The discovery, diagnosis, and treatment of infertility can be both physically and emotionally traumatizing. The initial workup and treatment, however, almost exclusively focus on the physical, rather than emotional, factors. For men, it begins with a semen analysis, to be followed by urinalysis, endocrine tests, the Kibrick test, the SCSA test, and a physical exam; Doppler stethoscope, thermography and venography for varioceles; and transrectal ultrasonography or testicular biopsy. Correction of problems may involve minor surgery, as in a variocele repair or vasovasostomy. For women, it begins with charting monthly basal body temperature changes and ovulation test kits, followed by a gynecological exam and hormone tests, ultrasounds, a hysterosalpingogram to verify open fallopian tubes, a hysteroscopy or endometrial biopsy to check the condition of the uterus, and a laparoscopy to check for endomteriosis. It may also involve an MRI to check the growth pattern of fibroids and surgery to remove fibroids or endometriosis. If immunological problems are suspected, more lab tests are to be done. Are you tired yet?

And this precedes the treatment cycles that must be tightly controlled, strict medication schedules, regular labwork and ultrasounds, etc., leading to the "BIG DAY": semen retrieval and inseminations or egg retrievals and embryo transfers. All of this attention focusing on the waist down.

What happens above the waist? While reproductive
clinics are set up to correct and manage the physical mechanics of making babies, they are often less prepared for the emotional turmoil that ensues. Ask anyone experiencing infertility and they will tell you that the diagnostic and treatment procedures themselves contribute heavily to the psychological wounds and emotional trauma of infertility. In the monthly pressure of timing interventions and beating the biological clock, there is little time or opportunity for dealing with the emotional side effects of the process. By not addressing the whole person, treatment procedures ignore vital elements in the process.

A mind/body split occurs whenever we feel that the body is not performing to mind's expectations or demands, such as when we are trying to conceive a child, leading to internal conflict with our sense of ourselves. Over time, we feel out of control, helpless, and angry at our body for not producing what our mind has already conceived through intense longing and
imagination.

When infertility treatment procedures deal with the individual only between the navel and hips, and draw a line between the emotional and reproductive centers of the human being, they reinforce the "mind/body split". Trauma occurs whenever the body or mind experiences injury and perceives a threat to the self that it cannot manage with existing resources. While the physical wounds of infertility center on the body's incapacity to reproduce and the numerous procedures to correct it, the psychological wound is the message of imperfection and failure. This can be experienced as shock, leading to a sense of numbness, anger, and grief. If a couple embarks on a treatment program without dealing with these feelings, they may be more vulnerable to experiencing future treatment procedures as traumatic. Invasive procedures, such as IUI and IVF, may be
experienced as wounding the integrity of body and psyche.

Mind/Body splits may result in physical or emotional symptoms, such as sexual performance problems, low sex drive, anxiety, and depression. Some individuals react with compulsive behavior and pursue repeated treatment cycles without a break, ignoring internal signals to slow down and rest. For others, the physical discomfort, pain, or exposure associated with a certain procedure may lead to heightened anxiety whenever this procedure is performed, creating internal resistance. Instead of feeling helpful, the procedures feel injurious, like "an insult" to
one's identity and integrity. Repeated unsuccessful treatment cycles add to the sense of failure. If a couple proceeds without addressing a partner's psychological trauma, the body will be forced to perform while the mind is resisting, widening the gap between the mind and body. This is like trying to move forward with the brakes on.

Sadly, if neglected, the emotional and psychological effects of infertility can impede treatment progress. Certainly they contribute to the absence of positive emotions that most couples complain of during treatment. One study by the Harvard School of Mind/Body Medicine shows that rates of depression in women dealing with infertility for an average of two years equaled depression rates in patients facing terminal illnesses, such as HIV and cancer (Fertility and Sterility, April 2000). Other studies have shown a strong correlation between negative emotions, such as anxiety and depression, and poor treatment outcome (Fertility and Sterility, October 2001.

In their desire to conceive a baby, the couple themselves may overlook or deny the traumatic aspects of their experience. Perhaps they fear that they be seen as complaining and not be
considered "good patients" by the medical staff. Or, one partner may be afraid that voicing his or her distress may be misinterpreted as a lack of support or commitment to the other.

We can erase the artificial line between the mind and body by paying attention to the totality of our experience and creating interventions that address the whole individual. The good news is that there is growing evidence that getting psychological and emotional support for infertility improves treatment outcomes. In one Harvard study, women who participated in a mind/body group had a 55% conception rate within one year; women who participated in a support group had a 54% conception rate within the same period. However, women who did not receive group
intervention had only a 22% conception rate during that year (Fertility and Sterility, April 2000). The healing factor appears to be effective treatment for depression, which more than doubled medical treatment outcomes.

Here are some suggestions for healing the mind/body split within you:

- Find a safe place to voice your experience of the diagnostic and treatment process. Be honest with yourself about your feelings. If you notice a "little twinge" inside, pay attention to it. If something seems "on the back of your mind," address it. It may help to start by writing in a journal and finding a special time to share it with your partner.

- Prior to doing a procedure, prepare yourself for it by reading about it and talking to someone who has already undergone the procedure. Resolve Support Groups or Cookies and Conversation Groups are a good source of experience. Write a script of the procedure going well, including positive affirmations and suggestions for relaxation. If you have been engaging in unending treatment cycles, talk to your partner about taking a month or more off from medical treatment to devote some time to your emotions and relationship. As scary as this prospect may seem to a couple "driven" to conceive, it can go a long way to restoring some
balance in your life and emotional health.

- Make emotional and psychological support a vital part of your treatment plan and overall health. Consider adding care that focuses on the mind/body connection, such as a mind/body group, Eastern medicine, individual or couples counseling, or a support group.