Interview: Dr. Alice Domar
Dr. Alice Domar, Ph.D., is a pioneer in women’s wellness. The founder and Executive Director of the Domar Centers for Mind/Body Health and the Director of Mind/Body Services at Boston IVF, she established the first Mind/Body Program for Fertility. Dr. Domar is also a senior staff psychologist at Beth Israel Deaconess Medical Center and an Associate Professor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School. Her cutting-edge research focuses on the relationship between stress and different women’s health conditions for which she creates innovative programs to help women decrease these physical and psychological symptoms. She has earned an international reputation as one of the country’s top women’s health experts.
Dr. Domar also recently lauched an app called FertiCalm. A Mind/Body relaxation app, FertiCalm gives the user more than 500 custom coping strategies for over 50 specific potentially distressing situations that can arise throughout one’s infertility journey. Find it here: http://FertiCalmApp.com/
To read more about Dr. Domar, her internationally-recognized work, and to find information about her speaking engagements, please visit:
How did you become interested in fertility counseling?
My parents went through primary and secondary infertility. It took them about seven years to get pregnant with my sister and five years to get pregnant with me. They talked a lot about how hard it was to go through infertility, so I was very aware of it growing up.
And hearing about it really impacted you?
It did. I got my Ph.D. in health psychology and the program called for a medical specialty as well. I chose OB/GYN because no one was really doing anything for the mental health of women who had OB/GYN medical issues. When I was doing my post doc, the head of the infertility center of Beth Israel Hospital proposed that we do a study looking at the impact of relaxation techniques on unexplained infertility. I started doing that project, and then began offering The Mind/Body Program for Infertility in September of 1987. It was immediately extremely popular, and we started noticing that women were getting pregnant. This led to getting two sequential grants from the National Institute of Mental Health, to study the impact of stress on reproduction. I've trained people all over the world in the Mind/Body Program. I lecture constantly about the stress/infertility relationship. I believe there are lots of people out there who have benefited from looking at this equation.
Can you talk a little bit about how stress affects fertility?
Well, it's a chicken and egg question. We know that infertility causes a tremendous amount of stress, and fertility affects every aspect of a person's life. It affects their relationship with their partner, it affects their sex life, it affects their relationship with their family, and their relationship with their friends. It affects their job or career. It affects their financial security, and it affects their relationship with God. There is really no other disease that does that. And, on top of it, people blame you for your condition. If you're diagnosed with cancer no one says to you, "Oh, just relax, your cancer will go away." But when you tell someone you’re dealing with
infertility they say, "Oh, just relax, just adopt, stop working so hard."
Infertility has been classified as a disease by the World Health Organization and yet it's not covered on most insurance policies in this country. People see it as an elective entity. The disease itself causes tremendous stress, and unfortunately, I personally think that stress then contributes to infertility. And the reason I can say that with relative authority at this point is there have been a lot of different studies looking at psychological interventions for infertility patients. And pretty much every one of them has shown that when women do some kind of stress management regime, their pregnancy rates double. In fact, in two of my studies they almost triple.
You also did a study that talked about how stress levels of those dealing with infertility are on par with cancer or heart disease.
Yes, they are. The one I did was the first to show that, and there have been two or three studies since then, and they all show that fertility patients and cancer patients incur comparable stress levels.
You established The Domar Centers For Mind/Body Health, can you tell me more about the program?
At The Domar Centers we have a lot of different modalities and we only offer ones that have research behind them. We offer the Mind/Body Infertility Program. We have three psychologists who do individual and couples counseling, mostly cognitive behavior therapy. We now have five acupuncturists, and I think we're going to have to bring on a sixth. We offer acupuncture 7 days a week, 365 days a year. And we have a nutritionist because we know that obesity or being underweight make you less fertile.
Speaking of nutritionists, you advocate health care professionals making better lifestyle recommendations for patients.
Yes. When I see a patient for the first time, that's what we call the Mind/Body Consult, where we go over all their lifestyle behaviors, because we know that excessive exercise, alcohol, nicotine, caffeine, depression, all those things can reduce fertility. I've had so many patients who literally cut back on exercise and spontaneously got pregnant. Or, look at the impact of anti-depressants. We published a paper about three years ago, a literature review showing that anti-depressants may hinder fertility. And yet, our own data show that anywhere from 11-13% of infertility patients are taking an SSRI, and no one's telling them to try going off it.
In regards to using modalities that have research behind them, you’ve talked about how group interventions might be more helpful than individual sessions.
Yes, the more powerful data is on group. A researcher in Wales found that skills acquisition, not simply talking about how hard infertility is, benefits women the most. And another meta-analysis showed that interventions that were more than five sessions were more effective than interventions that were fewer than five sessions. The Mind/Body Program is ten sessions. It’s CBT with probably ten different relaxation techniques. One of the ten is mindfulness, but muscle relaxation, autogenic training, hatha yoga, imagery. We do a lot of different ones so that patients can pick and choose the ones that work for them.
Why do you think the groups are so helpful?
I think it feels really safe. And I think infertility is still really so isolating. A lot of people don't talk to anybody about their infertility, they’re not going to post on Facebook, "Oh, my IVF cycle failed." With a group, someone can walk in a room and say, "I just found out my sister's pregnant," and everyone will go, "oh, we're so sorry." Which is exactly what she needs to hear, rather than, in the real world, people think, well, you should be happy for your sister. I think being with other people who really get it, you can talk about stuff and they say, “oh yeah, me, too.” Or hearing other people say stuff that you were embarrassed to even think about. It’s very
Why do you think there's so much shame and secrecy surrounding infertility and miscarriage?
It’s a question I've asked a lot. I think because it involves sex, and shame, and loss of femininity, or masculinity, virility. It's embarrassing. It’s part of your reproductive organs and we don't usually talk about stuff like that. Which makes it really hard because there's very little public discourse about it, and so all these ridiculous myths keep on going around. And celebrities that
have twins at fifty, they keep those myths alive, and so when someone does confide in another that they're going through infertility, that person proceeds to repeat all these myths.
Speaking of those myths, what are your thoughts on when people just say, "just relax and you'll get pregnant?”
I want to slap them. There is no data anywhere that shows that relaxation leads to fertility. When you look at the data on these psychological interventions like the Mind/Body Program, my patients work really hard. They’re coming to a class for 2 1/2 hours, for ten weeks. They're practicing relaxation techniques every day. They're doing cognitive behavior therapy every day. They're changing all their lifestyle habits. They're learning to communicate with their partner in a different way. That is not relaxation. That is a whole reset button.
You have seen extraordinary rates of success with your Mind/Body Infertility Program. Can you talk more about the outcomes that you've seen?
The outcome I focus on is psychological improvement because I'm a psychologist. I always tell patients that pregnancy is a happy side effect. The goal of the program is not pregnancy. The goal of the program is to get your life back, so that you don't live in 28-day cycles, that you become who you were before, someone who just also happens to be going through infertility. That said, usually more than half of our patients get pregnant within six months.
You wrote, in Conquering Infertility, “I always tell infertility patients that if you want to be a parent, somehow, some way you will.”
I do believe that. I think, a lot of the work I do with patients is, if they need to be moving in that direction, is to start thinking about what parenting really means to them. Are you becoming a parent to reproduce yourself or your parents? Are you becoming a parent because you want the experience of parenting a child? It’s a hard journey, but when people make it, and they move on to donor egg or donor sperm, and they have children, they are invariably ecstatic. You just had that baby, it's your baby. No question. There's no data to show that parenting a donor egg child is any different from parenting a genetic child.
What is your favorite thing about working with your patients?
When they get happier. When they get back to being the person they were before infertility. And I do, I love the babies, I certainly got into this field because I love babies. About every couple of weeks either someone brings in a baby to visit, the donor egg babies and the adopted babies and the pregnancy babies, it's really nice to see my patients happy.
Is there something you find yourself saying to most patients? Something you find yourself saying over and over again?
Yeah, it sucks. Infertility sucks. It's really hard and I think people going into it don't know how hard it's going to be.
What advice can you offer to someone seeking therapy while dealing with infertility?
I would ask your infertility doctor who they recommend. There are a lot of people who put out shingles saying they specialize in infertility, which means they've seen one infertility patient. They also can go to the American Society for Reproductive Medicine website, www.ASRM.org, and look under the Mental Health Professional Group, and all the members are listed. Those are the people who really specialize in reproductive medicine counseling.
*interview has been edited and condensed for clarity.
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