OUR PSYCHOLOGICAL HEALTH

Below is a summary of important points from the research articles I have featured on The Unexpected Trip concerning the psychological effects of miscarriage and infertility on women and couples, symptoms & behaviors, and treatments to consider.
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15- 24% of pregnancies end in miscarriage.

Studies have shown that women with infertility (including miscarriage) have the same levels of anxiety and depression as do women with cancer, heart disease, and HIV+ status. If this seems surprising, remember that procreation is the strongest instinct in the animal kingdom.

Studies have shown that after miscarriage, women experience:

*  PTSD (25%)

*  Acute stress disorder (28%)

*  Obsessive compulsive disorder

*  Panic disorder

*  Major Depression (51%)

*  Intrusive recollections, distress at reminders, flashbacks, strong feelings of helplessness, nightmares (77%)

The level of PTSD at 1 month is equivalent to that of other traumatized populations and it can last for several months.

Studies show that there is no lessening of distress for women who miscarry early.
 
Without treatment, symptoms worsen, and women and men experience psychosocial impairment and increased risk of future miscarriage.
 
There is a great need for routine screenings for disorders, after miscarriage, and expeditious administration of psychological treatment.
 
Symptoms you may see as a clinician: intense fear, helplessness, or horror; dreams, flashbacks, repetitive thoughts; avoidance of trauma-related stimuli; increased arousal (hypervigilence, exaggerated startle response, irritability); significant impairment in important areas of functioning; dissociative symptoms such as derealization, depersonalization, numbing.[Duration: 2 days-4 weeks (for ASD), >1 month (for PTSD)]
 
Women are particularly vulnerable to the above symptoms if they feel responsible, feel a lack of control, or feel a bond with unborn child.
 
Talk therapy is not as helpful as active therapies like CBT and ACT, with their focus on adaptation and repetitive thoughts. (PTSD, ASD, and OCD all involve repetitive thoughts.)

Acceptance and Commitment Therapy 

ACT (acceptance and commitment therapy): works on capacity to accept one’s experience, become more psychologically flexible and less avoidant of triggers, such as family events and social activities associated with babies and young children—activities that once provided the couple with intimacy, sense of belonging, enjoyment are now sources of stress and anxiety.

This is called experiential avoidance, and it is strongly correlated with increased amounts of infertility stress, marital dissatisfaction, depression, and isolation.

Avoidance takes a lot of energy and it results in feelings of helplessness and lack of control.

Infertile couples experience inconsistency between what is important to them and their actual life situation because living out their key value of becoming a parent has been thwarted. This creates a great challenge for the couple. ACT helps couples continue to live their lives committed to value-directed behavior in the face of not being able to fulfill their most cherished value.

ACT helps couple observe their negative thoughts rather than “buy into” them.

 

References

Bowles, S.V., Bernard, R.S., Epperly, T., Woodward, S., Ginzburg, K., Folen, R., Perez, T., & Koopman, C. (2006). Traumatic stress disorders following first-trimester spontaneous abortion. Journal of Family Practice, 55 (11), 969 – 973.

Brier, N. (2004). Anxiety after miscarriage: a review of the empirical literature and implications for clinical practice. Birth, 31, 138 – 142.

Cumming, G.P., Klein, S., Bolsover, D., Lee, A., Alexander, D., Maclean, M., & Jurgens, D. (2007). The emotional burden of miscarriage for women and their partners: trajectories of anxiety and depression over 13 months. BJOG, 114, 1138 – 1145.

Eifert, G.H. & Peterson, B.D. (2011). Using acceptance and commitment therapy to treat infertility stress. Cognitive and Behavioral Practice, 18, 577 – 587.

Katz, S. (2008). Mindful care: an integrative tool to guide holistic treatment in enhancing fertility. Perspectives in Psychiatric Care, 44 (3),207 – 210.

Lykeridou, K., Gourounti, K., Sarantaki, A., Loutradis, D., Vaslamatzis, G., & Deltsidou, A. (2011). Occupational social class, coping responses and infertility-related stress of women undergoing infertility treatment. Journal of Clinical Nursing, 20, 1971 – 1980.

Sejourne, N., Callahan, S., & Chabrol, H. (2010). The utility of a psychological intervention for coping with spontaneous abortion. Journal of Reproductive and Infant Psychology, 28 (3), 287 – 296.

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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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