What is grief?  

Grief is a normal response to loss, though feelings of grief generally fade over time, and this expected reaction to loss is not considered a psychological disorder. Although not common, sometimes the reaction to loss is more intense and long-lasting than expected and may result in the development of a psychological disorder such as complicated grief or prolonged grief disorder.^iv,v,vi

Feelings of sadness are often a part of grief. People worry that their feelings of grief may be symptoms of depression in part because sadness is also a part of depression. However, grief typically involves waves of emotions that come and go and lessen over time, with many individuals who experience grief reporting hope for their future. Conversely, clinical depression may be longer-lasting and more emotionally and physically intense, with constant low moods and less hopefulness.^vii Seeking professional help from a medical or mental health professional can provide clarity in distinguishing between the two and guide individuals towards appropriate treatment options based on their symptoms and needs.

Why grieve infertility?  

Studies indicate that individuals experiencing infertility often report feelings of grief, anxiety, depression, despair, and/or guilt.^viii Infertility often comes with significant stigma and taboo across many cultures, leading to feelings of isolation and shame among those affected. This societal silence can worsen emotional distress and decrease self-esteem, as people may perceive their inability to conceive as a personal failure.^ix,x

Moreover, infertility can deeply impact one's identity and self-worth, with individuals feeling inadequate or broken, especially when they struggle with the natural expectation to conceive, which intensifies psychological distress.^xi

The emotional toll of infertility is further compounded by the stress of repeated attempts to conceive, characterized by cycles of hope followed by disappointment. This repetitive process, often involving invasive and costly treatments, can lead to stress, anxiety, and depression.^xii,xiii

Fertility and reproductive health can be profoundly shaped by socio-cultural factors that influence both personal feelings and societal views of fertility issues. Research across different regions underscores this impact.^xiv For instance, studies highlight how cultural beliefs and societal pressures stigmatize infertility, such as examples in Sub-Saharan Africa,^xv China,^xvi and India.^xvii Societal norms and gender roles can also impact fertility decisions and healthcare access.^{xviii,xix,xx,xxi}

Infertility significantly affects both partners in a relationship, but each may experience grief differently due to their roles and societal expectations. While the partner undergoing the bulk of fertility treatment (often the female) receives more attention, the supporting partner might feel overlooked, battling secondary grief and isolation. Research indicates that women are more likely to seek support, whereas men might suffer in silence due to traditional roles. Literature highlights the importance of validating both partners' feelings and suggests inclusive support strategies such as joint counseling, increased awareness, and support groups for couples.^xxii  These interventions help both partners feel recognized and supported, enhancing resilience and relationship strength during infertility challenges.

For women and men who began infertility treatment with pre-existing symptoms of anxiety and/or depression, the additional experience of loss associated with infertility may result in a worsening of their emotional symptoms. Although research has not been conducted which directly answers the question about how fertility patients are coping specifically with their infertility experiences after fertility treatment ends, it is reassuring that research studies typically find that most people who undergo IVF do not have intense psychological symptoms consistent with a psychiatric disorder after IVF ends, regardless of whether or not they had a baby.^xxiii

Infertility grief stages

Dr. Elizabeth Kubler-Ross introduced the idea of the five stages of grief that people may experience when faced with loss. These stages of grief include denial, anger, bargaining, depression, and acceptance. The theory notes that people experiencing grief do not necessarily go through these steps in a particular order, i.e., they may not experience each stage, and/or they may experience each stage more than once during the grieving process. There has also been significant criticism of the five stages of grief model. Since the publication of Dr. Kubler-Ross' theory in the late 1960’s, grief responses are now understood to be diverse and may not fit that initial model.^xxiv It cannot be assumed that everyone’s grief experience should look like the five stages of grief rubric, and individuals do not need to feel concerned if their grief does not follow a particular path.^xxv

The idea of "stages of grief" can be applied to people experiencing infertility. For example, it is believed that some women with infertility diagnoses may experience denial, anger, bargaining, depression, and/or acceptance during each cycle in which they are trying to conceive. However, it is important to note that women’s experiences of grief associated with infertility are diverse and, as described above, may not fit with the stages of grief described by Dr. Kubler-Ross.^xxvi It is important to keep in mind that grief emotions are valid even when they fall outside the described stages.^xxvii

Healing infertility grief: tips for coping  

There are various ways that individuals cope with their infertility grief; below are some suggestions for coping and working towards healing.

1. Try not to avoid your emotions. Avoiding your thoughts and feelings about infertility may make it harder to cope. Consider talking about how you are feeling with family or friends who have been supportive about fertility issues and who will not minimize your emotional pain by saying things like “it will be ok”, “you can just try again”, “you should just relax”, or anything else that could be hurtful. You may also want to consider joining a support group,^xxviii,xxix journaling about your feelings, and/or connecting with a reproductive mental health professional^xxx to begin counseling related to your fertility challenges. Reproductive mental health counseling typically involves psychotherapy sessions that aim to provide emotional support, coping strategies, and guidance for individuals or couples struggling with infertility issues.

2. Avoid unhelpful coping strategies like using drugs/alcohol, social isolation, too much social media use, negatively comparing yourself to others, overworking yourself, self-blame, and/or forgetting to acknowledge the good things you have in your life.

3. Be kind to yourself and do not judge yourself for your emotional reactions to infertility. Consider what you would say to support a friend who was grieving infertility and say those same words to yourself.

4. Practice good self-care. Take time to do things that make you happy or calm. Make sure you are eating and sleeping as well as possible and find time to engage in healthy physical activity.  

5. Honor your limits. You do not have to go to a baby shower or party if you feel it will be too emotionally distressing to attend. At the same time, consider gently challenging yourself to engage in activities (even if for a short time) that you think could potentially help improve your mood. Social connection is often a helpful part of coping with grief so avoid socially isolating yourself.  

What if grief is not an issue?  

Although many people who have been diagnosed with infertility experience symptoms of grief, some people do not. This may be particularly true for people who are equally open to a life with or without children. Sometimes people may not initially experience feelings of grief related to infertility only to later feel it as older adults (for example when seeing their friends who have grandchildren). Overall, there is no right or wrong way to emotionally react to a diagnosis of infertility or fertility treatment. Therapists often suggest being comfortable with one’s feelings and not comparing them to others and their experiences.  

Conclusion

Grief is a common and natural reaction to loss or the threat of loss. With infertility, it is natural to feel emotional reactions to losing the chance to have children. Grief can feel like sadness, anger, anxiety, or shock. Although these feelings can greatly impact a person's life, they usually will fade over time. Infertility comes with shame and stigma in many cultures, and these socio-cultural factors impact the way we feel as well as process grief associated with infertility. Not everyone will follow the standard five stages of grief, and there is no right or wrong way to experience this kind of loss.