Infertility Is Painful, But You Can Take It On Powerfully With Both Grief And Hope
Infertility is a big word that encompasses many experiences. You may have been given a recommendation to see a reproductive endocrinologist because you have been trying to conceive for a year, you and your partner are part of the LGBTQ community and need ART (Assisted Reproductive Technology) support, or you have had multiple miscarriages or pregnancy losses. You may also have received this diagnosis from a doctor in order to start with an infertility clinic, or you and your doctor are trying to choose how to go on your fertility journey.
No matter what infertility means for an individual, couple, or family, one thing that joins these experiences is that the process can be painful, both physically and emotionally. Beyond the hormones or egg retrievals, there is the wait for the call about embryos or that you’re pregnant. There’s the pain of knowing you tried to conceive for a while and now need medical intervention in order to have a baby. Infertility can also bring up past trauma, even trauma that was already thought to be processed. There is also pain for those in a couple that have to face infertility together after already experiencing so much emotional and relational pain. A couple may have had the hope of the baby carry them through, only to come to these new losses related to having to go through the invasive, emotional pain that can occur throughout infertility. Your situation can also bring up painful feelings. You may have waited to have a baby until you were ready and then when ready, it doesn’t go as planned. Or you chose to go it alone because you want a baby, but wanting the baby is also a reminder that you are choosing to be single if it wasn’t your first choice.
Even the term infertility itself can feel cold and dehumanizing, based more on science and diagnosis than the experiences of those going through the process. However, it doesn’t have to be. You can choose to take on infertility powerfully. How? By allowing yourself–and organizing those around you–to hold both active grief and active hope. Women and families during infertility are often sold hope. While hope is certainly needed, what this emphasis on only hope misses is that there are also a ton of losses that came before and during infertility, which is why you also need to grieve. Grief is a type of pain that is essential to give as much attention to as hope because out of pain comes growth and out of hope sometimes comes loss and pain.
Admittedly, striking this balance of hope and grief can be complex and challenging. I often say to patients that it’s imperative that we grieve what was not, what you wished, what happened, and what the losses were, as well as maintain hope that you can have a baby–like many others have–this way.
Though Often Underrecognized, Grief Can Take Many Forms During Infertility
Our culture could use an updated definition of grief. When talking about grief, we usually think about grieving a death. But, grief is about loss, which can take any shape. With infertility, this loss can also take many forms (too many to list here in full), whether losing an embryo or implantation, having a miscarriage after one, continuing to not get pregnant through natural or IVF methods, not getting any eggs, not enough sperm, the loss of a cycle leading to negative pregnancy test, the loss of an embryo splitting, meaning you now have one baby rather than twins, etc. This hurts like no other pain because it is under-talked about and under-illustrated in our culture. There’s the loss of the experience of conception you imagined–that the baby is going to need to get here in a different way, that you need medical intervention, that it’s more invasive than sex, or that this is the last stop to ever getting pregnant.
Deciding to see how infertility can sometimes be psychosomatic (not just about biology, but what has happened historically in your life, what is going on emotionally right now, or what is not working or could work in your relationship with your birth partner) can also be a loss because you’re now confronting directly, through your body, what you hid from yourself to deal with later, told yourself wasn’t that big of a deal, or simply did not know yet. It’s a loss of the picture that you told yourself, the people you protected, or the way you maintained the couple, family, or yourself so it wouldn’t fall apart.
I also want to explicitly recognize the folks that have gone through way too many retrievals and are grieving that they can’t do more, are choosing to stop fertility treatments, or are deciding to not have kids. This is a very specific kind of grief that is not just about loss, but a plan of a family dying after months, a year, or years of treatments. It’s a complicated loss with many pain points that need to be felt deeply–with crying, holding, anger, fury, and hope–while moving onto adoption or a surrogate, or accepting not having children or having another baby.
Infertility can also bring up other losses outside of the process itself, including losses in the relationship. This can be a loss of knowing how to talk about anything else other than infertility, a loss of closeness and being in it together, a loss of sex in the relationship, a loss of intimacy and comfort, or even just a loss of really being there for each other in a deep meaningful way. Many folks also put their life on hold during infertility, including delaying career goals, not moving, not taking vacations because of money, procedures or doctor’s appointments, etc. These too are losses that need to be grieved.
Despite this diversity of loss during infertility, the need to grieve often goes unrecognized. As a culture, we normalize having an easy pregnancy, birth, and early parenthood, but we haven’t normalized infertility. Instead, we tend to avoid looking at how anyone (literally) can have infertility in their lives. Infertility does not discriminate. But, because it’s too painful, too unknown, and too hard to talk about, we typically ignore, hide, or bright-side about the loss and grief that are part of this process.
These Losses During Infertility Need To Be Actively Grieved To Be Accepted As Reality
Rather than hiding these feelings, it’s essential to allow yourself to go through full and active grieving. Grief comes in stages. There’s shock (“I didn’t know I’d have to use ART”), anger (“I’m mad at my friend for getting pregnant without fertility treatments”), sadness (“My body let me down over and over”), bargaining (“If I hadn’t done drugs, if I had eaten better or enough, if I had taken better care of my body, if this trauma didn’t happen in the past, if this cancer didn’t happen, if I had gotten pregnant sooner…”), and acceptance (“This is how to get the baby here and these are real losses in my life”).
Grief is the process of feeling what this loss brings emotionally, processing, and eventually accepting this loss. Allowing yourself to really experience this grief in all its messiness–the sobbing, the yelling, the moaning, the wailing–can be almost like an exorcism of pure pain. Similarly, it can also be like exercise–a continual process of growing our acceptance of something difficult by practicing grieving every day. With infertility, like grieving the loss of normality during COVID-19, grieving is acknowledging that while we’d rather have things be “normal” or how we expected, we need to accept this new reality or “new normal.”
For example, you may feel a loss when deciding that having sex for conception is not producing a pregnancy. Even though you tracked ovulation, were one with your body, and were active and aggressive in this process, it didn’t turn into a pregnancy. The lack of pregnancy through sex, as well as having to go through a more invasive procedure, can feel like a huge loss. Even though it’s not how you wanted or expected, you can grieve this experience and the loss of feeling in control of your body. Then, you can accept this reality by choosing to be an active patient who advocates, feels, and connects, as well as trying to make the process sexy with your partner in a different way.
Hope Too Is A Key Ingredient During Infertility
Beyond the acceptance in grief, however, hope is one of the main elements of fertility–hope that this can happen, that you’ll get that 5-7 day embryo, that you’ll get the all-clear to implant or start IUI, that insurance will approve all treatments, or that you and your partner will get through this hard time together. This kind of hope during infertility is not simply hope that things will get better, but it’s an essential ingredient to keep working to have that baby you’re trying very, very hard to create while enduring the pain. This is the hope that is not sold in cute baby pictures or the nice photos of smiling, happy couples on websites or Instagram (which are certainly being sold). Instead, this hope is grounded in determination, in vulnerability, in taking a risk, and in saying, “I want this and I’m willing to put in blood, sweat, loss, and tears, and hopefully a baby will come.”
I like to use the phrase active hope because it indicates how you have to live this hope every day and keep your mind on your dream, want, or the relationship to the baby you want to have in your life. Active hope is imagining what that life will be through infertility, while also hoping that all this–the work, pain, emotional upheaval, and grief–will be worth it, even if you don’t like it at all.
How Can You Actively Grieve And Actively Hope At The Same Time? Through Community
If actively grieving and hoping at the same time seems hard, that’s because it is. In infertility, there are about ten disappointments at a time, as well as months or years that feel lost to the process. These losses need to be acknowledged and felt in all their sadness and anger. And you have to do this while saying, “And I (or we) are going to have a baby! One day this kid will be here and it will all be worth it.” Though difficult, the losses and the hope are the way this baby will get here.
Holding active grief and hope can be helped through building a community, including online, in therapy, and with a friend, a sister, or a partner. With a partner, in particular, it is so golden to be able to grieve and hold hope together, whether through rituals like holding hands, walking in the park and talking post-treatments, one partner giving the other the fertility drugs or hormones, or having sad sex, mad sex, or tender touching.
During infertility, you need to surround yourself with people that can let you cry, not know, be human (meaning not perform), and be in your feelings without brushing them over because they’re painful or messy. I should note that holding both grief and hope during infertility is messy and deeply painful because you’re experiencing continual losses one after another or constant hard work over and over again. And that’s okay. It’s important to be honest with your feelings and allow yourself that space to feel whatever you may feel, as well as organize the people around you that can hang rather than avoid tough conversations.
Therapy can help lay the groundwork to talk about painful and complex stuff so that you can demand it from other folks in your life. Folks around you who want to be close need to buy-in for the real deal feelings–the messy ones, the teary ones, the ones that don’t make sense, the ones where they can’t make it better but have to just be with it. You need the folks who can let you cry in a ball and then say, “Okay! So you’re doing this thing. What do you need from me? How can I be with your grief through this shitty situation?”, as well as, “Yes, do it. Go through the treatments, talk to doctors about natural method and medical intervention, and be in charge.”
With community, you can let others get close to the losses and the hope rather than going it alone. Community, whether with a therapist, family, a social media group in your town, or a friend you can grab a lunch with on Zoom so you can process, helps significantly with loss. By sharing stories, pain, and experiences, we can forge new and deeper friendships and relationships, and get ideas of how to grieve while acknowledging these feelings are normal. And this creates hope in real time through the connection and the determination, while not ignoring the realness, gravity, and presence of the grief.