MINDFUL CARE

Mindful Care.An Integrative Tool to Guide Holistic Treatment in Enhancing Fertility

By Sharon Katz, MSN, APRN-BC

QUOTES:

(I have bolded certain passages.)

  •  The entire process of working with reproductive specialists made them feel exposed, defensive, and physically and emotionally challenged.
  • She felt as if her “emotions kill her baby” each time it tried to implant in her womb.
  • Susan was a survivor of an earlier childhood sexual trauma, and the stress of trying to conceive a child stimulated waves of anxiety and depression similar to the PTSD she experienced years before. The nightmares and flashbacks were severe, sometimes converting to rage toward her husband as he slept in the bed next to her. During this period Susan was also experiencing problems with male co-workers. While she longed for the love of a child, reflective of the love she had with her husband, all she felt was the rage she had toward the past. The conflicting emotions of rage and her desire to have a child she could love were tearing her apart not only emotionally but impacting her physically.
  • Awareness of the contrast of her feelings brought her in for psychotherapy. We discussed various mental health techniques that might augment infertility treatments, but it was clear that she was displaying significant psychiatric issues that were overwhelming. Susan’s stressful work situation in combination with the infertility treatments increased her stress levels significantly, and they triggered her unresolved PTSD symptoms. She had maladaptive coping skills, opting for overeating, working long hours, and verbally confronting everyone that challenged her behaviors. Sexual relations between Susan and her husband deteriorated to “fertility sex,” and they pushed each other into rigid patterns and superstitions that were so unlike their usual compassionate and loving relationship. The couple also began questioning all the treat- ments and expenses that were now controlling their relationship. At this point in the journey to bear a child, turning to an integrated focused mental health practitioner was just as important as the infertility interventions that physicians recommended to help them achieve their goal of pregnancy and giving birth to a healthy baby.
  • The imbalance of and the body’s response to the stress and how it might trigger other underlying emotional or psychiatric issues. Ongoing disappointment and chronic anxiety compound the process of maintaining a healthy emotional and physical lifestyle and relationship as well as affect the physiology of the body.
  •  The complexity of the stressful issues that a couple faces can have a direct impact on the sensitive hormonal response of the hypothalamus and the pituitary, as well as the nerve bundles that extend from the spinal cord, linking the brain to the ovaries, uterus, and fallopian tubes (Seibel & McCarthy, 1993).
  • Follicle-stimulating hormone (FSH), produced by the anterior pituitary, is critical to the reproductive development of both men and women.

  • Physiologic restorative processes, such as diet and exercise, are important to regain a sense of balance and control in the couple’s daily life. Energy therapies, (i.e., reiki, craniosacral therapy, emo- tional freedom technique, etc.) integrate the mind and body and help find an emotional/body balance.
  •  Domar, Friedman, and Zuttermeister (1999) concluded that the inclusion of mind/body techniques increased successful conception by 42% within 6 months of learning and practicing these techniques. Subsequent studies also illustrated that group support or mind/ body learning groups can increase conception to 54% (Domar, 2000). Studies have indicated that acupuncture can further enhance the success of holistic or invasive fertility treatments at a rate of 42.5% increased conception (Chang, Chung, & Rosenwalks, 2002).
  • Early in the psychotherapeutic process, Susan revealed defensive tendencies as well as cognitive distortions or magical thinking regarding the connection between sexual abuse and her inability to maintain a pregnancy.
  • The emotional and dramatic nature of her thoughts were not unusual for patients undergoing infertility treatments. It has been well documented (Domar et al., 1999) that emotions during the process of conceiving can be exaggerated by hormone treatments, stress, reaction to the intrusion into private sexual matters, and inability to control the process. Depression and anxiety disorders are the most common psychiatric symptoms (Domar & Kelly, 2002), but the diagnosis has to be carefully invest- igated and documented to differentiate between an adjustment disorder secondary to hormones, PTSD, or triggering of a significant mental illness.
  • Through body scanning, Susan was able to understand how tension mounts in her body with stress, blocking energy and shifting the blood supply, constricting the breath and oxygenation of the body. Through progressive relaxation techniques (mindfulness meditation practiced daily, use of a guided imagery CD, conscious breath work, and reiki) she was able to visualize her body opening up, relaxing, and allowing conception. The balance and change in Susan was remarkable. Her breath and whole body relaxed, she exhibited fewer emotional outbursts, and she was able to keep a perspective without exaggera- tion or distraction.
  • While the journey to conceive does not always end with a child, the adaptation and growth that many experience enhance their understanding of their circumstances and choices that they have to enjoy their lives.

 

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  • About Me

    Me: 41
    DH: 38

    Fertility issue:
    Recurrent Pregnancy Loss
    6 pregnancy losses
    All early
    5 with my own eggs
    1 with donor egg

    DOR
    Abnormal embryos

    Blood:
    Factor V Leiden heterozygous
    MTHFR heterozygous

    AFC: 2 - 12
    AMH: 0.2
    FSH: 6.8
    E2: 40
    LH: 2.8

    History:

    April 2011 -
    Natural conception, first try. Blighted ovum (gestational sac only). D&C to remove products of conception at 9 weeks.

    Oct 2011 -
    Natural conception, first try. Blighted ovum (gestational sac & yolk sac). Took Cytotec to induce miscarriage at 9 weeks. PTSD, depression, anxiety, insomnia, night terrors followed.

    Winter 2012 -
    Two rounds of Femara/Clomid + IUIs at Columbia and RS of NY. The idea: to produce more eggs and increase chances of catching a good one. BFNs.

    April 2012 -
    Natural conception, first try. Ultrasound showed activity in the uterus, but no complete sac. Diagnosed with "missed abortion." Natural miscarriage at 5 weeks.

    June 2012 -
    Conception after 7 mg Femara for 5 days + IUI. Diagnosed with chemical pregnancy. Natural miscarriage at 4.5 weeks.

    August 2012 -
    Natural conception, without trying. Chemical pregnancy and natural miscarriage at 5 weeks.

    October 2012 -
    ODWU at Colorado Center for Reproductive Medicine (CCRM).

    January 2013 -
    IVF with Dr. Schoolcraft.
    Straight Antagonist protocol

    What he predicted:
    I will produce 11 eggs
    Good chance 1 will be normal
    30% chance 2 will be normal
    Transfer 1, then a 45% chance of success
    Transfer 2, then a 65% chance of success

    What happened:
    7 follicles stimulated
    6 mature eggs retrieved
    2 died during ICSI
    4 fertilized
    3 out of 4 embryos CCS-tested
    All abnormal

    ***
    Aug/Sept 2013-
    Frozen Donor Egg IVF at Reproductive Biology Associates (RBA)
    What Dr. Shapiro predicted:
    6 or 7 will fertilize
    1 we will transfer
    1 - 3 we will freeze

    Protocol: Lupron, Vivelle patches, Crinone

    8 frozen eggs from donor thawed
    6 fertilized
    1 Day-5 Grade A XBbb blastocyst transferred
    1 Day-5 Grade A EBbb blastocyst frozen
    1 Day-6 Grade A XBbb blastocyst frozen

    September 13, 2013: Pregnant

    Protocol:
    Prenatal vitamins & baby aspirin,
    Vivelle patches & Crinone

    Beta #1: 171
    Beta #2: 706
    Beta #3: 7,437

    6 w 3 d: measured 6 w 1 d
    FHR: 80 bpm
    Fetus did not grow
    7 w: FHR 121 bpm
    8 w: heart stopped
    9 w: D and C

    Test results: We lost a normal karyotype male for unexplained reasons

    Quit stressful job
    Anti-inflammation diet
    Gluten-free diet
    Vit D, DHA/EPA
    Zoloft
    Therapy/energy work
    Creative Visualization
    Art Therapy

    March 14, 2014:
    Double FET at RBA
    1 Day-5 Grade A EBbb blastocyst
    1 Day-6 Grade A XBbb blastocyst

    March 24, 2014:
    Pregnant

    Protocol:
    Prenatals, baby aspirin, Folgard, Vivelle, Crinone, Lovenox

    Beta #1: 295
    Beta #2: 942
    Beta #3: 12,153

    1 fetus implanted

    Measured on track

    Fetal heart rate:
    7 wk: 127 bpm, 8wk:159 bpm, 9wk: 172 bpm

    Due date: Dec, 4 2014!

    NatureMade (USP Seal) Prenatals and 4000 Vit D3
    Baby aspirin
    40 mg Lovenox
    DHA and EPA
    Folgard 2.2

    Born: One perfect baby boy 12.4.14

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