Season 1, Episode 39

Does Stress Cause Infertility? With Dr. Alice Domar

In this compelling and enlightening episode, we delve into the complex relationship between stress and the ability to conceive. Our esteemed guest, Dr. Domar, brings a wealth of expertise as a senior psychologist at the Beth Israel Deaconess Medical Center (BIDMC), and an associate professor at Harvard Medical School.

Drawing from her extensive experience in cognitive behavior therapy and her bestselling book, “Conquering Infertility,” Dr. Domar explores the impact of stress on pregnancy rates and the psychological well-being of individuals and couples struggling with infertility. She passionately shares her insights on how stress can lead people to drop out of in vitro fertilization (IVF) clinics, emphasizing that it is often the stress of infertility itself, rather than financial concerns, that causes individuals to discontinue treatment prematurely.

At the heart of the conversation are the significance of patient-centered care and the patient experience in the realm of infertility treatment. Dr. Domar advocates for providing comprehensive support to patients, equipping them with essential skills to conquer the challenges of infertility and remain resilient throughout their journey.

Join us as we engage in this thought-provoking dialogue, where Dr. Domar shares her invaluable insights, research findings, and strategies for supporting individuals and couples on their fertility journey. This episode promises to be a source of empowerment, understanding, and hope for those navigating the challenging path of infertility, fostering a more positive and compassionate approach to infertility treatment and family creation.

 

Key Topics:

  • The impact of stress on infertility and pregnancy rates.

  • The emotional burden faced by individuals and couples struggling with infertility.

  • The importance of patient-centered care and support during infertility treatment.

  • Coping strategies to manage stress and navigate the challenges of infertility.

  • Advances in infertility treatment, such as IVF, and their potential for success.

  • The goal of building families and reframing the language around infertility treatment.

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Read This Episode Transcript

Lorne Brown:

By listening to the Conscious Fertility Podcast, you agree to not use this podcast as medical advice to treat any medical condition in either yourself or others. Consult your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guest or contributors to the podcast.

Welcome to Conscious Fertility, the show that listens to all of your fertility questions so that you can move from fear and suffering to peace of mind and joy. My name is Lorne Brown. I’m a doctor of traditional Chinese medicine and a clinical hypnotherapist. I’m on a mission to explore all the paths to peak fertility and joyful living. It’s time to learn how to be and receive so that you can create life on purpose.

Welcome back to the Conscious Fertility Podcast. Today we have Dr. Alice Domar with us. She’s a pioneer in the application of mind-body medicine to various health conditions. Her research focuses on creating innovative programs to help decrease physical and psychological symptoms associated with stress.

I personally am a big fan of Ali’s and I was introduced to her through, she’s written many books, but her book on Conquering Infertility is the introduction that I got to her mind-body approach. And I’ve seen her at conferences, as well, as we’ve traveled the globe. And I see her really as a pioneer of addressing the mind-body impact of infertility on men and women and creating resources and tools to help people manage the stress to improve those pregnancy rates. She is the chief compassion officer and director of research at Inception, the largest network of infertility clinics in North America. She’s a senior psychologist at Beth Israel Deaconess Medical Center. Did I say that correctly?

Alice Domar:

Yeah, Beth Israel Deaconess Medical Center.

Lorne Brown:

Excellent. And she’s an associate professor in obstetrics, gynecology, and reproductive biology part-time at Harvard Medical School. She’s a practicing psychologist, specializing in cognitive behavior therapy with individuals and couples. Dr. Domar has appeared on many networks, on the Today Show, Good Morning America, CBS This Morning, Dateline NBC, and the list goes on and on. And what I didn’t know, Ali, is that you toured with Oprah in the spring of 2004 and 2005 with the LLuminari team. So that was pretty cool, to hear that about you. I didn’t know that about you.

Alice Domar:

I did. It was actually really fun. It was Oprah those two years did a different city every Saturday. And so the Lluminary team traveled with her and actually, I know I probably shouldn’t admit this, but there was a huge rainstorm in San Diego and one of the other physicians stole one to the tablecloths because she didn’t have a jacket with her because she was so cold and she gave it to me. So I still have the tablecloth. So it reminds me of the tour whenever I put it out.

Lorne Brown:

And I should let people know that she is the best selling author of eight books and counting, and check out Amazon to see her list of books. And again, the one that I really enjoyed was Conquering Infertility. That was kind of my introduction to you. And I recently attended a conference, and you were one of the speakers and you talked a lot about stress and fertility and how stress actually from the IVF clinic’s perspective can reduce pregnancy rates because people drop out not so much from financial reasons, but from the stress of infertility.

Alice Domar:

Right. It’s a huge surprise. I’m sorry, are you done with my interview? Should I talk, should I start spouting science or?

Lorne Brown:

Yeah, you can. We’re going to have a discussion here. But yeah, I just thought that’s something that a lot of people, and especially the IVF clinics, may not be aware of, this patient-centered care and the experience is part of, if our goal is to help them have a baby, then there are people that are losing the opportunity to have a baby because of stress.

Alice Domar:

And this is what drives me crazy with this whole debate we have about stress and infertility. I have felt my whole career that there is some kind of relationship between stress and infertility. And I still believe, and I’m actually doing a huge study right now to look at the relationship between physiological aspects of stress and IVF outcome. But putting that aside, the stress of going through infertility and going through infertility treatment is enormous. And so I will not debate whether or not stress impacts infertility because it’s moot. Going through infertility and its treatment is really, really stressful.

And until 2004, the assumption was that people would stay in treatment until they ran out of money or their physician said to them, “You’ve got to stop.” And then in 2004, suddenly there were like five publications globally that said actually, and patients who have insurance and there are a lot of countries and now states in the US that have insurance, stress is the number one reason they drop out. It’s not that their physician says to them, “Your prognosis is bad.” It’s that they do one cycle or two cycles and like, you know what? I can’t do this anymore.

And that to me is a tragedy, and I think that’s one of my main goals now that I’m in Inception, is we need to support our patients better. We need to give them the opportunity to learn skills and strategies and techniques and get the partner more involved so that they have the emotional resources to stay in treatment until they actually get pregnant and have a baby.

Lorne Brown:

And we all want to feel good, we want to be happy, we want peace. And if you’re going to be on this journey, why not make it more of a positive experience? And as you just shared, if it’s more of a, if you’re able to cope in this difficult, challenging experience, there’s a chance you’ll stay in this process long enough to have a baby. You won’t drop out because of the stress.

Alice Domar:

There’s this whole concept of empty arms. And I think to myself, how many more babies would be born globally per year if people, and I’m not going to say women because men are stressed too, but women tend to take the brunt of infertility treatment, how many more pregnancies and babies would we have every year if we could provide the emotional treatment to meet the emotional needs of our patients as effectively as we’re meeting the physical needs?

I mean, the technology is extraordinary. When I got into this field 30 something years ago, IVF had maybe a five percent success rate. We have clinics now in our network that have 60 or 70% per cycle pregnancy rates, which is amazing. And so if you do a few cycles, you’re very likely to end up with a baby, but not if you drop out.

Lorne Brown:

And that’s the key because one of the biggest surprises when I see women and men in my practice is they thought it’s one cycle and it should work. And it’s quite surprising to them when on average it’s two to three cycles, two to three transfers to get that baby.

Alice Domar:

And it’s actually interesting that TJ Farnsworth is the CEO of Inception and they just had a meeting, our physician advisory board meeting, which I missed because I just had back surgery. And one of the new initiatives is not just helping people to have a baby, but helping people to build their family. And so it’s not, most people, most individuals or couples don’t just want one baby, most people want two or even three.

And so it’s not just a matter of doing an IVF cycle and getting one baby. It’s like how can you approach this in a way and maybe do one fresh IVF cycle, so only one retrieval, but you have frozen embryos so after you get pregnant, you actually can then have a second and maybe even a third child. And so it has to switch, I think, the lingo around fertility treatment to family creation, if that makes sense.

Lorne Brown:

Yeah, it’s a strategy. Often IVF can be a strategy so you can have more than one baby. In the lecture that I attended that you presented, one of your slides says, does infertility cause stress? Does stress cause infertility? And then you had yes as the answer.

So we just touched on it, but does infertility cause stress? Was it your research that shared how this was like getting a terminal illness and now in today’s present time, you probably can compare this, you may have data on comparing it to the stress around COVID as well.

Alice Domar:

Yes.

Lorne Brown:

So can you share a bit about how infertility causes stress and how it’s been measured and how it really has a negative impact on us?

Alice Domar:

My parents went through infertility to have my sister and me. I think it took them like seven years to have my sister and another five to have me. And so I know I grew up with a bias. My mom talked about a lot how hard it was in the fifties when everyone was having five or six kids that she couldn’t get pregnant. And so I knew infertility was stressful because I grew up hearing about it, but I don’t know, this is probably 25 years ago, we actually surveyed women with infertility and women with cancer and women with heart disease and women who are HIV positive. And we assessed their psychological state, and the infertility patients who were equivalent.

And that was a mind-blowing study. And it was a great thing for my patients because they were so anxious and so depressed and feeling guilty that they’re feeling this upset over not being able have a baby, when in fact it’s pretty universal, and in fact a number of studies have now come out showing that women with cancer and women with infertility have pretty equivalent stress levels.

And then you ask about COVID. So COVID hit, what, a little more than three years ago. And in fact Boston, where I live, was hit very hard. There was a conference at Biogen, an international conference, and it ended up causing 300,000 cases. And so Boston was hit early, very, very hard. And so I was at Boston IVF at the time, and us geeks are like, okay, let’s look at the impact of COVID on our patients because we had to shut down for three months because the board of health shut down Boston IVF.

And so we sent out a questionnaire saying, how hard is this for you? And we sent it out to thousands of patients and we got literally over, I think it was like 2200 responses, and before we got the data and I was working with all physicians, I won’t name names, but I was like, I really think our patients are still going to find infertility harder for them than COVID. And they’re like, oh my god, no, COVID is so scary. Everyone is dying. It’s on the front page of … And I said, you know what? I think for our patients, infertility is still going to, and I was right, that infertility still was the most stressful for them because it’s the strongest instinct in the animal kingdom. People want to procreate, they want to have kids. It’s the most natural thing in the world.

Lorne Brown:

And this, it’s important for people to hear this, people going through this, because it gives them a little bit of, okay, it’s normal that I feel this way because as you said, sometimes they feel guilt or shame that they’re struggling with infertility and there’s people dying in wars and people have cancer. But you have shown that it is as stressful as a terminal illness.

Alice Domar:

Yes. And in fact, Laurie Pasch, who is a psychologist at UCSF and does incredible research, she published a paper a few years ago, and there are very few of us in the US actually doing good research on the psychological aspects of infertility. So I really admire her research. And what she showed was the majority of women had clinical levels of depression and anxiety. So it was like 70 something percent of them were anxious and 60 something percent of them were depressed. For men, I think the majority were anxious. And then I think 30 something percent were depressed.

But if you look at the women, and again, no matter what the diagnosis is, the treatment tends to fall on the shoulders of the female patients. It’s emotionally devastating. I mean, there aren’t very many diseases where the majority of patients have clinical levels of anxiety and depression. And so I still at a small, private practice and I’m telling patients like, “Look, this is really hard. For many of you, this might be the hardest thing you’ve ever gone through or will go through.”

Lorne Brown:

And we’re going to not right yet, but we’re going to talk about resources and tools to help manage the stress, the anxiety, and the depression. I wanted to go to the second part of that question that was on the slide. Does stress cause or negatively impact infertility? Because I think of just the physiology of the hypothalamus pituitary variant and hypothalamus pituitary adrenal axis. Can you share some of the negative impact stress has on any disease process and what we see it has on the body?

And I want to just share this with our listeners first because we’re going to talk about stress and how it can impact infertility. I would never ask this question if there wasn’t a way to help manage it. I would never just add more stress to you. So if you keep listening, we’re going to talk about ways to manage the stress and this negative impact, what we call stress, not just for fertility, just in life, which is something great, because we talk about the evidence-based stuff.

I know way back when it was very debatable, can stress cause infertility? And I had two things going on in my head. I practice, I’m clinically trained as a hypnotherapist and I’m a doctor of Chinese medicine, and they talk about how emotions are the number one cause of disease when they’re out of balance. That’s just something they observed. Books have come out about the body keeps the score. Peter Levine’s, I think it’s called Waking the Tiger, [inaudible 00:12:54], a Buddhist conscious teacher, talks about the issues are in your tissues. And so it used to be they couldn’t really measure it. As of 2023, when we’re doing this recording, are we seeing data to show that stress can cause infertility? And then what is your thoughts and opinions on this as well?

Alice Domar:

So this is and has been the hottest topic of debate, probably, infertility for 30, 40, actually in the Bible they talk about this. So I think infertility right now is the stress and fertility question, and it’s also the yes or no for PGT question. So I’m obviously biased. I started the mind-body program for infertility in 1987 and we’re seeing these, we’ve done randomized controlled trials, we’ve seen increased pregnancy rates. So of course I believe that stress impacts.

Lorne Brown:

Can we emphasize that? So you actually did the mind-body programs and in your mind-body programs you saw [inaudible 00:13:47] RCTs. You saw an increase in pregnancy rates.

Alice Domar:

So let me talk about the debate and then I’ll talk about the research. So the debate is very hot. It’s still very hot. There’s still people all over the world who are debating this topic. The fact is, I finally came to the conclusion and I published an article in Fertility and Sterility maybe two years ago saying, can we just stop fighting about whether or not stress increases fertility or causes infertility?

But if you look at the data, you can’t just ask somebody how stressed are you? Because within fertility, your stress level goes up and down depending on where you are in your menstrual cycle. When people start an IVF cycle, they tend to be very optimistic. And so that may not reflect their true stress level. So I’m now looking at the physiological data. So let’s forget about self-report psychological data because it’s just not accurate. And in different cultures, if you look at Scandinavia, people don’t tend to report the level of psychological distress as they do in the US. Americans tend to complain a lot. And so you get much higher scores. So let’s just look at the physiological data.

So two studies have now come out of Europe, which have looked at hair cortisol, and apparently, I’m not a hair cortisol expert, but apparently hair cortisol is a pretty accurate reflection of the cortisol levels in your body for the previous three to six months. And cortisol, as we know, is the stress hormone. So this group has now done two studies showing that the higher the hair cortisol, the lower the IVF pregnancy rates. So here we have physiological data, forget about self-report, forget about stress, we’re talking about physiology. So I think that’s really cool.

And then about a little over a year, actually a year and a half ago, a Canadian company, a startup called [inaudible 00:15:29], came to me and they said that they have this device that measures 54 parameters of stress. And it’s this little thing you wear for five minutes every morning and it measures cardiac reactivity and EEG and EKG and all kinds of physiology I don’t understand. So we are right now in the midst of doing I think what will hopefully be the answer to this question.

And so we are recruiting 240 women in the US who are doing their first IVF cycle at one of the Inception clinics. They are wearing this device for five minutes each morning. And we’re going to see if physiological parameters of stress correlate with IVF outcome. And to be perfectly honest, regardless of the results, whether or not physiological parameters of stress correlate, what I really care about is the suffering of people going through treatment.

So as I said, can we just forget about this debate? So [inaudible 00:16:24] has also agreed to fund a study on what is the most effective way to reduce stress, because as I said, Talk About it Now, the mind-body program I started in 1987, we’ve now done two large randomized controlled trials and one was funded by National Institute of Health, one was funded by Johnson and Johnson. We’ve also done a randomized control trial, an online version of the mind-body program. And each one of them has shown massive increases in pregnancy rates.

So I think the first study was a 55% pregnancy rate in mind-body patients and a 20% rate in the controls. The second study I think was a 52% pregnancy rate in the mind-body patients and a 20% rate in the controls. And in this online study, which is a graduate student’s dissertation, the pregnancy rate of the women who did the online program was four times that of the controls. So you can’t argue with randomized controlled trials.

And so if we know that women who are going through infertility, and infertility treatment specifically, participate in some kind of program that’s designed to lower their stress levels, then they are far more likely to get pregnant. And these are statistically significant results, we use Harvard Medical School statisticians, then we have to believe there’s some relationship.

Lorne Brown:

And when we look at the physiology of what happens when we’re under stress, and many of our experts on the episodes have shared, and I’m curious if you agree with this, it’s not the stressor. It’s how the individual perceives and internalizes the stress. So even saying you have infertility, therefore you have stress, everybody’s different. And we’re born with different sensitivities, different nervous systems, and how we respond to the situation of, for example, infertility.

Alice Domar:

Absolutely. I can’t tell you that everyone going through infertility is stressed. I mean, to be perfectly honest, I’ve seen lots of people who are going through treatment who are pretty ambivalent. And that’s okay. So if someone has infertility and can cope just fine with it, more power to them. But it’s the people who are really struggling that I care about, not that … I care about all of them, but that I worry about because-

Lorne Brown:

They need the support because they’re struggling. They need the support.

Alice Domar:

They need skills, they need guidance, they need everything that you and I have been doing for decades. There’s so much that can be done. And we know looking, and if you look at this data, there’s a psychologist in Denmark named [inaudible 00:18:45] Frederickson, and I’m actually going to meet her next month at the European fertility meetings in Copenhagen.

And I’ve been worshiping her for, I don’t know, five, six years because she’s done, and she’s actually a psycho-oncologist. So she does research on cancer patients. So she’s not biased about any of this. I’m biased because I really have this belief system. She’s not biased. She’s now published two meta-analyses, which is where you combine not one study that I’ve done, but 35 studies that have been done around the world. And what she has concluded in both meta-analyses is that psychological interventions reduce distress and increase pregnancy rates.

Lorne Brown:

And do you think then some of the mechanism is around when you have a stressor and it becomes this, you go into depression. The research, we know more people suffer from heart attacks when they’re depressed. You shared already the elevation of cortisol and other stress hormones like adrenaline. Immune system’s important for fertility. And we know our immunity with chronic stress becomes depressed. There’s an increase in clotting because our body thinks I’m going to be injured, so I’ve got to clot. And we know that’s an issue with fertility, our ability to tissue repair.

I think of blood sugar regulation, like you talked about cortisol. Well, if you’re not sleeping well, you’ve got the insulin spikes and now you have increase in cortisol and then diet and stress. So all these, because diet’s a form of stress too, not just emotional stress. And I think I read in one, it was one of your papers or maybe in your book where you shared even bone loss from depression. And so we know that-

Alice Domar:

People who are depressed don’t eat well. We know that.

Lorne Brown:

Yeah. So then there’s the other side then. So when you talk about these physiological interventions, I think, I know you worked with Herbert Benson, right?

Alice Domar:

Yep.

Lorne Brown:

And I loved his book. I read it ages ago, and maybe can you share with us a little bit about who he is? Because I’m often sharing that I’d like to educate the men and women I see, is I want to share with you tools to help you regularly elicit the relaxation response because this will have physiological changes.

So we just talked about how stressors can lead to these negative impacts on the body, and there’s things you can do to oppose it or to elicit the relaxation response. So maybe let’s talk about Herbert Benson, because I think you two are the ones that did the research and started this in the early days. And I think of him as a pioneer and a brave person to do this as well, back when this was considered nonsense.

Alice Domar:

When I think of how badly I was treated in the first, what, 10 years of my career because I was suggesting a relationship between stress and infertility, Herb Benson, I worked with him for 17 years. I joined him as a graduate student and did my dissertation with him, did my postdoc with him, and then continued to work with him for another, I think what, 14, 15 years.

He was a Harvard Medical School cardiologist, and he was approached by, I believe Tibetan monks, I’m not positive, but he was approached by monks who said that meditation has a huge impact on health. And Herb sent them away, and finally he actually did a study and he actually showed that people with hypertension or high blood pressure who meditated could lower their blood pressure simply by meditating over a period of several weeks.

So I joined Herb as a graduate student. I did my dissertation there. He’s a cardiologist. And so my postdoc was funded by the American Heart Association or something, but my passion has always been in women’s health. And I really wanted to work in infertility, I think because of what my parents went through. And so when I was a postdoc, Herb Benson was invited to speak at OBGYN grand rounds at Beth Israel Hospital, where we were working. And he talked about the physiology of the relaxation [inaudible 00:22:25], which is the physiological opposite of the fight or flight response. So if this is your baseline, and you’re sort of a normal person right now, and this is where all of us would be in America if someone walked into a room with a gun. So this is baseline, this is gun, this-

Lorne Brown:

Just for the listeners because they can’t see you, so she’s-

Alice Domar:

Oh, sorry.

Lorne Brown:

So she’s showing …, Yeah, so you can describe it, that you’ve got the baseline and then you’re raising your arms to show that it goes really high.

Alice Domar:

If you’re in your baseline right now listening to us, but if someone walked into the room with a gun, your heart rate would go up and your blood pressure would go up and your rate of breathing would go up. When you elicit the relaxation, the response is the opposite. So from baseline, your heart rate goes down and your blood pressure goes down, your breathing goes down, and blood flow to your arms and legs go down.

And if you do this for a period of several weeks, you have what’s called a carryover effect, which means your blood pressure gets better and your migraines get better. And it has a carrier effect with lupus patients and multiple sclerosis patients and all kinds of things. So I was being trained at that point not just by Herb Benson to teach patients how to elicit the relaxation response, but Joan Borysenko had started the mind-body program, and that was for people with heart disease, and as I said, lupus, AIDS, chronic pain, et cetera.

And so Herb was asked to give OBGYN grand rounds and he was describing the physiology, the relaxation response, and the head of Beth Israel’s infertility division said, “Wait a minute, if you’re saying the relaxation response is mediated by the hypothalamus, which is sort of a master gland of the brain, we know that all aspects of fertility are also mediated by the hypothalamus. Could there be a relationship between stress and infertility as mediated by the hypothalamus?”

So we decided to do a study where I was going to recruit a hundred patients who had infertility and I was going to teach half of them the relaxation response and half be the control group. And this sounded just right up my alley, I was super psyched. It happened to be that the first three women who were recruited into the study were randomized to the control group. And so picture, this is 1986, ’87, there was nothing out there for infertility patients. So they see their infertility doctor’s like, hey, they’re doing this really cool study on relaxation. And I’m like, “Yes, sorry, we’ll see you in three months,” because they were controls.

And so they all were crying hysterically and I don’t cope well with crying. And I was being trained by Joan Borysenko how to run these mind-body groups. And I’m seeing cancer patients feel better, chronic pain patients. I mean, just incredible results. So I went to Herb Benson and I said, “Look, I can’t handle all these controls crying. Can we just stop the study and start a clinical program? Can I just start a mind-body program for infertility?” Boom, that was it. That was ’87.

And the program is now, I mean, I’ve literally trained people from around the world. I’m doing a training the first weekend of June. I have I think two people from Australia, one person from India, several people from Europe. I’ve trained someone in Japan and Malaysia. I mean, it’s just taken off because people going through infertility need skills acquisition. They need to be taught things that they can use to help themselves feel better.

Lorne Brown:

And some of the tools that you talk about, there’s using your breath.

Alice Domar:

Yes, absolutely.

Lorne Brown:

There’s guided imagery. Because I’m a big fan. And I’m going to ask you, I actually want to ask you this because you’re a psychologist. I’m a big fan of somatic type work when you’re doing listening, so the body scan or progressive relaxation, things that I know, and then cognitive behavior therapy. What’s your stance on talk therapy and then these relaxation tools?

Alice Domar:

So again, unlike a lot of people, I’m not going to tell you what I think. I want to tell you what the science shows, because I am a cognitive behavior therapist. And so obviously that’s where I’ve been trained. So what the science shows is that talk therapy solo for infertility patients probably isn’t all that effective. What the science shows, and again, you have to look at [inaudible 00:26:21] Frederickson’s meta-analyses, is that infertility patients gain the most benefit from skills acquisition, specifically cognitive behavioral therapy and mind-body so that they learn relaxation strategies to lower their physical and psychological manifestations of anxiety, but they also learn how to cope.

The mind-body program before COVID was in a group. People would sit around a room, and it’s really nice to be with people who get it. But we’ve also shown from my graduate student’s PhD thesis, you don’t need to be in a group. You can learn these things online and use them. And it works. I mean, as I said, you’re not just seeing these crazy increased pregnancy rates. You’re also seeing, and this is probably more important to me, much lower depression and anxiety and much higher quality of life

Lorne Brown:

Because we want the baby because we think it’s going to make us happy, right? And so even wouldn’t this be wonderful if everybody could feel at peace and happy, whether they have a baby or not, because they have these tools?

Alice Domar:

You know what, I would like to say yes. I would like to say sure. Even someone who doesn’t get pregnant, if they have the tools, is going to be fine. I actually can’t say that because, well, until five years ago, I did say that. There was a Canadian researcher named Judith Daniel who many years ago did a study where she found women in their sixties and seventies who had been through infertility, and a third of them had gotten pregnant, a third of them had adopted, and a third of them were child free. And in their sixties and seventies, their psychological profiles were equivalent.

And so I ran around for about 20 years telling my patients, “I know how hard this is right now, but you’re going to be okay. No matter how this is resolved, you’re going to be okay.” However, a couple years ago, a group from Sweden actually followed up on men and women 25 years after infertility. And the people who didn’t have children were not as healthy as the people who did. So infertility leaves a scar. And I will tell my patients, even if you get pregnant and have a baby, it leaves a little bit of a scar.

Lorne Brown:

And life leaves a scar. In our podcast, the Conscious Fertility Podcast, we share that infertility is kind of your wake up call, and not doing this in an insensitive or offensive way. We all have wake up calls and it seems like this brings us to ourselves to do our healing, to do our work so we can go through life. And we do have these, as you’re calling them, scars, and going through life, though, can we have these tools so we can find that peace?

And sometimes we don’t. Sometimes we don’t develop the tools. We never stop wanting. You don’t get to choose what you want so you can’t stop. Okay, I’m going to pretend I’m not going to want … That whole idea if I just stop trying, if I stop wanting, I’ll get pregnant. Yeah, there’s a part of you, I think it’s the subconscious, but there’s part of you that knows that you want it. So don’t lie to yourself because it doesn’t feel good either. It creates more conflict or resistance.

And so Ali, I always wonder because when they do these surveys, just because you go through a program doesn’t mean that you were able to develop and put those tools into your DNA. So I could go through a university program and be in the same class as everybody else, but not learn. And so I always wonder, too, when we survey people, I don’t expect that a hundred percent of the people that learn these tools will be able to incorporate them to a level where it has that change.

Alice Domar:

Well, yeah, I’ve been running that mind-body program for many years, and I have seen thousands and thousands and thousands of patients go through the program. Almost everybody feels so much better by the end of the program. I mean, one of the tools we use in all the clinical groups, not just research, is what’s called the Beck Depression Inventory. And I think the cutoff for normal is nine. And I think the average score for women entering the program is an 18 or 19. And 10 weeks later of the average score is a seven.

So we know they’re much less depressed, we know they’re less anxious. We know their headaches and their back pain and their GI stuff have gotten better. Almost all of them fall off the wagon once the group ends. Because when the group is ongoing, they’re meeting weekly, they’re filling out what we call a daily progress and a diary, telling the group leader how often they’re meditating, how often they’re doing their cognitive behavior therapy. They’re really in a program.

So the group ends, they fall off the wagon, all their symptoms come back. And some of them then say, “Oh wow, you know what, I guess all those things are really do help me.” And they go back on it. And then what’s interesting is I would say five years ago, half of my practice was women who were pregnant after infertility treatment. And I actually wrote a book called Finding Calm for the Expectant Mom because I was realizing how anxiety provoking pregnancy is in general, let alone after infertility.

And so if someone’s going through infertility and gets pregnant, that solves one problem. But pregnancy can be challenging too. And having a new baby can be challenging. And I was joking with someone I work with who went through IVF and is pregnant, and I was joking with her that I’m the only person she can complain to because she went through so much to get pregnant, she can’t complain to anybody. And I said, “Just vent to me. It’s okay.”

Lorne Brown:

Right. It’s interesting what you’re sharing there, how when they stop the fertility journey, they stop using the tools or meeting, that a lot of their symptoms come back. And so one of my meditative practices teachers, teachers of consciousness, she shared that, we meet once a week. So I still almost once a week meet. And I’ve been doing this since 2014. And she said it’s a paradigm shift and it’s something that you continually do. Just like you don’t exercise and go, “Oh, I feel good now, I’m going to stop my exercise program.” You regress a bit.

So it’s a good thing to share about expectation. These tools aren’t about, I’m going to do this for three months and then I’m done. These are tools, just like we brush our teeth every day, we shower, we may stretch, yoga. These are things that you incorporate into your life.

The other thing that I thought that you just shared is how there was anxiety in pregnancy. In my work with hypnosis, we always think about the conscious and subconscious is, and I think of John Kabat-Zinn’s book, Wherever You Go, There You Are. The reason I find these tools so important is the external world is like your reflection of your inner world. So if you have anxiety and depression with your infertility, once that is solved, you’re pregnant, now you’re going to have anxiety or depression around pregnancy. And then once the baby’s born, now you’re going to have anxiety, depression, whether they get into the right daycare, what college, do they marry?

So this is where a lot of the experts on, and I’m curious where your thoughts are on this, on our podcast, share that rather than trying to go and work on the outside world, okay, I’ve got to make sure I get pregnant, I’ve got to make sure my pregnancy’s this way and I get the right OB, is to also do the work inside. And then you’re not at the effect of the outside world. So become that eye of the tornado. Is that something from your experience, because you’ve been in this for a long time, do you subscribe to that idea that it’s a continuation, these tools that you have?

Alice Domar:

Absolutely. I mean, what I tell my patients every single day is the tools I’m teaching you are not infertility tools. These are life tools, and you’re going to need them. And it’s funny because this is just a funny story. One of the techniques I teach patients are called mini relaxations. And it’s like diaphragmatic breathing you can do when you’re stuck in traffic. And for my patients it’s you can use them for ultrasounds and blood tests and anything in the moment.

And so I think what’s one of the biggest takeaways from the mind-body program is these mini relaxations, which are just so effective in the moment. And literally five years after one of my patients finished the mind-body program, she and I were talking on the phone about something and I was looking for something for her in my desk drawer, and I closed the drawer on my hand, and I’m like, “Oh.” And she goes, “Ali, do a mini.” And so it was that much in the forefront of her head, that that was the first thing she thought of. And now thinking, okay, here’s a success story.

Lorne Brown:

And that mini, it’s one of the first things I teach the men and women I see, is the breath. And my style is breathing in for four, hold for four, and exhale for eight. Because it’s that exhale that seems to engage that parasympathetic, tells the nervous system it’s safe. And they often share they use it as they’re going in for their transfer and just when they get their blood test results constantly using it, and that’s their go-to. It’s always with you.

And what people have experienced is a lot of them have cold hands and feet and they say after doing this several times a day for weeks, that they notice their hands and feet aren’t as cold. Does that make sense? And I’m like, yeah, because when you’re in that sympathetic drive, the blood flow isn’t there. And when you’re constantly engaging the parasympathetic through your breath, you’re getting the blood flow everywhere. And I tell them, I go, “Think of it this way. Blood flow to the hands, blood flow to the ovaries because sympathetic, parasympathetic. So if your hands and feet are warm, good. And so keep up the breath and the other tools.”

Alice Domar:

I tell my patients, you take your lungs everywhere you go. No matter what the situation, no matter what is going on, you can do a mini.

Lorne Brown:

I like this idea of the minis, because again, I’ve learned through so many people on the podcast and my own trainings is these, as you call them minis, they seem to have more benefit if you’re doing these short things several times a day than one big one. So let’s say you do 20 minis and each mini is five minutes, that has more benefit than doing one two hour thing.

Alice Domar:

Well, that’s I think where Herb Benson and I disagreed a little bit because when I teach minis, it’s like one minute or two minutes, it’s in the moment quick. His data actually showed that in order to get the carryover effect from the relaxation response, you need to do it for 10 to 20 minutes at least five times a week to get that carryover.

Lorne Brown:

I would say let’s call it both then. Because that to me sounds like a meditative practice where you’re actually, you know, you’re an evidence-based psychologist, a lot of the conscious teachers on here talk about getting into this present moment. And when you call it a mini, to me you are creating presence, awareness, mindfulness.

And that seems to be where people, they don’t quite understand what’s happening, but there seems to be some magic happening in the body when you do a mini or what people say become mindful. It kind of takes you out of the story, out of the effect of it because you’ve brought some presence, awareness to this, you’re witnessing it. Something’s changed, something’s shift. And so I think I’m going to say both.

Alice Domar:

Oh, obviously the more you can do, the better. And what I tell my patients in terms of the minis is there are two times to do minis. One is when you tune into the fact that you need one, like you’re about to call the clinic, you’re about to check for your results, you’re about to get in the car. So tune in.

The other time is to identify situations that push your button. And so if you can like, oh my God, my heart’s pounding, or am I having a headache? Do a mini then, but then do a mini before you’re called in for your ultrasound.

Lorne Brown:

Get resourced, I call that in my practice. Get resourced, get resourced.

Alice Domar:

Be armed.

Lorne Brown:

Be prepared. Get your place so you can feel safe. And your research has shown that doing these mind-body tools, these minis, that you increase pregnancy rates. So that’s motivation a lot for the audience. And then the research has shown that it calms a nervous system. So it changes our heart rate. Muscle tension is reduced, so that feels good, right? Because muscle tension doesn’t feel great. We lower the consumption of oxygen, so it’s more available for our tissues.

The brainwaves we see is changing. We see a difference in hormonal profile, in our immune system. Blood pressure decreases, better sleep, pain reduced, hypertension, hot flashes reduced, those digestive issues, IBS, headaches, anxiety, premenstrual symptoms. To me, this sounds like I want some of this. If that was in a pill, I think we’d be taking theseght?

Alice Domar:

Well in fact, that’s kind of behind, and this is not a conflict of interest because I licensed it, but about six years ago, Liz Grill, who’s a highly well-known psychologist at Weill Cornell Medical Center in New York, she came to me at a Resolve fundraiser and said, “Have you ever thought of doing an app?” And I’m like, “Okay, so first of all, I’m a dinosaur. I don’t think I have an app on my phone.”

Anyway, long story short, she and I developed this app called Ferticalm, and one of the reasons we did it was because first of all, there are 702 mental health professionals in this country who belong to the mental health professional group of the American Society of Reproductive Medicine. I don’t know how many are in Canada. But there are millions of people going through infertility. So we know there are not enough mental health professionals trained to cope or serve or meet the needs of people going through infertility.

And so we have to go to the internet to see what is … Anyway, long story short, one of the things on the app is 10 relaxations in my voice. There are five longer ones and then are five minis. But the idea was, what can people do when they’re in crisis? What can they do when they’re at a family dinner and their little sister announces she’s pregnant for the third time by accident?

And that’s what we decided to do in the app, was to just for every situation which we knew caused our patients such pain, there are six things they can do in that moment to help them. So when your sister tells you she’s pregnant, you go to that scenario and there are ideas of what you can do to be self-protective.

Lorne Brown:

And so that app’s called?

Alice Domar:

Ferticalm, F-E-R-T-I-C-A-L-M.

Lorne Brown:

Ferticalm. All right, so you can download that.

Alice Domar:

And the idea of that is just there are not enough of us out there to meet the needs of patients. And people have crises at 11 o’clock on a Saturday, and they need tools in the moment to help them feel better. We even have scripts for how, when people say stupid things, like, “So when are you going to make me a grandmother?” Or blah, blah, blah. So we have scripts, snappy comeback lines for when people say stupid things.

Lorne Brown:

That is something also that makes the journey challenging because people will say things, well intentioned, but it can come across insensitive or offensive if you’re the one trying to conceive. And so it’s nice that you have this app and people have ways to, again, stay resourced when you have this. Or you know, you go to a party and you find out somebody’s pregnant. Couples, we see people drop friends because they’re pregnant, right? Because it’s just too difficult.

Alice Domar:

All the time.

Lorne Brown:

Which shows us that support is needed because people are struggling. And that’s evidence of that.

Alice Domar:

Support and tools and people like you who can help with the balance and the physiology. What I worry about is not that people who are coming to see me are coming to see you. What I worry about is the millions of people out there who are suffering alone and feel like there’s this shame and guilt about going through infertility. There’s this feeling that they’re the only ones suffering. Okay, so two weeks ago, the World Health Organization reported that one out of six people in the world, people of child bearing age, are going through infertility.

Lorne Brown:

That’s massive.

Alice Domar:

Yes. It’s like you take a walk through your neighborhood, you’re going to see people who either are going to go through infertility, are going through infertility, or went through infertility.

Lorne Brown:

Yeah. Because you feel alone in this. So I want to fill the [inaudible 00:41:00] that you’re not really alone because it’s one in six.

Alice Domar:

You’re surrounded.

Lorne Brown:

And we have a lot of people that listen to this that aren’t even trying to grow their family because they find what we’re talking about of interest. Because people just want to be happy, they want to feel good. And we talk a lot about tools. For those of you that are hearing this, one in six, that’s read the room cue to don’t ask somebody when you’re going to have a kid.

Alice Domar:

That’s right.

Lorne Brown:

If they don’t have one yet. Just because if somebody, there are some people that do choose not to have children. However, if you don’t want to unintentionally offend somebody, I think not joking about it and not asking about it is probably a good call.

Alice Domar:

Oh, never ask somebody when they’re going to have kids. And in fact, it was interesting, I think it was just yesterday in the New York Times, in the op-ed piece, I do sound like a nerd, I understand that. There’s data from the last 200 years on the percentage of women who don’t have children. And I’m guessing a percentage of that went through infertility and some women chose not to, and it was like 10 to 20% depending on their ethnicity and background.

But there are people who choose not to have children. Probably more likely they’re going through infertility. Don’t tell them, don’t tell them what to do, don’t give them advice. You probably, unless you went through it yourself and you went through exactly what your friend or relative is going through, don’t give advice. Ask them what they need.

Lorne Brown:

And as I think I’ve heard you say before, again with good intentions, but don’t say, “Just relax and it will happen.” Don’t say that either.

Alice Domar:

When I published my first paper on the pregnancy rates from the mind-body program, and this was, I think I published it in ’88 maybe, and we showed that in the first year we ran the mind-body program, a third of the women got pregnant. And again, these are the days when IVF had a five percent pregnancy rate. And I published it in Fertility and Sterility, and I got eviscerated by the infertility community, physicians, patients, advocacy groups, saying that I was perpetuating the myth of, just relax and you’ll get pregnant.

And I’m like, no, I’m not. What I’m saying is if someone’s going through infertility and they’re suffering, going through a program designed to reduce their suffering probably increases their chances of getting pregnant. And in fact, that publication is what got National Institute of Mental Health to actually come to me and say they would fund a randomized control trial.

Lorne Brown:

This is an important thing because I think the way they interpret it, the physicians and the advocacy groups is like you can will it. And what we’re saying is you can’t will the relaxation. It is a tool. It is an exercise, a process that you do to elicit the relaxation response.

Alice Domar:

And it’s hard work. You know what, doing a relaxation technique every day for 10 or 20 minutes, going for acupuncture, practicing your cognitive behavioral skills, all the stuff that we teach our patients, it takes work. And most people want a pill. This is not a pill. These are things that you need to practice to make yourself physically and emotionally healthier.

Lorne Brown:

And I will add to this then, because it is effort, I call it conscious work. So it’s called work, conscious work. However, the saying goes, the longer you do it, the easier it becomes, and the easier it becomes, the longer you will do it.

Alice Domar:

I remember Herb Benson used to tell people, “You would never leave the house in the morning without brushing your teeth.” He says, “Never leave your house in the morning without doing some form of relaxation.”

Lorne Brown:

So I want to direct our listeners where they can learn more about these techniques and tools to elicit their relaxation response. So Ali has several books, so check those out on Amazon. There is the app Ferticalm, so you can download that app, which she shared has scripts and mini and long tools to elicit relaxation.

On Acubalance, I run people through a 20 minute one. So it’s more the Herb Benson idea, where we use the breath, the body scan, and eye roll and some heart-brain coherence, so visual imagery to help elicit the relaxation response. And there’s just lots of tools out there. And I think starting with Ali’s Ferticalm is a great place to go to.

Ali, is there other ways that people can connect and reach you? And we’ll connect again over email, so I can put them in the show notes, but is there anything that you’d want to direct people for resources to help them on their journey to grow their families?

Alice Domar:

Well, obviously now I’m the chief compassion officer at Inception, which has clinics all over North America. And I’m about to have my first year anniversary, and one of my two main foci, focuses for the first year was to create programs for patients to reduce their stress. And I’m doubling my efforts on that.

I think my message is for anybody, you are not alone, there is so much out there that can help you. But I would also tell people, and we haven’t really talked about this, be really careful because there are a lot of people, practitioners, clinicians, et cetera out there who will take advantage of infertility patients because they are so vulnerable. And if it sounds too good to be true, it probably is. And research these entities before you pay any money or go or do anything else. Because now there’s a lot out there that’s really good and science-based and there’s a lot out there which is not. And so just be cautious.

I mean, talk to your physician, talk to the nurses in your clinic, talk to your friends. And I was watching the Today Show this morning, and they were talking about getting a therapist, and they said, one of the best ways is ask your friends, “Have you seen a really good therapist?” So ask your friends, but be cautious.

Lorne Brown:

Yeah, it’s true. Your friends often will share that they’ve had that, I call it transformation where they feel different because of the tools they’ve adopted. And I often share, because my patients have shared and it’s been my experience, I use these tools for me. I was brought to this work because I was struggling at some point, and it brought me to the work and it was transformative for me. And I learn more and I share it with my patients. Your personality changes, right? There’s a shift.

Alice Domar:

What I do tell my patients is when they come and see me, people don’t come see me when they’re feeling good. They come see me [inaudible 00:46:48] bottom. And I’ll say this to an individual patient and to people who start the group, “You will get your life back and whoever you were before infertility is still there. We just have to pull it out again.” People do recover psychologically. We just need to give them the tools, get them through treatment, get them pregnant, get them to have a healthy baby, and then be up all night and that’s okay.

Lorne Brown:

That’s okay. Ali, thank you for all that you do, all the resources, the publications, the advocacy that you do for the men and women going through infertility treatments and just struggling with infertility, to give them tools and resources to help them cope and manage the stress of infertility and to help increase pregnancy rates. We are so lucky.

Alice Domar:

I’m clearly doing it because my mom didn’t have it. I’m paying it forward.

Lorne Brown:

You’re paying it forward. And it is noticed and appreciated.

Alice Domar:

Thank you.

Lorne Brown:

Thank you.

Alice Domar:

It was so good talking to you.

Lorne Brown:

You too, Ali.

Alice Domar:

Thanks.

Lorne Brown:

Thanks again. Another shout out to check out Ali Domar’s books on Amazon, the app that she’s involved in, Ferticalm. And then if you go to Acubalance, you can contact us for the, I have an 18 minute meditation used to help you elicit the relaxation response, which I invite you to practice daily for health and wellness, and obviously to increase your chances of pregnancy. Thank you for listening to the Conscious Fertility Podcast.

Speaker 3:

If you’re looking for support to grow your family, contact Acubalance Wellness Center. At Acubalance, they help you reach your peak fertility potential through their integrative approach, using low-level laser therapy, fertility acupuncture, and naturopathic medicine. Download the Acubalance Fertility Diet and Dr. Brown’s video for mastering manifestation and clearing subconscious blocks. Go to acubalance.ca. That’s acubalance.ca.

Lorne Brown:

Thank you so much for tuning in to another episode of Conscious Fertility, the show that helps you receive life on purpose. Please take a moment to subscribe to the show and join the community of women and men on their path to peak fertility and choosing to live consciously on purpose.

I would love to continue this conversation with you, so please direct message me on Instagram at Lorne Brown Official. That’s Instagram, Lorne Brown Official, or you can visit my website, lornebrown.com and acubalance.ca. Until the next episode, stay curious, and for a few moments, bring your awareness to your heart center and breathe.

 

Alice Domar

Alice Domar

About Alice Domar:

Dr. Domar is a health psychologist who focuses on the application of mind/body medicine to women’s health issues. Her research focuses on the relationship between stress and infertility, with a focus on the impact of cognitive behavioral interventions as well as access to care and patient retention.

Dr. Domar is on the board for Parents Magazine and served 10 years on the board of Resolve, the National Infertility Association. She is the author of eight books, including Conquering Infertility and Patient-Centered Assisted Reproduction: How to Integrate Exceptional Care with Cutting Edge Technology, and is the co-creator of the apps FertiCalm and FertiStrong. She is a former chair of ASRM’s mental health professionals group.

Where To Find Alice Domar:  

 

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Lorne Brown
Alice Domar

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