The Fertility Sisterhood_Episode 7_Mental Health: Audio automatically transcribed by Sonix

The Fertility Sisterhood_Episode 7_Mental Health: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Lara Messerlian:
1 in 6 couples struggle with infertility, and we know that the environment plays a big role in how our bodies reproduce.

Carmen Messerlian:
In the Fertility Sisterhood, join me, Dr. Carmen Messerlian, Harvard epidemiologist and fertility expert, and my sister Lara, as we discuss what everyone needs to know about how the food we eat, the water we drink, the air we breathe, and our everyday environmental exposures impact our health and therefore our fertility.

Lara Messerlian:
Now, let's dive in and learn how we can clean up our lifestyles not only for ourselves, but for our future generations.

Lara Messerlian:
Hi, everyone. Welcome back to the Fertility Sisterhood podcast. I'm Lara Messerlian, and I'm with my wonderful, most talented sister, Dr. Carmen Messerlian. Today we're going to be looking at mental health, a really important subject. So a lot of people struggle with mental health. But did you know that mental health and your mental internal well-being actually really affects your fertility? So, Carmen, tell me a little bit about how your internal mental health and state actually has a correlation to your infertility and to your fertility outcome.

Carmen Messerlian:
So we have just recently published a really important paper in this space, and the paper was based on a hypothesis I've had for a very long time regarding adverse reproduction across the life course, meaning that certain women in our population have a high risk of poor outcomes in every area of reproduction, starting from a very early age, when they first enter, start menstruating, start having their periods. We see these women having a more likely to have disrupted menstrual cycles, premenstrual dysphoric disorder, meaning really bad PMS. We see these women having a higher risk of things like PCOS and endometriosis. These women also have a higher risk of infertility and then even if they do conceive, they have a higher risk of miscarriage, preterm birth, postpartum depression, and difficulty transitioning into menopause. This was the hypothesis that I generated through the science and research that I've done over decades. And when me and my team at Harvard went to look at the literature and really do a deep dive into the studies to show whether or not there was any association between early life stress, what I thought was very important was early life stress. So young women experiencing trauma, traumatic experiences, family dysfunction of any nature really disturbed early life experiences to homes that might have been dysfunctional, abuse that might have been emotional, physical, sexual, these experiences have been found through the studies that we've looked at, both animal and human, to show that women that experience these these life events, these stressful life events are at much higher risk of infertility. And it's not just infertility, it's all these other things that have a pathway to infertility that I mentioned, gynecological diseases like PCOS and endometriosis, premenstrual dysphoric disorder. These are all on a pathway where we see higher rates or higher levels of inflammation. So the stressful results in a disrupted pathway, the pathways that we've looked at are A, hypothalamic pituitary adrenal axis, that's the one that regulates your stress hormones, and that is really intertwined with the HPG axis, which is the hypothalamic pituitary gonadal axis, which is actually what regulates your hormones, your ovaries or your gonads. And so these two mechanisms in the body and in the mind create conditions from the brain to the body that result in disrupted processes that put a woman at higher risk. So that's the first thing we know. We know that these early life events, these early life experiences in women result in them having a much higher risk of infertility and a whole host of reproductive problems across life. So that's the first thing we need to be aware of when we talk to couples and talk to women that are infertile or struggling with their fertility is what is the history behind this? And is there healing and an opportunity to uncover some early life trauma that might allow the body and the mind to heal? Because we know that the body and the mind are really interconnected, and allowing that opportunity for healing might allow for better health towards the goal of getting pregnant and trying to regulate your adrenal, your stress hormones in relation to your gonadal ovarian hormones is really important and that's something that requires more than just IVF care, that requires things like meditation, stress management, stress, resilience, exercise, physical activity, enjoying nature, being outdoors, being mindful, allowing your healing and your body to move together in a way that's much more integrated, is the goal for this type of, I wouldn't say a problem, but this type of underlying mechanism that we know could be impacting the women that are listening to this podcast.

Lara Messerlian:
And what about men? How does chronic stress actually affect men and their ability to be fertile? And stress affects everyone. It's not just a female issue, right? Being in relationships can be stressful. Being, having work stress can be, can affect your overall health and well-being. What does it actually do to men?

Carmen Messerlian:
So that's a great question. So we went from the early life exposures and the stress that causes that can impact how you modify and regulate stress across life, and that's right. We can see that from an early age becoming what we call a new-named chronic stress, which is how we regulate stress on a day to day life. And some people can manage chronic stress better than others, but chronic stress, we do know through studies have been linked with an increased risk of infertility for both men and for women. In women, an increased risk of pregnancy loss and an increased risk of preterm birth. And as you point out, very well is that psychological distress and chronic stress and depression have been associated with decreased number of sperm and sperm quality and infertility in men as much as in women. And so it's not just about the female stress and the female's ability to manage anxiety and chronic stress. Really, a man and how he regulates his stress can really impact a woman's chances of getting pregnant. And so this is the idea behind the work that I do at Harvard and in my company called Be. The intervention is about holistic care of couples. It's about providing opportunities for couples to work together and to align themselves, to regulate together these issues in a much more holistic way.

Lara Messerlian:
That in itself puts a lot of stress on couples. For example, if you've gone through, even, if you're trying to get pregnant and if you've gone through a loss or significant loss, it's really difficult to overcome. I know I've spoken about this and maybe not too deeply because it's still a real pain point for me. But when I struggled with my loss in the second trimester, it was very traumatic. You experienced it with me because I called you from the doctor's office and I haven't really told the story too deeply on this podcast, but I was in my second trimester and my husband and I were expecting our first little girl. And then when we went to do the checkup, I was looking at the screen and they had a static image of a baby of a fetus on the screen. And I remember thinking to myself, oh, how strange, they forgot someone else's baby picture on the screen. I know, I was looking forward to looking at my own baby because I know my baby would dance around and bounce around and was really active. And so I saw this static image of this baby and it really confused me. And then the doctor came back and told us that she had no longer been with us. And I started screaming in the room right there. And I called my sister right away and we were sobbing and crying on the phone, but that was so traumatic for me. And not to mention because of my health concerns, we couldn't do a DNC for a couple of days until my blood, I was on blood thinners, I was taking Lovenox injections, and I couldn't actually do the surgery for a couple of days. So I had to carry her body for a couple of days before we could have it removed, which was psychologically really traumatic for me as well. But to this day, I struggle with that image of to this day, I wake up in the middle of the night and I see that image and it still bothers me. It still haunts me going through these traumatic experiences, really ....

Carmen Messerlian:
Yeah. So you bring up and.

Lara Messerlian:
Conceive again?

Carmen Messerlian:
Oh, no. So that's something else that we're working on and studies that we're looking at Harvard, related to the actual experience of infertility as being what we call a traumatic experience, it's a traumatic event. You had a traumatic event that results in post traumatic stress symptoms and post traumatic stress disorders are very common in couples that are trying to get pregnant. Even a failed cycle, the hope and the desire to get pregnant and to have that cycle become successful and then to turn out after the fertility treatment, all the injections, to come to the table and realize that there's no baby, there's no pregnancy, there's no implantation, there's no fertilization is a traumatic experience for couples. And it results in PTSD symptoms, just like you described with the fetus that was stillborn and no longer viable in your, during your gestational, second trimester weeks. And seeing that image, that's a traumatic experience for anyone who's hoping for a baby. And we don't appreciate enough in the space of the medical clinical side of things, how important the trauma is to the actual repeat cycle of failure. So that stress causes your body to have a biological, physiological, neurochemical result and the mind controls the outcome in the body and the body controls the outcome in mind. It's cyclical. And so the mind is now saying, I've had this experience, it's very traumatic and the stress hormones change and the way your body regulates and sees the opportunity for another pregnancy is different. And so now you feel failure, you feel negativity, you feel despair, you feel depression, you feel anxious. And those create conditions in your body that do not maximize your opportunity for success in the next cycle. And so it's like a vicious cycle where one adds the infertility might be associated with previous chronic stress, and then the chronic stress then causes you to have a longer time to pregnancy, which then causes you to have just like you have no chance of having peace. I have no peace in here either, unfortunately. As I was saying, was that the experience of early life stress compounded with chronic stress, compounded with infertility symptoms, and then a failed attempt while undergoing fertility treatment, either through a failed cycle or a miscarriage, then results in further failure, further time to pregnancy, that's increased because now your body and your mind are working against you. And so this is something that, you know, we really haven't paid enough attention to in the infertility care space. Mental health issues have not been addressed in the infertility care space. We don't do enough of a good job trying to care for the infertile couple as a holistic system in and of themselves that are together in one unit that require care and love and attention to help harmonize their experience, to help heal their experience, to help bring them together in a way that allows for healing of previous experiences from earlier in life to current experiences in the infertility world. And so this is an area that requires enormous investment from new innovations and new opportunities for care of the infertile couple. And a lot of couples struggle. We know in the data that it's about 50 to 60% of individuals diagnosed with infertility experience clinically significant symptoms of anxiety and depression. That's more than half of couples are struggling with real clinical symptoms of anxiety and depression. And yet we don't treat the depression, we don't treat the anxiety, we just get the eggs out, we take, we give them hormones and we think that's going to solve the problem, it doesn't. You need to get to the root cause. The root cause is the trauma. It's the experience of stress and anxiety and depression. Let's work downstream to address these root causes and create healthier couples so that the healthier couples have a much better chance of getting pregnant on their own.

Lara Messerlian:
Not to mention, that it also, likely encourages that emotional burden, most likely gets people to not want to continue the treatment or not want to continue having a child.

Carmen Messerlian:
.... It's so stressful that it's just like it becomes too much.

Lara Messerlian:
And probably is the cause of a lot of marital problems, like possibly failed marriages because of the fact that that.

Carmen Messerlian:
One of the number one reasons couples cite for divorce is infertility. And one of the number one reasons couples cite for a reason to end fertility treatment is because the mental-emotional burden on themselves and on their relationship. So it's a huge problem. And major one that hasn't been cared for hasn't been addressed. And again, putting a plug in for my company Be, where we plan to address this in a much more holistic way, in a way that cares for the couple, not for the individual, and that focuses on holistic, integrated well-being and prevention of problems before they occur.

Lara Messerlian:
So what social support, do you think, is just off the cuff? Like I know you're working on this in a really active way, but for people who are just listening right now, what are some takeaways that they could do to help them start to, I know you said making sure you meditate and all of that, but let's talk a little bit about healing in this next little section so that we can give some concrete advice to people who are listening.

Carmen Messerlian:
Yeah, that's wonderful. I think this is so beautiful. I'm so glad that we have a chance to talk to American women about this. I think the number one thing that I say and see is really an opportunity here to heal the couple, to bring them together. There's a lot of there can be a lot of hurt feelings and the infertility space, there could be a lot of blaming or feeling like you're being blamed if you're the one who has the cause of infertility. And there's a lot of financial stress that comes with infertility, there's a lot of financial stress involved in trying to care and provide pay for treatment. The number one thing, to me, is really bringing love back into the relationship and focusing less on trying to get those eggs and sperm to be done on the right day, at the right time, at the right place, super mechanical, really getting away from the mechanics of infertility, the mechanics of getting pregnant and going back to the lovemaking, to the pleasuring, to the happy place, to the place where we want to make a baby and focusing even though it feels like you're not focusing on the goal of getting your eggs and sperm, focusing on the health, the mental and physical health of you and your couple, and focusing on the love that you have and not letting go of the goal, but disengaging from the intensity of working on that outcome with so much vigor, with so much pressure. That pressure is damaging to your mental and physical health and does not allow you to holistically bind and bond with your partner in a way that's caring and loving. And to me, the most important thing and hard to do, but I think we need more social support for spouses, for couples. We need more support, either informal support groups or more formal support groups where couples can come together, either in group sessions as many couples can get six-eight couples in a room virtual, it could be to support each other, to understand each other. And then individual therapy as and it doesn't have to be psychotherapy, it could just be talk therapy, it could just be sitting with a group of people that understand, have shared experiences, even from couples that have been through it as being your coach, like a couple coach from another couple that had been through it that are willing to share their insights. And support and love and guide that couple through their experience. There's many forms that it can take. Even just being able to post in a community, on a web platform, having your symptoms or your experiences shared. And I think for me, and you heard me say this a lot in this podcast, is the male partner has been so neglected in this and really trying to empower the male partner to want to care and make a baby for his partner, for his female partner, helping him feel more empowered, more engaged, more loved, more attended to. They struggle to, and they're sad too, and they're anxious too. And they have no place to turn. They can't really necessarily turn to their guy friends and maybe they feel shame with their female partner. And we need to create a safe space for men to share with other men as well as men to share in couples scenarios with other couples so that there's more safety and protection of sharing these feelings, just getting them out and trying to heal them by talking about them and hearing other people and how they coped with it, I think is a start. And then things that we're looking at again in my company are things like meditation, heal together through individual meditation and joint meditation, individual exercise, joint exercise, things that you could do to align yourself with your partner that we know are health promoting behaviors are some of the things we're interested in promoting and supporting couples. And these are cheap interventions. They're relatively free, and our platform is going to have a huge section that's going to be free for everyone across the globe, because I really believe in universal care. Every couple deserves this, you don't have to be rich or white to do this. It could be, anyone across the globe deserves attention and understanding and a safe space to discuss and understand their fertility issues.

Lara Messerlian:
Yeah, that's really good. One thing that I really think is important too, that I've experienced in my marriage and my relationship with Brian when we went through our loss, like he was the one that told everybody first before I even told anyone, he told all his friends that we were expecting a baby and he was so excited about it. And so when we had the loss, it really broke his heart and it really affected him in a really deep way for a long time as well. And not just having the loss of losing our child, but also seeing how I had to struggle with the loss physically and emotionally and not being able to care for me or trying to care for me, but not knowing how to be there for me as I was going through this experience. So I think it's really important to understand that men are also, men have a double duty in the sense too, where they're like trying to be a really good partner to you, they're trying to support you, they may not always know how to do it. They're often doing their very best, but they maybe don't have the whole toolbox as to how to deal with emotional issues like this and may not have the support themselves to understand how to deal with these emotional issues that are life changing sometimes. And for me, I think I'd mentioned it in the past, it really shocked me when a couple years later he was, he had done a post on Instagram and it was the shoes that he had bought her that we hadn't filled yet, and he had still been thinking about it and obviously he was still thinking about it, but it was still affecting him to the point where he was sharing it publicly. And I don't know, it really broke my heart to see that he didn't know how to handle it. I had you and I could talk about it with you. And he's really good. His IQ is really high, but it's still they don't always have the same tools and the same support as we do. So we have to really consider that.

Carmen Messerlian:
Yeah, you raise a really good point, which is A, they have to navigate how to care for you experiencing the miscarriage, but they also have to care for themselves because they're experiencing it too, for themselves. And so they have to navigate both paths, which is how do I care for my wife, my partner. She's struggling, she's depressed, upset, she's experiencing trauma, traumatic event, and he's hurt for you, but he's also hurt for himself, for the loss of the baby. And it becomes complicated for men. And I want to see more attention paid to men because I feel in and this is the philosophy and part of the mission of my work is to support men to the point where they could become excellent partners. If we're talking about women's health, there's no factor that's more causally associated with a woman's health than her male partner's health. It's the number one strongest predictor of your own health is how healthy is your male partner. And so here we are, we're trying to work with helping support women to become healthy, yet we've forgotten that the number one factor that impacts a woman's health and we're talking about heterosexual couples and you could say the same thing in homosexual couples or same sex couples. The other partner, is such a strong influence on your health. So if I'm exercising and I'm healthy and I don't smoke and I don't drink and I do everything right for my body, if my male partner is drinking and smoking and depressed and anxious and irritable and unhealthy mentally and physically, then that's going to directly affect me and my chances of getting pregnant, my health and my being. And so the mental health that a man, a male partner is, is crucial or the other partner is crucial to the reproductive success of person who will be carrying and conceiving and carrying that baby. And so we need to think holistically.

Lara Messerlian:
I think in general I would tell this to Brian all the time over the last, little while with the pandemic and everything, I'd say, if you're not taking care of kids, I want you to be happy and I want you and Olympia to be happy. And I would say to him, we're not happy unless we see you being happy first, because our well-being as a family is 100% tied and linked to your well-being. So if you're not doing well and you're not thriving, then as long as I'm exercising every day and taking care of myself, I do that anyway. But if I don't see you doing that, and if you're not healthy and happy, we're all suffering because you're one of the main pillars in this in the family. And we all need to come to the table with a healthy approach. And we all have personal responsibilities to ourselves. But by doing that, we also have responsibility to our family. And so I think.

Carmen Messerlian:
Interlinked.

Lara Messerlian:
Exactly.

Carmen Messerlian:
Inextricably linked as even a causal way in a scenario of, of, if you're thinking about causes and stuff.

Lara Messerlian:
For everyone listening today we talked about mental health. We reviewed how stress can affect not just what's happening right now in your life, but previous traumas and stress actually greatly affect your fertility, it affects your gynecological health and well-being, so the key takeaway is for both men and women, mental health is critical in your reproductive health and fertility. There are adverse effects that can come about from having not just infertility but previous traumas. Make sure you try to get as much social support and love each other in your couple, whether you're same sex or male-female partner. Make sure you're supporting each other in the best way that you can and try to take some steps, whether it's meditation, whether it's psychological interventions, whether it's therapy. Try to take some active steps to help yourself during this time because it is hard on on couples and we hope that this was informative and entertaining, maybe a little less entertaining this time because it was pretty serious conversation. But we hope that you had something, you're taking some good feedback from all of this and applying it to your lives and to your scenarios, and we wish you a wonderful week, a lot of success. And we're so happy to be here.

Carmen Messerlian:
Yeah. Thank you, Lara, for the questions and for sharing your personal experiences, I think they were very valuable in this particular episode. And I want to just reinforce again how important coming together as a couple, no matter how you define your couplehood in a space of love and harmony and holistic well-being, that's the goal. You make love to make a baby. And going back to that, trying to support each other, to be more aligned on a loving, in a loving way. And again, my work on my company called, Be.Science is a website. You can get on a waiting list if you're interested in the company and the work that we're doing there and being part of the journey that we're preparing for couples across the globe. So thank you and stay tuned for the next time.

Carmen Messerlian:
Thank you for listening to the Fertility Sisterhood brought to you by Rescripted. We hope it has left you feeling more educated and empowered about the role environmental factors play in our reproductive health.

Lara Messerlian:
If you've enjoyed this week's episode, be sure to visit SEED-program.org to learn more about Dr. Messerlian's research. To stay up to date on the podcast, follow Rescripted on Instagram and TikTok at @Fertility.Rescripted or head to Rescripted.com.

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