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Thoughts on Spiritual Beliefs Affecting IVF

a blog by Traci Shahan, RN, WHNP-BC, Doctor of Nursing, Albrecht Women’s Care Denver IVF, February 13, 2012

I begin this blog with misgivings.

I intended to write about my professional experience helping patients navigate what is often a challenging life passage, sometimes a nadir, for some even a pivotal life experience — fertility treatment. I have ruminated for years — actually since 1996 — about the underpinnings of how, if and when a patient’s spiritual beliefs may affect fertility treatment and outcome. In 1997, I set out to pen my final doctoral paper about how spirituality affects fertility rates. My study design was poor, so I bagged it, took the easy way out, then wrote a few boring pages about the efficacy of a highly vaunted gonadotropin, quite in vogue at the time, which has long ceased to be available on American soil. Until now, I never got around to writing about matters of the spirit and fertility, although not a professional day has passed that it hasn’t crossed my mind. I work in a field that would rather skirt the issue entirely. What finally caused me to write about this issue was a call from a teary IVF patient last week who confided in me that she did not think she was pious enough to conceive because a friend had told her that if she simply prayed more that her AMH would go up, her FSH down, and she would conceive on her own without need of medical intervention. To me, this remark falls directly into the rubric of using religion and matters of the spirit to inflict pain. (I did recommend that she re-evaluate this friendship.)

Full disclosure: I am a current seminary student, I have lived within 35 miles of the small city that we natives fondly refer to as The People’s Republic of Boulder most of my life — a hotbed of New Agers and persons who espouse Eastern religious beliefs — and I grew up going to church most Sundays. Too, I was a fertility patient for longer than what seemed fair, resulting in my going through IVF one time, successfully. I am pretty well-versed in most world religions and spiritual paths, but I will forgo talking about religion per se. The goal of this blog is to simply communicate my observations in the hope that they might ease the path, conscience or mind of those of you wishing for a baby who find yourself trying to make sense of it all. In no way will this short blog answer all questions, and perhaps it could even raise some; however, if it can help one person, then it will have merited my struggle to write it.

Over the years, especially working with those patients who are veterans — say, in fertility treatment for longer than 18 months with no baby to show for it — many, if not most times, it has been my experience that patients find a way to communicate spiritual distress to me. By spiritual distress, I mean a patient who feels guilty or inadequate, or one who experiences cognitive dissonance and wonders if her past behavior, say, having had an abortion in college or stealing a comic book in grade school, earned her some kind of bad ju ju. Often she questions whether a higher being is punishing her, exacting revenge for past actions, resulting in her being infertile. As Anne Lamott so aptly describes such a feeling, which I have paraphrased poorly here, a bony index finger from the sky, pointing you out, menacingly, with the sinking feeling that you have done something wrong or bad and that you will be disciplined for said act — spiritual revenge.

I have read many volumes about spirituality, morality, physical disease, including fatal diagnoses, and the delayed ability or inability to conceive and bear a child. I have made my way through various reports on the utility and outcome of different types of prayer; for example, double-blinded intercessory prayer and its effects on terminally ill patients. I completed an externship with Dean Ornish, M.D., during a week-long retreat for patients with end-stage heart disease with one of the aims of the retreat to teach patients how to unwind and unplug, in part by implementing spiritual practices such as traditional yoga and meditation. Patients also participated in talk and group therapy. It was a satisfying experience, and I like to think we improved some patients’ lives.

While I was undergoing fertility treatment, I could not shake the feeling that my reproductive challenges and fetal losses, never mind the delayed ability to conceive, were somehow my fault. It is not by accident that I felt this way. We live a society that is predicated on theories of cause and effect, empiricism, reductionism and oftentimes a very elemental binary world view, courtesy of long dead thinkers such as Sir Francis Bacon and Rene DesCartes. Plus it feels satisfying to have an answer. Truth is many patients and I would rather have an answer that fingers our behavior as subpar instead of considering that life may very well contain random elements and occurrences like reduced ovarian reserve or a chromosomally flawed fetus. Many of us feel safe within the arms of a formulaic understanding of the world and our existence, whether the Pythagorean theorem or the axiom, If I am a good person and seed good in the world, this will be returned to me and I will have a pretty terrific life. Viktor Frankl addressed this need to make meaning out suffering in his seminal work, Man’s Search for Meaning.

By the time we made it to IVF, I was spent in every way, but most of all emotionally. I took no chances. I had my meds triple-checked by two nurses, kept our cycle a secret from everyone thinking that I would “fail” again, read everything that I could, and finally, in an act that I pity now, I asked our pastor to come to the transfer to bless the embryos. I figured it couldn’t hurt to have a man of the cloth present, and although Pastor Don didn’t bat an eye at this deviation from his standard clerical duties, the fastidious embryologist’s face betrayed his bewilderment. Honestly I don’t think he could have been more surprised if I had ushered a herd of goats past his microscopes and incubators. He sequestered himself behind his sliding office door, only to be seen again at the moment of transfer.

Do I think Pastor Don’s presence helped? No. The pregnancy was fraught with problems and culminated in a delivery just this side of disastrous. Too, I had a gravely ill baby for weeks after the emergency C-Section.

The question that I ask myself often is: do I see a reliable correlation in patients who confide their spiritual beliefs in me and their likelihood of pregnancy? The truth is that I do not see a correlation. As frequently as a pious patient prays and “toes the line,” and does not get pregnant, I interact with those who voice no spiritual or religious beliefs and becomes pregnant. Medical treatment is the only reliable correlation with pregnancy in our patients.

I will end with this observation: patients who have a network of friends, family and a faith community seem to be more resilient and to accept bad news more easily than those who feel alone.

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