The Fertility Problem No One Sees Coming

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Infertility stings. The diagnosis itself might bring up a cocktail of painful feelings, but going through treatment is also associated with higher levels of both depression and anxiety — and sometimes, that stress can exacerbate an existing mental health issue. With or without a strong support network already in place, those dealing with fertility struggles may have to look outside their immediate circles for the emotional help they need. And that's where a therapist who specializes in these issues comes in. Although a more general therapist for anxiety or depression can be helpful also, someone who specializes in infertility counseling is uniquely equipped to help women and their partners through these sensitive events — and to help navigate the inevitably difficult conversations with family and friends. "Infertility therapy" can include counseling about many different issues relating to fertility, including difficulty getting pregnant, miscarriages, and late-term losses. "All of those things bring up a lot of emotions and stressors that are unfamiliar or aren’t talked about openly among women and couples," says Julie Larson, LCSW, a therapist in NYC who specializes in infertility and grief counseling. "[Going to] infertility counseling is the moment when people stand back and realize they need some support."

"I wish more people knew about infertility in general so that women going through this would not feel so traumatized," adds Marni Rosner, DSW, LCSW. As someone who specializes in counseling women and couples going through infertility, she knows just how rough the experience can be: "Women that are diagnosed with infertility often experience it as a real assault to their identity," she says. "Their whole lives, they've been told that, if they work hard enough, they can do whatever they want, and all of a sudden that doesn't happen — sometimes, you just can't control your body." Here, we talked to Dr. Rosner and Larson about what infertility therapy is like, when to start considering it, and how those not dealing with infertility can support those who are struggling.

What are some signs that infertility therapy could be helpful for you?
Dr. Rosner says that if the process of getting pregnant is interfering with your relationships, that's usually the first sign that you would benefit from reaching out to a pro. She explains that family and friends alike may be at a loss for what to say or how to say it. That disconnect may result in a lot of tension in those relationships, whether or not you realize that's the root cause. "The technical term is 'disenfranchised grief,'" Dr. Rosner explains. "[It means] no one understands."

In other cases, someone who has had a miscarriage or an infertility diagnosis may realize she's struggling to find a way to tell others about what's going on. Larson says people often ask questions like, "How do you tell people? How much? What do you tell? And how do you cope with the ongoing persistence of that?" There are also some big (maybe totally new) emotions that may come with fertility issues, Larson adds. There may be a cycle of hope every month, followed by grief when that hope is dashed with a period. "It’s frustrating when you watch other people’s lives moving forward," she says. "It’s something you want that you can’t get; there’s anger in that, too." Women may also feel like their bodies are failing them, and experience a sense of guilt in thinking they're somehow responsible. On top of all that, the experience can also be incredibly isolating — even within a relationship. "No one's feeling understood," Larson says. All of these different feelings can be hard to control, so you shouldn't feel shy about reaching out for professional help.

What is counseling usually like?
For Larson, it starts with helping her clients figure out what's going right. "People walk in with all of these big emotions, and that has clouded the clarity of how they're making it through the day," she says. From there, she says her approach helps people understand what they need when those big feelings come up, and how they can get those needs met. "That's helping people to embrace coping and communication skills they already have, or to learn new ones," Larson explains. On top of that, her office acts as a safe environment to have tough conversations that might not be happening anywhere else in her clients' lives.

"Infertility brings up a lot of shame for people," Dr. Rosner adds. "Shame can be very toxic... When you don’t talk about it, it eats away at you." So providing a safe, empathetic space to talk through that shame, rather than letting it fester, is a major role for therapy. Then there's figuring out your support system. "Who are you going to reach out to? Who is going to be helpful, who isn’t, and who is worth taking a risk with?" asks Dr. Rosner. "A lot of people are trying to get something from someone they never get."

Counseling can also help you process the grief. "When women are going through this, they’re often in crisis," explains Dr. Rosner. "But when you develop a narrative [around your grief], including saying, 'This is what’s happening, this is why this is happening,' then, you can start to make a plan going forward."

How can you help a loved one who is dealing with fertility issues?
Dr. Rosner says the best thing is to check in, ask if there's anything you can do to help, and get curious. "A lot of people are afraid to ask the question or say the wrong thing," she says. Although it's great to be sensitive, being willing to start the conversation can make a huge difference in keeping up your relationship with that person. She suggests simply asking, "Hey, how's it going?" or "What do I need to know to help you?"