Event Review: Under Pressure - Mental health in reproductive science

The 14th session of the International IVF Initiative was held online on 15 May to support the professional IVF community during the COVID-19 pandemic. The event, 'Under Pressure: Mental Health in Reproductive Science', aimed to 'shine a light' on the pressures and pains of the profession and, through a survey, explore stress and burnout amongst IVF lab staff worldwide.

Senior clinical embryologist at London Women's Clinic, Swansea, Dr Giles Palmer co-hosted the event alongside Dr Marlena Angle, president of the board of directors for the Southwest Embryology Summit. Dr Palmer opened by explaining that reproductive scientists work in a highly skilled environment, where scientists 'race to do more and do it better'. The job is precise and relies on manual skills. However, modern regulations dictate that more time is spent on administration away from the laboratory.

Panel member Dr Jose Castilla, Medical Director of CEIFER Biobank, shared the findings of an ESHRE 2015 steering committee, which reported that only three out of 27 national health services recognised embryology as a profession. He also highlighted there was a lack of consensus on the minimum staffing-to-IVF cycle ratio. A more recent survey in 2018 by the US Society of Reproductive Biologists and Technologists showed that 89 percent of all IVF working professionals reported experiencing moderate to high levels of stress in their job.

As part of the IVF initiative, an online survey was conducted to formulate an international consensus on the topic. Preliminary data from the survey indicates that over 50 percent of respondents reported experiencing exhaustion to a significant degree in their work. I completed the survey in less than five minutes and found it easy to navigate. For me, it highlighted how much embryologists carry in the workplace, from managing the critical timing of embryo procedures to delivering bad news to patients.

The first speaker Dr Bryan Tully, an occupational psychologist, who spoke about stress and burnout in other professions, specifically policing. He explained that 'burnout' is associated with vivid imagery and is evident especially where professionals entered with very high ideals, goals and expectations. Burnout is characterised as emotional and physical exhaustion, loss of energy, debilitation and fatigue. Other symptoms include depersonalisation, alienation, cynicism and a lack of personal efficacy. He concluded that organisations should provide transparent and supportive working environments and policies, as a poor climate of social relationships leads to losing good staff, customers and productive value. Ideally, a practitioner should have a voice with management as well as support at their level.

The second speaker, Dr Helen Priddle, an embryologist working in the UK with a special interest in psychotherapy and wellbeing, talked through UK data from an earlier survey in 2018 that is awaiting publication. The response rate of 62.2 percent showed that this issue is important to the workforce. Overall the findings gave a 'pretty bleak picture of the experience of some people in some laboratories', she said. Over half the respondents reported their occupational health issues as stress and mental health. At the time of the survey, 24.6 percent of respondents were experiencing stress compared to 13.8 percent for the general workforce. This finding placed embryologists on a par with reputedly the 'most stressed' industry, health and social work.

Dr Priddle described the major stress triggers: low staff numbers for procedures, lack of breaks, long hours (weekend and overtime), working in a closed laboratory environment, maintaining highly manually dexterous and focused roles under time pressure. A lack of control over workload due to management's poor understanding of how this translates in terms of daily laboratory tasks was also highlighted. Dr Priddle identified the need for a culture of improvement to balance support for effective working. She suggested using established tools such as the Health and Safety Executive Stress Indication Tool, that measures attitudes and perceptions of employees towards work-related stress, to meet moral and legal responsibilities. The Association of Reproductive Clinical Scientists in the UK advocates that people need to report if they feel their health and safety, or that of a colleague, is at risk so that standards of care are not compromised. It was noted throughout that, internationally, stress management and mental health at work is not traditionally covered in professional training courses for reproductive scientists, but that perhaps it should be.

The final speaker, Dr Alice Domar, a psychologist who focuses on the application of mind-body medicine and the relationship between stress and infertility, began by explaining that stress burnout does not necessarily mean a person is mentally ill. Instead, it is a normal reaction to a highly stressful situation, better-termed 'adjustment disorder'. She defined stress as 'the consequence of not having the resources in your life to meet the demands'. She advised that even if you think you may be fine, it is essential to check in with colleagues and family to see if they agree, as we are not always aware of how we project our moods.

Interestingly, stress reactions by gender were generalised: men tend to watch more television and drink more alcohol; women exercise less and eat more junk food. These behaviour changes indicate that our go-to coping mechanisms are often counter-productive, as these strategies don't ultimately reduce stress-levels. She recommended some strategies, including relaxation techniques such as yoga, autogenic training, exercise, a healthy diet, and recommended trying a few until you find the one that works for you. One example of a quick strategy to immediately lower a state of anxiety she gave was to:

• Count down from ten down to one, one number for each breath.
• Inhale to a count of four exhale to a count of four.
• Take a slow deep breath, pause for a count of three then exhale and pause for a count of three

Another good tip I will take away is to balance the food cravings we tend to have when we are stressed in an 80/20 plan; '80 percent is the good stuff 20 percent can be the stuff that you really want'.

As the first international event exploring issues of mental health in the field of reproductive science, a sensitive and constructive light was shone on the areas of identification, need and support. The survey results will provide valuable findings for the workforce.