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Episode 53 Transcript

Ep 53 Transcript | Aftermath of Infertility (PTSD)

Hello, and welcome to Fertility Cafe. I’m your host, Eloise Drane. I’m starting today’s episode with a quick trigger warning. As you can probably tell from the episode title, today’s show is focused on infertility, pregnancy loss, and mental health issues like PTSD, anxiety, and Post Partum Depression. If you feel that any of these topics would contribute to negative feelings or upset, go ahead and skip this one. I know it’s a heavy topic right around the holidays, but I also feel strongly that through education and open discussion about these difficult topics, we can help provide comfort and support to those who need it.

Alright, so let’s dive in.

I think there is a serious misconception that no matter what a person goes through in order to have a baby… once that baby arrives, once the dream is fulfilled, everything is suddenly fixed. Every moment should be filled with gratitude: dirty diaper blowouts, sleepless nights, and gross snot-covered hands clinging to you 24/7 – all of it.

For people who have been on a fertility journey, these are welcome stressors and challenges, aren’t they? These are problems they have been yearning for, sometimes for a very, very long time. Shouldn’t they be happy for the sleepless nights? Shouldn’t they be walking on cloud nine, happily breathing in that new baby smell and documenting every moment with photo, video, and extensive social media posting?

People who have been open about their fertility journeys with friends, family, and on social media can feel extremely conflicted about this. If they post a rant or express negative feelings about parenthood, how many people will judge them for their ungratefulness? How long until a snarky cousin or aunt comments with “Well, this is what you wanted right?” Shouldn’t every single moment be savored and displayed with #blessed to document the miracle of parenthood?

In a word? No. People who have fought to achieve the dream of parenthood, for whatever reason, be it due to infertility, sexual orientation, or the choice of single parenting, experience all the ups, downs, and in-betweens of life raising a tiny human, just like the rest of us. They are allowed to feel an array of emotions, just like the rest of us.

Their perspective is certainly different from that of someone who had an uncomplicated fertility journey, but they are deep in the trenches of parenthood all the same.

They feel gratitude, of course. Likely in a way others don’t, with a deeper understanding of what it means to be grateful, to feel lucky. To not take the gift of parenthood for granted. But their perspective is also shaped by the emotional scars left behind in the wake of a difficult fertility journey.

The battle they have been through won’t just disappear from their memory. The worry, the disappointments, the ups and downs, the feelings of hopelessness, the financial strain… the trauma of it all, remains. It stays in a person’s body. It has literally shaped who they are as a human being, now and forevermore.

The reality is, the trauma and residual effects of going through any sort of fertility assistance are not magically remedied once the baby arrives. Yes, I am calling it trauma – a word that is typically reserved for major, often violent, or shocking events. Car accidents, witnessing or being victim of a violent crime, physical or sexual abuse, soldiers who served in war zones.

The American Psychiatric Association defines trauma as “any situation where one’s life or bodily integrity is threatened.”

There is increasing awareness in the field of psychology that so-called “Little T” trauma can have the same impact on a person as those “Big T” trauma events, like the ones I listed above. According to an article by Dr. Elyssa Barbash in Psychology Today, “Little T” traumas are “those events that exceed our capacity to cope and cause a disruption in emotional functioning.” Taken individually, they aren’t inherently life-threatening. They don’t necessarily signal any huge and immediate damage. Instead, they are often described as “ego-threatening,” as in events that can leave a person feeling a large degree of hopelessness.

Anyone who has been on the roller coaster of fertility will probably say that sounds familiar. Let me illustrate what I mean.

When a person discovers that, for whatever reason, becoming a parent is not going to come easy for them, that can be a huge shock to the system. Many of us grow up dreaming of the day we will have children of our own, and by the looks of the world around us, it seems that it’s a natural step for most adults. Everyone gets married and has kids, right? This of course varies depending on your culture, religion, family, and overall upbringing, but for the most part, having children feels like a given.

In many cultures, in particular certain faith traditions, childbearing is expected, and the quote/unquote “failure” to have children can even be seen as a divine punishment or an affront to the natural order of things.

The act of becoming a parent is a major milestone – the very core of an individual’s identity can be wrapped up in the desire and the reality of having children. When the reality sets in that it may not happen, and it certainly won’t happen easily, well, that’s definitely an “ego-threatening” event that can be labeled a trauma. A person is forced to reimagine their very identity, their hopes and dreams for the future – all of it.

As I said before, there are many reasons why a person might need extra help to get pregnant. Infertility rates keep climbing every year, and there’s no sign of that slowing down. But the matter goes well beyond the typical heterosexual couple who pursues IVF or other interventions.

Gay couples who wish to become fathers have a tough decision to make. While parenthood is much more accessible to the LGBTQIA+ community today than it was even five years ago, that doesn’t mean it’s easy. Or cheap.

The choices for gay men are limited: co-parenting, fostering, adoption or surrogacy are pretty much it. For men who feel strongly that they want a biological tie to their child, surrogacy is the only option. And, if you’ve been around this podcast for any length of time, you know that surrogacy is a massive emotional roller coaster all in its own right.

Lesbian couples have to decide who will carry the child, where donor sperm will come from. None of these choices are easy, and each one carries huge implications, down to the very DNA that will shape who their child is.

Then there are single individuals. It takes two to make a baby, so anyone who chooses to have a baby without a romantic partner is faced with similar decision-making. Will they pursue adoption? What about using donor material? For single men, who will carry the baby for them?

When pregnancy doesn’t come easy, for whatever reason, every single decision on the road to parenthood can feel excruciating. And there are a lot of decisions to be made, usually with no clear right or wrong answer. Do we go with this clinic or that? Would I be more successful with fresh or frozen eggs? Should I wait another year to see if I meet Mr or Mrs Right, or do I go it alone?

There’s a phenomenon known in the field of psychology called decision fatigue. You may have heard of it recently as it’s been discussed in relation to the pandemic. Sometimes it’s referred to as ego depletion.

The theory of decision fatigue is that, when faced with an inordinate amount of decisions to make, your ability to do so confidently and competently diminishes. Your brain literally gets tired, and it can affect large and small decisions alike. Many of us have felt this intensely at one point or another during the pandemic, when everyday activities became matters of risk assessment. Do I need to sanitize my groceries? Is it okay to go for a walk with a friend? How far apart should we stand?

When fertility becomes a matter of constant decision-making, it can take a huge toll on a person’s mental health. Stress, anxiety, and depression can crop up. Energy levels deplete. Everything just feels too difficult. The relationship between mental health and fertility is intertwined and extremely complex.

Inside this broad discussion of the aftermath of fertility are also the helpers – those people who selflessly stand up and volunteer to give a literal part of themselves in order to help another person realize their dream of becoming a parent. Women who step up and commit to the long, physically and emotionally difficult task of carrying a child for someone else. People who decide to donate their own genetic material, be that their eggs, sperm, or embryos, have to come to terms with the fact that a literal piece of themselves is now entwined in another person, another family’s DNA. How does one grapple with the enormity of that?

Fertility and the pursuit of parenthood is, by definition, a matter of life or death. And yet, too often, we treat it flippantly, as if it’s easy for anyone to achieve. As if there are no consequences to donating your genetic material or serving as a surrogate. Well, you knew what you were getting into, didn’t you?

The truth is, no matter what the motivation, no matter how much mental health work or evaluation is completed beforehand, no matter how many blogs you read or podcasts you listen to, there is no way to predict how a person will react to the emotional complexities involved in helping to create a human life — this is true for ANY person who becomes a parent, or any person who plays a role in the process.

For intended parents, imagine how great this complexity becomes when you have had to fight tooth and nail to arrive at parenthood – all the disappointment, uncertainty, grief, and adversity can take a massive toll.

When you consider all of this, I believe it becomes easy to recognize the fertility journey as a long series of “Little T” traumas, all compounding upon one another to have a great effect on a person’s mental state.

So while, yes, on the surface, it seems like the ultimate achievement of the goal — the baby — will help everyone heal and move forward, the truth is, the entirety of the emotional journey is not something a person just “gets over.”
It creates a very complicated emotional tightrope for parents to walk. On the one hand, parents who finally get to hold that baby in their arms feel extreme gratitude. On the other hand, those same parents are in the trenches with that new child – and they often feel guilt or shame when they get frustrated and angry during the 3:00 am wakeup or after the third blowout diaper of the day.

Shouldn’t I be grateful for every single moment, the good, bad, and ugly, since I fought so hard to create this life? Yes, and… it is absolutely okay and normal to have your moments of negativity. Trust me, as a mother of four very wanted children, I have had plenty of those moments.

If striking this balance is something you are struggling with internally, I want you to let yourself off the hook. Consider this your permission slip to feel your feelings. Parenthood is HARD. And it is okay to be both grateful and also angry, frustrated, tired, overwhelmed, annoyed… it all comes with the territory of being a parent, and feeling those things makes you human.

I know, though, how hard it is to get out of your own head about it. Especially when someone makes an insensitive comment or you encounter something that triggers you.

And people will trigger you with the things they say – if you’ve fought a fertility battle, you know. There are countless discussions in TTC communities recounting all sorts of cringe-worthy conversations. From the well-meaning “everything happens for a reason” to the not-so-well-intentioned “I cannot believe how much money you’re spending on this. Can’t you just get a puppy?”

In many cases, the person simply doesn’t know any better. Until you have been in the shoes of a person experiencing infertility or seeking third-party assistance to have a baby, you will never know what it’s like to go through it. I don’t pretend to know exactly how any of my intended parents feel, even though I have laughed, cried, and walked alongside so many. I can absolutely empathize, but I can’t pretend to know what it’s like to be on the other side of the equation.

We need to do a better job of recognizing, honoring, and talking about just how difficult it is when having a baby isn’t easy. And we also need to understand that no matter how much blood, sweat, and money a person puts toward achieving a goal, they are allowed to feel the full range of emotions about it.

After all, when a law school student complains about late-night study sessions, impossibly demanding professors, and overwhelming stress, do we shrug and say “Well that’s what you wanted right? You need to be grateful for that C you got on the test. Where’s your savor-every-moment Instagram post celebrating how lucky you are to have the opportunity to perform poorly on an exam?” You fought hard to get into law school. You invested tons of money on tutoring programs and LSAT prep books, you worried for hours and hours over which schools to apply to and whether you would finally get accepted. Don’t be ungrateful when it gets hard.

Of course not. And yet, for some reason, people feel the need to comment on how we experience parenting. Some people feel the need to police how we express our feelings toward our children in the tough moments.

There is a sometimes surprising lack of awareness and empathy when it comes to fertility and parenting. And it can be quite harmful if left unchecked.

I want to spend the next part of this episode painting a picture of what it’s like to go through a fertility journey. For those of you who have been there, or who are there now, this will sound familiar. It might even be too familiar, so if you don’t want to rehash the trauma of it all, please feel free to skip ahead. I get it – after all, the soldier does not need someone describing what it’s like to be on the battlefield.

But if you’re listening, and you haven’t personally experienced difficulty with fertility, keep listening. Maybe you’re a current or potential egg donor or surrogate. Maybe you’re listening to better understand what a friend is going through. Maybe you work in or are studying the field of third-party reproduction. Wherever you fit into this puzzle, it is important to try and understand what others are going through as much as possible.

Because the reality is, someone you know has struggled with fertility. About 1 in 8 couples suffers from infertility. There are millions of LGBTQIA+ individuals and couples who need third-party assistance. There are men and women who choose single parenthood, so they need donor material and possibly a gestational surrogate.

So while you may not be privy to their private struggles, I can guarantee you know someone who looks at fertility and parenthood and says “It’s complicated.”

Let’s try to put ourselves in their shoes, so we can be better educated and more sensitive to what they are going through.

As I walk you through the possibilities, I want you to remember the decision fatigue phenomenon. I think it will start to become very clear how and why mental health can become a serious problem for so many who are faced with fertility issues.

A person needing help with fertility will likely begin their often very long march toward parenthood by consulting with a fertility specialist. The clinic will complete an intake evaluation, discuss options, and possibly perform some physical assessments.

They may perform lab tests, physical exams, a semen analysis, and other procedures to attempt to diagnose an underlying cause. Women may undergo multiple transvaginal ultrasounds, a pelvic laparoscopy, x-rays, and more. Men may need scrotal ultrasounds to look for any physical issues.

After waiting for the results of all this, the patients will have more information about what their different options are. To break it down as simply as possible, there are three main decisions that have to be made by anyone needing help with fertility: who is going to supply the egg, the sperm, and the uterus? Of course, as we know, nothing about those decisions is ever simple.

Will there need to be an egg donor? A sperm donor? A gestational surrogate? If using donor eggs, who is going to supply those? Will you ask a friend, use fresh or frozen, what traits do you want to search for in the donor database? Most of these same questions apply to donor sperm.

When the intended parent themselves will be providing the egg or sperm for the embryos or the uterus for carrying the baby, medical treatments will need to be started. Some treatments will begin with medications to help regulate and optimize hormone levels. In some cases, such as when a physical cause can be identified, surgery is the best course of action. This would be for things like endometriosis, uterine polyps, or blockages in the tubes that store and carry sperm.

If initial medication or surgical interventions aren’t enough, the patient can move on to additional interventions. This might include intrauterine insemination, commonly referred to as artificial insemination, or in vitro fertilization, also known as IVF. Some couples may need to use donor eggs, donor sperm, donor embryos, or they may need to work with a gestational surrogate.

I won’t go into all the details in these procedures, but I would like to note that every step of the way throughout this process, the intended parents are worrying, anxious, stressed out, hopeful, excited, and cautious, plus a myriad of other emotions at any given moment.

According to the Cleveland Clinic, the outlook for people who struggle with physical causes of infertility is pretty good. They estimate that 9 out of 10 couples will eventually get pregnant after fertility treatments. Of course, this varies wildly based on a person’s individual circumstances, and no outcome is ever guaranteed, adding even more anxiety to the whole process. There are no guarantees that a treatment will ever take, no guesses as to how many attempts or how much money will need to be spent.

And then, if pregnancy is achieved, there are no guarantees it will result in a live birth of a happy, healthy child. Pregnancy loss is more common than we’d like to think. 10 to 15 of every 100 pregnancies end in miscarriage before 20 weeks gestation. Approximately 24,000 babies are stillborn each year in the US, which accounts for about 1-2% of all pregnancies. A lot of times, these terrible outcomes can’t be predicted or prevented.

That is a LOT of uncertainty, heartache, and worry. It’s truly an emotional roller coaster and a ride no one wants to take, full of stress and grief.

Imagine sitting in the waiting room at your doctor’s office as you wait to be called back following complications of yet another miscarriage or another negative pregnancy test. Or waiting for the phone call from your gestational carrier, anxious to know if the embryo transfer worked. While you wait, you try to distract yourself by scrolling through social media on your phone only to see yet another friend or family member announcing their pregnancy.

The pain inside you grows deeper and deeper. Of course, you want to be happy for your friends and the people around you, but you can’t help but feel hurt as you’re reminded of how badly you want to experience parenthood. You’re desperate to feel that same level of excitement you see others experiencing and wonder why you haven’t been able to yet yourself. And if you’ll ever be able to.

Fertility journeys are a whirlwind of emotions ranging from anger, sadness, guilt, excitement, and hope. Couples who are going through it together have to figure out how to navigate each other’s emotions as well, as they try to maintain a healthy relationship dynamic. If there is a known cause for the fertility struggles, the affected person can feel a sense of guilt or shame for being the one with the “broken” reproductive system. And on the flip side, the person who does not have a physical issue causing infertility can struggle with feeling resentment or anger at the other. One study found that couples who undergo fertility treatments unsuccessfully are three times more likely to get divorced.

When you think about it, that’s not very surprising. It’s widely known that parents who experience the trauma of the death of a child are very likely to get divorced. We hear that and think “of course. The stress would be unimaginable. Those poor parents.” Yet we don’t always apply the same empathy and understanding to parents who have experienced pregnancy loss. Some might even scoff at the comparison, saying “well those parents had X number of years raising their child, of course they have more to grieve.” To that I say: one person’s grief is incomparable to another. The way you experience your loss is real and impactful to you, and it has nothing to do with how grief is felt in others.

Even without miscarriage or pregnancy loss, infertility itself can feel a lot like the grieving process. There is a very real sense of loss felt when someone realizes they aren’t able to achieve one of the major milestones in life: becoming a parent. People have to grieve the loss of their own identity as well, because they are now faced with a very different picture of what their life will be. And unlike typical periods of mourning or bereavement, the grief they are experiencing isn’t typically known to many people, so the usual grace and care extended to someone who has lost a loved one, for example, doesn’t happen.

Some people are able to cope with the emotional stress and hardship that comes with fertility struggles, but others end up going down a much more difficult path. Anxiety, depression and even post-traumatic stress disorder can arise as a result of infertility and pregnancy loss. Study after study has shown that the rate of the mental health issues is significantly higher among people who have faced infertility. One found that major depression was present in up to half of those surveyed. Women undergoing IVF are more likely to have low self-esteem and a significant lack of confidence.

All of this is to say that no matter the outcome – be it a happy, healthy baby or not – the experience of a fertility journey has a profound and life-changing impact on a person. It can, and often does, trigger real mental health issues like depression, anxiety, and PTSD.

I’ve spent a lot of time talking about fertility from the perspective of intended parents, but we can’t forget about the helpers on the other side of the equation – those women who agree to help someone’s dream of parenthood become a reality. Gestational surrogates and egg donors play a crucial role in the process for many people, and they also experience a full array of emotions as a result.

The same misconceptions and lack of understanding occur when surrogates and egg donors experience negative feelings about their involvement. Didn’t you know what you were getting into?

Once again, I say yes, and… how you react to complicated physical and emotional acts, like that of donating your eggs or becoming a surrogate, can’t always be predicted. Complications occur. Regrets happen. Some egg donors can develop depression or anxiety after going through the process, as they process what it means to have a version of themselves out there in the world somewhere. As they read blogs that make them worry for their future fertility. As they struggle with a physical complication that was caused during egg retrieval. Though rare, there are women who have painful side effects or damage from donating. All of that can have an impact on a person’s mental health, requiring treatment or therapy to overcome it.

It’s the same story for gestational surrogates, though I would argue that due to the sheer amount of time a woman is on that journey, there is an even greater risk for problems. This is one of the major reasons why surrogates can and should be compensated for their efforts – there is a very real physical, emotional, and psychological impact, regardless of if all goes as planned or not.

The truth is, post-partum depression can and does occur in gestational surrogacy, and it’s definitely something to be aware of.

Now, you probably know that I am the founder of a surrogacy and egg donation agency. I’ve been a surrogate myself, and I have been immersed in the industry for nearly two decades. And yet, the awareness that surrogates can and do experience post-partum depression is not widely known or discussed.

Although all surrogates should be thoroughly screened by a mental health professional prior to starting the process, it can be nearly impossible to predict how you’ll feel once you’ve carried and given birth for your intended parents.

There is so much preparation that goes into searching for, interviewing, selecting, and working with a gestational carrier. There are mounds of paperwork, several different criteria to be met, and lots of background checks to be run. Of course, stable mental health is a key qualification for someone wanting to be a surrogate.

That’s why one of the first disqualifiers for a woman seeking to be a surrogate is if she has a current or relatively recent history of depression, anti-depressant usage, or other mental health issues. There are many reasons for this, as you can imagine, but in general, this is because we want the surrogate to be in the right frame of mind, in good health, and for her to have all indications that a pregnancy will go smoothly. Depression can be extremely serious and it can affect the woman’s health as well as that of the baby.

Once a candidate is selected, there is yet another layer of mental health due diligence to complete: she will need to be cleared by a mental health professional to proceed.

Prior to signing a surrogacy agreement, I always want my intended parents and their surrogate to talk about the possibility of postpartum depression. They need to set clear expectations in the contract that outline if and for how long the intended parents should pay for health insurance or any mental health treatments related to postpartum depression. This kind of care is needed more often than you might think.

In spite of all this work up front to ensure everyone is happy and healthy, PPD can still creep in. It’s not something that can be predicted.

Recovering from childbirth without a baby can be a difficult experience. Even when it’s expected and intentional, as with a surrogate, her body expects her to hold, feed, and be with the baby she just carried for nine months. Her body goes through all the same hormonal and physical changes. There are documented physiological needs in a mother and baby that can’t just be switched off when that mother happens to be a gestational surrogate for the child who isn’t hers.

Experiencing the postpartum period without a newborn to snuggle can be hard to cope with, physically and emotionally, for a woman, no matter how expected this was.

The entire surrogacy journey is an emotional rollercoaster, and most surrogates become quite close to their intended parents. Once the journey comes to an end, some surrogates feel a little lost and sad to not be in regular contact with the new parents. And to be honest, it can sometimes feel like a letdown, now that the intended parents are settling into life with their new family. It’s easy to see how a surrogate may start to feel lonely after all is said and done.

I always encourage my intended parents to help surrogates in the postpartum period by expressing gratitude, sharing photos or updates about how the baby is doing, and by checking in from time to time. I make sure to help educate all of our intended parents about how to transition to the next phase of relationship with their surrogate, and of course, the type of communication expected after delivery should have been clearly outlined in the contract ahead of time.

It’s important to note that postpartum depression can affect anyone involved in bringing to term or caring for a new baby. New fathers, new parents whose child was born via surrogate, and surrogates themselves can all suffer from depression related to the new addition.

Postpartum depression, or PPD, is a type of major depression that begins after having a baby. According to the American College of Obstetricians and Gynecologists, it can develop up to a year following delivery but more commonly develops within 1-3 weeks. A lot of people report feeling sad or “down” for a few days after giving birth. It’s normal to experience so-called “baby blues” for a short period of time, but if those feelings continue longer than a week or two, you may be experiencing PPD.

PPD is a very serious but treatable condition. Because PPD is often caused by hormonal changes that the body goes through during and following pregnancy, it can definitely affect gestational surrogates. As I mentioned before, a woman’s body does not care about the intent behind the pregnancy. The hormonal changes will happen regardless of if the child is meant to be given to the intended parents immediately after delivery. So, surrogates can and do develop the baby blues and postpartum depression.

A mild case of the baby blues is pretty common, as life adjusts back to normal. But if the feeling lasts longer than a couple of weeks, it may be turning into a case of PPD.

Though there are no actual treatment options available for baby blues, there are a number of things you can do to feel more like yourself again. Most of it is the standard advice: Rest, talk it out with a trusted friend or therapist, make sure to eat healthy and stay hydrated.

Most importantly, understand that it really is ok to ask for help. Today, many healthcare providers are especially vigilant about checking in on new moms postpartum, and that is fantastic. But other people are involved as well and can be experiencing depression. The lack of sleep, change in routine, and the general chaos that a new baby brings to a household is very real. So if you are the non-birthing parent, it’s okay to reach out for help. Some people feel that they don’t have a “right” to claim postpartum mental distress because they didn’t go through the physical act of giving birth.

To be blunt, that is nonsense. Research shows that at least 1 in 10 new dads experience postpartum depression. I imagine the same would be found if populations of non-birthing parents in general were studied – men, women, and non-binary new parents alike.

There are several reasons for this. Many non-birthing parents feel disconnected from the process, and perhaps feel regret or grief for not experiencing pregnancy as they had hoped. Research shows that hormone levels are also in flux for the non-birthing parent, although to a lesser degree.

More practitioners are becoming aware that postpartum depression affects more than just the person giving birth, but it’s still rarely screened for. And it can be especially hard to identify since men tend to show different symptoms than women. According to the University of Texas OB/GYN department:

Common symptoms for paternal prenatal or postpartum depression can include:

Anger, sudden outbursts, or violent behavior;
An increase in impulsive or risk-taking behavior, including alcohol or prescription drug abuse;
Low motivation;
Physical symptoms slike headaches, muscle aches, stomach, or digestion issues;
Poor concentration;
Suicidal thoughts’
Withdrawing from relationships;
Working a lot more or a lot less.

I would add, too, that regardless of gender, a person can experience any of this. The way depression or other mental health issues manifests in an individual can vary widely. The bottom line? Mental health following pregnancy is fragile for anyone, and it can be even more so for people who have already been fighting through the battlefield of fertility. When in doubt, tell someone how you’re feeling. It can make a massive difference in how you feel and how you are able to care for others.

I mentioned earlier that, in general, we are trending toward infertility, pregnancy loss, and alternative pathways to pregnancy being less taboo. Still, the stigma and shame still exists. Donors and surrogates still face tons of misconceptions, some of which can be hurtful.

A lot of women still follow the old advice to keep their pregnancy a secret during the first trimester, for fear that they may have to announce a miscarriage. As I mentioned before, a person’s religious upbringing and personal faith can also contribute to some of the stigma. Some people wonder if they are being punished, or if they aren’t worthy of becoming a parent.

There is also a very real divide when it comes to race and fertility. There is a widespread and somehow still persistent belief that people of color don’t struggle with infertility. That is objectively false. Women of color are actually 2x more likely to experience infertility than others.

There are a lot of different reasons why this is the case. This may be partly due to the fact that women of color are more likely to have underlying conditions such as uterine fibroids, endometriosis, and PCOS- all of which can greatly impact the ability to conceive and carry a pregnancy. There are also very serious issues with lack of access to proper care as well as a deeply ingrained distrust of the medical establishment among many people of color.

Communities of color also tend to hold on to the stigma of infertility. It’s rarely talked about, and when it is, it’s often treated like a dirty little secret. All of this means that people of color are among the least likely to actually seek treatment. You can go back to episodes 17 and 18 where my friend Regina Townsend and I discuss this issue at length. She is the founder of the Broken Brown Egg, an organization that empowers, educates, and advocates for Black people facing reproductive health issues.

So what can you do to support someone struggling with fertility?

Let’s begin with what you shouldn’t do. Avoid comments that might be well-meaning but end up causing distress.

Things like “trying is the fun part!” or “everything happens for a reason” are some of the last things a person suffering from infertility wants to hear. I promise you, they have heard the old “just relax” advice a thousand times, and it isn’t helpful.

Instead, let them know you are there to listen. Ask if they’d like to talk about it. Tell them you are sorry and wish they didn’t have to go through this. Give them a hug and just listen. People don’t want to be told it will all be okay – sometimes they just need to have their pain acknowledged.

What can you do to cope with fertility issues yourself?
First, find your support system. This could be friends or family members, your faith community, or even an online support group made up of people going through the same type of struggle. Seek mental health counseling, individually and as a couple if possible. Be open with your doctor about how you’re feeling – they may be able to adjust medications or suggest a way to help alleviate some of the stress, anxiety, or depression.

Also, give yourself and your partner the space and the grace to process your emotions in your own way. Everyone copes with stress differently, and aside from behaviors that harm self or others, there isn’t a wrong way to handle tough situations like infertility or pregnancy loss.

Finally, work on setting boundaries. With others, yes, but also with yourself and your partner. Limit the amount of time you spend talking about, researching, or thinking about your situation. Set a timer if you need to! It can really help to find other things to focus on and to seek out friends or family members who you can discuss other topics with. Yes, knowledge is power, but it can be really tempting to shift into information overload. Give yourself permission to veg out with Netflix and escape from time to time.

I think in the majority of cases, mental health is overlooked in the world of fertility care. Sure, we vet surrogate candidates to make sure their hearts are in the right place, and we encourage intended parents to seek counseling, but how often is that brushed aside in favor of the more task-oriented, results-driven process of making a baby, often at all costs?

Fertility, parenthood, or the lack thereof is a major piece to the identity puzzle for most adults. It’s viewed as a given: you’ll grow up, get a job, meet your partner, buy a house, and settle down to start your family. It’s the American dream. One that most of us envisioned and dreamed about as kids — what would our families look like? What would we name our kids? What would our family home be like?

To suddenly reach the stage of life when parenthood makes sense, and then be told that, no, it’s not possible for you. Not without a ton of work, medical procedures, and lots and lots of money… Well, that’s a hard pill to swallow for most people.

Fertility is ultimately a physical problem, yes. It’s the mechanics of joining egg and sperm to gestate inside a uterus. But there’s so much more to it than that. I believe fertility and mental health cannot be separated. The mind and body are so entwined, especially when it comes to matters like parenthood, relationship, and love…it stands to reason that the mental and physical would be so closely connected.

As a society, we need to do better in terms of showing care, empathy and support to people who are just doing their best to navigate parenthood – no matter what stage they’re at in the process. Whether a person decides to fight a long and costly battle to achieve fertility, whether they choose to forego parenthood, or anything in between, they deserve the space and respect to feel their feelings. How much a person spent on IVF is not relevant to how they feel about their toddler who is throwing their tenth tantrum of the day. Parenthood is a roller coaster of emotions for everyone, and anyone who says otherwise is lying to you. Let’s all work on showing more kindness and empathy to those around us.

I also hope that in the near future, we will see more purposeful collaboration between fertility specialists and mental health professionals. It could only help, not hurt, the mission we have to help anyone who desires to become a parent do so. It’s my hope that as we move forward, mental health issues and the way they intersect with infertility, alternate paths to parenthood, and pregnancy loss will be less stigmatized, more commonly discussed, and widely accepted as needing equal attention as someone seeks medical help to become pregnant. And that more attention be paid to the non-birthing people who are equally affected by the colossal task of bringing new life into the world.

I hope you’ve found this discussion helpful as you weigh your next steps. We would love for you to rate us. So if you haven’t yet, go to your listening platform of choice and subscribe, rate and review this podcast. 5 star reviews are our favorite.

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Thank you so much for joining me today. Remember: “love has no limits – neither should parenthood.”

Listen to this episode here.