COUNSELLING: DEPRESSION, ANXIETY, GRIEF
COPING WITH THE IVF WAITING PERIOD (the 2 week-wait)
by Francine Blanchet, Specialist Fertility Therapist
Counselling for Infertility and Miscarriage
When you are waiting to take the pregnancy test after your IVF embryo transfer or your IUI treatment, you may often find yourself thinking a lot about whether you are pregnant or not.
You might also find yourself frequently checking for physical signs to tell if you are pregnant. You may find that this intense focus on the result of treatment makes you feel nervous and worried. Patients often ask us for suggestions about how to deal with these intrusive and persistent thoughts.
It is normal to feel anxious, stressed or worried during the waiting period, and although it is a very commonly held belief that stress directly impacts fertility, there is very clear scientific evidence to show that stress does not actually make any difference to IVF or ICSI treatment outcomes (see ‘Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies’ J Boivin, E Griffiths, C A Venetis 2011 British Medical Journal (BMJ) 342).
Nonetheless, you will want to do everything you can to try and remain as calm as possible whilst going through the two-week wait because it can be one of the most challenging parts of the process and anything you can do to help you get through it can only be good.
Although reducing stress and anxiety is easier said than done, most people are aware of what might help them take care of their mental health and lead to a better frame of mind. So here are some reminders and suggestions as to what might help you get through it: –
The Positive Reappraisal Technique
Positive reappraisal was first described by Lazarus and Folkman in1984 as a strategy that involves identifying personally relevant positive meaning in the face of adversity. No matter our experience, all situations involve some good aspects and some bad aspects, but which of these we pay attention to can often determine how good or bad we feel. The positive reappraisal technique can help you manage your worries by encouraging you to think positively about the situation you are currently experiencing.
In 2006, Deborah Lancastle began investigating the benefits to those in the two-week wait of using a positve appraisal intervention (Lancastle, 2006, Cardiff University). She applied the principle of positive reappraisal to help people experiencing the challenges of the IVF waiting period when there is not much a person can do to influence the outcome of a treatment. She found that thinking more about the positive elements of a difficult situation and dwelling less on problems and uncertainties about the future, helped people feel better.
In the context of fertility treatment, the positive reappraisal technique involves actively thinking about any positives about fertility treatment itself. It is important to realise that thinking about the positives of a difficult situation does not mean pretending that everything is wonderful when you do not feel it is or thinking that you will definitely get pregnant when you feel unsure that you will or ignoring all the negatives of a challenging situation.
What it does mean is choosing to take account of the good aspects alongside the more negative aspects of the situation and reminding yourself that even very challenging situations have some positive elements.
The positives of the waiting period will differ depending on your personal circumstances. Some people might focus on appreciating the support or kindness that friends or family have shown them during fertility treatment. Others might think about the ways in which their relationship with their partner is stronger now because of this shared experience. Perhaps the fact that there is IVF treatment at all can be seen as a positive thing without which you would not be able to try for a baby
To help you use the positive reappraisal technique Deborah Lancastle designed list of ten different ways of thinking positively. The statements are general and do not refer to any one specific positive aspect because we know that different people will have different ideas about what is or isn’t positive.
Practicing Positive Appraisal !
DURING THIS EXPERIENCE I WILL: –
Try to do something that makes me feel positive
See things positively
Look on the bright side of things
Make the best of the situation
Try to think more about the positive things in my life
Focus on the positive aspects of the situation
Find something good in what is happening
Try to do something meaningful
Focus on the benefits and not just the difficulties
Learn from the experience
1. Put this list of ten different ways of thinking positively into your phone
2. As you read the statements, think about how each of them applies to you personally. Think about the parts of your experience of infertility treatment that have led to something positive or some benefit, ot that help you carry on even when the situation gets really difficult.
3. As with any new way of thinking and behaving, it can take time for the positive reappraisal technique to become second nature. Thinking differently can feel strange and unilateral at first. However, practice will help, so try to persevere. You should find the technique easier the more you practice it, and you should then find that you are not dwelling so much on the thoughts that worry and upset you.
Other ways to cope during the waiting period
With the last few weeks full of blood tests, scans, frequent visits to the clinic and injections, and then, suddenly, you have had your transfer and everything stops… now all you have to do is wait… which we know is easier said than done. The two-week wait until the pregnancy test can bring added stress.
The most important thing is to find what makes YOU feel relaxed and happy throughout your wait, but here are some suggestions for what might help: –
1. Add some structure into the two weeks
Write out a plan for each day with a list of something you wish to do on each of those days to focus on and look forward to. Put yourself first – this is a difficult time for you.
2. Introduce things to improve your mood
Bring into your daily life things that make you feel positive and relaxed. Watch your favourite film; listen to a playlist of happy songs; go to your favourite restaurant for dinner.
3. Gentle Exercise
Exercise is another way to give you a feel-good glow. Obviously avoiding anything too strenuous, exercise is something to improve our physical and emotional wellbeing. Maybe a walk out in nature could bring some calm. Or doing some gentle yoga or stretching exercises. Perhaps play some calming, tranquil music while you do this.
4. Going back to work
For some this may be a good way of focusing your mind on other thing, but make sure to plan ahead to ensure you do not have too many demanding meetings and projects scheduled in for this period to make this time as stress free as possible.
5. Meditation and Mindfulmess
You may find meditating or learning mindful techniques help relieve some of the physical symptoms. Try the ‘Mindful IVF’ and ‘Headspace’ apps. Practicing ten minutes a day can help slow down your heart rate and slow your breathing and bring a sense of calm and ease. Maybe burn a scented candle to help create an atmosphere of peace.
6. Writing or Journalling
Buy yourself a beautiful book and some coloured pens or pencils. Writing down your thoughts and feelings at the end of each day and maybe illustrating them creatively can act as a release for all those stress-inducing experiences that build up during the day.
7. Talking to a Professional Fertility Therapist
To help you better manage your stress and anxiety levels before they become too much, you can always think about booking in a Patient Support session with one of BCRM’s specialist fertility therapists. If you know roughly when your embryo transfer will be book ahead (see below for details).
8. Pamper Yourself
Find ways to take care of yourself and be be kind to yourself. Perhaps book in for a pedicure, a foot or a head massage; or have your make up or hair done.
Maybe sdo a little shopping and treat yourself to something you especially like.
1-PRCI was developed during the PhD studies of Deborah Lancastle( Lancastle,2006, Cardiff University) supervised by Jacky Boivin. Where PRCI is used Please Cite: Lancastle D, Boivin J (2008).
Feasibility acceptability and benefits of a self –administered positive reappraisal coping intervention(PRCI) card for medical waiting periods. Human Reproduction, 23,2299-2307.@Cardiff University