fertility news

“Grief is the most selfish of all emotions, and infertility is grief -- a grief that no one else quite understands. In fact, most people don't have a clue. When you are suffering through infertility, every day that you awaken NOT PREGNANT opens a new wound. It's another death in the family. Yes, the pain can be that significant. Every minute of every day is spent mourning the loss of a child -- your child. They say that time heals all wounds, but not this one. Time is your enemy. Every day is another funeral, another failure.”

This quote from Ryan Jacobson a writer for TheBostonChannel.com illustrates the emotional challenges that confront couples dealing with infertility. Coping with infertility can be a daunting process. Testing and treatment are often invasive and expensive and can strain even the strongest relationships. In a few states insurance mandated coverage for infertility is available to ease the financial burden somewhat. However, for most people dealing with infertility the emotional strain that accompanies the testing and treatment is by far the hardest aspect for them to manage whether they have insurance coverage or not.

There are many reasons for this phenomenon. Most of us spend the better part of our adult lives trying to avoid pregnancy and we take our fertility for granted. We assume that when we are ready to start a family getting pregnant will be easy. So when we encounter difficulties we are initially shocked and can’t understand how this happened. Losing the ability to do something that seems to come so easily to everyone around us is just one of many losses the infertile patient will experience. The losses associated with infertility are many; here are just a few:

• Loss of control over one’s body
• Loss of reproductive destiny
• Loss of relationships
• Loss of status
• Loss of self-esteem
• Loss of privacy
• Loss of a dream

The emotional response to any loss is to mourn and to grieve. Common emotional responses to grief include: shock, disbelief, anger, guilt, blame, and shame. Since treatment can go on for months or years, over time the grieving may become chronic and lead to depression.

What makes the grieving of infertility especially difficult?
The grieving of infertility is especially hard because each menstrual cycle is a reminder of your inability to get pregnant. It has been described by one writer as “a mini grief cycle- the shock, anger, depression and acceptance...that makes it difficult to move completely out of because each cycle puts you back in it again.” With each treatment cycle you hope that you’ll be closer to discovering the cause of your problem or achieving pregnancy. Often times however, no cause is identified and the uncertainty can be devastating. One woman who attempted multiple IVF cycles said it would have been a lot easier if she knew she’d have to do 8 cycles to finally achieve pregnancy. The sense of failure grew worse with each successive cycle and the uncertainty made it extremely difficult to continue trying.

Because there are usually multiple treatment options available the grieving process may be delayed. Each option brings renewed hope but if the cycle was unsuccessful despair sets in and the grieving process starts again. The problem is that each unsuccessful cycle may not be fully mourned. Some authors suggest that infertility and the grief associated with it reemerges over time even if you have a baby or decide to live without children. This means it gets mourned again and again but from different perspectives.

It is difficult to mourn the loss of a desperately wanted child who doesn’t exist. Mourning the loss of the “dream-child” is hard for others to understand. They may not recognize each unsuccessful cycle or menstrual cycle as a loss and they may not grasp how profound a loss it is to those who experience infertility. This lack of recognition by our family or friends makes an already difficult situation worse for many reasons.

When someone dies, depending on our religious or cultural beliefs, there are rites and rituals that are followed. Whatever the beliefs, these rituals are designed to comfort and support the family and friends of the deceased during the period of mourning. No such rituals exist for the infertile.

Since many infertility patients feel stigmatized by the condition they may not discuss their treatment and keep the failed cycles a secret isolating them at a time when they need support from friends and family the most. To complicate matters some religions don’t condone certain procedures such as IVF or gamete donation. If we belong to one these religious sects and these are our only options for family building it not only removes another source of solace on which we’d rely during this time of mourning but challenges long-held beliefs.

How do you start working through grief?
To start, you must acknowledge the loss of the unborn child. This includes your dreams of passing on whatever qualities or traits you thought your child would possess. Establishing timelines for treatment and deciding when to end treatment can restore a sense of control over your life. It requires thinking about alternatives to having your own biological child such as using an egg/sperm donor when appropriate, adoption or living without children if treatment is unsuccessful. Some authors suggest that the longer you’ve been trying to get pregnant, the longer the mourning period will be. However painful this mourning period is denying or avoiding it may result in the inability to move forward.

If you are feeling overwhelmed by the infertility process support is available. Counselors with special training in infertility related issues or support groups can be helpful in restoring some normalcy to your life.

For additional information on this topic visit these websites:
Resolve:
http://www.resolve.org/site/PageServer?pagename=lrn_adp_home
http://www.resolve.org/site/PageServer?pagename=lrn_chfr_home
http://www.resolve.org/site/PageServer?pagename=cop_home

American Fertility Association: http://www.afafamilymatters.com/

References:
Hammer Burns L, Covington S. Psychology of infertility. In Hammer Burns L, Covington S, eds. Infertility Counseling: A Comprehensive Handbook for Clinicians. 2nd Ed. New York: Cambridge University Press; 2006: 1-19.

Harvey J. Disenfranchised Grief: New directions, Challenges, and Strategies for Practice. Champaign, IL: Research Press, 2002.

Jacobson R. Infertility: I Wish Someone Would Have Told Me. Available at:
http://www.thebostonchannel.com/womenshealth/10489743/detail.html

Unruh A, McGrath P. The psychology of female infertility: Toward a new perspective. Health Care Women Int 1985; 6: 369-81.

Luske M, Vacc N. Grief, depression, and coping in women undergoing infertility treatment. Obstet Gynecol 1999; 93: 245-51.

Sewall G, Hammer Burns L. Involuntary childlessness. In Hammer Burns L, Covington S, eds. Infertility Counseling: A Comprehensive Handbook for Clinicians. 2nd Ed. New York: Cambridge University Press; 2006: 411-27.

Tyler E. Barren in the Promised Land. New York: Basic Books, 1995.