puddle of my own tears for two days after my first round of IVF failed. You can take both tests yourself here and here.
If you’ve been infertile for a while - it’s almost ridiculous for people to suggest that you should be thinking positively all the time. You’d be a god damn robot if you were. No one can take a punch in the tits every 28 days and face it with a smile every time. That’s flat out insanity.
An offhand comment around negative thoughts can be particularly painful because it suggests you’re causing the most potentially psychologically debilitating, horrific event in your life. It is also a comment that is never able to consider the full picture. Maybe you are trying to set expectations with others and so while you’re privately hopeful, you’re publicly less so. Maybe you just had another failed month and 99% of the time you’re fine but on this day, you’re a train wreck. Who knows. They and their big flappy mouths certainly don’t.
Don’t get me wrong, I absolutely believe in the power of the human mind. Even if it’s to direct our energy and our mind into actions that better serve the outcome we’re seeking. But is it the mindset that causes the outcome, or is it the actions you do or don’t take as a result of a particular mindset that is always in “on mode” that causes the outcome. You’d need to look for confounding factors like diet, physical or sexual activity and other differences that may have contributed. And of course, the study didn’t do that. It doesn’t matter what you think or feel across a few days, it matters how you think, feel and act across each 30 days. As a simple rule: if you’re mostly fine, you’re fine.
Meta message: This is a subcategory of the “give up” comment. If you do IVF and it fails, just give up and you’ll get yourself a baby.
Ugh. Sooo much wrong with this statement. First of all, the drugs and the way your cycle is controlled to achieve IVF (especially the first stimulated cycle), puts your body through something quite unique and may contribute to changes that help to rebalance the body after you finish treatment.
It is well known in the medical community that people who have had even very long term infertility can become spontaneously pregnant after failed IVF or other fertility treatment. The largest retrospective study on over 2,000 women published in 2017 by the University of Aberdeen showed a 17% live birth rate independent of treatment and within five years of follow-up for patients who were unsuccessful with Artificial Reproductive Technology (ART) and 15% for those who had previously conceived successfully with ART.
That means approximately 1 in 6 couples will achieve a natural pregnancy after failed IVF or other ART procedures like Intrauterine Insemination (IUI) , Intracytoplasmic Sperm Injection (ICSI) or Intracytoplasmic Morphologically Selected Sperm Injection (IMSI). No, I am not making any of these crazy terms up. They are for real.
Secondly, most IVF success rates are quoted on a cycle by cycle basis to enable easier and fairer consumer comparisons between clinics. But cumulative success rates for IVF across both fresh and frozen embryo transfer cycles are very different.
Predictive analysis by the University of Aberdeen based on over 100,000 women which has been turned into a calculator, shows up to 100% success across just six cycles (embryo transfers) for the best prognosis patients, and even up to 40% for some of the worst. Australia and New Zealand have some similar analysis on over 50,000 women suggesting up to a 78% cumulative success rate across 8 cycles, but their predictive research didn't include other contributing factors that could further personalise the predicted outcome upwards for good-prognosis women and couples.
The point is, it’s important to never give up based on the well-meaning advice of someone who, most importantly, is not a gyno or your fertility specialist, and likely has never been through what you’ve been through.
Up to 8 cycles is considered the best practice option for enabling the greatest chance of a live birth. Of course you may be the lucky one in six who fall spontaneously pregnant after stopping mid way, but why not check the cumulative success rates first to determine if your odds would be better sticking with the program. It’s only been proven by science and hundreds of thousands of women after all…
So, the next time you get one of these comments, take a deep breath - and feel free to quote back some of this stuff to help educate them (read: give them a gentle smackdown).
If you’re feeling especially generous, send them a link to this article so they can brush up on their infertility empathy skills. After all, people don’t know what they don’t know, and you might be saving another woman in the future (including your future self) from the pain of a well intentioned but ultimately hurtful comment. One that is at worst wildly untrue or at best, scientifically misinformed.
Author: Michelle Bourke | Published 21st March 2021
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