by Dr. Osarumen Nicole Doghor reproductive psychiatrist at Texas Children’s Hospital
In my work as a reproductive psychiatrist at Texas Children’s Hospital, I have noticed families struggle with emotion regulation, interpersonal relationships and self-identity while experiencing reproductive issues.
Specifically, I would say the top five experiences that families exhibit are grief, anxiety and depression, relational strain, insecurity and shame and, finally, hopefulness.
It can be difficult for others to understand the immense sense of sadness and loss for women experiencing infertility. First, there is the primary loss of not having a child, as well as the secondary losses of finances for treatment, strain in relationships and lowered self-esteem. To discuss the primary loss, one needs to understand infertility as “blank mourning”. In essence, this is a term we use to describe the mourning for a wished-for experience; making it difficult to cope as there is no specific person or object to mourn. However, women going through infertility describe the same symptoms of bereavement one would have after experiencing a loss. For instance, many women describe an intense sense of longing when seeing other pregnant women or children, in the same way, someone who has lost a loved one would feel when reminded of their loved one.
Grief is a normal experience that women struggling with reproductive issues may encounter. However, it is important to note that women struggling with reproductive issues may suffer from more severe psychiatric symptoms, including anxiety or depression. Depression can set in when a woman starts engaging in isolation, excessive tearfulness, thoughts of not wanting to live, stops participating in previously enjoyed activities or feels shame and guilt. Some women begin struggling with insomnia, fatigue, or poor focus and concentration as symptoms of either depression or anxiety. Women can become excessively worried and anxious during different phases of infertility treatment as well.
I have also noticed that relationships can be strained during reproductive struggles and at times therapy can be helpful to discuss the grief that both partners are experiencing. Couples therapy provides an avenue for partners to be open about feelings of disappointment and pain in a nonjudgmental environment with coaching on how to communicate this distress to one another. Oftentimes people notice their relationship with friends and family feel different. They become tired of answering questions about their fertility status. They may find it difficult to attend birthday parties of small children and baby showers. This could lead to distancing oneself from certain friends and family members, limiting their social circle. These social challenges may be linked to underlying insecurity and shame. Women experiencing infertility may find it hard to see themselves in the way society defines womanhood. I have heard some women describe feeling “defective.”
Lastly, I have seen tremendous hopefulness. I have found women and couples struggling with reproductive issues to be some of the most determined people, with characteristics of strength and perseverance. I think balancing the hope is very difficult because women, their physicians, and partners tend to focus on the hope of eventually having a child. What I have found remarkable in my experience, are the individuals who can find a balanced view of hope in whatever circumstance they find themselves knowing they will survive and work towards building a meaningful life.