Infertility and Reproductive Health
Infertility is a complex, life changing process that is difficult to understand unless you've directly experienced it. Infertility deeply changes how you feel about yourself and how you interact with others. It is a major life stressor with a diversity of experiences felt by those affected: 1 in 7 heterosexual couples have difficulty conceiving and require fertility treatment. 10 percent of women have difficulty conceiving or maintaining a pregnancy. Same sex couples and choice parents will need third party reproduction to have a family. Resolution is complicated, and it can be helpful to increase support when feeling overwhelmed by primary or secondary infertility concerns.
Psychological Impact
Many people have a strong desire to become parents. Wanting to conceive a child and unexpectedly learning that you cannot is a major developmental and identity crisis. The psychological responses of infertility may include a range of reactions: grief, depression, increased stress and anxiety, guilt, shame, lack of control, anger, isolation, low self-esteem and relationship distress. Psychotherapy can assist in processing the complex feelings related to infertility and repeated losses.
Emotional Response
You may experience grief or depressive feelings from repeated fertility trials and monthly cycles of hope and disappointment. Feelings of despair and sadness increase with the loss of hope over time that a pregnancy will finally end the unpredictable fertility process. Complications from pregnancy loss can be traumatic and cause severe distress. Complex feelings may occur in third-party family building around the loss of genetic connection to the child.
Loss of Identity
Identity concerns may arise from not being able to achieve the expected adult developmental task of becoming a parent. This confusion of one's sense of self, along with the loss of no longer fitting in with friends who are pregnant or new parents, results in many women feeling stuck between two worlds.
Stress + Uncertainty
Infertility is associated with substantial levels of stress due to the strain of the constant unknown. Women report higher levels of anxiety and take on a greater feeling of responsibility for fertility, resulting in shame and guilt. Waiting periods, trying to do everything perfectly, hoping this cycle will be the one, while projecting a happy face can take a toll on self-care. To manage stress, it is helpful to utilize a mind/body approach that encourages wholeness, relaxation and mindfulness.
Anger, Control + Acceptance
It can be extremely challenging to give in to uncertainty and accept events beyond our control; an infertility diagnosis tests this beyond belief. People experiencing infertility can benefit from exploring the lack of control they may repeatedly experience both mentally and physically. Women often report frustration and self-blame regarding the body’s failure to produce a child. Often this leads to feelings of powerlessness, anger and resentment while searching for answers that simply don't exist. Learning coping skills to help face uncertainty without feeling overwhelmed can increase feelings of acceptance and promote self-compassion.
Support vs. Social Isolation
Infertility can be difficult to discuss with others, often leading to secrecy as couples conceal concerns around trying to conceive. You may want to reach out for support but feel misunderstood by family and friends who can appear insensitive to fertility challenges. It is natural to experience feelings of anger or envy toward friends and family who have achieved a successful pregnancy. Be open about your struggles and share experiences with trusting supports who can hold what you are going through.
Relationship Adjustments
Ongoing fertility concerns can decrease self-esteem and impact relationships with partners. Many couples report the loss of intimacy and sexual dissatisfaction as the focus turns to conception over pleasure or spontaneity. Relationships can also be strained due to the presence of an outside party once the decision is made to use donors or gestational carriers to build your family. Individual or couples counseling can teach healthy ways to support each other, communicate feelings and express needs and desires around family building.
Cancer and Fertility Preservation
Women with a cancer diagnosis may be faced with fertility preservation decision-making. There can be a sense of urgency to figure things out before starting cancer treatment. Some younger women will undergo cryopreservation to help preserve fertility for future family building. Other women may already have a child, yet wish to add to their family post-cancer treatment and need to consider fertility options or third-party family building. Decision-making and waiting can be overwhelming, on top of cancer treatment and recovery and everyday life responsibilities. Many complex grief emotions around desired family size may arise. It can be helpful to get extra support during this time.
Single Parents by Choice + Same Sex Couples
Reproductive challenges are experienced by single women and queer couples desiring to become parents. Single women and same sex couples may experience additional complex feelings due to the involvement of donors or gestational surrogates and societal or legal stressors. Fertility equality disparities may exist in fertility medical coverage for LGBTQ and single people. The involvement of a donor in fertility treatments may bring up attachment issues due the absence of a direct biological link to both same sex parents, or lack of a desired partner for choice parents. Parents may also experience anxiety while navigating the presence of a third-party donor or gestational surrogate, or when trying to explain their child's conception.
Women of Color
On top of the complex grief and stress related to infertility, women of color experience disparities in fertility treatment due to structural racism, discrimination and the longstanding bias that focuses on the white fertility patient experience. There is a lack of diverse representation everywhere: from infertility research participants to clinicians and imagery in waiting rooms. Women of color report a disconnect with fertility medical providers, and are more likely to have to advocate for themselves. People of color also experience challenges in finding racially diverse egg and sperm donors, or gestational surrogates when using third-party family building. In regards to stigma and support, cultural norms come into play as there may not be a safe space to speak about fertility challenges. A lack of confiding in family and friends about fertility challenges can lead to loneliness and isolation. Finding women of color specific support resources can be helpful to find peer encouragement and reduce isolation.
Existential Inquiry
Existential concerns can arise as clients focus on a search for meaning as fertility treatments extend over time and become increasingly difficult to resolve. For some, existential inquiry becomes significant once the decision is made to end fertility treatments and ultimately, stop trying to conceive. It is helpful to explore values and beliefs regarding identity shifts and changing life perspectives to find ways to reconnect to a childfree life filled with meaning and connection.
Secondary Infertility
Secondary infertility affects approximately 12% of women in the US, but it is not often discussed. The unanticipated stressor of secondary infertility can be a frustrating and painful experience as plans to increase family size do not go as planned. Some women experience secondary infertility once they have used all remaining frozen embryos from an IVF to try for baby number two. Other women may have had an easy time conceiving a first child and feel overwhelmed by the difficulty of trying to conceive a second child. Regardless of which path, many women report feeling misunderstood or dismissed by others in the desire to add to their family, stuck between the fertile and infertile world. Read more about secondary infertility here.
Coping Skills
Continue to live your life: infertility does not have to define you.
Honor your own needs during the fertility process.
Turn toward your partner for support, not away.
Respect differences in coping styles between you and your partner.
Utilize caring, empathetic friends and family members for support.
Express your true thoughts and feelings through individual therapy or couples counseling.
Join a support group to normalize feelings and connect with others who have similar experiences.
Practice deep breathing and mindfulness, or consider acupuncture or yoga to reduce stress.
Learn coping skills to observe thoughts, feelings and body sensations without judgment.
Spend time outside in nature and reconnect to the greater world.
Get Support
I welcome individuals and couples who need support navigating the intense emotional challenges of primary or secondary infertility. I understand the emotional, medical, psychological and relational aspects of infertility, pregnancy, third-party family building and the transition to parenthood. I am a professional member of RESOLVE and ASRM. Please contact me for an initial consultation.
Resources
RESOLVE: The National Infertility Association
Support groups and inferility information and resources
www.resolve.org