Just recently, on my way home from my private practice, I stopped by a doctor’s office to thank them for their recent referrals. On my way in, I picked up a mask by their front desk and put it on. As we all know by now, these medical masks have a particular smell. That’s when it all came rushing back to me: The failed pregnancy tests, the IVF treatments, the continuous doctor’s visits concerning our unborn child, and all the surgeries that my wife underwent after a very difficult delivery for our second son. I took a deep breath, realized what was happening to me at that moment, and then I was able to go into the office as normal.
I was experiencing a flashback, triggered by the smell of a hospital mask.
Navigating infertility can be traumatic and quietly upends our lives. After my wife and I underwent years of infertility and complicated pregnancies ourselves, I devoted much of my time and energy as a couple therapist and researcher on couples navigating infertility and reproductive loss. I’m here to tell you – infertility and reproductive loss is hard enough as it is, but it doesn’t have to destroy your relationship.
Infertility Can Be a Form of Trauma
Infertility is a form of reproductive trauma. This is a collective term, inclusive of all the forms of deleterious and difficult circumstances that couples may find themselves in on their journey to becoming parents. Recently, the CDC states that 1 in 5 couples in the United States experience infertility – a drastically sharp increase from the “1 in 8” statistic that has become so infamous over the years. In my recent study published in Psychological Trauma: Theory, Research, Practice, and Policy, my colleagues and I found that individuals in our sample of women who went through infertility and reproductive loss had a PTSD provisional diagnosis rate of 43%. This is much, much higher than the 5% prevalence rate of PTSD in the general population. That’s significant.
Disenfranchised Grief
One of the hardest parts about this statistic is that many couples navigating infertility may not have a socially sanctioned way to express their trauma, or even recognize that they are indeed feeling grief and trauma at all. Dr. Kenneth Doka calls this “disenfranchised grief”. Doka defines disenfranchised grief as any grief associated with loss which may not be socially viewed as a loss. For the individual experiencing disenfranchised grief, Doka says that “the constant refrain is: ‘I don’t have a right to grieve’”.
For those of us navigating infertility, this disenfranchisement often comes through the intellectualization of our pain. We’ve heard it before, right? The well-meaning advice, such as “have you tried adoption?” or “just relax and it will happen!” leaves us feeling like we are crazy – or, that we want to punch someone in the mouth.
Keep in mind, it is okay to give others a script for how to support us. For many of us going through infertility, we have to coach others in giving us empathy. Saying things such as “I appreciate your advice and positivity, but goodness, I just need someone to listen and recognize my grief” can work wonders.
Being in the Boat with Your Partner
Getting this emotional support from those in our social circles during infertility is absolutely crucial. But it is even more crucial to get this support from our partner. My wife and I published our story of navigating infertility in the Journal of Couple and Relationship Therapy, where we dissected our relationship in the hopes of helping other couples avoid our relational mistakes or mimic how we supported each other. In this writing, I described my own experience of infertility as being alone in a tiny boat during a massive storm in the middle of the ocean. I feel alone, lost, and scared that these huge waves are going to overtake me. But then, I turn to the back of the boat, and I see that my wife is there with me. It is so incredibly important to remember that your partner is grieving too, and that you can grieve alongside your partner. In my experience, though, I have seen many individuals turn to their partner during the storm of infertility and others abandon ship.
Going from ‘What the Hell Was That?’ To, ‘What Was That?’
One of the biggest things that leads to us metaphorically abandon ship is mismatched grieving. In other words, one partner is at one stage of grieving (or maybe, not grieving at all) and the other partner is at another stage. One partner may be experiencing really, really intense emotions rooted in trauma, while the other is “just trying to stay positive”. This mismatched grieving can cause disenfranchised grief even in the couple relationship. Suddenly, when there is a big emotional reaction rooted in infertility or reproductive grief, the other partner may react with “what the hell was that?!”, we become emotionally flooded, and then there is unproductive conflict. Or, maybe, one partner intellectualizes the emotion by trying to find the silver lining (such as “we still have another transfer we can try”, or “the doctor is hopeful that IVF will work”).
As a couple therapist working with couples navigating infertility, I spend a lot of time working with couples on changing the “what the hell was that?!” to a “what was that?”. When we can just have a stance of curiosity with our partner, be present in the moment, and recognize that they are experiencing grief and trauma, we can have more space to simply listen, be empathic, and be supportive.
A part of this process is recognizing that intense emotions in our partner might bring us anxiety. We might see that our partner is really grieving or is being retraumatized in their infertility experience, and this makes us incredibly tense. It can even make us emotionally flooded. It is extremely important to remember that you cannot fix the trauma in your partner – but you can support them. When you see a big emotion in your partner, remember to:
– Take a deep breath – Stay curious – Name their emotion – Just listen – don’t give advice or try to keep it positive
Self-soothing is incredibly important here. Sometimes, I tell partners to picture their anxiety in that moment as a cloud, and just take a second to watch that cloud go by in their mind. Once we take just a second to say goodbye to the cloud, we can just be present with our partner and support them emotionally.
Supporting Each Other During Infertility Is Worth It
Infertility is hard enough as it is – it does not have to destroy our relationships. It can be so powerful to simply recognize that our grief is mismatched, and that is okay. When this happens, we can turn towards our partner in their bids for emotional support, sooth ourselves when we are flooded, and join one another in grief. When you can do this with your partner, you might recognize that they are in the boat with you.
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Dr. Clayton Brigance, PhD, LPC, is the founder and clinical director of Shiloh Counseling, LLC, in Ballwin, Missouri (just outside of St. Louis). Clay’s clinical focus and utmost passion is working with couples navigating infertility and reproductive loss. Clay and his wife have had their own experiences with infertility, which was recently published as a duoethnography in the Journal of Couple and Relationship Therapy. Clay has also published several other articles as well on counseling couples going through infertility and reproductive trauma in some of the top scientific journals, such as The Family Journal, Contemporary Family Therapy, and Psychological Trauma: Theory, Research, Practice, and Policy.
Clay is on the Healthcare Task Force for the Institute of Reproductive Grief Care in San Diego, California, where he works with medical doctors, nurses, and other mental health professionals on how to advocate for couples going through the unique journey of infertility. Clay has spoken on this special topic across the country to various audiences, including the American Psychological Association. Clay is currently Level III trained in Gottman Method Couple Therapy and will soon seek full certification. Clay’s dissertation was focused on how couples achieve couple satisfaction in their relationship during infertility from the lens of the Gottman Method. Clay, his wife, and their two miracle boys live in Ballwin, Missouri (though Clay is often pining away for his home state of Kentucky).
