What do Chrissy Teigen, Nicole Kidman, Mariah Carey, Tyra Banks, Sarah Jessica Parker, Angela Bassett, Hugh Jackman, and Jimmy Fallon have in common? They have all publicly disclosed their experiences with infertility.
Like miscarriage (discussed in the Crozet Gazette April 2024 column), infertility is common, affecting 8-12% of people worldwide. One in six couples in the United States encounter infertility. It is defined as an inability to establish a pregnancy after 12 months of trying. Approximately 1/3 of cases are due to male factors, 1/3 female factors, and 1/3 “combined” factors.
And, like miscarriage, our societal norms around infertility are of secrecy and silence, engendering feelings of shame and isolation.
The emotional responses to infertility can include similar feelings as those following miscarriage: a sense of failure and inadequacy, loss, shame, guilt, hopelessness, and anger. People may feel that their body is letting them down or that they are broken. And infertility often comes as a shock, an unexpected occurrence, contradicting the assumption that pregnancy will occur fairly easily once a couple is ready to try.
When couples are struggling to conceive, it can seem as though everyone around them is getting pregnant without problem. This can result in natural, but uncomfortable, feelings of yearning, envy, and resentment.
The sense of loss can encompass one’s identity as a man or woman capable of having children, and identity as a future parent. It can be disorienting and distressing when our dreams and plans for having children are upended unexpectedly. There is also a loss of a sense of control over one’s body and one’s future.
Uncertainty and anxiety about the future can loom large. The hope and anxious anticipation of each cycle, followed by painful disappointment if the cycle is not successful, becomes an emotional rollercoaster. The ups and downs are often wrenching. Some find it hard to think about or focus on other things in their lives, or to enjoy and appreciate other parts of their lives, such as hobbies, social activities, relationships, and achievements.
It is important to seek professional help if needed, especially for more intense negative emotions. One-quarter to one-half of women who encounter infertility become clinically depressed. Signs include disturbances of appetite and/or sleep (either too much or too little); low energy; losing interest in activities; not being able to experience pleasure; trouble concentrating; excessive guilt; intense anxiety, and/or impairment in daily functioning.
Infertility can be thought of as a shared family stressor, or a “joint stressor” (as opposed to an individual stressor). It often causes strain on relationships, in part due to related depression, financial strain, and changed sexual dynamics. Each partner may have different coping skills, some that help the relationship, and some that may not. Also, family culture and expectations about having children may sometimes contribute to painful feelings, possibly exacerbating feelings of guilt and shame. Certain events, such as baby showers and family gatherings can be emotionally fraught, not to mention social media postings about pregnancy and parenting—as well as well-meaning but unwelcome questions from relatives and friends.
Most instances of infertility can be treated without needing to pursue assisted reproductive technology (ART), such as IVF (in vitro fertilization), but instead can be successfully addressed with medication or surgery. If a couple does get to the point of needing ART, the treatment is psychologically and physically arduous and can lead to increased stress. The process can be painful, invasive, and time-consuming, involving frequent appointments, multiple medications, blood tests, ultrasounds, daily hormone injections, and procedures such as egg retrievals. It may mean scheduling vacations around cycles, or missing work for appointments. ART can be quite expensive. The direct hormone effects are unclear but could contribute to mood swings, insomnia and/or irritability.
It can be useful to share these struggles with others, to elicit support and feel less alone, although the decision about whom to tell can sometimes be difficult to navigate, as is natural to want to avoid unelicited advice and intrusive questions.
Some tips for coping with the stress and negative emotions associated with infertility:
- Communicate openly with your partner about how you both are feeling. Be honest.
- Communicate with key friends and family members about your feelings and your needs. Set boundaries as well: things you prefer them not say or do.
- Engage in whatever relaxation techniques work best for you (such as breathing exercises, meditation, spending time in nature, music, art, etc.).
- Continue to engage in other activities and interests.
- Pay attention to your basic daily health needs: sleep, eat well, exercise.
- Talk with a therapist: individual or couple’s therapy.
- If depressed, seek out mental health assessment and care.
Before starting infertility treatments, engage in proactive discussion with your partner including:
- Financial planning: how much you are willing to spend and how will you pay for it
- What will you do if the initial treatments are not successful
- How best to support one another through the process
The stigmatization of common and normal experiences such as miscarriage and infertility make these emotionally complex life situations even more difficult. A powerful antidote is the support, understanding and reassurance that can result from sharing our struggles with others and realizing we are not alone.
As a resource, visit the National Infertility Organization website at Resolve.org.
