Fertility Treatment Trauma and Responding to Loss With Compassion

Guest post by Dr Tara Seed, principal clinical psychologist and clinical lead of an NHS perinatal trauma and loss service.

Reproductive trauma may not be a term you have heard before. Yet a frequently hidden part of it is the grief, loss and emotional impact that can accompany infertility and fertility treatment.

If this is part of your experience, you are not alone. Feeling frightened, overwhelmed, angry, envious or exhausted does not mean that you are coping badly. These are understandable responses to something that matters deeply and often involves prolonged uncertainty.

There are also genuine reasons for hope. Advances in fertility investigation, assisted conception and reproductive medicine mean that there are now more possibilities and pathways to parenthood than ever before. IVF, ICSI, donor conception and other forms of support have enabled many individuals and couples to create families in ways that would not have been possible in previous generations.

Having more choices can bring hope. It can also feel confusing. People may be faced with unfamiliar language, complex decisions and an overwhelming amount of information about different treatments, clinics and possible next steps. Greater choice does not always make the path feel straightforward and no treatment can promise a particular outcome.

We are surrounded by narratives suggesting that there is plenty of time to have a baby. Women now have greater opportunities to work, travel, develop relationships and explore the world before deciding whether to become a parent. These opportunities are important and hard won.

Alongside this, there can be limited awareness of how fertility changes across the lifespan. Female fertility generally declines gradually and then more rapidly from the mid-thirties, although this varies considerably between individuals. Fertility difficulties can affect people at any age and may arise from female factors, male factors, a combination of factors or causes that remain unexplained.

The message is not that people should feel frightened or pressured into having children before they are ready. It is that access to balanced information can help people make choices that are right for them.

For many people, fertility treatment does lead to the family they longed for. For others, the path is longer or more complicated than expected. The full emotional reality of fertility treatment encompasses the possibility and uncertainty, the hope and fear and the determination and exhaustion.

Why fertility treatment can become traumatic

The journey often begins with wondering, imagining and perhaps quietly fantasising about having a baby. There may be an expectation that pregnancy will simply happen.

From an early age, many of us receive strong messages about preventing pregnancy. Sex education may have concentrated on the apparent ease of becoming pregnant rather than explaining fertility across the lifespan. It can therefore be profoundly disorientating when pregnancy does not happen as expected.

Trying to conceive may gradually become waiting, checking and monitoring. You may track ovulation, analyse physical symptoms and move repeatedly between hope and fear. A positive pregnancy test may become negative a week later. Each month can develop its own cycle of anticipation and loss. This is understandable and not your fault.

Fertility treatment can bring appointments, investigations, procedures and unfamiliar medical language. It may involve taking time away from work while trying to ensure that nobody notices. People may attend an early morning scan, receive difficult news and then return to a meeting or continue with an apparently ordinary day.

There is also the vulnerability of placing your trust in clinics, doctors, embryologists and care co-ordinators. You may find yourself checking whether information has been passed on correctly, whether results have been understood and whether anything important could have been missed. This makes sense, it is important. It is not your fault.

Conflicting advice about what to eat, drink, take, avoid or do differently can make it feel as though you must research every possibility because this might be the one decision that changes the outcome.

The reality is that some parts of fertility treatment can be influenced but much of it cannot be controlled. When the outcome matters so deeply, having control over only a small part of the picture can feel frightening.

Other people may try to help by saying: “Just stay positive”, “Try to relax” or “It happened for someone I know when they stopped trying”. These comments usually come from a wish to offer hope. However, they can unintentionally imply that the outcome depends on having the right attitude or being sufficiently relaxed. This can add self-blame to an already painful and isolating experience.

Why the losses are often invisible

Some fertility journeys involve a biochemical pregnancy, miscarriage or later pregnancy loss. These are real losses but they are not the only losses people may experience.

There can be the secondary losses, the losses of a treatment cycle, an embryo that did not implant or embryos that did not continue to develop. In that moment, there may be the loss of the family you expected, the sibling you hoped to give your child or the future you had already begun to imagine.

There may be no funeral, few shared memories and no socially recognised period of bereavement. Other people may not understand the significance of an embryo transfer, the wait for implantation or a pregnancy that ended before it could be seen on a scan.

Meanwhile, friends may be announcing pregnancies, attending baby showers, joining antenatal groups or choosing nurseries and schools. You may be happy for them while also feeling devastated for yourself. Both experiences can be true at the same time. You are not alone in this.

Understanding the three emotional systems

Compassion-Focused Therapy offers one way of understanding these experiences. It describes three systems involved in regulating our emotions: threat, drive and soothing.

None is inherently good or bad. We need all three. Difficulties arise when threat and drive become dominant and the system associated with safety, rest and connection becomes difficult to access.

The threat system

The threat system evolved to identify danger and protect us from harm. It activates emotions such as anxiety, fear and anger. It involves the amygdala and stress responses including adrenaline and cortisol.

During fertility treatment, this system may scan constantly for signs of threat. An internal threat might be a physical sensation or change in your body. An external threat might be a phone call from the clinic, an unexpected result, an investigation that does not go to plan or another person’s pregnancy announcement.

This system can be helpful. It enables us to notice concerns and seek support. However, repeated uncertainty and loss can leave it working overtime. The mind may search continuously for what could go wrong, even when there is nothing useful to do in that moment. It is trying to protect, and it operates from a ‘better safe than sorry’ approach.

The drive system

The drive system helps us move towards goals and is associated with motivation, achievement and reward.

It can help people research clinics, consider treatment options, organise medication and prepare questions. It can support problem-solving and help manage treatment alongside work, relationships and everyday responsibilities.

Drive may also provide a temporary sense of control. After a disappointing outcome, moving quickly towards another test or treatment can feel easier than stopping and experiencing the loss.

Drive is necessary but remaining in it constantly can become exhausting. There may always be one more article to read, supplement to consider or treatment to investigate.

The soothing system

The soothing system is associated with safety, care and connection. It helps balance threat and drive.

When we can access it, we are not striving towards the next goal or trying to escape an immediate danger. We may be better able to rest, think clearly and feel connected to ourselves and others.

This does not mean feeling happy about what has happened. It means creating moments in which the mind and body do not have to fight, fix or prepare.

During fertility treatment, rest may feel like giving up. Stepping away from research may feel unsafe. Offering yourself kindness may feel undeserved. Learning to access soothing alongside threat and drive can help create a more sustainable balance.

Bringing compassion to fertility loss

Compassion is not forced positivity, self-pity or pretending everything will be fine. Within Compassion-Focused Therapy, compassion involves recognising suffering and developing the courage and wisdom to respond helpfully.

It does not remove uncertainty, grief or fear. It can help you work alongside them without adding shame and self-criticism. To manage your fertility journey, it may help to:

Notice which system is leading

Pause and ask:

“Am I in threat, drive or soothing right now?”

You may notice that you are scanning your body, anticipating bad news or repeatedly checking information. Alternatively, you may be pushing yourself to research and plan because stopping feels too difficult.

Approach this with curiosity rather than criticism. Your mind is attempting to protect you. Then ask: “What might help bring a little more balance right now?”

Separate influence from responsibility

Consider what is genuinely within your control. This might include preparing questions, attending appointments, taking medication or deciding who to involve. How can you lean into what you can control and let go of what is outside your control?

Try to distinguish this from the outcome itself. You can make thoughtful decisions and follow every instruction without being able to control whether treatment succeeds.

An unsuccessful outcome does not mean that you did something wrong.

Speak to yourself as you would to someone you love

Imagine your closest friend was experiencing exactly what you are going through.

What would you say about her grief, her body and the way she has coped? What would you want her to understand?

You might write these words down and return to them, treating yourself as you would a close friend.

Prepare emotionally for appointments

Compassionate actions and preparation can help manage the journey. Preparing for an appointment does not only mean writing medical questions. Consider what you might need emotionally before and afterwards.

Could somebody accompany you or be available afterwards? Could you avoid returning immediately to work? Is there something that usually helps you feel grounded or cared for?

Find safe connection

Think about who can offer the kind of support you need. Who can help you feel safe, secure, loved and connected?

You may want someone who can listen without giving advice. At other times, you may need somebody who will help you take a break from talking about fertility.

Support might come from a partner, friend, family member, therapist, charity or fertility community. Connecting with people who have experienced something similar can reduce the sense that you are carrying an invisible burden alone.

You are also allowed to set boundaries around pregnancy announcements, baby showers or conversations that feel too painful. Protecting yourself during grief does not make you uncaring.

You do not have to earn compassion

Fertility difficulties can leave people feeling that they must work harder, cope better, remain positive or find the perfect next step.

Compassion offers a different position.

It recognises that this is difficult because it matters. It makes room for grief without treating grief as failure. It allows hope and fear to coexist and reminds you that needing rest, care and support is not the same as giving up.

You do not have to minimise the loss because other people cannot see it. You do not have to prove that it was significant enough to hurt.

Your experience matters and you do not have to carry it alone.

Fear Free Childbirth publishes guest pieces from practitioners, researchers and women who’ve lived it. If fertility, pregnancy or birth is your territory, write for us.

Keep reading

• IVF Anxiety: What It Actually Takes To Get To This Place
• Recurrent Miscarriage, with Naava Carman
• Coping with a Miscarriage, with Susie Gower