During this time of uncertainty and stress, we are pleased to partner with Ferring Pharmaceuticals to make this content available and provide you with support.
Alice D. Domar, PhD - Dir. of Integrative Care, Boston IVF, Associate Professor of Obstetrics, Gynecology and Reproductive Biology, part time, Harvard Medical School
Elizabeth A. Grill, PsyD - Associate Professor of Psychology, Director of Psychological Services, The Center for Reproductive Medicine, Weill Medical College of Cornell
*The content in this article is solely the recommendations of the authors.
Restaurant closures, working from home, treatment cycle postponements, constant reminders to practice “social distancing”. You may feel as if there’s widespread uncertainty about the future, which can create heightened sensations of fear. The lack of control that comes with periods of instability can lead to feelings of anxiety and despair.
If you find yourself feeling anxious most of the time, don’t worry. This is an entirely normal response to a highly unusual crisis. Most of us have had periods of uncertainty in our lives, or times where we feel like we are failing or have had losses or had to deal with financial hardship or challenges. People out west have dealt with fires and earthquakes, those in the Midwest and south with tornadoes, and those in the north and northeast with blizzards.
Many of us remember the fear and chaos following 9/11, but this is different. It may feel like all of your vulnerabilities are coming to the surface.
It’s common to play out worst-case scenarios in our mind related to your future health and fertility. The antidote is to assemble a toolkit of coping strategies to help you get centered and stabilized in times of uncertainty. The following strategies will help you manage your distress, feel more in control, and nourish yourself during the coronavirus crisis and beyond.
Stay Informed but Set Limits on Media Coverage
The current coronavirus crisis has many of us glued to the news, which can lead to a tailspin of stress and anxiety. Here’s what you can do to stay informed without spiraling and to restore balance.
- Select a few credible outlets to trust as your sources of accurate Most rumination and worry are rooted in lack of information, wrong information, or both.
- Don’t say glued to your television, internet, social media, or devices for constant Limit yourself to a few updates a day—and preferably not right before bed. Hearing about the pandemic repeatedly can increase distress.
- Remember that many media sources focus on the scary Try to seek out and read the good stories—the restaurants donating food to those who have lost their jobs, people donating money to food banks, strangers delivering groceries to the elderly.
- Set boundaries and limits when it comes to online searches and chat rooms related to COVID-19 but also to infertility! Set a timer to limit your hours of online Only search reputable sites. Join professionally moderated chat rooms and webinars.
- You will want to stay up to date on news of the outbreak, but make sure to take time away from the news to focus on things in your life that are going well and that you can
- Create a list of activities to do in your free time so you have options to choose from and are not tempted to turn to the
- Instead of spending hours online, use that time to help yourself feel better through meditation, breathing exercises, physical exercise, journaling, or by practicing self-care.
Establish Routines & Make a Plan
If like most Americans, you are working from home, you might feel a bit lost without your normal schedule. Most of us are accustomed to waking and getting to work at a certain time, and our work schedules are often established. It can feel disjointed and unnatural to not have that structure, or any structure, such as going to the gym, hanging out with friends, attending book club meetings, going to church, etc. That is why it is crucial to provide yourself with as much structure as you can. Wake up at the same time each day.
Shower, get dressed, and keep the same work hours daily. Eat your meals at the same time, and figure out a way to exercise at the same time as you used to go to the gym. Lastly, stop working at the time you normally would. If it would help, write down your schedule and keep to it as much as you can. If you had regular social connections, try to keep them and be creative how to accomplish that. If your place of worship offers online access, use it at the same time that you would have in person. You can arrange your book club meeting through Zoom. You can have a glass of wine with your friends online, and you can “see” your family on your computer.
Know that during times of uncertainty, feeling stressed, depressed, on edge, and angry are completely normal reactions to an outbreak like COVID-19. Social distancing and quarantine can exacerbate these feelings and lead to feelings of despair. Understandably, those who have been struggling to build their families are no strangers to these emotions or the feelings of loneliness and isolation. Staying connected to trusted friends and family is one of the best ways to reduce anxiety, depression, loneliness, and boredom through the infertility struggle AND social distancing, quarantine, and isolation.
With social distancing as the new temporary normal, staying connected may take some creativity and planning. Use the telephone, email, text messaging, and social media to connect with friends, family, and others. Talk about your feelings related to the outbreak and the impact it’s having on your fertility journey. Equally important, albeit not easy, is to have conversations completely unrelated to the outbreak and your family-building plans. Connect visually with friends and loved ones using Skype or FaceTime to replace the in-person things you enjoyed doing together. With virtual visual connection, you can still enjoy cooking together, sharing hobbies, or getting your friends together for an occasional happy hour.
While connecting with others is one of the best buffers against distress, also know that it’s OK to give yourself permission to have alone time, especially if you are sharing space with partners, parents, roommates, etc. Create a room or corner that is tranquil space just for you, and set boundaries so you are not disturbed. Wearing headphones or moving to a separate space can provide the much needed peace you need to navigate these chaotic times.
Practice Breathing & Relaxation TechniqueS
There are lots of ways to combat and decrease your anxiety, but the best way to start is to learn and practice breathing and relaxation strategies, since they work right away, in the moment.
The easiest way to practice is to download the free apps FertiCalm (for women) and FertiStrong (for men) and keep on going through the situations (petals for women, tree leaves for men) until you get to the petal/leaf that says “Relaxation." There are 10 prerecorded relaxations; 5 are “mini” 1- to 2-minute relaxations, and 5 are longer 10- to 15-minute ones. Use the “mini” relaxations in 2 ways—every time you notice that you are feeling anxious, do a mini; and start identifying situations that you know can make you anxious (watching the news, talking to anxious friends) and do a mini beforehand. You can do minis several times a day, anytime and anywhere, until they become your default way of coping with stressful thoughts and situations. To keep your overall stress level under control, do a longer relaxation at least once, and ideally twice, a day. If you practice daily, you will notice immediate relief, and after a week or two of regular relaxation practice, you should notice that your overall stress level starts to decrease.
Remind yourself that humans are incredibly adaptable, and although you may feel overwhelmed and unsettled much of the time right now, over the next days and weeks, we will all get accustomed to the new temporary normal. But in the meantime, use the minis and longer relaxations to keep you calmer and to help you feel more in control.
Set Boundaries and Say “No”
In times of crisis, we often feel the need to help those around us. However, as good as it may feel for you to help others, it is incredibly important that you maintain a solid self- protection zone. Whether it is requests to donate money, volunteer, work extra shifts, or care for others, think carefully before committing yourself. Here are a few ways to say no.
- “No”. No is a complete sentence, although it may not feel comfortable to say So here are some other suggestions…
- “No, but how about…”. So if someone asks you to donate money to a shelter, and you are not able to donate financially, perhaps offer to donate some baked goods or some canned goods you have and don’t need, or donate your time if safe and
- “No, because…” So if your boss asks you to come into the office despite most of the workforce being instructed to work from home, you could say that the reason you can’t come in is that that your partner has diabetes or that your elderly mother lives with
- “I need to get back to you about ” Most of us don’t think of responses quickly and frequently say yes to requests simply because we don’t know how to say no politely. By saying that you need to get back to them, it gives you time to carefully consider the request and decide whether or not you want to say yes, and if declining, what you are going to give as an explanation.
Do be aware that helping others tends to make us feel less anxious and overwhelmed, so if there are things you want to and are able to do, then say yes. But choose what will make you feel good, versus doing things that may add to your emotional burden, and don’t overextend.
Take Care of Your Body
There are lots of ways to handle stress, and some of them are better for you than others. Many individuals who are trying to conceive have already restricted their lifestyle behaviors and are limiting alcohol and caffeine, have toned down their exercise regime, and have worked hard at maintaining a healthy weight. However, when we get stressed, we tend to seek out things that, at least temporarily, help us feel better, such as a lovely glass of wine, a good cup of coffee, and/or an intense workout. We are also being bombarded by stories in the media about the blessings of comfort food, with tempting pictures of mac and cheese, meatloaf and mashed potatoes, and heaping bowls of ice cream. There is, of course, nothing wrong with comfort food, and at times like these, if eating ice cream will provide you with a few moments of bliss, go for it—just not every day. Try to focus on an 80/20 plan for eating. If 80% of what you eat is the good stuff (fruits and veggies, lean meats, fish, nuts, whole grains), the other 20% can provide some of those comfort moments, without the guilt.
Given that this current situation might not improve for weeks or even a few months, it is important that you keep your body as healthy as you can. If you are actively in treatment, or trying to conceive on your own, maintaining good lifestyle habits is still important.
Follow your doctor’s recommendations, which frequently include limiting alcohol consumption to, at most, one or two a week, and 1 cup of coffee per day, no smoking or exposure to secondhand smoke, no exposure to THC or CBD, and working to keep your BMI in the 20-30 range (ideally 20-25), and trying to work out moderately (brisk walk, swim, midrange biking, regular [not hot] yoga) 3-5 times per week.
There are other ways to take care of your body. Choose to wear your favorite perfume or lotion, even if you are working from home. Shower and dress, even if you are sitting at your computer all day. When you are at the grocery store, carefully choose the treats you want as your 20%. Continue to take a prenatal vitamin.
Even if you can’t pursue treatment for the next few weeks or months, remember that your health habits, as well as your partner’s, do make a difference. Staying healthy and treating your body well can help you feel stronger emotionally and physically, help you feel in control, and make it easier to cope.
Practice Good Sleep Hygiene
Lots of things can interrupt our sleep, and one of the top culprits is stress. Many people are feeling stressed these days, and, as a result, insomnia is becoming far more common. Here are some tips to encourage good sleep habits that can lead to a higher quality of sleep, allowing you to feel more rested throughout the day and, as a result, less stressed. Many of us don’t realize that when we are sleep deprived we feel irritable, stressed, and sad.
Learning good sleep habits can significantly improve your sleep and thus your mood.
- Limit caffeine and eliminate nicotine exposure, especially in the late afternoon and Also, while alcohol consumption may help you fall asleep, it tends to interrupt your sleep later in the night, so you might feel far less rested in the morning.
- Establish a regular exercise routine but not right before you go to Even 10-15 minutes of exercise can improve sleep.
- Make sure to keep to a regular nighttime While this might feel silly if you are working from home, and thus might not have to establish a set early wake-up alarm, you will sleep better if you go to bed and get up at the same time each day. Do the same thing each evening, such as reading quietly, meditating, taking a warm shower or bath, or simply stretching. Try to avoid using devices in the 30 minutes before bed. Use your bed only for sleeping and sex, so your body habituates to relaxing while in bed, not getting worked up watching the news or a tense TV show.
- If you feel tired during the day, limit any napping to no more than 30 You can’t make up sleep deprivation with naps. If you are feeling tired, try going for a brief walk, stretch out, or do a few yoga poses. A brief nap will increase your energy level, but don’t allow yourself to take a long afternoon snooze.
- Make sure that you continue to be exposed to natural light, even if you aren’t commuting to Keep your shades up, work near windows, and try to take walks during the daytime. Even with the disruptions we are all facing, you need to maintain a normal sleep/wake routine.
- Make your bedroom as sleep enhancing as you Keep shades down, use a white noise generator if there is a lot of noise outside. The cooler the room (ideally 60-67°F), the easier it is to sleep. Don’t have your phone charging near your bed.
- Be careful about what you eat and drink in the hours before you go to Spicy and citrus foods can cause indigestion, which can be made worse by lying down soon after eating. The same goes for carbonated beverages. Heavy, large, and fatty meals can also make it harder to fall asleep.
Maintain Hope & Balanced Thinking
It’s hard enough to stay hopeful, control negative thoughts, and stay positive along the infertility journey! Now add a world pandemic and social distancing to the list, and many of you are asking, “ARE YOU KIDDING ME?”
Have you noticed the downward spiral of negative thoughts that can occur when you are worried? During these stressful and unprecedented times, each day or hour can bring new changes that can cause us to feel like we have lost control of our daily lives. Not only are you navigating the changes in the world, you are also monitoring the shifts in your fertility treatment, as cycles may be canceled or postponed. Many of you will obsess over next steps and spend hours online tracking news and reading about what others are doing. For some, this provides a sense of taking control back from a process that feels out of control. However, these behaviors can also lead to rumination, worry, and preoccupation.
Feelings of powerlessness and helplessness can be debilitating, often leading to feelings of increased anxiety, hopelessness, and despair. Thankfully, there are easy steps you can take to regain a sense of control by refocusing your negative thoughts.
Learn to catch yourself when you start to have negative thoughts. Identify the thought that causes the most panic, fear, sadness, frustration, helplessness, etc. Common thoughts are: “Now that my cycle has been postponed, I will never have a baby” and “I am the only one who feels this way. No one understands my pain, loneliness, and frustration.” You can challenge these types of negative thought patterns by asking yourself, “Is this thought contributing to my stress?” If the answer is yes, then you need find a way to distract yourself from the thought (see sections on relaxation, breathing, and self-nurture, staying active and connected) or to restructure the thought. Push yourself to come up with realistic more balanced thoughts instead of all-or-nothing thinking. For example, “My cycle is not postponed forever. As soon as the clinic allows, I will be cycling again and will do everything I can to have a baby. In the meantime, I will control the things I can, so that I’m in the best mental and physical shape possible to cycle” and “If I reach out for the support I need, I will find people who understand.”
Personal Self-Care and Activities That Bring Joy
During stressful times like this, it can feel so natural to be angry with the world, yourself, and/or your body. Many people experiencing stress related to seemingly uncontrollable situations stop doing nice things for themselves. The opposite is true; this is a really important time to nurture yourself. In times like this, although a lot of things are largely out of our control, often we can still choose how we spend our time.
You require and deserve more enjoyment because your life may feel overwhelmingly stressful. By nurturing yourself, you reclaim your power to make yourself happier and to be more in control of your body and mind. Here are some suggestions to try:
- Make a list of 20 things that used to bring you pleasure and These may include an afternoon nap, reading a book unrelated to conception or pandemics, taking a mindful walk (6 feet from others), eating your favorite dessert guilt free, listening to your favorite music, taking a bath, lighting a scented candle, or putting flowers in every room of your house. Start to incorporate items from your list into your daily practice as a reminder that you matter and deserve to feel good during this difficult time.
- Pace yourself between stressful activities and reward yourself by doing something pleasurable after a hard task (see list above).
- Keep a feelings Write down your sad, angry, or jealous feelings, and see if things start to feel a little lighter. Pour out your emotions on paper; don’t show it to anyone, this is just for you
- Keep a gratitude journal, where you write things down that you are grateful for or that are going This can shift negative thoughts and help you maintain a sense of hope and positive thinking.
- Make a list of activities you always wished to do, if only you had extra time at These can include: learning to meditate, catching up on podcasts, doing laundry, cleaning the fridge, organizing a closet, starting an arts and crafts project, learning a new hobby, planting a garden, or trying new recipes.
Know When to Ask for Help
We know that many of you may be experiencing increased levels of distress during this time. It is certainly normal to feel concerned and out of control with the current COVID-19 situation. You may feel concerned about your own health or the health of your loved ones who are more vulnerable. You probably feel anger about how long you will need to remain in this situation, uncertain about the future, and frustrated about how long you will have to wait until you can resume fertility treatment. Loneliness and boredom associated with feeling cut off from others only adds to this perfect storm.
Everyone reacts differently to stressful situations. How you respond to the outbreak can depend on your background, age, personality traits, the community you live in, and how long you have been trying to conceive. Situations like the current pandemic can trigger other times in your life that you felt out of control, like your struggle with infertility or other previous trauma. Be aware of these triggers and get the support you need. When times get tough, practice patience and compassion, not just with others but most importantly, with yourself.
- How do you know when it’s time to reach out for professional help? Ask yourself some of the following questions:
- Have you lost interest in activities that used to make you happy?
- Do you find yourself unable to think of anything other than the pandemic or infertility?
- Are you isolating yourself more than you used to (not connecting with others in your home, virtually, or by phone)?
- Do you have more difficulty with others in your life, such as your partner, family, friends or coworkers?
- Are you feeling bitter, guilty, worthless, hopeless, or that you are being punished?
- Are you having trouble getting a good night’s sleep, sleeping too much, or are there changes in your appetite?
- Are you feeling the desire to use alcohol or drugs to cope?
- Are you experiencing intrusive distressing memories, flashbacks (reliving the event), nightmares, or are you easily startled?
If you experience any of these reactions more often than not, and for an extended period of time, contact your health care provider to get support and a referral to a mental health professional. Reach out to other people who are struggling to conceive at RESOLVE (www.resolve.org), where you can find relevant chat rooms and support groups. Seek counseling with a mental health professional trained in reproductive health counseling (go to asrm.org and look under mental health professionals listed who specialize in infertility).