Tuck’s home page states: “Everything you need for a great night's sleep.” As someone who has struggled with getting a full night of sleep without interruption for most of my life, I was intrigued to learn more. Tuck is an online organization that offers everything from evidenced-based information on sleep to mattress reviews. Below is a well-researched and easy to follow article on the link between fertility and sleep. Head to Tuck.com for this and more.
Fertility and Sleep
Sleep and fertility are natural components of human life, but both are easily disrupted. For the 6.1 million American women who struggle with infertility, it’s possible that sleep and sleep dysfunction may play a role in their ability to conceive.
New research is diving deeper into the complicated relationship between sleep and fertility for both men and women, offering insight into the delicate complexity of the reproductive cycle.
In this article, we’ll look at the science behind the fertility-sleep connection, discover how sleep disorders each have their own impact on infertility, and share our favorite advice on how to improve your sleep health.
How Sleep Affects Fertility
The Importance of Sleep
To understand why sleep has the power to impact fertility, it’s critical to also understand how important sleep is to our physical and mental health.
Sleep consists of three distinct stages: light sleep, deep sleep, and REM sleep. All three are crucial for our well-being, and anything which impacts either the total amount of time spent asleep or the duration of stages can impact us in a wide range of ways.
This is because we sleep for many reasons, not just one. Scientists are still studying the various benefits of sleep, including:
CDC initiatives suggest seven hours of sleep a night for adults over the age of 21, but a third of Americans fall short of this goal. Signs indicate that poor sleep becomes more prevalent as we age, as a study of Americans over the age of 50 found that only 32% reported getting enough sleep.
Aside from their impact on fertility, sleep deprivation and sleep dysfunction are associated with a long list of ailments. These include daytime exhaustion, mood disorders (such as anxiety and depression), weight gain, a higher risk of disease (including cardiovascular disease, type 2 diabetes, and cancer), memory problems, and higher levels of stress hormones and inflammation markers.
Given the importance of sleep and the impact poor sleep can have on your mind and body, it’s no surprise that sleep also plays a role in fertility.
What Is Infertility?
The American Society for Reproductive Medicine defines infertility as “the failure to achieve a successful pregnancy after 12 months or more of appropriate, timed unprotected intercourse or therapeutic donor insemination.” In women over the age of 35, the time limit may drop to six months.
American women have an infertility rate of approximately 15.5%. This number climbs to 24.3% for women who have never previously given birth. Another study estimates that around 6.1 million American women have struggled with infertility to some degree.
There is no one cause of, or treatment for, infertility. As we’ve covered, fertility is the result of a complicated coordination of bodily processes and hormones in both men and women. Just as the causes of infertility vary widely between individuals, so do treatments.
However, if you struggle with sleep dysregulation or a sleep disorder, it is possible that poor sleep or circadian rhythm dysfunction is impacting your fertility.
How Sleep Impacts Fertility in Women
Fertility, like sleep, is a complicated process. The finely-tuned mechanisms of the reproductive cycle are still being studied, as is sleep, so the places where they interact are still in the early stages of research and understanding. However, initial studies are clear on the link between sleep and fertility.
The Menstrual Cycle & Hormones
Sleep can have an effect on hormones, but the menstrual cycle itself can cause fluctuations to circadian rhythms in addition to having an impact on overall sleep quality. While menstruating women without pain report sleep disturbances, these complaints worsen in severity for women suffering from premenstrual syndrome or menstrual pain. Pregnancy can also cause similar sleep health problems.
In the other direction, poor sleep, sleep deprivation, and circadian rhythm disruptions can all impact hormone levels in ways which are not yet fully understood.
The majority of research on the subject has focused on the impact of circadian rhythm disruptions. Shift workers, for instance, have long been known to have prolonged menstrual cycles and more incidence of abnormally heavy flow and severe menstrual pain.
Melatonin, a hormone associated with the sleep-wake cycle, is thought to be a potential cause of these effects. Shift workers are known to have abnormal melatonin levels when compared to the general population. In addition to sleep, melatonin also influences the immune system, controls reproductive hormones, and may play a role in egg fertilization and embryo viability.
Of course, melatonin is not the only hormone involved in sleep and fertility. Research on the interaction between estrogen and circadian rhythms has been limited but may also prove to be important. “Clock genes” are related to the expression of circadian rhythms as well as successful reproduction, and estrogen is known to modify the effect of these genes in the reproductive system. One sign that estrogen and circadian rhythms are further linked is that polycystic ovary syndrome (PCOS), a significant cause of infertility in women, is associated with both disordered sleep and abnormal estrogen levels.
Two other hormones which are being studied in the context of sleep and fertility are prolactin and follicle-stimulating hormone (FSH).
Like melatonin, prolactin is secreted from the pituitary gland. While its name references its role in prompting lactation, prolactin also affects fertility and fluctuations are associated with PCOS and lack of normal ovulation. As with many other hormones, prolactin is released at higher levels during sleep and production is suppressed by sleep dysfunction and poor sleep quality.
FSH, on the other hand, has a less obvious connection to sleep. However, levels of FSH were 20% lower in women who slept for less than seven hours a day when compared to women getting enough sleep, even when factors like age and weight were accounted for. Both abnormally high and low levels of FSH are known to have profound reproductive effects.
Finally, the mental impact of sleep can’t be discounted when considering the relationship between sleep and fertility. Sleep dysfunction is associated with an increased risk of mood disorders such as depression and anxiety. While the impact of mental health on the reproductive cycle is also an area in need of further study, some research has shown that anxiety and distress can lead to lower rates of pregnancy.
How Sleep Impacts Fertility in Men
Although male fertility is not as complicated as female fertility, it is still complex enough to affect sleep and sleep problems.
Not sleeping enough and sleeping too much are both associated with male fertility problems. Men in these categories were 42% less likely to conceive with their partner, while men who reported having problems sleeping more than half the time were 28% less likely to conceive.
There may be several reasons for this effect. Low levels of testosterone, for example, are known to result in a lower sperm count. Like other hormones, testosterone can be influenced by a wide range of factors. Sleep deprivation and stress are both known to result in low testosterone levels.
Another potential culprit is anti-sperm antibody (ASA) production. In one study of men who fell asleep past midnight, ASA levels were higher than in those who went to bed between 10 P.M. and midnight. This study also showed low sperm counts and lower rates of sperm survival in the late-sleeping group.
As in women, circadian rhythms also influence fertility in men. Studies with mice have shown that when “clock genes” were deleted or mutated, both circadian rhythms and reproductive abilities were disrupted in both male and female mice.
While further research is needed to understand the impact circadian rhythm disruptions have on humans, we do know that male fertility is linked to the sleep-wake cycle. Semen collected before 7:30 A.M. has a much higher sperm count and concentration when compared to semen collected later in the day, as well as having a higher proportion of healthy, normal sperm. Seasonal changes also have an impact, with sperm count increasing throughout spring and decreasing in summer.
IVF/Assisted Reproductive Technology and Sleep
Assisted reproductive technology (ART) is best understood as a range of treatments for infertility. However, the success of these treatments can also be influenced by sleep and sleep dysfunction.
FSH and Melatonin and IVF
In-vitro fertilization (IVF) is the most common form of ART, while other types include intrauterine insemination and third-party assisted ART. Women undergoing IVF keep close track of their hormone levels, and research suggests that two of those hormones — follicle stimulating hormone (FSH) and melatonin — are particularly important to IVF while also being influenced by sleep.
FSH is one of the hormones that controls the menstrual cycle. In the average woman, FSH levels peak just before ovulation. As previously discussed, women who sleep fewer than seven hours a night have FSH levels 20% lower than women who sleep for seven or more hours.
While both high and low levels of FSH can impact reproduction in different ways, candidates for IVF are primarily concerned with abnormally high levels. The research is still ongoing as to whether high FSH levels correlate with poor IVF outcomes, but many ART clinics do not accept clients with FSH levels above a certain cut-off. In this case, it seems possible that too much sleep may be more of a concern than too little sleep, but research on sleep and FSH is still in the early stages.
More research has been done on melatonin, although there is still much researchers do not know about its potential role in IVF.
Oxygen and Seminal Quality with IVF
In addition to influencing (and being influenced by) circadian rhythms and playing a role in the menstrual cycle, melatonin is also a powerful antioxidant. Oxygen damages cells and is particularly dangerous for embryos. In IVF the embryo is temporarily outside the womb and therefore exposed to more oxygen, so studies have begun to examine whether melatonin might offer protection against this damage.
Male fertility is rarely given as much attention in IVF research, but poor seminal quality can still affect IVF success rates. Melatonin may play a role here as well, as it has been shown to improve the quality of semen samples through neutralizing oxygen and nitrogen. Studies on both animals and humans have indicated that adding melatonin results in improvements to sperm count, mobility, and viability.
Sleep Levels and IVFAs with fertility in general, sleep dysfunction can also impact the success of ART treatments by affecting both physical and mental stress levels.
One study showed that 45-75% of women undergoing IVF regularly slept for less than seven hours a night, resulting in both elevated inflammation markers and increased anxiety. The impact of reduced sleep on IVF success is still unknown, but researchers involved in the study believe their results show that treating sleep loss may be useful in improving IVF outcomes.
Infertility and Sleep Disorders
The International Classification of Sleep Disorders places sleep disorders into six major categories:
If you suffer from sleep dysfunction or believe you do, speak to your doctor. Not only will they be able to direct you towards the most effective treatment, but proper diagnosis will give you and your care team a better understanding of the effect it may have on your fertility.
Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea is a common sleep-related breathing disorder. People who suffer from OSA stop breathing multiple times every night when the tissue and muscles of their throat become overly relaxed and block airflow. (Snoring, a common symptom of OSA, is the result of tissue and muscle vibration.) When the airway becomes blocked, blood oxygen levels decrease, which results in an increased heart rate and the possibility of waking up with a gasp to regain normal breathing.
Men are at a higher risk of OSA, with rates of 3-7% in men and 2-5% in women. (Many people with sleep apnea do not realize they have the condition, making it difficult to obtain accurate numbers.) Because of this, the majority of research on OSA and fertility has focused on men.
The regular lack of oxygen caused by OSA has been shown to reduce fertility and testicular antioxidants in male mice. Sperm were less mobile and more likely to be impacted by oxygen stress, but sperm levels did not appear to be affected.
Erectile dysfunction is also a well-known symptom of OSA, appearing in 10-60% of men with the condition. As OSA-related erectile dysfunction is caused by blood vessel cells no longer sending the correct signals, treatment of the underlying cause is crucial. While not necessarily a long-term barrier to fertility, erectile dysfunction (and other forms of sexual dysfunction) are still considered to have an impact on fertility levels and the likelihood of pregnancy.
OSA may be partially caused by (or influence) androgens, also known as “male” hormones. Androgens are present in women, but ordinarily at lower levels and with more subtle effects. The connection between androgens and OSA would explain why women with PCOS are at a higher risk of developing OSA.
Luckily, OSA can be treated effectively. Treatment usually involves the use of a continuous positive airway pressure (CPAP) machine during sleep to keep the airways open during sleep. CPAP therapy has been shown to alleviate OSA-related erectile dysfunction. It also decreases prolactin levels in women. As people with PCOS are known to have increased prolactin levels, there is hope that treatment of OSA may aid in the treatment of infertility caused by PCOS.
Circadian Rhythm Sleep-Wake Disorders
As discussed earlier, circadian rhythms are the “inner clock” which regulate a wide range of effects in our body, including hormone production and our sleep-wake cycle. Circadian rhythm disorders (CRD) are just as complex. They include:
What all these disorders have in common is that they describe a kind of circadian rhythm dysregulation. One way to describe these disorders is that sufferers live with a kind of permanent or semi-permanent “jet lag” when compared to the rest of the population. In fact, jet lag is itself considered a (temporary) circadian rhythm disorder.
There are few statistics on the prevalence of CRD. However, nearly a third of night workers meet the criteria for shift work sleep disorder, and delayed sleep-wake disorder is the most common circadian rhythm disorder treated by sleep specialists.
No matter which CRD an individual suffers from, it may have an impact on their fertility. We know that night-working women show altered reproductive cycles, that the circadian rhythm has a major effect on hormone levels (particularly melatonin), and women who suffer from CRD are more likely to have poor reproductive outcomes. So, although we do not yet know the full effect of CRD on fertility, the connection is clear.
While research has indicated a circadian rhythm component to male fertility, the majority of CRD-related fertility research has centered on women. This focus continues past conception, and some studies have found that babies born to shift-working mothers had significantly lower birth rates when compared to the children of mothers who worked during the day.
Treatment for circadian rhythm sleep-wake disorders differs depending on the disorder in question. Light therapy, behavioral therapy, and doctor-prescribed melatonin supplements are all common treatments and can contribute to a far healthier sleep-wake cycle.
Insomnia can be short-term (lasting under three months) or chronic (lasting over three months), and can indicate sleep-onset insomnia (difficulty falling asleep) or sleep-maintenance insomnia (difficulty staying asleep). Whatever form it takes, insomnia is the most common sleep disorder, affecting some 60 million Americans. 40% of women and 30% of men will experience insomnia in their lifetime.
Like infertility, insomnias can be caused by a wide range of biological, mental, environmental, and lifestyle factors. Everything from anxiety, to blue-light exposure, to medication, to underlying disorders can cause forms of insomnia.
In terms of insomnia’s relationship with infertility, the cause is less important, unless it is due to an underlying issue with its own effect on fertility. (Infertility can also be the cause of insomnia itself, as anxiety and depression are common among infertile couples and are known to cause or worsen insomnia.)
Women with insomnia have been found to struggle with infertility at rates four times those of women who sleep normally. This was true even when controlling for age, weight, and health complications, but the chronic health problems associated with insomnia can also have their own impact.
One theory to explain insomnia’s impact on fertility is that it has to do with the immune system. Sleep loss is known to increase inflammation and suppress the immune system. One of the markers used to measure these effects is also seen at high levels in women with unexplained infertility, indicating a possible relationship.
The treatment of insomnia is highly dependant on the individual. Cognitive behavioral therapy, medication, lifestyle changes, and other therapies can be used individually or together. Since insomnia can be caused by so many factors, it’s crucial to understand the basis of your own insomnia in order to treat it effectively.
Improving Your Sleep Hygiene
Sleep hygiene refers to your bedtime habits and rituals. Each person has their own sleep routine, but good sleep hygiene starts with going to bed at a set time every night and then supporting sleep with healthy routines, lifestyle changes, and a bedroom set up to encourage high-quality sleep.
Along with the treatment plan suggested by your medical team, there are techniques you can use to improve your sleep health whether or not you suffer from a sleep disorder.
Fertility is a complicated process which can be impacted by many different elements. Although the relationship is not yet fully understood, it’s clear that sleep is one of those factors.
We hope this article has helped you understand the ongoing research into this topic, as well as steps you can take to improve the quality of your sleep. It’s important to remember that effective treatments are available for sleep disorders. Speak to your doctor about any concerns you have about your sleep health. Not only will you sleep better, but your care team will have a clearer picture of your fertility journey.
Jenny Silverstone created MomLovesBest.com in order to offer new mothers the advice they need when the doctors office is closed. At MomLovesBest,com, you'll find accurate, well-researched information from doctors, nurses, and other mom with real-life experiences. It's a judgement-free zone covering everything from trying to get pregnant to the parenting questions you didn't know you'd need to ask. Jenny knows first hand what it takes to become a parent and wants you to know that there is quality help available when you need it!
Below is a handy graphic you can find on MomLovesBest.com that offers some solid info on trying to get pregnant:
Chiemi Rajamahendran is a wife, a mom of 2, and founder of MissConception Coach. MissConception Coach was born out of the passion and dedication to offer love, support and guidance to women TTC and experiencing Infertility issues. She experienced and witnessed firsthand the isolation created by going through treatments and loss and vowed to make this experience a better one for others. She considers it her life passion-to offer online support to women no matter where they are in their journey, or in the world! Chiemi says: “I want every sister to know she is seen, she is heard and is not alone. I want to make sure every sister can receive support in the comfort of their own home, where they feel safe and the most comfortable. Our sisterhood of support and guidance is tailored to those experiencing stress and anxiety related to Infertility and related procedures such as IUI/IVF." Read below to learn more about Chiemi and Miss.Conception Coach, and then head to the below links to see for yourself how her noble life goal has helped so many.
What inspired you to start Miss.Conception Coach?
After witnessing and experiencing how isolating ttc and experiencing loss can be. I saw such a hole in our support system from the medical side to the 'after'. I know what I needed wasn't there and I knew the support that really helped me was from friends, and an inner circle of people who had experienced something similar. I wanted to facilitate that same sort of environment of women supporting other women in a safe, private community.
Your bio on Instagram reads: “We are changing the conversation about #infertility.” As someone trying to get people to talk out loud about infertility, I really connect with this idea. How do you hope to change the conversation?
By encouraging sisters to speak about how they are feeling, even if those feelings are jealousy, anger, fear, shame or sadness. I want to help them understand that it’s ok to feel these things and not to feel guilty! To acknowledge it is totally ok. It’s normal to process these feelings- they don't make you a bad person. You can own them and know that your rock bottom moments can be inspiring and powerful! They can inspire other women who might feel embarrassed about feeling them too and reassure them that is 100% normal. Sharing these hard feelings only prove the incredible amount of courage and strength inside someone fighting infertility.
Miss.Conception Coach advocates connection and you facilitate private groups for people dealing with infertility. How have you found this to be helpful for people in need? What would you tell someone who is interested in reaching out but might be nervous about doing so?
It's HUGE! When you ask someone on the other side of infertility what was the #1 thing that helped you survive that time, their answer is always “the support I got from other women experiencing the same thing.” It's so true! Even if via online, it is the daily, safe, familiar connection of having that group there that really carries us. I made a new group because so many members were now pregnant and wanting to continue that friendship and support! Now we have a whole separate group called Bump To Bottles. It's been amazing watching the journeys of these women who started together years ago, and now have toddlers! We do also join 'forces' with the two groups ('The Miss.Conception Coach Group' and 'Bump To Bottles.') We recently did a big surprise giveaway which the Bump To Bottles ladies hosted and donated to the Miss.Conception Group ladies! Tons of prizes and so much love and support felt showing support to the sisters still fighting. I tell anyone who I speak to, to please join our group. That there is no pressure but that I know they will get so much comfort in just being a part of that sisterhood.
The Inspire section on your website offers posts about infertility and personal experiences. Has there been one post in particular that you’ve found that people seem to connect with most?
Yes! The post I did last Summer: Status Updates Women With Infertility Want To Post On Social Media But Don't went viral! It is first hand shares from sisters, speaking the truth about what they go through on a daily basis. For example: 'Crappy day; after spending 10k and giving myself daily injections, Dr tells me my eggs are duds.'
You hosted the Bloggers Online Fertility Conference in 2015, do you plan to do so again in the future?
I have hosted two and they were such a wonderful experience. I'm not sure there is a third one in store but definitely something, that brings together our community again with a similar platform! I really want to start focusing on local face to face meets ups, groups and get togethers!
Since starting Miss.Conception Coach, what has surprised you most about this community you’ve created?
The resilience of the women in it! And the compassion and about of giving towards other's even when one is at their rock bottom. Such unconditional love and support towards one another!
You also founded Bloom Fertility Body Care, the first (and only) body care line custom made for women trying to get pregnant. Can you tell me more about this revolutionary product line?
Yes! I saw so many products for pregnancy and post pregnancy/babies etc., but NOTHING for women ttc, when really all natural products are the most important! I decided it was time for something just for ttc sisters. They truly deserve it more than anyone else! It is all natural body care that also has hormone balancing essential oils. I am working on the cream now and it will be launching soon! The feedback so far, from our soft launch, has been amazing and nothing but positive.
Are there any words of advice you could give someone who might be at the beginning of their TTC journey?
That you are doing the best you can. That it's enough! You aren't broken and don't need fixing. To keep sharing how you feel to those around you. To protect yourself and know the triggers that can affect how you feel. That's it's not selfish to put yourself first right now. You deserve all the love and support for this journey ahead. To just BE and allow for things to fill you with joy when you are feeling overwhelmed. Not to look for 'adding more' but just resting. Often after failed treatment and cycles we automatically go to “what can we do more. what did we not do enough of, and what can we fix.” Throw that away and just let you heart and soul rest. You did enough.
Egg donation has helped thousands of people a year achieve their dream of having a child. Often, these parents find it difficult to know how, when and even if they should share with their child the story of their conception. Julie Marie had a hard time finding the right resources to help her start this conversation with her own child, so, she created her own story. Please read below to learn more about the journey to the creation of this wonderful book that will surely inspire and help so many others.
Like many newlyweds, my husband and I dreamed of having children. We looked forward to creating fun family traditions in a home full of love and laughter.
Shortly after we started trying to conceive, I was diagnosed with the disease of infertility and we learned we were among the 1 in 8 couples who have trouble getting pregnant or sustaining a pregnancy. I was shocked to learn I had diminished ovarian reserve (DOR) and an undetectable anti-mullerian hormone level (AMH) at the age of 35. To make devastating news worse, we soon learned our insurance did not cover infertility and we would have to pay for our treatment out of pocket.
We were unsuccessful with intrauterine insemination (IUI) and quickly moved to in vitro fertilization (IVF). Given my ovarian insufficiency, our plan was to have two consecutive egg retrievals in hopes of retrieving as many eggs as possible. Time marched forward as we lived in an isolating bubble of infertility treatments. Tens of thousands of dollars and several complications later, we completed our two egg retrievals which resulted in only 2 total embryos. The first embryo transfer was unsuccessful and the second transfer resulted in a heartbreaking miscarriage.
Following the miscarriage, we reflected on the long and incredibly painful journey which had brought us to that point. We were not confident we would ever be able to achieve a viable pregnancy with my eggs. It was important to me that I carry the pregnancy if possible and we valued the option of my husband having a genetic link to our child. After considering our options, we decided to move forward with egg donation. Once the decision was made, a small glimmer of hope was restored. Our experience with egg donation was very smooth and, in the end, was the answer for us. I became pregnant and we are incredibly grateful to now be called Mommy and Daddy!
Years of struggles inspired me to become an infertility volunteer and advocate, by both helping other women currently going through infertility and through infertility advocacy to lawmakers.
My experience as a mother through the gift of egg donation inspired me to write the children’s book Happy Together, an egg donation story. Happy Together is a heartwarming book to help parents introduce the concept of egg donation to a young child. It is a story told through clear language and cheerful illustrations, I hope the book will comfort children with the assurance of being very much wanted and loved!
For more information, please visit www.happytogetherchildrensbook.com or Amazon.
In her brilliant article, Bethany Bray speaks to counselors in the field about the isolation and
heartbreak that often accompanies infertility and miscarriage. She writes about why these
experiences can be so all-consuming and goes into depth regarding ways to help facilitate
hope and healing.
Please find the original article, published in the September 2015 edition of Counseling
This past summer, Facebook CEO Mark Zuckerberg and his wife, pediatrician Priscilla
Chan, announced that they are expecting a baby. This celebrity baby news grabbed headlines for a different reason than most, however. The couple’s announcement included a candid acknowledgment that they had been trying to have a baby for several years and had suffered three miscarriages along the way.
“It’s a lonely experience,” Zuckerberg wrote in a July Facebook post. “Most people don’t discuss miscarriages because you worry your problems will distance you or reflect upon you — as if you’re defective or did something to cause this. So you struggle on your at sharing our experience will give more people the same hope we felt and will help more people feel comfortable sharing their stories as well.”
Zuckerberg and Chan’s post resonated with millions of people (witness the post’s 1.7 million “likes,” nearly 112,000 comments and 49,000-plus shares as of the end of August) and helped raise the curtain on some painful yet common issues that are rarely talked about openly.
Although many people who face miscarriage and infertility feel alone or isolated, statistics show the circumstances are much more common than people may think. Miscarriage, defined as the loss of a pregnancy before 20 weeks, occurs in 15 percent of known pregnancies, according to the American Congress of Obstetricians and Gynecologists. The U.S. Centers for Disease Control and Prevention reports that about 12 percent of women ages 15 to 44 have “difficulty getting pregnant or carrying a pregnancy to term,” while an estimated 7.4 million women in that same age bracket have used fertility services.
“Trying to make sense of it all is really, really challenging. The depth of the pain and the challenges you go through are hard to put into words,” says Kristin Douglas, a licensed professional clinical counselor and American Counseling Association member in Kentucky who has personal experience with infertility and multiple miscarriage losses. “You don’t ‘get over’ these kinds of losses. You work through them, but you don’t get over them.”
Mourning what might have been
A person or couple can’t help but think about the future, even if cautiously, after a fertility treatment or positive pregnancy test. Considerations from possible baby names to how the mother might be “showing” by a certain month naturally spring to mind.
“When that is taken away” — either through miscarriage or an unsuccessful fertility treatment — “you’re not grieving the past, you’re grieving what was going to be. You’re grieving the future,” says Valorie Thomas, a licensed marriage and family therapist and licensed mental health counselor in Florida. “With pregnancy loss and infertility, each time it doesn’t happen, you’re grieving … for all the ways you were thinking it was going to be. Helping the client to see that can be eye-opening — acknowledging that it’s real, it’s a loss [and] it’s gut-wrenchingly painful.”
Thomas knows this pain firsthand. She has been pregnant 10 times, but only one — her sixth pregnancy, a now 16-year-old son — was carried full term. Thomas and her husband also have a 7-year-old daughter whom they adopted.
Unlike when other family members, friends or acquaintances die, miscarriage and infertility can leave clients without memories to grieve. Often, people don’t even realize that they have the right to grieve, says Thomas, an ACA member who has a small private practice and is an adjunct professor at Rollins College in Winter Park, Florida. It’s the type of loss “that’s hard to understand,” she says. “You [typically] think of a loss as something that was already here, and you’re grieving it [no longer being here].”
With fertility treatment, she says, “You get the call from the doctors saying, ‘The pregnancy test was negative, we’ll see you next month,’ and they hang up,” leaving the individual or couple reeling with a flood of emotions, from anger and frustration to sadness and embarrassment.
Clients who are struggling with infertility or grieving a miscarriage can present with a range of issues in a counselor’s office. Depression, anxiety and intense stress are very common, Douglas says, as are feelings of guilt, anger, disappointment, frustration and fear. It is also possible for these clients to wrestle with trauma symptoms associated with their loss, she says.
It is not uncommon for couples or individuals to have experienced both infertility and miscarriage. Miscarriage, or “the inability to carry a pregnancy to term,” may be part of the infertility experience, Thomas says. But even when there is no overlap, couples who experience a miscarriage may share some of the same emotional responses as those who are having difficulty conceiving, she says, including a sense of helplessness, desperation and loss of control.
Because miscarriage and infertility can be taboo subjects, clients may not realize that they can — and should — acknowledge a pregnancy loss. For example, Thomas says, perhaps a client feels “down” every autumn but doesn’t know why. It could be that she experienced a miscarriage years or even decades ago during the fall that she never processed.
Professional counselors can provide help and support in a variety of ways to those who have experienced infertility or miscarriage. This might include helping clients work through the pain and stress of disappointment, self-doubt and even family or cultural expectations. It might also encompass encouraging these clients to practice self-care and teaching them coping mechanisms to help them get through the bad days.
Above all, counselors must familiarize themselves with infertility and reproductive issues if they are going to be sensitive and effective helpers for these clients, says Ebru Buluc-Halper, a mental health counseling graduate student at Pace University who runs a support group for couples and individuals going through infertility.
“If [a counselor] doesn’t know what they’re talking about, it’s a huge turnoff,” says Buluc-Halper, an ACA member who led a poster session on multicultural considerations in infertility counseling at ACA’s 2015 Conference & Expo in Orlando, Florida. She has friends “who were very frustrated by [a therapist’s] lack of knowledge and were turned off from therapy because they wanted to be understood. It doesn’t happen to everyone, but it does happen.”
“People want to be heard and want someone to talk to,” says Buluc-Halper, who has personal experience with miscarriage and fertility treatment. “They are deeply in need of empathy and understanding, which they’re not getting from the people around them, sometimes even from their partners.”
Counselors who don’t understand miscarriage and infertility — at the very least possessing a basic knowledge of the processes, terminology and biological factors surrounding these issues — risk reinjuring and alienating clients, agrees Douglas, an assistant professor of counselor education and coordinator of the counseling clinic at Murray State University in Kentucky. People who disclose their miscarriage or infertility struggles are often subject to the well-meaning but hurtful comments and assumptions of others, she says. Among the statements that are common: “If you just relax and de-stress, you’ll get pregnant”; “Just give it time, it will happen”; “At least you weren’t that far along to get attached”; “Maybe you should just adopt”; and “Maybe it’s not in your cards.” Comments such as these are often completely untrue and very upsetting to the receiver, says Douglas, who wrote her doctoral dissertation on miscarriage at the University of Wyoming.
“The last thing a person wants is to talk to a counselor who is going to say some insensitive and hurtful things in response to what that person experienced,” Douglas says. “There is a fear of what a counselor might say. Are they going to say the insensitive things that everyone else says? Things that are so hurtful or that minimize the loss?”
Handle with care
One of the most important things counselors can keep in mind is that no two clients’ experiences are the same, says Courtney Armstrong, an ACA member with a private practice in Chattanooga, Tennessee. Each client will attach a different meaning to what she or he is going through.
“Everyone’s experience with infertility is different. You can’t just make assumptions,” says Armstrong, a licensed professional counselor who accepts client referrals from a fertility clinic in her area. “You have to respect that it’s a process for people to come to terms with their infertility. It’s not something you can help them reason their way out of. You have to treat each person individually because every person is going to respond in a different way.”
Counseling and therapy must also be individualized in cases of miscarriage. Douglas says she finds it much easier to talk about her first miscarriage, which involved triplets, than her second, which was a single baby. “People would never compare the death of a sibling or a parent to that of an uncle or other relative,” Douglas says, “but somehow, [people] just lump all the miscarriages together. Each failed fertility treatment is not the same either.”
There is no one-size-fits-all way to address a client’s infertility or miscarriage in counseling, agrees Thomas. “It’s important that the counselor be aware [of] spirituality and traditions and culture. Your clients are bringing all of that to you,” she says. “You can’t just [use] a cookie-cutter approach.”
Thomas terms miscarriage a “silent sorrow,” saying that the loss typically goes unacknowledged by society. Too often, she says, the message that women who have experienced miscarriage receive is: “Get over it. You’ll be fine. Don’t worry about it.”
“But depending on your spiritual beliefs, depending on what that meant to you at the time, what it signified, what does family mean to you, what does creating a family [mean to you], how bad you wanted it — all those things play into your reaction,” Thomas says.
Paying careful attention to the language the client uses can provide counselors clues about how the person is processing the loss, she says. For example, does the client say, “I was 10 weeks pregnant, and I lost the baby,” or does she use another word? If the client or couple isn’t ready to use the word “baby,” the counselor shouldn’t refer to the pregnancy that way either, Thomas advises.
After going through pregnancy loss and several rounds of in vitro fertilization, Armstrong
and her husband made the choice to be child free. Making that conscious decision was
empowering, she says. “The choice piece is the really important part — deciding if this is
the best and right thing for me,” she explains.
Likewise, Armstrong says, in counseling it can be empowering for clients to find
meaning and realize they still have the ability to make choices in an unwanted situation.
Wanting to be a parent and wanting to be pregnant are two different things, and helping
clients to uncouple those two concepts in their mind can be helpful, she says.
“If they’re going to explore infertility treatment, adoption or other options, is this about
having a child or having a child that’s biologically connected to you? The most important
thing is that they feel they have the freedom to make a choice,” she says.
Thomas’ experience with infertility caused her to rethink the assumptions she’d held
growing up in a Catholic family with nine brothers and sisters. “In my family, it was just
assumed we’d all have large families,” she says. “When that didn’t happen for me, I had
to revisit [that] and ask myself if I’d be OK if that didn’t happen. Then I came to grips
[with the realization] that you can create family in different ways. It was OK that I had
other parts of myself to be a whole person. I realized that it may be different for me.”
How to help
Heartbreak can accompany miscarriage and infertility. But so can hope and healing. Here
are a few ways counselors can help clients who are processing these experiences.
Storytelling and narrative therapy: Two of the most important things counselors can
provide to these clients are a listening ear and empathy. “It’s just so important to listen to
their story, really listen to their story,” Thomas says. “Every one of them is so different.
Each one has a different journey. Listen compassionately and really be present.”
Douglas recommends inviting clients, but not pressuring them, to talk about their loss
experiences, such as where they were and how they felt when they learned they were
pregnant, what it was like to be pregnant, what happened during their miscarriage and
what feelings they had when they learned their pregnancy was over.
“Just like with other types of trauma, you want to be sensitive to not retraumatize clients
by having them share their story over and over again,” she says. “But at the same time, if
clients feel it would be healing to share their story, invite them to share it and process it
as many times as they feel they need to. It can be healing to remember, to talk it through,
to process these things with other people, especially if clients did not feel their loss was
acknowledged or if they did not have the opportunity to share their story in full with
This hit home for Douglas as she wrote the narrative of her first miscarriage for her
doctoral dissertation. It was the first time she had written out the entire story, start to
finish, she says. Afterward, she read the four-page narrative aloud to her own counselor
in a therapy session. “It was such a powerful moment. I just sobbed and sobbed as I read
it,” Douglas says. “It was then that I realized I had shared my story with lots of different
people but never the whole thing beginning to end — only parts. That was huge for me. I
had a further glimpse into the power of story, the power of vulnerability, the power of
giving voice to nebulous experiences and the power of validation. Sharing my story
beginning to end was emotional but very healing.”
The empty chair approach: This Gestalt technique can be helpful for processing
“unfinished business” — something all too common for those who have had a
miscarriage, according to Douglas. Counselors might ask clients to speak to an empty
chair as if their child who was miscarried were sitting there. Or use the empty chair to
have clients speak to whomever they need to — perhaps a co-worker who made an
insensitive comment or a doctor who came across as callous, sterile or impersonal. The
empty chair can also provide a means for clients to speak to their deity, even venting
frustration or another emotion.
“This can be a way to give the client a voice or provide a degree of closure,” Douglas
says. “It not only helps clients work through complex feelings as they process lost hopes,
dreams and frustrations, but also helps them have an important, needed voice.”
Journaling and letter writing: Writing a letter can provide clients an outlet to tell their
miscarried baby that they miss and love the child. Similarly, clients can write themselves
a letter from the baby, Thomas says.
“At some point when they’re ready, have the client write a letter from the baby to the
parents. They can say, ‘I’m still here. I love you.’ That’s very healing, but it shouldn’t be
done right away,” Thomas warns. “It takes time. [The parents] have to be ready for that.”
Creating a journal can also help clients process a pregnancy loss by encouraging them to
explore the loss and what it meant to them, Thomas says. Each experience will be
different, whether it is the client’s first miscarriage or third, whether the client already has
children at home, whether it was an unplanned pregnancy and so on.
Expressive arts and other creative therapies: Douglas displayed copies of some of the
pastel chalk drawings she created as part of her own way of coping with her miscarriage
loss when she co-presented a session at the ACA Conference in Charlotte, North
Carolina, in 2009.
She advises counselors to pay attention to their clients’ creative interests and incorporate
those interests into the therapeutic process, if appropriate. For example, if the client likes
to garden, planting a tree in honor of a child who was miscarried might be healing for the
client. If the client has a flair for design, perhaps she could design a bracelet with charms
that represent the pregnancy. Douglas finds that expressive arts or other creative therapies
not only help clients work through challenges associated with their loss, but also assist in
making the intangible tangible.
Douglas had one client who enjoyed scrapbooking. Creating scrapbook pages became her
version of a journal and helped her find meaning in the miscarriage she had suffered.
Scrapbooks or other creative projects can include ultrasound images, hospital bracelets,
photos of baby gifts that were received or a narrative written by the client about what it
felt like to find out she was pregnant.
“One of the challenges of miscarriage is the intangibility,” Douglas says. “When you
have such few items, those ‘artifacts’ such as an ultrasound photo become very important
in validating your experience and your loss. You cling to those things.”
Mind-body and wellness approaches: Thomas says mind-body approaches such as
yoga, relaxation techniques, meditation, deep breathing, guided imagery and repeated
prayer can be helpful to clients who have experienced miscarriage or infertility. In one
case, Thomas used guided imagery with a client before her fertility treatment, instructing
her to envision that her grandfather, who had passed away, would be with her to support
her throughout the procedure.
In addition, encouraging clients to pursue a wellness lifestyle, including eating healthy
food, exercising regularly and getting enough sleep, can be helpful, both because of the
health benefits provided and because it gives clients a new area of focus. Spending time
on healthy cooking, for example, can divert a client’s energy and focus away from
frustrated or anxious thoughts. Assure clients that they are working to be “in the best
place they can be to ride this roller coaster,” Thomas says. The thought becomes: “I am
doing the best I can to make my body healthy so I have a chance of conceiving.”
Encouraging clients in the practice of self-nurturance, such as taking 30 minutes each day
to do something they really enjoy, can also help refocus their energy away from the stress
of fertility treatments. Thomas instructs clients to think of 10 things that they enjoy doing
and that make them happy. Then she asks clients, “How many of these things are you
doing? You’re allowed to enjoy things during this time. Look for ways to enjoy
Developing signals: Sometimes social situations can be overwhelming for individuals
who are going through infertility or who have experienced a miscarriage. Buluc-Halper
and Douglas both suggest that counselors have these clients develop a signal to let their
partners or trusted friends know when they need to change the subject or take a break
during social gatherings.
But clients also need to be realistic about what they can and cannot handle, Buluc-Halper
says. “Going through this experience is a good time in your life to put yourself first,” she
says. “[When] you’re expected to show up at a dinner or a baby shower and you
emotionally, truly, cannot handle it, it’s OK to put yourself first and say, ‘It’s not a good
day for me.’ Put yourself in touch with what you’re feeling. You’re in such a fragile state.
There are days when you wake up and you know that you can’t go, and others when you
are strong enough.”
Externalize the problem: Buluc-Halper suggests that counselors help clients remove the
word infertile from their vocabulary. Infertility is not their identity, she explains. “We
don’t say, ‘I’m cancer.’ We say, ‘I have cancer,’” she says. “Infertility doesn’t define
them. It’s just part of their journey. Finding a way to externalize that does make it easier
to go to the dinner, the family gathering, the baby shower, [knowing] this is just part of
my journey. Everybody will go through something in their lives, and this [infertility] is
one of the things that we just happen to be going through. … Everybody will find some
sort of resolution, whatever that may be. As in every experience, there will be a
resolution. It might not be the resolution you envision, but you will find some kind of
The trusted friend: When clients are hesitant to tell family and friends about what they
are going through, Buluc-Halper suggests that they pick one person, such as their mother
or a favorite sister or cousin, to confide in. Ideally that person should be able to serve as a
buffer when awkward or painful subjects or questions are raised at family or social
gatherings. In Douglas’ case, she had a trusted friend who would intercept baby shower
invitations for her, knowing she wasn’t ready to face such a baby-focused event.
A cultural perspective: A client’s cultural background can play a huge role in how that
person views and deals with miscarriage or infertility. At the same time, counselors
should never assume that individual clients will experience these issues within the
cultural norms of their respective backgrounds, Buluc-Halper says. Doing a cultural
genogram with clients can help counselors get a better idea of the role that cultural
background plays in a person’s life, she says.
Thomas agrees, noting that she asks clients about their spirituality and family of origin at
“The very, very important part for all counselors to remember when working with
infertility clients from a cultural perspective is to be very aware of their own cultural
biases,” Buluc-Halper says. “Be cognizant not to distort the couple’s experience based on
how you assume that culture perceives infertility in terms of its ideologies, in terms of its
experiences or in terms of the resolution. … They might not be experiencing infertility
the same way you might expect them to based on their cultural background.”
Taking a break: For clients who are going through fertility treatments, each stage brings
a series of decisions and procedures that can be exhausting, Armstrong says. Counselors
can offer their clients reassurance that if they decide to take a break from treatments, it
doesn’t mean they are giving up, she says.
“Maybe take a month off, regroup and then go on to the next stage [of fertility treatment].
Tell them, ‘You’re not giving up. You’re just backing off for a minute to get some
perspective and come back,’” Armstrong says.
Internet forums: Numerous websites and online forums are available for people going
through infertility and reproductive issues. Although these sites provide helpful
information and a way to connect with and find support from other people facing similar
issues, the sites can also cause clients to spend more time focusing on issues that cause
them anxiety, stress or sadness.
In Armstrong’s case, she stopped visiting online forums while she was undergoing in
vitro fertilization because they were provoking her anxiety. Although such forums can
offer support in many situations, Armstrong found they could also act as a platform to
swap “horror stories” or misinformation. “Some people find them very helpful, while
others find it makes them feel worse,” she says. “It helps them know that they’re not
alone, but there can also be a risk because it can make them more worried.”
If online forums don’t appear to be serving clients’ best interests, counselors can suggest
that they take a break and attend in-person support groups instead. Support groups,
whether online or in person, can play an integral role in breaking through the isolation
that often accompanies experiences of miscarriage and infertility, Buluc-Halper adds.
Grief: Douglas theorizes that women grieve miscarriage loss developmentally. “This is a
life that would have been,” she explains, “and you will most likely grieve in different
ways and different stages for what that child would have been like [as it aged]” — such
as when the child would have started walking and talking or when the child would have
started kindergarten. Missed milestones may be extra emotional as time passes. As a
result, grief may resurface over and over again, but in different ways, complicating the
healing process, Douglas says.
Anniversaries: In cases of miscarriage, multiple dates can be painful, such as the day the
couple found out they were expecting, the baby’s due date, the date they lost the
pregnancy and so on. Counselors might suggest that clients engage in extra self-care on
those anniversaries or commemorate the dates with rituals such as playing a meaningful
song, lighting a candle or sending up a helium balloon with a letter inside to their
miscarried child, Douglas says.
Control: One of the most difficult aspects of dealing with infertility or miscarriage for
clients is accepting that what has happened or is happening is largely out of their control.
“A lot of people blame themselves and think, ‘I’m not doing enough or could be doing
things differently,’” Armstrong says.
In cases of infertility, some clients will do things to try to take control of the situation,
such as cutting gluten out of their diets or taking their temperature daily. Counselors need
to be sensitive to the fact that these clients may have devoted a lot of time and energy to
finding different methods that might increase their chances of conception, Armstrong
says. If the methods are giving them more confidence or security about their situation,
that can be good, Armstrong says, but if the methods are only serving to make clients
blame themselves further, that can be harmful. “Be mindful and aware of helping clients
find what makes sense and what may not be influencing whether or not they get
pregnant,” she says.
In cases of miscarriage, Armstrong says she most often points to biology with clients.
The human body is designed to abort a pregnancy that could be harmful, she says. “I
really try and bring it back [to the fact] that we don’t understand all the reasons why
[women miscarry], but it’s purely biological,” she says.
Offering hope: Individuals receive very straightforward — and sometimes upsetting --
information from medical doctors about their infertility, including the slim percentage
they may have of getting pregnant or the complications that could happen as a result,
On the other side of that coin, a counselor’s focus on the positive can provide clients an
antidote to discouragement, she says. “Hope is such a big factor. … Put [clients] back in
charge of their life,” she advises. “Offer hope that there are some coping strategies
[available and that the client is] a normal person responding to the struggles of creating a
family. [Tell them], ‘You need to give yourself permission to be angry and cry. … Keep
the faith. If you want a family, it will happen. It may just not be the way you
Couples: It takes two
Spouses or significant others will naturally deal with miscarriage or infertility in different
ways and process things at different rates. In fact, it is common for a counselor to see
relationship partners who are in two very different states emotionally, Armstrong says.
One partner may have already accepted what has happened, while the other is still in a
bargaining stage, thinking, “Surely there is something we can do” to change the situation,
Counselors can help by educating couples that the grief that accompanies a miscarriage
or infertility will come in waves and that each partner is likely to be at a different point
along the grief spectrum. Once couples understand that it is natural to feel differently
about what they are experiencing, they often express a sense of solace, Armstrong says.
“They’re relieved [because] they don’t see themselves in conflict, just at different stages
in the process. Then they can understand and be more patient with each other,” she says.
“Help them understand that they’re in different stages and how to communicate and best
support each other” wherever they are in the process.
Differences in spirituality level or religious background can threaten to divide a couple
during a miscarriage, notes Thomas. For example, one partner may consider a miscarried
baby to have a soul, while the other does not.
“Spirituality can be very healing or create a lot of conflict if they’re coming from
different perspectives,” Thomas says. “One may feel it’s ridiculous to grieve, while the
other feels it’s necessary. Work with them to be respectful of each [other’s perspective].”
It can be helpful for counselors to suggest that a female client bring her partner to
medical and therapy appointments when possible, Buluc-Halper says. It is important that
the client learn to rely on her partner for support throughout the entire process, not just
during times of extreme anxiety, she points out.
“Partners don’t always understand how all-consuming this [infertility] experience is,”
Buluc-Halper says. “You’re the one that is doing blood work, and your arm is purple
from all the injections. It’s not to diminish the male experience of this, but they don’t
always understand why the female can’t really detach herself from the issue.”
As important as empathy is for counselors, it is equally important to teach that skill to
couples, Thomas says. She often has couples hold hands as they tell each other what the
miscarriage journey has been like for them. The counselor is there to assure both partners
that whatever they are feeling is valid, real and quite possibly intense, Thomas says.
“Give them a safe place to explore what this has been like for them — sometimes for the
first time,” Thomas says. “What does that loss mean to them? [They are] really seeing
each other describe what happened and how they’re feeling right now. Because they
grieve differently, it’s important to validate their experience and [explain] that it may
trigger some previous losses and intensity that might scare them.”
“With infertility, they can get stuck and not want to move on if they’ve had a pregnancy
loss and not really grieved it,” she says. “They need to slow down and experience what
they need to experience before they go on to the next step.”
Breaking the silence
By inviting conversations about miscarriage and infertility, counselors can play an
important role in removing the stigma and isolation that surround these issues. Douglas
cites the example of breast cancer, a once-taboo subject that is now openly talked about
and advocated for with well-publicized campaigns and fundraisers.
“Invite the conversation and break the silence,” Douglas says. “Help give women and
men permission to grieve miscarriage losses and give voice to those losses. Give them a
safe, nonjudgmental place to share their stories. Invite those stories. Take time to listen to
those stories over and over again, as many times as people need.”
For more information
Bibliotherapy resources for clients and practitioners
Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her at firstname.lastname@example.org.
written by Carrie Alexander, The Tired Girl
Originally posted on The Tired Girl (http://www.thetiredgirl.com/p/thank-you-hormones.html) on 6/22/17
I'm okay. Not like Britney Spears in 2007. But like Britney in 2017. We have both gone to dark places and seen some shit, but we are definitely on the upswing. She is good* and so am I.
I have rarely hesitated spilling my sad guts here, but I have had pause to share that I am okay without children. And it's because people with children feel sorry for me when I am sad that I don't have any, but as soon as I am okay I can envision the judgment.
People may think we didn't try hard enough, didn't want it bad enough. We could have adopted a child from the state, we could have gone to Russia, or Ethiopia. Could have fostered. What about surrogacy? If we had REALLY WANTED a child we could have one, some people think. So that means we must be selfish. We wanted them, but only kind of.
And without discussing each individual option with people it can't be understood from the outside. I don't feel selfish. I will never be able to explain my actions to anyone that wants to challenge me. Everyone has to forage their own path through reproduction.
I am plenty judgmental about a lot of things in life, but weirdly not in the realm of child rearing. You want to hoard babies from China? Great - thank God for you! You want to go into debt with surrogacy? Fabulous - I wanted a baby that looked like my husband too. Abortion? It seems pretty traumatic to carry a baby you really don't want. Keeping a baby you thought want to give up adoption? I'd want to keep my baby too. All judgment falls away when it comes to the reproductive choices people make. But for some reason I assume people with children don't have that - I don't have proof, it's just something visceral to me.
There are many reasons I am okay, and the biggest reason is because I don't know what I am missing. I had Ralphie the dog and now Teddy the dog and they give me a place to put my momness and love. Everyone needs to talk baby talk at some point.
But otherwise I don't know the joy I am missing by not having kids.
I don't know what it's like to look at a small version of my husband that I grew in my body and felt kick. I don't know what it's like to be so sleep deprived and still feel a thud of love when a little person clings to me for comfort.
And those of you with kids don't need to convince me - because the best thing I have going for me is that I don't know. I can't miss the Porsche I don't have. Or the taller height I don't possess.
I have filled my life up with other things. Things that probably seem shallow or selfish or lazy to parents, but have meaning to me. I gave this process all I had and I don't have children to show for it. My life feels full and happy and meaningful. I'm okay. #thankyouhormones
*Britney's "good" seems slightly more tenuous than mine. But she can comfort herself in millions of dollars, so she's got that going for her.
pregnantish is the first online magazine dedicated to helping people navigate all things Infertility. Founded by Andrea Syrtash, pregnantish offers a wealth of information on this often overwhelming and emotional process.
You can find Andrea and pregnantish here:
www.andreasyrtash.com and www.pregnantish.com
Follow pregnantish: @pregnantish on facebook, @pregnantishmag on twitter, and @pregnantish on Instagram.
You went from writing about relationships to focusing on Infertility, what led you to start pregnantish?
Funny, I always say that I'm doing the same work as I've done for a decade, which is help people navigate relationship challenges. Infertility is so often pegged as a medical issue (which it is!) but it also affects relationships in the deepest way: the relationship you have with your partner (if you have one. If you don't, that's a whole other challenge!), the relationship to your family and friends and the relationship you have with yourself and your body.
I created pregnantish (small p because...not yet pregnant!) because I've covered so many chapters of modern day relationships through my books, articles and TV appearances. I felt like a huge chapter of peoples' relationships, infertility, needed to be addressed.
I always say that I'm credible, not clinical. I'm credible in that I'm a relationship journalist who has tracked trends, published books, coached people for a number of years while I've been going through trying to get and stay pregnant. I've had a medical issue since I was 14, when I was hospitalized with endometriosis, and always knew I may have challenges getting pregnant, but never imagined it would take so long. It's been over 7 years and almost 6 years ago I had open-stomach surgery to remove a freakishly large fibroid tumor.
I was frustrated that content in this category was relegated to clinics, message boards and parenting sites. Bloggers do great work, and there are great advocacy sites out there, but I was searching for a high-quality lifestyle site to address this. There are over 7 million people going through this challenge. I didn't understand why it had to be a vertical on a parenting site and not an independent site/digital magazine dedicated to this audience. (I should also clarify that we address singles and LGBT who may not be 'infertile' but still need support as they go through fertility treatments.)
At pregnantish we work with a team of professional journalists and a health book editor. I take the content we share very seriously and make sure we have premium content to serve this smart and thoughtful audience.
Has there been a topic that most resonates with people?
Yes! Anytime we publish articles or social posts about the misconceptions, it resonates with our audience. One of our most popular pieces is 'Stop Telling me To Look on the Bright Side' Our audience is sick of people telling them to just relax and think positively and it'll happen! They want people to know that they have a medical issue that requires more than the quick fixes people share with them.
You advocate for talking openly about Infertility. Do you think there has been a shift toward others doing the same?
I'm starting to see a shift, for sure. Celebrities are 'coming out' about their own experiences of miscarriage, IVF and/or surrogacy. Some brands are starting to recognize that this is a group that shouldn't be ignored. My hope is that the taboo is broken. One of the great essays on pregnantish is 'Let's Break the Taboo of Infertility.' that we launched the site with. The writer, Elissa Strauss, talked about how breast cancer used to be taboo and now it's hard to imagine as there are walks and merchandise and awareness. We imagine infertility will become more talked about ahead...it's so isolating to feel like nobody knows what you're going through.
You present at many conferences and are interviewed often. What question are you most often asked?
I'm asked why I created pregnantish when I already had and have a pretty comfortable credible brand in the relationship space. I just hosted a pilot for Fox in the Spring. I'm still out there regularly in the media sharing sex & relationship advice (which is sexier than infertility!), so people ask why I've moved on. It's important for me to communicate that I haven't moved on. I see infertility as a chapter of many modern-day relationships, so I want to address it.
People also probably offer a lot of thoughts or unsolicited advice. What is the craziest thing someone has suggested to you?
Definitely! That's the biggest pet-peeve with our audience, for sure. The craziest advice I got (last year!) was that I should just hold my legs high up in the air after sex and it'll work. It was comical, actually. After over 7 years, many treatments, surgery, pregnancy losses...I didn't realize it was that easy! :)
What has been the most helpful advice someone has offered?
The most helpful advice I got a few years back was that if I want to be a parent, I'll find a way."
What advice would you offer to someone starting out on their Infertility journey?
Firstly, not to feel badly that you have anxiety or stress. People will tell you to stop stressing, but this response is incredibly normal and expected. Practice self-care - that's critical. For some, that may mean skipping your 15th baby shower or it may mean getting a massage or speaking with a counselor. Find what comforts you.
Finally, I always say that you don't need to know the how, the when or the where of it. You just need to know the what - that you'll be a parent. You'll get there.
I’m so excited to introduce you to Christine of Infertility Illustrated. Currently working in corporate communications in Chicago, Il., Christine studied illustration in college and is using her talent to share what it’s like to deal with infertility. Drawing true-to-life, funny, and insightful representations of her experiences, anyone that has gone through infertility or is currently going through it will find her work relatable. Head to her Instagram page to find more amazing illustrations: Infertility Illustrated
You started Infertility Illustrated in August 2017. What motivated you to do so?
We'd been trying for a few years and I've been pretty ignorant about the greater fertility community out there. I was sitting at my desk and just thinking about how my husband was once again starting this exciting new chapter professionally and coincidentally I was having another miscarriage. And it was just the two things contrasted with each other that made me draw a quick little sketch and share it on instagram.
You surpassed 1,100 instagram followers in 5 months, what kind of feedback have you gotten regarding your posts?
It seems like a lot of the illustrations are really relatable and that's what I was hoping for! I really wasn't expecting much at all. My goal is to show "a day in the life of infertility" and what it's like to deal with all the stuff we deal with. So, I'm just really glad people are enjoying my pictures!
Is there an illustration that you’ve found resonates the most with people?
I don't know if there is one in particular that resonates with people the most, but overall, I think the illustrations that are the most relatable are the ones showing just those everyday thoughts and feelings where you're just silently praying to yourself that acupuncture will help you or you're just upset because someone's pregnant with their second child and you can't even have one.
In your first post you list your infertility “creds.” What has the medical process been like for you?
It's been really, really long. I'm so tired of it, you know? We're not ready to give up, but it's been really exhausting. The roller coaster really is the best way to put it. I've heard that analogy a lot and it's so true! Your emotions are constantly going up and down with each new cycle. I never would have thought we would have had to take this road as far as IVF and beyond. I guess maybe I was a little naive because even with IVF I was pretty convinced it would work on our first try. I think educating yourself is a slippery slope, or at least it was for me. When I started to read stories of people who had to do multiple rounds of IVF I sort of had that eye-opening, panicked feeling of "oh my gosh, this could potentially go on a lot longer."
Are you trying anything beyond medical interventions?
I've tried acupuncture in the past, but it started to get a little expensive. We have to pay out of pocket for all of our medical costs so it gets hard to afford everything you want to do. I've also incorporated maca powder into my diet and last year I gave up coffee and alcohol for most of the year in the hopes that maybe all those things would help. But this year I'm back on both coffee and alcohol, they help keep me sane!
What has been most helpful as you navigate your path?
It was really great having a doctor that I trusted and knew I could contact (and would get back to me immediately) about anything. I'm in Chicago now, so with a new doctor, but my doctor in Virginia was amazing. She got me through 2 ectopic pregnancies, IUIs, IVF, and FETs and she was the best! Having doctors and nurses who genuinely care about you is so important and makes everything a little bit easier to handle.
What has been hardest for you during this time?
The hardest thing this past year was going through IVF alone. My husband deployed (he was in the Navy) on the day I started IVF and after the IVF coordinator went through all the instructions for everything I just started bawling in her office because I was going to have to do it alone. So I was mixing my medications, administering my shots, and then dealing with the heartbreak of failure on my own and that was really hard. Infertility is a couples' issue and a lot of the time in the past year I was by myself. Granted, I chose to do it by myself, I could have postponed IVF until he came back from deployment, but when you've been at this for so long you don't want to have to keep putting it off.
How is your partner dealing with this process?
He has been really supportive and understanding. He hates that he hasn't been there for me as he should have this past year, it was pretty hard and frustrating for him. He's a guy that likes to "fix things" so when he can't fix this, he'll just go around and look for other things to fix around the house. I think it's his own way of dealing with the stress of all this.
We often field ridiculous things from people we know and love (and sometimes from complete strangers). What is the least helpful thing someone said to you?
Ugh I feel like there have been so many and I can't even pinpoint one now. When I had this last miscarriage, I went to a general OBGYN because I didn't have a doctor in Chicago yet and she said "you know you can stop"...as in you know you can stop doing fertility treatment. At the time I found it incredibly callous because I was literally in the middle of a miscarriage and so sad and here's this doctor telling me I should maybe give up. Not at all helpful.
What is the most helpful/supportive thing someone said to you or did for you?
My friends and family have all been really, crazy supportive so I hate to single any one situation out. When my husband was deployed, my mom drove 8 hours for the weekend to be with me when I had my IVF retrieval and my brother came down and waited on me when I had my first frozen embryo transfer. My amazing neighbor and friend brought me groceries and picked up my medicine when I had OHSS and could barely walk and she took out my trash for me, which was a small thing, but really sweet! My sister bought me a bracelet that says warrior. So, I've had a lot of support and I'm pretty lucky there!
What would you like others to know about your experience thus far?
I don't think there is any one thing I would want people to know about my experience. My biggest thing is to take care of yourself! Infertility sucks so you have to take time to do the things that make you happy!
What advice would you give to someone about to begin the process of infertility interventions (medical or otherwise)?
Brace yourself. It could be easy or it could be a really long road. Try to take everything in stride, one cycle at a time. And again, you do you! Don't let anyone pressure you into anything!
I want to introduce you to an amazing couple: Virginia and Tom Hanada. High school sweethearts from Portland, Oregon, Tom is a professional writer and Virginia is a professor of Child Development and published researcher. Beyond these accomplishments, they have also published a book, one that I encourage anyone going through infertility to read. And buy extra copies of so that you can hand it to people when they ask, “so when are you going to have kids?”
You can find the Hanadas on Facebook, Twitter, or Instagram
Virginia has also recently started a website: https://angryladybits.blogspot.com
You wrote, Down the F’n Tubes: an ode to fertility futility. It’s a book that accomplishes many things: it gives those with no infertility experience insight into what it’s like; it gives those that have had experience a chance to feel understood and less alone; and it helps brings humor to a crappy situation. How did the book come about?
During our long, early morning drives to and from infertility appointments, we’d talk about my lady bits as though they were characters.
“Ugh, the endometriosis is like a tentacle monster, getting all up in there”.
“ANOTHER cyst? They're like sea monsters wedging their way into a bathtub.”
Imagining these obstacles as characters made it funny. Bearable. We started toying with the idea of turning our experiences into an illustrated humor book. We just didn’t know how.
And then we came across Dr. Seuss’ “Oh, the Places You’ll Go!” There are moments in that book where he discusses “the waiting place” and “failure” and all these concepts that are so much more poignant to us now.
We realized that Seuss’ lyrical, imaginative style was the perfect format to tackle complex topics and emotions, and make a very individual experience universally relatable.
Ultimately, that was the goal – to make the world understand how infertility FEELS. Not to mention that it was fun to write a bunch of rhyming sex puns.
So often the partner’s voice is left out of the process. Down the F’n Tubes really captures what it’s likes for the both of you. Can you talk about how each of you has handled your infertility journey?
Regardless of whether infertility is male-factor, female-factor, or unexplained, women are burdened with most of physical aspects of infertility: blood tests, ultrasounds, medicine, injections, miscarriage, etc. However, the psychological anguish and frustration is a shared experience. We wanted to address that by including both perspectives.
Writing this book together helped us cope with infertility because it was something we could control. I’m as Type A as you can get! I pack at least 1 week before leaving for a trip and figure out vacation plans months in advance. Infertility stripped control from our lives because we couldn’t plan a day in advance, let alone a week. After a couple of years of this, I felt like a shell of the person I was before we started trying to conceive. Not being able to do something we are biologically programmed to do felt like the ultimate failure. It was also incredibly isolating and lonely for us. It seemed like everyone around us was super fertile. We weren’t sharing with a lot of people, so it hurt every time someone asked if we wanted kids or reminded us that we should start having kids because, you know, we’re getting old. Writing this book gave us an outlet to share our experience, and something to look forward to.
The book does a great job of using humor to normalize infertility. What else were you hoping to accomplish in writing it?
We want to raise awareness about infertility. A lot of people think infertility is uncommon. That it only happens to other couples. We wanted to capture what infertility felt like, from the beginning, so that everyone could relate to it. As others have eloquently written, people dealing with infertility grieve the family they might not have, but they grieve silently and in a vacuum.
The book is meant to validate the raw emotions people feel going through infertility, and to remind them that they are more than their infertility. We hope our book reaches people who are struggling with infertility, but more importantly, helps others understand why the people they love who are dealing with infertility feel so broken.
This book has also been a great conversation piece in professional settings. When colleagues ask the “When are you having kids?” question, instead of fumbling around with a “Oh, uh, we’re, uh, thinking about that…” we can confidently say, “We actually just published a book about infertility. And because you asked that question, you now have to buy it.” That little joke opens up conversation and awareness, and teaches people valuable lessons in tact (and they often end up buying the book out of guilt, so there’s that!).
Down the F’n Tubes is certainly helpful to others. What has been most helpful to you both while going through this process?
Honestly, writing this book saved our sanity. It was so hard to process the emotions we were feeling. We needed to vent. We needed to scream “FUCK SHAME” as loud as we could to as many people as we could.
Infertility had started consuming our lives and our self-image. But once we started working together on this story, we realized that we had found a way to define infertility instead of being defined by infertility.
And the conversations it has sparked have been incredible! After we started sharing the book, so many friends and family members began confiding their own infertility struggles to us. Some of these friends have Facebook pages filled with pictures of their children; we had no idea the pain and heartbreak they experienced to have these families. It’s a shame that no one talks about the struggle. It can be so demoralizing when everyone on Facebook has children with seemingly no effort.
Once we started to have these conversations with other people, it alleviated so much of our emotional burden. We realized we weren’t alone.
What has been the hardest?
The uncertainty and lack of control was really hard. Every ultrasound took 3 hours out of our day, and sometimes we wouldn’t know if we needed an ultrasound until the day before. One week we had to go FIVE TIMES. If we didn’t have flexible schedules and accommodating jobs, this would be impossible. Even so, we felt really guilty and unproductive in our careers, careers that we have worked towards our whole life.
A commonality among those going through infertility is fielding ridiculous comments from others. A near stranger told my husband to “just flip her over.” Your latest Instagram post says, “So the next time you tell someone to relax so they can get pregnant, STFU. Please and thank you.” Is that the most absurd thing you’ve heard or has someone said worse?
Funny enough, an early draft of the book had an entire section of bad advice that we unfortunately had to cut for space and story flow. But here are some of the rhymes that hit the cutting room floor:
Their family and friends couldn’t help but be nice,
With a whole fucking stork of unwanted advice.
“Smile! You can’t make strong eggs if forlorn.”
“Your sperm are more active if you watch gang-bang porn.”
“Don’t eat cheese, don’t eat fish.”
“How ‘bout coffee?”
“No laptops on balls.”
“Wait two days ‘tween each wad.”
“Don’t bike, you might fall.”
“Have you tried asking God?”
Those are all actual conversations… yes, even the gang-bang porn one.
To be fair, people can also be amazing and seem to know just what to say. What has been the most helpful or supportive thing someone has said to you?
“I’m sorry, that sucks” is the most supportive thing our friends have said to us. That’s because there’s no unsolicited advice, judgment, or pity. It also meant a lot when friends affirmed that we don’t need biological kids (or kids, for that matter), to be considered a family. We are a family.
At the end of Down the F’n Tubes, you write, “A life without trees can be happy and complete. Because sometimes it’s hard to get gametes to meet.” The most helpful thing my therapist ever said to me was that I’d have my family. Whether it was IVF, adoption, surrogacy, or not having kids, I’d create a family. I think what you’ve written there is a reflection of that and really hit home for me. Can you talk a little more about this?
I LOVE what your therapist said. There is so much truth to that statement, and it’s an important perspective to maintain. In fact, the field of child development defines family as two or more persons related by birth, marriage, adoption, or choice who have emotional ties and responsibilities to each other. Tom and I became a family once we made a commitment to each other. We just had the desire to expand it.
We all start with an idealized version of what our family will look like. But infertility is one of those things in life that just isn’t fair. It sucks. It’s frustrating. It upends all of our well-laid plans. But it’s not the end. How couples attack infertility is their choice, and all choices should be respected.
But it’s important to not lose yourself in the process. Always keep perspective and don’t lose sight of the things you have in life.
What would you want to tell someone who might be at the start of their infertility journey?
It’s easy to lose yourself in the day-to-day, cycle-to-cycle frustrations of infertility. We want to remind others that infertility does not define you, and it is not your fault. Don’t let it control your life or take away your joy or accomplishments. And be sure you have open, honest conversations with your partner about finances and expectations.
And most importantly, remember that you are not alone. No matter what your Facebook feed tells you, no matter what your mother-in-law tells you, no matter how it feels at 7am when you’re getting your third ultrasound for the week, always remember that you are not broken, you are not a failure, and YOU ARE NOT ALONE.
Recently, I posted an account in my personal stories section, written by Amira Posner. I asked Amira if I could also write something about her website, as I think it is an amazing resource that deserves attention.
If you are in the Toronto area and are struggling with reproductive issues, you are in luck. She practices in the area and hosts a Mind-Body Infertility group. If you’ve read any of my interviews with the Specialists, you know that the Mind-Body connection is integral to one’s reproductive health.
If you’re not in the area, fear not, she offers Skype and phone sessions as well.
But what I really want to highlight is something that first drew my attention to her work. She offers a service called “Fertility Friend.” From her site:
Going through Infertility can feel very isolating. Often, it seems like nobody understands. Healing Infertility has started a new program called “fertility friend.” If you are struggling with infertility and want to connect with someone who is also going through the experience, join our fertility friend program. We call it one on one “peer support.”
Get yourself connected and supported. If you are going through IVF treatment, we can also put you in touch with someone who has gone through the same treatment.
Our own history in this field has shown us that communication through a peer support programme like fertility friend can be valuable to a person feeling isolated and suffering with the difficult emotions that come with this experience.
As the name suggests, Infertility Out Loud is intended to give a voice to people going through infertility and all things related to it. To me, Fertility Friend is a perfect representation of what IOL stands for-connecting people through common experience and bringing solace through feeling “heard.”
The tag line of my site, taken from my bio: reads “because relating to others is a powerful tool.” Fertility Friend enables you to relate to someone and to use that tool to help you along your journey. If you come here looking for support, I hope you will also go there to find even more.
Visit Amira and Fertility Friend here.