In many ways this may be the most important section of the Plan. It is our minds that drive action and our success or failure is, in part at least, down to our current mental make-up. 

For example, you may decide to take certain steps described in this Plan but if you don’t then actually implement the actions then they clearly will not have any effect. A lot of people read “self-help” books and either don’t believe the advice can work, don’t try it at all or try it for a short time only to return to their previous ways. They then complain the advice doesn’t work!

I do not have a lot of time for most self-help books but when you separate the good from the bad there are some helpful things out there. It is worth noting that Einstein believed that humans only use a small percentage of their brains and that by harnessing the full power great things are possible.

Anthony Robbins is a famous American self-help guru and in his books he often refers to a concept called “Personal Power”. In essence, this is all about taking action. Actually, walking the walk by consistently and persistently taking the steps needed to achieve something.

Of course, a pre-requisite for this is actually having a goal in the first place. It is the goal itself that provides the motivation. Let’s start this section by looking at goal setting.

Goals

A lot of the information written about goal setting seems phony. Some of it is. Many of the books are written for a US audience and so to more reserved folk they can seem a bit over the top. However, behind all the hyperbole there is real power in having specifically-formed goals.

What can they help with?

How can they help?

There was a study done at Harvard University in 1979 where students were asked whether they had written goals. At the time only 3% had actually written down their goals. When the researchers carried out a follow-up 10 years later it turned out that the 3% with written goals were earning on average 10 times more than the other 97%[1].

What is also interesting about this study is the fact that 13% of students had goals but they had not been written down and 10 years later these individuals were earning twice as much as the 84% that had no goals at all. Whilst this study focused on financial success it illustrates the power of written goals.

Another study at the University of California showed that by writing down goals you are 42% more likely to achieve them.[2]

Why does putting goals in writing increase our ability to achieve them so significantly? Nobody knows for sure but it seems that committing goals to paper brings clarity of purpose and provides direction for our minds. Edwin Locke, a leading researcher in the area of goal setting over the last 40 years, describes the benefits of written goals as follows:

“Goals affect performance by directing attention, mobilizing effort, increasing persistence, and motivating strategy development [(ways of achieving the goal)].”[3]

The very fact that you are reading this Plan suggests that you have a goal: to have a baby. The key question is have you written it down in detail? If not, now is the time to do it. Don’t put it off, grab a pen and paper and do it now.

What can we do?   

Here is a step-by-step process to set your goals. The focus here is of course success with IVF but you can use this process to set goals in any area of your life.

You will need to revisit this process once you have been through the Plan but it is important to make a start now.

Choose your goal

What is it that you want to achieve? Once you have decided visualise the goal in as much detail as possible.

Write it down

Commit the goal to paper. Don’t use a scruffy piece of paper, use something that befits the goal. It is important that you take the detail visualised in the previous step and write it down. It should be clear and specific and should be expressed in the present tense, as though you have already achieved it. So, for example, rather than “I want to have a baby” you should write something along the lines of “I have a beautiful, healthy baby utilising my own eggs and my husband’s sperm.”

Set a deadline

By what date do you want to have achieved the goal? Be realistic whilst also making the deadline challenging. Doing this will help you maintain the focus required to achieve the goal.

Set sub-goals

Big goals can seem overwhelming. By definition a big goal is likely to mean that there are several things that must be done along the way to achieving it. Breaking things down into smaller chunks helps the goal seem more manageable and therefore more achievable. Completing the chunks along the way also serves to keep motivating us towards the goal.

You will probably need to revisit this part once you have been through this Plan. That’s ok. Complete it as best as you can now and return to it later.

Look for obstacles

It is rarely the case that the process of achieving a challenging goal is smooth. It is therefore helpful at the outset to project forward and identify things that may crop up that could get in the way. Once you have identified these list ways of overcoming them. Forewarned is forearmed.

Develop a plan

Start by writing down today’s date and the deadline for achieving the goal. Then place your sub-goals at appropriate places in between. Use each of these as headings and list the individual steps necessary to achieve each sub-goal. For the purposes of succeeding with IVF you should include the steps in this Plan that you have decided to follow. Some steps, such as following the MDWT (see the Nutrition Section), may be things that you want to follow throughout the process, in which case list them under each sub-goal.

Again, you will need to come back to this once you have been through the Plan.

Once you have completed this step you will have a roadmap to follow.

Prioritise

Each day do the thing(s) that will have the biggest effect in moving you closer to your goal. You may have heard of the 80:20 rule which states that 80% of the value is in 20% of the tasks. Focus on that 20% day in, day out. If you are able to do more then great but don’t neglect the 20%.

Visualise

Every day take at least 5 minutes to imagine how your life will be when you have achieved your goal. Engage all your senses and ensure that you experience it in as much detail as possible. See what you will see, feel what you will feel, hear what you will hear, smell what you smell and taste what you will taste. Make sure that you do this in the first person so you see things though your own eyes and not an image of yourself doing the thing that you are visualising. At first visualising may not come naturally but with practice it will come. Imagine things as vividly and as realistically as possible.

Take action

As hypnotist Paul McKenna says “if all you had to do was think about what you wanted and it magically showed up a few moments later, everyone would be driving a Ferrari, living in a mansion [and] wearing expensive jewellery!” The final step is to take action. Follow your plan, take the steps each and every day until you have achieved your goal. Don’t allow any setbacks to knock you off course. With big goals setbacks are almost inevitable. If you come across one get back up, dust yourself down, adapt your plan if necessary and keep going. Never give up, absolutely never give up.

Stress

In the Oxford English dictionary stress is defined as:

“a state of mental or emotional strain or tension resulting from adverse or demanding circumstances”.

Stress is not necessarily a bad thing; it is actually an important part of our body’s defence mechanisms. It is the continued unnecessary stress responses produced by our bodies that can be problematic. For early humans the stress response helped them fight off wild animals or run away from danger (the “fight or flight” response). When a dangerous situation arose our body would pump out hormones which gave a boost of energy to help them deal with the situation. Whilst these hormones are helpful in such situations they can have a negative effect on our immune systems if they are released too often. This then leads to chronic inflammation that over time can lead to serious problems.

Our nervous system controls our stress response and cannot differentiate between a real or a vividly imagined event. In addition, it cannot tell the difference between a threat to our life and a threat to our ego. The result is that as we go about our daily lives many of us experience frequent and inappropriate stress responses to dangers that may never happen or events that do not actually threaten us. In the grand scheme of things getting stuck in traffic, arguing with a friend or getting an unexpected bill are minor events but if we are not careful we can blow them out of proportion and in doing so we trigger the stress response unnecessarily.

Too much of this can cause health and fertility problems.

What can it affect?

How can it harm us?

The health effects of too much stress are well documented. It has been linked with increased risk of heart attacks[4], Alzheimer’s disease [5], depression[6], cancer[7], diabetes[8], obesity[9] and strokes[10]. Too much stress is serious stuff.

There have been many studies on the impact of stress on IVF success and the results have been mixed. Some conclude that stress has little or no effect whereas others conclude that stress does have a negative effect. Explanations for the differences may lie in the difficulties in measuring stress levels – it is difficult to assess objectively what is going on in people’s minds – and how different people react to stress, some being more resilient than others. However, there are numerous studies that found stress has a negative impact. Add in the fact that clear links have been shown between stress and health issues generally and it is reasonable to conclude that stress may also impact fertility. If there was any risk at all that stress may impact IVF success my wife and I decided that we would take steps to address it.

Unlike other areas, analysing the impact of stress does not lend itself to measuring the effect in numerical terms. For example, in some areas it is possible to conclude that doing x (whatever x might be) leads to a y% improvement or z times difference.

However, higher stress levels have been associated with:

1. fewer eggs available for collection[11]
2. lower numbers of fertilised embryos and transferred embryos[12] [13]
3. decreased embryo implantation rate[14]
4. lower pregnancy rates^{[15] [16] [17]}
5. lower live birth rates and birth weight^[18]
6. poorer treatment outcomes generally^{[19] [20]}.

In men the position is similar. Increased stress levels have been linked with:

1. decreased sperm concentration[21] [22]
2. lower sperm counts[23] [24]
3. lower sperm motility (ability to move and propel)[25] [26]
4. decreased morphology (proportion of normally-formed sperm)[27] [28]

What can we do?

The question now is what can be done to relieve stress? Each of us will experience events that would cause stress in most people. Whether it is an accident, the death of a family member or divorce a certain level of stress is to be expected. However, as we said earlier much of the stress we experience is not the result of big events, it is the result of minor events that we react excessively to. It is our body’s reaction to these events that trigger our stress response unnecessarily. In other words, it is not necessarily what happens to us, it is the way we react to it that is important.

A number of things have been shown to improve our resilience to stress; if you suffer from excessive stress levels you should consider doing one or more of the following things on a regular basis. My wife, for example, found hypnosis, weight training and reading to be very helpful:

1. hypnosis[29]
2. guided imagery[30]
3. yoga[31]
4. mindfulness meditation[32]
5. jogging[33]
6. using colouring books[34]
7. spending time in nature[35] [36]
8. taking a walk[37]
9. tai chi[38]
10. weight training[39]
11. reading[40]
12. creative activities[41]
13. gardening[42]
14. volunteering[43]
15. laughing[44]

Positive Attitude

Having a positive or optimistic attitude can have a significant impact on our health. The same is true of a negative or pessimistic attitude but of course the nature of the impact is very different! For example, a study[45] of 70,000 women found that women with the most positive attitude had a near 30% lower risk of dying from a variety of diseases compared to the women with the most negative attitude. Specifically, optimism is associated with lower levels of heart disease[46], a stronger immune system[47], better cholesterol levels[48], lower blood pressure and slowing the aging process[49].

Having a positive attitude has also been shown in a number of studies to improve the outcomes of patients undergoing treatment for a variety of conditions including heart disease[50] [51], lung cancer[52], alcoholism[53], chronic pain[54], keyhole surgery[55], hysterectomy[56], back pain[57], heart attack[58] [59], obesity[60] and mental health issues[61].

Clearly there is something at work here…

What can it help with?

How can it help?

There aren’t many studies that look specifically at the effects of positive and negative attitudes on IVF however there are a few more that look at the effects of depression and fertility/IVF. Depression is not the same as a negative attitude or pessimism but there are some similarities. Some of these studies show no/little effect whereas others show a significant effect.

The one study[62] that I could find looking specifically at positive and negative attitudes took 198 women undergoing IVF and looked at how optimism and pessimism affected IVF success. The researchers divided the women into groups based on whether they were optimistic or pessimistic and then looked at pregnancy rates over the course of 18 months. They found that women who were pessimistic were 18% less likely to become pregnant.

When it comes to depression a large Swedish study[63] involving over 23,000 women carried out over 5 years looked at the effects of depression on IVF success rates and found that women who were depressed and not receiving antidepressants were 42% less likely to become pregnant.

Another study[64] this time at Boston University School of Public Health and Medicine looked at the effects of severe depression on women’s ability to conceive and found that those with severe depression were 38% less likely to conceive.

To complicate matters, another study[65] has shown that women with depression who take a type of anti-depressant called non-selective serotonin reuptake inhibitors (also known as non-SSRIs) are 3.5 times more likely to suffer a miscarriage in the first trimester compared to those that do not take ant-depressants.

As a side note it has also been shown[66] that a positive attitude can affect newborn babies with optimistic women giving birth to healthier and heavier babies.

What can we do?

Whilst my wife was certainly not depressed her outlook did tend to be slightly pessimistic so based on the above we decided to take action.

If you suffer from depression, think there is the slightest chance that you may suffer from it or are taking non-SSRI anti-depressants you should consult your doctor. End of story. It is not something that you should try to treat yourself.

If you do not fall into one of these categories and simply want to become more optimistic there are a few things that have been shown to encourage positive thoughts:

Visualisation

Studies[67] [68] [69] have shown that visualising your “best possible self” increases optimism. This exercise involves taking at least 5 minutes (the longer the better) to close your eyes and visualise how your life will be in the future if everything has gone exactly how you want it go. You should cover every area of your life including relationships, career, health, IVF success and hobbies. You should see things through your own eyes and make the experiences as rich as possible to include sights, sounds, smells and feelings.

Once you have done this commit your best possible self to paper. Don’t worry about spelling or grammar just get everything down on paper in the same level of detail as you visualised.

Do this at least 3 times a week and everyday if possible. It is very similar to the visualisation that you should do as part of the goal setting process so you can combine the two exercises if you prefer.

Keep a gratitude and kindness journal

Periodically noting down the things that you are grateful for and your acts of kindness has been shown to increase optimism as well as life satisfaction[70] [71]. This can be a very simple process whereby you keep a notebook and every now and then write a short note. Again, the more frequently you do this the better the results.

Meditation

Meditation has been shown to cultivate greater optimism and positive thinking[72] [73]. It is also extremely relaxing. There are many different forms of meditation ranging from “body scan” meditation where you concentrate on specific parts of your body to walking mediation where you consciously focus on each footstep. There are so many types that it would be impossible to list them here. In addition, people tend to find that they prefer one form over another. If you would like to give meditation a try there are several good resources online, including www.mindful.org.