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The American Fertility Association’s Monthly Newsletter

April 28 , 2008

Jackie Boivin, Ph.D.

Getting Intimate With Stress and Fertility: Part 2
Jackie Boivin, Ph.D.

How much stress is too much stress?

This is the million-dollar question for which no one has an answer. When people take medication we know at what dosage negative side effects can happen. Unfortunately, there is no such precision with stress, and never will be because people vary too much in how they react to events and how stress affects them. Some people seem to thrive on stress whereas others become sick and run down with the slightest amount of stress. This may seem a very unsatisfying answer, but it is very important because it explains why general results often do not match up with individual experience. In other words, knowing that there is an association between stress and fertility in the general population, does not mean that your stress will reduce your fertility.

If I relax will I get pregnant?

People with fertility problems constantly get advice to reduce stress levels with the idea that doing so will increase their chances of pregnancy. Common advice to relax, adopt, go on holiday or even stop thinking about fertility is easily and freely given by those who, frankly, know nothing about stress and fertility. In fact, doing any of those things is unlikely to improve fertility. Adopting does not make people pregnant and the pregnancy rate in infertile couples who adopt and those who do not, is the same. Holidays do not produce babies either, though they will make you feel better. Research has shown that when it comes to thinking about the fertility problem, the reverse is actually true: those who think about it often are more likely to eventually conceive, probably because they spend much more time working out their fertile period, consulting medical doctors or researching ways to stay healthy, all of which increase their chance of getting pregnant.

People with fertility problems are often encouraged to participate in psychological therapies aimed at reducing stress, and thereby increasing the chance of pregnancy. There are many psychological therapies: some teach relaxation exercises or coping skills, some help people express their negative emotions, and others provide validation and group support, to name but a few. In a recent review of 8 studies examining the effects of psychological interventions, it was found that all reduced distress and helped women and men to feel better. However, this did not necessarily translate into a higher pregnancy rate. In 3 studies women who participated in the psychological intervention had a better pregnancy rate than those who did not, but in a further 5 studies there was no improvement. Although effects on pregnancy rate were uncertain, the effect on emotional symptoms was much more consistent; most psychological therapies helped people feel better and, in this sense, they can help to improve quality of life during this demanding experience.

What actions should I take?

Do something about stress to improve your quality of life and minimize the disruptions it can bring to the project of having a child. As noted previously, high stress makes people unhappy and can sometimes lead them to engage in negative health behaviors that compromise fertility. This is particularly important if stress is causing you to want to drop out of treatment prematurely. If you do not have support from your partner or close family and friends, then you might want to consider participating in a support group or enrolling in a psychological program aimed at reducing distress. These are successful in reducing distress, and may help you discover coping strategies that would make going through the infertility experience easier for you and your partner, even if they don’t increase your chance of pregnancy. Finally, keep the issue of stress in perspective. Stress rarely (and most likely never) causes a person to never reproduce, and women get pregnant even in the most demanding of life circumstances. It is impossible to judge from the general findings presented here how your body is responding to whatever stress you might be experiencing.

Bibliography

Counselling:

*Excellent resource for men and women to help deal with all issues caused by fertility difficulties
Daniluk, JC. The Infertility Survival Guide. California: New Harbinger Publications, 2001.
Boivin J. A review of psychosocial interventions in infertility. Soc Sci Med 2003;57:2325-41.

Stress and life style effects on fertility treatment

Klonoff-Cohen H, Chu E, Natarajan L, Sieber W. A prospective study of stress among women undergoing in vitro fertilization and gamete intrafallopian transfer. Fertil Steril 2001;76:675-687.
Lancastle, D., & Boivin, J. (2005). Dispositional optimism, trait anxiety, and coping: Unique or shared effects on biological response to fertility treatment? Health Psychology, 24,171-178.

Impact of stress hormones on reproductive hormones

Ferin M. Clinical review 105: Stress and the reproductive cycle. J Clin Endocrinol Metabol 1999;84:1768-73.

Jacky Boivin, MA, PhD (Concordia), CPsychol is Reader and a Chartered Health Psychologist in the School of Psychology, Cardiff University and Honorary Fellow in the Department of Obstetrics and Gynecology, University Hospital Wales. Her principal area of focus has been the scientific investigation of psychological issues in reproductive health.

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Carolyn Berger, LCSW

Foster Care: Exploring the Real Deal! Part 2
By Carolyn Berger, LCSW

In the January issue of “Connections” AFA Adoption Coordinator Carolyn Berger wrote on the basics of adopting through foster care. Here, she continues exploring the realities
of this family building option. But first, here’s a recap of the most important points in the January article.

More people are adopting through foster care, in part because the Adoption and Safe Families Act (1997), freed more children in foster care to become available for adoption sooner.
In 1999, 46,000 children were adopted from foster care, compared to 17,000 children in 1990.
Since foster care is government sponsored, it’s a comparatively inexpensive adoption alternative.
Since many foster children need to be placed with their siblings, determine if you are able to adopt more than one child at a time.
Some foster children come with special needs, so you need to consider whether you can go the distance to parent a particular special needs child.
To identify a child with whom you might be compatible, review waiting children’s profiles with a knowledgeable person outside the system, and with an experienced adoptive parent through foster care.
Given that the majority of kids in foster care are black and Latino, you must candidly assess your ability to handle a transracial adoption if you are Caucasian or Asian.

While you are in the information-gathering phase of creating a family through foster care, you will want to cast a wide net to find the children who are available. Both The Collaboration to AdoptUsKids and The Dave Thomas Foundation websites have helped make matches between foster kids and adoptive parents, by broadening the scope of parents’ searches beyond their local departments of social services to a national level. Both have been recognized for their imaginative and innovative ways of finding permanent homes for foster children. So, initially at least, they are excellent research tools.

If you become serious about fostering, you may want to go back to these websites to broaden your search beyond your local department of social services. Then you can bring any of the children you read about to the attention of your social worker. Says Sarah Gerstenzang, Associate Director at AdoptUsKids, and author of Another Mother: Co-Parenting With the Foster Care System (2007), “We want waiting children to use our website to look for families, too. With the help of their social worker they can help find parents to adopt them, and this is an empowering experience.”

It’s a good idea to read about the issues you can encounter while raising a child who has lived in a number of homes. Foster children, on average, live in three different homes and are about ten years old when they are adopted. In other words, they have histories. Through trial and error, and often some professional help, you will need to understand your child’s past and help him come to terms with it. Social workers often have incomplete information about the children they are placing, so you will most likely need to explore all available avenues to get a clearer picture of a child’s life, as well as the meaning behind multiple evaluations.

One of the most important facts about children in the foster care system is rooted in the reason they entered the system in the first place: They lived in homes where they were abused and/or neglected, sometimes unspeakably so. Being cognizant of this will help you prepare for the child who may become a part of your family. Many of these children have been shown, time and again, that they are unimportant, and the foster care system can exacerbate this by moving children from one foster home to another without adequately preparing them. (The fact that the foster care system is overburdened is largely to blame.) As an adoptive parent one of your goals will be to show your child that he belongs with you forever. Understandably, this may not be an easy lesson for him to learn.

You will probably need to develop new parenting techniques and strategies even if you have already raised a few children, since many foster children have had to develop survival skills to cope with difficult environments—skills that are undesirable in “normal” home environments. (Your child may have had to lie or steal to avoid abuse or just get his basic needs met.) And, you may well need to bring in professionals to help your child adjust. Says Matt, a foster father in Long Island, New York, “ If you learn that your child is struggling with a difficult issue stemming from his past, you should get him into therapy. You are this child’s father, and you can’t be a father and a therapist at the same time.”

You may also have to work harder to “claim” your child as your own despite his history with his biological parents and various foster families. Read Parenting the Hurt Child (2002) by Gregory C. Keck and Regina M. Kupecky. The authors address bonding, and offer some valuable insights, as well as plenty of practical advice on raising a child from foster care.

Your next step is to contact your county’s Department of Social Services, which places children in your geographic area. While the exact process varies from state to state, becoming eligible to foster parent involves a home visit, home study, and child abuse clearance. In addition, prospective foster parents are required to take an in-depth training course to learn more about foster children and how to parent them. Once training is completed and certification has been achieved, your home is open for the placement of foster children. While you wait for your child, reach out to other parents you met through your training classes, as well as experienced foster parents. Whether you meet them in your county or over the Internet, they can provide you with the fruits of their experience. Remember, there will be many points after your child has been placed with you, and before you have adopted him, to assess whether you and he are a “good fit.”

Laura Ann and Henry of Topeka, Kansas, built their family through foster care. When they got married, Henry already had three children from his first marriage. Laura Ann desperately wanted kids, and after six years of marriage Henry suggested they take in foster children and “see how it goes.” Carl and Ronnie, the two children they took in first, had special needs and various diagnoses ranging from a learning disability to emotional problems. The couple got both of them into therapy, and had Ronnie evaluated for medication to treat his ADD. Two years later, Laura Ann and Henry were able to adopt them. Later, they brought in three more children from foster care. The couple felt supported by their social workers, who visited them often and recommended books for them to read. They also participated in a monthly parent support group. Eventually, Laura Ann and Henry adopted those three children, too. “Adopting through foster care fulfilled my need to become a mom,” says Laura Ann, adding in her characteristically offhand way, “These kids really needed us, and, you know, I think we just may have saved them.”

Carolyn Berger, LCSW, is the Adoption Coordinator of The AFA. She has two teenage sons. Her second son joined the family through adoption.

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The American Fertility Association, 305 Madison Avenue Suite 449, New York NY 10165.
Support Line: 888-917-3777. Fax: 718-601-7722. www.theafa.org