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A Day in the Life of a Fertility Counsellor

by Wendy Martin

Bristol Centre for Reproductive Medicine

I originally became a specialist fertility therapist in 1996 when I worked for CRM “The Centre for Reproductive Medicine” in Bristol.

Since then, CRM is now BCRM and over the years I’ve gained an enormous amount of experience and expertise in counselling people who are going through every kind of infertility issue and treatment.

BCRM prides itself on the care it gives its patients and so the clinic offers a confidential and independent ‘Patient Support Service’ before, during and after treatment. This service provides the chance to talk through what’s happening to you. It gives an opportunity for you to not only understand and process your emotions but also to think about ways to cope with any difficulties you and your partner may be experiencing due to fertility issues.

Counselling at BCRM is free and the clinic offers one initial complementary ‘Patient Support’ appointment to every patient, prior to starting any treatment. Thereafter, if you’re an NHS patient you can have one complementary session for every cycle of treatment; and if you’re a self-funding patient, you can have three complementary sessions for every treatment cycle. Further appointments can be made but there is a charge.

These appointments can be booked either with me on Tuesdays, Wednesdays and Fridays or with my colleague, Francine Blanchet, on Thursdays.

A Typical Day

I normally have five appointments in a day but my work can also include attending various meetings such as a Multi-Disciplinary Team meeting, a BCRM Full Team meeting and a Senior Team meeting.

Many people have family and friends who they turn to at difficult times, and so frequently the people I see have never sought counselling or emotional support before. For the first time in their lives perhaps, they find themselves in a situation when their normal sources of support are not quite enough. Often many of their good, close friends are having babies and it’s hard to turn to them to discuss their fertility problems. That’s where the Patient Support Service can come in.

I know patients can experience some anxiety at having to reach out for help. However, even though what’s being discussed may be emotionally challenging and hard, and talking about your innermost feelings with a stranger may seem daunting, I do my best to create a comfortable and easy atmosphere, which allows people to talk freely.

Patient Support is not all about managing grief and loss, rather it’s about finding the best ways to go through what is, for many, the most challenging time of their lives. During counselling sessions, I try to help people find their inner strengths and rediscover the coping strategies they have used in the past to enable them to navigate difficult times. These can be drawn upon to assist them in finding their way through what can be a fairly stressful experience. I try to foster a sense of hope balanced with reality, so that people can develop an understanding of what they can control in their lives – and therefore what they can do to help themselves during the process. However, I also try and enable people to recognise those things they have little or no control over and to help them accept that they may not have as much control over making a baby as they had hoped. I recognise this is not easy for them.

The tools and techniques I offer

It’s normal to feel a little anxious or stressed when undergoing fertility treatment, and although it’s a very commonly held belief that stress directly impacts fertility, there is very clear scientific evidence to show that stress does not actually make any difference to IVF or ICSI treatment outcomes (see ‘Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies’ J Boivin, E Griffiths, C A Venetis 2011 British Medical Journal (BMJ) 342).

Nonetheless, BCRM realises it’s important that patients try to remain as calm as possible whilst going through their treatment, not only because it makes it more manageable for them, but also because for some, the journey may be longer than anticipated or hoped for. Also, if patients find it all too stressful, they may give up sooner than they would otherwise do – and consequently won’t have given themselves the best chance to succeed

Although reducing stress and anxiety is easier said than done, most people are aware of what might help them take care of their mental health and lead to a better frame of mind. These things can include reflexology, meditation, moderate exercise like yoga and walking, massage, acupuncture and so on.

In terms of what I offer in the course of my work, I have been trained to help people with the following tools and strategies:

Who might I see in the course of my work?

Throughout my day I can see a wide range of patients for a variety of issues. The following are some examples:

• A 34-year-old woman who is at the start of her two-week wait. She’s had a good quality embryo transferred but is extremely anxious and unsure of how she’s going to cope over the next few days with the overwhelming feelings she’s experiencing. She has gone back to work after taking a day off following her embryo transfer but is finding it hard to concentrate and focus. We discuss ways in which she might be able reduce the demands made on her over the next couple of weeks and she decides to speak to her manager who is supportive and understanding. I ask her what she normally does to reduce anxiety and if she has anything planned to help her get through this highly challenging time. She and her partner are taking a short walk together every evening after work and they have something nice planned for the weekend. I ask her if she’s ever done any meditation as many people say it benefits them a lot – even if it is only ten minutes a day. She says she hasn’t, so I mention the ‘Mindful IVF’ and ‘Headspace’ apps which people say help calm their racing thoughts. We agree that any form or distraction is good – be it watching box sets, listening to music or doing something creative. She also has one good friend who does not have children who she is going to speak to a bit more during this difficult time.

• A couple who are about to start IVF. They thought it would be helpful to get some support for themselves prior to embarking on the treatment. I explore with them their feelings and thoughts about the upcoming treatment and they express their hopes that this is going to finally work out for them after two years of trying unsuccessfully. I discuss with them their expectations and how they imagine the treatment will go. They also voice their concerns about doing the injections, the

impact the hormones may have on her general wellbeing and whether it might affect her mood and, in turn, their relationship. We discuss this and find ways in which they can keep lines of communication open between them to maximise the support they give each other.

• A 29-year-old woman whose husband has just been informed he has very low sperm parameters. She is shocked to hear that they’ll need ICSI treatment in order to conceive and is devastated that they’ll never be able to have a baby naturally. Needing medical intervention to get pregnant seems so unnatural to her and it’s nothing like she’d ever imagined would happen. We spend some time looking at her sense of grief and loss – but also to see what resources she has (both within her and around her) to help her get through this difficult time.

• A couple, 35 and 37, who have recently discovered their first blastocyst transfer has not been successful and who find they are not dealing with it in the same way at all. As I help them talk it through, they come to understand that there are differences in the way they are each reacting to this event. I discuss with them how people respond in different ways. As they listen to their partner tell me what they’re going through and how they’re responding, they each become more able to accept their partner’s perspective and are better able to support each other.

• A 40-year-old single woman who has decided to try for a baby as a solo mum using donor sperm. I discuss with her the emotional and ethical implications of having a baby this way. We explore the resources and support she has as she embarks on this exciting but challenging journey. I mention ‘The Stork and I’ and “The Donor Conception Network”.

• A 22-year-old woman that has put herself forward to be an egg donor. I ask her why she has decided to donate her eggs and what she feels about any future children being able to contact her as adults. She is very clear she is not the mother of any child born but is very happy and open to communication with them in the future – should they ever want it.

• A 38-year-old woman who has had IVF with her husband owing to a diagnosis of a low egg reserve. The news had shocked her as she’d been confident that getting pregnant naturally in her later thirties would pose no problem. The fact that the embryo transfer was then unsuccessful has exacerbated her disbelief and grief. She was convinced that she had done everything right – with improved diet, cutting out coffee and alcohol and taking supplements. They had both made considerable sacrifices and changes to their lifestyles and yet it still hadn’t worked. I explore her sense of needing to be in control in a world where she feels at times quite out of control and we look at aspects of her life over which she which she can exert some control.

• A couple who are dismayed that their ICSI cycle has been unsuccessful. She is 32 and they’ve had ICSI because of a sperm issue. They’d had a negative test the day before and they’re shocked. They tell me that everything had gone so well during the treatment and everyone had been so positive. The embryo was top quality and they’d assumed it would definitely work. There was no reason why it shouldn’t. He had been so positive and optimistic and had been absolutely sure she was pregnant. He is now quite angry that nobody prepared them for the fact that, even if everything goes really well during the treatment and a high-quality embryo is transferred, this is still no guarantee of pregnancy. He is afraid that none of the other three frozen blastocysts will work as the first was the best one they had. I listen to their shock, concerns and distress and their fears for the future.

On discussing this with them it appears they hadn’t grasped that, on average, someone of her age has a 50% chance of success in any given embryo transfer – even if it is of high quality. We also look at how the result of one embryo transfer has no bearing on the outcome of the next, and that even a low-quality embryo can result in pregnancy. We also talk about how they may better manage their hopes and expectations for their next embryo transfer whilst still keeping positive and hopeful that it could happen next time. I then sensitively explore with him how he feels about the fact that the reason for the treatment is because of his sperm motility and morphology. I tentatively wonder if his anger may have something to do with this. He agrees and says he feel terrible that his young wife has to go through all the injections and the effects of the hormones and then the egg collection – and there’s nothing wrong with her at all. He just couldn’t bear the thought of her having to do it all again.

Final words

My work is immensely rewarding, highly satisfying, incredibly varied and gives me a huge sense of purpose and meaning in my life. I feel deeply honoured to be trusted by those who are often vulnerable and in distress and who are seeking moral or emotional support at a very difficult time in their lives. I want to thank all the patients who have shared their experiences and feelings with me over the years – I have learned so much from them all.

To make an appointment call a BCRM Patient Advisor on 0117 259 1159