Transcript for Episode 77: Infertility and Mental Health
NASW Social Work Talks Podcast
Announcer:
This episode is sponsored by ECINS, the world's most collaborative case management system.
Greg Wright:
Welcome to Social Work Talks. My name is Greg Wright. Millions of Americans deal with infertility. According to the Centers for Disease Control, about one out of 10 women aged 15 to 49 have problems conceiving a child, and about one in 10 men in the United States has infertility issues. That number is expected to grow as more Americans wait longer to have families.
Our guest, Steven Miller, sits on the Mental Health Professional Group at the American Society of Reproductive Medicine. Steven has a master's degree in psychology, and is earning his masters in social work at the University of Wisconsin-Madison. Steven thinks that more social workers should be educated about infertility.
Welcome to Social Work Talks.
Steven Miller:
Thank you.
Greg Wright:
How did you first become interested in the issue of infertility?
Steven Miller:
My wife and I struggled for at least six or seven years with infertility ourselves, and kind of felt blindsided by the diagnosis of male infertility is, had no clue what that was. We kind of just went through just the hoops and stuff of trying to get infertility coverage.
Just going through IVF kind of opened my eyes to a whole other side of mental health. The clinic we used was amazing and offered a lot of support for us, but we were also going to St. Louis and traveling five hours for doctor's appointments. In Wisconsin, the nearest person that knows about infertility, it's about an hour away. So when we're traveling five hours away for our treatments, and then traveling an hour to do counseling, it just wasn't feasible for us.
So I saw that as an opportunity to make a really big impact because one, there's not a lot of men in reproductive mental health, and there's a lot of stigma for male infertility and just infertility in general, along with mental health. I think mental health is getting better, but there's still a lot of stigma between infertility.
I started thinking about how can I get involved with this field. I just went on Amazon to see are there any textbooks on this topic, and the first one that came up was infertility counseling and was by Sharon Covington. And she's a licensed social worker through Shady Grove Fertility clinics and she's, I think the director of all that. I just had emailed her and said, "Do you have any advice in getting into this field?"
She referred me to the America's College of Preventive Medicine and their mental health group. So I joined that in February, of 2021. Definitely was the greatest thing I could do, because I'm meeting a lot of people through there. There's a number of psychologists and social workers that are involved from all over, and actually just went to a conference in October [inaudible] conference in Baltimore and was just a tremendous learning experience.
So that's how I really got into it because I really want to make it a big impact, and I felt like this was a great way to take my experience of infertility in going through IVF. Also, knowing that my experience is not everybody's experience, but knowing that there's a need for it.
Greg Wright:
Yeah. So I'm wondering whether you are seeing in a lot of the curriculums at our social work schools, whether this is an issue that social workers are educated on at that level?
Steven Miller:
I initially thought about this when I had a class last semester. It was human behavior and environment and there was a nice section in the textbook. There was a case study about infertility and the mental health piece of it, and just the different treatments and all that stuff. Then there was a nice section in a textbook, but what I had noticed was when we got to that section, it was never discussed.
I feel like this professor did a great job with the class, and when I highlighted, like, "Hey, why are we not talking about this?" She did an awesome job of just... I shared a video with her, one of the TED Talks and stuff and she posted it on our canvas so the class could see it. But yeah, typically it's not talked about, so it got me thinking. I'm like, "Okay, is this my experience or do other people have the same experience?"
So I started asking others in my full-time job, when you were going through education or in social work or whatever field you're in. I said, "Did you have any conversations about reproductive mental health or infertility mental health or even reproductive loss like miscarriage or anything, is there any talk about that?" All of them said, "No, we haven't really had a discussion on it." Then I started thinking further okay, well let me just do some exploratory stuff.
I don't know if you're familiar with the social app Reddit, but I asked there and there's a social work subgroup in that app. I just kind of did a poll and asked the same question. I think there was 233 people that replied and also mix between current students, people that have their MSWs and people that are licensed. 92.7 percent said, no, that they have not had any discussion or class or anything.
Greg Wright:
Wow. Is it an issue that it's a stigma still to talk about infertility?
Steven Miller:
I absolutely think so. Everyone that I've talked to has always said I know somebody that had a miscarriage or I know somebody that's struggling with infertility. I know somebody that was... My sister was a surrogate, but yet we're not talking about it, and really the only way to reduce stigma, is to talk about it. People are looking for support for mental health regarding infertility, they look at bios for therapists and some of them will say grief, depression, anxiety.
But I think people going through infertility doesn't necessarily associate that. They feel like infertility is this really specialized thing. I think it's even could be further stigmatized in just knowing that therapists aren't even talking about it or counselors or psychologists, this must be something that we shouldn't talk about.
Greg Wright:
What does a woman go through mentally, when they are dealing with an infertility issue or a miscarriage?
Steven Miller:
From what the research [inaudible], there's a lot of depression, anxiety, grief of loss of being able to conceive naturally. I think we have this idea and that viewpoint of how your life should be. When that doesn't happen, it's almost like an existential crisis for women. Even socially, you think about how much is put on a woman to become a mother. A lot of inadequate feelings. So when it doesn't happen, they take responsibility, that's their fault, their body, it's body betrayal.
You think about all the shots they have to take too, hormone shots and that really messes with emotions. Silvia Schneider Fox, she did a nice talk about invisible grief and loss. I think we think about grief as something tangible, like if somebody was elderly or just died of natural causes, people think, okay, yeah, you have grief. That's something that we can see. But when it's something that you have, and that's not tangible for people to see, I think it's hard for them to conceptualize grief in that way.
Greg Wright:
Also, I think that women are blamed for it more. I think about in history, there was a King Henry, the eighth and he wanted a son, and so he married five or so wives and it was always a blame on the women, why aren't you making him an heir, when in fact he might have been the one who had an issue that prevented that.
Steven Miller:
Historically, yes. I think people feel that is a woman's issue. Even if you think about the research, there is more research on women in reproductive health than there is for men in reproductive health. And part of that may come down to the historical context is just being passed along, is that this is a woman's issue. It has nothing to do with men, when in fact 40 to 50% of the time, it is due to male factor.
Greg Wright:
Male also has a mental health issue, what does a male experience when they are realizing that they have an infertility issue or their mate, a partner who they are trying to conceive with might have this issue?
Steven Miller:
I think it's hard for a man to see his significant other, to see them struggle with this, and knowing that they have this diagnosis and trying to come to acceptance of that. I think it's hard for them because they have their own emotional issues that are going along with it. I think a lot of men will put that to the side to be kind of that solid rock and foundation for their significant other.
But when you do that, you're also neglecting your own self care. From my own personal experience, men that have infertility, they see that their wives... They want something better for them. I don't know times where I was like, "You know what, why don't you just leave me, find somebody where you can have a child. I know you want to have a child." So it's almost like self sacrificing.
I also had thoughts about my family tree. If I don't have children, then my family tree ends, so it's almost like I said, the existential, what does this look like for me if I don't have children, because you said, the expectation is you get married to have kids. When it doesn't happen, it's a struggle. Yeah, we're just neglecting our own feelings because we don't want to be burdensome. We already see our significant other struggling and if we're struggling too, we don't want to be burdensome. We don't want to put more on them to have to worry about, so we kind of just keep it in.
Men are going through grief as well. Men have ideas of what their life would be like. When it changes it out to be different, the partner could be in two different spots in the grief process, and how you manage that, and that's a difficult thing to manage. I know that there was research in Denmark that showed that couples that did not conceive with IVF or any sort of fertility treatments, 25% of them ended in divorce. So it takes a toll on the relationship in each individual.
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Greg Wright:
How can a social worker help?
Steven Miller:
I think there's many people that wouldn't even disclose infertility because of the stigma. So I feel like even when you're doing your initial assessment or intakes, questions about infertility or miscarriage are very rarely discussed or asked. So I think being able to ask the questions, more people would open up about their infertility, if they're asked.
When we think about suicide, we ask the questions, and some of us are fearful, although if we ask a question, they need to think about it. But if we don't ask the question, they're not going to bring it up. I think that's the same thing with fertility or even miscarriage. I think it just gives a bigger picture of what their life is like.
Adoptive parent, I think infertility also goes with even foster care and adoption. They say adoptive parents are 10 times more likely to have experienced infertility or have gone undergone fertility treatments, than those that have not. 39% of foster care parents said their motivation to be a foster parent was due to infertility. Infertility itself, this doesn't affect individual. You think about parenting, how does this really impact person?
In 1993 was [inaudible] and there was another guy that had did research and they compared psychological distress amongst cancer patients. It was HIV positive, infertility, and then I think a heart attack or cardiac arrest or something like that. What they had shown was that the psychological distress amongst cancer patients and infertility, there was no significant difference. Meaning that the psychological distress was very similar to undergoing a cancer diagnosis.
It is a tough thing when you're getting constant reminders of it. If you're out in public, you see another family with children, it's a reminder of something that you don't have. Or when you hear baby announcements, birth of a child, they're in that ambivalent stage of like, I'm really happy for the person that I know that just had a baby or is pregnant, but I'm also grieving the loss of what I don't have.
So it's kind of figuring out how do I balance that? How do I accept where I'm at right now? Micro level, I think is providing some mental health support. Let's talk about it in the academic setting. Let's get people knowledge and awareness of these issues, whether that's through training or academic classes or even just talking about the subject within a class.
But then you have the macro level, which is, there's only 17 states have mandated infertility insurance coverage. The average cost for IVF, including meds and just the different cycles and all that, is about $38,000. So there's a lot of legislative and policies and different things, that at a macro level, social workers could assist with as well.
Greg Wright:
What are some self care activities that a person who is dealing with infertility can adopt?
Steven Miller:
I think reaching out to other people. I know RESOLVE has some peer support groups. Not everybody is into groups, but RESOLVE does a great job and a lot of them are virtual now. I think all of them are at this point. So there's peer support groups. Sometimes it's very helpful to have a group and there are some that are specific [inaudible] and there's peer support groups for couples.
And really just having the therapist highlight, when you've gone through a tough time before, what are things that you used to do? Some people have gone for walks or going to nature, they may go see a movie. They might hang out with friends. I know for me personally, I think the biggest thing for me was when friends that were couples would invite us over or have us come to dinner, and it's just the four of us, there's no kids, I think that is super helpful for anybody that knows somebody going through this. It's okay to not have the words, to give them support and you can say, I don't know what to say. I think just being there, the support has been helpful.
Greg Wright:
Do you advise people who are dealing with infertility to be open with others, or is it really just a private thing, that you should only share with a few friends, family members?
Steven Miller:
My feeling is be open about it. Isolation can even just increase depression. If you're doing IVF and you're not successful, the more times you try it and the more times that you're not successful, there's research that says there's more likelihood to have depression. I think if you're open about it, you're going to realize and see that there's a lot of other people that have gone through something similar. And sometimes, knowing that you're not the only one going through it is super helpful.
I know there's a lot of Facebook groups out there that just provide that support for me personally and just being open about it. I even have a sticker on my bumper that talks about National Infertility Awareness Week. Who knows who will look at it. A lot of people look at a bumper sticker or [inaudible] and they're like, "Oh, what is that?" It's still providing information.
Greg Wright:
I was just wondering if you want to tell the folks here more about what RESOLVE is?
Steven Miller:
Yeah. So RESOLVE is the national infertility nonprofit. They do a lot of work with doing peer support groups, as well as a lot of advocacy for different laws and trying to get mandated coverage for every state, instead of just for 17. Also, working on trying to get insurance coverage at work, really a plethora of knowledge, along with ASRM.
They have a plethora of knowledge of infertility, they have videos and different things about facts verse fiction about fertility myths. I think a common one is this, when you're less stressed, it'll happen, and that's not always the case. RESOLVE also has a good directory of, if you need mental health support, finding somebody there. You can also access people from the Mental Health Professional Group, there's a directory to see where people are, and see if there's anybody in your state that could provide help.
Greg Wright:
Are there some resources out there that you recommend that social workers look into on the issue of infertility?
Steven Miller:
Yeah, absolutely. Mental Health Professional Group has a webpage, but they have a lot of knowledge on the articles, some current research, videos, webinars that would pique people's interest about mental health and infertility, so that would be a great start. They have a biography to give more information on different topics within the infertility world, on reproductive mental health.
RESOLVE and then American Society Preventive Medicine, that's a great website to get information more about the medical pieces of it. And then SART, which is the Society of Assisted Reproductive Technology has also a lot of great information. I also do have, through the School of Social Work at UW-Madison, we are going to have a webinar series in February, perspective on infertility and mental health.
So there's going to be three talks. One from Dr. [inaudible], he taught out of Thomas Jefferson University, who is very well known for his work with male infertility. And then the second one is with Dr. Anna Flo, she's out of Nia College in New Jersey, and she's doing a talk on the female perspective of infertility mental health. Then we have one of our own professors, Jeanne Ferguson, and one of the clinic directors from Wisconsin, [inaudible], McKellar that are doing a talk on third party reproduction in surrogacy and mental health.
It's an emerging field and I think that we should have more and more people getting involved in understanding of this.
Greg Wright:
Yes, absolutely. I thank you for this interview.
Steven Miller:
No problem. I appreciate the opportunity to speak about this.
Greg Wright:
Absolutely. Thanks for being here.
Steven Miller:
No problem.
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You have been listening to NASW Social Work Talks, a production of the National Association of Social Workers. We encourage you to visit NASW's website for more information about our efforts to enhance the professional growth and development of our members, to create and maintain professional standards, and to advance sound social policies. You can learn more at www.socialworkers.org. Don't forget to subscribe to NASW Social Work Talks wherever you get your podcast. Thanks again for joining us. We look forward to seeing you next episode.