While mental health isn’t your specialty, you may be feeling the pressure to provide more psychological support for your patients struggling with infertility. With your practice busier than ever, you’re worried about finding the time to properly support them. But what if there was a simple tool that could help you better manage the mental health needs of your infertility patients?
For some, infertility is solely a medical condition. But for others, its prolonged and cyclic nature make it traumatic.¹ ² Dr. Irena Milentijevic, a licensed psychologist who specializes in counselling women and couples experiencing infertility and pregnancy loss, believes the trauma of infertility is all-encompassing and, for many, long-lasting: “It takes over your life,” she says. “It preoccupies your mind to the point where you’re always tense and it’s hard to relax.”
This long-term trauma can ultimately lead to Post-Traumatic Stress Disorder (PTSD).³ This psychiatric disorder can develop in people who experience a single or series of traumatic events.³⁻⁴ PTSD is not limited to physical threats to safety, but also includes emotional and psychological harm, such as infertility.⁴
You know some of your patients are experiencing mental health struggles, but the prevalence of PTSD amongst patients with infertility may be surprising. In the general population, only 6% of people will experience PTSD in their lifetime, but for patients with infertility, this increases to over 40%.¹ ⁵
While some patients develop PTSD over time, others are already showing signs when they first enter your office. Heidi and her husband were trying to conceive for a year before visiting a fertility clinic. “Having a family is one of the most important things to me,” she says. “The mental toll of trying and failing to get pregnant came quickly. I was always anxious. By the time we got to the fertility clinic, we were already at our wit’s end.”
Recognizing the signs and symptoms of PTSD is crucial to help patients like Heidi who are dealing with so much more than the physical impact of fertility treatments. Infertility-related distress is difficult to cope with even without the potentially debilitating symptoms of PTSD, which include:⁴ ⁵
1) Intrusive memories
Distressing memories, flashbacks, or recurring dreams of an event related to their infertility.
2) Avoidance
Staying away from places or people that remind them of their infertility.
Ignoring feelings or emotions pertaining to fertility.
3) Negative thoughts or mood
Viewing themselves or others poorly.
Feeling detached or emotionally numb.
Experiencing memory loss, especially relating to infertility events.
4) Arousal and reactivity
Feeling on guard or on edge.
Difficulty concentrating.
Trouble falling asleep.
Triggers can also worsen PTSD symptoms, and your clinic may be full of them. “If you experience a loss or trauma, even routine tasks like simple blood draws and ultrasounds can be very triggering,” says Dr. Milentijevic. “There’s an overwhelming sense of fear, pain, and anxiety.” Being on the lookout and asking questions about what provokes these emotions can help you minimize triggering responses in your patients. However, this type of vigilance is more effective when you know which of your patients are suffering from PTSD. The most efficient way to accomplish this is by screening.
Screening may seem time-consuming for a busy fertility practice, but the process is simple and can greatly benefit your patients. Dr. Milentijevic too often works with patients who suffered months or years without seeking help. She wishes fertility clinics would screen patients sooner, before the situation gets out of hand. “For physicians to initiate a referral, most often the patient has to be really struggling or breaking down in the office,” she says. Even when they ask for support, some patients don’t get the help they need. This could be avoided through the proactive use of screening tools.
Heidi knew that she was really struggling with her mental health, but her doctor didn’t take her concerns seriously. “I never felt so minimized,” she says. “I guess I needed to wait until I snapped for it to matter.” She ended up pressing pause on trying to conceive and is undecided on when or if she’ll re-start.
Heidi’s story is not an isolated incident. The psychological toll of infertility can be immense and is one of the top reasons people stop trying for a baby. Taking a few minutes to screen and support your patients can improve your clinic’s success rates and patient satisfaction.⁶ ⁷ Psychological interventions can decrease infertility stress, anxiety, and depression, all of which decrease the likelihood that PTSD will develop.¹
Simple changes, like regularly screening and speaking with your patients about the signs and symptoms of PTSD, can greatly assist them in getting the help they deserve. But, while that sounds great, there are no guidelines on when and how frequently to screen for PTSD. Since most patients have been trying to conceive for at least a year before consulting with you, screening upon initial consultation will give you a baseline score. Continuing to screen after any failed cycle will allow you to actively monitor your patients and identify who needs to be referred to a mental health specialist.
You may worry about how you’ll manage all this within the allotted appointment time. However, there is a simple 20 question screening tool—the PCL-5—that can be completed by your patient before you even see them. You can use the score to determine if your patient may have PTSD and address the results during the appointment. While the numeric score can provide a provisional identification of PTSD, a mental health specialist is needed for a conclusive diagnosis.⁸ The short time it takes to add up just 20 items will give you a clearer understanding of how patients are coping on their infertility journey.
Some of your patients are struggling with PTSD, but using the PCL-5 screening tool and discussing their symptoms openly with them will help you confidently address their psychological needs. Even with your hectic schedule, this is a practical and doable solution that helps you fulfill your goal of better supporting your patients.
Click here to learn more about how to easily screen your fertility patients for PTSD.
References
1. Roozitalab S, Rahimzadeh M, Mirmajidi SR, Ataee M, Esmaelzadeh Saeieh S. The Relationship Between Infertility, Stress, and Quality of Life with Posttraumatic Stress Disorder in Infertile Women. J Reprod Infertil. 2021;22(4):282-288. doi:10.18502/jri.v22i4.7654
2. Rooney KL, Domar AD. The relationship between stress and infertility. Dialogues Clin Neurosci. 2018;20(1):41-47. doi:10.31887/DCNS.2018.20.1/klrooney
3. What is Posttraumatic Stress Disorder (PTSD)? Accessed August 23, 2023. https://www.psychiatry.org:443/patients-families/ptsd/what-is-ptsd
4. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults: (501872017-001). Published online 2017. doi:10.1037/e501872017-001
5. Post-Traumatic Stress Disorder. National Institute of Mental Health (NIMH). Accessed August 5, 2023. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd
6. Van den Broeck U, Holvoet L, Enzlin P, Bakelants E, Demyttenaere K, D’Hooghe T. Reasons for dropout in infertility treatment. Gynecol Obstet Invest. 2009;68(1):58-64. doi:10.1159/000214839
7. Frederiksen Y, Farver-Vestergaard I, Skovgård NG, Ingerslev HJ, Zachariae R. Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis. BMJ Open. 2015;5(1):e006592. doi:10.1136/bmjopen-2014-006592
8. VA.gov | Veterans Affairs. Accessed August 5, 2023. https://www.ptsd.va.gov/understand/common/common_veterans.asp
Comments