Reduce Distress and Increase Pregnancy in Women with Fertility Problems with Mind-Body Practices
By John M. de Castro, Ph.D.
“mindfulness becomes the perfect antidote for the paradoxical land mines infertility presents. Mindfulness starts from the perspective that you are whole and complete already, regardless of flaws or imperfections. It is based on the concept of original goodness: your essential nature is good and pure. Proceeding from this vantage point gives you freedom from the bondage of inadequacy and insecurity.” – Janetti Marrota
Infertility is primarily a medical condition due to physiological problems. It is quite common. It is estimated that in the U.S. 6.7 million women, about 10% of the population of women 15-44, have an impaired ability to get pregnant or carry a baby to term and about 6% are infertile. Infertility can be more than just a medical issue. It can be an emotional crisis for many couples, especially for the women. Couples attending a fertility clinic reported that infertility was the most upsetting experience of their lives.
Women with infertility reported feeling as anxious or depressed as those diagnosed with cancer, hypertension, or recovering from a heart attack. In addition, infertility can markedly impact the couple’s relationship, straining their emotional connection and interactions and the prescribed treatments can take the spontaneity and joy from lovemaking making it strained and mechanical. The stress of infertility and engaging in infertility treatments may exacerbate the problem. Since mindfulness training has been shown to reduce depression, anxiety, and stress it is reasonable to believe that mind-body training may be helpful in reducing the distress in women with fertility issues.
In today’s Research News article “An internet-based mind/body intervention to mitigate distress in women experiencing infertility: A randomized pilot trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7080396/), Clifton and colleagues recruited childless adult women who were seeking care for infertility. They were randomly assigned to either a wait-list control condition or to receive a 10-week online program of mind/body for fertility including weekly online modules and homework assignments. “The skills and strategies taught included: (a) knowledge regarding the relationship between stress, lifestyle, and fertility; (b) relaxation techniques including diaphragmatic breathing and Hatha Yoga; (c) mindfulness; (d) cognitive restructuring; (e) stress reduction strategies; (f) listening and communication skills; (g) strategies for emotional expression and effective coping with anger; and (h) assertiveness training and goal-setting skills.” They were measured before and after training for anxiety, depression, perceived stress, and fertility problems.
They found that in comparison to baseline and the wait-list control group, the women who received the training had significantly lower levels of anxiety, depression, perceived stress, and infertility related stress specific to sexual and social concerns. At the end of the study the women who received the training had significantly higher self-reported pregnancy rates. 53% of the trained women reported successful pregnancy while only 20% of the wait-list control women did.
The study was a randomized controlled trial but the control condition, wait-list, was passive. It would be important for future research to include an active control condition, such as online health education. In addition, the program included a complex set of practices and it is impossible to tease apart what components or combination of components were necessary for the effects observed. It would be interesting in future research to examine the effectiveness of the individual components.
Nevertheless, these are interesting and potentially important findings. The online mind/body for fertility program produced significant reductions in the distress levels of the women and increased the likelihood of becoming pregnant. By reducing the psychological distress produced by infertility the program appeared to markedly improve the likelihood of becoming pregnant. This is very helpful in reducing the suffering produced by infertility and thereby improving pregnancy success..
In addition, the fact that the program was implemented online makes it scalable at low cost to large groups of women over wide geographic areas and the women can engage in the program at times and places that were most comfortable and convenient for them. This greatly expands the usefulness of the program.
So, reduce distress and increase pregnancy in women with fertility problems with mind-body practices.
“Many women fear that becoming mindful and starting to meditate will make them passive in their quest for a child. This simply isn’t so. The wish for a child remains vibrant and active – it’s simply that happiness doesn’t depend on the fulfillment of this wish.” – Beth Heller
CMCS – Center for Mindfulness and Contemplative Studies
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Clifton, J., Parent, J., Seehuus, M., Worrall, G., Forehand, R., & Domar, A. (2020). An internet-based mind/body intervention to mitigate distress in women experiencing infertility: A randomized pilot trial. PloS one, 15(3), e0229379. https://doi.org/10.1371/journal.pone.0229379
To determine if an internet-based mind/body program would lead to participants experiencing infertility (1) being willing to be recruited and randomized and (2) accepting and being ready to engage in a fertility-specific intervention. Secondary exploratory goals were to examine reduced distress over the course of the intervention and increased likelihood to conceive.
This was a pilot randomized controlled feasibility trial with a between-groups, repeated measure design. Seventy-one women self-identified as nulliparous and meeting criteria for infertility. Participants were randomized to the internet-based version of the Mind/Body Program for Fertility or wait-list control group and asked to complete pre-, mid- and post-assessments. Primary outcomes include retention rates, number of modules completed, and satisfaction with intervention. Secondary exploratory outcomes sought to provide preliminary data on the impact of the program on distress (anxiety and depression) and self-reported pregnancy rates relative to a quasi-control group.
The retention, adherence, and satisfaction rates were comparable to those reported in other internet-based RCTs. Although time between pre- and post-assessment differed between groups, using intent-to-treat analyses, women in the intervention group (relative to the wait-list group) had significant reduction in distress (anxiety, p = .003; depression, p = .007; stress, p = .041 fertility-social, p = .018; fertility-sexual, p = .006), estimated as medium-to-large effect sizes (ds = 0.45 to 0.86). The odds of becoming pregnant was 4.47 times higher for the intervention group participants as compared to the wait-list group, OR 95% CI [1.56, 12.85], p = .005 and occurred earlier. The findings suggest that the research design and program specific to this population are feasible and acceptable. Replication efforts with an active control group are needed to verify distress reduction and conception promotion findings.