What Do Pregnancy Loss and PPD Have in Common?

On Facebook yesterday, I stumbled across a link to an article on Babble.com titled “Suffering in Silence — How One Woman Coped With the Loss of Her Baby.”  It is truly one of the best written articles on pregnancy loss–in this case, miscarriage–I have ever read.  In reading the article I couldn’t help but be reminded of how I felt after my ectopic pregnancy and when I found out the twin to my daughter didn’t make it past the second month of pregnancy.

UNNECESSARY TABOOS

So, what do pregnancy loss and PPD have in common?  Well, to start with, both seem to have become through the years taboo topics that you rarely hear others bring up on conversation….least of all by those who are in the process of grieving their pregnancy loss and those who are suffering from PPD.   The only people you would be willing to share such a private matter with are certain family members and close friends.   Ironically, it’s at times like this that you need support the most.   Grieving in private, which is what I did when I suffered both my losses, only increases your risk for depression.

THE NUMBERS…YOU WOULD NEVER KNOW

Second, because people don’t talk about their experiences, society as a whole really has no concept of how frequently pregnancy losses and PPD occur.   The author, Jody Pratt, points out:

“An estimated one in seven pregnancies ends in miscarriage. Each year in the U.S. alone, over 700,000 babies don’t survive to be born. Millions of people must be mourning them. So, where are they?  ‘The only tradition our society does have regarding miscarriage is that you’re not supposed to talk about it.'”

As for PPD, an estimated one in eight new mothers experience it.  So, where are they all?  Before I had PPD myself, I hadn’t heard squat about it from anyone I knew.  After I had PPD, I’ve only come across a handful of those I personally know that mentioned their own experiences to me.  Believe me, they are out there.  Thanks to the stigma of mental health and lack of awareness, all too many moms suffering from PPD continue to keep their experiences to themselves, not knowing that what they have is a true illness and there should be no shame associated with feeling the way they do.

ANOTHER CONSEQUENCE OF THE TABOOS

Another consequence of people not talking about their experiences is that people have no real concept–not unless they, of course, have firsthand experience themselves–of what it’s like to lose a baby during pregnancy, regardless of how early in the pregnancy the loss occurred.   Comments that either I or others receive in reaction to the news of pregnancy loss lean in the direction of “Just keep trying….you’ll succeed.”  “At least this happened now rather than later on in the pregnancy, after seeing your belly growing and feeling the baby kicking and moving and feeling your love for the baby growing daily.”  You wouldn’t think that it would be possible to feel an emotional connection within the first few weeks of pregnancy, since there is nothing about an embryo that resembles a baby yet.  For me, even the few weeks during my first pregnancy was more than enough time to become emotionally invested.  When I found out it had to be terminated due to what they referred to as an ectopic pregnancy, I was devastated.   Then, when I lost the twin to my daughter at two months, I cried on and off for a few days but forced myself to move on because I couldn’t risk having my grief jeopardize my pregnancy. 

When it comes to PPD, unless you’ve been through it yourself, it’s hard to really know what the PPD mom is really going through.  All people know is that having a baby is supposed to be a happy time and you only really see happy moms.  So, when a mom who is suffering from PPD isn’t glowingly happy but instead is suffering from PPD, comments she receives may tend to send like the following:  “You have the healthy, beautiful baby that you’ve always wanted.  What more could you want?  How could you not be happy?  Pull yourself together…your baby needs you.  All new moms go through this after having a baby.  It will pass on its own.  You’ll be fine in no time.”

BREAKING THE CYCLE

Parents who grieve should speak up more.  Though, with the reactions they get from even the most well-meaning of family and friends, it’s no wonder people want to keep their grieving to themselves.  It’s also no wonder that most expectant parents do not tell anyone about their pregnancies until the end of the first trimester, because there is a greater likelihood for pregnancy losses to occur during that time.  As a consequence, if you do (God forbid) experience pregnancy loss, you automatically end up suffering in silence because people didn’t even know you were pregnant to begin with.  Being as risk-averse as I am and prone to believing in “jinxes,” you better believe my husband and I didn’t tell anyone at all about my pregnancy until the first trimester was over and I didn’t tell colleagues until I could no longer hide it from them at around 6 months!   I grieved in silence after both of my losses because they occurred before the first trimester was over.

At the same time, family members and friends should learn how to support grieving parents better.  Maybe take some sensitivity training or something.  Learn that keeping what you say to a minimum–in this case, LESS IS MOST DEFINITELY MORE–just your being there for the grieving parents and offering a listening ear (if they ask you) and avoid offering advice especially if you’ve never suffered a loss like this yourself.  Read up on articles such as the one Katherine Stone had previously written up that provide suggestions on how to support someone who is grieving.  Follow the blogs I list under Pregnancy Loss/Infertility Websites & Blogs.  It would also help tremendously for people to know that there are many others who are going through–or have gone through–pregnancy loss (or PPD).  I mean, look at the numbers!   Articles like this one written by Jody Pratt should be accessible via pregnancy books, magazines, and newspapers.  In all forms of media that expectant parents would have easy access to.  As I mention in prior posts, the best place to obtain non-judgmental emotional support is a therapist that specializes in pregnancy loss (or PPD).   Doing so is an investment in your mental health down the road as you embark on future pregnancies that will one day, hopefully, be successful.

PREGNANCY LOSS – A RISK FACTOR FOR PPD

Finally, negative life events related to childbearing–e.g., history of and unresolved grief associated with pregnancy loss (previous stillbirth, abortion, miscarriage) and  multiple failed IVF cycles are a significant risk factor for PPD.  There is a lot at stake emotionally with the baby that is conceived after years of trying, possibly with the help of IVF and after failed attempts/cycles and perhaps even miscarriages.  Click here and here for more info.

Infertility and Pregnancy Loss Resources

Just a real quickie from me today….In case you hadn’t seen 2 recent posts over at Postpartum Progress, one of which is on PPD after miscarriage or stillbirth, and the other on the difference between grief and depression after pregnancy loss.   In one post, Katherine Stone links to a mother’s struggle with PPD after miscarriage.  In the post, she links to pregnancy loss/infertility websites that can help those currently struggling with the devastation caused by such experiences.  I’ve added those links to my site (under Pregnancy Loss/Infertility Websites), since as I mentioned in my previous post on my IVF experience, women who have suffered a pregnancy loss(es) and/or infertility are at greater risk for PPD after a successful pregnancy…or even adoption.  I’m highlighting this info for you because I have had to struggle with both, and want anyone going through this to know there are resources and support out there.   And of course, PLEASE feel free to reach out to me anytime you need to!

Forget the Myths, Here are the Realities of Pregnancy, Childbirth and Postpartum Experiences

Pregnancy is NOT always a smooth, easy and blissful experience

Pregnancy is always a smooth, easy and blissful experience.  Not only that but  you (and your skin) are supposed to “glow.”   Nah, don’t you believe that for one instant!  Grant it, there are those who experience one or more births that most women can only dream of having.  You will occasionally hear about births that progressed so quickly and easily that no pain relief, episiotomies, or stitches even, were needed.  I have a friend who said that labor started so suddenly while still at home that she just gave birth there.  Where all it took were some intense contractions and a few pushes, and it was all over.  Within minutes, baby was contentedly breastfeeding. They couldn’t even wait for help to arrive.  Now, that’s a childbirth experience that can’t be beat! 

In terms of pregnancy and its associated physical challenges—like nausea, vomiting, water retention, difficulty sleeping in the later months—Susan Maushaurt (pg 50) in her book The Mask of Motherhood: How Becoming a Mother Changes Our Lives and Why We Never Talk About It says:  “We fight off our symptoms with a grim determination…..and get on with it, to show the world….that pregnancy is no big deal, really.”  Maushart describes how her nausea, which was triggered by practically every smell and so severe and debilitating, and yet she was “as likely to publicize it as [she] would a bout of bed-wetting.”  Like Maushart, I experienced nausea a lot.  In fact, I was nauseated by every little smell for the entire duration of my pregnancy.  Unlike Maushart, I wasn’t afraid to tell people.  I told people at work, I told my friends, I told my family.  Why would I want to hide this information from others?  It seems that Maushart, along with countless other women, choose to keep quiet due to fear of being judged as not taking it like a woman.  It seems that if we were to dare complain about any aspect of pregnancy and postpartum, we would be branded a failure.  Deep down, we compare ourselves with those women who glow and love every minute of being pregnant.  What we all need to realize is every woman is unique and so every woman’s pregnancy, circumstances and therefore childbirth experiences will be different.  Some experiences will be great, while others won’t be.  That’s just reality.

The reality is that—and you seldom see any of this unless you’re deliberately on the lookout for such information—about 15-20% of pregnancies fail to carry to term, per Ruta Nonacs in her book A Deeper Shade of Blue: A Woman’s Guide to Recognizing and Treating Depression in Her Childbearing Years (pg 84).  Many women suffer from repeated miscarriages.  With each miscarriage, there is grieving and the more a woman grieves and the longer the period of grieving, she becomes increasingly more vulnerable to depression.  Studies show that women with recurrent miscarriages (and/or infertility) experience clinically significant depression. Needless to say, it is very difficult to cope with a loss at any point, whether it’s a loss during the first trimester, later in the pregnancy, at childbirth (stillbirth or death from preterm birth), or up through a few weeks postpartum (neonatal death).  You wouldn’t think that it would be possible to feel an emotional connection within the first few weeks of pregnancy, since there is nothing about an embryo that resembles a baby yet.  For me, even the few weeks during my first pregnancy was more than enough time to become emotionally invested.  When I found out it had to be terminated due to what they referred to as an ectopic pregnancy, I was devastated.  I can’t even imagine carrying a baby to term only to have the baby die.  That has got to be one of the most devastating experiences any woman could ever have to endure.

Each woman is different in terms of their ability to cope with and move beyond a loss.  Some are able to cope and move on relatively quickly.  For others, the experience is so devastating that they may not be fully able (or willing) to let go of the pain and memory of their loss, and fall into depression.  These women should seek professional help to help cope with their loss and move on with their lives.  It really helps to share your feelings with therapists who, unlike friends, family, colleagues and neighbors who—despite good intentions may unintentionally say something that hurts your feelings—make for non-judgmental and supportive listeners.  It isn’t good to keep all your feelings bottled up inside.  Grieving and getting a certain amount of emotional support from others are components of the healing process.  It’s best to deal with grief as it occurs rather than letting those negative feelings accumulate and stay unresolved over time.  At some point, your body and psyche may get to a point that they can no longer hold back depression.

Women who have had previous experience(s) with miscarriage and/or traumatic birth experience—including, but not limited to, having a stillborn baby—will tend to experience high anxiety levels, due to great fear of yet another pregnancy loss, during a subsequent pregnancy.  High anxiety levels make it difficult for a woman to enjoy her pregnancy.  Women who have had to endure IVF cycles and/or repeated pregnancy loss—e.g., miscarriage(s), stillbirth(s)—have experienced much psychological trauma to get to this point and are considered high risk for a perinatal mood disorder.  There is a correlation between feelings of loss and the age of the mother, how long she has been trying to conceive, and whether there were previous pregnancy losses, which in turn lead to feelings of failure and inadequacy, not to mention higher anxiety levels and stress, which can cause a woman whose body and brain are already challenged by hormonal fluctuations to become depressed. 

Let’s not forget that pregnant women can become depressed—this is referred to as antenatal depression.   In fact, approximately 1 out of 10 women experience antenatal depression, though many cases are undiagnosed.  Per Postpartum Depression Demystified“by Joyce Venis, RNC and Suzanne McCloskey (pg 59), untreated cases of depression during pregnancy have a 50% chance of worsening after childbirth.   Depression during pregnancy generally does not go away once the baby is born.

So, in short, while it’s true that mothers who are fortunate enough to have smooth pregnancies each and every time they have a baby more than likely feel that this is a true statement, pregnancy is NOT always a smooth and blissful experience. 

A smooth pregnancy does NOT mean a smooth postpartum period

I had a relatively smooth pregnancy so the thought never occurred to me that I could possibly develop PPD.  Unfortunately, a smooth pregnancy does not always guarantee a smooth postpartum experience.  You could totally love being pregnant and loving every minute of the pregnancy but still end up with PPD.  If you find that a number of the risk factors in my post “Risk Factors for PPD” apply to you, you could still fall prey to PPD despite how well your pregnancy went.

The childbirth experience is subjective and unique to each woman.  What one woman deems as a good childbirth experience may be completely different from another woman.  What is satisfying to one woman may be disappointing for another.  Some women may view a good birth as one in which the baby came out fine, despite the long and painful process.  Some may view a good birth as one that is completely “au natural,” in which no pain relief is administered and the baby is delivered vaginally.  Yet others may view a good birth as one where there is very little pain, or pain that they can deal with, thanks to the invention of the epidural.   Increasing numbers of women are even opting to have caesarians despite the lack of medical necessity and out of preference for being in control and able to decide what day to have the baby and minimize the chance of any complications.  Ultimately, it’s the woman’s perception and satisfaction of her childbirth experience that matters and key to starting off her postpartum experience on a positive note. 

For some, unfortunately, a disappointing childbirth experience increases a woman’s risk factor toward postpartum depression—particularly if there are any complications like an emergency caesarian, pre-term birth and any medical problems of the baby resulting with a stay in the NICU.   Many women long, hope and prepare for a natural childbirth experience.  In other words, no medical intervention of any sort.  A vaginal delivery with no epidural, no forceps, nothing.  Just plain endurance, willpower and heavy-duty breathing exercises.   What they don’t plan for—baby in breach position or other unforeseen medical emergency for the mother and/or baby—are the times an emergency caesarian or other medical intervention may be required.  For these women, not being able to have the birth experience they had hoped for can cause a tremendous sense of loss, disappointment and grief.   It’s situations like this that it’s best to adopt a realistic attitude of hoping for the best but realizing that anything, really, can happen. 

If you read my recent post about my childbirth experience, you’d know that I had to lose my uterus due to a rare complication called placenta accreta (where the placenta grew into my uterine wall) only 3 days after having my baby.  I would say, without a doubt,  that that experience paved the way to my PPD.  I wouldn’t say that that experience alone is what triggered my PPD, since my PPD didn’t start until the 6th week postpartum.  Needless to say, when you experience a complication like that, which not only takes a lot out of a person physically since it’s a major surgery with 4 units of blood loss—this being only 3 days after childbirth, another big deal physically—on top of the hormonal fluctuations, sleep deprivation, and daily procedures in the hospital, your body is not in prime physical condition, is it?  I was planning to treat all this in a practical and matter-of-fact sort of way and move on.  Put this all behind me.  There was no way for me to even know that in just 6 weeks’ time, I was going to get blindsided with PPD.   Something I could not just snap out of all by myself, without medical intervention. 

The following are just examples of obstetrical complications leading to a traumatic birth experience…. the types of experiences we hope never to have but in reality do happen to some women: 

  • Emergency caesarian (especially after having had no pain relief and enduring many hours of labor)
  • Baby going into distress during or after delivery
  • Inability to see or hold the baby immediately upon birth
  • Extremely difficult and long labor
  • Baby requiring surgery to correct a serious congenital defect
  • Husband not being there with you
  • Last-minute change in OB/GYN delivering your baby 

The disappointment of falling short of your birth plans, frustration of this unexpected turn of events, inability to do more for your baby, and/or lack of control can be too overwhelming, too much to bear for a new mom whose hormones are already topsy-turvy and “playing tricks” on her emotions. 

Hear No, Speak No, See No….

Those who’ve been fortunate enough to have smooth and stress-free experiences lack empathy for those who don’t have such experiences.  After all, empathy comes from personal experience.  On the one hand, without going through a difficult pregnancy, childbirth and postpartum experience yourself, there is no way for that person to know what any of that’s like.   On the other hand, women who have had negative experiences with pregnancy and childbirth, such as ectopic pregnancies, miscarriages, and infertility, generally do not talk about these experiences with others for several reasons.  After all, who wants to hear bad news?  Even if you think that someone else would be understanding, chances are you are reluctant to burden someone else with heavy news and/or you don’t feel they can empathize or know what to say to you.  People are generally inclined to stay away from awkward situations.  Because people don’t openly discuss their difficult pregnancy, childbirth and postpartum experiences, the public is only aware of the smooth, easy and blissful pregnancy, childbirth, and postpartum experiences.  It’s natural to feel you’re an imperfect mom when things don’t go smoothly because you only hear good things from other moms.  Or you simply want to hide the fact that your birth experience was not as good as you’d hoped it would be.  Unfortunately, this only supports the notion that all pregnancies are smooth, easy and blissful experiences.  Not to mention, it also makes women like me who have infertility issues, as well as pregnancy, delivery and postpartum complications ask themselves the question “Why me?” and feel worse that they are being deprived of positive experiences every other mother seems to be enjoying.  This only makes them feel more alone in their experience than ever.

Unfortunately, it’s human nature to avoid wanting to hear about problems you have during delivery and/or the postpartum period—as I unfortunately experienced firsthand. People only want to hear what they want to hear, which is that your experience was like any other mother’s experience.  They don’t even want to hear the details of how the labor and delivery went.  They just want to hear these 6 words:  “Mom and baby are doing fine.”  This is what I refer to as the “spare me the details” effect.  Same thing whenever you ask anyone the question “How are you” and you expect the answer to be “Good, thanks.”  People don’t want you to go into details, especially if they’re negative in any way.  I always get this strange look from people whenever I provide a response that’s in any way negative.  It’s almost like, how dare I provide a response that isn’t within the socially acceptable “Good, thanks.”

Empathy seems to be the key that gives people the understanding and realization that others need help and support, that all is not always peachy keen.   You learn from life’s experiences, which motivate people to do certain things.  Why do you think I do what I do?  To help other women, so they can be empowered with knowledge.  Ignorance is NOT bliss when it comes to things like pregnancy, childbirth, and postpartum experiences.  Be in the know.  Also, it’s best going into labor and delivery not having high or certain expectations, since you won’t be setting yourself up for disappointment.  All you should and can do, really, is to hope for the best and be as knowledgeable as you can about the REALITIES of pregnancy, childbirth, and postpartum experiences—including PPD!  After all, PPD is the #1 complication of childbirth.

Unresolved Grief & Anxiety from Multiple IVF Cycles and Years of Trying to Have a Baby: Risk Factors for Perinatal Depression

Today, women are having babies later and later in life, as there are now more professional women in the workforce than ever before. As you have most likely heard, a woman’s fertility drops due to egg deterioration by the time she’s in her late twenties and drops faster and faster every year past the age of 35. Infertility is, in the majority of cases, due to a woman’s age, but there are other causes such as the quality of the man’s sperm. In some cases, the woman’s eggs are fine but either deteriorate after fertilization occurs or fail to implant, thrive and develop into a fetus that carries to term. Repeated attempts to conceive over one, two or more years and then having your OB/GYN recommend you see an infertility specialist is disappointing and truly devastating for any parent who has always had dreams of having a family. The disappointment and feelings of failure can become all-consuming, especially for the woman who feels this is a reflection of failure on her part to have a baby while all her friends and colleagues seem to be having babies left and right.

The steady ticking of my “biological clock” kept reminding me that time was running out for me to have a baby.  Counting days and using a thermometer to figure out my “window of fertility” each month felt like a science experiment, or math exercise, that we kept failing at. Then, after months and months of trying to conceive, we succeeded in early 2003 only to discover that it was an ectopic pregnancy that had to be terminated by way of 2 injections of methotrexate, a drug used for cancer patients.  

We were never able to conceive again after the ectopic pregnancy, probably due to my high anxiety/stress/distress levels. I’ve heard many people say, including doctors, that stress and anxiety affect fertility. Some couples will find, just as my husband and I found, that the harder you try to get pregnant, the more stressed out you get. As each month goes by and with every unsuccessful attempt, the couple gets more and more stressed out and distressed. As each month went by, I became more and more desperate to have a baby. With each period and each negative home pregnancy test, there was this overwhelming disappointment. Each period symbolized yet another month of failure, and a step farther away from the likelihood of ever having a baby. You would be surprised to hear stories of couples adopting or having a baby through IVF, and afterwards actually succeeding in conceiving naturally! It’s logical to assume that, with the focus no longer on trying to get pregnant, the stress levels are down and voila, an unexpected pregnancy! I have at least 2 friends who experienced this unexpected and wonderful surprise.

During the summer of 2003 we attempted our first IVF cycle at an IVF facility nearby. That was honestly a nightmarish experience, mostly due to the way they made me feel like a number, a guinea pig for their research statistics. Other factors that doomed my first cycle included the stress from not being familiar with the treatment protocol and the cold, unfriendly, and disorganized environment of the facility.  In general, I felt the facility was managed poorly.  They even did a terrible job with the handling of my billing.  No one who needs to go through IVF should be subjected to this additional stress.  A facility with their reputation should be run in a much more patient-friendly manner.  That facility left a lot to be desired. Never did the staff make me feel like I was a person with feelings, particularly my very own doctor.  After the end of the cycle, when they told me that I could not change doctors, I told them I would not be coming back. 

After that, it was by chance discussion with a colleague that introduced me to the RMA of New York.  My husband and I started our first IVF cycle the following March (2004).  Less than 9 months later, we had a healthy baby girl. The whole IVF process was a pleasure compared to the previous experience. Every staff member there was professional, efficient, courteous and friendly, giving me a warm and comfortable feeling every time I was there (which was quite often). What a contrast between this place and the last!

I must mention with sadness, however, that I had originally started off with twins but was in a car accident during my first trimester (May) where someone went through a red blinking light without stopping. Her car forced mine into the metal pole holding the blinking light up at that intersection, knocking it completely over. Thank God, I was not hurt. Since her car broadsided mine, had she been traveling any faster than she was–which could not have been very slow if she was able to push my car into the traffic light pole at the opposite side of the intersection, knocking it completely over–I could’ve been badly hurt. I shudder at the thought. Needless to say, I was extremely shaken. Within a few hours of the accident, I started spotting. Fearing for the worst, I went in to RMA the next day to get an ultrasound done to make sure my twins were okay. The doctor told me that, unfortunately, the heart in the smaller of the two fetuses had stopped beating and the dead fetus would be reabsorbed by my body with little if any bleeding. That was a truly sad day for me. I felt so devastated that I wanted to go after the girl that crashed into me and make her pay for the loss of one of my babies.  But my doctor explained that in many cases, the strongest of two fetuses, or twins, would survive, taking most of the nutrients coming through the placenta; there was no way to prove that the car accident caused the fetus to die.

Despite my feelings of loss and sadness that I would not be having twins like I thought I would, I was able to cope without spiraling into depression. How do I know for sure? I did experience a great deal of anxiety, stress and even distress over failing to get pregnant after nearly 2 years of trying on our own and then with our first IVF cycle, but I can say for sure I wasn’t depressed back then because I now know what it’s like to be depressed. I did feel sad and cry a lot, but that’s a natural reaction to feeling bad about not being able to have the one thing your heart so desires. There were no changes in my eating and sleeping patterns. I didn’t feel hopeless or unable to function.  I was able to go to work and handle other day-to-day activities.

During each IVF cycle, a woman is subjected to a number of infertility drugs to regulate her hormones to induce changes in her body to create the maximum number of viable eggs for fertilization. Her body is then subjected to the egg retrieval process where she is actually given anesthesia so she is not conscious during the process, followed by the egg transfer process where she receives at least one viable egg that has successfully been fertilized and multiplied. Next, her body is primed with progesterone in preparation to receive at least one egg for implantation into the uterine lining.  Ultimately, she carries the baby (hopefully) to term. 

Since hormone changes lead to mood changes in some women who are predisposed to react to these types of changes, infertility drugs used to regulate hormones like estrogen and progesterone may also cause mood changes. Even the pill has been linked to depression.  Women who have experienced mood changes from being on the pill may also experience mood changes from infertility drugs. Just think of it this way. Menstruation happens from estrogen levels dropping due to the lack of a fertilized egg implanting in the uterine lining. Women who are sensitive to drops in estrogen tend to experience mood disturbances such as irritability (like me)-i.e., premenstrual syndrome (PMS)-and in more serious cases anxiety, insomnia and depression (i.e., premenstrual dysphoric disorder or PMDD).  All this is further evidence that hormonal changes affect mood for some women, and absolutely not a mind over matter thing for them.   Had I been predisposed to depression due to hormonal changes, I more than likely would have developed symptoms from being subjected to the multitide of hormone-influencing substances (e.g., the pill, Pergonal, Follistim, Repronex, Gonal F, Lupron, progesterone) .  Note: Different combinations of these were used during my two IVF cycles. 

Unresolved Grief & Anxiety Built Up During IVF Cycles and Years of Trying to Have a Baby are Risk Factors for Depression During Pregnancy & Postpartum

Depression is more common among women with infertility issues, since more is at stake for those who have gone through many months and sometimes years of failed attempts at getting pregnant and failed attempts at IVF. Most women do not succeed in getting pregnant on the very first IVF cycle. I fall into this category,  but I feel blessed to have succeeded with my second cycle. Repeated failed attempts are bound to take a toll on the couple. Each time you complete a cycle only to have your period appear is such a disheartening experience that, if repeated numerous times, can leave you vulnerable to depression. With each additional cycle you endure and fail, you feel more and more hopeless and desperate. All the more reason why I am so grateful to this day that we succeeded on our second try.

Many women who successfully become pregnant through IVF cannot help but be anxious the entire duration of their pregnancy, fearful that something will jeopardize the pregnancy (e.g., miscarriage, stillbirth, pre-term birth, preeclampsia, or some other complication).  Optimism is not the typical outlook of a woman who has experienced infertility, miscarriage(s) and other complications. Realizing this is more than likely their only shot at having a baby, it is natural for them to feel anxious all through pregnancy (in terms of spotting and other complications) and through the first year of the baby’s life (with every health concern from SIDS to fevers, weight, colic, etc.).  

This is why I would encourage you, if you’re undergoing IVF, to avoid trying to cope with all your anxiety, stress and distress yourself, and instead see a therapist–one who is experienced in working with women undergoing infertility treatments–if you find that you’re spending most of your time feeling down and crying, you’re unable to function at work and at home, and your relationship with your husband is suffering.  Talking to a non-judgmental and understanding professional experienced in dealing with infertility issues can help with working out issues that–over time compounds and if unresolved–can reach a point where the body and psyche become vulnerable to depression. In between IVF cycles–whether there is a miscarriage or not–it would be in your best interests to give some time in-between cycles to give your body the rest it needs both physically and emotionally. Try to resist the urge to subject yourself to one cycle after another–of course to the extent allowed by your financial situation and health insurance–despite your “biological clock” that is ticking, reminding you that time is of the essence. If you do successfully become pregnant, you will be bringing with you on your pregnancy journey any unresolved grief and heightened anxiety. It won’t take much for the huge changes in hormone levels to push your already-vulnerable situation into depression.

Your IVF facility can more than likely refer you to a mental health professional(s) specializing in infertility. Otherwise, you can contact RESOLVE, an organization that provides a listing of mental health professionals who specialize in infertility. Just as I found it hard to share my PPD experience with others because they didn’t understand how badly I felt, not having experienced PPD before, I found it hard to share my infertility and IVF experience with others because they hadn’t experienced infertility and IVF before. I felt the need to stay away from others who were pregnant or had young children because seeing them only served as a painful reminder of what I so desperately wanted but couldn’t have. But staying away from other people caused me to feel further removed from everything and everyone. I felt like someone who didn’t belong to the mother crowd because I couldn’t be one myself.  I felt I was being deprived of being able to have a family like I’ve always dreamed of having. I had nothing to show for having gone through countless painful (and pain-in-the-neck) menstrual periods. I endured all of that for nothing. In retrospect, it probably would have been beneficial for me to give the mental health professional that my husband and I went to after our first failed IVF cycle more than just one shot at helping me get beyond my grief. But my personality–stubbornness, pride or what have you–didn’t want to have to deal with it. I was able to move on and within a few months I started my second cycle with a different IVF facility, and I managed to do just fine there.  They say that sometimes the best thing to do is start with a clean slate.  Especially if your gut tells you to do so.

All that it took for us to get pregnant and have a baby has made my husband and me all the more aware that the daughter to whom we gave birth is a miracle baby whom we will always treasure and never take for granted.