Relax, Stretch, Birth
The women sitting silently in the hospital waiting room are all riding the infertility roller coaster. Some tap on their phones, others read, most simply sit.
Their ages span 20 years, and they are of several faiths and varied ethnicities. All of them, however, yearn to bear a child and, for this, submit to months of shots, screenings and testings, drugs and hormonal surges, egg retrieval and embryo implantation—hoping for good news and ready for heartbreak. They are anxious, highly stressed and often depressed, their self-esteem fragile.
“The psychological distress experienced during [in vitro fertilization] treatment not only dominates daily and married life, it also impacts negatively on fertility,” explains cognitive behavioral therapist Karen Friedman, founder and director of the Rimon Mind-Body Fertility Center at the Hadassah–Hebrew University Medical Center on Mount Scopus in Jerusalem. “Research from Harvard shows that reducing stress and depression increases pregnancy rates by 30 percent in women with unexplained infertility.”
One in eight women is diagnosed as infertile, with the cause unexplained in a fifth. It is in this latter group that pioneering Harvard Medical School professor and psychologist Alice Domar, Ph.D., has found that mind-body programs not only ease psychological symptoms, but also boost pregnancy rates. Twenty-five years ago, use of relaxation strategies to enhance fertility was soundly derided. Today, such techniques are routine in leading American fertility clinics.
In September 2013, Friedman brought these strategies to Israel, using a $30,000 gift from Los Angeles real estate investor and philanthropist Stanley Black, to open the Rimon center on Hadassah’s Mount Scopus campus. (Rimon’s $100,000 annual budget is met entirely by donations that Friedman solicits.)
“We named it Rimon because the pomegranate symbolizes fertility,” says American-born Friedman, who moved to Israel 25 years ago with a Harvard Ph.D. in developmental psychology, a husband and a baby, whose seven siblings were later born at Mount Scopus. Based on Domar’s model, Rimon, which offers a range of mind-body programs, is unique in Israel. Open at no cost to all women in IVF treatment, Friedman sees it as an example for all Israel’s hospitals.
Rimon’s outreach begins in Hadassah’s IVF waiting room. “I go from woman to woman,” says Friedman. “I tell them: ‘You are going through a very hard process. It is normal to feel stressed. We can help.’ I give even those with no interest—as yet!—in joining a support group my phone number, urging them to call me ‘if you want to talk or just to have a good cry.’ I validate what they are feeling.”
While the initial response is often: “I don’t need support. I am coping on my own,” by the end of the conversation many agree to come to one of Rimon’s mind-body therapy or yoga groups.
“They find it really makes a difference,” says Friedman. “Once these women get through the support door, we try not only to help them get pregnant but also to remind them that their life and marriage are about more than pregnancy. When fertility procedures move slowly, a woman needs to reconnect with the positive aspects of herself and to like her body again.”
A mind-body discipline comprised of physical postures, breathing techniques and relaxation, yoga originated in India over 2,500 years ago but has been widely practiced in the West only in the past few decades. Initially no more than physical exercise, it has increasingly become a way in which patients dissatisfied with conventional medicine seek to take control of their own health. Researchers have followed closely on their heels with studies conducted to determine the effectiveness of yoga as a complementary intervention for conditions as diverse as cancer, schizophrenia, asthma, heart disease, high cholesterol, back pain, arthritis, insomnia, anxiety, depression, posttraumatic stress disorder, stress and even the common cold.
Yoga is no magic cure-all, but it may help modulate the body’s stress response. While stress is a normal psychological and physical reaction, with the fight-or-flight alarm system hardwired into our brains, modern life can be such that the alarm system rarely shuts down. And the resulting high levels of stress with which we live have been definitively linked with an array of serious health problems.
Kaden Harari, like Friedman an American ola, is one of Rimon’s yoga instructors. “Yoga helped me with a back injury,” she says. “I realized how much it can [help with] many aspects of a person’s life, and I could not keep it to myself.” She qualified as a teacher and decided to teach yoga to patients undergoing fertility treatments.
In 10 weekly, 75-minute sessions, she teaches techniques that calm the body and increase blood flow to the reproductive organs. “In times of extreme anxiety, our bodies shut down the reproductive and digestive systems,” says Harari. “Adrenaline, cortisol and prolactin levels rise and inhibit the main reproductive hormones—progesterone and gonadotropin-releasing hormone.
“I teach breathing techniques that the women can use to cope with stress at any time,” she adds, “do physician-approved bodywork poses to counter the body’s instinct to hunch under stress and complete each session with restorative poses that calm and ground, quieting the chatter of the mind.”
For Hadassah–Mount Scopus IVF director Dr. Aryeh Horowitz, Rimon proved itself in its first year. “We see a close connection between medical treatment and psychological therapy in IVF,” he says. “Rimon has filled our clinic with life and optimism.”
As crucial as stress-reduction for many women in Rimon’s yoga classes are the relationships they form with classmates. “Of the thousands undergoing fertility treatment each year, most won’t discuss it, although failure to become pregnant can cause grief equal to losing a loved one,” says Friedman. “In class, women become friends, give each other social and emotional support, cheer one another on the journey and continue meeting long after the course ends.”
“You gave each of us the personal empowerment to take a small step,” says Nechama, a Rimon “graduate” who declined to give her last name. “An intimacy formed that enabled us to speak freely. Among all the complications and crying, there is finally friendship—which is a huge source of strength. I think the power of a group like this is that it becomes a kind of island each week, where we can take off our masks. Here we are truly understood and can be completely honest. The group changed my life.”
It is this vital peer support that has prompted Friedman to launch yoga courses for ultra-Orthodox women undergoing IVF. “The pressure of infertility on this population is immense, but they were not open to Rimon,” she says.
Friedman first had to get approval from Jerusalem-based Torat Hamishpacha, which researches the intersection of women’s health and fertility issues and Jewish law; many Orthodox women turn to the organization’s anonymous hotline with fertility questions.
After they received approval, Friedman says, “recruitment was rapid. Our first two haredi groups began in October.”
Harari teaches one. “These women are enthusiastic about learning the breathing work and postures,” she says, “while I gently remind them to be present and in the moment and let go of any expectations. I am in awe of these women who stay true to their modesty and identity but still open themselves to this new world.”
For Friedman, the ultra-Orthodox groups are only a beginning. She wants to introduce a half-hour of relaxation therapy for every woman immediately prior to embryo implantation as well as open groups for couples, with icebreaker cooking classes as their first and last sessions. “Men are often bewildered by the stress levels in their partners, and women need help understanding that men are also stressed,” she says. “The more empathetic the men, the more time and space the women are able to give them.
“For me,” she says, “this outreach is feminism. Giving women a sense of self and helping them through this agonizing time is the most important work I can do.”
For Harari,who has been married for 30 years, the work has special poignancy. “I underwent IVF treatment myself with no success,” she recalls. “There was little awareness then that yoga relaxation breathing could help. I have worked hard on myself to reach the point where I can treat women for infertility and take joy in supporting them through their IVF ordeal.
“The love and compassion inside me for the children I never bore is now for them.”