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Season 4 Joyce Harper is Professor of Reproductive Science at the Institute for Women’s Health, University College London, author, public speaker, scientist and host of the podcast Why Didn’t Anyone Tell Me This? Together with expert guests and people with lived experience, this podcast offers practical tools to help you build a life of good health and happiness. www.joyceharper.com Instagram, TikTok: @profjoyceharper Facebook: Global Women Connected
Joyce Harper (00:22)
It's a great pleasure today to be speaking to my friend Professor Jackie Boven about
trying to conceive, just relax, the truth about stress and fertility. Jackie is Professor of
Health Psychology at Cardiff University and Director of Women's Health Research
Wales. Trying to conceive can be one of life's most emotionally challenging
experiences, as I know too well that it took me seven years to have my family. Yet many
people are still told that if only they relax, pregnancy will happen.
I certainly had that said to me many times. So in this episode, myself and Jackie
separate myth from evidence. We explore the real relationship between stress and
fertility, the psychological impact of going through fertility treatment, the role of
counselling and peer support, and how couples can navigate difficult decisions
together during fertility treatment.
Welcome Jackie.
Jacky Boivin (01:17)
Hi Joyce, how are you?
Joyce Harper (01:19)
Good. Always good to see you, Jackie. let's start with telling us about your career and
what led you to focus on the psychology of fertility and trying to conceive.
Jacky Boivin (01:32)
So originally I wanted to be a medical doctor. That's what I wanted to be, but I couldn't
stomach the anatomy. It was I just couldn't deal with it. So I thought what I'd rather do
then is something that's got biology in it, but no anatomy. So I did psychobiology. And
that eventually led me to reproductive health, fertility, and those sorts of topics. and
eventually became over time an expert in women's health.
Joyce Harper (02:05)
You very much are an expert, and I'm really looking forward to digging deeper into some
of these. Now, we have had in this mini-series conversations around fertility testing,
around lifestyle, what it's like to go through fertility treatment, juggling our time at work,
all these sorts of things. And as you know, I've been through fertility treatment as well.
And the common phrase that many of us on this journey sometimes hear, all too often
actually, is Just relax and it will happen which I personally feel is a bit unhelpful, but
what's your view on just relax it will happen?
Jacky Boivin (02:47)
So I I mean it's So common to hear patients tell us that somebody said, just relax and
you'll get pregnant. So I think that's really unhelpful. And I think it's unhelpful for several
reasons. One, it blames the woman usually, because the it's usually directed to
women. Relax, stop thinking about it, and you'll get pregnant. And of course, that
means that something in her or her not Relaxing or stressing out around her fertility is
actually causing the infertility. So I think that kind of blaming is just not helpful. The
other thing is that the implication of it is that if you relax, somehow your fit fertility will
be restored. So the implication is that it's stress itself that's causing the infertility when
there's not really any evidence for stress having that kind of direct biological role where
you're really and somehow your block tubes open up or your ovaries start working
regularly. It it just doesn't work like that. Fertility doesn't work like that.
Joyce Harper (04:01)
So let's let's split into two scenarios. If we're trying to conceive naturally, or couples
who are going through IVF and other or other assisted reproduction, what do what does
the research actually tell us about these two scenarios with regarding to stress, distress
and outcomes?
Jacky Boivin (04:26)
okay, so I think that the reason people, well, first of all to start, a lot of people think that
stress affects fertility. So stress causes infertility, stress causes miscarriage, cause
stress causes all kinds of things related to reproduction. And I think that comes from
research that's mainly been done on non-human animals, where they can randomize
little mice, for example, to a stress condition and a not stress condition. And if you put
animals in those conditions, then litter sizes are small, smaller than they would
otherwise be. But of course, humans are kind of slightly different animals. That's the
first thing to say. And I think that if you're trying to conceive naturally It's true that you
have interactions between the biology of the stress response and the biology of
reproduction, because we know that from this kind of non-human animal research that
I'm talking about. So there is capacity there for those two to interact. And it makes
sense from an evolutionary perspective that if it's a bad time, there's scarce resources
or there are lots of predators around, that you wouldn't be Focusing on reproduction.
You'd be focusing on fighting off the predators or finding resources. But what people
always forget is that we have very selfish genes, as you know, and they want to
reproduce. And reproduction is a one of the most important aspects of of of our Genetic
makeup, if you will. So eventually we also have mechanisms that suppress this link
between stress and fertility because it's never a good idea to not reproduce at all. And
so, in the context of natural reproduction, either we habituate to the stress around us,
and people will say that they get used to the stress at work, for example, or our stress
system stops responding to the stressors and it's environment or our fertility
compensates for the s the influence of stress hormones on the reproductive access
because it's it's there to reproduce.
In the context of medical treatment, it's even less likely that stress would have an effect
because if you think of the treatments that we have, the fertility drugs, they're there to
almost overstimulate the reproductive axis. And so the stress would have to be
absolutely enormous in order for it to say counterbalance ovarian stimulation, to
actually prevent ovarian stimulation from producing fall.
And of course, if you just look in a broader world context, some of the countries that
have the worst poverty, the most scarce resources, are also the countries that have the
highest fertility rates. So it just is a concept and it's possible in highly controlled non
human animal research settings, but it's not something that causes long-term infertility.
In people as a direct effect. There are indirect effects, but
Joyce Harper (08:06)
Can can we just take one step back? So what what is stress and what's it actually doing
to our body? You mentioned some of the hormones there. So what are the stress
hormones? What's what's going on when our body is stressed?
Jacky Boivin (08:21)
so imagine this this is the way depending on what theories you use, but this is probably
the most common theory of stress. So first of all, an event is in your environment. And
you perceive that in environment, you ask yourself the question, is this a threat to my
well being? And when you perceive a threat, it gets transduced internally from the brain
and it activates different parts of your body, right? So you can have a fast-acting
reaction that causes sweaty palms and racing heart and so on. And it can have a slower
response through the release of cortisol stress hormones, for example.
So that's what happens in terms of the physiology of when you perceive that threat. But
cognitively, you then ask yourself the question: do I have the resources to manage that
threat? And the the management of the threat is things like your coping resources. You
know, can I problem solve myself out of this situation? Do I have social support? Do I
have financial resources? These are all your coping resources. So
Those stress reactions, the physiology or things like feeling tense or insomnia or all
these other stress reactions, they occur when the threat is really high and your
resources are really low. That's the greater likelihood of stress effects. But most people
can manage the stress that's around them and their environment because they have
enough coping resources. And we see it in fertility clients, for example.
Why is is it the case that there's not a hundred percent of people that go do counseling?
It's because most people can feel they can cope with their own resources with the
family and friend support, with clinic support, and so on. It takes a long time for people
to feel that they don't have the resources to manage. And then they go, okay, I I can't do
this on my own. I'm gonna see the counselor, and that's the coping resource that brings
these two things into.
Balance and so stress reactions can happen, but the extent of stress reaction you
would need to shut down the reproductive system would be enormous. You know, it's
it's not likely to be your typical stress that the typical average couple faces when they
undergo fertility treatment.
Joyce Harper (11:10)
And you mentioned cortisol, so that's the the probably the hormone that many people
have heard about. so what so cortisol goes up when we're stressed. Have there been
studies that have measured cortisol in different groups of people who were trying to get
pregnant to see if there was any differences?
Jacky Boivin (11:32)
yeah, there are studies that look at stress hormones, but they're kind of imperfect
studies in a way, because the the fact that the stress hormones go up doesn't
necessarily mean that it has a knock-on effect on something else. So for example, there
are studies that have looked at salivary cortisol, for example, or hair cortisol, or the the
manifestation of cortisol.
All in hair samples, which is slightly more chronic stressors. And you can have these,
these can be elevated, but that doesn't mean that the axis that produces that stress
hormone depresses the reproductive system. It could be elevated and not have an
effect at all on the axis that regulates reproduction, or that axis that regulates
reproduction.
Production may be under the control of fertility drugs, in which case, even if you had
high levels of cortisol, it wouldn't have an effect, right? So it's it's that kind of balance
that's often not properly examined in the context of humans.
Joyce Harper (12:53)
And what about when we relax? So when we relax, what are the important hormones
there and what is relaxing doing to cortisol?
Jacky Boivin (13:04)
well I think that people will see that there may be differences in hormonal response, but
the the better effect of relaxing Is the effects that it has in a more behavioral sense of
what we're doing that might interfere. So when we're stressed, it's not just the inside of
the body that may be responding, it's also what we're doing in terms of behavior. So, for
example, when people are really stressed, they might have sex less often, and that's
going to have a direct effect on fertility. Or they might be overeating Or under-eating,
that's going to have an effect. And as you know, these are clearly well demonstrated
effects. Or you might over-exercise and really get into marathon running and so on, and
that affects your reproductive system. Or, and we see this all the time: that when
people are stressed, they stop treatment, they stop fertility treatment. And we have
even in places like Belgium, where they have six free cycles, 25% of people drop.
Drop out after the first unsuccessful cycle. And it's that that that percentage is about
55% after the second unsuccessful cycle. And this is despite the treatment being free
and people having still a good prognosis to achieve parenthood. So, because it's too the
stress of treatment is too great for them. It just they drop out. And of course, if they're
not doing the treatment, they're not going to be able to get pregnant. So it's not just the
Internal changes we have to think about, it's the behavioral changes that stress causes.
Joyce Harper (14:49)
Yeah, and you've it that's important what you said there because if another common
saying that I've heard if a couple are trying to get pregnant, not getting pregnant, is just
go through IVF. And we've already discussed on this podcast in the in the last few
episodes. Just going through IVF is another crazy statement. I I having been through it
myself, it was a very, very hard procedure to go through. It was not easy. And certainly
Jacky Boivin (15:16)
Yeah.
Joyce Harper (15:17)
I had stress when I was trying to get pregnant because every time you get another
pregnant sorry, another period, you are obviously became very sad. So it really does
have an effect on your mental health. But going through fertility treatment is a very
stressful procedure. And the study I did years ago asking people that were past
reproductive age but had wanted children and didn't have children, those that'd been
through IVF, it was that emotional reasons why they stopped IVF. It's not financial. as
you said, in some countries it's paid for, but it's it's just very, very hard to go through IVF.
So is there anything that we should be advising couples about, as you said, it's it's the
sort of s more social side, having less sex, eating, overeating, things like that. So
whether they're trying to get pregnant naturally or going through IVF, Are there ways that
they can try to regulate themselves so they're not becoming super stressed by the
situation that they're in?
Jacky Boivin (16:26)
Such an important question and thanks for your kind of Reflections there. I mean, there
are many points in the fertility treatment that are extremely difficult for people. Even
starting on the journey is really difficult. And it's difficult if you're doing it on your own.
It's difficult if you're doing it as a couple because sometimes people say, you know, for
couples it's easy, they can support each other. So there are many points along the way
where there'll be A lot of stress and anxiety. I guess the thing to consider is this balance
that I was talking about earlier. So, first of all, obviously when you imagine being under
treatment, it's it's a threatening situation. There are many unknowns for people. And we
know that having a lot of uncertainty is a very stressful can can act as a stressor in itself.
So the first thing that think Needs to happen is not actually from the couples, I think it's
from the clinics. Many clinics don't really inform people of the reality of fertility
treatment. And I think people are poorly prepared for what undergoing fertility treatment
entails. There's a kind of norm within the the service providers that to to go cycle by
cycle. So you talk about here you're going to be doing a cycle of treatment and then
we'll see what happens. But the reality is that for a lot of people they'll need multiple
cycles to achieve a pregnancy. And if for a lot of people they'll do them and not achieve
pregnancy at the end of it. And if people were better prepared for those, then they could
better manage those demands. And I you know, in our kind of multi-cycle planning
approach, what this really means is Being prepared, first of all, for the fact that it's likely
to take multiple cycles. Two, that people give you the opportunity to think about the
challenges that might arise, whether financial challenges, relationship strain, the
physical demands of treatment, like you said, the worrying about whether this
treatment cycle is gonna work, all of those Are known challenges. They're not secrets in
IVF. We all know what the challenges are. And when you ask couples, well, what would
you do if you had a financial challenge? What would you do if you had relationship
channels? They can readily come up with solutions, right? So what we need to do is
prepare couples for the possibility those might arise so that they can have a kind of IVF
plan, imagine what the challenges might be, and prepare for them in advance.
Rather than be in the middle of a super stressful interaction in a couple and have to
think of what the solutions might be so they're not so stressed out or they're not so
conflicted with each other. And the clinics can do that. We have lists, they could just
put them on a waiting table somewhere in the clinic. The other thing that stresses
people out is these protocol changes where your treatment doesn't work, and you
know, Joyce, you have written so much about this.
The treatment cycle doesn't work, the couple wants something different. And they
immediately go to all kinds of add-ons that could, you know, and they think they could
improve their success rates. But in reality, we could we could tell in advance the
couples that there likely be protocol changes or not, right? If the cycle doesn't work,
we're not going to do anything. Or if the cycle doesn't work, we might adjust your drugs.
And tell people in advance all the possible prot not all, but the main protocol changes,
like you might have to use exterior, or you might have to have more drugs, or so people
can anticipate them in advance and think of decisions, what what decisions they would
make if they were faced with that. I mean, we do it with birth plans. We should have IVF
plans as well. and I think that would help people to prepare for their IVF cycles. I've
probably gone on a little bit too much on that, but it's a lot IVF is a lot about preparation
and putting your resources. You see the threat and putting your resources up front. So
when the threat happens, you're ready. You know what to grab to help yourself through
the the situation.
Joyce Harper (21:20)
Yeah, and I IVF Add ons has come up in all of the episodes of this miniseries. And the
next podcast is going to be with Sarah Lenson, who's been doing some brilliant work
down in Australia. And
Jacky Boivin (21:30)
Yeah, great.
Joyce Harper (21:32)
we're the whole episode's gonna be about IVF add ons. so we'll we'll go that Yeah, and
Jacky Boivin (21:36)
Yeah, I think that's that's gonna be really important.
Joyce Harper (21:39)
it and it is such an emo emotional roller coaster, and a lot of people that have in relation
to add ons, they found it very stressful when they've been maybe partway through their
treatment. Hannah Vaughan Jones, who I had on this podcast in one of the first
episodes I ever did four years ago, has been through a lot of fertility treatment. And she
she said that there was one day she was literally they were had just had her eggs
collected. And then the clinic came up with, there's all these add-ons that we think you
should do. And she's like so emotionally stressed already. And then they're add they're
adding this at
Jacky Boivin (22:15)
Yeah. Yeah.
Joyce Harper (22:16)
Totally Inopportune moment. That is not the time to have this conversation around,
Jacky Boivin (22:23)
No exactly.
Joyce Harper (22:24)
you know, it's it's it's crazy. And you also mentioned mentioned counselling. Now in the
UK, I don't know what the situation in other countries, but in the UK, I believe every
patient is offered a counsellor. And I don't think that many of them take it up because I
think we have this thing in our head that if you're seeing a counsellor, there's something
wrong, but Having been through fertility treatment and those that listened to the last
episode with Becky Kearns and the stress of going through this and trying to juggle your
work, I started crying again because I so many emotions came up from when I was
going through fertility treatment. And I I think counseling really should be encouraged. It
gives the patients a platform with someone who's really experienced in dealing with any
emotional issues that could come up, to it's a space for you to talk about it and to
unload how you're feeling around going through this treatment. What what do you think,
Jackie?
Jacky Boivin (23:26)
Yeah, I I think that these big life events people can always benefit from having
discussions about the life event to find a way to process it and integrate it with the rest
of their life story. How do you make sense of something like this? but at the same time,
you have to balance it with what people want to have And the research shows that when
you make counselling mandatory, people don't benefit from it. It benefits when
counselling is targeted at at-risk groups, for example, that already have vulnerabilities
because of past trauma, for example, or vulnerabilities because of past episodes of
depression or other mental health conditions. Or, you know, they have a history of
recurrent miscarriage they they it just wears them down after four, five, six
miscarriages, right? And you just feel like you need to have those discussions. but for a
lot of people this will not be Their first point of entry. The majority of people don't use
counselling. So what do we do with those people? Do we just say, sorry, we can't, you
know, if it's the counsellor or nothing? And that's why we've certainly encouraged
fertility staff to train to be able to provide patient-centered care so that everybody gets
something and the staff are more prepared to support. People psychologically. And
more recently we've been doing also things like workshops on sharing bad news or
expectation management with staff. Because otherwise people would all those people
that don't see counselors wouldn't get anything. So it's it's a balance there.
Joyce Harper (25:35)
So you mentioned about bad news. So the bad news that can happen in so many stages
for anyone going through fertility treatment. So obviously, first is finding out that you're
may not be able to respond well to the fertility drugs, or you have an egg collection, but
maybe you don't get many eggs, or you don't get many embryos, or you don't have many
embryos to transfer, or I need to freeze, and then you've got the two week wait for your
pregnancy test, and then for a small group of people, that will be successful, but for the
majority of people it will not be successful. And people I know get so concerned when
they haven't got pregnant, even though we know the data, we know the data in the UK
for the youngest group, so the under 35s, is still only about 33% chance of getting
pregnant in any one cycle. So it you mentioned that. We we talked about counselling,
you've mentioned training the staff in the clinic. Is there is there anything else that
couples going through this could do? I know some clinics are employing psychologists
to help and give support. Is there any way that couples can help of or find help with this
emotional roller coaster that they're embarking on?
Jacky Boivin (26:59)
yeah. I think you forgot also two other points that we see in research, which are really
high stress points. When there is a psycho cancellation, early cancellation, because as
you say, there's no eggs or no sperm or no fertilization. That's that stress level is the
same as the stress level if this you get to the point of a pregnancy test and it's negative.
also spotting during the second week of the waiting period.
It's extremely stressful that you get like high peaks there. And of course, when you get
pregnant, it's not rose garden. It's still massively stressful for people. And most people
will get pregnant, of course, they can experience a miscarriage, but even if the
pregnancy continues, it's per se it's experienced like a high-risk pregnancy, and it's got a
lot of high stress there. In terms of strategies, well there's no inherently good or bad
coping strategy, but the situation can make it so. So the thing to do is to think of the the
coping resources that will help people. So for example the kind of strategies that might
work during the two-week stimulation phase Might be effective there, like problem
solving, you know, making appointments, being organized, trying to get a lot of
information, et cetera. But using problem solving to try to control the stressor would be
completely useless and probably harmful if you were using it during the two-week
waiting period, because the outcome is uncontrollable and unpredictable.
So trying to control that situation would just result in more frustration and angst, right?
In those situations, you're better to use things like distraction or relaxation or changing
your way of seeing the situation, like being more positive. you know, not positive as in
happy go lucky positive, but every negative situation has possibilities for you to focus on
some positive aspect of it or positive aspect of the outdoors to give yourself a little bit of
psychological break from the negativity of the situation. so kind of knowing which
strategies are better in the different phases of the cycle can be quite useful. I think if
you're talking, because you mentioned couples specifically, I think then for couples
what you really need to focus on
Is the fact that you have two individuals undergoing the same event. And so, you know,
the perceptions of threat and the perceptions of resources are times two, right? and
sometimes women say, their partner doesn't care because they don't feel like the threat
of it, or they're not as stressed out about it, or one partner likes to cope in a completely
opposite way the other partner and it causes relational strain. So being clear at the
beginning and having honest conversations about how you see the situation and what
kind of coping resources you think you're going to use. If one really wants to talk to
everybody about it and the other one really doesn't, it's going to cause all kinds of
massive stress, right? But if you talk about that in advance, then you could probably
find a match there. You know, let's just talk to our closest friends about it.
Something like this, right? The other thing is that there are many decision points in
fertility treatment. So you mentioned some things, like you have to decide are we going
to have treatment, right? If you're having trouble conceiving that, that's one big
decision, and you may have different viewpoints about that. Or should we switch now to
using donor eggs? Massive decision. How much money do we want to put into doing
This treatment. All of those are potential high stress decision moments. And they're
being really good at decision making as a couple is going to be useful. So, you know,
lining up your options, what the pros and cons of each of them are, and then valuing
which of the things are the pros you really, really want to have and the cons that you
really really want to avoid, and deliberating amongst yourselves about these things you
know doing it in a kind of structured way also I think is really gonna be important. And
lastly I think you just also need to step out of the whole fertility thing sometimes and
just go out and do activities that are that take you out of that as well.
Joyce Harper (31:58)
Right, you've you've you've brought up a lot there. So obviously there are people that go
through this treatment on their own, but if we if we let's talk
Jacky Boivin (32:04)
Yeah.
Joyce Harper (32:04)
about the couple more, you've brought up so many different issues there. And one is
that they are two very different people, and so many people are yin and yang with their
partner. So I I was definitely with my partner. I wanted to tell everybody he didn't want to
tell anybody.
Jacky Boivin (32:21)
Yeah.
Joyce Harper (32:22)
so I absolutely relate to that that as you suggested, those conversations are important
to have as soon as you can, and you can only have those with each other. Are you going
to tell anybody? Are you going to tell family or friends? Where do you draw the line? And
we did a women's hour podcast about this a few months ago about how everyone's
going to be different. Some people will want to tell for example work. We discussed that
with the in the last podcast with Becky Kearns.
Some people want to tell their employers, some people will not want to tell their
employers. it's an obvious thing if if you're someone that normally drinks alcohol and
you're out with friends and you're not drinking alcohol, they will start putting two and
two together. So it there's so much just on the day-to-day discussions around that. But
then as you said, the decisions around the fertility treatment, s there's a point if you if
you're not if it's not working, there's a point where one of you or both of you will decide
that enough is enough, or we do go down this next treatment, or we don't go down that
next those are really, really key decisions. And as you've said, I think having those
conversations before, and if you've have everything on the table as you suggested
earlier, and knowing what all the possibilities of treatment are right at the beginning,
then as a couple, you can sit in your own comfort of your own home and discuss where
you might draw the line. And and this will this probably will change as you go through it.
I know people that went through one IVF cycle and said, I can't do that again. And then
our dear friend Jessica,
Jacky Boivin (34:03)
Yeah.
Joyce Harper (34:03)
11 rounds of IVF. Hannah Hannah Vaughan Jones, I think she was on her fifteenth
embryo transfer when she then got pregnant. Everyone's got their own Tolerance for
how much of this because it is so emotional about how much they can go through. So,
do you think one of the key things is those conversations with whoever's going on this
journey with you, understanding that you're different people and trying to talk as much
as possible and not blame each other and all those sorts of things, but sit and discuss
as openly as you can rather than just let things sort of snowball?
Jacky Boivin (34:43)
Yeah, no, I totally agree with you. it has to be open and it has to be in a cooperative spirit
to have those discussions, you know, so you're not like going into the conversation
wanting to compel the person to do the thing that you would like, the option that you
would like. And I think one of the things that I I've noticed is that we're really all very
good at gathering information. But we're not necessarily very good at deliberating on
that information so There are some cognitive heuristics and biases that humans have.
Like we look for information that just confirms what we think. So we bring to the table
only the information that just says the same thing as we want, right? And so you're when
you're having discussions, you're just always armed with the your side of the argument,
and the other ones there with their side of the argument, and then you can't find the
middle ground. So I think what's important there Is that you gather your information and
then you lay out the options. We could do this, we could do that, we could do the other
thing, A, B, C, D. And the first thing you do is what are the things that are completely
non-options for us that are not acceptable? Because then you can already agree on
something, and that makes you think, okay, we can reach a common consensus. We
would never use donor eggs or donor sperm, for example. You could like rule something
out.
And you've already feel like you've done something together, and then go through all the
different ones and lay out for each one of you what are the pros and cons. I mean, I'm
I'm making it sound like it's a very systematic process, but obviously it's very much
more natural when you're actually doing it. But those things are the things that are really
important, and always, as you say, in the spirit of open communication and being trying
to get to a point of collaboration.
Yeah.
Joyce Harper (36:55)
And they their views might might change. I know people that have changed their minds
about
Jacky Boivin (36:58)
Yeah.
Joyce Harper (37:00)
donor conception, for example. So they might change.
Jacky Boivin (37:04)
yeah, absolutely. Very common. Very common. That in adoption. People start off
absolutely no, never. And then the the desire for parenthood is what comes at the
surface and other options become acceptable.
Joyce Harper (37:21)
Do you do you think finding other people who are going through what you're going
through, we'll all have a different experience, but are the s are there patient support
groups that would be useful if they didn't want to talk to the clinic or didn't want to talk
to the counsellor or a psychologist? Who who else could they get some support from?
Jacky Boivin (37:43)
I think the peer groups are really important. People get a lot of out of that. chat rooms,
forums, Reddit groups, wherever you can get people that have similar experiences. I
have a lot of discussions about that with our patient and public involvement group here
at the center.
So on the one hand, these things are really good because they often validate the
experiences that you have in a way that other people who aren't going through the same
thing as you are can do.
I think you also can get information, but from the perspective of the user, like someone
can give you information about a medication, but someone who's had it and has had
tremendous breast pain as a result of it can tell you more about what that breast pain is
like, for example. So so there's a lot of information there that's really useful. But
And this is the point of discussion with these PPI groups that I've just mentioned, or
advocacy groups. it it they can also have like a negative influence. So sometimes
people use forums because they're not satisfied with the health care they get, and they
can be quite negative in the groups about the healthcare experiences, and that can
actually put other people off seeking care. and we've been talking about that in.
In the context of some research we're doing about dysmenorrhea, and people are so
dissatisfied with the way dysmenorrhea or severe period pain is managed that it all the
other people, including their own daughters, for example, get put off and don't go and
seek medical attention. So there is that kind of alternative side to them as well. And it's
it's kind of difficult to know what to do about that because on the one hand,
And the forms are really useful or th that pathway is really useful. But you know, you
can't really tell them, don't talk about negative things, because that's one of the things
they enjoy about going not enjoy, but that that is positive about going to the group. So
it's a tricky one, that one.
Joyce Harper (40:06)
Yeah, and another thing that worries me is if they get some advice that's not the same
as or doesn't agree with the advice they would have got from their clinician. So for
example, maybe maybe using
Jacky Boivin (40:17)
Yeah.
Joyce Harper (40:17)
an add-on or it worked for me, you know, this treatment that costs three thousand
pounds, it worked for me. And then people might be led to think, it might work for them
but but understanding that we're all very different. So please don't ever take any any
medical advice from anybody, which which leads me into social
Jacky Boivin (40:35)
No, I absolutely agree.
Joyce Harper (40:37)
Yeah, and that that leads me into social media. So what are we seeing out there in
social media with regards to the emotional side of fertility treatment? Is it is it do you
know if it's good or is it harmful?
Jacky Boivin (40:55)
I think it's what we've been talking about now. I I think there's a lot of misunderstanding
about how psychology works sometimes. and we get these opportunistic commercial
interests here that can come in for example, of the genre relax and you'll get pregnant,
but the relax is through some you know womb massage for example
Joyce Harper (41:34)
Good.
Jacky Boivin (41:35)
or you know some some other way that's gonna help you to relax and and and probably
for people they don't need to spend that amount of money to relax, number one. And
number two, it's not gonna get them pregnant. So it's like false advertising. It might
change their quality of life. But it's not going to get them pregnant, which is, you know,
the lure that's in these posts oftentimes. And I I remember a conversation I had in a
fertility, not a conversation I had, a conversation I overheard in a fertility clinic. This was
years ago, a clinic on Harley Street in London. And I was waiting to see the director, and
I overheard these two patients talking that didn't know each other, and one patient
Said, I've just done reflexology and I got pregnant is the most amazing thing. And she's
describing this. And I could clearly see that this person was in her 50s and she probably
had donor eggs. And I thought to myself, the reason you're pregnant is because of the
donor eggs. But in her mind, she had done reflexology at the time of embryo transfer,
and that's what got her pregnant. That was her.
Causal explanation for why she got pregnant. And I just thought that was like
remarkable to kind of imagine that. And of course, the other patient was listening and
going, Yeah, maybe I'll do that. Yeah, where did you go? And they were exchanging
information. So the social media is a little bit like that when it comes to psychology. It's
opportunistic, I would say, sometimes.
Joyce Harper (43:26)
Yeah, we there's a number of us that are very adamant that we should be following
evidence based medicine. And this absolutely relates to fertility treatment. And there is
so much. I mean, the I IVF add-ons are almost all non evidence based, and some of
them now are ingrained in IVF clinics and they cost thousands. And some of them have
been around for 30 years, that we'll talk about in the next podcast.
And there's no evidence still that they work, but people are are are doing it. And and if
that breaks my heart, I think they're so vulnerable and they will
Jacky Boivin (44:04)
Yeah.
Joyce Harper (44:04)
do everything anything they can.
Jacky Boivin (44:07)
Yeah, but you know, I I there's something very interesting there. I I a hundred percent
agree with you on that. but there's something interesting that we've discovered in our
research, which is patients do not like to repeat the same cycle. They really don't,
because they think to themselves, why would the cycle get me pregnant when it didn't
last time? They like a change. They like something to to be different. And I think the add
ons you know let's put aside all the commercial interests and all that kind of stuff. I I I
think that it fulfills that need for them to have something different that gives them the
feeling that that they have a a a chance at pregnancy again. Whereas if they just
repeated the cycle, they would have the same chance in a way, right? The add-on is
ineffective. So you might as well just repeat the same thing. It would have exactly the
same effect. But It it serves a psychological function there, I think.
Joyce Harper (45:11)
Yeah, with with the success rate, as I said, it's it's only about thirty-three percent for the
the young younger group. So if you're older than that, your chances are even less. And
we've got so much data on this from authorities like the HFEA that govern facility
treatment in the UK. If it was me, when it was me going through, I didn't change things. If
you're looking at the evidence, you just need to repeat it. It's not it's not seventy f
Jacky Boivin (45:39)
Exactly.
Joyce Harper (45:40)
It's not 76% chance of getting pregnant, 76% chance of not getting pregnant. So you
shouldn't keep changing things. That to me, well, we're both systematic people, so we
we would just want to do the same thing and maybe after three or four goes, then
change something. But that leads us nicely, Jackie, into education. So you and I have
worked together on fertility education and the need to help people understand about
trying to get pregnant naturally, but also trying to get pregnant through fertility
treatment. So from your research, what are the main things that people don't know
besides the fact that they should just not keep changing their IBF cycle? What other
what other things do people not know about their fertility from your work?
Jacky Boivin (46:31)
I I I think the the I remember I used to do the fertility show, give talks there on stress and
fertility, and I I had said to the organizers, I'll do those talks, but they have to be first
thing in the morning. Because then when people are going up and down the stalls,
they're gonna see the things that aren't going to help them and they're not gonna be
lured into it. So I think an having an understanding of the relationship between
psychology and fertility, I think would be really useful, especially Stress and fertility,
because I think that lures people into a lot of different corners. And I think for me, of
course, I would like to have a better education on the reality of fertility treatments, as
I've described earlier in this podcast, that it's multiple cycles, the possible challenges,
the possible protocol changes. So people can start these fertility treatments and make
informed decisions thinking about all those things, but also planning potentially for
those things. So for me, that that would certainly be something that I those two things. If
we could do those two things, I think we'd we'd be well ahead. But of course, yeah, I
think those those two things. I'm going to stick to that.
Joyce Harper (47:56)
Yeah. Going back to the very first question about just relax and and you'll get pregnant.
So we've discussed that just relax is and and reducing your stress is not going to
improve your chance of getting pregnant, but it is important for your mental health. But
as you said, when they go around these shows and things, there is And and they listen
to social media, there are so many harebrained things, and actually things that are
offered by the clinic. There are so many things that are really not going to help. but
they're but for their own emotional resilience and trying to get through their fertility
experience or journey. I know some people don't like journey, but I th I think looking
after your mental health, your own mental health. So for me just even outside the
fertility sphere, just trying to get women to look after their own mental health because
of the crazy lives that we're living, I think relaxing is is really important. But you don't
need to put some strange magnet in your vagina or or you know, d go in an ox
Jacky Boivin (49:11)
Stare at a red dot.
Joyce Harper (49:12)
yeah, I'm trying to think of all the crazy things. I I you know I this
Wellness is just in two branches now. There's all the back to basics, which do sensible
things like go in go for a walk in nature and read a book and you know, walk on the grass
or whatever. And then there's all this crazy stuff, which is all the money-making stuff
about vitamin infusions into your bloodstream and hyperbolic chambers and precious
suits that are draining your lymphatic system and all these crazy things. And
Certainly, my advice for anyone trying to get pregnant is yes, relax, but relax for your
own well-being and your own mental health, because it is a difficult journey that you're
on. But you don't have to do any of these crazy things. If you're listening to a crazy thing
on social media, I would try and scroll over it. Swipe the other way so you don't have to,
because I just think it's insane. What do you think about all these crazy,
Jacky Boivin (50:07)
Yeah. Yeah. Yeah.
Joyce Harper (50:11)
crazy new ways of trying to relax?
Jacky Boivin (50:17)
So I I think again they serve a psychological function. So I think that fertility and
infertility are highly unpredictable, uncontrollable events, but that have immense
personal significance. And I think that when people are choosing things like this, they're
trying to restore a sense of control. And this follows very well-established psychological
Ways that people have to overcome tragic life events. So when tragic life events happen
to you, the first thing you need to go, why me? That's the question people, why did this
happen to me? And people have to find a way to integrate this with how it fits and it sits
in their own life story. Second, people try to restore control. Sometimes, you know,
when people have infertility, they go out and they go like on a whole diet thing and they
eat all kinds of broccoli or you know, vitamin fertility, vitamins and so on. It's not so
much the vitamins they're after. It's the restoring the sense of control that they can have
over this very, very unpredictable life event. And I think the third thing that people try to
do is restore their sense of feeling good. I mean these things will knock you off your
socks. They really, really are difficult. And people will try to do things to restore their
well being. And I think their things like you're talking about what like relaxation or really
good things are going to be the things that help people. And people know what are the
things, you know, spending time with family and friends, doing artwork, whatever it is,
right? The thing you want to avoid is the thing in the middle, because that restoring
control in an uncontrollable and unpredictable situation is just gonna not help you. And
that's what leads to add-ons and leads to buying little red circles that you stare at or all
kinds of getting into hyperbolic chambers and what have you, you know? So y you have
to think, you know, you have to be able to differentiate those things, I think. But it's part
of adaptation to tragic life events, you know.
Joyce Harper (52:46)
It it is a tragic life event. I was gonna mention the word grief earlier and we were talking
about stages. if if you don't have a transfer, if you have a negative pregnancy test, have a
miscarriage, it is obviously a huge grief event. And the why me, my goodness, I had
years of saying why me, why me? yeah, that's very hard.
Jacky Boivin (53:06)
Yeah. Yeah.
Joyce Harper (53:08)
And the fertility supplements, we have done a number of research projects recently on
fertility supplements, and they will be coming out soon and be published and I will talk
more about them then. But Jackie, this leads us very nicely to the last questions which I
ask all my guests. So my first is, what makes you happy, Jackie, and where is your happy
place?
Jacky Boivin (53:33)
I thought about this. I thought, great question. so I I my happy place is being outdoors.
and you know, when I was a kid Up until I was about fifteen. From the last weekend in
May to the first weekend in September, on the Friday and for the entire weekend, we
would go on my dad's land. And there were four or five families and the cars, you know,
you can imagine these old cars back in the seventies and stuff would open, the doors
would open and four or five kids would drop out of it and then you would play in the
countryside. You know, cars were decanted is the way that I can think of it. And you just
roam the countryside.
And that's always stayed with me. And if ever I have stressful events or something, I
always, you know, imagine that area and the being outdoors. And now, you know, it
doesn't matter what the outdoor is now, the festival, the allotment, the sitting in the
garden taking a walk in the park, it always feels it gives me that sense of freedom and it
gives me that just the sense of wonder of nature really. So that's my happy place. And if
I can twin that with, you know, a loved one even better.
Joyce Harper (54:47)
Fabulous. And the very last question, Jackie, what advice would you give your younger
self?
Jacky Boivin (54:54)
The first thing I thought was don't go out with idiots. That that was the first thing I
thought. Then I thought I thought you probably
Joyce Harper (55:00)
I've had that before.
Jacky Boivin (55:02)
wanted some like career advice.
Joyce Harper (55:04)
Necessarily in in my book there was a lot of choose choose your partners more wisely.
Yeah, I I'd agree with that one.
Jacky Boivin (55:14)
Yeah, yeah. So yeah, that's mine. Don't go out with idiots. But no, seriously, in terms of
a career, I was very fortunate. You know, I was one of those young people. I came from
a a poor background and you know, I didn't have the kind of advantage to compete you
know, I could get all great school grades and everything, but once you get to graduate
school and you have to take entrance exams and everything, it was very difficult to
compete, especially since I was second language. My first language is French.
And I I do remember at that time, you know, at some point thinking, you know, I I just
can't do it, you know. And I fortunately for me, my mother said, you know, well, you
can't fall at the first obstacle. You gotta keep going, right? But if I could go back to
myself then, I would reassure myself that, you know, it it just might take more time, but
to keep your sense of self in terms of that, you know, and your your knowledge of your
capacities and being able to work through the those challenges as we w we've been
talking about. You know, if I'd been prepared for them I would have been said, yeah,
okay. I know what this is, you know.
Joyce Harper (56:36)
Well, we're very lucky that you did persevere and your contribution to fertility, fertility
psychology and education has been immense. It's always great working with you and
spending time with you, Jackie. And thank you so much for sharing your
Jacky Boivin (56:51)
Thanks.
Joyce Harper (56:52)
great wisdom on this podcast today. Thank you.
Jacky Boivin (56:55)
Yeah, I really enjoyed it, Joyce. As always, you're always full of life. Love it. Thank you
very
Joyce Harper (56:59)
Thank you