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Deborah Howell (Host): You know, taking care of your mental health is just as important as taking care of your body when you're struggling with infertility. In honor of National Infertility Awareness Week, Dr. Tiffany Edwards, a Licensed Clinical Psychologist and Patient Educator here at FCI, is with us today to help us better understand what we need to know about fertility and mental health.

This is the Time to Talk Fertility podcast. I'm your host, Deborah Howell. Dr. Edwards, it's so nice to have you on with us today.

Tiffany Edwards, PhD, MPH: It's a pleasure. Thank you for the invitation.

Host: Well, let's dive right in, shall we? How does infertility affect mental health?

Tiffany Edwards, PhD, MPH: I think it can affect a person's mental health in many different ways. I think it has a lot to do with the way they ascribe meaning to the term, to the diagnosis. You know, for a lot of patients that meet with me, they oftentimes come in and tell me that they're struggling with feelings of shame or guilt or fear or, uncertainty.

They may be the first person that they know that has struggled with infertility. Many of their friends, might be attempting pregnancy or might be pregnant. And so I think it's natural that we all struggle with those questions of why me and why is this occurring and what's making us struggle, if you will.

So those feelings and those questions and thoughts, those can lead to feelings of sadness or discouragement, loss of hope, if you will. I think many people also struggle with feelings of guilt. Was it something that I did or didn't do? Like maybe I waited a little too long or maybe I should have done things differently.

And so, I think a lot of people also, they kind of struggle with fear and the uncertainty of maybe this won't work and what if this doesn't work? I think for a lot of people, they've always identified being a mom or that's what they thought, that it might look like in the future for them.

And so if you're struggling with infertility, then I think you're also struggling with this idea of what I had always maybe envisioned my role and my identity and to be that is changing now and what does that look like for me? So that can lead to feelings of uncertainty and anxiety. So I think there's a range of different feelings and things that might occur when one is facing infertility or struggling with it.

Host: Yeah, then you don't want to let your partner down, et cetera, et cetera. In your practice, you must come across this on a daily basis. How common is experiencing emotional distress when someone's dealing with infertility?

Tiffany Edwards, PhD, MPH: I think it's very common. I think it's a natural reaction to question why and to want to know why and to get certain clarity and to just better understand why are we struggling with this. So I think it's natural, it's expected, and most people struggle with the questions of why and what next and what does this mean.

I think the way, you once again, you kind of ascribe meaning to those questions, the way you cope with that, can slightly differ, but I think most people that are not just dealing with infertility, but with any medical diagnosis or with anything that was kind of not expected, there is a certain level of struggle and wanting to understand and know what next steps are.

So it's incredibly common, honestly.

Host: Okay. Now, does infertility affect the emotional wellbeing of men and women equally?

Tiffany Edwards, PhD, MPH: I would say once again, that both men as well as women may struggle with the questions of why and wanting to understand. I think many times it's the person that might be challenged by infertility or the diagnosis that might experience it more at the internal level, of those questions of why me, what am I doing perhaps. Whereas their partner might feel it a bit more at the external level in terms of wanting to help their partner or be there as a support. But I think they both face those same struggles that I've mentioned in the beginning of what does this mean both for our family, for us as a couple, for me as an individual. And I think the way you think about, and the way you respond to those questions can oftentimes dictate the way you feel about that and whether you feel sad or with loss of hope or discouraged or frustrated or wanting answers and wanting to go forward. So I think we all struggle with a lot of the common questions.

I think it has a lot to do with which individual might be taking on some of that personal and responsibility or those feelings of a personal responsibility, if you will.

Host: I want to switch tracks for just a minute if you don't mind, and ask you what is mindfulness?

Tiffany Edwards, PhD, MPH: Mindfulness at its most basic idea is really just a focus on being present, if you will, and trying to stay grounded in the present moment. Being aware of yourself in space and the environment, if you will.

Host: And are there mindfulness exercises that you can recommend?

Tiffany Edwards, PhD, MPH: There are lots of different exercises, honestly. I think some that tend to be my favorite, and maybe I should back up and say that my style tends to be incredibly basic cause I'm not a therapist that will encourage people to go out and buy all these things and do all these things. Cause I want things to be as accessible as possible for a lot of people.

So some of the strategies that I tend to encourage patients to at least start out with is, the most basic really is just trying to focus really on your breath. So if you feel like you're feeling kind of overwhelmed or a bit stretched thin, or you're just feeling overwhelmed in the moment, I think there's nothing better than just literally taking a minute even. It doesn't need to necessarily be this like nine minute long thing, but taking a couple seconds or one or two minutes to just literally sit back and breathe. You can close your eyes, but just really focusing on trying to calm your breath and taking a few deep breaths in and deep breaths out, so that's one of my favorite.

You are also talking to a nature girl, so, for me personally, like whenever I get exposure to nature, so if I have the opportunity to step outside for a second, just to get some fresh air, that does me wonders. Now, there are times where I can't step outside or go into nature or take a walk, let's say.

So, it's been my experience that even looking out the window, just seeing the sky or just looking outside of my current environment really, really helps. One other exercise that I actually really, really like, it's typically recommended for individuals that are suffering with maybe anxiety or panic attacks, but it's called the 5-4-3-2-1 method. And that's essentially where you're focusing on your senses. And so what it is, is if a person is really overwhelmed or they're feeling very nervous or very anxious, you're encouraging them to really focus on their five senses. So you're really encouraging people, within that moment; tell me five things that you can see right now, and then you tell them to tell me four things that you can touch, that you can actually feel. Tell me three things that you can hear. Tell me two things that you can smell and tell me one thing that you can taste. So what makes these strategies really important is because you're really, at its core, trying to get the person to focus on their present state. Because many times if we're thinking too far into the past, we're oftentimes thinking about things that I could have done or I should have done, or wish that I would've done. And so I think that can lead to feelings of regret or sadness or woe is me. And then if we think too far into the future, then we start getting into those questions of what if. And I think that can lead to a lot of uncertainty and anxiety. So it kind of swings in both directions. What these strategies do is they take the mind and it centers it in the present, because honestly, no one is able to think both about the present as well as the past, nor the future.

The mind can't be in all three at the same time. It can really only be in one state. So these strategies are really trying to encourage you to be in the present moment, focus on what you're feeling, thinking, being in the moment. So what makes that the one strategy, that I just mentioned, really effective is because if you're focusing on your senses, looking at things that you can actually physically see, hear, touch, smell, taste now, whatever you might have been struggling with, momentarily or kind of in the moment, you're now trying to redirect that energy into the present.

So those are really effective strategies that I personally use and those are strategies that I try to encourage patients to also use when they feel like they are feeling very overwhelmed or struggling in the moment.

Host: Let's talk about being overwhelmed. What steps can patients take to stay engaged in the activities they love, if they are feeling overwhelmed?

Tiffany Edwards, PhD, MPH: That is a really interesting question. Because one thing that I oftentimes find, it's kind of funny actually, but there are many times where patients might come and they'll be talking with me and they'll let me know things like, yeah, I just started taking yoga, or I just started doing meditation and so naturally, so one of my first questions is, so is it something that you enjoy? Is it something that is a nice activity for you? And they're always like, no, I really don't like yoga. And I don't like journaling. And so one of my first questions is, well, what's making you want to take up yoga?

And then it's because that's what everyone's doing, or that's what everyone told me that I should be doing. And so what I always do is just first try and encourage people to do an activity that you actually like. So if you don't like yoga, but you like to journal or you like to color, or you like to just watch funny movies, stick with what you like, that will actually give you some joy and peace and benefit.

So I think that's number one is if there are some activities that you've always done, they've always made you just feel good and energized and stick with those. So don't try to take up new things just because other people might have recommended it. Now, it's not me saying don't go out and try things. But if you try it and you don't enjoy it, don't continue doing it just for the sake of it, if you will. And so that's number one. And what I also like to encourage people to do, cause I think many patients, like when they start treatment, they get this idea that they have to stop everything or maybe just don't want to engage in a lot of those same activities with friends or family or do all of those things.

But if there's one or two things that you really did enjoy, maybe you and your partner went on a date like once a week or something. Try to keep those things going even at the start of treatment. And don't let those fall off by the wayside. Cause I think it's important to keep up those activities that always were there that brought you joy, that's going to be even more useful for you as you move forward.

Host: Yeah. Sense of continuity.

Tiffany Edwards, PhD, MPH: Yeah, exactly.

Host: Now, why is it important to have a strong support system in addition to your partner when dealing with infertility?

Tiffany Edwards, PhD, MPH: I think it's important because what I mentioned at the beginning, I think there's a lot of unknown and uncertainty, especially when you're in treatment. You don't know what you're going to be doing or to be expecting. And there are people that tell me that they don't have a strong network of support.

Maybe it is just them and their partner. And I think that's fine, honestly, if I'm honest with you. It's really not really about some large network. If you have that, that's a blessing and that's wonderful, but it really can just be one or two key people that you can really, really talk to. And just let them know what you're struggling with.

You can be very vulnerable with them, and I think that's the key is to have key people that can be there as a support for you, not necessarily lots of people. If you have that, that's wonderful, and you can tap into all of those people. But if you only have one or two people, maybe it's your partner and a good friend or a colleague or a parent: use those people and really let them know you need some support.

Host: Yeah, it's like you have to vent this stuff cause there's so much going on with, you know, inside you when you're going through the infertility process. How does one build a strong support system? Do you have any suggestions?

Tiffany Edwards, PhD, MPH: I do. I think the one thing that maybe I encourage patients the most, cause I think we oftentimes, and it's not just people that are going through infertility treatment. I think most of us kind of do this. We assume people know what is going on with us. We also assume that they know what we need. Like especially with your partner, you just expect them to just look at your face and know exactly what you're thinking and know exactly what you're feeling.

And that would be wonderful if that was the case, but it's oftentimes not. So I really like to encourage patients to do, if there's any point within your life where you get to actually ask for what you need and what you want, now is that time. So, because for a lot of people, their network of support may not know what they're going through, may not understand what it's like to go through treatment for infertility, may not know all of what is involved in this. So what I encourage people is to let your network know this is how you can best support me right now. This is what I need from you. Let me be the one to start the conversation. Let me mention what's been going on with treatment. So like, let me guide it or just let them know this is how you can best and support me in this moment. It's been my experience working with both patients, but also working with their family and spouses and friends and things, they will appreciate that guidance, cause many times they're struggling with what to ask or what to say or what you might need. So I think it's absolutely fair and beneficial to tell people this is what I need right now. This is the way you can best and support me in this moment.

Host: And what support groups does Fertility Centers of Illinois offer?

Tiffany Edwards, PhD, MPH: We've actually got three different groups. So one is our most popular group. It's called No Partner Needed, and it's a support group that is for women that are single and starting families on their own. And it's a incredibly, fun group. They're very engaged. It's a very popular group. We also have a loss group. So that's for any family that has experienced any type of loss kind of along their journey. And then we also have a third group that's more of a infertility group kind of in general. And that's for any patient that is struggling with infertility, that's going through treatment. These are open not just to FCI patients, they're open to anyone that might fall into one of those three categories.

They're absolutely free and they're through Zoom, currently still, with everything going on.

Host: So say I'm new and I fire up the Zoom for the first time, what can I expect at these support groups?

Tiffany Edwards, PhD, MPH: I think you can expect to have the opportunity to talk with other people that know what you might be feeling and what you might be thinking and what your journey might have been. Cause they're also in that same kind of journey with you. So I think it's a nice place to talk with other people where you don't have to explain everything that you're thinking and feeling.

Cause they're oftentimes kind of in that same space also. So I think that's one of the benefits with attending any kind of group. It's that shared understanding based on experience.

Host: So wonderful. Can someone schedule a one-on-one appointment with you or other behavioral health specialists at FCI?

Tiffany Edwards, PhD, MPH: They absolutely can. So it's me and my colleague and we are available to meet with patients at whatever stage in their journey, whether they're just starting treatment, whether they're in the middle of treatment, whether they're at the end, maybe of their treatment journey. We are available to meet with them one-on-one and we look forward to it. So yeah.

Host: That's wonderful. Well, after talking to you for these few minutes, I feel more safe, secure, and a lot calmer. Is there anything else you'd like to add to our conversation to make us all even more calm?

Tiffany Edwards, PhD, MPH: I would just say, what you're feeling and thinking is very normal and to be expected and there is always people here to support you, including myself. So I welcome the opportunity to be a support for anyone that's listening.

Host: Well, this is such wonderful information, Dr. Edwards. Thank you so much for being with us today to share your expertise and to just be with us.

Tiffany Edwards, PhD, MPH: It was my pleasure. Thank you. It's always lovely talking to you.

Host: That was Dr. Tiffany Edwards, a Licensed Clinical Psychologist and Patient Educator at Fertility Centers of Illinois. You can schedule an appointment to talk to a fertility specialist at 877-324-4483, or visit fcionline.com for more information. And if you enjoyed this podcast, you can find more like it in our podcast library and be sure to give us a like and a follow if you do.

This has been the Time To Talk Fertility podcast. I'm your host, Deborah Howell. Have yourself a terrific day.