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Dr. Alice Domar is a health psychologist with over 34 years of experience as a fertility therapist and has conducted decades of research on the relationship between stress and infertility. She pioneered the application of mind/body medicine to infertility care and currently is the Chief Compassion Officer and Director of Research at Inception. This article is written from the point of view of Dr. Domar based on her more than 3 decades of extensive experience working with patients experiencing infertility.

If you get the sense that everyone is talking about infertility these days, that’s probably because it is a common issue. According to the Mayo Clinic, infertility is estimated to impact about 10 to 15% of couples in the United States. What’s more, over 2.5 million infertility treatment cycles are being performed every year. This actually means that you could know lots of people who might be going through it or have been through it—friends, relatives, neighbors, and coworkers. Some may have let you know, and likely some may be keeping it private. In my experience working with patients, many people with infertility may feel guilt and shame and thus may not feel comfortable sharing, and sometimes the partner with the diagnosis might not want anyone to know.

What could experiencing infertility feel like?

Not great. From a psychological perspective, a study from 2021 showed many women and men undergoing treatment report high levels of anxiety and report significant symptoms of depression. In one study of women experiencing infertility, the incidence of suicide risk was over 9%.

Why can infertility be so hard?

Infertility can impact many aspects of the individual’s or couple’s lives, including:

their own relationship (people may not react to infertility in the same way or at the same time)

  • their sex life (imagine being told by a doctor when one can and can’t have sex or associating sex with failure)
  • their relationships with friends and family (who may seem to get pregnant naturally)
  • their job (infertility treatment may involve coming to the doctor’s office early every morning for a blood test and a vaginal ultrasound; so apart from the general discomfort of that, it may impact one’s work schedule)
  • their financial security (most infertility treatments are prohibitively expensive when they aren’t covered by insurance)

This is why it’s probably not a surprise at all that many people experiencing infertility may feel stressed, frustrated, and lonely.

How can I support someone with infertility?

Here are some tips on how to be more sensitive and careful with some infertility-related issues:

1. Negative Pregnancy Tests

There can be a huge difference between a negative pregnancy test after the first month of naturally attempting to conceive through unprotected sex versus undergoing a month or more of daily injected medications, regular monitoring, a surgical procedure, and personal financial investment, resulting in a Big Fat Negative (BFN). Someone who just started trying naturally may view another month of unprotected sex differently than an individual or couple undergoing fertility treatment who faces a decision as to whether or not to try another treatment cycle, with all of its challenges. For someone you know with infertility who has just had a BFN, this can represent a big disappointment. They may have had pictures of their fertilized eggs or embryos, or they may have thought about that little embryo becoming a baby. The thought of trying again may feel daunting. Do both partners feel OK about trying again? What if one wants to and the other doesn’t? Can they afford to try again?

two friends hugging at the beachThe recommendations below are based on some of the conversations that my patients have told me they have had.

Instead of saying:

“You can always try again.”

“It just wasn’t meant to be.”

“I don’t understand why it is taking so long for you to get pregnant.”

Consider saying:

“I am so sorry.”

“What do you need from me? A hug? A home-cooked meal? Want to take a walk together?”

“I am sorry that you are going through this. Remember that it’s not your fault.”

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2. Pregnancy Announcements

For someone who has never experienced infertility, it may be hard to understand that someone else’s pregnancy has the potential to cause such incredible distress. If you are the person with the pregnancy announcement, you may think that being pregnant has nothing to do with the infertility of someone else. Shouldn’t they be happy that you don’t have to experience infertility as well? Doesn’t it give them hope? Even if you don’t understand, this may be one of those things you accept.  Pregnancy announcements may be excruciating for those struggling to conceive. It may be normal for anyone going through infertility to become almost phobic about impending announcements. This does not mean that deep down they aren’t glad you don’t have to go through what they are. In fact, they may be happy for you. But those feelings may be buried far deeper than the longing they have to conceive their own baby. Individuals who have never had a moment of jealousy when others got better grades, scored more goals, were accepted into a better school, got a higher-paying job, or found a cuter partner suddenly may be overcome with it when others conceive easily.

Instead of saying:

"I don't understand why you are not happy for me."

"I am happy with the way I made my pregnancy announcement. Don't be offended."

"If you can’t be happy like everyone else with my news, I can’t be around your negativity."

Consider saying:

"If/when I/we get pregnant, how do you want me to let you know? Email? Text? A phone call?"

"I promise to not make a pregnancy announcement without telling you first."

"I understand that if I were to get pregnant easily, that might be hard for you. In addition to telling you however you want to hear the news, I promise to follow your lead on what you will need after that."

Infertility can truly represent a personal crisis for many who experience it. If you haven’t been through it yourself, it can be difficult to understand why it can be so hard. But the truth is that treatment cycles may not work the first time. And many people may not be able to afford the treatments they need to help maximize their chances. One does not need to have the same experience as a loved one in order to be empathetic, loving, and supportive. Consider these tips, and your friend/relative may appreciate you all the more.

If you or a loved one is in need of additional support or resources, visit fertilityjourney.com. From potential treatment plans to information about cost and coverage, Fertility Journey is here to help provide useful information and resources along the way. Because no one should have to go through this alone.