Читать книгу Pathways to Pregnancy - Mary Wong - Страница 11

3

More Than Surviving

Although you may not always be able to avoid difficult situations, you can modify the extent to which you can suffer by how you choose to respond to the situation.

DALAI LAMA XIV, THE ART OF HAPPINESS

Cary: Depression and antidepressants

Cary, a physician, was approaching forty-three and had been trying to conceive for four years when her co-worker referred her to me. She had attempted IVF twice, at forty and forty-one, but her doctor had cancelled both attempts because the injectable hormone drugs had failed to stimulate an increase in egg production. On her third IVF attempt, her ovaries produced multiple follicles from which the doctor retrieved four eggs, but although one was fertilized, no pregnancy resulted.

She came in devastated that her lifelong dream of having a baby might never come true. She’d been with her first husband since she was twenty, but when she was thirty-two and finally ready to start a family, she caught him having an affair. More stress followed as Cary’s father divorced her mother, remarried, and then fell ill and died. Overwhelmed by emotional trauma, she began taking antidepressants and was still taking them when she first came to see me.

“I really wanted to be in love with someone and have a baby,” she told me. “So, I spent the next five years trying to find a partner, and didn’t care about anything else.” At thirty-eight, she met a man who wanted a baby, so they started trying. She loved him but didn’t care whether it lasted; she just wanted a baby. But when she hit forty, she realized they were incompatible. Instead of looking for a new partner, she bought a house with a swing set in the back yard and a park beyond, and assumed she’d raise a child alone.

Ironically, the moment she stopped looking for true love, it landed on her doorstep. At forty, she married her next-door neighbour, ten years her senior. Without wasting time, they sought the help of a fertility clinic. Based strictly on her age, the doctor said there was no time to waste.

The RE diagnosed poor ovarian reserve (POR). Although her follicle stimulating hormone (FSH), a key indicator of ovarian aging, was still within normal limits, he said the shells of her eggs were hard. He doubted sperm would be able to penetrate her eggs naturally, so she’d probably need IVF with donor eggs. Adding insult to injury, he told her to lose weight, as if a clause in some contract dictated she wouldn’t get pregnant unless she lost twenty pounds.

Like many of my patients, Cary came to me as a last resort, gravely disappointed that her life hadn’t fallen into place as planned. But throughout this long journey, she’d opened herself to exploring every possible way to become a mother, through birth or otherwise. It was then that I told her about a previous patient with a similar fertility profile, including low ovarian reserve, who’d conceived through IUI without fertility medication.

The panic factor

When fertility doctors provide women with statistics and numbers showing they’re reproductively old, even if they’re only thirty-five, they don’t intend to create panic, but this is often the effect. And if a woman is over forty and emotionally sensitive like Cary, they’re likely to feel defective, depressed, and out of control.

The doctors’ words cause women to fear they’re in a race against time to conceive, but really those words represent an educated guess; no doctor knows for sure what’s going to happen. For someone like Cary, who was anxious to begin with, the doctor’s words exacerbated her emotional state. She tried to get off antidepressants but ended up staying on them and seeing a psychiatrist to help her manage her anxiety and depression.

Antidepressants and conception

A small amount of prescription medication for an adult is a huge amount for a tiny developing fetus. But what do you do when you have severe, unmanageable anxiety and depression, and nothing short of medication helps? The only right answer is the one that’s right for you.

A 2015 study found that both continuous use of antidepressants and untreated major depression during pregnancy increase the incidence of premature delivery with all the potential accompanying health risks.¹ But if you have major depression, going off antidepressants may pose a greater risk for your mental and physical well-being than staying on them, and may put your baby at risk once you are pregnant.

Concerned about fetal health risks, Cary tried to get off antidepressants prior to trying to conceive but found medication was the only way to successfully manage her anxiety. Based on extensive advice from her psychiatrist, she stayed on a dose that was workable while she was trying to conceive.

If you wish to come off antidepressants, you must consult your doctor about the impacts on your mental and physical health. Whether you decide to wean yourself off medication (the only safe way to go off antidepressants), or you are trying to manage the stress and anxiety every woman feels when dealing with fertility challenges, there are things you can do to avoid panic, anxiety, and depression.

It can’t be stressed enough

Based on my own experiences and those of the women and men I work with, dealing with the emotional and physical challenges of infertility on top of the ongoing stress of daily life can be difficult. For couples undergoing treatment at a fertility clinic, the drugs, daily appointments, and financial commitment add exponentially to the physical, emotional, and psychological burden.

One study showed that the stress women experience when trying to conceive is comparable to that of someone facing a life-threatening condition such as cancer.² Such stress triggers our bodies’ fight-or-flight response. This instinctive reaction, which evolved millions of years ago to help us protect ourselves from perceived threats, diverts energy and blood flow to the heart, brain, and limbs so we can run away.