NASW Social Work Talks - EP77: Infertility and Mental Health

Episode Date: December 8, 2021

Guest Steven Miller speaks with us about infertility and mental health. He holds a master's in psychology and is earning his MSW at the University of Wisconsin, Madison. He sits on the Mental Health Professional Group at the American Society of Reproductive Medicine (ASRM). See the show notes page for related resources.

This episode is sponsored by eSENSE, the world's most collaborative case management system. Welcome to Social Work Talks. My name is Greg Wright. Millions of Americans deal with infertility. According to the Centers for Disease Control, about 1 out of 10 women aged 15 to 49 have problems conceiving a child. And about 1 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, Stephen Miller, sits on the Mental Health Professional Group at the American Society of Reproductive Medicine. Stephen has a master's degree in psychology and is earning his master's in social work at the University of Wisconsin-Madison.

Stephen thinks that more social workers should be educated about infertility. Welcome to Social Work Talks. Thank you. How did you first become interested in the issue of infertility? My wife and I struggled for at least six or seven years with infertility ourselves and kind of felt blindsided, you know, by the diagnosis of male infertility. It's like, I had no clue what that was. And we kind of just went through, you know, just kind of 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, you know, the nearest person that knows about infertility, it's about, you know, an hour away. So when we're traveling five hours away, you know, 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 and and reproductive like mental health and there's a lot of stigma between you know for male infertility and just infertility in general along with mental health and i think mental health is getting better but there's still a lot of stigma between infertility i started thinking

about like you know like how how can i get involved with this field i just kind of went on Amazon to see like if are there any textbooks on this topic and the first one that came up was infertility counseling and it was by Sharon Covington and she's a licensed social worker through Shady Grove Fertility Clinics and she's like I think the director of all that and I just had emailed her and said you know do you have any advice in getting you know into this field and she kind of referred me to the American Society of Medical Medicine and their mental health group so i joined that in february of 2021 definitely was like the greatest thing i could do because like i'm meeting a lot of people through there there's a number of psychologists and social

workers that are involved from like all over um and actually just went to a conference in october the asr conference in baltimore and was just a tremendous learning experience so that's kind of how i really got into it because i really want to make it a big impact um and i felt like this was a great way to take my experience of infertility and journey through IVF and also knowing that my experience is not everybody's experience, but knowing that there's a need for it. Yes. So I'm wondering whether you are seeing in a lot of the curriculums that our social work schools, whether this is an issue that social workers are educated on at that level. i initially kind of thought about this when i when i had a class last semester and it was human

behavior and environment and like there was a nice section in the textbook there was a case study about it you know about infertility and how like the michael howe piece of it and like just the different like treatments and all that stuff and then there was a nice section like in the textbook but what i had noticed was when we got to that section it was never discussed they feel like this professor i mean did a great job with the class and what i highlighted is like hey what why are we not talking about this um and she did an awesome job of just like i shared a video with her um one of the ted talks and stuff and she posted it on our like our on canvas so the class could see it but yeah typically it's not talked about you know so it kind of got me thinking like

okay is this my experience or is this you know do other people have the same experience so i started kind of asking others in my like my full-time job you know when you were going through education you know education or in social work or you know like or count whatever field you're in and said you know like did you have any conversations about reproductive mental health or infertility mental health or even like reproductive loss like miscarriage or anything like that is there any talk about that and all of them said no like we haven't really had a discussion on it then i kind of started thinking further like okay well let me just do some exploratory stuff And I don't know if you're familiar with the social app Reddit, but I asked there, like, and there's a social work, like, subgroup in that app.

And I just kind of did a poll and asked the same question. I think there was 233 people that replied. And it's a mix between, like, current students, you know, people that have their MSWs and people that are licensed. 92.7% said no, that they have not had any discussion or class or anything. Is it an issue that it's a stigma still to talk about infertility? I absolutely think so. Everyone that I've talked to has always said like, oh, I know somebody that had a miscarriage or I know somebody that's struggling with infertility. Like I know somebody that was my, you know, my sister was a surrogate, but yeah, we're not talking about it.

You know, and really the only way to kind of reduce stigma is to talk about it. When people are looking for support for mental health, you know, regarding infertility, like they look at vitals for therapists and some of them will say grief, depression, anxiety. But I think people going through infertility doesn't necessarily associate that. Like they feel like infertility is like this really specialized thing. And I think it's even could be further stigmatized and just knowing that, oh, well, therapists aren't even talking about it or counselors or psychologists. You know, this must be something that we shouldn't talk about. What does a woman go through mentally when they are dealing with an infertility issue or a miscarriage? From what the research has, I mean, there's a lot of depression, anxiety, grief, grief of loss, of being able to conceive naturally.

You know, 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. you know like and even socially i mean you think about like how much is put on a woman to be like become a mother a lot of inadequate feelings um so when it doesn't happen they take kind of responsibility that's their fault you know their body it's body betrayal i mean you think about like all the shots they have to take too for like hormone shots and that really messes with emotions sylvia schneider fox she did a nice talk about like invisible grief and loss and i think we we think about grief as something tangible like if somebody was elderly like or the side of natural

causes you know like people think okay yeah you know you have grief that's something that we can see you know 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 also i mean i think that um women are like blamed for more and um i think about in history you know there was um a king um henry the like eighth and um he wanted um a son and so he married you know five or so wives and you know it was it was like always um a blame um on the women you know why aren't you making him an heir when in fact he might have been the one who like had um an issue that prevented that historically yes i mean i think people feel like that is a woman's issue i mean even if you think about

the research there is more research on women and reproductive health than there is for men and reproductive health and part of that may come down to like the historical context of this being passed along is that oh this is a woman's issue it's just not that's nothing to do with men when in fact you know 40 to 50 percent of the time like it is due to male factor a male also has um a mental health issue um what does a male experience when they um are realizing that they have um an infertility issue or they're like mate um a partner who they are trying to conceive with might have this issue i think it's hard for a man you know to see like his significant other like to see them struggle you know like to struggle with this you

know like and knowing that you know they have this diagnosis and trying to come to kind of acceptance of that and 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 kind of put that to the side to be kind of that solid rock and foundation like 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 like they see that their wives like they want something better for them i don't know like times where i'm like you know what why don't you just leave me yeah like leave me find somebody where you can have a child you know like i know you want to have a child so it's almost like self-sacrificing i also like you know

thoughts about like my family tree right i'm like if like if i don't have children then like my family tree kind of ends you know so it's almost like i said the existential like what does this look like for me like if i don't have children because like you said the expectation is we have you know like we you get married you have kids you know i mean it doesn't happen it's it's a struggle you know like yeah we're just like neglecting our own feelings just you know because we don't want to be burdensome you know like we already see our same color struggling and if we're struggling too we don't want to be burdensome like we don't want to put more on them like i have to worry about so we kind of just keep it in and men are going through grief as well

You know, men have ideas of what their life would be like when it changes out to be different. I mean, the partner could be in two different spots in the grief process. And how do you manage that? You know, like, and that's a difficult thing to manage. And I know that there was research in Denmark that, you know, 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. collaborate. eSins gives you the tools to provide the best support possible, and you can get it for free. Apply at eSins.com slash NASW. That's e-c-i-n-s dot com slash NASW.

How can a social worker help? 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 like if they're asked when we think about like suicide we ask the questions you know and some of us are like are fearful like oh well if we ask the question like they're gonna need to think about it but if we don't ask the question like they're not going to bring it up you know and i think that's the same thing with fertility you know like with infertility or even miscarriage um i think it

just gives a greater you know bigger picture of like what their life is like adoptive parent i mean i think infertility also goes with you know even foster care and adoption you know they say you know for adoptive parents their adoptive parents are 10 times more likely to have experience infertility or have undergone fertility treatments than those that have not. 39% of foster care parents said their motivation to do foster care or be a foster parent was due to infertility. Infertility itself, I mean, just doesn't affect the individual. I mean, you think about parenting, like how does this really impact a person? Just because, I mean, in 1993, it was Alice Domar, and there was another guy that had done research and they compared

psychological distress amongst cancer patients. It was like HIV positive, infertility, and then I think like a heart attack or cardiac arrest or something like that. And 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 like a cancer diagnosis you know because i mean it is a tough thing when you're getting constant reminders of it you know like if you're out in public and you see you know another family of children it's a reminder of you know something that you you know you don't have you know or when you hear baby announcements you know 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 like what i don't have so it's kind of like figuring out like how do i balance that how do i accept where i'm at right now like you know micro level i think of us you know providing us some mental health support let's talk about in the academic setting right let's let's give people knowledge and awareness of these issues whether it'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 Only 17 states, like, have mandated infertility insurance coverage. I mean, the average cost for IVF, including, like, meds and, like, just the different cycles and all that, is about $38,000.

So, I mean, there's a lot of legislative, you know, and policies and different things, you know, that at a macro level self-workers could assist with as well. What are some self-care activities that a person who is dealing with infertility can adopt? i mean i think reaching out to other people um i know like resolve has like some peer support groups not everybody's into groups but i mean resolve does a great job of and a lot of them are virtual now um i think all of them are at this point so there's like peer support groups you know so sometimes it's very helpful to like have you know a group and there are like some that are just specifically for men and like and women and there's you know peer support groups for couples and really just you know having a therapist highlight you know like when you've

gone through a tough time before like what are the things that you used to do you know like so i mean some people like gone for walks and go to nature like they may go see a movie they might hang out with friends you know like and i know like for me personally i think the biggest thing for me was when friends that were couples like would invite us over or go you know have us come to dinner like and it's just the four of us like there's no kids you know i think that is super helpful for anybody that knows somebody going through this and it's okay to not have the words to you know give them support and you can say like you know i i don't know what to say and i think just being there you know support has been helpful do you um advise people who

are dealing with infertility to be open with others or is it really just like a private thing that you know you should only share with like a few friends family members my feeling is is be open about it isolation can even just increase depression you know if you're doing ivf and you're not successful yeah like and like the more like the more times you try and the more times that you're not successful like there's research that says like there's more likelihood to be 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 like knowing that you're not the only one going through it is super helpful like i know like there's a lot of facebook groups

out there that just provide kind of that support for me personally and just being open about it i mean i even have a car bag on my bumper you know that talks about national infertility awareness we who knows who will look at it you know a lot of people look at a bumper sticker like or car magnet like oh what is that and it's still providing information i was just like wondering if you want to tell uh the folks here like more about what resolve is yeah so resolve is the the national like infertility like non-profit so they do a lot of work with doing like peer support groups as well as a lot of advocacy for different like laws and trying to get mandated coverage you know for every state instead you know like instead of just the 17 um also working

on like trying to get insurance coverage at work really a plethora of knowledge along with um asrm you know like they have a plethora of knowledge of like infertility you know they have videos and different things about facts versus fiction about fertility myths um i think a common one is this like oh well you put you know like when you're less stressed it'll happen and that's not always the case but and resolve also has like a good directory of if you need you know mental health support you know finding somebody there but you can also access people that from the the mental health professional group, there's a directory to kind of see where people are and see if there's anybody in their state that could provide help.

Are there some resources out there that you recommend that social workers look into on the issue of infertility? Yeah, absolutely. So the mental health professional group has a webpage, but they have a lot of knowledge on there on the articles some recent current research videos kind of webinars that would pique people's interest about like mental health and infertility so that would be a great start they have a bibliography like um to give more information on different topics within the infertility world on reproductive mental health and then i mean resolve and then american society

reproductive medicine they have that's a great website to get like 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. And I also do have, through the School of Social Work at UW Madison, we are going to have a webinar series in February on perspective on infertility and mental health. So there's going to be three talks, one from Dr. Bill Pitak 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 Flores-Lock. She's out of Nyack College in New Jersey, and she's doing a talk on the female perspective of infertility mental health. And then we have one of our

own professors, Jean Ferguson, and one of the clinic directors from Wisconsin Children's Institute, Brie McKellar, that are doing a talk on third-party reproduction and surrogacy and mental health. It's an emerging field, you know, like, and I think that, you know, I wish more and more people kind of getting involved in understanding of this. Yes, absolutely. I thank you for this interview. No problem. I appreciate the opportunity to speak about this.

Absolutely. Thanks for being here. No problem. 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.

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