Resilience in infertility
I have written previously about stress and infertility with the bottom line being that the effects of stress on infertility are unclear but the experience of infertility is undoubtedly stressful. So, today I want to discuss resilience - how we can respond or adapt to adversity and stress in our lives in a way that improves our quality of life.
There is strong evidence that couples experiencing infertility have high levels of stress and decreased quality of life (1,2,3,4). But, a growing body of research shows that resilience can mitigate the effects of this stress. For example, a recent simple but well designed study of Chinese women undergoing IVF showed that higher levels of resilience were associated with higher perceived quality of life, despite similar self-reported levels of stress (5). The women completed scientifically validated questionnaires that measured their levels of fertility related stress, overall quality of life, and resilience. Women with higher levels of resilience reported a better quality of life than women with the same level of stress but lower levels of resilience. This finding suggests that resilience may help mitigate the impact of stress during infertility.
What is resilience?
The American Psychological Association (APA) defines resilience as the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship problems, serious health problems, or workplace and financial stressors. This ability to adapt well comes from a set of behaviors, thoughts, and actions that can be learned and developed (6). But, like building a muscle, or learning an instrument, this takes time and intentional practice.
How can you build your resilience?
There are four core components of resilience — connection, wellness, healthy thinking and meaning6. Investing in each of these components can help build resilience.
Connection
Infertility is a uniquely isolating experience. Despite 11% of US women struggling to conceive at some point in their family building journey, it is something we don’t talk about. And, with good reason. We’ve all experienced the well meaning but ultimately hurtful comments of a friend or family member or perhaps even felt judgement for our childlessness. It is also not uncommon for a sense of isolation to develop within couples as each member processes their fears and emotions around infertility independently. However, feeling a strong connection to others, particularly people who understand or share our experience, is a core component of resilience.
So, as scary as it is, identifying the people in your life who may understand your experience and allowing yourself to be open with them about your struggles may actually help. With your partner, aim to keep an open dialog about how you are feeling, even when you think you may not be on the same page. I know that, for myself, I am often surprised by the support I received when I allow myself to be a little vulnerable, whether with a friend, acquaintance, or my husband.
Groups and communities can also be great for fostering a sense of connection. As I’ve written before, infertility support groups can provide a wonderful sense of community and support.
Wellness
Yes, it is a buzzword and some may even say that wellness has become an Instagram fueled competitive sport. But, to practice wellness, you don’t need to start the latest fad diet or newest fitness craze. Practicing wellness simply means focusing on the things that help you feel strong in body and in mind.
We are all tired of hearing that we should eat a healthy diet, exercise, and get enough sleep. But, stress is as much physical as it is emotional, so, by helping us feel physically stronger, these things can make us more resilient in the face of stress. In fact, regular exercise has been shown to ease the symptoms of depression and anxiety.
Practicing mindfulness can also bolster your resilience. Things like meditation and yoga are great for cultivating mindfulness, if they work for you. (And, if so, check out Kerry Hinds for wonderful restorative fertility yoga and guided meditations.) But mindfulness is simply “a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations”. So, anything that fosters this state for you is practicing mindfulness.
Healthy thoughts
I don’t like the term “healthy thoughts”. Thoughts are thoughts - they are neither good nor bad and each serves a purpose. That said, there are some thought patterns that promote resilience and others make resilience hard to access.
“All or none” or absolutist thinking is one example of a thought pattern that can make it hard to access your resilience. This is when you see the world as either good or bad, right or wrong, full of opportunity or completely lacking in it. It is when you find yourself using words like “always”, “nothing”, “completely”. While absolutist thinking is a common stress response, it can block us from seeing the good in our lives and ourselves in spite of our current situation. So, long term, it serves to reinforce stress rather than support resilience.
But, building resilience doesn’t mean not having these kinds of thoughts. Rather it is about learning how to recognize when your own thoughts are amplifying your stress and then shift your perspective. Finding a family member or friend who understands your experience but is distant enough from it to help you think more rationally, may be helpful in this process. Alternatively, coaches and therapists are trained to help you identify these thought patterns and adopt perspectives that serve you better.
Meaning
When you’re struggling with infertility, it is common to feel stuck or lost leading to a sense of lack of pride, purpose, or meaning in your life. While these feelings are natural and understandable, looking for ways to feel more meaning or purpose in your life can help you be more resilient in your struggle.
For some people, a sense of purpose comes from getting involved in a cause they feel passionate about. For others, it may come from investing in their professional development. Regardless, as I address in this post, you are more than your infertility. So, invest in things that help you feel proud, whatever they are.
Others may find it helpful to find meaning within their struggle - to recognize the strength they have as a result of their challenge. For example, during my own struggle with infertility, I would repeat the chorus of Leonard Cohen’s song Anthem to myself like a mantra. It goes:
Ring the bells that still can ring
Forget your perfect offering
There is a crack in everything
That's how the light gets in
For me, this served as a reminder that my struggle, while painful, also offered a unique clarity and strength. It helped me to feel stronger in my vulnerability.
Conclusion
The experience of infertility is extremely stressful. But, approaching the challenge with a focus on resilience, may mitigate the impact of this stress on our quality of life or sense of well being. So, here I’ve provided suggestions on how you might do so. But, it is important to keep in mind that building resilience is not easy or fast. In fact, it is probably something you’ll find yourself working on again and again in life. What I offer here is not meant as a prescriptive list of things to do. Rather, it is meant to spark your thoughts on what building resilience might mean for you. Where might you build deeper connections? What areas of wellness might you invest more in? How are your thoughts influencing how you respond to stress? And where might you find more meaning or pride?
I hope you find this helpful. Feel free to email me with follow-up questions. To receive more content like this, sign-up here.
Domar AD, et al (1993) The psychological impact of infertility: a comparison with patients with other medical conditions. Journal of Psychosomatic Obstetrics and Gynecology 14 Suppl, 45–52.
Masoumi SZ, Garousian M, Khani S, Oliaei SR, Shayan A. Comparison of quality of life, sexual satisfaction and marital satisfaction between fertile and infertile couples. Int J Fertil Steril. 2016;10(3):290–6.
Namdar A, Naghizadeh MM, Zamani M, Yaghmaei F, Sameni MH. Quality of life and general health of infertile women. Health Qual Life Outcomes. 2017;15(1):139.
Aduloju OP, Olaogun OD, Aduloju T. Quality of life in women of reproductive age: a comparative study of infertile and fertile women in a Nigerian tertiary Centre. J Obstet Gynaecol. 2018;38(2):247–51.
Li, Y., Zhang, X., Shi, M. et al. Resilience acts as a moderator in the relationship between infertility-related stress and fertility quality of life among women with infertility: a cross-sectional study. Health Qual Life Outcomes 17, 38 (2019). https://doi.org/10.1186/s12955-019-1099-8
American Psychology Association (2020) Building your resilience. https://www.apa.org/topics/resilience