Is this therapy area one that IVF clinics should offer?
The relationship between stress and infertility is established, even if it may not be a primary factor. But even without a primary association, stress is unpleasant and hardly conducive to creating the optimum environment for assisted reproductive technology (ART).
However, one of the problems with ART is the stress of trying to conceive builds on the patients’ pre-existing stress of not getting pregnant!
With this in mind it is clearly desirable to reduce stress for patients. We’ve already discussed counselling and psychotherapy as complimenting ART. These are often offered as in-house services by many IVF clinics.
But what about stress reduction services that can be associated with IVF treatment?
These are not necessarily provided within the clinic itself.
Hypnotherapy, provided by reputable therapists, may be a viable evidence-based option worth considering. And a professional relationship between an IVF clinic and a hypnotherapist could be beneficial to patients. Especially if counselling alone isn’t providing a remedy to the stress they are experiencing.
What is hypnosis?
Hypnosis is a normal state of consciousness. It can be defined as directed daydreaming. A person in hypnosis not asleep and is aware of his/her surroundings in a detached sort of way. This makes the mind more receptive to what it feels are acceptable suggestions.
The purpose of hypnosis is to bypass the critical faculty of the conscious mind allowing access to the subconscious. This is where the aforementioned acceptable suggestions are implanted. There are many ways to induce hypnosis, known as hypnotic induction. It goes without saying that induction should only be undertaken by a qualified, reputable hypnotherapist.
How effective is hypnotherapy in the ART setting?
It definitely works, and there are two areas that highlight this!
Effectiveness in the clinic setting
A 2004 study presented at the European Society of Human Reproduction and Embryology Congress concluded that hypnosis can double the success of IVF treatments1.
Conducted by Professor Eliahu Levitas, Soroka Hospital, Israel, the study of 185 woman undergoing embryo transfer during IVF found that:
- 28% of the women in the hypnosis group became pregnant
- 14% of the women in the control group became pregnant
This study suggests that the use of hypnosis during embryo transfer may significantly increase implantation and clinical pregnancy rates. The investigators also found that patients’ attitude to the treatment was highly favourable. This was probably due to the gentle approach and the fact that it is non-invasive.
Effectiveness outside of the clinical setting
There have been no large-scale studies in this area, but anecdotal evidence suggests that a positive effect might be expected2. Obviously, research is required to demonstrate this. A simple hypothesis suggests that infertility may be exacerbated by stress and that hypnotherapy alleviates stress.
Some psychology experts believe that the psychological issues surrounding pregnancy are not sufficiently well addressed for many women with fertility problems. Hypnosis, in future may play a larger role in addressing these problems.
There is some evidence for this. Studies conducted by Dr. Alice Domar, Research Director, Beth Israel Deaconess Behavioural Medicine Program for Infertility, Boston, supports this hypothesis. Her work shows that unresolved issues about having a baby can potentially be removed with counselling and mind/body techniques such as hypnosis3.
What do the patients think?
To get some idea of this I spoke to a New York based hypnotherapist, who specialises in female issues.
Do you think that psychological issues may be behind some fertility problems in women?
“I think that it is possible, particularly where previous emotional trauma exists such as PTSD. However, I think that stress itself may play a bigger part in the general population of infertile women. I treat it as a stress problem first.”
And how do patients respond?
“They respond well. Stress is nasty, no matter what your external problems are. So, it’s good to alleviate it. And hypnosis DOES work. The evidence is there, in a way that it is not for some other holistic treatments. Although I believe all therapies help to reduce stress. Hypnosis is a pleasant state to be in. There is no bitter pill or worse, an addictive pill or one with horrid side effects to worry about. In some ways it is the ultimate me time experience. I’ve never known anyone get phobic about a visit to the hypnotist!”
The evidence is strong for success in health-related issues
- In one study, researchers tested the effectiveness of a 15-minute pre-surgery hypnosis session versus an empathic listening session in a clinical trial with 200 breast cancer patients. They reported that patients in the hypnosis group reported less post-surgical pain, nausea, fatigue and discomfort than those in the listening group.4
- A University of Washington Medical School trial found that hypnosis before wound debridement significantly reduced pain reported by burns patients on one pain rating questionnaire5
- Hypnosis is widely used in the area of natural childbirth. One significant study showed that prenatal hypnosis preparation resulted in significantly less use of sedatives, analgesia, and regional anaesthesia during labour and in higher 1-minute neonatal Apgar scores6
So, what’s not to like about hypnotherapy?
Not a lot, apparently!
Our hypnotherapist concluded, “It is entirely in line with the Hippocratic Oath: ‘First do no harm’! Secondly, it works. And, thirdly, it is cost effective when compared to medications. Downsides are rare, but some people are resistant. Usually this can be overcome, but it might take more time than the patient has to spare. Also, some hypnotherapists, particularly those without a formal background in psychology are reluctant to treat patients where there are underlying serious emotional disturbances or mental problems such as PTSD. With those patients it is better that they are referred back to counselling and their medical professional team before rushing headlong into hypnotherapy. Whichever country you are in, make sure they’ve got the qualifications, the experience and that they are current members of a professional and established organisation that has a good reputation to protect.”
It seems like IVF clinics have a good incentive to recommend hypnotherapy as a compliment to counselling
For certain patients who are experiencing stress or emotional difficulties, but for whom drug treatment or other holistic treatments may not be appropriate.
With that in mind, where clinics wish to establish a working relationship with professional hypnotherapists, they should ensure that the proper qualifications and experience are in place.
Neil Madden, Editor
The Fertility Hub
References
- Levitas E1, Parmet A, Lunenfeld E, Bentov Y, Burstein E, Friger M, Potashnik G. 2006, Impact of hypnosis during embryo transfer on the outcome of in vitro fertilization-embryo transfer: a case-control study. Fertil Steril. 2006 May; 85 (5): 1404-8
- Watkins, Anne. Hypnotherapy: The forgotten treatment option for infertility. British Society for Clinical Hypnosis. https://www.bsch.org.uk/infertility.html. Accessed March 2020
- Domar A, Rooney KL. 2018. The relationship between stress and infertility. Dialogues Clin Neurosci. 2018 Mar; 20(1): 41-47
- Montgomery GH, et al. 2007. A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. J Natl Cancer Inst. 2007. Sep 5; 99(17): 1304-12
- Shelley Wiechman Askay, David R. Patterson, et al. 2007. A Randomized Controlled Trial of Hypnosis for Burn Wound Care. Rehabilitation Psychology. August 2007. 52(3): 247-25
- Vandevusse L, Irland J, Healthcare WF, Berner MA, Fuller S, Adams D. 2007. Hypnosis for childbirth: a retrospective comparative analysis of outcomes in one obstetrician’s practice. Am J Clin Hypn. 2007; 50(2): 109-19
