MISCARRIAGE & INFERTILITY

Infertility refers to difficulty in becoming pregnant after a reasonable period of sexual intercourse without contraception. In women who are under 35 years old, infertility is diagnosed based on the woman engaging in sexual intercourse for one year without getting pregnant. In women who are over 35 years old, the period where the woman engages in sexual intercourse without getting pregnant is 6 months.[1] Miscarriage, on the other hand, is the loss of pregnancy before 18 weeks and it is the most common pregnancy complication. Advancing maternal and paternal age are associated with increased risk of miscarriage. Other risks include being underweight or overweight, smoking and high alcohol consumption. It is often experienced as very stressful both physically and psychologically.[2]

Canadian Statistics

  • By 2009-2010, it was estimated that 12% to 16% of couples had experienced Infertility.[3]
  • Among couples who reported having tried to become pregnant, 15% had sought medical help for conception. These couples were usually married, childless, and had a female partner aged 35 or older.3
  • Of the couples who sought help, 42% reported using fertility-enhancing drugs, and 19% reported using Assisted Reproductive Technologies (ART) such as in vitro fertilization, intracytoplasmic sperm injection (sperm is injected directly into the egg), and frozen embryo transfer.3
  • Roughly 16% of couples in Canada experience Infertility; that is 1 in every 6 couples.1
  • Causes of Infertility:1
    • In 30% of Infertility cases, the Infertility issue was with the male partner’s reproductive system. This could be because of poor sperm quality, low sperm count, a history of Sexually Transmitted Infections (STI), or hormonal imbalances.
    • In 40% of Infertility cases, the Infertility issue was with the female partner’s reproductive system. This could be because of age, lack of egg production, a history of STI’s, problems with the uterus or the fallopian tubes, hormonal imbalances, early menopause, and having excess tissue around the reproductive organs (endometriosis).
    • In 20% of Infertility cases, the cause is from a myriad of factors that occur to both partners’ reproductive systems. Some possible issues arise from one or both partners’ past cancer treatments, chronic illnesses (diabetes, tobacco and alcohol use), or due to being underweight or overweight.
    • In 10% of cases, the specific cause for Infertility is not found.
  • The chances of a woman getting pregnant decreases with age. Ninety one percent of women can get pregnant at the age of 30 and by age 35, this number decreases to 77%. By the age of 40, only 53% of women are able to become pregnant.1

Behaviours associated with Miscarriage & Infertility:

  • Nightmares or flashbacks about the Miscarriage4
  • Avoids anything that may remind them of their loss such as family and friends who are pregnant4
  • Relationship problems and/or discord[4]
  • Search for meaning behind the loss2
  • Inability to sleep[5]
  • Change in eating habits5

Feelings associated with Miscarriage & Infertility:2,4,[6]

  • Guilt
  • Shame
  • Anger
  • Depression
  • Anxiety
  • Grief

Thoughts associated with Miscarriage & Infertility:

  • “No one will be able to understand what we are going through.”
  • “I am such a failure – It’s my fault that I was not able to carry this baby.”
  • “I feel so guilty and ashamed. I can’t give my wife a baby.”
  • “We are heartbroken. How could this happen to us?”

Miscarriage, Infertility and the Body:5,[7]

People who have experienced a Miscarriage and couples who have Infertility issues often experience different physical symptoms. These may include:

  • Vaginal bleeding during first trimester (Miscarriage)
  • Pain in the belly, lower back, or pelvis (Miscarriage)
  • Sperm abnormalities (Infertility)
  • Ovulatory dysfunction (Infertility)
  • Uterine abnormalities (Infertility)
  • Tubal obstruction (Infertility)

Miscarriage, Infertility and the Brain:

Hormones are important to reproductive health because they regulate menstruation, fertility, menopause, and a person’s sex drive. The region of the brain, called the hypothalamus, produces a hormone (Gonadotropin-Releasing Hormone [GnRH]), which then triggers the pituitary gland to release two other hormones (Follicle Stimulating Hormone & Luteinizing Hormone). This starts the process of ovulation or egg release in the ovaries. During this process, the ovaries produce estrogen and progesterone to help prepare the uterus for pregnancy. When the hypothalamus slows or stops releasing GnRH, the results can be irregular or missed periods, such as in the case of Hypothalamic Amenorrhea, which is one of the common reasons for Infertility.[8]

Stress can interfere with the female partner’s reproductive process and is one of the major causes for Infertility and Miscarriages. The hypothalamus, the pituitary gland, and the adrenal glands control the stress response. The stress response pathway creates cortisol and adrenaline (stress hormones), which give people energy to responds to the stressful situation.[9] Unfortunately, the body uses progesterone to produce cortisol and adrenaline. Constant stress therefore causes progesterone levels to decrease.10 Given that progesterone is a hormone that is responsible for nourishing the uterine lining in response to pregnancy, high amounts of chronic stress means that a woman’s body has less progesterone available to conceive or maintain a pregnancy.[10]

 Does Psychology work?

  • Cognitive-Behavioural Therapy (CBT): Research has shown that CBT can decrease depression and/or anxiety among those who have experienced recurrent Miscarriages. Generally, during CBT sessions, the therapist helps the person examine his/her negative thinking and difficult emotions and find effective coping strategies.[11] CBT has also been found to reduce thoughts of helplessness and unhappiness.[12]
  • Eye Movement Desensitization and Reprocessing (EMDR): For some, experiences like a Miscarriage can be traumatizing. Research shows that EMDR therapy can reduce anxiety and subjective distress when people experience a traumatic event. EMDR therapy can improve self-awareness, change beliefs and behaviours, reduce Anxiety and Depression, and lead to positive emotions.[13]
  • Interpersonal Psychotherapy (IPT): IPT identifies an interpersonal problem or a difficult life event, such as a Miscarriage or Infertility, and addresses it by helping the person improve communication, change relationship expectations, and improve social support network. There is evidence that IPT was able to reduce grief and improve social support and recovery from Major Depressive Disorder.[14]
  • Emotionally Focused Couples Therapy (EFCT): Research shows the effectiveness of EFCT on relationship distress by fostering expression and responsiveness to attachment needs in an emotionally meaningful way during therapy. The aim of EFCT is to help partners understand that their partner is anxious that their attachment needs will not be met. EFCT helps them develop ways to meet each other’s needs so that there is attachment security in the relationship. This will be helpful for couples experiencing relationship distress due to Infertility.[15]

Tips to Manage Miscarriage & Infertility Issues!1

Here are a few things that couples can do to increase the chances of getting pregnant and manage a Miscarriage or Infertility issues:

  • Eat a healthy diet.
  • Get regular exercise.
  • Quit smoking.
  • Drink fewer alcoholic drinks.
  • Try yoga or other stress-reducing activities.
  • Mutual support and consideration from both partners is also the best way to preserve the quality of the marriage and get through the negative effects of a Miscarriage or Infertility.5

Experiencing a Miscarriage or Infertility issues can be challenging for both partners and creates stress in the relationship. Oftentimes, people experience sadness, guilt, and anger. At times, the experience may be traumatic and can also lead to Depression or Anxiety issues. In order to work toward healing, it is important for couples to reconnect emotionally, which often helps to counteract feelings of isolation and loneliness, leads to each partner turning toward the other for support, and restores a sense of calm and comfort in each partner’s lives. Couples become a stronger team in facing these challenges and work toward relying on one another for comfort and security. Therapies at Hopewell Psychological can also help by offering you a supportive, trusting, non-judgmental, and collaborative environment in which to heal from the stress.

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*Psychologists are covered under Insurance Companies in Canada. You will need to check with your insurance company about the specific details regarding your coverage.

References

[1] “Fertility.” Government of Canada. 2013. Web. April 2017.

[2] Nikcevic, A. V., & Nicolaides, K. H. “Search for meaning, finding meaning and adjustment in women following miscarriage: A longitudinal study.” Psychology & Health. 29. 1. (2014). 50-63. DOI: 10.1080/08870446.2013.823497

[3] Bushnik, Tracey. “The Health of Girls and Women in Canada.” Statistics Canada. 2016. Web. April 2017.

[4] Luk, Bronya Hi-Kwan, and Loke, Alice Yuen. “The impact of infertility on the psychological well-being, marital relationships, sexual relationships, and quality of life of couples: A systematic review.” Journal of Sex & Marital Therapy. 2014. DOI: 10.1080/0092623X.2014.958789.

[5] Adolfsson, A., Arbhede, E., Marklund, E., Larsson, P., & Berg, M. “Miscarriage – evidence based information for the web and its development procedure.” Advances in Sexual Medicine. 5. (2015). 89-110. http://dx.doi.org/10.4236/asm.2015.54011

[6] Legendre, G., Gicquel, M., Lejeune, V., Iraola, E., Deffieux, X., Sejourne, N., Bydlowski, S., Gillard, P., Sentilhes, L., & Descamps, P. “Psychology and pregnancy loss.” Journal de Gynecologie, Obstetrique et Biologie de la Reproduction. 43. 10. (2014). 908-917. DOI: 10.1016/j.jgyn.2014.09.019

[7] Lindsay, T. J., & Vitrikas, K. R. “Evaluation and Treatment of Infertility.” American Family Physician. 91. 5. (2015). 308-314.

[8] Bhongade, M.B., Prasad, S., Jiloha, R.C., Ray, P.C., Mohapatra, S., & Koner, B.C. “Effects of psychological stress on fertility hormones and seminal quality in male partners of infertile couples.” International Journal of Andrology. 47. 3 (2015): 336-342. DOI: 10.1111/and.12268

[9] Prasad, S., Tiwari, M., Pandey, A.N., Shrivastav, T.G., & Chaube, S.K. “Impact of stress on oocyte quality and reproductive outcome.” Journal of Biomedical Science. 23. 36 (2016). https://doi.org/10.1186/s12929-016-0253-4

[10] Wetendorf, M., & Demayo, F.J. “Progesterone receptor signaling in the initiation of pregnancy and preservation of a healthy uterus.” Int. J. Dev. Biol. 58. (2014): 95-106. DOI: 10.1387/ijdb.140069mw

[11] Nakano, Y., Akechi, T., Furukawa, T.A., & Sugiura-Ogasawara, M. “Cognitive Behaviour Therapy for psychological distress in patients with recurrent miscarriage.” Psychology Research and Behavior Management. 6 (2013): 37-43. http://dx.doi.org/10.2147/PRBM.S44327.

[12] Esselstrom, L. “A Guide for the Psychosocial Treatment of Infertility.” Loma Linda University Theses, Dissertations & Projects. 304 (2014): http://scholarsrepository.llu.edu/etd/304

[13] Chen, Y.R., Hung, K.W., Tsai, J.C., Chu, H., Chung, M.H., Chen, S.R, Liao, Y.M., Ou-Keng, L., Chang, Y.C., and Chou, K.R. “Efficacy of Eye-Movement Desensitization and Reprocessing for patients with Posttraumatic-Stress Disorder: A meta-analysis of randomized controlled trials.” PLoS ONE. 9.8 (2014): E103676. https://doi.org/10.1371/journal.pone.0103676.

[14] Johnson, J.E., Price, A.B., Kao, J., Chien, W., Fernandes, K., Stout, R., Gobin, R.L., & Zlotnick, C. “Interpersonal Psychotherapy (IPT) for Major Depression following perinatal loss: A pilot randomized controlled trial.” Archives of Women’s Mental Health 19.5 (2016): 845-859. DOI: 10.1007/s00737-016-0625-5

[15] Carr, A. “The evidence base for Couple Therapy, Family Therapy and systematic interventions for adult-focused problems.” Journal of Family Therapy. 36. (2014): 158-194. doi: 10.1111/1467-6427.12033

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