QUESTION: My partner and I have been trying to conceive for over a year. I am also suffering from depression, though I am not seeing a doctor or therapist for this condition. I recently read that depression can affect a woman's ability to conceive. Could this be true?

ANSWER: Research studies have documented the correlation between stress and infertility since the 1980s. The usefulness of such information has lagged because the focus has been on vague definitions of anxiety, rather than symptoms of depression. Recently, however, a refined look at depressive symptoms and their impact on biology has been enlightening, offering new hope and a mind/body approach that has proved to be a heartening success for some women.

Consider these findings:

• Women with a history of depressive symptoms reported twice the rate of subsequent infertility (Psychosomatic Medicine, 1995, vol. 57)

• Women with depression, when treated showed a 60 percent viable pregnancy rate within six months, contrasting with 24 percent when depression went untreated. (Journal of American Medical Womens Association, 1999, vol.54)

• Women who experienced depression following the failure of their first in vitro fertilization (IVF), had much lower pregnancy rates that their non depressed counterparts during their second IVF cycle (Journal of Psychosomatic Research, 1993, vol. 37)

The research does not stop there. Another study (Fertility Sterility, 1998, vol. 69) suggests that because mind/body programs are effective for reducing negative emotions that may impair IVF success, patients should be offered such a program in conjunction with IVF.

What is the mind/body connection between depression and fertility? Stress brought on by anxiety and/or depression can alter immune function. We have all heard about how the effects of depression can lower our immunity, making us more vulnerable to colds and other viruses during emotionally stressful periods. It is not such a stretch to discover that a suppressed immune system can adversely affect our ability to conceive.

Reproduction is one of our most delicately balanced biological systems. Psychological stress can affect our ability to get pregnant on multiple levels, including inhibition of the hypothalamus that helps regulate hormonal levels, or over activation of the hypothalamus which can change the pituitary and adrenal responses. Since the pituitary regulates both how much of a hormone is made and how much is released in the body, its alteration can have dramatic effects on the hormonal balance necessary for ovulation, fertilization, tubal functioning or even successful implantation of the egg once it reaches the womb.

Infertility causes depression, but what about prevention? The bad news is that even when women have not been depressed previously, depression often occurs by the second to third year of infertility and does not return to normal levels until six years later. The good news is that researchers have recently become proactive in studying the effects of treatment for non depressed women BEFORE they get depressed.

A new study reported in Reproductive Endocrinology (April 2000, vol. 73, issue 4), treated women who were in their second year of infertility and not yet depressed. The women who received group psychological interventions to stem the tide of depression caused by infertility, had significantly increased viable pregnancies compared to those who did not receive preventative treatment for depression.

What can you do to increase your chances of getting pregnant?

The following activities were part of the treatment program that the women in the prevention study received. Consider these as possible guidelines for a mind/body approach to help you conceive whether or not you suffer depression currently:

• Relaxation Techniques
  Yoga, meditation, and visualization increase the body's resources for achieving balance. Consider a daily meditation, yoga or some other activity that calms the mind, but do not stop there. I have had success in my own psychotherapy practice using a body-centered hypnosis, which utilizes imagery, not only for childbirth, but for infertility, too. The hypnotic effects of visualization, coupled with relaxation can be a powerful technique for communicating with the emotional center of the brain (limbic system) that regulates hormonal activity and balance.

  Visualize your womb in a state of fertile health and readiness. Make a relaxation tape, or have a professional assist you in creating an audiotape in which imagery and sound helps you experience the sensation of conception and pregnancy. (My audiotape "Body Centered Hypnosis for Pregnancy, Bonding and Childbirth" can serve as an example of a visualization tape.)

• Emotional Expression
  Releasing feelings is essential for deep relaxation. Do not use visualization as a form of "positive thinking" alone. Without releasing the "negative" feelings and fears you experience, you will be likely to repress your fears and disappointment, resulting in depression.

  Acknowledge your anger, grief, disappointment and fear. Share your anxieties and feelings with others who may feel similarly. Cry when you are disappointed and verbalize anger when it arises, rather than hold it in. Releasing feelings will allow you to feel better later, allowing you to be hopeful instead of hopeless.

• Cognitive Restructuring
  Write your feelings in a personal journal, but with an eye towards releasing your disappointment and continuing towards your desired goal. For example: When writing you may find yourself saying, "I will never have a child". When you are tempted to express your feelings as a negative projection of your destiny, remind yourself that you are deeply disappointed, even angry. Stop short of crystal ball interpretations that lead to depression. Acknowledge the feelings rather than project them onto a futuristic event. Instead, bring yourself back to reality and write the truth of your actions, "I am doing everything I can to conceive."

• Group Support
  Your desire to become pregnant and your inability to "make it happen" may bring up emotions that surprise you. It is common for women to harbor feelings of inadequacy that effect their self esteem and performance at work as well as their marital relationships. Anticipate your needs. Do not let these feelings overwhelm you. Instead, use this opportunity to get the support you need from others, friends or professionals, to make this an opportunity for learning and growth.

  Supportive group therapy was a part of the treatment in the study correlated with increased pregnancy. Sharing feelings can help you feel less alone and allow you to work through discouragement. These groups focused on the impact of infertility on self esteem, marriage, family, friends and work. Find ways to share your feelings rather than hold them inside.

Do not delay! Seeking treatment may not only help you conceive, but may prevent an even greater spiral of depression that can result from protracted infertility. Treating your depression now may help stem a vicious cycle.