Grief and Loss

Let’s talk about grief and loss and how this cycle can turn into depression during the infertility journey. Women with infertility are constantly going through grief and loss over and over, every month. It is devastating.  Many women end up crossing over into clinical depression because of how intense this cycle can be.

In both grief and depression people cry, they feel depressed, they’re having trouble sleeping, they may not have an appetite, they may not feel like doing anything, and they may not take pleasure in anything. There is no timeline for grief. In addition, cultural and circumstantial factors contribute to how people express and cope with it.

During a prolonged battle with termnal illness, as well as after the death of a loved one, a community of family, friends and co-workers often unites to provide ongoing support to those who are grieving. That does not happen when a couple is going through infertility and unfortunately it is quite the opposite.  There is no support, no one knows about it usually, and if they do people can say things that are very hurtful.

This puts women are greater risk of depression going through infertility. People suffering from major depression tend to be isolated and feel disconnected from others, and may shun such support and assistance. People who don’t get such support, or who avoid it, may be at greater risk for slipping into clinical depression during the grieving process.

Some suggestions to dealing with grief and loss with infertility:

  • Expect to feel depressed. Loss of appetite, trouble sleeping, and sadness are all part of the normal grief process, and are best not interfered with.
  • Expect grief to wax and wane over time. You may feel “fine” one day, only to slip back into deep grief the next day.
  • Build and use a support network. Grieving individuals need others to talk to and to care for them not just for a few days, but over an extended period of time. Find a support group or a therapist.
  • If you experience thoughts of suicide, serious weight loss, or are unable to perform daily functions such as getting out of bed or going to work for more than an occasional day, consider seeking additional professional help.

That’s the question, isn’t it…I can say yes it is, just in my brief clinical experience, but after reading more lately, I can say for sure it is. Also I am seeing more and more secondary infertility. This is when conceiving child #1 wasn’t a problem, but the 2nd child becomes a challenge to conceive.

Infertility rates are on the rise and here are some reasons why.

About 10 to 15 percent of couples are truly infertile. But that number is getting closer to 15 or even 20 percent simply because more people these days are delaying childbirth, leading to a lot more infertility.

The trouble with waiting longer to have children is that a woman’s eggs decrease in both quantity and quality starting at age 30. When I say starting, we don’t know how fast that decline is and for some women it maybe faster. Also miscarriage rates increase because the rate of having a child with abnormalities also increase.  Typically once you hit 40, the likelihood of chromosomal abnormalities and unhealthier eggs are much higher.

Many preliminary diagnostics can be performed by a patient’s OB/GYN you don’t need to go see a specialist right away, but also don’t wait too long. If you are 40 you probably should go straight to a specialist and if you are in your 30s after a year of trying to conceive you should see a specialist.

I am moving the Friday Oakland Infertility group to Thursdays at 6:30pm bi-weekly starting this Thursday.  The Orinda group at Reproductive Science Center will continue on Mondays bi-weekly.  Contact me if you have any further questions.


Grief and Infertility

There are no words that can describe the hell of losing a baby. I have had a number of infertility patients recently who have experienced loss. They call me, despondent, frightened and scared that their loss will recur. They stop in my office, shut the door, pace or sit, and cry or rage about the unfairness of it all. Know what? They are right. One out of six of us will go through infertility. I would like to see the statistic of average length of time spent in fertility therapy, because the longer fertility treatment goes on, the more likely that the patient becomes depressed, hopeless, sad and angry.

I’d like to talk a little about grief. Of course Kubler-Ross’s work was seminal and set the stage for fantastic advances, partly by taking grief out of the closet. I have taken lots of grief courses over the years and what I have learned is no family endures it the same: some are livid, other members are sad, and some are positive. The point is that every death and grief experience is different, and the same holds true for infertility.

I get asked a lot from patients: Is what I’m feeling normal? My response is, “What is normal? You are allowed to feel any way that you do.” You see, we get so caught up in being perfectly put together, it’s alluring to think that if we try just hard enough — add another acupuncture session, eat raw food, swear off cranberry bliss bars, then we will “deserve” a baby. And what I have to tell you from the front lines of reproductive endocrinology is that there is not fairness. There is biology, and there is human reproduction which any Ob/Gyn will tell you is very inefficient. There are flawed gametes and counterintuitive hormones. So, yes, whatever you feel is normal. And whenever you feel it, it is normal. The Pampers aisle in the store is a for sure, certain commercials, women pushing carriages, Hallmark anything, and people at work who love to recount the details of their labors. All of these and many more are triggers — even years after losses.

In sum. Grief is a patient, wily beast, which will strike from a position of power and seem to render you useless. This is an abject lie. In your grief lies your strength to persevere, to protect yourself, to help others and to prepare for parenthood — however you ultimately become parents. And, yes, I really believe that if you stay the course, you will become parents one way or another.


Before we answer that question, let’s say a word about stress.

It’s not a surprise to you and me that you may be more stressed out than other people. It’s incredibly stressful to feel like you’re some kind of freak, your body is out of control, or that you can’t have a baby.

It’s also no secret that you are more likely to be depressed, feel anxious and have low self-esteem.

But it may surprise you that there appears to be a link between stress, your brain, and problems such as depression and low self-esteem.

It’s important to note that women with infertility are inclined to produce more stress hormones (like cortisol) than other women do in a given situation.

Over-production of stress hormones like cortisol is not good. For example, too much cortisol increases abdominal fat.

And, according to the Montreal Neurological Institute, it is associated with shrinkage of a section of the brain called the hippocampus. Shrinkage of the hippocampus has been associated with Alzheimer’s as well as reduced self-esteem and feelings of self-control.

Unresolved chronic stress can’t be ignored, simply because it worsens the psychological and physical aspects of infertility.

According to research at UCLA, meditation creates stronger connections between regions of the brain. It also appears to slow down shrinkage of the brain as people get older.

It could be that meditation reduces stress and thus protects your brain.

Find a meditation book or program that appeals to you and give it a try! Start with only 5 minutes a day and don’t worry that your brain what shut up…that’s what’s supposed to happen!

Be Honest About Your Feelings:

It’s perfectly normal to be angry about your infertility, as well as intensely sad.  The level of depression and anxiety in the infertility population is the same as in cancer, heart disease, and HIV-positive patients.

To hate pregnant women is a normal, natural, negative thought. It’s the pain and grief speaking. Mixed emotions are natural, too. You can feel happy for the good fortune of a friend, while feeling like life has cheated you at the same time.
In a nutshell, it’s OK to be angry and all right to be sad. Jealousy is part of the package, too. Those feelings don’t make you a bad person. They make you a real person, with real feelings. Feelings that happen to hurt like hell right now.

Be Selective about how and where you hang out:
What’s the one topic that dominates the conversations of all pregnant ladies and new mothers? Babies. Intelligent women with masters degrees, exciting careers, stimulating hobbies, and a passport full of stamps from around the world are suddenly unable to discuss anything except runny noses and car seats. It’s not their fault, of course. Nature gives relatively sane women a bad case of baby tunnel vision for the sole purpose of the perpetuation the human species. But all that baby talk can be total agony for someone who can’t participate. Pick social situations that you can handle.

I recommend that women get back to the interests and activities that they enjoy. Our whole life can become our fertility treatments and women feel like their not doing anything useful when they are not in cycle.

Infertility is a medical condition that takes a heavy physical and emotional toll on every woman who lives with it. Between the fertility drugs, the surgeries, the egg extractions and the acupuncture, our bodies become misused and exhausted. Add in the mindless comments from strangers, plus the way we tend to mentally beat ourselves up for our “failures” and it’s no wonder our self-esteem spirals downward and our psyches crumble.

Now, more than ever, is a time to look inward. I think it’s important to do a lot of self care because we want to do the antithesis of what will add to our depression. I recommend some form of relaxation and says to take care of your relationship since baby making can become all-consuming.

Therapy is another great option. There’s also an organization called Resolve whose goal is to “provide timely, compassionate support and information to people experiencing infertility.” It’s a national group with regional chapters set up to provide local support. And more informal support groups, such as the Advanced Fertility Issues message board on BabyZone, can give you a place to vent, get information and support, and be with others who understand your situation.

Whether the pregnancies of others make you happy, make you cry, or leave you with a mixed bag of emotions, always remember that you have the power to choose the situations and conversations you’ll join. And own up to the fact that infertility is a major life crisis that affects your well-being and relationships, so take time out to take care of yourself.

Infertility and Marriage

Let’s talk about marriage and infertility.  Infertility can wreak havoc on a marriage. Even the happiest marriages can be torn apart by the struggle of infertility.

Infertility can put a wedge between husband and wife like nothing else. But trying to have a baby can also bring a couple together and bond them in new ways, if they let it.

When my husband and I tried to get pregnant, we struggled.  There were miscarriages, multiple IUI’s and an IVF. Infertility creeps into your marriage in small ways. Intimacy seems futile and unproductive, making it seem like a chore rather than love. Resentment starts. And the hardest part is, both husband and wife feel sad, frustrated and alone because they can’t discuss their feelings with their spouse for fear of hurting them.

My bout with infertility lasted 3 years, but my husband and I made it out with our marriage intact because of three things. First, we decided we were in it together. No matter what happened, there would be no blame and no fault. Second, we continued to live our lives. We tried to enjoy the moment together instead of focusing on the children we wanted and didn’t have. Third, we sought outside help (counseling and support groups) because we realized this was bigger than us and even though we were a strong couple it had the potential to ruin what we had.

There were some dark days, of course. There were days I felt utterly alone. My heart goes out to anyone struggling with infertility, and I hope somehow you are able to not let it consume you or your marriage. You will have the family you are meant to have. Talk to your husband. Talk to a counselor. Get into a support group. Get the help you need to get through this time together.

I now run support groups in Oakland and Orinda as well as see individuals and couples in the East Bay.