Emotional Support

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If you are faced with infertility, are single, or are in a same-sex relationship, and you want very much to be a parent, you are probably thinking about the options of adoption and donor assistance. The good news is that they both offer the satisfactions and pleasures common to all parenting – plus some special responsibilities.
Prospective parents tend to focus on short-term, concrete aspects of the decision, such as timing and cost, while giving less attention to how each will affect the life of their family in the long term. People often say, “We just can’t think that far out; we’ve had so many disappointments.” Or, “I’ll cross that bridge when I come to it.”
However, no matter how elusive the goal of becoming a parent might seem, it is nonetheless important to spend time exploring long-term implications. In both adoption and donor assistance, it’s not just about you as a prospective parent; it’s about building a family, with a child at the heart of that family. Understanding how each option will play out over a lifetime will inform the decisions you are making now.
Coming to Terms with the Losses
Though difficult, coming to terms with feelings about infertility, or about being a single parent, will help you make the best decision for yourself now, and will influence how you help your child later. Because infertility is traumatic it can affect the ability to think clearly, make the best possible decisions and move forward from a position of strength. Failing to grieve can also compromise a parent’s sense of entitlement to a child who is not biological, thus making it more difficult to feel competent and empowered as a parent. This may also be true for those singles who are disappointed and confused about not having a mate, and apprehensive about raising a child by themselves.
Why is addressing these issues important? Both adoption and parenting through donor assistance address childlessness – but they are not a cure for infertility. Though painful, grieving ultimately helps you to move on either to a child-free life or to becoming a parent through different means. It’s important to mourn the loss of the biological child you expected and hoped for so that you can fully embrace the child you may have.
Asymmetry
The fact that donor assistance provides the opportunity for one parent to have a genetic connection to the child has some obvious benefits to all, including the fact that there are fewer unknowns in terms of background and more control over the prenatal environment and pregnancy. It does, however, create asymmetry in the relationships to the child. In some cases this may predispose the non-genetic parent to feel “left out,” or the genetic parent to feel more “entitled” as a parent. In the case of female infertility, pregnancy and birth may be helpful in redressing the imbalance for the mother. However, if left unaddressed, feelings generated by the asymmetry can be damaging to the family.
In adoption parents share the same status because neither has a genetic connection to the child. This may sometimes have benefits in terms of family dynamics. On the other hand, the child has no genetic tie to the family. The fertile parent loses the opportunity to have a genetically-related child, and for some people that is very difficult. The spouse or partner who is infertile may, particularly in times of stress, feel guilty about this. The fertile parent may have difficulty acknowledging his or her loss, worrying that it may be hurtful to their mate.
The Different Worlds of Adoption and Assisted Reproduction

As you think about adoption and donor assistance, keep in mind that these two paths to parenthood are at different stages in their evolution. By being aware of the respective histories and models you will be able to understand differences in vocabulary, settings, roles of professionals and values. This in turn will enable you to identify the implications of each option for you and your family.

History
The differences between these two choices begin with the histories of adoption and assisted reproduction. Adoption has been around for a long time whereas assisted reproduction has developed more recently. This helps to explain some of the contrasts between them.
Adoption
Adoption is a deeply-rooted institution which many value as meeting the needs of society, children and parents. It functions within an extensive framework of policy and practice. However, adoption thinking has changed significantly in the past 30 years, and practices in the field have been altered accordingly. The voices of adopted persons and birth parents began having a significant impact in the 70s and 80s. Organizations that developed to represent their points of view highlighted the fact that adoption is not an event but a process with life-long implications, and they called for more openness and access to information. Adoptive parents and professionals initially resisted these proposals, but reforms were implemented as it became evident that they offered substantial benefits for children and, by extension, their families.
Assisted Reproduction
Assisted reproduction has a relatively brief history. Although donor sperm was first used at the end of the 19th century, donor egg technology dates back about 20 years. Because of the short history and privacy protections granted to donors and patients, people considering donor assistance often have little to draw on in terms of information about how the use of donor gametes plays itself out in a family’s life.
However, changes are afoot in the area of donor assistance. Public discussion and openness have been increasing. The use of donor sperm by single women and lesbian couples who are open about their choice is one factor leading to more dialogue. The emerging voice of those conceived through assisted reproduction is also having an impact. As was the case in adoption, some individuals conceived with donor gametes are advocating change, contending that the child’s interests should be accorded more attention. Parent groups such as the Donor Conception Network are addressing the needs and interests of parents, children and donors. Continued debate and growing public awareness of these issues could have an impact on the field of assisted reproduction.
Different Models
Not only do adoption and assisted reproduction have different histories, each also has its own distinctive style of operation. For the prospective parent this means having to evaluate the pros and cons of two very different experiences. However, policies and practices are subject to change, and the assisted reproduction model in particular could undergo modifications as time goes on.
Adoption
Adoption works within a social/legal framework designed to protect the interests of the child, and balance the interests of the prospective parents and birth parents. The focus is on the process of building a family, which is seen as a system with the child at its center. This system is often referred to as the “adoption triangle,” or “adoption circle” – adoptive parents, birth parents, and child. The government is involved in setting standards, formulating policy, tracking outcomes and doing research on adoption. As a result, there are multiple bureaucracies involved in adoption which are usually effective, though slow and often frustrating.
Assisted Reproduction
Assisted reproduction is based on a medical/business model. It focuses on fixing a medical problem; the goal is a viable pregnancy. Patient autonomy, privacy and measurable success are valued, which leads to a relatively short-term perspective. This means that patients eager to have the long-desired child often move quickly from in vitro fertilization (IVF) to donor assistance without stopping to consider the long-term implications for the family they will create. The uncertainty of a successful outcome also means prospective parents find it harder to spend time visualizing life as a family and the child as a real child. Responsible practices do encourage people to look forward, but because the model is a medical one, preparation for the social and emotional aspects is not intrinsic to it.
In the U.S. there is little governmental oversight or public policy role with respect to assisted reproduction. Some states regulate certain aspects of assisted reproduction, but their main influence is through licensing and certifying medical practitioners. Government-sponsored research is limited. There has been more discussion of the social and public policy implications in Europe, England and Australia, where government has a much more prominent role in assisted reproduction. For example, several European countries have banned anonymous donation. In a number of countries there are now registries for children and donors, as in adoption. It is hard to predict what influence these developments may have on the U.S.
Thorny Issues
Parents encounter a variety of ethical issues in both adoption and assisted reproduction. Ethical questions have been debated and discussed more extensively in the area of adoption because it has been around longer. There is agreement that society has a stake in assuring that certain rights are protected and standards are met. As part of the social/legal model, government policies and related professional practices have been worked out for handling many ethical problems in adoption. In the area of birth mother expenses, for instance, many states now stipulate who can provide what types of remuneration under what circumstances. In the case of international adoption, the U.S. is finalizing preparations to implement the Hague Adoption Convention, which establishes a set of internationally agreed upon minimum requirements and procedures for adoption among participating countries. It is intended to protect the rights of, and prevent abuses against, all parties and to ensure that such adoptions are in the child’s best interests.
In many arenas assisted reproduction is generating vigorous debate and discussion regarding ethical issues. The dialog covers a broad range of topics. For instance, to what extent should a future child’s interest, or even society’s interest, be considered, and who determines that interest? Which business practices and types of commercialism are incompatible with creating life? Is it appropriate to pay someone for donating eggs and if so, how much?
In this country, doctors and their professional organizations grapple with these questions, but other interested parties participate as well. A generation of children conceived with donor gametes is just coming of age, spurring debate and discussion as adoptees did in a previous generation. Reflecting the culture at large, the media is becoming more interested in this field. Undoubtedly there will be continued attention from legislators and from religious and secular leaders as well. Because assisted reproduction involves many hot button issues (embryo disposition, genetics, exchange of money for eggs and sperm, gay and lesbian parenthood) it is likely to have ever increasing visibility.
It appears that in coming years the field of assisted reproduction will be more volatile and contentious than adoption. Whether and to what extent American society will agree upon a new policy direction remains to be seen. The U.S. could align with the countries in which government involvement is expanding, or it could adhere to a more individualistic, market-driven approach. It is difficult to determine what specific principles and prohibitions might be decided were American society to opt in favor of a more interventionist role. It is clear, however, that a child born today as a result of assisted reproduction is likely to grow up in a more charged environment and to sense the tensions surrounding these issues.
Perspectives on the Two Different Worlds
So what does this mean for your decision making? For some, the newness, innovation and initial level of privacy of assisted reproduction will be appealing. Some may prefer adoption because, relatively speaking, it is a more established and structured system, and, whatever may be the unknowns or difficult questions, there remains the overriding satisfaction of giving a child a home.
As with the other topics, there is no right or wrong answer – the important thing is to understand the issues in order to make an informed decision.
The choices you make now will be the subject of discussions with your children, particularly during adolescence. While all children challenge their parents in the course of growing up, the questions associated with adoption and donor assistance are particularly sensitive, and dealing with them requires special preparation by parents.
For example, a child conceived by donor gametes may ask why you didn’t adopt when there were children who needed homes. A donor-conceived daughter or adoptee may question why, because it’s important to her, you didn’t seek a birth mother or donor who was willing to be contacted. It may be hard to imagine talking with an adolescent about such decisions but these discussions are common for adoptive families and we would expect them to be similar in assisted reproduction.
Shared Information About the Child’s Origins
Like many prospective parents, you may be dubious about discussing origins with the child you might adopt or conceive through donor assistance. People often worry that this information will distress a child or weaken the parent-child relationship. They may also want to protect the child from a possibly negative reaction and avoid an acknowledgement of their own infertility. They may hope that not talking about these issues will make them go away.
Further confusing prospective parents, some professionals either advocate avoiding disclosure or are neutral on the subject. As Ellen Singer of The Center for Adoption Support and Education writes, “…parents continue to be counseled by some medical and mental health professionals that it is not necessary to share the circumstances of the child’s conception with their child – that it is not necessary for the child to know the truth about how he came to be part of his family.” Fortunately the field of adoption offers much evidence that parents can learn how to talk with their children about these sensitive topics, and that such openness is beneficial. (“Talking with Children Conceived through Donor Insemination, IVF with Egg Donor or Surrogacy,” www.adoptionsupport.org)
The Child’s Need to Know
It is a basic human need to know how we came to be. For most people, knowledge of their origins is an ever-changing picture compiled over a lifetime from tidbits of information gleaned from notes in baby books and stories told at family gatherings. This process contributes to our identity and helps us understand where we fit into the world. When this information is available or accessible, it may seem unimportant. However, for those who do not have this information or have access to it, as is often the case in adoption and in unidentified donor assistance, it can take on added importance.
Adoptees talk about a sense of something absent, “a missing puzzle piece,” felt keenly by some, less so by others and not at all by a few. They talk about how they feel when their physical characteristics aren’t shared by the people with whom they live, when their aptitudes and interests are unique within the family and when they are asked to provide medical information they don’t have. There is growing evidence from first person accounts that the same phenomenon operates in assisted reproduction. In the words of a 54-year-old donor-conceived man, “Our stories belong to us and we are entitled to the truth. This is not just some abstract right, it is a practical issue: people may need to know their family medical history, for example, or to understand what may otherwise be inexplicable physical or personality traits. But I do not think that it needs to be justified: we do not have to explain why or prove that we are entitled to know the truth about our lives.” (David Golancz, “Time to Stop Lying,” The Guardian, August 2, 2007)
The Parents’ Job to Tell – Lessons from Adoption
There are many reasons why parents should take the lead in discussing origins with their children, whether their family was created through adoption or through assisted reproduction.
There’s a good chance the child will find out regardless 
Experience with adoption shows that information will get out through an amazing variety of ways – accidents, coincidences, the Internet, youthful ingenuity. For instance, in the emergency room when lab tests disprove a biological link, when a child stumbles upon the box of old legal files on the closet shelf, or when Aunt Helen chooses the memorial service to fill in the gaps for an adopted adult at the death of the parent. These things really happen. Most women using donor assistance tell at least one or two people in order to get the support they need. But privacy is very hard to maintain and there is always a possibility that a child might find out inadvertently.
Parents send a negative message by not telling 
People often feel that infertility and conception are private subjects. However, secrets carry with them the message that there’s something shameful to hide. Past generations of adoptive parents came to realize that by not telling they were sending a message that being adopted was something to be embarrassed about, ashamed of, something to hide.
Children need medical and background information
People need accurate medical information so they will know both what their history is and what it is not. Many individuals conceived with donor gametes who do not know about their parents’ use of a donor have worried needlessly about medical conditions which they were not at risk for. This was previously the case in adoption, as well.
The information belongs to the child
The fact that parents who adopt or conceive through donor assistance possess certain background information about their child and the child’s biological history does not necessarily mean it’s fully theirs. Over time and as the child/adolescent is ready, it is wise to share all of the information.
For parents considering the use of donor gametes it is helpful to think in terms of whether they would want to know if their own biological parent(s) were someone other than who they thought they were. The vast majority of people say that they would want this information, both for medical reasons and because of simple curiosity. They also imagine that it might give them important information about themselves. Most people feel that they would not want their parents to hide such an important piece of information, as it might make for a family dynamic that is unnecessarily confusing for the child. Children who come into the family through adoption and donor assistance express the same set of reasons for wanting to have accurate information about their origins.
Anticipating the Child’s Reactions
It is normal for children to want to be “just like everyone else,” so hearing that they have a special story can bring up a multitude of emotions. It may cause embarrassment, for example, when a child announces his story to his class and is greeted with questions that he cannot answer. It may also lead to confusion when a child wonders what it means to have half siblings, either in or outside of his immediate family. Or a child may be sad upon hearing he may never meet his genetic father. Parents want to be sympathetic to a child’s concerns, whatever they may be. Experience with adoption indicates that children’s reactions are quite individual (even within the same family) and also vary depending upon the child’s age. But there are some topics that will be important within either approach to family building.
Background Information
Adoptees often want to sort out what part of themselves was contributed by their genetic heritage and what part came about through their experience growing up in a particular family. They want to know about the birth parents’ physical characteristics, personality, interests and abilities and medical background. While we know that some donor children share the same basic need to have information about their genetic heritage, there are some differences. For instance, feelings of loss of connection may be present for some donor children, but the intensity may be less than for adoptees since it involves only one-half of their genetic make-up.
The Motivation of the Birth Parent or Donor
Children who were adopted often have questions about the motivation of the birth mother. The answers may involve poverty, broken relationships and/or lack of social or family support. Thus the story is often replete with loss, sadness and unknowns. Understanding those aspects is a challenge, especially for a young child. However, there may also be the information, or implication, that the birth mother – and possibly the birth father – wanted the child to have the security and resources that she was unable to provide at a particular time in her life. Children born through donor assistance will also have questions about the motivation of the donor. However, their more probing questions are likely to come up at a later age than the adoptive child’s.
Money
The role of money can be a focus for both adoptees and donor children. In adoption, this issue may arise when poverty, or a lack of money, was part of the decision to place a child. Children who were adopted often ask, “How much did you pay for me?” or “Why didn’t you give my birth mother money so she could keep me?” In the case of donor assistance, the absence of the dramatic birth mother story means that the money issue could loom larger for the child. Prospective parents usually focus on the generosity of the donor. Although this often plays a role with donor egg, money is a real incentive, as demonstrated by the significant drop in donors in countries that have banned financial incentives.
Siblings
Interest in siblings is another important focus for adoptees, who talk about looking for siblings who might be related to them at the mall, and imagining that they might date someone to whom they are related. For donor children, siblings are likely to be an even more compelling topic, since a child conceived through donor sperm could have upwards of 25 half siblings. There may be fewer potential siblings in the case of egg donation, but with split egg and multiple donations, the number can still be high. What does it mean to be one of many half siblings? Will consanguinity be an issue? Will a child’s healthy sense of specialness be compromised by knowing that they were one of so many?
Handling the Child’s Questions
How you initiate discussion about your particular kind of family, handle questions and respond to your child’s feelings will have a strong influence on how comfortable your child will be with who they are and how their family was built. It is helpful when parents are open to their children’s questions, sympathetic to their feelings, matter-of-fact about the way their family was built and confident about the strength of the bonds within the family. This applies to families built through adoption or donor assistance.
Being an adoptive parent or the parent of a child conceived through donor assistance means making decisions about what information to share, and when, and about the level of contact with the birth family or the donor, if known. Fortunately there is a wealth of resources for adoptive parents and a growing number and variety of resources for parents of donor children to help you carry out this responsibility.
Summary
Adoption and donor assistance are two viable and fulfilling paths to parenthood. By carefully weighing the long-term significance of these options, you will ensure that you can proceed with confidence that you’ve made the best decision for you and your future child. Should you choose adoption or donor assistance, the issues we have discussed here will be only one small part of your life as a family, not the central part. Adoptive families and families created through donor assistance experience the same bonds of love, commitment, caring and thankfulness that exist in any family.
Contributed by: 
Robin B. Allen, MSW, Infertility and Adoption Coach
Michelle Hester, LCSW
This article appears in two installments (Winter 2007 and Spring 2008) in the RESOLVE Mid-Atlantic Region Newsletter. It is a condensed version of a longer article written by the authors.
For the full text, go to: www.beyondinfertility.com
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This article is protected by copyright laws and may not be reprinted or posted to a site without permission from the authors. Readers are welcome to forward it to a friend or link to it as long as the link includes the contact information. If you would like to seek permission to reprint the article in full, please contact us.

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Recently, while reading a novel (which had nothing whatsoever to do with infertility, miscarriage, or other types of pregnancy losses), I came across these lines … “Losses that are invisible or unreal to others can be hard to bear. There are no ritual releases. No funeral rites, no mourning garb.” For me, these words triggered a visualization of a procession of the many women I have met in the past 20 years through support groups, couple or individual therapy sessions, and daily life who have experienced pregnancy loss of one sort or another. Death … death of a child … death of someone who never saw, and was never seen by, others in this world … death of plans, dreams, hopes, desires. So many levels of loss – invisible and unreal to others. And for those who experience recurrent miscarriages, those losses are experienced over and over again.
The Patient’s Fact Sheet: Recurrent Pregnancy Loss offered by the American Society for Reproductive Medicine (2005), defines recurrent pregnancy loss as “the miscarriage of two or three consecutive pregnancies in the first or early second trimester.” It goes on to say that, “[a]lthough approximately 25% of all recognized pregnancies result in miscarriage, less than 5% of women will experience two consecutive miscarriages, and only 1% experience three or more.” But for those parents experiencing these losses, it feels like the percentages are overwhelmingly 100% in their own lives.
As a therapist, I have met with a number of women who have experienced pregnancy losses; hearing some of their stories may help in understanding the emotional effects of recurrent miscarriage. Recently, I met with two women separately who had experienced multiple miscarriages. Robin*, married and 24 years old, has sustained three early miscarriages; she also has a three-year-old son. Adrianne*, 41 and married to a man with children from a previous marriage, has experienced five early first trimester miscarriages. Adrianne had been diagnosed with endometriosis in her 30s; she was treated with laparoscopic surgery and hormone therapy at that time. In both cases, no clear-cut medical reasons could be found to explain the losses, though a genetic link was frequently postulated as a possible cause.
When I first met with these women, they were expressing feelings of exhaustion, overwhelming sadness, dread, despair, guilt and grief. They felt hopeless and helpless, their bodies out of control. Anger was ever present and always seemed right at the surface. They were constantly reminded of what they perceived as a complete personal failure by the many co-workers, friends and acquaintances, all of whom seemed to be pregnant or had just had babies. Robin said six of her close college friends were all pregnant again for a second or third time. Adrianne’s recently-married younger sister was pregnant as well. They both struggled with feelings of jealousy along with guilt for these feelings.
Robin’s and Adrianne’s husbands had difficulty understanding many of the feelings their wives were experiencing – the deep depressions and fears that they might never have a child – and arguments and fights often arose, causing additional stress to already vulnerable marriages. Family and friends who had been very supportive with the first loss became almost non-existent as the losses added up. Adrianne said that she had received many cards from caring and supportive friends and family after the 1st and 2nd miscarriages. The 3rd miscarriage saw just a few cards, and by the 4th miscarriage, nothing. At a time when they needed more support than ever, more shoulders to cry on, more ears to listen, the “support well” had virtually dried up! Sometimes, Robin said, “I feel like a broken record. I don’t think my friends or family even want to be around me, since I seem only to be the bearer of bad news.” The isolation and loneliness felt profound and overwhelming – some of it self-imposed, some of it experienced through the perceived lack of concern and caring by those around them.
Both Robin and Adrianne found that their minds obsessed fearfully over and over again –Will I become pregnant? When? Will I ever be a mother? Why can’t I stay pregnant and carry a baby? Is there something wrong with my body … with me? Will we ever be a “normal” couple? More often than not, the medical system can find no reason for a miscarriage. And with no clear, explainable reason, women often start thinking, “Well, it must have been something I did,” believing there must have been some way they could have prevented the loss. They anguish over the “Whys?” and “What ifs?” The guilt can feel overwhelming. We live in a scientific world that always seems to promise answers. Thus, it seems natural to us to ask and expect to understand why things happen, to find reason and structure in the face of chaos and insanity. But the reality is, as Freda & Semelsberger state, “miscarriages are not caused by working too hard, having sex, carrying heavy packages, being too stressed, not eating properly, sleeping too little, or exercising (p. 51).
“Many women have higher levels of depression and anxiety for up to a year after a miscarriage,” and some even experience post-traumatic stress disorder (Freda & Semelsberger, p. 25). In her article The Magnitude of Miscarriage, Sharon Covington says, miscarriage is “a multifaceted loss … loss of a baby, a part of yourself, your health, control, innocence, potential, relationships with others, possibly your reproductive capacity, and on and on.” Can you imagine this happening over and over, again and again? You’ve not even had the opportunity to grieve the first loss and another one is upon you. Both Robin and Adrianne said that though they were sure their friends meant to be well-meaning and supportive, each one heard, in some form or another – “Well, at least you know you can get pregnant.” Why, they wondered, did their family and friends believe such a statement would somehow make them feel better? Instead, they felt their pain was minimized and unacknowledged.
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Grief tends to be cumulative, current losses pulling in some of the old, perhaps unresolved, feelings of pain from past losses. And, as James & Friedman note, grief is “the most neglected and misunderstood experience, often by both the grievers and those around them” (p. 3). Even after they have been able to process through some of their initial feelings of emptiness, sadness, anger and guilt, many of those who have experienced recurrent miscarriage will discover their grief is triggered again and again throughout the succeeding years to come – around due dates, miscarriage anniversary dates, Mother’s and Father’s Days, the holidays as well as the birthdays of their friends’ children. “I just couldn’t go to Amy’s one-year birthday party,” Adrianne said, “Andrew [her first son] would have just turned one too. I cried all day, thinking about how Andrew would never be one or any other age.”
So how have these two women coped over the past several months and how can others who experience recurrent miscarriage cope in their daily lives? Robin has gone on to become pregnant again. Freda & Semelsberger note that many parents “look to a future pregnancy as a primary method for resolving grief” (p. 25). As of this writing Robin is fifteen weeks pregnant and has passed through her first trimester, which was filled with high anxiety around the possibility of losing yet another child through miscarriage. She has returned to her low-stress job as a part-time employee, and is thinking about volunteering a few hours a week at a local charity that serves the homeless. She found attending a local support group of parents who had suffered similar losses to be extremely valuable. Sharing fears, hurts, pain, joys, blessings and coping strategies helped Robin and her husband to know they were not alone in their journey. She has also discovered that a support group for those who become pregnant after a loss is available and is planning to begin attending that group soon.
Adrianne has chosen to start a yoga class and to participate in a ten-week Mind/Body Support Group I run through our medical practice, where she is learning ways to trigger her relaxation response through various techniques including diaphragmatic breathing, meditation, visualization, journaling, cognitive restructuring, and other life style changes. She is finding that these techniques can be applied to so many different areas of her stressful, daily life. For Adrianne it was also important to develop and create a special ritual ceremony to honor all her children; several of the friends she met through her grief and loss group helped her to create a ritual that was meaningful and special to her. Both Robin and Adrianne continue to meet with me on an ongoing basis. Some other examples of ways to cope with these losses that I have read about or others have shared with me include:
  • Find a safe space to express your feelings, such as when feeling angry … a private room to yell, scream, or punch pillows.
  • Make a conscious choice to give yourself a break and not attend all those baby showers or spend a lot of time with pregnant friends.
  • Educate yourself about miscarriage through reading materials and talking with medical professionals.
  • Become pro-active on your own behalf within the healthcare system by asking questions, bringing up concerns with medical personnel, bringing a support person along with you to your medical appointments.
  • Acknowledge your pregnancy in some way – through writing about your pregnancy and loss experience, putting together a memory book and includes important dates from your pregnancy, planting a tree or creating something in memory of your child, naming the baby, purchasing something such as a necklace or bracelet with charms to represent each of your losses.
  • Become actively involved in a grief and loss support group,** attend a mind/body relaxation group, treat yourself to massage, Reiki, or some other complementary treatments.
One of the most important things, I believe, is to allow yourself to honor and respect the time and energy needed to grieve these losses, and not to impose upon yourself or allow the world to impose upon you a time line on your grief process. My experience is that there is no magic formula for how or for how long to grieve. Everyone will grieve in his or her own way, based on several factors, including individual personality, available supports, responses by the wider community, past history of losses and ways of coping, the circumstances surrounding the loss, the relationship between the partners, among many. Each parent will come to his or her own resolution and integration of the losses. I encourage you to seek out all the help and support you can find at this time – there is a plentitude of reading materials, internet sites, support groups and therapists in this area.
Contributed by: 
Carol S. Miller, MSW, LCSW

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A woman once told me of the painful dilemma she experienced following her miscarriage. She had been longing to be pregnant, hoping for years to hear the words, “You’re going to have a baby.” When it finally happened, her spirits soared. Bu the elation quickly turned to despair when she started to bleed. The confirmation that there was “only an empty sack” was the final blow. She grieved intensely for many months over the loss of this precious baby. Also hurting, her husband felt powerless to help her. She poignantly reflected that she did not want to stop mourning, as it was her only tie to her baby. Resolving her grief would mean letting go of the biological child she might never have.
A miscarriage is an event full of dilemmas and conflicting emotions. If you are involved in RESOLVE and have had a pregnancy loss, you may wonder where you fit in. Having conceived, are you part of the fertile world or do you belong to the infertile world, not having given birth to a live baby? Others may try to minimize your pain by saying, “At least you can get pregnant.”
If you have had difficulty conceiving and then miscarried or if you have had repeated miscarriages, the dilemma grows. You continue to grieve for the wished-for child, while grieving at the same time for the baby you have lost. You feel you are so near and yet so far. For some, the pain is too great to consider trying again. For others, the hope generated from having conceived can be addictive, keeping them in treatment indefinitely. They struggle with the decision over when to stop trying and move on. Unlike other experiences that get easier to handle with repetition, having recurrent miscarriages makes it harder. It becomes especially difficult when you find support from family and friends diminishing with each loss, even though you need it more than ever.
Diagnostic and therapeutic technology available today make the miscarriage dilemma even more complex. During IVF, eggs are retrieved and united with sperm in a laboratory, so that you know conception has taken place within hours of the event. When the embryo transfer fails to result in pregnancy, it can feel like a miscarriage. With any pregnancy loss following IVF/GIFT/ZIFT, there is profound sadness and grief. And yet you may be instructed to undergo another cycle almost immediately. This can thwart your chance to grieve.
In addition, the new technologies used in early pregnancy often facilitate bonding and attachment to a developing baby. Blood tests can confirm a pregnancy before you have missed a period. Sonography enables you to see a heart beating or your tiny baby moving before others are even aware of the pregnancy. This visualization helps to confirm and make the pregnancy a reality. Finally, amniocentesis and chorionic villi sampling can provide information about your baby, including its sex, even before you are wearing maternity clothes. Ach unique detail strengthens your feelings about your baby and can make a miscarriage feel like a death.
Yet miscarriage is enigmatic. Even though it can feel like a death, there is nothing tangible to mourn. There are no burials or memorial services to facilitate grieving. You may find yourself suffering intense emotions, often in isolation, as others may not understand the impact of your loss. The manner in which you grieve is highly individualistic and follows no predictable course; there are no instructions to follow. Much depends upon your own personality and life experiences.
Grief can feel like a tidal wave that sweeps over you with force and fury. Shock, anger, rage, guilt, blame, sadness and depression can engulf you, growing and cresting with time. It peaks somewhere between one to six months following a miscarriage. Nevertheless, swells of grief can be triggered long after the waters have settled. Difficult times include your first menstrual period, due date, Mother’s/Father’s Day, holidays, the anniversary of your miscarriage. It can be especially painful when a friend with whom you were pregnant delivers a healthy baby. As years pass, seeing this child can continue to trigger feelings as you recall what your child might have done at this age. Your triggers are unique and relate to memories and dreams about your baby. For some, triggers may be a song, holiday or time of the year, while for others it may be walking into the doctor’s office or passing a hospital.
Another aspect of the dilemma relates to the difference between men and women and the way they deal with grief following a miscarriage. A woman is usually more attached to the developing baby. The loss of the baby can feel like a loss of a part of herself, shattering her self-esteem and self-image. Her emotions may be more apparent as she tearfully needs to continue to talk about the experience. She may take longer than her spouse to heal emotionally from the miscarriage.
On the other hand, a man is often less bonded with the baby early in the pregnancy and seems to grieve and recover more quickly. He may appear less emotional, partly because he may have been treated like an outsider by medical professionals during the crisis. He may easily be forgotten in the process by family and friends as the focus is often on this wife’s pain. As a result, he is likely to repress his feelings and seem detached from his wife’s grief. Or he may feel that he should be strong for his wife, thinking that being positive and upbeat will make her feel better. In reality, what they both need is a time to cry together, to talk about what has happened and what might have been had this pregnancy continued.
These differences between wives and husbands can sometimes cause misunderstandings and hinder emotional healing. When you are both grieving in contrasting styles, you may find it difficult to be there for your spouse. You need to be patient and understand your partner’s feelings, realizing that different doesn’t mean better or worse. Each of you will need your own time and space to integrate this loss into your life. But you also need to keep communication open between you. Perhaps you want to set aside a limited amount of time each day to talk about the miscarriage. If talking feels too difficult, share your thoughts and needs in a note or letter to your partner. Make a conscious effort to do one thing every day, which shows your partner your love.
Finding ways to recognize and acknowledge your baby’s existence can help diminish the miscarriage dilemma and facilitate grieving. These things can be shared in private or with family and friends immediately following the loss or even years later. Taking positive action to remember your baby may include: having a memorial or religious service; planting a tree or flowers; giving a donation or special gift to a charity; putting together a memory box with special items gathered for your baby; engraving a charm to wear; naming your baby; writing a letter in which you share your dreams about this child and say goodbye; donating a book on pregnancy loss to a support group or library; using creative talents to channel emotions, such as drawing, sculpting, music and poetry.
Several years ago a woman shared with me a poem she wrote after her pregnancy losses. It summarizes to me the many things you feel after a miscarriage while capturing what helps the most.
Your Kind Words
By Nancy Carlson
Please spare me from your kind words.
Just be there for me.
My insides writhe when you tell me “It’s for the best.” “It was meant to be.” “He’s with God now.” (Why can’t he be with me?)
“You’ll have another.” (as if babies were interchangeable)
Your soothing words do not soothe but open the wound that never heals; nothing anyone can say can take away my aching, drawing emptiness. 
Please forgive my pain turned anger that mistakes your intentions and pushes you away.
Please just be there.
Suggested Reading:
Miscarriage After Infertility, M.C. Freda and C.F. Semelsberger. Fairview Minneapolis Press, 2003. www.fairviewpress.com
Contributed by: 
Sharon N. Covington, MSW, LCSW-C
Director, Psychological Support Services

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The loss of a baby in pregnancy, whether early or late, is a profoundly sad experience. In a moment, your joyous hopes and dreams are turned to grief and despair, leaving couples feeling hollow and alone. Earlier in pregnancy, others may not have known you were pregnant while later in pregnancy, your baby is “known” but primarily to you and your partner. The fact that your loss is invisible to family and friends, is what makes it so difficult to grieve and mourn. 
Grieving is the normal process of painfully releasing your connections to a loved one. When it occurs before a life has been fully lived, such as during pregnancy, you are grieving prospectively; that is, you are grieving the hope and dreams of what you believed was to come. Your dreams of the future and lost potential are not visible to others and you may find yourself struggling with these intense feelings alone. Thus, you may feel like your emotions are so out of sync with how the rest of your world is responding: that is, you feel like you are over-reacting, while the rest of the world seems to under-react. Nonetheless, grieving must be done and is the tribute you give to your baby’s life. 
Each person will grieve in his or her own way and time-frame, based upon personality and life experiences. Grief is highly personal and, unfortunately, no established guidelines can speed you through this healing process. While certain phases of grief are universal—shock, emotional anguish, and resolution—the feelings often reoccur over time and may reflect the depth of connection you have with the one you lost. With a pregnancy loss, several factors may contribute to the sense of loss you had for your baby and thus may intensify your grief. These include:
  • Time—the longer you have been trying to conceive, the harder the loss may feel;
  • Technology—the more advanced the technology used to achieve or maintain the pregnancy, the greater the emotional investment in the pregnancy and the greater the loss may feel;
  • Age—racing against the biological clock increases the sense of pressure and connection;
  • Gestation—feelings of attachment grow as the pregnancy progresses; and
  • Multiple pregnancy losses—grief often builds with each loss as well as diminished confidence in a future pregnancy.
All these factors impact grief and may help you understand why this loss feels so profound. 
Grief is the emotional response to a loss; mourning is the way we deal with these feelings. With “visible” loses such as the death of a family member or friend, we have established rituals that facilitate and encourage mourning. Funerals, religious services, formal mourning periods, and memorials and memorial funds are some examples. It is useful for couples who have lost a baby to miscarriage to modify these rituals to help them cope with their loss. Variations of these rituals can help you acknowledge and validate your baby’s existence, and thus give you the “right” to grieve. Your ability to heal is directly related to your ability to grieve and mourn the loss of your baby. 

Over the years, I have worked with many couples who have lost a baby in pregnancy or after birth, and have learned the importance of rituals and grieving activities for helping people mourn and mend their broken hearts. Rituals and actions that acknowledge this loss as real and worthy of mourning facilitate healing. The following are measures that some people have found helpful:
Adapt mourning rituals that recognize your baby’s life. You may want to consider having a memorial service or religious ceremony for your baby, even if only you and your partner participate. Choose a special place, such as a beach or park you love, and read poems, prayers or letters to your baby that you can save or scatter into the water or air. Light a candle at your church or synagogue, or buy a special candle you keep at home and light in your baby’s memory. Purchase an item for a worthy organization, such as a toy for a children’s hospital, that reflects what your baby might have liked. Some women like to buy a charm or locket that they wear as recognition of their baby, as is done for new babies or living children.
Do something physical to work through your emotions. Research suggests that physical activity and exercise helps people deal with feelings of depression and anxiety. It also provides the opportunity to work through your emotions while strengthening your body. Consider training to run in a race or walk for a charity event in your baby’s memory. Plant a tree that will bloom when your baby was to be born or cultivate a vegetable plot where you can work the soil, tend the garden, and see the fruits of your labor. Any physical activity that is goal oriented, with a beginning, middle, and end, such as running a marathon or climbing a mountain, is especially helpful.
Use your creative ability to express your grief. When I have encouraged my clients to use some of their creative energies to work through their grief, I have seen the most inspired works of art. Make a scrap book or memory box of mementos related to your baby, such as sonogram pictures, cards, or something you might have purchased for her or him. One father I know who loves to work with his hands crafted a memory box from wood. If you like to sew, make a quilt or other item to save or give to a charity in your baby’s memory. Drawing or painting, playing or composing music, or sculpting works that reflect your feelings about your baby help to give meaning to this life. Writing is also a compelling way to express feelings. It is important to find a way to say “goodbye” to your baby and writing a poem or letter can be a powerful method. Many have found keeping a daily journal of their feelings after a loss not only saves the precious memories that could be forgotten, but also helps you see your progress in your grief journey.
Keep in mind that “A feeling shared, is a feeling diminished.” It is most important to find understanding people to whom you can express your feelings. You need to be able to talk about your grief with others who truly understand, which helps validate your feelings. At times, family and friends are not able to understand the magnitude of this loss and you need to find other empathetic people. Pregnancy loss support groups, Internet chat rooms dedicated to the subject, and counseling with a mental health professional with special training in pregnancy loss grief are excellent resources. You may, also, want to educate your family and friends on the deep grief of such an invisible loss —to help them understand your needs, and that your strong emotions are normal and, indeed, healthy. You may want to give them articles such as this to help them in this process.
Find a way to connect meaning to your baby’s short life. While the loss of your precious baby is filled with enormous sadness, it is important to find purpose and meaning from this experience. Very likely, you will not discover this immediately and it may appear to you over time. It is what I call “the gifts” your baby gives you. For some people, the gift is engaging in therapy and working through problems of the past, related or unrelated to their lost baby, which allows them to find happiness in everyday life, despite their loss. For others, it may be getting involved in organizations or support groups like RESOLVE, which can provide new insights, offer new relationships or help build new skills that last a lifetime. Be aware that your baby, though invisible to others, will always live on in your heart and let your tribute to his or her life bring out the best in you.
Contributed by: 
Sharon N. Covington, MSW, LCSW-C
Director, Psychological Support Services
Reprinted from Resolve Family Building Magazine, Spring 2005

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Although infertility is widely acknowledged as a crisis for individuals and couples, it is less recognized as a trauma that impacts their families. Yet, involuntary childlessness is an inter-generational crisis that has the ability to strain, even damage, family relationships over time by impairing communications and interactions. Invisible losses, such as miscarriages, failed medical treatments, or adoptions gone awry, may highlight a family’s inadequate means of dealing with problems. Old family issues, jealousies and resentments may resurface or other family struggles, such as parental illness or the pregnancy of a sibling, may take priority over reproductive difficulties, leaving the infertile couple feeling isolated and abandoned. The lack of acknowledgment of the losses associated with infertility may damage family interactions, particularly if family members use negative coping techniques such as blaming, side-taking, denial or avoidance. However, the family experience of infertility also has the potential to bring out the best in the family system, promoting growth and well-being for the members. This article will examine family dynamics impacting infertility and discuss ways to help deal with the demands infertility places on the family system.

Family systems

Some families faced with infertility grow closer and find ways to provide support, compassion, and understanding in the midst of the maelstrom of profound loss and despair. These families are able to handle the myriad of negative emotions of infertility, and weather the pain of its many losses. They acknowledge the despair of this unique loss and its impact on the family as a whole, not simply on the individual or couple. Family members listen, openly communicate warmth and compassion, and ask for what the couple wants or needs during the infertility journey. And, they are willing to provide support in a variety of ways, including participation in rituals for commemorating losses as a family (e. g., attendance of service after a miscarriage) and a willingness to adjust family life to accommodate the realities of the infertile couple’s situation (e.g., adapt gatherings to meet treatment plans or emotional needs). However, even strong, healthy families can find the challenges of infertility daunting and draining, particularly the pain of being an observer in a drama in which your loved one is suffering and there is little one can actually do to relieve suffering.
Involuntary childlessness is an interruption of the family life cycle. Family building is a developmental stage that represents generativity or fostering the next generation. It is a life cycle stage in which each and every member of the family transitions from one developmental stage to another, and in the process assumes new roles and new role responsibilities: couples move from being spouses to parents; their parents become grandparents; their siblings become aunts or uncles; nieces and nephews become cousins, and so on. Infertility is the obstacle blocking these normal transitions and preventing all family members from assuming new developmental roles.
Interruption of normal life cycle transitions can highlight a family’s unique flaws, precipitating negative behaviors such as: parental favoritism; poor communication; and/or unhealthy coping strategies. Infertility may also require family members to re-examine some long-held family beliefs if they cause increased distress. For example, the belief that an offspring is not an adult until he/she is also a parent, or children owe parents grandchildren. In short, infertility has the ability to distress not only infertile couples but also, also, their families, resulting in ‘collateral damage’ that lingers long after the problem of childlessness has been resolved.

Inter-family relationships

Very often parents of an infertile couple feel caught between their infertile child and their ‘fertile’, sometimes pregnant, child(ren). Naturally, both offspring may expect to rely on their parents for emotional support at this significant time in their lives. While this is a realistic expectation, many parents may, for a variety of reasons, end up providing more support to the ‘pregnant’ child than the infertile couple. Sometimes this happens when a parent is more knowledgeable about providing support around pregnancy and parenthood issues than about infertility. Other times, it may be that pregnancy and grandparenthood is a happier, more enjoyable experience, while infertility brings sadness, loss, and a variety of negative emotions. In addition, the infertile offspring may not have asked for parental help, keeping infertility a secret, or may have asked for assistance that is impossible to provide. Many parents become paralyzed by their child’s pain and feel helpless to know what to do. Sometimes they feel trapped in the middle—or worse, their children demand they declare a specific loyalty or that they take sides. It is important to remember that parents still set the tone for family interactions and values, even in adulthood, and must refuse to take sides.
A significant challenge to parents of adult children is knowing when and how to provide feedback—particularly when it may not be wanted or appreciated. It may be difficult for a parent to say, “Telling me to support you by asking that I reject your sibling is inappropriate. I will support you in any way I can, but not by being hurtful to your sibling.” Or, “While it is wonderful that you are overjoyed with your new baby, I expect you to be compassionate of your sibling’s feelings while they struggle to have children, too.” Parents must be aware that watching a sibling move through the stages of pregnancy is typically most difficult for the infertile couple.
Parents faced with their children’s infertility are often baffled by this crisis. It is an ‘invisible’ loss that involves private marital issues, complex medical treatments, and a rollercoaster of emotions. They may know how to support a fertile child, because of their own experience, and may be less clear about their role of support for an infertile child. As with other experiences in parenting, they may have difficulty dealing with different children, with different needs, and coming from two very different life experiences.
Families dealing with infertility must find ways to help each member feel respected and acknowledged, despite their differences. It is important to define goals for strengthening the family which help to keep the group intact, communication open, and strengthening the functioning of all members.
The following suggestions are advice for family members and couples struggling with infertility and is based, in part, on Patricia Irwin Johnston’s Understanding Infertility: Insights for Family and Friends:

For family members

Acknowledge infertility as a medical and emotional crisis with a wide variety of losses, disappointments and ‘costs’: physical, financial, social, marital. Do not attempt to deny or minimize involuntary childlessness either by avoiding the topic or offering empty platitudes like, “Everything will be fine” or “Just relax”. Avoid offering unsolicited advice and never interfere by taking sides, blaming, or imposing rigid expectations or limitations.
Be sensitive to the pain, stress, and emotional pressure of childlessness or the inability to expand one’s family as desired. If it is difficult to know what to say, tell the couple rather than saying nothing. Ask them what you might say or do that would be helpful. Try to frequently convey care and compassion and do not ‘forget’ the couple over time as the months and years of the infertility struggle drag on. Be cognizant that some junctures in the journey may be more difficult than others such as after a miscarriage, failed in vitro fertilization cycle, or surgery that fails to produce the hoped for results. Remembering the couple with a card, phone call, donation in their names, flowers, or some other kind gesture can make the journey less difficult.
Be supportive. Do not assume you know what supportive means to your loved one but, instead, ask how you can be supportive: what would they find most helpful and useful? If you are able, consider ways in which you can assist emotionally (listening during a ‘good cry’) and functionally (offering financial assistance). Offer to simply listen and be ready to listen when called upon.
Emphasize the importance and value of the couple (and each partner) in the family. Encourage and welcome their involvement as a couple or individually in family events and activities. Once it occurs, infertility becomes a part of the family’s history; how a family adapts and copes with the events and stress will be forever part of the family’s past. Like any stressor, infertility can strain family functioning or improve it. Families need to be sensitive about the needs of the infertile couple, particularly around child centered family gatherings. It is important that they understand the infertile couple’s decision not to come may be important.
Always keep the lines of communications open. Stress the importance of honesty, candor, tact, and diplomacy in family interactions. It is not a good idea to hide pregnancies ‘out of kindness’ or not invite the infertile couple to child-centered family events; or keep secrets out of fear of upsetting the couple. Always think about how things are told as much as what is being told: tact, kindness, and privacy can go a long way to soften the blow of difficult news. Open communication also means being able to express concern if there is evidence of significant emotional distress. When expressing concern always offer suggestions for help, such as seeking support and counseling through RESOLVE or an infertility counselor.
Respect the boundaries the infertile couple sets regarding their infertility. Some couples prefer a high level of privacy about infertility. Other choose a more open approach. Be sensitive to the couple’s boundaries as concern for one couple can feel intrusive for another. When in doubt, ask the couple their preference.

For infertile couples

The infertile couple must recognize that very often parents and siblings are unable to comprehend the depth and multifaceted nature of the ‘costs’ of infertility. Ignorance does not mean that family members are callous or heartless. Recognizing that family members may need to be educated about how infertility impacts the couple is important.
Be sensitive to the pain your childlessness may cause your family members, particularly parents. Parents may feel guilty or responsible for the infertility, distressed by their inability to ‘fix things’, or they may be experiencing their own life stressors.
Be supportive. Even though you are going through a crisis, do not ignore or overlook other family crises or get into a contest of ‘whose pain is worse’. A personal crisis does not mean you have permission to temporarily check out of the family—be aware that others may be in need at this time too. Furthermore, providing support to others at times of suffering can often provide comfort to oneself.
Remember that you are and always will be a part of your family. Your infertility is now a part of your family’s legacy and your ability to manage the crisis in a healthy and admirable manner will set the tone for handling similar problems in the future. Do not let infertility become a single issue that permanently damages family relationships. As much as possible, continue participation in the life of the family as an active member of the family. If your family is very unsupportive, you may distance yourself from them. Seek the assistance of a therapist to help you understand your family dynamics.
Keep the lines of communication open and avoid conflict based on misunderstandings and misperceptions. Be prepared to educate your family about infertility. Educate them with books, articles, brochures, and websites. Some RESOLVE groups run workshops for family and friends to help them in understanding the infertility experience. Check the National RESOLVE website at www.resolve.org for more information.
Be aware of healthy boundaries. If you and your partner would prefer more privacy on the issue of infertility, each of you must convey this to your family. Privacy boundaries can be maintained without excluding loved ones from a difficult life experience. It just may take more communication.
If you have an unsupportive family, build a healthy support network for yourself. Continuing to expect support from family members who are unwilling or unable to provide it will only add stress to your life. While you can’t choose your family, you can choose your friends and, for many people, relationships established while active in RESOLVE become this “chosen family”.
Contributed by: 
Sharon N. Covington, MSW, LCSW-C
Director, Psychological Support Services
Linda Hammer Burns, PhD
Reprinted from Resolve Family Building Magazine, Fall 2002

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Infertility is an experience that strikes at the very core of one’s life. Reproduction is considered the most basic of human needs, propelled by powerful biological and psychological drives. When the ability to reproduce is thwarted, a crisis ensues and impacts relationships with others, life goals, social roles, and sense of self. A host of emotions emerge in a somewhat predictable and repetitive process as one moves through medical diagnosis and treatment. Feelings of disbelief, anger, sadness, guilt, blame, anxiety and depression can be overwhelming and finding appropriate avenues to express these emotions is important.
For most people, IVF is not the first course of treatment for their infertility-it is the last, best option for having a child. It occurs after long months and sometimes years of treatment failure, often at tremendous emotional, physical and financial cost. Couples beginning IVF usually do so with the burden of grief and disappointment from infertility, and may feel depressed, angry, tired, and anxious. Although emotionally depleted, couples are attracted to a technology that offers hope where none may have existed. They find themselves drawn into new emotional turbulence of contrasting feelings of hope and despair, which seems to be generated in part by the experience of the technology itself.
The opportunities that IVF creates brings with it significant challenges. IVF is considered by patients to be the most stressful of all infertility treatments. Patients have rated the stress of undergoing IVF as more stressful than or almost as stressful as any other major life event, such as a death of a family member and separation and divorce. While general assumptions may be made about stress levels during IVF, the experience for infertility patients will be personal and unique-each patient will experience the stress differently based upon his or her own personality and life experiences.

The multifaceted aspects of ivf

The aspects of IVF that are perceived stressful to patients are multifaceted and affect all parts of their life: marital, social, physical, emotional, financial, and religious. Time is stressful, both in the time commitment to an intense treatment which leads to disruption in family, work, and social activities, and for some, in long waiting periods for treatment services. IVF stress impacts the marital relationship with an emotionally laden experience and, by removing the conjugal act of procreation, sexual intimacy is lost. Couples, also, are stretched financially paying for the high cost of IVF treatment with a relatively low probability of success. Dealing with the medical staff and with the side effects or potential complications of medical treatment has its own stress: hot flashes, headaches, mood fluctuations, shots, sonograms, future health concerns, and decision making about embryos and multiple pregnancies. Religious, social, and moral issues may also make IVF stressful, especially for those dealing with third party reproduction, when these values are in conflict with the choice of treatment.
The first treatment cycle has been found to be the most stressful for patients, with high levels of confusion, bewilderment, and anxiety. This may be due to inexperience with the process or possibly inadequate preparation of the patient by staff in terms of information and discussion of care. While experience seems to help the stress level in the next cycle, if it is unsuccessful the stress level rises again with the third cycle as the “stakes” have been raised. For many couples, IVF can feel like gambling where the stakes are high and the chance of success unknown. Like gamblers, some IVF patients may have unrealistically high expectations of success or feel compelled to try “just one more time” finding it difficult to end treatment after having already invested so much physically, emotionally, and financially to have a child.
Join a support group
Within a treatment cycle, patients view IVF as a series of stages which must be successfully completed before moving onto the next phase of treatment: monitoring, oocyte retrieval, fertilization, embryo transfer, waiting period, and pregnancy test stages. The level of stress, anxiety, and anticipation raises with each stage, peaking during the waiting period. Research has shown that in order of perceived stress for patients, waiting to hear the outcome of the embryo transfer is the most stressful, followed by waiting to hear whether fertilization had occurred, and then the egg retrieval stage. Patients are aware of the importance of these key phases in the IVF process and the uncertainty of the outcome is highly distressing.
Despite the stressful consequences of infertility and IVF, it is important to note that research has shown that the vast majority of patients are well adjusted. Further, there seems to be no long-term impact on the marital relationship and individual functioning. In fact, some research has shown that the crisis of infertility may actually improve marital communication and emotional intimacy. Couples may learn coping skills and communication patterns that provide life-long benefit.

Tips for preparing for ivf

IVF has the potential to be an emotionally, physically, and financially exhausting experience due to the “high stakes” and “end of the line” nature of this treatment. Thus, patients need to consider thoughtful preparation before beginning the process. If you are a patient about to begin a cycle, here are some tips to help get ready for IVF:

Gather information and plan ahead

Good decision-making involves being well educated and informed about your body, the IVF process, and your clinic/treatment program. IVF is an anxiety-producing experience, and one of the best antidotes for anxiety is information and knowledge. The more you know and understand about the process, the less stress you may feel. Look for articles and other reading materials about IVF. If your practice runs educational IVF classes, attend as a couple and talk to others who have been through IVF.

Prepare for decision-making

It is important to anticipate decisions that may occur during IVF and discuss your options ahead of time. Sometimes these decisions may have moral and religious implications which you will need to consider and discuss. You will need to decide how many embryos will be transferred while maximizing your chances for pregnancy and minimizing the possibility of multiple babies. You will also need to decide what you will do with extra eggs and/or embryos, i.e. freeze, dispose, or donate them. If there is a possibility that donor gametes (sperm or egg) will be used in the cycle, it is important that you carefully discuss the issues involved in raising a donor-conceived child before starting the cycle. Counseling can assist you in exploring these issues and is a recommended treatment guideline of the American Society of Reproductive Medicine.

Tend to your psyche and your relationships

A long struggle with infertility may have taken a toll on how you are feeling about yourself, your marital relationship, and/or your relationship with others, causing distress and isolation. You will want to be in a good place emotionally and have your relationship on solid ground before starting an IVF cycle. Facilitate communication with your partner by setting a limited amount of time to talk about IVF, possibly 20 minutes every day, and then putting infertility talk aside. Discuss ahead of time your hopes and expectations of each-for example, whether you want to be together at appointments, on the day of the pregnancy test, and when you are expecting a call from the doctor. Counseling can be very helpful when you and/or your partner are feeling depressed, very anxious, emotionally stuck or in a rut. An ounce of prevention is worth a pound of cure, so get help early before problems get too big.

Garner your supports

Friends and family can be your best support or they can be your worst. Decide in advance who you will tell about the procedure by identifying who will give you the support you need. In hindsight, patients often wish that they had not told so many people at the start as it sometimes adds to the pressure. It can be helpful to designate a friend/family member as a “spokesperson” who will let others know, when you are ready, what is going on. In addition, look outside your usual support network to those who truly understand-other infertility patients. If it is available in your medical practice, consider joining an IVF support group, or check out other infertility self-help organizations, such as Resolve. The internet is, also, a ready source of infertility support and information, through various websites and “chat rooms”. A great deal of healing can come from others who understand.

Identify your stresses and your coping mechanisms

Each person experiences stress in different ways so it is helpful to identify where yours may come from. For some, it may be in just getting to the clinic in the morning for monitoring, for others it may be injections. Anticipating ahead where your stresses may come from will help in developing coping strategies. Know your own and your partner’s styles for dealing with stress and what has helped in the past. For example, women may need to talk and receive support, while men may prefer to be involved in an activity or hobby to cope. Learning to accept differences in the way each of you handles and deals with your feelings can reduce conflict. In addition, exercise is one of the best ways to alleviate feelings of stress, anxiety, and depression although it may have to be adjusted during the treatment cycle. Humor is a great coping mechanism and can help you get through difficult times. No matter how tough things get, you can always find something funny about it and laughing about it is good for your health. Stress management classes, listening to relaxation tapes and other mind/body techniques used regularly can help in handling these feelings and dealing with treatment procedures.

Decide what you have control over and what you don’t

To help eliminate any unnecessary stress, you will want to make you life as simple as possible during the cycle. This is not a time to make important decisions or changes in your life, such as a move or job change. If at all possible, avoid major undertakings at work that can add stress to your life. In addition, you will want to think about how to deal with other daily life challenges on the job, at home, and with family and friends. You do have control over the choices you make in your daily life while how the treatment course progresses is usually out of your hands.

Anticipate problem areas

Plan for possible changes and difficult times during your cycle, such as the waiting period after transfer and the day you will get the results. Expect the unexpected, as changes are frequently made in the cycle because of everyone’s unique medical situation. There are possibilities for failure at every step of the cycle, from a poor response to medication to no fertilization after retrieval.
The two-week waiting period between transfer and receiving the pregnancy test results is often described as the most difficult part of the cycle. Having had daily contact with your medical support staff during monitoring and retrieval, you suddenly are on your own after transfer and just have to wait. You need to think about how to fill your time during these two weeks, and then consider where you will be when you receive the results (probably not at work) and whether you want to be together to hear the news. To allow some time to deal with what you learn, you may want to consider “fibbing” to family and friends by telling them the results are due a few days later than reality. This will give you breathing space and time to adjust to the news before dealing with others.

Look past this cycle at the beginning

It is important to be looking ahead as you prepare for IVF and to consider your limits as you begin the process. It is easy to know how you will feel if treatment is successful and you become pregnant. However, you must also understand that if you are unsuccessful in achieving a pregnancy, you cannot get away from the sadness, loss, and disappointment that are part of the grieving process. Think about the number of cycles you are willing or able to do, and how much more time and money will be involved in infertility treatment, knowing that you can always reassess later. Remember that with each cycle new information is learned and that it helps knowing what to do next. Consider exploring other family building options, such as adoption, which will give you some control and provide information for future decision-making. No matter what the outcome of IVF, you need to recognize you have succeeded in doing all that is within your power to have a child and can feel good about yourself. Having done so minimizes future regrets.
Let’s get started together. Call us today to discover what’s possible, 1.888.761.1967 or schedule an appointment online.
Contributed by: 
Sharon N. Covington, MSW, LCSW-C
Director, Psychological Support Services

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