WOMEN’S SILENT STRUGGLES -Reproductive grief, the hidden weight of trying, losing, and hoping again
By Sònia Gayete Lafuente, MD, PhD, who currently is a Foundation for Reproductive Medicine Research Fellow at the Center for Human Reproduction (CHR) in NYC. She can be reached through the editorial office of The Reproductive Times.
BRIEFING: All over traditional as well as social media, emotional and mental health-related aspects of reproductive health and fertility, as well as their counterparts, infertility, pregnancy loss, and other reproduction-linked issues, have lately become important topics of discussion. Always shaped by personal and family, as well as cultural backgrounds, and often increasingly political, conversations about these subjects have never felt more urgent. If one is only willing to look, one often finds experiences of hope and heartbreak, resilience and vulnerability, as well as shame and silence, only too often hidden behind splashing headlines and hashtags with the purpose of excluding even close friends and family and leaving the individual to process things quietly and alone. Unsurprisingly, so-affected women are often not only physically but also emotionally severely damaged in identity, relationships, and overall emotional well-being. This brief article is only the first in a planned series of articles in the VOICE by this author, inviting readers, including, of course, infertility patients, but also healthcare providers and, hopefully, policymakers, to engage more deeply with the emotional aspects of reproductive health. Today’s article attempts to point out some of the suffering patients experience along their fertility journey, divided into three stages where support is most needed: the pressure to conceive, the struggle with infertility, and the grief of pregnancy loss.
THE FERTILITY CLOCK AND OTHER CAUSES
Societal pressure to conceive and its impact on mental health
The expectation to conceive is still deeply rooted in society. Even from people who know little or almost nothing about the person they are talking to, their question may not even be whether a woman wants children at all, but when or even why she is not already having them now. The psychological toll from such social pressure can, of course, be significant and usually increases in intensity with age.
Ethnic and religious backgrounds often further complicate things, and queer individuals may face an especially difficult time. Now imagine that an infertile woman faces these questions who, quietly, may have tried for a long time to conceive. How must she feel?
And then there is, of course, also the "fertility clock," called the biological clock. What is meant by this term is the unfortunately indisputable fact that female fertility declines with advancing age, with this decline speeding up after age ca. 38 years. As women get older and remain childless, societal pressures, therefore, further increase and become especially painful for infertile patients who often do not wish to share knowledge of their infertility, even with their closest friends and family. For so-affected women, fertility then sometimes becomes a symbol of personal worth, making the woman feel inadequate even vis-à-vis close friends and family. And yet, only rarely are these struggles publicly or, even in the infertility literature, addressed.
To truly support reproductive well-being, we must normalize conversations around family-building wishes and timelines and recognize that choosing when, how, or whether to parent is deeply personal and worthy of respect. We also must recognize that having children, a concept for millennia baked into routine societal behavior, in several Western as well as Asian societies can no longer be counted on. There are several reasons for this development: Women in many societies are no longer as eager to get married, and maybe even more importantly, having children in many developed countries has become extremely expensive. Consequently, many developed countries, the U.S. included, face declining birth rates, not even being able to meet replacement levels for their dying citizens.
INFERTILITY
The emotional rollercoaster of infertility and navigating vulnerability and uncertainty
Infertility is not only a medical diagnosis but often an emotional crisis. Month after month, test after test, hope builds, and then, more often than not, collapses.
Infertility practice is, indeed, likely the only medical specialty outside of experimental medical practice in which treatment failure rates by far exceed success rates. In other words, every treatment cycle, not different from natural conception, even at peak fertility at young ages, will, with greater likelihood, not lead to pregnancy but result in embryo implantation, ongoing pregnancy, and, ultimately, a healthy birth. Suppose one considers the healthy live birth of a baby the ultimate success of any fertility treatment. In that case, the failure rate, indeed, further increases, considering that roughly half of all embryo implantations are lost during pregnancy before the viability of a fetus is reached.
Returning to patients with infertility, many find themselves feeling vulnerable in ways they never anticipated, and these feelings can have consequences. For example, not infrequently, intimacy with partners can become challenging, as anticipated time planning of the couple gets delayed and delayed again. Moreover, once again, cultural and religious backgrounds may make things even more complicated than they already are. For example, different religions disallow several infertility treatments and/or require patients and their fertility services providers to jump through, at times, complicating hoops to even be able to apply for fertility treatments.
And then there are, of course, again cultural backgrounds with more or less societal emphasis on parenthood. Pregnancy-delaying and/or preventing issues will, in societies where pregnancy, especially for women, is these days framed as a central life achievement, often take on life-threatening connotations. But simply feeling too embarrassed to share their struggle with friends and family — fearing judgment and/or pity — and, therefore, emotionally isolating, will already intensify their suffering.
Healthcare providers must be aware of the importance of the cultural backgrounds of their patients and must be sensitive to the emotional weight patients often carry with them when they finally take the step of reaching out to a fertility clinic for help. It is then the provider's responsibility - whether nurse, embryologist, or physician - to ensure patients feel not just monitored but truly seen, heard, and taken care of. Nothing is more disempowering than feeling rushed or even just treated like a commercial transaction by those meant to help. Emotional support must be an integral part of fertility services at all fertility clinics and should never become another layer of stress for patients.
PREGNANCY LOSS
From hope to heartbreak: Grieving for a baby - never met!
Few experiences compare to the grief of losing a pregnancy. A phrase often heard from patients is, "one moment, - the promise of life; and the next, it is gone." Whether it is a miscarriage, stillbirth, or even a medically or socially necessary abortion, the loss is real, and the undeserved self-blame can be profound. Yes- even for those who, for whatever personal reasons, had to decide to terminate a pregnancy, losing a pregnancy is never easy and always painful.
And almost every loss comes with maternal guilt. What did I do wrong? What could I have done to prevent it from happening? Women start wondering about their diet, was what they had lifted too heavy, or whether it was their intercourse. In fear of a potential repeat, what they could have done differently becomes, at times, an all-consuming question. And, although rarely logical, it is a powerful emotion, as it is human nature to try to find answers, make sense of things, and, hopefully, find a way to avoid a repeat.
In the currently popular culture of glorifying one's autonomy over our body, it becomes almost impossible to accept that some outcomes are just beyond our control. This kind of thinking also characterizes the early pregnancies for those lucky enough to get to this point. The first question on the ultrasound table, then, is unsurprisingly often: "Is there still a heartbeat?" And once confirmed, - exhaling, “thank God… I couldn't sleep all week thinking about it."
Grief for lost pregnancies can even continue beyond later successful births when some parents continue to celebrate hypothetical birthdays, milestones never reached, and love never fully given. These silent anniversaries can echo for years.
EMOTIONAL SUPPORT
Addressing the emotional needs of infertility patients comprehensively
Emotional care for infertility patients is often somehow left behind, even in fertility clinics that provide excellent clinical care. One hears only too often from patients of having had the feeling of "being in the production line of a factory, never having seen the same physician, or, especially in more recent times, only having been able to see the nurse practitioner or physician assistant rather than their own doctor" (not that RNPs and PAs cannot provide excellent care).
Good patient support requires validation. People healing from failed fertility treatments or pregnancy loss need safe spaces to cry, share, express anger, and even rage, or simply be able to acknowledge to themselves that "this happened to me." This acknowledgment alone can be powerful because it can break the patient's isolation and build resilience. Understanding this, in some cases, may then lead to the realization that therapy can help, but so can patient groups, online communities, or any caring person who listens without assuming, without judging, and without trying to fix. At the Center for Human Reproduction, I have learned that, after initial consultations with patients, the most important consultations are those after failed treatment cycles.
Mental health professionals must be increasingly integrated into routine infertility care. As infertility providers, we must support systemic changes with more accessible mental health services and policies that respect the complexities of reproductive journeys, hopefully creating a culture where healing is not a private burden but a collective responsibility.
While grief may never fully disappear, healing is possible. The key lies in integrating the pain and honoring what was lost, while still choosing to move forward. Ultimately, almost everybody finds new ways to love, hope, and move forward - sometimes as parents, sometimes not.
If you are reading this right now and find yourself somewhere on the here-described spectrum, ranging from uncertainty about your fertility to the deep pain of loss, we hope that you now understand that your experience matters and, most importantly, that you are not alone!
READING LIST
Bindeman J, Abbasi R, Sacks PC. The Mental Health Traumas of Infertility: Impact and Consequences. Obstet Gynecol Clin North Am. 2025 Mar;52(1):133-143.
Cuenca D. Pregnancy loss: Consequences for mental health. Front Glob Womens Health. 2023 Jan 23;3:1032212.
Ruderman RS, Yilmaz BD, McQueen DB. Treating the couple: how recurrent pregnancy loss impacts the mental health of both partners. Fertil Steril. 2020 Dec;114(6):1182.
Massmann K, Jagannatham S, Stone J, Platt LD. The Impact of Stillbirth on Maternal Wellbeing. Obstet Gynecol Clin North Am. 2025 Mar;52(1):145-156.
Bar V, Hermesh T, Reshef P, Hermetz S, Hertz-Palmor N, Gothelf D, Mosheva M. Healing hearts: mind-body therapy for mothers after stillbirth's silent grief. Front Psychiatry. 2025 Feb 28;16:1534616.