Research shows there is considerable emotional impact when people experience fertility problems - and that getting the right support can make all the difference. We spoke to an leading expert clinical psychologist to find out more.
We spoke to Dr. Lauren Berman, the Chair of the Mental Health Professional Group of the American Society for Reproductive Medicine, about common emotions people facing fertility struggles experience, the options and professional support available and how people can access them, as well as advice around self-care.
Dr. Berman also explained why good mental and emotional care is so important both from fertility clinics and patients perspectives, and how this has evolved during the pandemic.
Listen to the podcast of the interview here
Watch the video version:
Read the Interview Transcript:
Catherine Hendy, ELANZA Wellness:
Dr. Berman, Welcome.
Dr. Lauren Berman, ASRM:
Thank you. I'm so excited to talk to you today.
Catherine Hendy, ELANZA Wellness:
Likewise. So I just want to start by saying, emotional support around fertility must actually be really tough area to work in sometimes. What is it that you like about this field and working with fertility patients in particular?
Dr. Lauren Berman, ASRM:
Well, I actually started my career working with mind-body. So my dissertation, way back a million years ago, was about the impact of stress on physical health. So that I did in the late eighties. And so you can see that, like I had this whole mind body perspective that was in my mind. And then I also started working with trauma cases, particularly sexual trauma. People who grew up in very dysfunctional families, and that's where I started working at the beginning of my career. And then when I hit upon fertility treatment, the two arenas merged. And so because there is a lot of mind-body in fertility treatment, it's health psychology. And and then it's also, there's some component of reproductive trauma or trauma treatment that goes into this work. But it's been my honor and privilege to work with people who are going through this journey.
Catherine Hendy, ELANZA Wellness:
So you mentioned trauma. Is that something you find that people might commonly be experiencing? Or what are some of the areas that you help people with most frequently?
Dr. Lauren Berman, ASRM:
So I have worked a lot with folks who have stillbirths or multiple miscarriages, and that can be very traumatizing just loss after loss, after loss, or just to have this great hope and then lose the baby. So I do a lot of work with people who have had those kinds of experiences. And then I also just sometimes just the idea of losing of an IVF not working is a loss. There's a beautiful quote. Can I read it to you by Laura Bush? It's so beautiful. I mean, I didn't know she was such an amazing writer, but here's what she said.
"The English language lacks the words to mourn an absence for the loss of a parent grandparent spouse, child, or friend. We have all manner of words and phrases, some helpful, some not. Still, we are conditioned to say something, even if it's only: 'I'm sorry for your loss.' But for an absence, for someone who was never there at all, we are wordless to capture that particular emptiness. For those who deeply want children and are denied them, those missing babies hover like silent ephemeral shadows over their lives. Who can describe the feel of a tiny hand that is never helped?"
So it gives me goosebumps when I read that it's profound and it really touches on the sense of loss that many patients feel.
Catherine Hendy, ELANZA Wellness:
It seems to be that you're kind of saying that this is a grief, but it's a different kind of grief. The grief has a different texture.
Dr. Lauren Berman, ASRM:
Spot on. I mean, that's exactly the case. Exactly the case. Okay.
Catherine Hendy, ELANZA Wellness:
And what might a typical appointment look like? Would it be talking therapies or other other tools that you can use?
Dr. Lauren Berman, ASRM:
So there's a lot of talking therapies. There's a lot of cognitive behavioral therapy has been shown by research to be very helpful, just giving people tools, to be able to feel cope with the losses, cope with the anxiety, cope with the depression that accompanies fertility treatment. Those tools are really, really helpful. I work with I think, you know, that I work with EMDR, which is a trauma treatment to help people process those horrible experiences of loss.
Catherine Hendy, ELANZA Wellness:
Do you mind explaining a bit more about EMDR? What, what that stands for and what it involves?
Dr. Lauren Berman, ASRM:
Okay. That's that takes a while. Let me see if I can do it in a short period of time, but EMDR stands for eye movement, desensitization and reprocessing, and I'll give you a metaphor or maybe it's not a metaphor, but yeah, this is a metaphor. So on my desk, I'm not going to show you what my desk looks like because during COVID I have not kept my desk as spotless as when patients actually come into my office because we're doing a lot of tele-health now, but on my desk are a lot of papers. And when I am, what I'm going to do when I have some time is I'm going to go through the papers and I'm going to read them and figure out what I need to do with them. I'm going to process them. And then I have to my left, I have two tall file cabinets.
Dr. Lauren Berman, ASRM:
I'm going to put them in the file cabinet. And when I put them in the file cabinet, they're not going to be in my face. They're not going to be a, they're not going to be agitating me. They're not going to be reminding me that they're there, but there'll be in the file cabinet. If I need them, something will say, Oh, I need to go find that. And I'll go find that. So the papers on my desk are like traumatic memories, traumatic memories are often very active and they stay very present in a sense in a sensory way, in a cognitive way, they may affect your body. And so if we can process those memories and put them in the file cabinet, then they're there. They're never going to disappear, but they're not activating you. They're not aggravating you. And that's what EMDR does. And we, we, we accomplish that mostly through eye movement and certain protocols. Did I explain it, Catherine?
Catherine Hendy, ELANZA Wellness:
Yeah. So it would be a kind of session where you would talk to somebody whilst they're doing sort of eye movements. And, and is that evidence sort of published evidence showing that that's effective?
Dr. Lauren Berman, ASRM:
There's actually a significant amount of published evidence. And it was originally pioneered on Vietnam veterans. And they have been publishing on this for maybe 25 years. So there's some good evidence, the veterans administration, which is a federal agency here in the U S actually has approved it for treatment for veterans. So it's a really nice treatment and I'm actually pretty scientific for a psychologist. So I'm not, I I tend to do a little research before I would adopt something.
Catherine Hendy, ELANZA Wellness:
While we're on the topic of evidence. I just wanted to talk a little bit about the rates of mental and emotional struggles, what people are facing fertility treatment or any battle with their fertility. Is it quite common?
Dr. Lauren Berman, ASRM:
It's very common. And I was just reviewing an article, but I did not take down the specific statistics, but the rates of anxiety and depression are very, very high in fertility patients. It is such a stressful process and it taps down into the most primal part of us that yearning to build a family. And so when it doesn't work or when there's obstacles or snags, it just grabs hold.
Catherine Hendy, ELANZA Wellness:
Accessing really good supports. Why is that kind of potentially a better thing to do than talking to friends or family?
Dr. Lauren Berman, ASRM:
A lot of my patients say to me that their friends and family don't get them. They don't get fertility and they say insensitive things. They say things like just relax and it will happen. They say things like maybe it's not God's will that you should get pregnant. And they're, they're meaning well, but it's, it, it actually hits patients where it hurts the most. So part of it is that they don't want to expose themselves in, in a way to that kind, those kinds of insensitive comments, because those, those relationships are very important for support and social support and getting through this time. But there are things that just can't talk to friends and family about. So that's number one. It's to have somebody who's, who's acutely aware of what this is about, what this means, who understands the terminology, what is an IVF? What is an IUI? Yeah. So we understand the terminology. We also understand the processes. We can also communicate with the doctors. We also, we're just an objective outside person. And then we have a lot of tools of the trade, like EMDR and cognitive behavioral therapy and things like that.
Catherine Hendy, ELANZA Wellness:
From the perspective of a fertility clinic why might it be a good idea for them to offer this kind of support to their patients? Can it actually help with outcomes?
Dr. Lauren Berman, ASRM:
Number one, patients are suffering. This is like I said, very emotionally difficult emotionally fraught process, and their patients are suffering really. And so to just to alleviate suffering, it helps to talk to somebody to access mental health care. That's that's I think for first and foremost and when a patient is agitated, anxious, depressed stress, right? How are they going to be? They're probably gonna call more on call the clinic more often, need more time. They may lose their temper. They may have emotional outbursts, which is natural and valid, but it's also, I think, harder for the staff. So there is a staff burnout from patients that are suffering.
Catherine Hendy, ELANZA Wellness:
Maybe you've seen as well some kind of statistics around even dropout rates of treatment, which, you know, are obviously a bad thing for patients who are not able to continue with that treatment, and for clinics.
Dr. Lauren Berman, ASRM:
You're absolutely right, Catherine, that there have been some studies now looking at patient dropout rates and comparing those with mental health issues. So if the more, the more, more people that drop out are, are pinpointing mental health issues, stress how emotionally difficult. This was, how much pressure this push put on the couple, the couple's relationship and that leads to higher dropout rates. So patients end up coming, spending all this money here, going through all that emotional roller coaster. And then it's just too much for them. And they drop out. Whereas if they had, if they were working with a mental health professional, that would give them some may, may give them the support they need. There is also some, there were, we're always trying to dig into this. There is some research suggesting that there are higher pregnancy rates and patients that have the mental health support that they need, but I would not say that equivalent unequivocally. But but we're, we keep digging into that. We keep trying to research that.
Catherine Hendy, ELANZA Wellness:
That's kind of one of those really interesting areas. That's still being studied. Isn't it around even looking at when people are stressed, they're more likely to make unhealthy lifestyle choices.
Dr. Lauren Berman, ASRM:
That's exactly right. That's exactly right. Yes. So it's not a, it's not a magic kind of Hocus Pocus that my stress hormones are going to keep me from getting pregnant. It may be that you're smoking or drinking more or eating more or doing things that are unhealthy.
Catherine Hendy, ELANZA Wellness:
You referenced this a little bit earlier about telehealth. So since the pandemic has that slightly changed how people might engage or even engage with mental and emotional health services?
Dr. Lauren Berman, ASRM:
You know, I did a talk on this earlier today for my professional association. It was all fresh in my mind. Yeah, it's, we are all doing almost exclusive tele-health and patients are loving it really, because, so let's say you're working from home or even working from your office in front of a screen, and you need to, you want your mental health appointment. Well, in the old days, you would have to make an excuse to your boss. You know, some, some people are very open about it, but some people, they just don't want their boss to know their business and leave and drive in heavy traffic to my office and then have their 45 minute, 50 minute appointment and then drive back to the office. Well, that may block out two hours from their day. Yeah. Whereas now they closed the door. If they have a door, find a place, you know, in the building to have a, you know, quiet and quiet and privacy and they can have their session. So it's so much more convenient. If they have children at home, they can schedule when the baby naps or when the kids are in school, you know, doing their zoom school. Here there's there's, there are a lot of mental health professionals and clinics in Atlanta and then three, five hours away, very few or not. So people don't have to take a day off of work and drive all the way to Atlanta to, to do their mental health appointment.
Catherine Hendy, ELANZA Wellness:
They're much more accessible. You mentioned before the strain that fertility treatment can put on a couple's relationship as one example, but we're also seeing far more individuals undergoing fertility treatments?
Dr. Lauren Berman, ASRM:
Well, all people who are using donors are actually asked to come see a mental health professional because we want them to understand the implications of using somebody else's DNA, somebody from outside of their family to build their family and all the decisions I'll need to make. So, so I do quite a lot of consultations with people using donors. Some of them are a man and wife. Some of them are a couple who are unmarried. Some of them are two gay dads. People are, are guys that want to be dads and they're married or to two women who are married, who want to be moms. Some of them are single moms by choice, or want to be single moms by choice. And every once in a while, I see a man who wants to be a single dad by choice.
Catherine Hendy, ELANZA Wellness:
That's interesting because I'd imagine this still more stigma around some of those routes to parenthood.
Dr. Lauren Berman, ASRM:
Yeah. I see that more in single moms by choice. Sometimes they're just heartbroken that they had always planned to find the right guy and they didn't, and they come face to face with, well, it's now or never because there is women women lose their fertility at a much younger age than men do so, so they there's a lot of they're, they're struggling with the stigma and the men who come to it don't seem to be struggling that much. And usually they're coming a bit younger, although once in a while I see an older man and the gay dads and the gay moms are just excited. So it's time to move on. Let's, let's do this. ASM is very attentive to the needs of the LGBTQ community. We actually have a special interest group that was started by one of my colleagues. And just to make sure that there is presentations at our conferences and information that gets out into the, the the world about LGBTQ family building.
Catherine Hendy, ELANZA Wellness:
Do you think that currently clinics are offering enough services or enough waste to support patients?
Dr. Lauren Berman, ASRM:
The clinics I work with, and I do think there's still a lot to be learned about the trans community. We've heard reports about a lot of insensitivity if for a family building people coming in for family building. So, so we have some education to do there.
Catherine Hendy, ELANZA Wellness:
Yeah. I think there's always an opportunity to do better and do more since that we've, we've had some interesting things from patients saying that they weren't necessarily signposted to help. They weren't aware that help could be available.
Dr. Lauren Berman, ASRM:
I think that's actually really important because I see a lot of people who just were not aware that it was, it w it would be good for them to go to the clinic. And so we need to do a much better job with getting the word out that these are the resources, these are the things to look for etcetera.
Catherine Hendy, ELANZA Wellness:
And do you have any advice for self-help or self-care for people who are facing fertility struggles?
Dr. Lauren Berman, ASRM:
Self care is really, really valuable. And I think it's critical actually in this journey. So my self care is gone right now in terms of, I used to go get a foot massage or Manny Patty, and I haven't done that in a while. But number one, it's really helpful just to set aside time to do something to devote to self care could be something as simple as a bubble bath, or just sitting in a in a nice room where you're reading a good book. It could be doing yoga at home. But it's also helpful to join resource groups like resolve that are, have offered support and advocacy for fertility treatment and fertility patients. And anybody who's doing family building, it's also around adoption. Taking vacations from treatment is sometimes a good thing. Sometimes it's the timing isn't right. But if you can take a vacation from treatment, when you're going on that emotional roller coaster, sometimes it gives you space to recover. So that's a nice self care. So anything that you can do to set aside learning meditation.
Catherine Hendy, ELANZA Wellness:
Just speaking about meditation that we spoke a bit about earlier, how grief was a big theme that you encounter, what are some of those other emotions that things like meditation can help with?
Dr. Lauren Berman, ASRM:
So meditation really helps us with mind body focus, so we can really get in touch with our body. We can also learn better how to modulate those emotional States. So sometimes, you know, I tell my patients that when we're really stressed or anxious, we start to get tunnel vision, and we don't have access to our full, beautiful brain. So so if we can learn how to meditate or modulator the States, we can have more full access to our brain. We can make better decisions. We can interact better, we can engage better. So meditation is a great option and it does help.
Catherine Hendy, ELANZA Wellness:
So you've obviously spoken to hundreds and hundreds of people facing facility struggles. Over the years based off that, are there any things that you would say should be avoided saying to someone who's going through those problems or actually on the flip side, some things that are good in helping support somebody.
Dr. Lauren Berman, ASRM:
You know, I have a handout that I've given to patients who to help them create sensitivity among their support group. Do you want me to read it? So keep it long, but it does a lot of do's and don'ts, so this is designed as a letter for people to send or personalize and send to people who who are in their support network, who they would like to teach to become more sensitive. So this would be, again, a letter.
"I want you to know that you're an important person in my life. I want to help you understand what I'm going through. That's why I'm sharing this with you. First of all, I might not be the best friend or daughter or sister or daughter-in-law et cetera right now because of the toll infertility tends to take on my emotions. I want you to know that I'm current.
I currently live on an emotional roller coaster, which depends on treatment, successes, failures, vacations, et cetera. And some days I might be hopeful and optimistic. And on other days I might be grieving or feeling empty. I may be stressed by financial strain or irritable for medications or scared of pregnancy loss or an upcoming procedure. It will be hard for you to know exactly where I am emotionally at any point in time. I know you want to be there for me and you don't know quite how to approach me. That's why I'm giving you this information on some do's. And don'ts of being a supportive person in my life for me to read you the do's and don'ts okay. So don't tell me just relax and you'll get pregnant. Don't tell me that my being pregnant may not be meant to be, and don't tell me that it's God's will don't complain or brag about your own pregnancy.
Don't often offer advice on procedures or processes unless I inquired. In other words, don't tell me, have you tried IVF or maybe it's to think about adoption, don't minimize my problem or compare it to other people's problems. Like, well, think how nice it, it would be to be on a child-free vacation. That's a really insensitive thing to say. Don't share my fertility challenges with anyone else and don't avoid me because I'm not in a good place and please don't be insulted or take it personally if I can't hold your baby or go to your baby shower. So those are some doubts. If he's here's some dues do try to empathize with how difficult this is for me and say something in pathic, like, I'm sorry, you're going through this. That's awful. I can't imagine how you must feel. Hang in there. I'm here for you.
I'm thinking about you. Please let me know if you want to talk and I'm so frustrated for you. Please listen, just listen. If I ask you for a talk and if you can let me cry on your shoulder or silk, please distract me. Take me out to a movie. In other times, of course, lunch, or for Manny petty, please offer to come with me to the doctor and please email me or my husband, discreetly and sensitively in order to break the news of your or neutral friends pregnancy. If I'm religious, you can ask. If you can pray for me, please hold up more than your fair share of our relationship right now and understand that I may not be myself right now. And it's not a reflection of how I'd be, feel about you. Thank you for being in my life, whether it shows right now or not. I'm really glad to have you here for me. Here's to hoping that I'm in a better place sometime in the near future."
Catherine Hendy, ELANZA Wellness:
It's really nice that you finished with the 'dos' as well, because I think that even when people are aware of the 'don'ts', I think that avoiding that you mentioned can come into play, where people can get maybe even more isolated. If there's anything final that you'd like to say to people around getting help, if they're, if they're struggling at all, or if they're experiencing any of the things that we discussed today, what would your advice be?
Dr. Lauren Berman, ASRM:
I would say that they're not alone, that there are wonderful resources and joining a support group, which is now much easier because it's done on tele-health is a wonderful thing. What I have observed when I've run support groups is that people are looking around and saying, you get me and that in and of itself is healing, but there are mental health professionals out there who are experienced and trained in this particular arena. And we are there for you. And please access us.
Dr. Lauren Magalnick Berman has been a practicing clinical psychologist in the Atlanta, Georgia area since 1989. She has served as Clinical Faculty at Georgia State University Counseling Center, Administrative Director and Clinical Supervisor of Metropolitan Counseling Services and Adjunct Faculty at Argosy University. She Chairs the Executive Committee of the Mental Health Professional Group of the American Society for Reproductive Medicine and she is on the Board of the Jewish Fertility Foundation. She is the owner of the Fertility Psychology Center of Atlanta.
Dr. Berman received her bachelor’s degree in psychology at the University of Pennsylvania and her Master’s and Doctorate in Clinical Psychology at Emory University.
For more resources and events designed to take the fear out of fertility, visit ELANZA Wellness's community pages: www.elanzawellness.com/community