This article was originally published on Mommbites.com
As little girls, many of us likely played mommy – we stuffed pillows under our shirts and strutted around for a moment and then pulled the pillow out, grabbed a nearby baby doll and poof, we were mommies. Easy peasy, nothing to it. Nowhere in our imaginations was there heartbreak over negative pregnancy tests, miscarriages, let alone fertility treatment. Yet, in reality, the journey to motherhood is rarely linear or easy, and for 10-15% of couples, the road is long and difficult because they face the added challenge of infertility.
If you aren’t getting pregnant the old fashioned way…
After six to twelve months of trying to conceive without success, an OBGYN will likely draw several labs to look at hormone levels and may recommend a test called a hysterosalpingogram. This is also the time when many couples begin seeing a more specialized fertility provider called a reproductive endocrinologist. Although not for every woman, a jumping off point for fertility treatment is a medication called Clomid. On the upside, Clomid is a pill that is taken for five days rather than needing shots or frequent monitoring as with more invasive procedures like Intrauterine Insemination (IUI) or Invitro Fertilization (IVF). On the downside, Clomid is the most likely of all fertility treatments to make you feel moody, sad and overall miserable. More specifically, roughly 40% of women feel depressed, 45% experience mood swings and nearly half report some form of mood symptoms during the five day treatment. These symptoms may even persist through the duration of the cycle, but they will cease with onset of your period.
These side effects are so common that they even have a nickname: the ‘Clomid Crazies,’ which often may include difficulty sleeping, irritability, mood swings, tearfulness, anxiety, and general yuck (think bad PMS).
Will I have the Clomid Crazies?
There is no way to know in advance who will experience side effects from Clomid. In general, women at greatest risk are those who have a history of anxiety and/or depression and those with bad PMS/PMDD. Some women are given progesterone in addition to Clomid and this combo may exacerbate the ‘Clomid Crazies.’ But, remember, these symptoms are temporary and will absolutely self resolve. It’s also important to note that there’s no assurance anyone will suffer from these side effects even when they have every risk factor. I’ve had some patients feel great on Clomid who I would have anticipated feeling lousy and vice versa – for better or worse, our bodies are not always predictable in these scenarios.
The Nitty Gritty Science
The reason for the so-called ‘Clomid Crazies’ is that Clomid tricks the body into thinking that estrogen levels are lower than they actually are. It does this by blocking some estrogen receptors (Clomid is a selective estrogen receptor modulator). The body responds to the perceived low estrogen levels by producing Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). High FSH stimulates the ovary to produce multiple egg follicles that are released during ovulation, which is stimulated at the appropriate time by the high LH.
One additional side effect of Clomid is twin and triplet pregnancies – can you figure out why?
In terms of mood, low estrogen levels classically cause feelings of depression, whereas high estrogen levels cause feels of anxiety. Some women are vulnerable to hormone fluctuations – the changes in hormone levels (rather than the levels themselves) lead to mood symptoms. Often these women suffer from severe PMS called PMDD (premenstrual dysphoric disorder). So, it makes sense that when Clomid tricks the body to believe hormone levels are fluctuating, it also causes moodiness, anxiety and depression for some but not all women.
What if I don’t conceive with Clomid?
Women who fail to conceive with Clomid often will then go onto IUI or IVF. The hormones and medications used in these treatments are not classically associated with mood changes. However, the process of undergoing fertility treatments is incredibly stressful and may cause feelings of anxiety and sadness, isolation and irritability. Waiting to know if a cycle was successful can be torture, and if it wasn’t, there is an understandable sense of failure (even though it is NOT your fault).
Women unfortunately often take on the responsibility as the identified ‘patient’ (regardless of the cause for the infertility), and shoulder the burden for the success or failure of the process. This commonly leads to anxiety and guilt about inability to conceive and pregnancy loss. But it’s imperative to remember that it is no more a your ‘fault’ or responsibility than your partners. Parenthood is a partnership and that partnership must be in full force during this process because doing it solo is so much harder than when done together. Don’t forget to keep lines of communication open and share your feelings while giving your partner the chance to do the same. He or she may also be having a myriad of emotions that deserve to be discussed and validated.
At the same time, try to find time to do things together that have nothing to do with getting pregnant. Plan little trips, date nights and excursions and focus on topics beyond conception. This tip holds for pregnancy and parenthood – you were partners first and it’s imperative you remain engaged as adults in addition to focusing on your interest in becoming and then being parents for the good of your relationship.
Don’t forget your friends
Despite how common infertility is, women paradoxically often feel very isolated while trying to conceive, mostly by their own doing. There is no shame in facing infertility and staying quiet during the process makes everything worse. If you open up, you will find that people will quickly share their stories and be incredibly supportive.
Be sure to plan dates with close friends during the two weeks of waiting to get you out of your head and out of your house – time moves faster when you’re out and about, enjoying life with people you love.
For some women, it becomes impossible to think of anything beyond the fertility process – it becomes all consuming in a very negative way. Sometimes, the sense of foreboding, sadness and anxiety are so overwhelming that it’s impossible to enjoy life. In these scenarios, seeking therapy and sometimes taking antidepressant/anti anxiety medicines can be incredibly helpful. Contrary to what many think, most medications used to treat depression and anxiety are considered safe when one is trying to conceive and during pregnancy. The possible risks of remaining untreated are often more significant than the potential risks from the medicines, and some even postulate that remaining super anxious and/or depressed can actually make getting pregnant harder (but that’s up for debate).
Unless you are fertile Myrtle, the journey to holding your baby in your arms is likely to be harder than anticipated. It’s ok if you’re stressed and it’s ok if you are feeling upset, anxious and angry sometimes – but these feelings don’t deserve to control your life. Yes, they’re normal emotions as anyone goes through this process, but you should still feel like you and should still be able to enjoy life. If negative feelings are taking over your day more often than not, than reach out for help. Therapy and sometimes medications can make a process that might feel at times like torture more manageable. You will get through this and will be a mom, one way or another. In the interim, you deserve to still find joy and live life while on your fertility journey.