Infertility Struggles and Pregnancy Loss

Data suggest that one in eight couples struggle with infertility and that one in four couples suffer from pregnancy loss. With those statistics, you may either fall into one of those groups or know someone who has. Even though the conversation around fertility struggles and pregnancy loss is increasing, a veil of secrecy still exists among those affected, making it more challenging to take care of yourself or your loved ones who struggle.  

Reasons that infertility is still kept secret:

The stories of successful fertility journeys are ubiquitous, while the narratives of the struggles and losses remain scarce in comparison. Infertility may still be kept secret for the following reasons :

  1. Self-Protection – Discussing fertility struggles is emotionally draining, to begin with. Individuals may not have the emotional capacity to field others’ energy or opinions about their journey. The sheer mention of a fertility issue may be met with questions or unsolicited advice from the person who is trying to be supportive. For example, hearing “Have you tried x, y, z?” can be triggering.
  2. Shame – You may come from a community where fertility is tied to motherhood/fatherhood/personhood—i.e., defining oneself as mother/father/parent is intertwined with the racial/cultural/religious narratives that shaped how you grew up. So when the process of having a baby fails to happen as expected, you may feel a sense of shame/embarrassment. 
  3. Avoidance of strong opinions about treatments – Even though seeking infertility treatment is becoming more common, you may want to avoid those who have strong views about said treatments.
  4. Lack of education and information – Many of your informative years were spent learning how not to get pregnant. You may have learned about abstinence and various forms of birth control, which supported the underlying assumption that getting pregnant is relatively easy when, in reality, you have a 20% chance of getting pregnant each month.

The benefit of keeping these issues private is that people need time to process before they share with others. Sharing means inviting others into a delicate and emotional process that is still getting sorted out.

How Do You Show Up For Yourself? 

The journey to parenthood isn’t as easy as most people think. If you’re like many other women, you know what it’s like to be the supportive friend watching others have their first, second, and third child. You are happy for them, as you manage your pain in silence.

Establishing a self-care routine is vital during this journey. Identifying how you feel and what you need may be challenging initially, but it is a foundation for prioritizing your mental wellness.

While many differences exist between infertility struggles and pregnancy loss, one commonality between the two is grief. The inability to get pregnant, a series of early pregnancy losses, and late pregnancy loss/stillbirth are grief experiences and represent the most profound losses. 

Pregnancy loss, however it happens, symbolizes the loss of hopes, dreams, and expectations for your life that is not unfolding as you imagined. Having the framework of grief as a lens to guide your self-care may be helpful.

How Do You Show Up For Others? 

You know your loved one is struggling but worry about what to say or when. Experiencing that internal conflict is normal. If someone has confided in you about their struggle, find comfort in knowing that you and your support are trusted and valued. When you care about your loved one, you want to provide comfort and do whatever it takes to soothe your friend or family member. In these instances, I find the easiest way to acknowledge a challenging experience is some variation of the following:

  • “Thinking of you…”
  • “I am here for you…”
  • “Tell me more…I am listening…”

If your loved one is undergoing treatments and/or has experienced a pregnancy loss, saying either one of those phrases can help them feel seen. 

Be mindful that simply asking someone “How Are You?” can be triggering in the infertility and pregnancy loss communities when all you expect (or have time for) is the automatic “I’m fine” response. Maybe they’re not fine. In those instances, it may be best to say, “So nice to see you” and then check-in later when you have more time to respond.

Infertility struggles and pregnancy loss are periods of time characterized by emotional highs and lows. The impact of this journey will continue to impact many lives. Whether you need support or are playing a supportive role, knowledge and a sense of community can help you feel empowered while navigating challenging discussions.

*This article was inspired by a recent talk about fertility struggles and pregnancy loss hosted by SOFI.

Related articles: Disenfranchised Grief: A Q&A with Alex Zappala

Should You Try To Get Pregnant During a Pandemic?…

In a matter of weeks, the coronavirus (COVID-19) pandemic has dramatically changed our communities. Schools, economies, and cities have shut down as we attempt to mitigate the virus. Individuals and couples who have waited months to conceive are now questioning whether it’s safe to try to get pregnant. For those who are pregnant, you may have concerns about the impact of the virus on your pregnancy. 

While initial research is limited, the effect of this disease on fertility and reproductive health remains unclear, thus creating uncertainty as hopeful and expectant parents navigate the unknown.

COVID-19 and Conception

 If you are trying to get pregnant, theoretically, there should not be any reason you should not. However, please keep the following in mind:

  • Limited research exists about the transmission of the virus between mother and child. Therefore, medical providers have recommended that women abstain from actively trying to conceive until more data becomes available. 
  • Since each individual’s fertility journey is unique, adhering to the guideline to wait may feel frustrating. 
  • For those who struggle with fertility issues, postponing trying to conceive exacerbates an ongoing emotional wound. You should ask yourself how it would feel to wait even longer, as well as how you would feel about managing a pregnancy during a larger medical crisis. It is a personal decision that is best discussed with your partner, medical provider, and perhaps your therapist.
  • Should you become pregnant, access to medical care may look different as medical providers move to virtual appointments or performing specific exams in your vehicle. At individual offices and hospitals, partners are prohibited from attending appointments or from being in birthing rooms. 
  • If you don’t have COVID-19 and want to pursue Assisted Reproductive Technology (ART), the American Society of Reproductive Medicine (ASRM) supports clinics resuming care with precautions. Those precautions include performing general risk assessments, mitigation measures for the clinic and staff, and building testing capacity. The guidelines also suggest that clinics can open when certain milestones are met (e.g. reduction of cases for at least 14 days) and when local hospitals can safely address crisis care without overwhelming their capacity.
  • If you meet the criteria for COVID, please check with your doctor about when it is safe to resume trying to conceive or pursue ART.

COVID and Pregnancy

  • The impact of COVID-19 on pregnancy is still unknown. As stated earlier, little is known about the transmission of the virus between mother and child.
  • A small study of nine pregnant women in Wuhan, China, revealed that infected mothers were no more likely to have worse symptoms than non-pregnant women. 
  • The Center for Disease Control (CDC) states that “pregnant people seem to have the same risk as adults who are not pregnant.” However, they also noted that since individuals’ bodies constantly change during pregnancy, there is an increased susceptibility to infections in general.

COVID and Fertility Treatments

When the pandemic hit the US, many individuals and couples saw their fertility treatments postponed or canceled. Having spent months or years and thousands of dollars to prepare for cycles to have them delayed caused great emotional hurts.

The taskforce for the American Society for Reproductive Medicine (ASRM) recognizes the unique challenges faced by patients in the fertility community. In its latest report, ASRM noted that US states and cities are increasingly recognizing infertility care as essential services and have provided guidelines for resuming care when appropriate. As such, the benefits of providing treatment will be balanced against the risks of patient and staff exposure to the virus.

Coping During Fluid Times

We are living through an unprecedented time in our history, one that is heightened by uncertainty and anxiety. Therefore, self-care is even more critical. You may want to try:

  • Sticking to your routine as best you can. Waking up, eating, and going to bed at the same time each night help to bring some structure to your day, especially when information is constantly changing.
  • Meditating or practicing mindfulness to soothe anxious thoughts. Anxiety is expected during a medical crisis, so find what a practice that works for you.
  • Exercising can be challenging, especially with restrictions on being able to go outside. However, you can find many exercise programs online that can be done in the safety of your home. 
  • Giving yourself permission and space to grieve the loss associated with needing to wait or postpone treatments. You are living through a disappointing time that deserves to be honored. 

Everyone, pregnant or not, should be following the precautions outlined by the CDC. As medical guidelines change as we move through the pandemic, please check with your doctor about how they directly affect you. 

Also, if you need more emotional support, most licensed mental health professionals are equipped to provide services online.

This article was originally published on on May 4th, 2020.

It has been updated to include new data from the American Society for Reproductive Medicine’s Covid Task Force Update on May 11th, 2020.

The updated version of this article was published on Thrive Global on May 12th, 2020.

Related articles: Regrouping During Uncertain Times, How Do You Know When You Need a Fertility Coach

Disenfranchised Grief: A Q&A with Alex Zappala

The experience of grief transcends different types of losses. While we may all be familiar with its stages of grief, one element of grief that often goes unnoticed is called Disenfranchised Grief.

Recently, I had the opportunity to speak with Alex Zappala, a writer and therapist from the loss community called Grief Uncovered™, about how disenfranchised grief impacts those struggling with pregnancy loss and infertility.

To read more from our Q&A, please see below:

Can you explain the concept of disenfranchised grief, for those who are unfamiliar with it or who may have experienced it but never gave it a name?

Disenfranchised grief – a term first coined by Dr. Kenneth Doka – occurs when a person’s mourning process is not fully supported or recognized by their larger community or society and becomes devalued. 

Doka (2002) has identified five ways we may see disenfranchised grief:

1. The loss isn’t seen as worthy of grief (ex. non-death losses)

2. The relationship is stigmatized (ex. partner in an extramarital affair)

3. The mechanism of death is stigmatized (ex. suicide or overdose death, pregnancy loss, pregnancy termination for medical reasons or otherwise)

4. The person grieving is not recognized as a griever (ex. co-workers or ex-partners, parents whose children are no longer here)

5. The way someone is grieving is stigmatized. (ex. the absence of an outward grief response or extreme grief responses).

How have you seen disenfranchised grief show up in the lives of the women you work with?

Disenfranchised grief shows up in my community when women, men, and couples feel less entitled to honor their losses because of how it occurred or from a particular circumstance like pregnancy loss (miscarriage), pregnancy termination for a medical reason (TFMR), and infertility. 

  • While pregnancy loss (miscarriage) is often misunderstood, it is still the loss of a pregnancy and triggers feelings associated with grieving like anger, sadness, and loneliness.
  • Even though research tells us that early losses (at five and six weeks) has a profound effect on a person and register as a loss, some may feel less “entitled” to grieve because they never “knew their baby” or “could not have bonded so quickly.” For women and couples who have experienced losses, there appears to be an unspoken rule about an “entitlement” to grief that depends on how far along they were in their pregnancies.
  • Regardless, pregnancy loss at any stage is painful, and feelings of grief are normal. Minimizing the impact of the loss due to the length of pregnancy or the perceived ability to bond with one’s baby exacerbates the pain that already exists.  
  • Ending a pregnancy is a delicate topic in general. Because of this sensitivity, women and couples within the pregnancy loss community may experience disenfranchised grief when faced with ending a pregnancy for medical reasons. These reasons include a fetal diagnosis with chromosomal or genetic conditions that result in a poor prognosis or an incompatibility with life or a risk to the mother’s health. While the parents of these babies have made heartbreaking choices out of concern for the baby’s (or their) health, they may not feel open to discussing their losses, especially if they fear judgment from loved ones who have strong opinions about their medical decision.  
  • Struggling with infertility is akin to a perpetual grieving process. Constant grieving over the loss of achieving a family the way you imagined, exacerbated by the grief associated with failed fertility treatments month after month, takes its toll. 

What impact does it appear to have on these women, their grieving processes, and their lives as a whole?

The impact of disenfranchised grief on women is multi-layered. 

Women, men, and couples struggle with pregnancy/child loss/infertility experience grief for the reasons described above. They may also question themselves, their sense of womanhood as a result of these losses. Or, they may even mention feeling like their bodies are “broken” or “damaged” because they are unable to carry a child. 

With so much of the world oriented toward parenthood, redefining a sense of identity outside of grief as it relates to parenthood takes time, extreme care, and patience.

What sorts of recommendations for coping strategies do you tend to share with your clients when they are encountering this?

  1. Acknowledge your pain. It matters.
  2. Accept that grief can trigger many different and unexpected emotions. Also, accept that grief can be triggered by many different and unexpected emotions. Don’t judge what comes up.
  3. Understand that your grieving process will be unique to you. I always say, “Your grief, your process!”
  4. Seek help where you feel supported and valued.
  5. Support yourself emotionally by taking care of yourself physically by eating properly, getting enough sleep, and exercising.

What do you think is needed in order for us to de-stigmatize and validate pregnancy loss? Whether in the field or not, how can we all do our part?

One in four women experiences a pregnancy loss (miscarriage), and 1 in 8 couples struggle with fertility issues. 

Social media is a powerful medium that is being used to promote awareness of many important issues, of which disenfranchised grief is one. The more we discuss the not-so-obvious ways that grief shows up for people, the more we increase awareness and de-stigmatize loss and grief.

Alex Zappala is a Counseling Psychology EdM candidate and writer with a personal commitment to demystifying and normalizing grief. You can follow her on Instagram: @griefuncovered.

Our Q&A was originally published on April 26, 2020. You can find it here.

Related articles: Regrouping During Uncertain Times

Regrouping During Uncertain Times

Dear Fellow Infertility Warrior,

The spread of Covid-19 has quickly crippled our nation. What was happening in China, South Korea, and Italy felt so distant weeks ago until it became our reality. Those of us in California, New York, and Washington state (where the virus seems most concentrated at the writing of this post) are adjusting to a new normal where the grocery store shelves are bare, we’re isolated in our homes, and toilet paper feels like budding currency.

Amid this national chaos, we are dealing with additional challenges as a result of the virus. IVF cycles, months and years in the making, have been canceled or postponed. Long-awaited transfers have been too. For some, that translates into thousands of dollars and months and years of hopes crushed and cast into limbo. 

The impact of the virus on pregnancy is still unknown, leading to another layer of uncertainty and worry for those of you already pregnant. 

Living through a medical crisis, while our nation is undergoing a larger health one, further compounds the emotional trauma that comes along with our journey. Constant change and uncertainty only heighten the emotional chaos you may feel when you are doing your best to stay grounded.

While there is no easy way to get through this, remember that we have endured hardships before, and we can do so again.

Initially, you may need to retreat, reprocess, and regroup. It may look like a variation of what I have outlined below which I found helpful in the past:

  1. Honor your feelings – Anger, sadness, frustration, etc. Give them a voice. If your feelings had words, what would they say?
  2. Journal – Use it as much as you can to capture your thoughts and feelings.
  3. Needs – Ask yourself what you need most right now – words of comfort, affirmation, a hug, or something else? Identifying what feels most helpful is important.
  4. Reconnect with yourself – You’ve just gone through yet another disappointment in a string of disappointments. Be tender with yourself. Get lost in a book, mindless television, or listen to music that you find uplifting.  
  5. Control – Focus on what you have control over vs. what you don’t. Stay in the present as much as you can.
  6. Strength – Lean into the strength that got you to this point. Faith, community, connection – any or all of it is fair game. Get support wherever you find it.

Lastly, I know you have heard this before, but I will say it again – WE ARE ALL IN THIS TOGETHER! 

Sending love and light to all,

~ Dr. Loree

How Do You Know When You Need a Fertility Coach

You’re resourceful. You’ve thoroughly researched your doctor. You’ve put together all the information about the fertility process you could possibly find. 

You might have friends or family members who’ve already gone through the process, so you have an idea of what to expect. 

But no matter how much we might think we know about fertility, being thrown into the seemingly endless cycle of appointments, tests, procedures, and potential disappointments can be jarring, even for the savviest of women.

Your medical doctor is responsible for overseeing your treatment process. But the intricacies it involves, along with all the dense medical terminology, can get lost in translation. 

Imagine how you felt after first hearing terms like AFC, FSH, AMH? 

A therapeutic or fertility coach can help you understand how these new medical issues can impact your fertility journey.

Going through the fertility process can be a traumatic experience. But you can work with a professional to mitigate its impact and start prioritizing your mental health. 

What Exactly Do Coaches Do? 

Therapeutic or fertility coaches guide you through the fertility process and help you identify a plan that works for you. A coach can be the “point person” who helps you manage everything outside of the time you spend with your doctor. 

Coaches are space holders and mentors. They help you stay on track while assessing your needs at every step of the way. Coaches help you manage your experience throughout the treatment process. 

Coaches can assess and help you navigate your struggles with helping you make lifestyle changes in your food and exercise. They can encourage you to use additional treatments such as acupuncture, massage, and chiropractic care while keeping your that your budget and spiritual needs in mind. 

A Therapeutic Coach or a Fertility Coach: Who Should You Work With? 

With so many coaches and mentors in the field, it can be hard to figure out who you need to work with. Here’s a breakdown of what you can expect from different coaches: 

Fertility Coach or Mentor

Most fertility coaches and mentors have gone through the process themselves, giving them first-hand experience with the fertility world. 

Having personal experience with fertility treatments can make a fertility coach a good option when you need a sounding board as you work through treatment-related issues that may come up for you. A fertility coach can offer support and guidance around your fertility journey.

Therapeutic Coach

Therapeutic Coaching is the intersection where therapy and fertility coaching meet. 

Most women going through the fertility process tend to focus on the here and now as they try to navigate the complexities of the fertility world. But this can keep them from addressing emotions that can come up when women struggle with fertility issues. 

A Therapeutic Coach can help you create a space where you can work through feelings and emotional difficulties with the guidance of a licensed psychotherapist. 

Therapeutic Coaches can also include anyone who’s been trained in specific research methods that address the emotional pitfalls of the fertility process. 

For many women, fertility issues can be experienced as traumatic events. Research shows that this can lead to challenges with anxiety and depression.

Having the support of a licensed clinician through Therapeutic Coaching can help you manage and overcome traumatic emotional triggers, such as hearing unexpected diagnoses and going to doctors’ appointments. Developing a plan for managing them is part of the foundation taking control of your long-term mental and emotional wellbeing. 

Other Coaching Resources for the Fertility Process

Other professionals you might see in your research include nutritionists, naturopaths, chiropractors, or functional medicine doctors. Each one can provide a unique perspective on how to care for yourself during fertility treatments.

Choosing the wrong coach can lead to frustration and an inability to address the root causes of whatever issues you’re trying to address. So it’s important to understand what your unique needs are so that you can choose the right professional to work with.

How Coaching Can Help You During the Fertility Process

Fertility research is still grossly underfunded. The data we do have continues to show that women who undergo mind/body programs can have higher chances of conceiving, fewer miscarriages, and better egg-retrieval rates (if they pursue IVF). 

Other benefits can include:

  • Having the personal space to manage your nutrition, lifestyle choices, and emotional wellbeing.
  • Getting help to create an action plan that matches your needs.
  • Having support and advocacy for your medical and emotional needs.
  • Saving money: Working with a coach or participating in a structured program can potentially increase pregnancy and IVF success rates. This can reduce the number of additional treatments you might need down the line. 

You may need more support around creating a healthy nutritional plan. Or you may be someone who needs more emotional support. In order to find a good fit, identify the areas where you need support and find a coach who has expertise in those areas.

Having someone on your treatment team who understands what you’re going through and has the practical solutions and strategies to help you along the way is invaluable.

Do Your Research

Most coaches offer a 15-minute consultation so you can learn how their services might address your needs without feeling obligated to sign up for coaching you don’t think is right for you. 

In the meantime, if you still don’t know where to start, my 6-Step Fertility Self-Care Plan provides information about managing the fertility process. You can also get more information about my Therapeutic Coaching services here.

There are plenty of resources for getting the help you need during the fertility process. But this can make it harder for you to figure out who you should work with. 

The more you know about what different coaches can provide, the sooner you can get started creating the self-care plan you need as you start this next chapter in your life.

Fertility and Infertility Self-Care Plan for the Holidays

The holidays are a time when we find ourselves surrounded by families and their children. You’ll be participating in holiday traditions that other families share each year.

But if you’re struggling with fertility issues or undergoing fertility treatments, the holidays can be a painful reminder of the family you wish you had. 

The emotional stress that the holidays can bring adds to the stress of the fertility process. This can cause you to feel overwhelmed and make it harder for you to enjoy this special time with family and friends. 

So I’ve created a Fertility and Infertility Self-Care Plan for the holiday season to help you navigate what may not be the “most wonderful time of the year” for many women. 

1. Check-in With Yourself Each Day During the Holidays

Daily prayer or meditation sessions help you identify what you need at any given moment. Journaling can also be an effective way to process emotions and observe your responses to situations and people around you. 

Remember that your emotional needs can change daily, and that’s okay. But the more awareness you have around those needs, the better you’ll be at making sure you’re taking care of yourself throughout the holiday season. 

2. Eat Sensibly and Stay Active 

Food and holiday celebrations go hand-in-hand, and the holiday season often becomes a time for us to over-indulge.  

Too much of a good thing can leave you feeling sluggish at a time when you need all the energy you can get. So enjoy your favorite holiday foods in moderation. 

Regular exercise at the right intensity for your needs can improve your mood and help digest all those holiday calories while helping you manage stress. 

Eating sensibly and staying active during the holidays can make it easier for you to enjoy this special time without any unwanted stress. 

3. Just Say No and Have a Backup Plan for Holiday Events

Be selective about which holiday events you want to attend. If you aren’t sure if you want to go to a certain party, ask yourself, “How will I feel if I go? How will I feel if I don’t go?”

Being around pregnant women or parents and their children can trigger women who are struggling with fertility challenges. Give yourself permission to opt-out of any parties where you know you won’t be comfortable.

You can also arrive late or leave early if you think there’s a chance that you might find a particular event difficult. The important thing is to have a backup plan and know when you need to use it. 

4. Prepare in Advance for the Questions You Don’t Want to Answer

Decide what information you plan on sharing about your situation when people ask questions you may not want to answer. 

Prepare answers in advance for common questions like, “When are you having children?” or “Isn’t it about time you thought about starting a family?”

Rehearse your answers ahead of time, and don’t feel shy about telling others that you don’t feel comfortable answering certain questions.

5. Don’t Pretend There’s Nothing Wrong 

Be transparent and share your feelings. Sometimes the act of saying how you feel lets you move through negative emotions a little faster to find space for more positive ones. 

Being honest about what you’re going through can take away the power it can have over your feelings and emotions. Owning how you feel can help you be more in control and empowered to connect with others in an authentic way. 

6. Celebrate the Holidays the Way You Want

If you feel like celebrating, enjoy it. Listen to your favorite holiday music, plan out your holiday decorations and meals, or go shopping. Do what feels right for you.

The holidays are yours to enjoy however you want. There’s often a pressure to do things a certain way, and expectations from others can add to the stress of the holiday season. 

Learn to recognize what the holidays mean for you, and start creating your own celebrations and traditions. 

7. Take a Break From Fertility Treatments

If going through potentially mood-altering treatments during the holidays sounds like more than you can bear, talk with your doctor about taking a break. 

It might make more emotional sense to revisit your treatments after the holiday season is over. 

8. Create Your Own Child-Free Holiday Traditions

This step may feel like the hardest one of all, especially since you probably dream about someday having holiday traditions with children of your own. 

But it’s okay to create new ones in the meantime. You may find comfort in celebrating with friends and family members who also don’t have children. 

9. Practice Having an Attitude of Gratitude

Giving thanks can feel tricky when you’re overwhelmed with sadness. But when you can, learn to be grateful for what you have. 

You might be surprised by how gratitude for the small things in life (like your favorite tea, candle, or space) can lead to more significant moments of gratitude in your life.

10. Reach Out for Support When You Need It

If you’re working with a therapist or coach, schedule a session sometime during the holiday season. 

You can find a support group online or in-person to help you navigate the challenges that the holidays can bring. 

Knowing you have a safe space and the support you need, free from unhelpful advice or unwanted comments, is priceless.

The holiday season is one of the hardest times of the year for women and couples who are struggling to start a family. Wherever you are on your journey, remember to be gentle with yourself and with others. 

Use the steps and tools listed above to help you make your way through the holidays more confidently and with greater ease. I wish you a joyful holiday season and celebration for you and your loved ones. 

Originally published in Thrive Global on November 18, 2019.

Related Article: Set Intentions, Not Resolutions