Why I’ve Been Guilty of Saying “Just Relax” and Why I Won’t Ever Say It Again

Since becoming a fertility coach and joining in on discussions in the TTC community on social media, it’s become very apparent to me how hurtful “just relax” is to those struggling to conceive. But I’ve been guilty of saying it… Let me explain why.

Why I’ve Been Guilty of Saying “Just Relax” and Why I Won’t Ever Say It Again

My career started when I joined an IVF clinic as a trainee embryologist in 2009. We had morning meetings when we discussed how many patients were being referred to us and how we would schedule them in based on their cycles over the upcoming weeks. Since our clinic was a part of the public healthcare system, we provided treatment on the equivalent of the NHS and only had a few private treatments. Occasionally there would be a long wait for the NHS treatments. Many times, we would get phone calls from patients on the waiting list calling to cancel their upcoming treatment because they were pregnant. We would celebrate them and congratulate them and during these meetings we would discuss how this happened. The answer that everyone around the table agreed to in unison. They relaxed. The requirement for treatment on the NHS at the time was that the couple needed to be trying for over a year and living together for 2 years. These couples would go from trying and trying, to knowing they’d be able to start IVF, and that took the pressure off of them. They stopped having “let’s make a baby I’m ovulating sex” and went back to unscheduled, unprotected, “let’s have fun sex”.

BUT. This brings up a massive issue.

The couples that conceived while waiting for treatment? They’re the exception, not the rule. These couples were diagnosed with unexplained infertility, which is approximately 30% of couples struggling to conceive (J Reprod Infertil. 2015 Jan-Mar; 16(1): 1–2. Un-explained Infertility, the Controversial Matter in Management of Infertile Couples Mohammad Reza Sadeghi,). And how many times did this happen? Maybe once a month. At the time we were treating 1000-1200 couples per year, and we had a dropout rate below 1%. So, was it fair that we told couples to relax based on a few exceptions? At the time, we didn’t think we were saying anything detrimental.

Equally, we would have couples come through for IVF treatment and leave pregnant, saying they’d be back for a sibling and not return because they would go on to conceive their second child naturally. Couples who had been told they needed IVF, had unsuccessful treatment and went on to conceive naturally, “when they were least expecting it”. Knowing that these couples exist are helpful to those of us working in fertility. What’s not helpful? Telling people struggling with infertility that these patients exist…

Working in any healthcare environment, our job is to make people feel better, heal them, help them.

When we give examples of how it can work for other couples, we think we’re giving our patients hope. In reality, we’re possibly making them feel worse about themselves because their infertility diagnosis comes with stress and anxiety, and instead of making them think that it can work for them too, what’s actually going into their head is something more along the lines of “it’s still not working for me, everyone else is getting pregnant and I’m not”. We may make them doubt themselves, their bodies and their fertility even more. Adding stress, rather than helping them cope with their existing stressful diagnosis or problems.

I attended virtual ESHRE a few weeks ago and one of the sessions was a wonderful talk between Jacky Boivin and Dr Angela Lawson, both discussing the phrase “Just relax and it will happen”. Lawson says, “Although the statement is likely intended to let women know that others are optimistic about their chances of having a baby, at its core it blames women for being too stressed to conceive.” There is no direct link between stress and infertility i.e., stress in itself is not a cause of infertility, but an infertility diagnosis is stressful, and causes distress. Stress can indirectly affect your chances of getting pregnant, the strategies we seek to help us cope can be detrimental to fertility. What do you do when you’re stressed? Some people overeat or binge on unhealthy foods or alcoholic beverages. Being overweight or having a high BMI can affect your fertility. Some people turn to smoking. Smoking is proven to have a negative effect on quality of eggs and sperm. Stress can lead to depression, which diminishes the motivate to look for help, solutions treatment etc. All of these strategies or solutions we may seek will give us a fleeting moment of pleasure, distraction or stress relief, but long term they can actually have a detrimental effect on stress and subsequently, possibly also our fertility.

What else is wrong about “Just relax”?

It’s a statement. It’s like suggesting our patients can turn the stress on and off like a switch. It doesn’t give an indication on how to relax. It doesn’t explain that stress causes an increase in cortisol levels which may have a negative impact on ovarian function (Oman Med J. 2017 Sep; 32(5): 443–444. The Impact of Lifestyle, Diet, and Psychological Stress on Fe-male Fertility Salvatore Giovanni Vitale et al, J Biomed Sci. 2016; 23: 36. Impact of stress on oocyte quality and reproductive outcome. Shilpa Prasad, et al). And most importantly, it doesn’t explain that there are things that you can do to counter the cortisol, in order to help our patients de-stress. You can help decrease your cortisol levels by increasing serotonin and dopamine (Int J Neurosci 2005 Oct;115(10):1397-413. Cortisol decreases and serotonin and dopamine increase following massage therapy Tiffany Field et al). Relaxation techniques, exercising, sleeping well, and even laughter - can all help counter increased levels of cortisol.

We weren’t handing out tools to the couples to try to help them de-stress. By the time patients came to us, they were ready for IVF. There were requirements they needed to meet. If they didn’t meet the weight criteria, we gave them nutritional plans to follow and gave them a few weeks to meet the BMI requirement. If they were smoking, we gave them pamphlets and information on how to quit. If they were stressed out? We told them to just relax. We meant it in the loveliest, warmest, “don’t worry, you’ll be fine, I’m attempting to help reassure you” way possible. But of course, now, I understand why it will never be perceived that way. And I won’t ever say it again.

-Sandy Christiansen, Fertility Coach

MSc, HCPC registered clinical embryologist, ESHRE certified embryologist

Medical Disclaimer:

The information provided in this blog is intended for general informational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider or qualified medical professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this blog.