People assume that once a fertility struggle is ‘over’, all is perfect. But, do infertility scars ever fully heal?

"But I just don't understand, I mean after all this time? I have my little girl now—so why did her telling me she was pregnant make me feel like I was right back there again?"

These words were spoken recently by Maria, one of the many women I work with therapeutically in my role as a perinatal psychologist who specializes in fertility issues. Like many who go on to conceive successfully via ART, she knows she is one of the lucky ones. So she thought, like many, that once she had finally got pregnant, gave birth, and became a mom to her daughter, she would leave the pain and trauma of infertility behind her.

Of course, she did for a while. Attending postpartum classes, buying clothes for her little one, planning her Christening, and making mom friends at playgroup were all important steps for Maria on her postpartum journey post-infertility. These were important milestones away from the feelings of not fitting in, of being a ‘failure,’ and of the loss that she associated with her struggle to conceive.

But recent research carried out in Taiwan (1) suggests that even when women become pregnant via ART, it can be hard to shake off these feelings and to engage wholeheartedly with the joy of being pregnant and becoming a mother. While a study by Fertility Network UK in 2016 highlighted levels of anxiety and depression, fertility trauma and its impact on the transition to parenthood and on one’s sense of self as a parent is less recognized.

What is fertility trauma?

Fertility or infertility trauma, also known as ‘reproductive trauma’, is a term first coined by perinatal psychiatrists Dr. Janet Jaffe and Dr. Martha Diamond in 2005, to describe the psychological impact of a range of experiences such as infertility diagnosis, recurrent pregnancy loss, reproductive injury, and fertility treatment on individuals and couples. While most people associate trauma with soldiers coming back from war, we know that infertility involves surviving repeated traumatic experiences such as those described over a period of many years. 

Research carried out recently into the impact of miscarriage and ectopic pregnancy, for example, estimated that 2 in 5 women showed PTSD symptoms up to 3 months afterward (2). Although only a minority will go on to develop full-blown Post Traumatic Stress Disorder, it is common for individuals and couples to experience some of the following symptoms of PTSD:

• Re-experiencing or intrusion symptoms i.e. constantly thinking about pregnancy or fertility treatment, flashbacks to previous losses, or even nightmares about aspects of fertility treatment.

• Avoidance i.e. avoiding baby showers or friends who are pregnant again, or avoiding places or events connected with families.

• Changes in mood and feelings about self and the world i.e. negative emotions about others who may be pregnant, feelings that the world is divided into those who are pregnant and those who are not, loss of joy, shame, anger, or envy.

• Hyperarousal and heightened emotional reactions i.e. insomnia, irritability, anger, concentration difficulties, hypervigilance, or panic attacks.

• Experiences of fight-flight-freeze.

While thankfully, studies suggest that these symptoms lessen once couples become parents, we also know that experiences that we may not have had time to process may re-emerge once our brains tell us it is safe.

How might fertility trauma impact us after becoming parents?

In order to survive the fertility roller-coaster, individuals and couples develop a range of coping skills including numbing, dissociation, compartmentalization, a ‘keep-going’ mentality, and emotional detachment. Let’s face it: the business of early parenthood often means there simply isn’t time to process all that you went through to become a parent.

Some research suggests that couples who conceive via ART may initially be anxious and overprotective of their baby. Women who become mothers after recurrent pregnancy loss also struggle to allow themselves to complain or be negative about parenting. However, with the right support, those who become parents following ART are just as securely attached as others who conceive spontaneously and express more pleasure and gratitude in their parenting role. But of course, there will also occasionally be reminders of what they have endured and lost, and some of those losses are not obvious.  

They weren’t immediately obvious to Maria, either. But she came to realize in therapy that she had been triggered by her sister-in-law’s pregnancy announcement back into unresolved feelings of loss: loss of the experience of falling pregnant spontaneously, back into feelings of loss she used to have when friends would announce pregnancies, and back into the loss of failed IVF cycles. She also re-experienced the same panicked sensations and difficult emotions she used to have then.

Typical triggers for fertility trauma after becoming parents may include:

• Experiences of parenting – not having the family we imagined, not being the parent we thought we would be, conflicts with our partner, conversations with other parents about experiences of conception, pregnancy, and birth stories that don’t match ours.

• Transitions for our children – developmental shifts i.e. weaning, the firsts and lasts that come with parenting an only child, children starting school, or children asking questions about siblings or family formation.

• Transitions for us – secondary infertility, subsequent losses, birthdays and due dates, and other losses i.e. of a job, of friends connected to our infertility story, or menopause.

• Transitions for others around us – others getting pregnant, having an abortion, or losing a pregnancy.

What can I do if I feel impacted?

RAIN: RECOGNIZE what you’re feeling. ACCEPT your feelings. INTEREST – reflect on why you might be feeling this now. NON-IDENTIFICATION – letting the feeling go once you have felt it.

Find out more about trauma and how it might be impacting you. Grounding and breathing exercises can be very helpful in managing trauma symptoms.

Speak to a trusted person or your partner about what has happened.

Be the expert in you.

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Seek out professional support with a counselor or therapist with experience in working with fertility trauma.

Allow yourself to grieve the losses and perhaps create rituals to commemorate those losses. Create a journal, rewriting and accepting your ‘reproductive story,’ its losses, and unexpected gifts.

There is no doubt that our ‘reproductive story’ is what makes us the parents we are—perhaps more anxious and more risk-averse than others, but also at times more emotionally connected and grateful. More aware too of the incredible privilege of being a parent.

Want more on this topic? See below for some interesting articles and books.

Articles

• Huang, M et al (2019) First-time mothers’ experiences of pregnancy and birth following assisted reproductive technology treatment in Taiwan. Journal of Health, Population, and Nutrition, 38 (10).

• Farren, J., Jalmbrant, M., Ameye, L., Joash, K., Mitchell-Jones, N., & Bourne, T. (2016) Post-traumatic stress, anxiety, and depression following a miscarriage or ectopic pregnancy: A prospective cohort study. BMJ Open, 6 (11).

Recommended books

• Haines, S. (2015) Trauma is really strange. Jessica Kingsley Publishers: London.

• Jaffe, J., Diamond, M. & Diamond, D. (2005) Unsung Lullabies: Understanding and Coping with Infertility. St Martins Press: New York.

• Flemons, J. (2018) Infertility and PTSD: The Uncharted Storm.

*This article was originally published on Fertility Help Hub.