Michelle and her husband had been struggling to conceive a baby since their wedding three years ago. The longing for a child; the grief of pregnancy loss; the fertility treatments and tests; the pressure from family; the belief she was doing something wrong and more had taken a heavy toll on her mental health. Whilst her husband was supportive and stoic, he too felt hopeless and heartbroken, and their all-consuming desire to become parents had strained their marriage.
Michelle is not alone in her experience of infertility. Infertility is a complex trauma shared by many that can have long-lasting psychological effects, even after a successful pregnancy, according to research[i]. Women with infertility and a history of pregnancy or baby loss are more likely to feel less satisfaction, reduced self-esteem, and more depressive symptoms than women who have not experienced fertility challenges.
Infertility can cause trauma, and trauma can cause infertility too.
The loss of a loved one, the end of a relationship, a job loss, adverse childhood experiences (ACE) and other traumatic life events can significantly impact a woman’s reproductive system. Stress can shut down the activity of the hypothalamic-pituitary-gonadal axis, which governs the reproductive system. This can disrupt the connection between the brain and ovaries and cause menstrual cycle irregularities and hormonal imbalances.
The effects of trauma on fertility are proven by research. In a study of 774 women of reproductive age, 195 of whom were pregnant, researchers found that women who had experienced negative events at a young age, like abuse, neglect, or family dysfunction were more likely to have experienced abnormal absences of menstruation and fertility challenges[ii].
Michelle had visited various medical and fertility practitioners, as well as new age practitioners too. Some were helpful but could not identify the root cause of infertility; others exacerbated her feelings of shame and inadequacy. Taking an integrated approach to healing, it was an IMI naturopath who first identified the missing clue in Michelle’s infertility case. Michelle was carrying deeper trauma. With Michelle’s agreement, the naturopath referred her for psychotherapy.
Through psychotherapy, Michelle’s story came to light. When Michelle was in her twenties, her mother had passed away just weeks after being diagnosed with cancer. Feeling responsible for her father and younger siblings’ wellbeing, Michelle suppressed her grief and pain. Instead, she threw herself into the role of mum and caregiver, determined to give her family the continuation of traditions and celebrations to lessen the pain of their loss. When things didn’t go to plan, she would blame herself, believing she had failed her mother and family.
Michelle was experiencing Post Traumatic Stress Disorder (PTSD) – from both traumatic life events and infertility. Both traumas were feeding into each other, significantly reducing Michelle’s likelihood of conceiving.
In therapy, Michelle was able to process the complicated grief and emotions around the loss of her mum and her infertility challenges. We spent time unpacking some of the new-age beliefs from well-meaning friends and healers: “manifest and it will happen”; “think happy and positive thoughts”; and more, which inevitably lead to self-blame, denial, repression, and internal fragmentation. Instead, we welcomed and listened to all of Michelle’s emotions.
Gradually, we were able to revisit the painful memories and traumatic events that had overwhelmed Michelle’s system at the time, allowing her to access acceptance of her losses, integrate her experiences and find self-compassion for her struggles. Her symptoms of PTSD – nightmares, insomnia, and social withdrawal – began to ease. Fourteen months later her menstrual cycle came back and after another year she naturally conceived and gave birth to a healthy baby girl. With courage, hard work and commitment on a three-year journey of therapy with naturopathic support, Michelle healed from both traumas and fulfilled her dream of having a baby.
Therapy for infertility
Through trauma-informed psychotherapy, we have supported women experiencing infertility-induced trauma, trauma-induced infertility, or both, who have made the courageous decision to meet complex trauma in a safe space and gone on to conceive and/or come to a place of acceptance and healing.
it is only in a safe, non-judgmental, and compassionate space that you can bring your complex feelings and have them normalised.
It is normal for women experiencing infertility to feel loss, grief, disappointment, a sense of failure, hopelessness, anger, shame, and blame. It is normal to feel betrayed by their own body and a sense of powerlessness over their body, life and hopes. It is normal for intense feelings to come up during monthly cycles of loss, the date a baby was due, or times of year associated with loss. And it is normal to experience mixed feelings about occasions related to motherhood, like a friend’s baby shower, which can bring up all sorts of difficult emotions – from pain and jealousy if they do attend to guilt and increased social isolation if they don’t. Infertility is an emotional and, often lonely, rollercoaster ride – one that can lead to extreme exhaustion and burnout.
Navigating and normalizing these and many more complex feelings is not easy or always doable with a partner, family member or close friend. And therapies and treatments that do not validate the multiple losses, ongoing trauma, and strong emotions experienced can do more harm than good.
Psychotherapy, however, welcomes and invites you to bring all parts of yourself, with a ground of emotional safety, to express, meet and explore difficult emotions. This is an essential part of the healing process and can foster much-needed self-compassion.
Healing through trust.
When we experience trauma, it stimulates defensive strategies – fight/flight, freeze, and withdrawal – and disrupts our capacity to feel safe.
At the time of trauma, this may have been necessary for survival, but later, when it becomes chronic, it compromises our basic needs for connection. In this way, we can become stuck in a well-honed defensive strategy that – even in the safe space of therapy – can be hard to switch off and foster feelings of trust and relational connection.
Skilfully done, therapy can support your healing at a neurological level – it can rewire your neural pathways. To do this, therapy needs to be offered at a regulated pace that ensures you are not flooded or overwhelmed, and your stress is not reactivated. When a session is difficult, we contain what arises in a safe space, so you are not left to cope on your own. Through trusting relational therapy, we revisit the trauma of the past from the safety of the present, so your adaptive defensive mechanisms can down-regulate and you can recover your capacity for trust and connection with others.
The psychotherapy process
Before we begin to work on deeper healing, it’s important to understand the tapestry of your life. In the initial sessions, we work together to paint a picture of who you are, what causes you stress, what brings you joy, who or what you lean on for support, the relationships that weigh you down, your coping strategies, and more.
We then start to overcome the hurdles impacting your emotional and mental wellbeing and preventing you from feeling your emotions. We gently loosen up and challenge beliefs and pressures, both internal and external, that are causing greater suffering and disconnect.
This then creates a pathway to gradually delve deeper into original trauma in the safety of the therapeutic relationship, allowing you to open up what has been shut down, and meet and address the trauma in a way that is empowering.
Every person and their situation are unique. There is no script or set process, but we do draw on several techniques to support you. Emotionally focused therapy prioritises emotion and emotional regulation, recognising we are innately relational and wired to connect. Psychodynamic psychotherapy aims to bring the unconscious mind into the conscious, which can help you to understand deeper rooted feelings and recognise different parts of yourself. Mindfulness-based and body-based approaches can help you cope with the infertility anxiety, allowing you to slow down, ground, and bring more awareness to your inner experience. Cognitive Behavioural Therapy (CBT) will not heal infertility trauma but allocating ‘worry time’ – a CBT approach – can help with anxiety rumination. It can teach you to contain your worry to designated periods, so you better regulate the frequency and timing of anxious thoughts.
As a core process psychotherapist, it is humbling to accompany women struggling with infertility, perinatal loss or complicated pregnancy and support them through this complex part of their journey. There is immense courage in being willing to heal from traumatic experiences and try the therapeutic interventions offered, which I deeply honour and respect.
If you or someone you know would like more information or to work with me, you can book a free, initial 30-minute chat. In this conversation I can better understand your needs and share my approach to decide if it’s right to work together. I can also signpost you to other resources and services – much needed given the loneliness and isolation that can surround those struggling with infertility.
About the Author
Carole Bradshaw is a Core Process Psychotherapist that supports people in Hong Kong and across the globe on their contemplative enquiry and healing journey. She specialises in helping people with anxiety, stress, depression, shock, grief, overwhelm and more. As a reflector of awareness, she brings to the relationship a safe space for clients to speak and be heard, share, and be received. In this highly relational, humanistic, and depth-based psychotherapy, deep shifts and genuine healing from old and recent trauma are possible.
[i] Schwerdtfeger, Kami L, and Karina M Shreffler. “Trauma of Pregnancy Loss and Infertility for Mothers and Involuntarily Childless Women in the Contemporary United States.” Journal of loss & trauma vol. 14,3 (2009): 211-227. doi:10.1080/15325020802537468
[ii] Marni B. Jacobs, Renee D. Boynton-Jarrett, Emily W. Harville. “Adverse childhood event experiences, fertility difficulties and menstrual cycle characteristics.” Journal of Psychosomatic Obstetrics & Gynecology, 2015; 36 (2): 46 doi: 10.3109/0167482X.2015.1026892