COVID-19, fertility care, & mental health


TAMMY: I’m Tammy Sun, the Co-founder and CEO of Carrot Fertility. Thank you all for joining us today. 

In this webinar, we are going to review and talk about, a few of the most common questions that we’re receiving from members and other people about mental health and fertility — a lot of these topics range from managing stress and anxiety during this very unusual and heightened time of uncertainty, to how people are navigating the impact that this may have on their family planning at this time. If you’ve attended any of our other webinars before, the format should be familiar, but I’ll just review it quickly. We’ll start with some questions that Carrot is already helping our members with, and then we’ll open up for questions from our audience. Q&A is open, please use the Q&A function in Zoom at any point to ask your questions.

A few quick reminders before we get started.

  1. Outside of this webinar, Carrot’s Coronavirus & Fertility Resource Center is open and free for everyone at carrotfertility.com. We’re regularly updating with the latest guidance and common questions about COVID-19’s impact on fertility care and adoption. You can also access our Carrot Care Team on that page for any additional questions.
  2. We’re not providing advice — always talk to your physician to determine the best plan for your situation

On behalf of Carrot and all of our staff, we commend all of the healthcare workers and mental health specialists supporting all patients during such a challenging time. We are so impressed with the thoughtfulness and care that fertility clinics have taken to support Carrot members during this time.

And now for a quick intro to our panelist Peggy Orlin. Peggy Orlin is a licensed marriage and family therapist who specializes in the emotional aspects of infertility, third party family building, and adoption. She has been practicing since 1984. At Pacific Fertility Center, she has co-led stress reduction classes for patients and coordinates discussions for staff on ethical issues in reproductive medicine. Her involvement with third party family building includes psychological education and screening of all involved - including donors, recipients and gestational surrogates. In addition to her infertility counseling, Ms. Orlin enjoys work with couples and adults dealing with grief and loss, as well as those coping with anxiety and relationship problems. I’m so pleased to be with her here today. Thank you so much for joining us.

Like I mentioned, first we’ll start with a few questions we’ve received so far, then move on to the open Q&A. So if that’s okay with you Peggy, I’ll just dive right on in.

As we’re going through fertility treatments, it’s already a high stress situation. What are the things, for folks who are listening,  can do right now to deal with the uncertainty of not knowing when I’ll be able to start treatment again?

PEGGY: This is an unprecedented time for everyone. With fertility we already know that’s intensely stressful for people, so dealing COVID-19 adds a huge second level of stress. There are a few things though that people can do. 

First, for fertility patients, remind yourself that this shutdown of fertility services and cycles will come to an end. It is temporary! You will be able to return to treatment. Then I have another suggestion for people who have a partner. Schedule time every day to talk with them about your infertility treatment. Use that time to discuss your thoughts and feelings, this sounds typical  and some already do this, but let’s set some parameters around it. Set aside 15 minutes for this discussion, and do this at the same time everyday. Take a walk after dinner, and use that time to do it, this way it creates some structure. This allows the partner who is thinking about the treatment to know that it will be discussed every day and limits the talk for a partner who may be less enthused about discussing the issues. 

As Tammy mentioned earlier, I just want to reiterate that Carrot’s Coronavirus & Fertility Resource Center, and another resource for infertility patients is resolve.org, it’s a wonderful organization and has lots of online resources for people.

TAMMY: And to follow up on that question with another question of my own, do you have general suggestions for dealing with stress at the moment? 

PEGGY: Great question, I love this because it’ll give me the opportunity to do a couple experiential exercises with the people listening. I’m going to list a whole bunch of suggestions, they’re not mandates. Don’t put this on your ‘should list’ if you want to try it you can. I suggest you continue to get moderate exercise, meditate, or learn a breathing technique.  You can do mindful meditation, there are a lot of online yoga classes right now, I recommend restorative yoga because I find that to be the most relaxing. Listen to relaxation tapes, you can find these online pretty easily. Another thing to do is to find little bits of joy in your life. I think we lose sight of those things in times of stress. The other day in Berkeley there was a huge rainbow, and I probably looked at it for 15 seconds, but it gave me maybe a minute of joy. And it was a really wonderful feeling. Feel gratitude when you’re able to. Find humor where you can, there’s a lot of it online these days. You can give back to others, shop for a senior who’s fearful of going out to the store. When you take walks in your neighborhood, which a lot of us are now doing, say hi to people. It may not be something you did in the past, but look at them and say hi and wave, it’ll make you feel better.

I want to go back to what I mentioned earlier about mindful meditation. I think meditation, there are probably a lot of people listening who already meditate, but for those who’ve been reluctant to start meditating, I think a way to start is using mindful meditation. I just want to describe what that would be, for say a walking meditation. You can do mindful meditation with anything, you can eat dinner and your vegetables tonight doing mindful meditation. So a walking mediation can be something you do at home, your backyard if you have one, or out on the street. The idea is to bring your intention to what you’re doing. Bring you attention to your body, your breath as you walk. You walk very slowly, but fast enough so you don’t feel like you’re falling or going to lose your balance, but it’ll be slow. Notice your body at every step you take— feel your feet, your legs. How do your hips move in the sockets? What are your arms doing? Just focus on everything that’s happening in your body. While you’re doing that notice your breath. We’re all breathing all the time, so notice it. How fast is it? How slow? Can you slow it down a little bit? Take a longer inhale, take a longer exhale as you walk. Start with this, you can even start with just one minute. Then you can try 2 minutes, and then 3 minutes. The advantage of this, over regular meditating where you’re just focusing on your breath, is that it gives you something else to focus on. And for a lot of people that’s much easier. 


TAMMY: That was great Peggy, thank you. Right now a lot of people are feeling stressed, and thinking about stress in the context of ‘Oh Gosh, does this impact my chances of getting pregnant?” what would you say to folks on this webinar who are thinking through that question?

PEGGY: I would tell them that we’re not 100% clear if stress can impact getting pregnant. There are different studies that exist that have differing opinions on this. But, the vast amount of research indicates that when patients are doing a medicated cycle at a fertility clinic, the medications they are taking will mitigate the effects of stress on our fertility. Where stress strongly impacts fertility is that it can cause patients to discontinue their treatment due to feelings of being overwhelmed by their stress.

TAMMY: One of the biggest challenges of this time, is really time. One of the other questions we got is ‘I feel like my window for getting pregnant is running out, and I’m worried about the impact a month or two delay may have on my fertility. What can I do to deal with this?

PEGGY:  You mentioned earlier in the introduction about staying in touch with your doctor. Doctors are in touch with everyone they work with by email. Ask them the facts, ask them your about your situation, and where it fits into this question. It helps to know, it helps to be educated. And it can help you not spiral down into those difficult feelings. 

Another thing about this, I think there are ways to deal with this, potentially if you find yourself spiraling down into difficult feelings. What people will do when this is happening is that they’ll start thinking in non-productive ways. They’ll say to themselves “I’ll never succeed” and will use “never” or “always” in the statement which people know, probably in their own relationships, tend to be buzzwords which upset others, so you upset yourself with it.  But unless the doctor told you that was your case, it is probably not true. 

Another way people use their thinking that causes trouble for themselves is that they catastrophize, or they go to worse case scenario. So they say to themselves “I’m a failure” vs “It’s been a struggle to get pregnant”. So there’s a technique for that and it’s under the rubric called Cognitive Behavior Therapy. There are plenty of websites that have this, and I can send you some to add to the Carrot Resource Center. You can do these techniques alone, with a partner, or with a professional. The technique I think is most useful when you’re having obsessive thinking is called Cognitive Restructuring. In a nutshell, when people are upset they think in the non-productive ways I mentioned. Cognitive Restructuring has about four steps that you go through to help yourself judge when you’re being realistic vs the times when you’re using the non-productive thinking. Once you can get yourself calmed down, and know what’s really true, it’s helpful.   

One last technique. This one is the simplest, and again, I’m going to let you do it with me. I’m going to teach everyone, and it’s going to take around 15 seconds. 

If you’re having obsessive thoughts  this is called distraction. Close your eyes if that is comfortable for you, or set your gaze lightly at the floor. Take a moment to visualize a stop sign in your mind, see the 8 sides of it and the white on red lettering. Picture a stop sign on the streets. That’s it. All done. If you do this when you are having repetitive thoughts about treatment, the technique may move your mind to another track and disrupt the obsessive thought. It’s like the engineer on the train, switching the track.

TAMMY: It’s so great to get all these little tips and tricks, for anyone to practice. I think right now everyone has gone down into catastrophizing, or has fallen down one of these rabbit holes. So this is really, really great. One more question we have, before we open it up to the Q&A, is “I was mid-cycle and my clinic had to cancel due to closures related to COVID-19. How can I deal with the disappointment of this and get myself mentally ready to start all over again?”

PEGGY: It sounds like the question is looking for a specific way to get over the disappointment so that the person feels prepared for the next cycle. The problem with that is that’s not how our feelings work. They are messier than most of us would like. Dealing with disappointment is an ongoing process. Of course you are disappointed. This means more waiting. And we all know how difficult waiting is for people going through fertility treatment. You don’t need to get over the disappointment before you can begin your treatment again. It doesn’t follow a linear path. Disappointment will also diminish if you allow yourself to feel it for a while. It’s when you try to completely avoid the feeling that problems arise and the feelings begin to sneak up on you.

This may be a good time to mention depression. Depression is a common response to much of what we have been discussing. Being depressed, say like when someone has a failed cycle, for a short duration is common. It becomes a problem when it doesn’t lift after a week or two weeks. Symptoms would include a lack of interest in doing things you used to enjoy, excessive crying or irritability, loss of appetite or overeating, inability to concentrate, changes in sleep or your energy level, or thoughts of suicide. If anyone has these symptoms for more than a week, please contact a medical professional who can refer you to a psychiatrist for treatment. Depression is treatable. And for those who are having suicidal thoughts, there are suicide prevention hotlines all over the country where you can get help.

TAMMY: We have a good number of questions coming through from the Q&A. So I’m going to start on this one about sleep. The question is “I’ve been having trouble sleeping with changes in my day-to-day schedule and worries about COVID-19. What can I do to manage that?”

PEGGY: Many sleep problems are short lived. Sleep problems are an incredible drag, partially because they make you feel less able to cope. The number one step in reducing sleep problems is to stop worrying that you aren’t getting enough sleep. I know that sounds like ridiculous and impossible advice. I’m going to tell you about my personal experience as a poor sleeper as an example. A number of years ago I took a sleep class to learn to sleep. The class was 6 weeks long and the techniques were difficult for me to implement. But I attended the class every week. Each week I was anxiously complaining about loss of sleep and a fear that I would not function well. My instructor’s reply was, “So what?” I was upset with this response so I continued to repeat myself. He did too. Every anxiety was met with “So What” It turned out to be the best advice he could have given me. I eventually began sleeping more when I reminded myself that the lack of sleep would be uncomfortable but that it would not seriously harm my health. Worrying about things we cannot control or change does not help. It does help to do what you can, implement a plan for dealing with the challenge and then try to put it aside. 

TAMMY: Our next question is from a person who’s partner works in a high risk environment. The question is “My partner works in a high-risk environment, and it’s causing me a lot of stress. What can I do to cope with this”

PEGGY: This is a case where I would want to get educated. What’s happening to my partner? What’s happening at work? What steps are they taking to stay safe? What steps are their employers taking to keep them safe? You feel a loss of control in these situations, and I think everyone is feeling that loss during this pandemic. You have to remember that when people are participating, and doing their part, in helping to flatten the curve it builds mental strength. It helps you combat the stressful situation, and the whole globe is experiencing this. 

TAMMY: We all are certainly in this together. The next question is from someone who is watching a lot of news  “I’m constantly watching the news and refreshing websites to see the latest information available. Is that healthy for me or should I stop?”

PEGGY: Lots of websites dealing with COVID-19 are suggesting that people cut down on screen time. That’s a great suggestion for many people, but if you cope with your stress by learning, reading about COVID-19 may make you feel empowered. That is not true for everyone. Perhaps you need to limit the amount of time you are online. Absolutely look at well researched websites. The WHO offers excellent information. You need to learn what stress reducers work for you and which you can skip. The main factor is to try some of them and find out which ones work.

TAMMY: Being online more is potentially increasing because we’re staying and working from home with the shelter in place order. Which leads us to our next question that popped up “My city has a stay-in-place order in effect, and I’m really struggling with working from home and having to stay inside. Any suggestions for dealing with this change?

PEGGY: There’s a website I saw earlier and I happen to have some notes on it, it’s from the Anxiety and Depression Association of America.

They suggest that you try to reframe the thought “I am stuck inside” to “I can finally focus on my home and myself.” It can be an opportunity to refocus your attention from the external to the internal. Focusing on what you might like to get done during this time. Like, I’ve noticed gardens in my neighborhood are really well weeded this year. And lots of people are taking their dogs out for walks. 

Other things to do, that they suggest is to try to stay as close to your normal routine as possible. Try and maintain some semblance of structure from the pre-quarantine days. As you work from home, it could be tempting to fall into a more lethargic lifestyle, which could lead to negative thinking. Wake up and go to bed around the same time, eat meals, shower, adapt your exercise regimen, and get out of your PJ’s. Do laundry on Sundays as usual. Not only will sticking to your normal routine keep you active and less likely to spiral, it will be easier to readjust to the outside world when it’s time to get back to work.

They also suggest journaling. Writing down your feelings can be very healing for some people. It’s important during this time to stay connected to the people that you care about.  Many licensed mental health providers are offering telehealth over HIPAA-compliant video chat platforms. Remember to reach out for help if your anxiety is reaching proportions that feel  unmanageable without professional help.

TAMMY: Another question, Peggy, on stress “I’m a healthcare worker, and my stress levels have gone way up. Are there resources available for me?”

PEGGY: There are resources online. One of the best ones is from the National Center for PTSD. What they suggest for healthcare workers: 

  1. Regularly check in with their own support network of family and friends
  2. Take stress reduction breaks, get refreshments and do bodily care
  3. Focus on what they CAN do, not what they can’t do.
  4. Work in teams where you can
  5. Get regular peer consultation
  6. Recognize that the rest of the world is beyond grateful for their work and sacrifice.  

TAMMY: Absolutely, if there are any healthcare workers who are with us today on this webinar we’d like to pause and take a moment to express our incredible gratitude and respect for the work that you’re doing, always, but particularly now.   

Another question we have is somewhat related to shelter in place “I’m feeling lonely and isolated right now. Are there online support groups or other people I can talk to going through this?”

PEGGY:  I mentioned Resolve.org is a wonderful resource for fertility patients needing support. They offer support groups in all areas of the U.S. 

The clinic that I work at, Pacific Fertility Center, offers a monthly Mind/Body Support class to fertility patients. For now, the class will be offered online. Go to PFC’s website for details. You can also find country-specific resources on Carrot’s Coronavirus & Fertility Resource Center at carrotfertility.com. You can find support for everyone on the WHO website. 

TAMMY: That is really great, and I know we only have a few minutes left on this webinar, and I want to be respectful of everyone’s time. Peggy, is there anything you’d want to add just in closing that we haven’t really addressed today but you’d like to say to folks on the line?

PEGGY: I’m not sure if I have anything new to say, but I would like to reiterate that the stress reduction techniques are able to be used by anyone, for any circumstance in your life. The only stress reduction strategies that will definitely not work are the ones you never try. We don’t know exactly what the future will bring.  Everyone is worried. Everyone wants to stay safe and healthy. Please stay connected to people you love and who love you. The pandemic will end. 

TAMMY:  Thank you Peggy, thank you so much for joining us.  For any Carrot members that may be listening, we’d like you to know that our teams are continually driving efforts to support those family forming journeys that may have been impacted by monitoring global, regional, and national-level information very closely. Carrot has resources available on our COVID-19 Resource Center page as well as by contacting the Carrot care team. We’ll continue hosting webinars in the coming weeks to make sure you’re getting answers to the questions you have about every aspect of fertility care in the current crisis. These will be posted on our Coronavirus & Fertility Resource Center at carrotfertility.com

Thank you so much again to Peggy. And I hope everyone stays well, stays safe, and stays healthy.

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