The Impact of Stress Reduction on Infertility
Episode 438 | Host: Emilie Aries | Guest: Dr. Alice Domar
The link between stress and fertility is clear.
Dr. Domar’s research sheds light and hope on this widespread challenge.
Content warning: this blog post and podcast episode include mentions of pregnancy loss.
Odds are, you either know someone or are someone who has experienced infertility or pregnancy loss firsthand. In recent years, these conversations have moved from being completely behind closed doors to a bit more on the public stage, increasing visibility in a powerful way. But there’s still a lot to do before women feel as comfortable discussing a pregnancy loss as they do a migraine or knee surgery.
Dr. Alice Domar is a psychologist and Chief Compassion Officer at Inception Fertility who has researched the link between stress and infertility for decades. One barrier she sees to creating a more compassionate and accepting world for people experiencing fertility challenges is the terminology itself. Both “pregnancy loss” and “miscarriage” imply an error on the part of the pregnant person, as though they wrongly carried or misplaced their baby. We discuss this semantics issue and so many other facets of her work in this episode.
A two-way link between stress and infertility
Years ago, Dr. Domar received two grants to follow a cohort of women experiencing infertility. In the randomized controlled study (meaning the sample size was varied enough that socio-economic and other factors could be eliminated), a portion of the subjects enrolled in mind–body stress reduction programs. The result: women who took those courses were 2-3 times more likely to get pregnant than those who did not.
Does this mean deep breathing will solve all your fertility issues? No, but it does suggest that stress levels are a factor in terms of our bodies' willingness to conceive.
On top of all this, it’s no surprise that infertility causes anxiety and stress. It’s easy to see the spiral that develops when stress can reduce fertility and a constant struggle to become pregnant or carry a child to term increases stress.
The benefits of stress-reduction techniques
Of course, the answer isn’t as simple as “just relax and you’ll probably get pregnant,” but Dr. Domar’s research supports the fact that stress can decrease the efficacy of fertility treatment, and building healthy mind–body habits can increase it.
The best approach is to incorporate many unique, holistic practices, to find the one that works the best for your body and brain.
Practice relaxation techniques. Smaller examples include taking slow deep breaths when you feel triggered by an online pregnancy announcement or an unhelpful comment from a friend or family member. Larger practices include hatha yoga and meditation—activities proven to reduce stress when performed regularly.
Take the wheel. Think of your mind like a bus, Dr. Domar says. To be healthy, you have to be driving the bus, but so often someone else—our mother-in-law, our boss—is manning our mental controls. Our minds are so good at telling us we need to slow down. They give us headaches or stomach aches, but we have the tendency to simply take a pill and push through. We need to start listening and examining what these symptoms are trying to tell us and take charge of doing something about it
Retrain your brain. In addition to physical symptoms, our minds also have a tendency to tell us “facts” that don’t serve our goals or our stress levels. For instance, my brain might be clinging to the narrative of “I will never have a second child.” If, instead, I can turn that narrative into “I am doing everything I can to have another child,” that’s a much healthier mindset.
Hope for the future
Despite the distance we still have to go in dealing with infertility, both socially and medically, Dr. Domar sees hope in the dramatic rise of the success rate of IVF (from 5% per cycle when she began her work to 60% now) and the growing willingness of public figures to speak out about their own struggles with infertility. These are game-changers, and there’s a lot of promise ahead.
But first, we need better terms! Do you have any ideas for terminology that better reflects the lived experiences of women experiencing infertility? Programs like peanut.io’s Renaming Revolution Glossary are getting a headstart on this goal, and Dr. Domar hopes to use fresh vocabulary when she launches her next program. Share your thoughts on the Courage Community on Facebook or in our group on LinkedIn to keep the conversation going.
Related Links from today’s episode:
Dr. Domar’s books, including Conquering Infertility
L’oreal Thompson Payton’s Bossed Up episode 410
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[INTRO MUSIC IN]
EMILIE: Hey, and welcome to the Bossed Up podcast, episode 438. I'm your host, Emilie Aries, the founder and CEO of Bossed Up. Today we are talking all about the connection between stress and infertility.
[INTRO MUSIC ENDS]
So as a big old trigger warning right off the bat, we are talking about pregnancy loss, infertility issues, reproduction, all the things abortion, everything comes up on this one. If for any reason this is not a topic that feels safe for you, this is not the episode to listen to. I am going to get pretty vulnerable and share quite a bit in today's episode, too. So you'll kind of hear me compartmentalize my feelings and intellectualize them and, frankly, chuck them to the recesses of my unconscious in the midst of this interview. But I do appreciate you just hanging with me as I'm navigating these issues very much myself right now. So thank you for making some space and being compassionate as I sort of share what's going on. It's my hope that in doing so, you will feel less alone if this is your truth or if or when this ever impacts you personally or the people you love, because ods are, it will, one of those things, right? This impacts so many people that it's really important to me that we normalize it by talking about it. And joining me to break all this down with an expert perspective is Dr. Ali Domar. She's the chief compassion officer at Inception Fertility, and a senior staff psychologist in the department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center, and an associate professor of obstetrics gynecology, and reproductive biology at the Harvard Medical School. Dr. Domar is a health psychologist who focuses on the application of mind body medicine to women's health issues. Her research focuses on the relationship between stress and infertility, with a focus on the impact of cognitive behavioral interventions as well as access to care and patient retention. She is the author of eight books on these topics, including conquering infertility and patient centered assisted reproduction. How to integrate exceptional care with cutting edge technology. Dr. Domar, welcome to the Bossed Up podcast.
DR. DOMAR: Thank you for inviting me.
EMILIE: So, I'm excited to talk with you about a topic that is so relevant for a lot of hard driving, high achieving, career oriented women like myself, who it feels like just as our careers are starting to really take off and get some traction, we're also running up against a biological clock that starts ticking very loudly. So, tell me a little bit about your work and what you've seen when it comes to, frankly, pretty stressed out women like myself and our attempts at becoming parents and navigating fertility and motherhood.
DR. DOMAR: So I've spent my whole career researching the relationship between stress and infertility. In other words, we know that infertility causes stress and a lot of stress. And I can talk about all the research we've done on that. But also, does stress impact fertility? Does it cause infertility, et cetera? And it was very personal for me because my parents went through infertility. It took them, I think, seven years to get pregnant with my older daughter and then another five to get pregnant with me.
EMILIE: This was older sister.
DR. DOMAR: Older sister, yeah. And so she's almost five years older than me, and this was a long time ago. I'm a dinosaur. And there was not much available. And my mom, my whole childhood and adolescence would talk about how awful it was for her. Those were the days where everybody had five kids and she couldn't get pregnant. And my dad was useless because he just wasn't a touchy feely kind of guy. And so I think always at the back of my mind, it was like, I have to help women like my mom. And ironically, she got pregnant with my sister after they gave her the equivalent of thallium.
EMILIE: Wow. Is that still available?
DR. DOMAR: I don't even remember what it was called in those days. But clearly, there's also the seed planted. If you reduce stress in someone with infertility, they're more likely to get pregnant. And, in fact, I believe that the research I've been doing for the last 37 years has actually supported that hypothesis. For some people, not for everybody. For some people.
EMILIE: Sure, I mean, the fact of the matter is, and correct me if I'm wrong, but it seems like there hasn't been a ton of funding and attention paid towards this issue until relatively historically recently. Is that accurate?
DR. DOMAR: Yeah. I'm like a salmon swimming upstream. Because honestly, when I started going to the fertility meetings and talking about the fact that I thought stress reduction increased pregnancy rates, I'd be laughed at, harassed or insulted or criticized. And then I actually got two grants, one from the federal government and then one from Johnson & Johnson, where we looked at pregnancy rates in women who did what we call mind body programs. And we found, and these are randomized controlled studies, and we found that women who attended these groups were two to three times more likely to have a baby. And so all of a sudden, I had data to back up what I was talking about.
EMILIE: Yeah. And not to geek out too much, but when you say randomized controlled studies, you also are cutting across things like class and socioeconomic status, because you do think that there are certain people in this world who experience a lot more chronic stress than others, who are also less likely to have great nutrition or great medical care or access to reproductive health care. And so it gets confounding very quickly, doesn't it?
DR. DOMAR: Extremely quickly. And, in fact, until relatively recently, most people didn't have insurance coverage or the ability to pay for treatment. We've made, like, insane progress in the last 20 years where I think it's probably just as common to have coverage now. In fact, the federal government, I think, has just announced in 2024 they'll cover IVF. So now you're cutting across, which is amazing, because it used to be, you know, it was rich, white people who could afford treatment, and now it's a much more diverse group of people. So with research, when the treatment is free, you do get a cross section of socioeconomic status, race, everything. So that kind of research is more accurate than just sort of looking at who shows up at an infertility clinic.
EMILIE: Sure. Sure. Absolutely. I want to talk about the connection between stress and infertility in its many forms, because I'm curious about mind-body programs. I have, like, a million questions actually bubbling up here because I did a mindfulness for childbirth class for about 16 weeks or so prior to giving birth to my son two years ago. And that really kicked off a deeper relationship for me between meditation and stress reduction and just overall well being, which I think becomes only more important as you become a parent for the first time. But it does feel paradoxical, or a little bit, like, cyclical, in that stress. Obviously, infertility creates stress, especially when there's stigma, shame, silence around it all.
DR. DOMAR: And I wish more people would talk about it.
EMILIE: Right. Well, I was going to say the most cathartic thing I have done this year in navigating recurrent miscarriage myself is starting to talk about it right here on this podcast and bringing it up in as many conversations, particularly with men in addition to women. And I thought at first it was kind of like throwing a wrench into whatever conversation I was in. And then I realized every single person has a story to relate to that. And so, you know, normalizing the discussion of it has helped me reduce some stress around it and feel less alone.
DR. DOMAR: I mean, it's interesting because, you know, I'm not like a celebrity watcher, but I'm so impressed with Meghan Markle and Chrissy Teigen and Tara, everybody who's coming out talking about their infertility, talking about their miscarriages. No one talks about miscarriages. There's this old wife's tale. Don't tell anyone you're pregnant till twelve weeks. And I remember I had a miscarriage in between my two kids and I remember telling everybody I'd miscarried and it was like, how could you talk about that? But then I had friends come out of the woodwork who had had a loss. One of my best friends had a loss of 16 weeks and had not told anybody. So yes, there's a tremendous amount of stress in trying to get pregnant and, or having miscarriages. And I sort of lump that together because when I think of infertility, I think not being able to have a baby.
EMILIE: And I don't think that says commonly understood because as someone with recurrent miscarriage issues this year, if I say infertility, people think, how long have you been trying to get pregnant? And it's a weird chasm I feel like I'm falling into because I'm getting pregnant really easily and then I'm terrified I'm going to lose the pregnancy because I have twice.
DR. DOMAR: And it's terrifying.
EMILIE: It is really just like a constant drumbeat of fear and vulnerability.
DR. DOMAR: Because you're scared of getting pregnant.
EMILIE: Yeah.
DR. DOMAR: An infertility patient, all they want is to get pregnant. Someone who's had one or two or more miscarriages wants to get pregnant but is also terrified of getting pregnant, which is why we're starting this whole new initiative for people who get pregnant easily and then miscarry. So with the stress of infertility. So I published a paper probably 25 years ago that showed that women with infertility had the same level of anxiety and depression as did women with cancer, AIDS or heart disease. And people still talk about that because if you've never had infertility and there's no one you love in your life who's had infertility, you can think, oh, come on, that's like a rich white women's issue. Like, stop complaining, you can't get pregnant. Or stop complaining, you can't have a baby. Which makes me insane. But infertility has a psychological hit of a potentially terminal illness. And we did a study, I don't know, in March of 2020 when Covid hit, because I was thinking, okay, our infertility patients are going to care way more that they can't get treatment right now than they are about COVID I mean, they're scared. Everyone was scared of COVID. So we actually did a study of 2000 - 3000 women and showed that women were pretty much more stressed about not being able to have treatment than they were about COVID. And there was one study out of New York where they closed the clinic, I think for three months. 22% of women said that not having access to treatment for three months was equivalent to the death of a child. And I think people really need to understand that it's the strongest instinct in the animal kingdom, like, procreation is if you want to have a child, that's all you can think about, and it impacts every area of your life, and You can't get away from it,
EMILIE: Right. Well, from my experience, you start to telescope out what the future will look like, and you're like, well, what if this happens? Or what if that happens? Or here's how I'll have to make all these changes, or just preparation or what have you. And the nesting instinct starts so early on. And then I have felt like the rug has just been pulled out from underneath my feet so many times this year, both in life and pregnancy and in business. And like, it just permeates every aspect of your life, for sure. Understandably so, because bringing a child into this world impacts your life in so many ways. And I'm curious what you feel about stress reduction and what stress reduction really means. Because part of what has really frustrated me as a data driven person who really likes information and likes, you know, we have smartwatches and smartphones and so much data and information is that, you know, there are no easy answers with infertility or pregnancy loss. But part of what has been so infuriating for me is that my care team, which has grown exponentially in the last few months, right, I've gone to my midwife, my OB, my PCP, a naturopath, gone to a radiology clinic, gotten everything looked at I possibly can. And I think a lot of my doctors kind of want to tell me to calm down, is how I feel. Like they're like, I wouldn't worry, you know, I'm not too worried. Which I understand why they're saying that to me. They want me to feel normal. And yet I'm like, okay, show me the data. Let's look at the lab. Somebody look comprehensively at my 120 pages of blood work and tell me what you see. And it's just like dealing with the American medical system, which feels so siloed. And not to mention, I've spent $4,000 out of pocket, because even though I pay $300 a month for really good insurance, my insurance finds creative ways to not pay for what they say they will. Right? So what do we do? Clearly, telling women in my situation to just calm down is not what you mean by stress reduction. So what does that look like in the best of sense?
DR. DOMAR: I mean, honestly, if I had a nickel for every one of my patients where someone has said to them, just relax and you'll get pregnant, I'd be as rich as Bill Gates. And in fact, that's what I was criticized for early in my career, that I was perpetuating the myth of just relax and get pregnant. And I'm not saying that. I mean do I believe that stress might make it harder to get pregnant? Yeah, I do believe that, because every animal, when you stress them out, reproduction decreases. So you can't say that stress does not impact reproduction. Do I think that stress may very well decrease the efficacy of infertility treatment? Yeah, I think that, too, because there have been so many studies showing that if you have women go through vigorous stress management programs, whether they're in person or online, then, yeah, they are more likely to get pregnant. But I'm a psychologist, and so for me, the primary issue is not so much get pregnant, it's get physically and psychologically healthier. And so the mind body program that I created is a combination of relaxation strategies, stress management, lifestyle changes, group support, you know, learning how to deal with grief and guilt and shame, learning better communication strategies with your partner. Because if you have a partner, I can guarantee you the two of you are never in the same page at the same time. And what I tell patients the very first day is mind body medicine or behavioral medicine, or whatever you want to call it, is like a buffet. And so there is no one strategy that I can tell you is going to work for you. And so I want to teach you ten different things, and you need to figure out which ones work for you.
EMILIE: Yeah, I love that and can see how that would be very helpful, especially the whole grief and loss thing, because there's no social container for pregnancy loss. You're like, what do I do with this grief? And my husband's experience of the grief is wildly different than my own. And so like, my therapist and I have had many a conversation about how I've completely avoided the mourning process as much as I can, and how that's probably worthy of some further introspection. However, I'm fully intellectualizing this whole experience, which is my M.O., but at the same time, I can understand the critique because I'm in it, too. I've been talking about burnout prevention for a decade for women, and I get hit with the same victim blaming critique that you probably do. And I guess what I'm trying to do specifically this year, when I see bias and systemic oppression and sexism, um, like creeping up in so many pervasive ways, is think in addition to the individual solutions, what do the systemic solutions look like? What do you think our workplaces could be doing better? Or our governments, our society, our healthcare system could be doing better to get at the root cause of all the stress and maybe create some safety and mental and physical security for these women.
DR. DOMAR: Well, do you have two days to talk about it?
EMILIE: I would love that.
DR. DOMAR: See, so the way I've approached it is I'm now working for a company, Inception, which has lots of clinics all over the US, and I'm the chief compassion officer. And so I have been and will be creating more programs to decrease stress in patients and decrease stress in employees because, you know, we need to change the way we care for infertility patients because it's a very medical model. When I tour these clinics and I talk to the nurses who work in the operating rooms where, you know, patients have procedures, I'm like, these are healthy young women, most of whom are pretty career driven, and they've been successful at everything they've done. I mean, the old motto is, the harder you work at something, the more likely you are to get it, which doesn't apply in infertility. I said, you have to remember, probably half your patients have never had an iv. So we're taking healthy young women and men and we're turning them into patients and it's a new experience for them. And so you have to change the way you care for patients.
EMILIE: Yeah, I mean, it's such a vulnerable experience for the achiever who's running into, frankly, like a fight with their own body, right? And feeling disappointed in their hustling harder is not helping in the whole getting pregnant and staying pregnant piece, so, oof.
DR. DOMAR: Well, it also can make it worse because, and I hate to say this, but as I said, I'm a psychologist, I still have a small private practice, but I'm often the first person to say to a patient, let's look at your health habits. Like, are you eating well? How much are you drinking? How much are you smoking? How much are you exercising? Because trying to get pregnant lifestyle habits might be different from living. Like, I don't want you exercising an hour and a half a day, five to seven days a week. I want you to tone that down, you know. I don't want you to take people out for drinks every night because alcohol can impact fertility.
EMILIE: Well, it was so funny I was reading your wonderful piece by L'Oreal Thompson Payton, who's a friend of the show and was recently on the show herself. And in fact, she put you on my radar and helped get us connected. But I was shocked at this quote where you lumped marathon running next to smoking and drinking as, like, things that could negatively impact fertility. And I was like, oh, my super athletes here in Colorado think they're so fit and they're doing the best. But actually, you're saying exerting yourself to that extent can harm your ability to reproduce, yeah?
DR. DOMAR: You want to be sort of in the middle of the curve. You don't want to ever be too much or too little. But, yeah, there is data to show that being a couch potato is bad, but being an uber athlete is also bad because if you're running every day, you're doing it because it reduces stress and because it means you can eat a cupcake. Right. Your body thinks you're being chased by a bear every day. And if you're being chased by a bear every day, does your body think you can get pregnant, which is going to make you fat and slow? No, because you're clearly living in a dangerous situation. And so you want to be healthy and you want to walk or you want to swim or you want to do things that are moderate. I can't tell you how many patients I've had who've been trying to get pregnant for a long time have done everything possible, and I'll say, okay, let's work on getting you to not run 35 miles a week, which is a very threatening thing for someone to hear, and so counter anyway. And once they get down to a certain threshold, they get pregnant.
EMILIE: Yeah. Well, I remember reading Ina May Gaskin's Natural Childbirth book. This is real mind body stuff, because it's about the physiology and mental state of natural, drug free childbirth. And she basically created a hippie commune where women delivered babies in huts for a while in Tennessee somewhere. But she's a midwife, and she writes about the history of midwifery and. Yeah, I'm not in that.
DR. DOMAR: Good, good.
EMILIE: Yeah, we love a hospital birth. My mom's a labor and delivery birth.
DR. DOMAR: I was just talking to a pregnant colleague who's delivering next week, and I said, that's the reason why God invented epidurals. Yeah, totally.
EMILIE: I love that. But what she did say is, like, look, if your body feels threatened, she has a whole chapter called sphincter law. Things tighten up. Like, you are not meant to be giving birth in a panic. In fact, your body has ways of shutting that down if it feels like you're in danger. And similarly, your body is not going to feel like, innately, for the sake of the continuation of the human race, that it's a good idea when you're super stressed out, to paint a picture that's a very personal one. You know, this was the most challenging year in business I've had in ten years. I had to lay off two thirds of my staff. We've had just, uh, a biggest challenge when navigating the tech downturn and the war on DEI has just really negatively impacted our bottom line for the first half of this year. And I was just holding on for dear life as we faced existential threat as a business. I'm really thrilled to say we've turned it around completely. And next year is looking great. We're ending the year in a great place. But physically and mentally, you know, my health was not where it needed to be. And it doesn't surprise me in retrospect that my blood work came back with high blood pressure, with a little bit of high blood sugar. Like, just signs of generally not taking care of myself following two back to back pregnancy losses. So it strikes me as true and everything you're saying makes sense. And I want our workplaces to understand. Stress reduction doesn't mean bringing in a burnout keynoter. It means managing workloads, staffing your teams properly, creating compassionate leave policies around pregnancy loss, you know, and even the Pregnant Workers Fairness Act, which just went into law this summer. I don't know if you followed that law. I had Sarah Brafman from a better balance, know pregnant women now have more legal protections and rights in the workplace to reasonable accommodations.
DR. DOMAR: Supposedly.
EMILIE: Supposedly, yeah, it's always an, um, argument anyway. But legally, we do, if miscarriage qualifies for that protection. But it means you have to disclose to your employer, which can get really tricky really fast.
DR. DOMAR: Okay, but why should miscarriage be something we're embarrassed about? Like, I might be in new surgery next week. I'm not embarrassed to say I'm having new surgery. Why should we be embarrassed to say we've had. And I was actually thinking about this the other night because we were discussing this new pregnancy loss program. Like, okay, I hate the word pregnancy loss. I hate the word Miscarriage. We need another word for a pregnancy that didn't end in a baby. A wanted pregnancy.
EMILIE: Do you have any ideas?
DR. DOMAR: I was literally lying awake, this is what happened when you're postmenopausal, is you lie awake at night and you think about these things.
EMILIE: I was arguing with my husband about this when we had our first miscarriage, because I was like, I didn't miscarry sh*t, okay? This is not my fault. Don't say it's a miscarriage.
DR. DOMAR: And you didn't lose a baby. It's called pregnancy loss. Oh, she lost the baby. She did not lose the baby. In fact, I was just talking to a friend of mine who's just had two losses, and I kept on saying something about her baby dying, and she says, wow, that is so powerful. She goes, that's how I feel. But everyone talks about pregnancy loss. You didn't lose the baby.
EMILIE: Well, you start to come up right against the pro-choice movement. A friend of mine who was not very helpful in this moment, when I called her and said, I lost a baby, I said it, really, now that I'm a mom, it means so much more to me than I think if I hadn't yet had a child. Like, I envisioned this baby as being a fully living human being, and at eight weeks, that baby is no more. And she said, well, don't tell that to my progressive, Gen Z pro-choice staff members. And I was like, oh sh*t, that was not what I needed to hear right now.
DR. DOMAR: It's a fine line. So I said, a wanted pregnancy.
EMILIE: Yes. Totally different.
DR. DOMAR: So we have to come up with a term for somebody who got pregnant because they wanted to or were happy to be pregnant, and that baby died in utero. There needs a new word.
EMILIE: Oh, my God. I'm going to bring that to therapy with me this week. Thank you for that. Uh, I'm going to go ahead and bottle up that grief that I don't want to deal with right now. I wanted to go back to the shame thing, though. Here's why I think it's a shameful thing. It's not really shame. It's exposure. It's vulnerability. Because, let's say I'm on partner track in my law firm, and I've had three miscarriages in a row. Now I got to tell the partners in my law firm, as I'm driving towards this pinnacle promotion in my career, that I'm currently actively pursuing a family which they see as a threat to my commitment to the workplace. That's the public narrative that gets in the way.
DR. DOMAR: And she's right. And I was just talking to someone who's looking for a new job, and she was saying, I'm trying to get pregnant, and I can't tell them I'm trying to get pregnant, but I don't want to start the job. And that's not fair because her partner can do anything he wants. It doesn't matter whether or not they're trying to get pregnant. And it's really frustrating. And you're right, we don't have enough. I was just talking to someone who works for a European based company. She gets six months paid maternity leave. If she were to have a stillborn, God forbid, she still gets six months paid leave. And if she had had a miscarriage, she would have gotten eight weeks paid leave.
EMILIE: Wow. Okay. So that is what I'm talking about when I say, what can workplaces do better? That's exhibit A. Maybe we just need to look to Europe.
DR. DOMAR: We need to look to, you know. My cousin had twins and had, uh, a year after I had my second child. She lives in France. Full year of paid leave. And she had an option of a second year unpaid with job guarantee. I was working for a hospital, and because I had a C-section, I got eight weeks. But going back to infertility and pregnancy loss, one of things we also don't explore is what about the partner? And if we talk about a heterosexual couple, male factor can lead to pregnancy loss. And so when you talk about shame and it's this idea of pregnancy loss and all the things that happen to a woman's body, there are things with the sperm that can cause miscarriage.
EMILIE: Okay, so 50% of the time, right? It's pretty equitable, too, right?
DR. DOMAR: 50% of the time, infertility has a male factor, or up to 50% of the time with miscarriage. I actually don't know the statistics in terms of what, because we know the age of the egg is a pretty big deal. But we also know that the age of the sperm and the quality of the sperm can lead to pregnancy loss. But you also said that your partner is not feeling the same way about the losses as you are. And, you know, I counsel patients with, I don't want to use loss who have had a pregnancy, not go to term involuntarily and they're like, well, my husband isn't grieving. Like, he feels bad for me, but he's not grieving. I'm like, because it was totally abstract for him. It's just he was told you are pregnant. He might have seen something on the screen. You didn't get your period. You were nauseous, you were bloated, you were tired, and then you had a loss, you bled, you had terrible cramps. I had never experienced cramps like I did when I had my miscarriage. So for you, it's a very concrete thing and it's easier to lose something, I mean, to grieve something when it's real.
EMILIE: Totally. That's exactly Brad's experience. Yeah. He said it didn't feel real to me yet because we never even made it to our first scan or ultrasound both times. And so he was not feeling grief because he didn't feel like it was real.
DR. DOMAR: It's like someone telling you something bad rather than you experiencing it.
EMILIE: Right. And it exacerbates the isolation for me. And that's something we've been talking a lot about, is like, okay, I'm mourning something here that has no narrative in society to really explain the experience, and I'm doing it alone. And like, he's compassionate, he was trying to walk the walk with me.
DR. DOMAR: But it's not the same. I keep on telling this when I visit our clinics. The minute you tell someone they're pregnant, they're not just pregnant, they are thinking of names. They are thinking what is going to look like. They're imagining how they're going to make the pregnancy announcement or do the gender reveal or anything like that. And so it's not a pregnancy test. It is a life. And if you already have a child, you're thinking, how far apart are they going to be in age? How am I going to handle two children? Is our car big enough? Is our apartment big enough? Everything.
EMILIE: Exactly. There's this cascading.
DR. DOMAR: Exactly. It's not just a positive pregnancy test. It's a life change.
EMILIE: It's like a branch in your life tree just forms and then it just goes away overnight. It's so disorienting. So I'm proud of the fact that I'm ending the year not only with a, ah, better financial situation in my business, yay. But I've really spent the last, I'd say two months saying nothing matters but my health, mentally and physically right now. That is what needs my full attention at this current moment. After just trying to like, push through and be strong, that was not really working. And I came back from my weekly yoga class, that core power yoga that I try to get to once. I have successfully gotten to once a week for six weeks in a row now, which is a big achievement with a toddler at home. I do it at 8:15 at night. So 8:15 and 9:15 in the evening. I come home and I said to Brad, that is the best thing I do for myself. And I don't know, like what, practically, I know it's a buffet, right. And you can pick and choose based on what's going to work for you. But practically speaking, what's in the buffet line that you would encourage folks listening who want to mitigate their stress as it relates to fertility in particular. What should we be picking and choosing from on that buffet?
DR. DOMAR: So I said, number one, are relaxation techniques. And that's either like mini relaxations, like taking slow, deep breaths when you're looking at social media and seeing yet another birth announcement, or you go into the bathroom and you're getting your period, or someone says something stupid to you. These are just minis that you can do. It's like diaphragmatic breathing, and then big relaxations like Hatha yoga, meditation, progressive muscle relaxation, autogenic treading for those of us whose minds race a lot.
EMILIE: Wait, what is that?
DR. DOMAR: Autogenic. Autogenic training. It's a very focused relaxation technique where you actually have to listen to a guided. Because even I, who've been teaching this for years, it's basically someone saying your hand feels warm and relaxed, and you say these things to yourself several times. And even for me, it's incredibly effective. So you have to pick a relaxation technique that works for you. Because if you are like me and your mind races, I don't do so well with meditation because I'll say, you know, peace and calm, and then I'll be thinking about the laundry. So I need something focused. So those are the two in terms of relaxation. And then we got to work on the mind. Your mind is your worst enemy. And so, for example, what I tell my patients is, think of your mind as being like a bus. To be healthy, you need to be driving your bus. But most of us have our mother in law or our boss or somebody else driving our bus, and we need to be in control. And our minds are so great, our brain is so smart in terms of telling you when you need to slow down, and so it'll give you a headache, or give you a stomach ache or, not let you sleep. And when our brain is sending these signals, what do we do? We take drugs.
EMILIE: Someone's making money off of those drugs, Dr. Domar.
DR. DOMAR: So someone's making money off those drugs. I don't want to insult anybody, but when you're unable to sleep because your mind is racing, going and taking a pill to make you sleep is not going to make the quality of your life better. And so when we have these physical signals or psychological signals or behavioral signals, we need to stop and say, what is my mind trying to tell me? And then, you know, what we teach is called cognitive restructuring, where you got to start paying attention to what your mind is saying to you. Like, I was one of these kids who was not all that interested in school. I was way more interested in boys and volunteering at the hospital than I was in studying. My dad was an MIT professor. He thought that academics was the be all and end all. And so he used to always say to me, you're lazy. Because I would come home with B’s, because I just didn't care. And so my husband catches me all the time where I won't do something. I'll go, yes, because I'm lazy. And he goes, you're the least lazy person I know. But that's like an old thought. And so we have to tap into some of the old stuff or our fear speaking. And so, for someone who's had losses, there's a thought like, I'll never have two kids. And that's the kind of stuff that feeds into your anxiety, but you need to stop and reframe it, as in not to analyze you, but to say, I'm doing everything I can to try to have a second child. And that's a lot healthier thing to think than to let our brain just go crazy on us. Does this make sense?
EMILIE: Absolutely. And we talk a lot about narrative on this podcast, in part because I took Marshall Ganz's class at the Kennedy school on public narrative and organizing. And how do I rewrite my inner critic? To be my inner coach is something we talk a lot about. When you say driving the bus, all I come back to is why I started this company ten plus years ago. Now it's to be the boss of our careers and lives, and it's extraordinarily humbling. Everything I've gone through in the last two years, becoming a mom, grieving the death of pregnancies that were very much wanted. And just because you're in charge, just because you're the agent of change in your life, doesn't mean you can control everything. But focusing on what you can control is what I'm hearing loud and clear from you.
DR. DOMAR: So you can control a portion of what you're thinking, you can control what you eat, you can control what you physically do. And what we haven't even talked about is you can control who you hang out with. And one thing I tell my patients all the time is you can lose friends. Like, just because someone was your best friend in second grade, if you find that you're not in a balanced relationship or they're really critical of you or you just don't feel great, cut them out. You can do that. It's fine.
EMILIE: Yeah. And it doesn't take much. It's just not seeking them out. Right. Like creating some space for people who make you feel good. And I'm dying to have the authors of The Good Life came out last January. I'm obsessed with it. I talked about it all year. I got to get them on the pod. About the quality of people in your life making such a big difference. Dr. Domar, I have to leave it at that. But I want one last question, which is, where can my listeners go to learn more about these great resources that you're sharing? And if I can squeak one more in, what gives you hope in this rather sort of frustrating line of business that you find yourself in?
DR. DOMAR: So I work for Inception, so it's, inceptionfertility.com is the main website. I think I have a website. I think it's dralicedomar.com, and my older daughter created it. And you'd think I would actually know it, but I'm not sort of one of the people who focuses on that. But I've written a bunch of books. One is on infertility called Conquering Infertility. And I have a small private practice, but it's only for people who actually physically are in Massachusetts. What gives me hope? When I got into this field a long time ago, IVF had a 5% per cycle pregnancy rate, and now it's 60. That's number one. Number two is that as I said, Meghan Markle and Chrissy Teigen and all kinds of people who are famous have come out and talked about their infertility and they've talked about their pregnancy losses and they've talked about, you know, I remember this is probably before you were born, when Betty Ford, who was the president's wife, and Happy Rockefeller, who was the vice president's wife, both had breast cancer. And they came out and talked about it, and no one talked about breast cancer. Okay, fast forward. We have football players wearing pink cleats in October. So if breast cancer can do that, why can't we talk about infertility and why can't we talk about wanted pregnancies that end in no baby and we need a new term.
EMILIE: I agree. Let's crowdsource it. Okay, listeners, I want to hear from you right in with your suggestions on the terminology.
DR. DOMAR: We need an idea because we're launching this program next year and we need to call it something. And I will not call it miscarriage and I will not call it pregnancy loss.
EMILIE: Well, I'm excited to keep up with it and see more about what comes down the pipe. Thank you so much, Dr. Domar, for the incredible work you do.
DR. DOMAR: This has been great, thank you.
EMILIE: For links to everything Dr. Domar and I just discussed. Head to bossedup.org/episode438. That's bossedup.org/episode438. And now I want to hear from you. What has your experience on these topics been like? What's your take? Chime in here, people. I don't want to be the only one sharing what's going on in my neck of the woods. I would love to feel less alone by hearing kind of what's come up for you if you've navigated anything related to reproduction as it intersects at your career. It's so funny to look back on the motherhood at work series I did from the naive perspective I had three years ago when I was just getting pregnant with Max. It was also positive. I mean not that it was easy, because there's a lot of stress that comes with becoming a parent, even if everything medically goes smoothly. But just thinking about the challenges we talked about back then versus the challenges I'm talking about now, it's been a rough couple of years.
So, look, I think in some ways my perspective has broadened in a really powerful and hopefully more inclusive way. But I want you to know that if you've been feeling alone or isolated in some of the major challenges, medically or mental health wise, or any of that that you're navigating, you're very much not alone. And I hope today's episode and Dr. Domar's advice can shed some light on the interventions that might help for you.
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Let's keep the conversation going, as always, in the Bossed Up Courage Community on Facebook or in our Bossed Up group on LinkedIn. And until next time, let's keep bossin’ in pursuit of our purpose. And together, let's lift as we climb.
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