If you have ever gone through infertility treatment, you know that your brain can become a very noisy roommate.
Not the quiet, respectful roommate who occasionally asks if you need anything from the grocery store. More like the roommate who follows you from room to room offering unsolicited commentary about your follicles, embryo grades, age, AMH, uterine lining, other people’s pregnancies, and whether that cramp or breast tenderness you just felt four days after your embryo transfer means something.
Although well-meaning, your brain is misguided. It prepares you for what it perceives as “danger” at all times to protect you, but this results in a constant state of stress and unrest. Because infertility involves so much uncertainty, your brain often decides that its job is to fill in the blanks. Unfortunately, it rarely fills them in with something like, “You know what? We really don’t have enough information yet. Let’s make some tea and watch Netflix.”
Instead, it tends to go directly to:
“This cycle isn’t going to work.”
“My eggs are terrible.”
“My body is failing me.”
“Everyone else gets pregnant except me.”
“I waited too long.”
“If this embryo doesn’t implant, I’m never going to be a parent.”
And my personal favorite category: interpreting every physical sensation during the two-week wait.
Cramp? Implantation.
No cramp? Definitely didn’t implant.
Breasts hurt? Pregnant.
Breasts don’t hurt? Not pregnant.
Tired? Pregnant.
Not tired? Obviously doomed.
Your brain can turn a perfectly ordinary trip to the bathroom into a forensic investigation.
The problem isn’t that these thoughts show up. Of course they do. You are a deeply feeling human being going through something uncertain, expensive, invasive, emotional, and largely outside of your control. The problem is that when your brain says something, you automatically assume it is true.
Meet Your Fertility-Brain
There is a concept from Acceptance and Commitment Therapy (ACT) called cognitive defusion. This sounds very clinical and sophisticated, but it really isn’t. Cognitive defusion essentially means learning to notice your thoughts without automatically believing everything they say.
Think about how easily this happens.
You don’t usually say:
“My brain has generated a hypothesis that this IVF cycle may be unsuccessful.”
You say:
“This isn’t going to work.”
And suddenly a thought has become a fact.
Your brain has gone from commentator to CEO without anyone approving the promotion. Cognitive defusion is the process of gently demoting it. Your brain can still attend the meetings. It can submit suggestions. It can even send strongly worded emails.
It just doesn’t get to make every decision.
Try adding five little words
One of the simplest ways to practice cognitive defusion is to add:
“I’m having the thought that…”
So instead of:
“This cycle is going to fail.”
Try:
“I’m having the thought that this cycle is going to fail.”
Instead of:
“My body has failed me.”
Try:
“I’m noticing that I’m having the thought that my body has failed me.”
Instead of:
“I’ll never be a mother.”
Try:
“I’m having the thought that I’ll never be a mother.”
Read those sentences again.
The scary thought didn’t disappear.
You didn’t replace it with:
“Everything is amazing! My embryo is definitely implanting!”
Because you don’t know that either.
You simply put a little space between you and the thought.
And that tiny space matters.
It reminds you that your brain is producing a thought because you are scared, disappointed, hopeful, exhausted or some complicated combination of all four.
The thought is real, but that doesn’t mean the thought is true.
Please don’t add “thinking positively” to your fertility to-do list
I think this distinction is particularly important during infertility treatment because patients are constantly told to “stay positive.”
As if you don’t already have enough to do.
Take your medications.
Get your blood drawn.
Schedule your ultrasound.
Call insurance.
Order more medication.
Don’t forget to take your trigger shot at a certain time.
Drink a lot of water.
Eat protein.
Try acupuncture.
Reduce stress (yeah, right).
And, apparently, maintain an unwavering belief that everything will work out beautifully.
No pressure.
There is nothing wrong with positive thinking when it genuinely helps you. But ACT doesn’t require you to replace scary thoughts with happy ones.
You don’t have to convince yourself that your transfer will work.
You don’t have to visualize two pink lines.
And you certainly don’t have to worry that having negative thoughts will somehow cause your treatment to fail.
Sometimes the most psychologically flexible response is simply:
“I really want this to work, and I’m scared that it won’t.”
Both things can be true.
Your brain is trying to protect you
Here is another thing that helps me understand anxious thoughts: your brain is not necessarily trying to torture you.
It is often trying to protect you.
If you’ve experienced a failed cycle, miscarriage, disappointing fertilization report, or negative pregnancy test, your brain remembers.
So the next time you approach something hopeful, it may whisper:
“Don’t get excited.”
“Remember what happened last time.”
“Prepare yourself.”
“This probably won’t work either.”
Your brain believes that if it predicts the disappointment first, maybe the disappointment will hurt less.
But anticipating pain doesn’t necessarily prevent pain. Sometimes it just makes us experience it twice as your brain can’t tell the difference between the actual event and just thinking about the event.
You don’t need to argue with your brain.
You can simply notice what it’s doing.
“Oh. There’s my brain trying to protect me again.”
And then return to what is actually happening right now.
What do I actually know right now?
This is one of my favorite questions.
During fertility treatment, there is often an enormous gap between what we know and what our brain is predicting.
What do I know?
“My embryo transfer was four days ago.”
What is my brain predicting?
“It didn’t work because I don’t feel anything.”
What do I know?
“I have three embryos being biopsied.”
What is my brain predicting?
“They will all be abnormal.”
What do I know?
“My friend just announced her pregnancy.”
What is my brain telling me?
“Everyone gets to have a baby except me.”
That doesn’t mean you have to dismiss your fear.
It means you can recognize the difference between information and imagination.
Your brain is remarkably talented at both.
And then comes the most important question
Once you’ve noticed the thought, ask yourself:
“What do I want to do next?”
Not:
“How do I make this anxiety disappear?”
Not:
“How do I stop thinking about infertility?”
Not even:
“How do I convince myself everything will be okay?”
Just:
“What would help me be the person I want to be for the next hour?”
Maybe you go for a walk.
Maybe you finish your work.
Maybe you call your friend.
Maybe you cry in the shower.
Maybe you put your phone down because you have officially exceeded your daily allotment of fertility-related Google searches.
Maybe you eat dinner with your partner and declare infertility a prohibited topic for the next 60 minutes.
Maybe you watch something completely ridiculous on television.
Your difficult thought is allowed to come with you.
It just doesn’t have to drive.
You are still in there
Infertility has an annoying ability to feel all-consuming.
At some point you may realize that you are no longer Monica-who-is-going-through-fertility-treatment.
You have somehow become an infertility patient, a full-time position with terrible benefits.
Your calendar revolves around appointments. Your conversations revolve around treatment. Your browser history and ‘open tabs’ are horrifying. Your bathroom contains enough medication and pregnancy tests to open a small pharmacy.
And your thoughts begin revolving around the same thing.
Cognitive defusion is one small way of reclaiming some space.
You are the person noticing the thought.
You are not the thought itself.
You can feel afraid and go to dinner.
You can feel jealous and still love your pregnant friend.
You can be devastated by a failed cycle and laugh at something stupid the next day.
You can desperately want a baby and still enjoy the life you have right now.
None of those things cancel each other out.
As I wrote before about letting our emotional “hair” down, we don’t need to spend all of our energy trying to tame every uncomfortable feeling before we continue living our lives.
The same is true of our thoughts.
Let them be messy.
Let them show up.
Notice the particularly loud and persistent ones.
And when your fertility-brain starts following you around the house, predicting your future, analyzing your symptoms, and generally behaving like an unpaid reproductive endocrinologist, you can acknowledge it.
“Thanks, brain. I know you’re trying to help, but I’ll take it from here.”
Warmly,
Monica
