A THIMBLE OF HOPE: SURVIVING THE DREADED TWO-WEEK WAIT by Judith Daniluk, Ph.D. and Emily Koert, M.A. - SUMMER 2011

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A THIMBLE OF HOPE: SURVIVING THE DREADED TWO-WEEK WAIT

by Judith Daniluk, Ph.D. and Emily Koert, M.A.

“Yesterday was a very bad day, but then I reminded myself that implantation takes from 6 to 12 days and I might not have enough HCG in my system to show up yet… A very fine thread to grasp while holding a thimble of hope.”

The dreaded two-week wait – commonly called 2WW in online chat rooms and fertility support groups – has been identified as one of the most, if not the most, stressful part of the treatment process, whether one is undergoing IUI, IVF, or ICSI. After the stress of repeated tests and injections, and the distress of baring your body and sexual relationship to public scrutiny, you are then faced with the torture of two weeks of not knowing whether you are going to be one of the lucky ones who beat the odds and end up with a viable pregnancy.
 
“I’m a mess and truly feel like I am losing my mind.” This period between implantation and awaiting treatment outcome is notorious for pushing women and couples to heights of anxiety. Women have described how they can drive themselves crazy interpreting symptoms such as breast tenderness, tiredness, and nausea as hopeful indications of a viable pregnancy. These thimbles of hope help women and their partners cope during the waiting period. Unfortunately, the cruel trick of nature is that premenstrual symptoms can mimic the signs of early pregnancy.

With IVF and ICSI, the stress can be even greater because the transfer of embryos brings the woman one step closer to an actual pregnancy, but also increases her sense of accountability for the outcome. For this reason, women often try to make themselves the “perfect vessel” for the embryo through strategies such as taking a leave from work, reducing or eliminating all exercise, or refraining from forbidden foods or negative thoughts.

However, there is little conclusive evidence to suggest that strategies such as positive thinking and stress management can significantly increase the chances of success. In fact, in a recent review of 14 studies of 3583 infertile women undergoing fertility treatment, Dr. Jacky Boivin and her colleagues at Cardiff University found no significant relationship between a woman’s level of stress and her chances of a successful pregnancy.1 In contrast, there is evidence that women become pregnant even under extreme stress (for example, during sexual assaults). This should reassure women and their partners that despite the stress they inevitably feel during the waiting period, a pregnancy is still possible.

In fact, after the doctors and medical scientists have done all they can, there is little influence you or your partner actually have over the outcome of treatment. Eating good foods and thinking good thoughts will likely go a long way towards keeping you sane during the wait, but this isn’t likely to affect whether or not you get pregnant. Nevertheless, you can exercise some control over how you cope during the 2WW.

The following tips for staying sane are not a “one size fits all” method. Each person finds comfort through different strategies. This can be particularly challenging if you and your partner have different reactions to treatments and different ways of coping with stress. For example, it is not uncommon for one partner to hold back emotionally to protect him or herself from more disappointment if treatment fails, while the other member of the couple is more optimistic. These contrasting approaches can place some strain on the relationship, especially if one partner interprets the other’s caution as a lack of commitment to having children. But if viewed without interpretation or judgment, these differences can also offer a good balance of cautious optimism.

Ultimately, the strategies most likely to work for you are the ones that fit with your beliefs, personality (e.g. the tendency to see the cup half full vs. half empty), and typical coping style. Below are some suggestions to help you get through the two-week wait.

Strategies for staying sane during the 2WW

Let the past inform the present. Think back to a very challenging situation with which you feel you coped well and ask yourself, “what got me though this challenge?” This may help you identify strategies to deal with the present situation.

Stay active. Force yourself to stay busy to keep your mind off your body and your fertility. If you stop your life, you’ll end up focusing on the clock, the calendar, and every twitch or sensation in your body. If your work isn’t too stressful, then keep working. If it is, do other things that will help you keep your mind occupied. Get creative: read trashy novels, watch movies that you enjoy and don’t depress you, go shopping, cook an elaborate meal, or do calming visualizations – whatever distracts you from worrying and helps pass the time.

Just breathe. When you’re anxious and stressed, slow, calming breaths can help you feel better physiologically and emotionally. Mind/body techniques can increase your sense of control and decrease symptoms of stress related to infertility. In her book, Conquering Infertility, Dr. Alice Domar offers a detailed self-help guide to mind/body relaxation techniques such as yoga, meditation, journal writing, and guided imagery to cope with the stress of infertility, feelings of failure, and envy of women who are mothers. Simple techniques such as paying attention to and slowing down your breathing can calm your nerves and help you cope with the intensity of the waiting period.

Be kind to yourself. Pamper yourself with indulgences such as manicures, pedicures, facials, massage, fancy dinners, or sweet treats. This isn’t the time to be worried about your weight or to be self-critical. After months or years of dealing with infertility and medical treatment, you’re likely not feeling very good about your body – so think about using this time to nurture it. After all, if treatment is successful, your body will be carrying and nurturing your child. Do some light exercise such as walking or yoga, try to eat well and get sleep when you need it, even if that means napping during the day.

Practice forgiveness.  You need to forgive yourself for acting or thinking in ways you said or hoped you wouldn’t. The same applies to your partner who isn’t perfect either – who may not seem bothered by the wait or who says something completely insensitive that reduces you to a puddle of tears. You can’t expect to be 100 percent supportive of each other all the time. Remember that you’re in this together and you’re both invested in the outcome – so you need to cut each other some slack during this very challenging time. Male partners may find it useful to read What He Can Expect, When She’s Not Expecting – a new book by Mark Sedaka with some great suggestions on what to, and what not to say to your partner when you’re dealing with infertility and medical treatments.

Maintain your boundaries. If it is too painful, give yourself permission to stay away at this time from people who ask too many questions, upset or may upset you, expect too much from you, are pregnant, or have babies or young children. Think of it as having a doctor’s note relieving you from attending any baby- or child-related events.

Reach out for support. Identify your sources of support and reach out to them (partner, friend, sister, minister). You may find it useful to contact other infertile women through support groups or online blogs (e.g. ivfconnections.com; fertilethoughts.com). Some women even have “cycle buddies” who help through the ups and downs of treatment cycles.

Do volunteer work. Some people find that the best way to distract themselves from their own concerns is to do something for someone else – walking dogs at the SPCA, volunteering at a downtown soup kitchen, getting involved at church, or spending time with elderly people at a care home. Ideally, any activities that involve young children or babies should be avoided because they can be painful reminders of your current situation. If volunteering isn’t your thing – that’s fine too. It just may be too hard to muster the energy to give of your time to others when you’re feeling like your resources are already depleted.

Rely on faith/prayer/spirituality. Whatever your beliefs (a traditional religion, a belief in some higher power or karma, or a connection to nature), nurture this aspect of your life. You may do this through prayer, spiritual or inspirational literature, spending time in nature, or attending spiritual/religious gatherings. It is not unusual to find oneself making promises in exchange for a successful treatment outcome, as in the case of the following woman during her 2WW: “I'm not a religious person, nor do I have a strong belief in God, but I find myself asking the universe to give this to me and in exchange I will try very hard to give them back a really great human being.”

Have a Plan “B”.  If you and your partner need to know that you are committed to pursuing other options if this treatment cycle isn’t successful, then by all means make a plan “B” before you begin the 2WW. This might include another treatment cycle, third party reproduction, or adoption. Having a back-up plan may take some of the pressure off the current cycle and give you some comfort in knowing that, one way or another, you are committed to becoming parents. However, some people find they cannot entertain other options if this cycle fails for fear that they will “jinx” it, and that’s OK too.

Cultivate humour. When faced with such a life-altering outcome and after the distress of fertility investigations and treatment, it can be difficult to find anything to be happy about or to see the humour in anything. However, humour can be great therapy. A recent study conducted in Israel by Shevach Friedler and colleagues suggests a bit of humour may even improve pregnancy rates after IVF.2 Make a point of doing things that make you laugh and bring you joy such as watching funny movies or watching tapes of your favourite comedian. Whatever tickles your funny bone, laughter can lighten your mood and serve as a good distraction from your thoughts.

Seek professional help if you need it. If you are feeling overwhelmed with anxiety or negative thoughts, don’t struggle in isolation. Professionals can help by lending a listening ear, validating and normalizing your concerns, and helping you to develop coping strategies. Most fertility clinics have a list of trained counsellors they can recommend. You might also check with the counselling special interest group of the Canadian Fertility and Andrology Society for the names of members in your area. Local and national support groups can also be a resource for information on counsellors with expertise and training in infertility.

Celebrate your successes. Unfortunately, it’s impossible to fast-forward two weeks into the future. Accept the fact that you will be riding on a roller coaster of emotions. That’s to be expected. The stakes are high. So do what you can to stay sane and grounded and celebrate your small successes (“I got through the day without crying”). During the dreaded two-week wait, fill your thimble of hope with one certainty – eventually you will have your answers and be able to get on with your life.

Suggested Resources

Daniluk, J. (2001). The infertility survival guide: Everything you need to know to cope with the challenges while maintaining your sanity, dignity, and relationships.

Domar, A. D. (2004). Conquering infertility: Dr. Alice Domar’s mind/body guide to
enhancing fertility and coping with infertility.

Indichova, J. (2001). Inconceivable: A woman’s triumph over despair and statistics.

Sedaka, M. (2011). What he can expect when she's not expecting: How to
support your wife, save your marriage, and conquer infertility!

References

1Boivin, J., Griffiths, E., & Venetis, C.A. (2011). Emotional distress in infertile women and failure of assisted reproductive technologies: Meta-analysis of prospective psychosocial studies. British Medical Journal, BMJ 342:doi:10.1136/bmj.d223.

2Friedler, S., Glasser, S., Azani, L., Freedman, L. S., Raziel, A., Strassburger, D., Ron-El, R., Lerner-Geva, L. (2011). Laughter may be the best medicine to achieve pregnancy after IVF. Fertility and Sterility. Advance online publication. doi:10.1016/j.fertnstert.2010.12.016.

About the authors
Judith Daniluk, Ph.D., is a professor of Counselling Psychology at the University of British Columbia. Her areas of clinical and research expertise include women’s sexuality and reproductive health and the psychosocial consequences of infertility. As well as contributing extensively to the clinical and scholarly literature, Judith is the author of Women’s Sexuality Across the Lifespan: Challenging Myths, Creating Meanings and The Infertility Survival Guide: How to Cope with the Challenges While Maintaining your Sanity, Dignity and Relationships.

Emily Koert, M.A. is a doctoral student in Counselling Psychology at the University of British Columbia. Her area of interest and specialization is in women’s reproductive health. She is currently working on her dissertation research on women’s experiences of permanent, unintentional childlessness after delayed childbearing.