psychomatic infertility uly conceptions of the mind article.pdfcharing cross and west london...

8EUROPEAN JOURNAL OF CLINICAL HYPNOSIS, VOL1: NO. 4

JULY 1994

The role ofh y p n o t h e r a p yi n t e rvent ions in

m e d i c a l l y - u n e x p l a i n e d ,funct ional and

psychosomatic infert i l i t y

B yPhi l l ip D.R.Quinn and Michael Pawson

A to ta l o f 40 f ema le pa t i en t s aged be tween26 a nd 42 y ea r s ( m e an 3 2 y ea r s ) w h o h adbe en e x p e r i en c i n g e i t he r p r im a r y i n fe r t i l i t y( 3 0 p a t i e n t s ) o r s e c o n d a r y i n f e r t i l i t y ( 1 0pa t i e n t s ) a n d ha d b e en r e c e i v i n g s t a n da r di n f e r t i l i t y i n v es t i ga t i on s a nd t r ea tm en ts f o rbe tween two and 12 years (mean 3 .5 years)w e r e r e f e r r e d f r o m F e r t i l i t y c l i n i c s a t t h eChar ing Cross and West London hospi ta ls forhypno therapy , wh ich was to be emp loyed ina s s o c i a t i o n w i t h f u r t h e r s t a n d a r d m e d i c a lt reatments in appl icab le cases.Of th is g roup, 26 pat ien ts went on to achieves u c c e s s f u l f u l l - t e r m p r e g n a n c i e s a f t e r a nav e r a ge o f n i n e s e s s i o n s o f hy pn o th e r ap y ,g iv ing b i r th to a to ta l o f 28 heal thy ch i ldren.There was a very low spon taneous abor t ionrate of seven per cent ( two instances) .

N in e o f t h e s e s uc c es s f u l pa t i e n t s r ec e i v e daddi t ional medica l t reatments (GIFT, DI , IVF,c o r t i c o s t e r o i d s a n d m i n o r s u r g e r y ) , t h eef fec t iveness of which appeared to have beengreat ly enhanced fo l lowing hypnotherapy. A f u r t h e r e i g h t p a t i e n t s o n t h e p r o g r a m m ea c h i e v e d c o n s t r u c t i v e o u t c o m e s i n w a y sother than by achiev ing pregnancy. Successfu l pat ients genera l ly repor ted a h ighleve l o f sa t is fac t ion w i th the i r exper ience ofpregnancy, labour and b i r th .Other benef its from the hypnotherapy reportedby 17 of the part ic ipants, including several ofthose who did not achieve pregnancy or othersatisfactory outcome, included the alleviation orr e s o l v i n g o f v a r i o u s m e n s t r u a l a n dgynaecological problems.

Conceptionsof the

mind

Summary

Psychomatic Infertility

9 EUROPEAN JOURNAL OF CLINICAL HYPNOSIS, VOL1: NO. 4

F o r e w o r d

1 Hull M.G.R., GlazenerC.M.A. et al. “PopulationStudy of Causes,Treatment and Outcomesof Infertility” BMJ291:1693-1697. 1985.

2 Human Fertilisationand EmbryologyAuthority, Paxton House,30 Artillary Lane, LondonE1 7LS. Second AnnualReport, 1993 (whichincludes data supplied bythe Office of PopulationCensuses & Surveys,10 Kingsway,London WC2B 6PJ)

3 Jones G.S andPourmand K. “AnEvaluation of EtiologicFactors and Therapy in555 patients with PrimaryInfertility”J. Fertil. Steril.13:398, 1962

4 Warner M.P. “Resultsof a Twenty-five YearStudy of 1553 InfertileCouples”. N.Y.StateJ.Med. 62:2663, 1962

Phil l ip D.R.Quinni s Director o f theAssoc ia t ion fo rAppl ied Hypnos is andpast -Presiden t , theFederat ion o fH y p n o t h e r a p i s t s . A p a r tf rom be ing in pr iva teprac t ice at Louth andin London, he runsInfer t i l i ty Therapy t ra in ing seminars forexper ienced hypnotherap is ts and has formedthe Fer t i l i t y Enhancement HypnotherapyGroup to fur ther the deve lopment of fer t i l i t ytherapy and to accredi t the success rate oftherapis ts work ing in th is f ie ld .

Michael PawsonMB BS, FRCOG.

i s SeniorLecturer andConsul tant , theA c a d e m i cDepartment ofObste tr ics andG y n a e c o l o g y ,Chelsea andWestminster Hosp i ta l , 369Fu lham Pa lace Road, LondonSW10, England.

I N F E RT I L I T Y ( t h e i n c ap ac i t y t o p r o d u c e a l i v e c h i l d – a u t h o r s ’defin i t ion) is a h ighly d is tress ing and emotive condit ion that is said

to affect around 17 per cent 1 of would-be parents . Where there havebeen no previous chi ldren, the condit ion i s descr ibed as Pr imary (1°)i n f e r t i l i t y ; w h e r e t h e r e i s d i f f i c u l t y i n p r o d u c i n g a s e c o n d o rsubsequent chi ld, i t is referred to as Secondary (2°) infer t i l i ty.

Despi te advances in medical expert ise, success rates cont inue to remain low inp a t i e n t s w ho h av e b ee n r e f e r r e d on fo r h i - t e c h t r e a t m e n t s s u c h a s I n - V i t roF e r t i l i s a t i o n ( I V F ) , G a m e t e I n t r a - F a l l o p i a n T r a n s f e r ( G I F T ) a n d A r t i f i c i a lInseminat ion us ing Donor sperm (DI) a f te r fa i l ing to respond to the s tanda rdsurgical and other procedures more widely available in NHS infer t i l i ty c l inics .

According to recent ly-publ ished da ta 2 provided by regis te red Brit ish cl inics , in1 9 91 t h e l i v e b i r t h f a i l u r e r a t e p e r t r e a t m e n t c y c l e f o r t h e a bo v e f o r m s o fass isted conception over a s ix-year per iod between 1985–1991 was 88.7 per cent(GIFT), 95.1 per cent (DI) and between 81.4 per cent and 90.8 per cent for IVF.The same da ta shows tha t a h igh propor t ion of a l l t he r ef e r r ed pa t i en t s s t i l lfa i led to respond even to repeated treatments : in 1991 these f igures were 83 percent (GIFT), 89 per cent (DI) and 85 per cent ( IVF).

Around 28 per cent of pat ients present ing with infer t i l i ty have no apparent medicalcause for thei r problem (medical ly-unexplained infe r t i l i ty) . For such pat ient s , theove ra l l med ica l success ra te in t e rms of l ive b i r ths ( ra ther than jus t concept ionsachieved) is reported to be much lower than the norm: one study 3 has put th is a t 20per cent ; another 4, based on a much higher sample over a longer period, indicateso n l y a 3 p e r c e n t s u cc e s s r a t e . A l l o w i n g f o r a g e n e ra l l y a cc e p t ed s p o n t a n e o u sa b o r t i o n r a t e o f a b o u t 2 5 p e r c e n t ( a p p a r e n t l y n o t t a k e n i n t o a c c o u n t i n t h epub l ished f igu res ) a more recen t s tudy 1 has indica ted p robable l ive b i r th successrates of around 55 per cent (pat ient age group 25–34 years) , 37 per cent (35 years orolder ) , 32 per cent (where the durat ion of infert i l i ty is 3–5 years) and 22 per cent(where the durat ion of infe rt i l i ty is f ive years or more) .

Correspondence to:21 B, High Holme Road, Louth, Lincolnshire LNll OEX England

JULY 1994 Psychomatic Infertility


JULY 1994

The principles on which thehypnotherapy programme was based

turned conventional wisdom on its head.Rather than viewing infertility as eithera disease or an inherited malfunction,the programme considered thepossibility of infertility being apurposeful, possibly functional,condition having useful antecedents.

This was in response to personalobservations and what is now a generalunderstanding that the procreative and thenurturing instincts of all mature non-humancreatures, domesticated or otherwise, can beradically and adversely affected either bysuddenly raised arousal levels (acuteshock/extreme anxiety) or by the stressresulting from chronic arousal.

In the wild, situations such as the loss of a mate,t h e p r e s e n c e o f e x c e s s i v e p r e d a t o r s ,n e s t d i s t u r b a n c e , o v e r c r o w d i n g ,m i g r a t i o n or other unsettled environmentalconditions, can cause procreative activity(including courtship rituals, mating and nest-building) to cease.

Also an already pregnant female may re-absorbor abort her foetus; or any live progeny may be

abandoned or destroyed. Yet it seems that anysuch apparently negative outcomes of arousal andstress may paradoxically be essential to speciessurvival: released from the encumbrance ofdependants during adverse conditions, thesexually-mature adult has a far better chance ofpersonal survival and may thus live to breed again(and restore population numbers) when thoseconditions improve.

One is inclined, somewhat mystically, toattribute the patent wisdom behind this harshreality to the external force of Mother Nature.More realistically, these responses areautomatically internally activated under certainconditions by genetic pre-programming,developed following generations of exposure tosuch factors. In a more specific way, this geneticwisdom may be illustrated for example by a youngchimpanzee’s inherited snake phobia or a newly-hatched chicken’s inborn fear of hawks, both ofwhich are also innate survival responses.

It seems reasonable, given our evolutionaryk i n s h i p7 to other mammals and their reptilianpredecessors, that there are psychological,behavioural and physio logical humanequivalents to al l the above phenomena,including the condition described as medically-unexplained infertility.

The Phi losophy behind the programme

5 Neale C. and BettendorfG. “Comparison of theResults of GonadotropinTherapy under VariousConditions.”Clinical Application ofHuman Gonadotropins.Stuttgart:Thieme, 1970

6 Pawson, Michael“An Holistic Approach toInfertility”Holistic Medicine,1:211-218 (1986)

The inabi l i ty to make a diagnosis in medical ly-unexplained infert i l i ty and the lowsuccess rates in these and o ther res is tant cases tends to indicate that both the causeand to a large extent the cure in many such instances may l ie outside the scope ofa l l o p a t h i c m e d i ca l a p p r o a c h e s . Y e t f o r m a n y y e a r s v a r i o u s au t h o r i t i e s 5 , 6 h a v er e p e a t e d l y p r o p o s e d t h a t p s y c h o s o m a t i c a n d f u n c t i o n a l f a c t o r s s h o u l d n o t b eignored – even in those ins tances of infert i l i ty that appear to have a physical bas is .O n e 6 has warned that where potent ia l ly p r o t e c t i v e psychosomatic condi t ions ( suchas some cases of secondary amenorrhea) a re success ful ly over r idden by medicalt r ea tmen ts in an a t t empt to r es to re fe r t i l i ty , p sycho log ica l decompensa t ion mayresult . Successful but inappropr ia te medical intervent ions may thus be responsiblefo r the h igher l eve l s of pos t -par tum psychos i s tha t a re as soc ia ted w i th ass i s t edpregnancies , perhaps as a direc t consequence of overwhelming the various forms ofp s y c h o s o m a t i c c o n t r a c e p t i o n tha t may have unconsc ious ly been ac t iva ted in thepa tient 's sel f- interes t by her own psyche.

In the United Kingdom, Infert i l i ty Counsel lors – appointed under the terms of theHuman Fer t i l isat ion and Embryology Act 1990 – may now ass is t couples to copeemotional ly and pract ical ly with d iagnost ic and t reatment procedures, or help themult imately to cope psychological ly with chi ldlessness . However the psychosomaticand funct ional orig ins of infert i l i ty have cont inued to remain largely unaddressed.

One at tempt to remedy th is s i tuat ion resul ted in th is col laborat ive project betweenthe combined fer t i l i ty c l inics of two London teaching hospi tals (Charing Cross andthe West London) and a hypnotherapy pract i t ioner .



Survival responseMore specifically, other unconsciously-

prompted effects of this inherited survivalresponse may include ambivalence toparenthood, loss of libido, male infertilityfactors such as poor sperm quality(azoospermia, etc), sexual dysfunction,menstrual irregularities, failure to ovulate,hormonal imbalances, mucus hostility andantibody reactions to sperm, impaired lactation,child abandonment, baby-battering and bothante-natal and post-natal depression.

A more complex intelligence and a moredemanding social system may subject thehuman psyche to a more comprehensive rangeof potential stressors and arousal-activatingstimuli than those experienced by othercreatures existing at a subsistence level.

In subsistence-living it seems that onlyimmediate threats or challenges haverelevance. Thus, in non-human and incomparatively primitive societies, the stimulithat activate arousal and consequent stressinevitably involve only ‘here and now’situations. These include those stressors thatmay result from genetic pre-programming and,in mammals, the current effects of bothconditioning and traumatisation.

However, in a more advanced culture themore highly-developed human brain can add asignificant additional dimension to current

stressors. This stems from theotherwise invaluable ability of theverbal, analytical c o n s c i o u shuman intelligence (often referredto as the left brain) to anticipatepotential future events.

When used positively and forplanning purposes this facilitycan prove highly advantageous;but when combined with anegative/morbid inclination and afailure to take practical action,anticipatory thoughts can becomeanxiety-provoking worry, (theWhat if....? syndrome).

The stressful or inhibitory effectsof each of the three main groupsof potential stressors are:

PAST – unresolved traumas andnegative conditioning.

PRESENT – negative or unfulfilledexpectations/desires and unresolvedcurrent situations.

FUTURE – pathological worrying.

These are always deemed to be potentiallymaterially relevant in any therapy situation.

One object ive of the hypnotherapyapproach was to identify where possible anytypical situation in any of these three groupsthat could be relevant as a causative stressorin infert i l i ty. Another object ive was toincorporate early in therapy a relaxation-t raining st rategy that would help tocompensate for – thus reducing the negativeeffects of – stress from whatever source.

Difficult duplication

As a resul t o f wide variat ions inupbringing, experiences, intel l igence,education, expectations and coping skills, notwo individuals can be rel ied upon toperceive and respond in an identical way toany given situation or to any specific type ofs t r e s s o r .

Similarly, unlike scientific experiment, theart of individual therapists is not alwayscapable of exact duplication by others; onemay succeed where the other fails and vice-versa. The absence of meaningful constantstogethe with d iff icul t ies of design andexecution made valid controlled studiesvirtually impossible to incorporate in thisproject. It was therefore decided that theresults would have to speak for themselvesand be judged accordingly.

Although male factors (sperm defects/dysfunct ions , coita l fa i lure , e tc) a resignificant (about 30 per cent) as a cause ofchildlessness in couples1 ,a decision wasmade for the purposes of this project toconcentrate on female patients.

For simplicity’s sake and in view of thesource of referral, the term p a t i e n t w a sretained in preference to the more usual c l i e n t .

7 von Baer K.E.“Entwicklungsgeschichteder Tiere(Embryology of Animals)”1828

The hypnotherapy programmeturned conventional wisdom on its

head. Rather than regardinginfertility as a disease or an

inherited malfunction, it consideredthe possibility of it being a

purposeful, possibly functionalcondition having useful

antecedents.



JULY 1994

First session.

(a) The initial consultation (Time: up to 1.5hours).

A history-taking session, facilitated by the useof a subjective check-list form †(AAH) completedby each patient.

This gave background information on medicalhistory including current physical symptoms/ailments/medications; the frequency/degree ofarousal affecting the patient and the effects ofthat arousal; the patient’s level of stress; arousal-and stress-coping strategies; relevant personalityfactors; family background; and past/currentstressors.

Further enquiries provided specific informationregarding infertility investigations and treatmentsreceived by both partners; and any factors havinga possible connection with infertility/subfertilityor its causes, including sexual dysfunction,gynaecological conditions, domestic/matrimonial/relationship difficulties, pastrelationship problems and relevant fears orworries.

In each case, the time/date associated with theonset of various symptoms, problems orconditions was closely examined with a view tolocating possible stressors, unresolved traumaticexperiences and other sources of arousalstimulation.

(b) The induction of hypnosis andpreliminary training in trance management(Time: around 20 minutes.)

Following the induction ( A A H ) of hypnosis,patients were trained to achieve a trance state inresponse to a combination of verbal and othercues. Instructions ( A A H ) designed to protect thesafety and integrity of the patient in subsequenttrance states were then built-in during thissession and later reinforced.

The patient was then supplied with a double-sided audio cassette tape with two standardtherapy programmes ( A A H ) designed to enableeach patient to quickly achieve and maintain atrance state in appropriate conditions.

Side one of the tape – the FoundationProgramme – reinforced both the induction cuesand the safeguards and enabled the patient todevelop the trance state and manage it.

Side two was a relaxation training programmedesigned to counteract and compensate for theeffects of any ongoing arousal/stress and to assistthe patient in developing more constructiveattitudes and responses to potential stressors.

The patients were asked to use the tape at least onceeach day, both sides if possible, at the times theyfound most appropriate and beneficial.

Second and subsequentsessions

Analysis and additional therapy. (Time1.0 – 1.5 hours each)

Often based both on feedback and theinformation obtained from previous sessions,these periods focused on investigating thepossible psychosomatic and functional causes ofinfertility.

The three essential groups were examined:

(i) Past experiences Utilising hypnosis where necessary, both verbal

and non-verbal (e.g. ideomotor signalling)techniques of analysis were employed to locaterelevant reactive (traumatic) memories. Thesewere defused using various abreaction techniquesand redefined along more positive lines in orderto reduce future occurrences of arousal and tolower stress levels.

(ii) Current stressors“Denial” often meant that some current

problems (e.g. relationship difficulties) were notalways frankly disclosed during non-hypnosisinterviews, although they were often indicated byan interpretation of the initial consultationsubjective checklist. In such cases they usuallybecame quickly apparent during hypnosisanalysis sessions, often with a clear subconsciousindication as to their relevance to the block onfertility.

Often, the simple realisation as to the potentialsignificance of leaving such matters unresolvedprompted the prevaricating patient to take action.Sometimes a common-sense problem-solvingapproach on the part of the therapist wasacknowledged by the patient as being of value;but occasionally other forms of catalyst in theform of assertiveness training, etc., were neededbefore the patient felt able to face up to and todeal with the problem situation.

Therapy Procedures

†Note

Items marked (AAH)indicate formats andtherapy processesadapted from thosedeveloped by theAssociation forApplied Hypnosis.Limitations of spaceprevent them frombeing detailed in thispaper.



(iii) Negative anticipations andpathological worrying

Fears relating to the future of the baby, theoutcome of hospital treatments, possible financialdifficulties, loss of love or attention, childbirthpain, miscarriage, child deformities and otherworries were common sources of stress.

Patients for whom habitual worrying was aserious problem often had a related difficulty ingetting to sleep at night and simple reassurance toquell such fears was inevitably inadequate.

Three techniques were used to help patients tominimise this problem:

1. As taking ‘action’ reduces the incidences ofarousal, strategies ( A A H ) to convert w o r r y i n ginto p l a n n i n g were taught to patients, with asupportive audio tape being provided for theiruse.

2. Similarly, strategies to convert n e g a t i v e ( t h a twhich undermines life or well-being) thinkinginto p o s i t i v e (that which enhances and supportslife and well-being) thinking were also taught,again with a supportive therapy tape beingprovided.(AAH)

3. Whereas the previous two approaches wereessentially directed to the conscious mind,further instructions were given under hypnosisto restrain the sub-conscious mental processesfrom responding inappropriately to anxietiespertaining to the future. Again, a supportivehypnotherapy tape (AAH) was provided to assistthe positive conditioning.

Final session (Time: 0.5 hours)

Of those 26 patients who conceived during orfollowing the therapy programme, those whowished it (20 patients) were provided with afurther taped hypnotherapy programme ( A A H )

designed to facilitate pregnancy, labour, birth andthe post-natal period.

ResultsOut of the 40 participants of the hypnotherapy

evaluation project:

Outcome Number 1Twenty-six of the patients (65 per cent) agedbetween 26–41 years conceived and went on tohave a total of 28 live births. All births werestraightforward but one was delivered byCaesarian section on medical advice and one baby(of twins) required a plasma exchange.

a ) Of these successful patients, 20 hadexperienced between two and eight years of 1°infertility (mean 3 years) prior to commencinghypnotherapy. An average of ten sessions ofhypnotherapy was required by theseparticipants, although generally the youngerpatients (aged 26-35 years) requiredconsiderably fewer sessions than the olderpatients. Nine of this sub-group conceived followingcombined hypnotherapy/medical treatment(including a total of four GIFT, six IVF, oneDI session, one course of steroids, and oneminor surgery); prior to therapy, four ofthese patients had already received betweenthem a total of nine IVF sessions, nine DIsessions and two AIH treatment cycleswithout success.

For further details of this combinedhypnotherapy/medical approach, see OutcomeNumber 8.

b ) The other six successful patients hadexperienced 2° infertility for between two andfive years (mean 3 years). None of thesepatients received additional medicaltreatments. Two gave birth to twins. Theaverage number of therapy sessions receivedwas five. c ) Eight of the total 26 successful patientsconceived within two sessions of therapy,despite previously having had medicalinvestigations and treatments for infertility forbetween two and seven (mean 3.5) years priorto commencing hypnotherapy.

1 2 3 4 5 6 7 8 9 10

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JULY 1994

Outcome Number 2

Of the 26 patients who went on to achieve livebirths, two had other pregnancies that resulted inspontaneous abortions.

One of these patients, having conceivednaturally eight weeks into the hypnotherapyprogramme following three years of infertility,miscarried after seven weeks but conceived againwith three months.

The other patient miscarried at 11 weeks afterher first GIFT treatment cycle but went to termfollowing her second GIFT treatment (see Outcomenumber 8b).

This spontaneous abortion rate (7 per cent)compares favourably with the generallyacknowledged miscarriage rate for all confirmedpregnancies of around 25 per cent (or for GIFTpatients 30.3 per cent) in 19912.

Outcome Number 3

Two further 2° infertility patients (5 per cent),who had been participating in medicalinvestigations and treatments for three and fouryears respectively prior to commencing therapy,subsequently revealed during therapy a personalambivalence towards having further children thatthey had previously been loathe to disclose.

In one case, the patient’s partner also admittedsuch an ambivalence: it transpired that each hadbeen supporting what they believed to be theother partner’s wishes. In both cases the partiesconcerned happily discontinued both therapy andmedical infertility treatments.

Outcome Number 4

Six further patients (15 per cent) came to termsduring therapy with what they felt to be long-termand insurmountable personal relationshipproblems. They had been receiving infertilityinvestigations and treatments prior to therapy,between three and twelve (mean 5.5) years.

Three of these patients admitted clinging to thehope that a baby would act as a uniting force andrestore their marriages, whilst a fourth believedanother child would supply a need no longerfulfilled within her marriage.

The latter sought to satisfy her personal needs bydeveloping a fulfilling career; the other fiveseparated/divorced from their partners.

Outcome Number 5

Patients generally reported a high level ofsatisfaction with their experiences of pregnancy,labour and birth, including one patient who hadexperienced eight miscarriages/neo-natal deathsprior to commencing hypnotherapy.

Outcome Number 6

Sixteen of the forty participants at the initialconsultation complained of either menstrualproblems (pre-menstrual tension, dysmenorrhea,menorrhagia, amenorrhea and erratic menstrualcycles) and a further six suffered from variousgynaecological conditions (chronic and recurringfungal infections, vaginismus and endometriosis).

Twelve of the former group and five of the latterreported either worthwhile improvements in theircondition or complete cures (including one caseof endometriosis which apparently resolved itselfwithout medical treatment just prior to the patientsuccessfully conceiving).

A total of 14 of the 17 patients who hadbenefited in this way went on to achieve full-termpregnancies.

Outcome Number 7Non-successes:

One patient withdrew prematurelyfrom therapy, having found itemotionally too difficult tocontinue.

Two patients moved – one abroad– and could not be traced. Theultimate success or otherwise of thetherapy they had received could nottherefore be determined.

One patient after two failed IVFtreatment cycles went on to adopt ababy and did not therefore continueinfertility treatment or therapy.

One patient with a prevailing bloodcondition (venous thrombosis andlupus) did not conceive following15 sessions of therapy.

One patient did not conceive, forreasons unknown, following 17hypnotherapy sessions.

*

*

*

*

*



Outcome Number 8Combined Hypnotherapy/Medical approaches

(see Outcome Number 1a)

a) Hypnotherapy/DI combinations

DI statistics for 19912 indicate that only 11 percent of all DI patients achieve a live birth. Forthose that are successful, an average of 17 DItreatment cycles are necessary for this result tobe achieved by a patient of this age.

The successful hypnotherapy/DI patient (age26) had experienced six failed DI treatmentcycles prior to commencing therapy.

Following three hypnotherapy sessions thispatient achieved a live birth with just oneadditional treatment cycle.

b) Hypnotherapy/GIFT combinationsAccording to GIFT statistics for 19912

1) Only 8.3 per cent (about 1 in 12) of all GIFTpatients achieved live births, even after repeatedtreatment cycles.

All three Hypnotherapy/GIFT patients (ages32, 37 and 39 years) did so.

2) For those GIFT patients who were successfulan average of 8.8 treatment cycles were generallyneeded to achieve a live birth.

a) Two of the Hypnotherapy/GIFT patientsachieved this after one treatment cycle.

b) The third (aged 39) did so following hersecond treatment cycle. (See Outcome Number 2)

c) Hypnotherapy/IVF combinations

According to IVF statistics for between 1985and 19912

1) Only 15 per cent of all IVF patients achievea live birth as a result of IVF treatments.

Three (i.e. 75 per cent) of the fourHypnotherapy/IVF patients (ages 37, 41 and 42years) achieved this result.

2) Between 30 per cent and 43 per cent of IVFpregnancies achieved by patients in the 35–44age group were lost as a result of miscarriages,ectopics and perinatal deaths.

None of the Hypnotherapy/IVF patientssuffered such losses.

3) An average of 7.1 IVF treatment cycles wererequired for successful IVF patients in the 35-39age group to achieve a live birth.

The 37 year-old Hypnotherapy/IVF patientachieved this result following one IVFtreatment cycle.

4) An average of 9.5 treatment cycles wererequired for successful IVF patients in the 40-44age group to achieve a live birth. The two olderpatients in the Hypnotherapy/IVF group hadrespectively already received five and fourtreatments without success prior to commencingtherapy. Following hypnotherapy:

a) The 42 year-old patient succeeded with onefurther treatment cycle.

b) The 41 year-old patient achieved this resultin four further treatment cycles, two of which(from a hypnotherapy viewpoint) wereconsidered premature.

AID Gift IVF

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Figure 1: Outcome Number 8 – Successes per patient Figure 2: Outcome Number 8 – Successes per treatment cycle

Figure 3 Outcome Number 8 – Time take to conceive

DI Gift IVF DI Gift IVF

Average timeto conceiveafter start of

therapy (0.73)

Average pre-therapy fertility

period (3)

0

0.5

1

1.5

2

2.5

3

3.5

Year

s

Average duration ofpre-therapy fertility

treatments

5.9%



JULY 1994

Observations1. At the initial consultation most of the patients

acknowledged that, apart from other activestressors in their lives, they experienced varyingdegrees of distress from the consequences of theinfertility problem itself.

These included:

In the absence of an infertility counsellor whomight have addressed and helped to resolve suchissues prior to the commencement ofhypnotherapy, the hypnotherapist was required tofulfil this role as well to deal with other stressfullife experiences, and to locate and resolveunderlying psychosomatic and functional issuesspecifically affecting fertility.

The older the patient and the longer the period ofinfertility the more complex and time-consumingin therapy such factors tended to be. Generallyspeaking, the older 1° infertility patients (36–41years) tended to need considerably more therapytime (mean 13.4 sessions) than either the younger1° infertility patients (mean 6.7 sessions) or the 2°infertility patients (26–35 years) who required amean of 5 sessions.

Inability to respond2. Surprisingly, despite their other

psychosomatic or behavioural consequences notall stressors appeared to have a specificinhibitory effect on fertility; for example, evenheavy work-related stress seemed irrelevant as apossible causative factor in infertility.

Other stressors, most particularly phobiasresulting from past pregnancy, sexual traumas, oranxiety and insecurity created by unsatisfactoryaspects of personal relationships and domesticsituations, often proved highly significant.

With regard to the latter, situations whereexpectations and needs were not adequately mettended to be a significant factor both inintelligent, educated patients with highexpectations and in those insecure patients withneurotic needs resulting from childhooddeprivation or trauma.

In each case much of the stress resulted eitherfrom inaction on the part of the affected patients(e.g. failing to discuss their needs with othersconcerned) or from the failure or inability ofothers to respond adequately to the patients’expressed needs.

Most patients were affected by the influence ofmore than one unresolved stressor. It wasnoticeable however that pregnancy oftenfollowed quickly after certain factors, orcombinations of factors, had been resolved.(Number of instances – see box on next page)

It seemed evident from this that the decidingfactor as to whether or not arousal/stressinfluenced fertility negatively had little to dowith the severity of the stress but whether or notit was in some way focused on the reproductivesystem. This focusing factor may in some caseshave been physical, for instance spontaneoustension associated with intercourse following anearlier rape ordeal.

In other cases it might have been a negativeexpectation created as a result of an experience

■ Personal and relationshipstrains imposed by the standardmedical diagnostic proceduresand treatment régimes.

■ Frustrations caused byassociated problems, includingdelays between appointments,lack of continuity due to staffchanges, etc.

■ Severe disappointmentfollowing each treatment failure

■ Guilt and loss of self-esteemat their perceived ʻabnormalityʼ

■ Accumulating depressivefeelings about their continuedinability to have a family,uncertainty regarding the future,their inability to make long-termcommitments concerning work,etc.

■ Envy of and feeling the needto avoid pregnant women orwomen with babies

■ Feelings of isolation fromclose relatives or long-time friendsnow having young children

■ Well-meaning enquiries andexhortations regarding theirstarting a family by personsignorant of their problem.



and directly related (often unconsciously) in someway to procreation, creating an inhibitory effect.Such negative expectations could includeassumptions, e.g. It’s happened before so it willhappen again and projections, e.g. I suffered, somy children will suffer in the same way

This Stressor + Expectation combination couldexplain some anomalies, such as the apparentirrelevance of some stressors in unexplainedinfertility and the particular significance of others

more likely to create negative expectations. Similarly it could explain another paradox: why it

seems, anecdotally at least, that it is easier toconceive an unwanted child than one which isdesperately wanted. A fear of becoming pregnant,which actually betrays a positive expectation ofpregnancy, may actually stimulate pregnancywhile a fear of not becoming pregnant (indicatinga negative attitude often perversely associated withobsessional desires) may inhibit the reproductiveprocesses.

It certainly seems that a change in expectation,from negative to positive, can quickly producepreviously-denied results: two successes notincluded in the published figures concernedwomen who, having expressed hopelessness attheir situation after some years of infertility,telephoned eagerly for an appointment to join thetherapy project which by then had earned areputation for success with “difficult” cases andhad been highly recommended to them.

Prior to attending the first appointment, madefor approximately s ix weeks l a te r , eachcancel led with the happy news that in theinterim they had conceived.

PASTEXPERIENCES:

CURRENTINFLUENCES:

NEGATIVEANTICIPATIONS:

Rape/sexual assault traumas ...

Abortion traumas .............

Miscarriage traumas ..........Previous pregnancy/birth traumas .........Childhood traumas and deprivation..........

Resolvable relationship problems .........

Unsettled living conditions...

Fear of surgery/hospitals.....Fear of not conceiving........

Fear for child’s future.......

(3)(5)

(5)

(3)

(4)

(5)(4)

(1)

(2)(4)

Conclusion

As costs had to be privately funded,this study was limited. Some wouldargue that more comprehensiveresearch would be necessary in orderto confirm the value of hypnotherapyinterventions in cases of infertility.Yet, limited though this study was,there are still strong indications thatboth the personal and financial costsof infertility treatments might beconsiderably reduced by combining ahypnotherapy approach with medicalprocedures.

Higher and more quickly-obtainedsuccess rates (measured in terms ofacceptable outcomes rather thansimply pregnancies achieved) wouldbe of obvious benefit to all concerned:patients and their partners wouldsuffer less and be less penalisedfinancially; the burden on N.H.S.services would be reduced; andprivate fertility clinics with highersuccess rates would attract morepatients.


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