Guide to Coping with Female Infertility

Starting a family can be an exciting and joyous time, and those experiencing infertility may have a more complicated journey to parenthood. The World Health Organization defines infertility as the inability to conceive after one year of trying, or six months of trying for those over 35. According to estimates, 60 to 80 million couples worldwide live with infertility. In the US, as much as 15% of couples are unable to conceive after one year of trying. Even women who have had successful pregnancies may struggle with what’s called secondary infertility. 

Infertility comes in many forms. Male-factor infertility stems from problems like low sperm count or poor sperm movement. While female-factor infertility may arise because of abnormalities in the ovaries, uterus, fallopian tubes, and endocrine system. In some instances, the cause of infertility may not be readily apparent on standard fertility testing and will be diagnosed as “unexplained infertility”. 

The process of identifying and understanding your infertility can be overwhelming. Choosing to undergo infertility treatment or pursuing other options like surrogacy or adoption, is a major personal decision that will impact your physical, emotional, and financial wellbeing. Facing the challenges of infertility begins with understanding your unique situation, and the steps you can take to grow your family.  

Infertility and your options   

As you begin your fertility journey, consider the many options available to you, including those that allow you to preserve a genetic link to your future child. This journey is deeply personal and not all of these options may work for you, so think about connecting with an infertility specialist and a reproductive endocrinologist to discuss your course of action.  

Fertility medications  

One of the first options your physician may discuss is fertility medication. A physician will prescribe these drugs for both male and female reproductive organs to do things like stimulate the ovaries, thicken the uterine lining, and increase sperm count. Your reproductive endocrinologist will talk with you about which fertility drugs are best for you and your reproductive needs. 

Medical procedures for infertility  

If fertility drugs don’t achieve their desired results, your fertility specialist may recommend treating your infertility with an assisted reproductive technology (ART). Not all of these fertility options will be right for you, but these are some of your potential paths to consider: 

In vitro fertilization (IVF) 

IVF begins with the egg retrieval process. Your physician will first prescribe medications in the form of hormone treatments to stimulate the ovaries and to grow follicles to produce mature eggs. Then, they retrieve mature eggs from the ovaries and fertilize them with sperm in a lab to create viable embryos. Finally, one or more mature embryos are transferred to the uterus for implantation. The IVF process can take three to four months from the time of your initial consultation to the time you have your pregnancy test after your embryo transfer.  

Intrauterine insemination (IUI)  

IUI is a less invasive ART option for when it isn’t necessary to retrieve and fertilize an egg in a lab environment. With IUI, your physician will collect sperm, wash it to remove the seminal fluid, and insert it straight into the uterine cavity around ovulation. 

GIFT/ZIFT 

Other less common options similar to IVF treatment include Gamete intrafallopian transfer (GIFT) and Zygote intrafallopian transfer (ZIFT). In both of these procedures, sperm and eggs are transferred to the fallopian tubes for reproduction.   

Egg, sperm, or embryo donations  

If either a partner’s eggs or sperm are not viable for reproduction, a physician may recommend gamete donation. In gamete donation, a sperm, egg, or embryo is donated to another person or couple for conception. If one partner’s egg or sperm is viable, this option gives you the opportunity to preserve your genetic connection to your child. It’s also an option commonly used for same-sex couples and single parents. Using gamete donation can allow parents to avoid passing down any genetic disorders that may be present in their family history. 

Surrogacy  

If you or your partner cannot carry your child, your physician may recommend surrogacy. In surrogacy, an embryo is fertilized using your sperm, eggs, or a donor gamete, then transferred into the uterus of a surrogate.   

Adoption 

In adoption, a single parent or couple brings a non-genetically related child into their family. Options for adoption include private domestic infant adoption, foster care adoption, and international adoption.  

Managing Infertility   

Expect that learning how to manage your infertility may feel overwhelming at first. Before beginning treatment, your fertility specialist may recommend you create a plan or strategy for coping with the emotional ups and downs of your fertility journey. This could include finding a counsellor or support group, building or strengthening your support network, and incorporating a self-care routine into your day-to-day. 

Set aside time to focus on yourself and your relationships as you begin this process. Talk with someone you trust and feel comfortable asking for help as you set your fertility goals. If at any point along your journey, you’re struggling to cope, reach out to a professional for additional support.  

Speak to an infertility specialist 

Finding the right fertility specialist is essential, as they will be your best resource in choosing the right fertility treatment options for you. They will be able to discuss your medical options, help you understand the practical demands, and evaluate the costs of each. Your physician will likely refer you to a specialist, but don’t hesitate to get a second opinion if you don’t feel that they are a good fit. Your treatment is a very personal journey and you’ll be spending a lot of time with this person. You may also want to speak to a financial advisor at this time. 

Find a counsellor 

If you are struggling to cope or find a suitable outlet for your emotions, you might consider finding a therapist or a fertility counsellor to work with you before you begin infertility treatments. Addressing infertility is difficult for everyone, and admitting you need help is a huge first step in the right direction. If you’ve already found a fertility specialist, they will likely be able to recommend a therapist to work with you.  

Share your feelings  

You may be dealing with heightened feelings of stress and anxiety, and you may also be experiencing feelings of grief and loss. Keeping these emotions to yourself or pretending they don’t exist may make things worse, potentially even causing adverse physical effects. Learning to express your feelings and working to deal with them positively will strengthen you on your fertility journey.  

Join a support group 

A support group can be helpful if you don’t have anyone in your life that you are comfortable sharing your emotions with. Your friends and family members may not be able to understand what you’re experiencing. For some people, it can be a lifeline to find others who are going through a similar experience and learned to cope with infertility together.  

Challenges of pursuing fertility treatment 

Choosing to undergo infertility treatment is a brave step towards addressing infertility. Infertility treatments like in vitro fertilization (IVF) impact many aspects of a person’s life. Some people consider IVF treatment to be as stressful as other major life events like planning a wedding, buying a new home, or a significant personal illness. Infertility treatments are medical procedures with physical and emotional side effects that you will want to educate yourself on before you begin treatment. 

Physical Challenges 

If you’ve struggled with infertility, you may have already experienced physical challenges on your fertility journey. Before pursuing infertility treatment, consider the additional challenges you may face. As with any medical procedure, there will be physical impacts on your body. The hormone medications required for IVF come with a variety of side effects. Additionally, you will have to go in for frequent blood tests, and other invasive diagnostic testing. And if your treatments are successful, there’s also the pregnancy and any possible complications to consider. 

Emotional Challenges 

Mental health and emotional wellbeing can often be overlooked when preparing for infertility treatment, but psychological care can be key to improving your chances of getting pregnant. It can be hard to predict how everything will make you feel in the moment. Feelings of joy, excitement, hope, frustration, grief, or just being overwhelmed are all to be expected. It’s strongly recommended that you be proactive about ensuring you will have the emotional support and care you need throughout this process. 

Preparing yourself for infertility treatment 

One aspect of infertility treatment that can help you feel more in control of your body is to focus on preparing yourself physically and mentally. Many people report feeling stressed, anxious, or depressed during treatment, which can lead to negative outcomes. In particular, heightened levels of cortisol can lead to blood sugar complications, among other things, which is something you want to avoid when trying to get pregnant.  

Improving your overall health and fitness can make the changes your body will experience during IVF treatment easier to manage. Luckily, most of the recommendations for preparing physically and mentally for an unassisted pregnancy also apply to infertility treatment. Preparing your body for pregnancy, recognizing that the quality of your diet, exercise and emotional state can all have a positive impact on your IVF success rate. The following dos and don’ts can help ensure you’re at your best: 

Nutrition 

As you prepare for IVF treatment, it helps to adopt a healthy perspective around your eating habits, while trying to avoid making drastic changes like suddenly switching to a vegan diet. It’s recommended that prior to starting your hormone treatments, you should provide your body with the nutrients it needs to generate healthy cells. 

The “Mediterranean diet” is frequently recommended by fertility doctors because of its diverse nutritional profile. Whichever meal plan you opt for, it’s recommended that you include a variety of vegetables and fruits; healthy fats; and lean proteins like fish, beans, and legumes.  

To better support your organ function and limit the disruption to your endocrine system while taking hormone medication, it’s recommended that you avoid alcohol, tobacco, and recreational cannabis. It’s also recommended that you reduce your caffeine consumption. 

Speak to your doctor, and consider consulting with a dietician about what supplements, adaptogens, and other functional support they commend at each stage of your IVF journey. 

Exercise   

Developing an exercise routine to support your fertility journey has a lot of benefits. It increases blood flow, which will help ensure nutrients are distributed throughout the body. It also helps reduce the buildup of cortisol (the stress hormone) in your system, which will have a positive impact on your chances of a successful treatment cycle. Many women also turn to exercise as a healthy way to manage the weight gain associated with hormone medications. 

Before you hit the gym, you should be mindful of certain guidelines for exercise during IVF. If you are starting to exercise regularly for the first time, make sure you start a few months before you undergo treatment. The added strain on your body can negatively impact your IVF success rate. Fertility specialists recommend engaging in low intensity exercises such as walking, swimming, or low-impact yoga. You’ll want to keep your workouts to around two and a half hours per week and avoid twisting motions or body inversions. 

Mindfulness 

Mindfulness techniques like meditation and journaling may help you cope with your increased stress and anxiety. Learning to practice mindfulness can give you a sense of control over a situation that may feel completely out of your control. The following techniques can help you foster mindfulness in your day-to-day life: 

• Breathing techniques: Breathing exercises, like deep breathing and breath focus, encourage full oxygen exchange. This has the added benefit of slowing your heart rate and lowering or stabilizing blood pressure, while also easing tension and anxiety.  

• Meditation: Practicing meditation has a proven record of reducing stress and anxiety. Apps like Circle+Bloom, Headspace, and MindfulIVF offer meditation tailored to those going through fertility treatments.  
  
• Gratitude: Doing something as simple as writing down 3 things you’re grateful for at the end of your day can promote a more positive mindset and outlook.  
  
• Journaling: Keeping a journal while going through any difficult event in your life is a powerful tool to help you process and cope with the many emotions you are feeling, without becoming overwhelmed by them. 
  
• Intention: An important part of practicing mindfulness is to formulate concrete intentions that help you affirm your goals and stay focused on what’s important to you. 

Complementary therapies 

Studies show that complementary therapies can help people deal with the emotional and physical challenges they face with infertility. The following can improve blood flow, increase relaxation, and improve movement and flexibility: 

• Acupuncture: Studies have shown that acupuncture can promote the release of neurotransmitters and stimulate blood flow, which can aid in conception and reduce your stress response. 
  
• Massage: Getting regular massages can improve circulation, relax the nervous system, and reduce stress. It’s also an excellent form of self-care. 
  
• Kinesiology: Using a combination of acupressure and massage, kinesiology corrects hormonal imbalances through muscle monitoring. 

• Reflexology: This is a form of massage that focuses on applying pressure to the feet, hands, and ears to reduce stress and anxiety, reduce pain, lift mood, and improve general wellbeing. 
  
• Osteopathy: This is a manual therapy that uses gentle movements that improve the alignment and biomechanics of the body. 

Asking for support 

If you are pursuing infertility treatment alone, you may want to find a therapist or a support group that you can regularly meet with so you’re not processing your experiences by yourself. Whether you’re working alone or with a partner, you may want to talk through or think about your relational expectations leading into treatment. Consider some questions like these:  

• Do you want to share your fertility journey with family members? 
• Do you want anyone to come with you to appointments? 
• Should you set limits for yourself on how often you talk about your fertility journey? 
• Do you need to find additional support from a therapist or other professional? 

Resources like the American Society of Reproductive Medicine and Resolve.org can help you connect with the fertility support you need. 

Making a decision 

Infertility is a challenge for everyone, but you can tackle some of the uncertainty by planning. Work with your fertility specialist to set realistic fertility goals, develop a personalized treatment protocol, and build strategies to center your physical and emotional wellness. Ultimately, there is no right or wrong way to approach your fertility journey, as long as you focus on doing what’s right for you and your partner.