- Common emotional challenges people face during fertility treatment
- How fertility treatment affects relationships with partners and oneself
- Coping strategies for managing stress and anxiety
- Prioritizing mental health while staying focused on treatment goals
- When to seek support from a mental health professional
Full Transcript:
Dr. Aimee: I’m so excited to have my dear friend Rachel Goldberg on with us today. Welcome, Rachel.
Rachel Goldberg: Thank you so much for having me.
Dr. Aimee: You’re so welcome. I’m so excited to have you on because you come to my IVF classes, introduce yourself, talk about how important resiliency is during the fertility journey, and I’m so glad that you’re going to talk to everyone about the tips that you share with us in those classes. The title of today’s show is Building Resilience Through Fertility Challenges. Rachel is going to give us some great tips on mental health and relationships. I want to just share a little bit more about Rachel right now…
She’s a licensed therapist specializing in infertility, reproductive health, and eating disorders. With a compassionate and personalized approach, she helps individuals and couples navigate the emotional complexities of fertility treatments, pregnancy loss, and family planning. Her practice includes infertility counseling, third-party reproduction evaluations, and support for pregnancy and postpartum challenges. Rachel is extremely passionate about guiding clients through the mental health aspects of these journeys, offering insight and care as they make life-changing decisions such as egg donation or surrogacy.
You’ve helped so many of my patients, Rachel. Thank you so much.
Fertility treatment can be an emotional rollercoaster, impacting your mental health, relationships, and sense of self. We’re going to talk about practical tips for building resilience, coping with grief, and maintaining connection with your partner, helping you navigate the journey with strength and compassion. Again, I’m so excited to have you on. Let’s just dive right in. What are some common emotional challenges that people face during fertility treatment?
Rachel Goldberg: Infertility is a rollercoaster of emotions, as you said. It’s painful. It’s isolating and relentless. Some of the emotions that you feel…grief is involved, for sure. There’s the grief for the pregnancy they don’t have, the dream they’ve been clinging to that feels further away with no end in sight, the loss of time, finances, hours spent at the doctor’s office, on the phone with the insurance company, loss of relationship satisfaction, and loss of their baby if there is a miscarriage. All of this gets so jumbled, and it can manifest in so many different ways, it’s really insufferable.
There’s the emotion of anger. Angry that their body is not doing what it’s supposed to do. Angry at the process for being so invasive and unpredictable. At times, even at people around them who seem to have what they want so easily. They can feel shame, a deep sense of failure, like they’re broken or they don’t deserve to be parents. It’s irrational, but it’s a real feeling that they come away with.
Then, of course, there’s the big one, anxiety about every step of the process, every delay, every unanswered question. It’s a constant hum in the background asking, “Will this work? How long will it take? Will I ever have a baby? Will I ever feel good or find joy again?” People can also feel envy, and that envy then comes with guilt. It’s so hard to see others celebrating pregnancies or parenting milestones when you’re stuck in the cycle of waiting, testing, and feeling heartbreak over and over again.
Then there is the crushing sense of hopelessness that can step in. It can feel like every part of your life is on hold, like every ounce of energy, time, and money is going into this and it’s not guaranteed, and so far, you don’t have anything to even show for it. Then finally, I would say there’s isolation. It’s a lonely journey because most people don’t talk about it openly in their day-to-day life. Even well-meaning friends and family don’t always know what to say or how to support you, or worse, they say the wrong things.
Dr. Aimee: They certainly do. You just basically described the emotions of every single one of my patients as they walk through the door, and you put words to exactly how they’re feeling. Maybe they didn’t have words to describe how they were feeling, but this is certainly everything that they feel.
How can fertility treatments affect relationships, both with partners and with oneself?
Rachel Goldberg: With partners, fertility issues often will highlight the differences in how each other copes. One partner might want to talk about it constantly, while the other processes it more quietly. There’s an imbalance, and that can lead to one-sided conversations or even them avoiding talking about it altogether. Then there’s also timed intercourse or long periods of avoiding intimacy. It takes the romance and physicality out of the relationship. Any connection that they had before sometimes now feels forced or is just nonexistent.
There’s also the potential for resentment to creep in. Not necessarily over the inability to conceive, although that does happen, but also over things like one partner feeling that the other isn’t doing enough, such as changing their lifestyle habits or taking their supplements on time. There can be resentment over decisions that were made in the past. Maybe one partner was not ready to have children when you were, and now it’s much harder.
I want to emphasize that for couples who can communicate openly and work as a team, fertility treatment can bring them closer. It’s like you meet a really difficult journey, and they are the only two who truly understand what they’re going through, so it can strengthen their bond. However, the caveat to that is that it does require work. Sometimes going through this process, people don’t have the wherewithal to put in that work because they are tired and they’re in a dark place.
In terms of identity for oneself, fertility struggles often change the way people see themselves. It’s just one part of their life. As treatments continue, appointments, medications, and procedures, it can feel like your entire identity revolves around it. In some ways, you’re right, it does. They will start to feel disconnected from who they were before. They start to notice every pregnant woman in public, spend hours reading forums or on Facebook Groups, they start to pull away from friends who don’t understand what they’re going through. They become so focused on the outcome that everything else feels meaningless, which honestly, it has merit.
Here’s an example. I had a client, imagine she’s in a work meeting where the focus is on should they use blue or purple for a campaign ad. When you’re going through surgeries and heartache over wanting an actual live human being to be in your arms, thinking about the color of an ad just seems so menial. You want to scream at everyone who is talking about silly things.
For a period of time, there’s just this feeling of sadness and frustration mixed with depression and anxiety, and just all this long time of waiting. If you look back, people will often say they barely recognized themselves, it was as if they were a shell of a person.
Dr. Aimee: Now that we’ve talked about the darkness, let’s look to the light. I would love for you to share with us coping strategies. What do you recommend for dealing with all of this stress and anxiety of fertility treatment and the emotional impact it can have on you? You don’t have to feel this way. You don’t have to suffer like this. You don’t have to suffer in silence, you can work someone like Rachel. Teach us some of these coping strategies that you teach your clients.
Rachel Goldberg: I’m definitely going to get to that, but I want to start by being realistic about coping. Many people going through fertility treatment are desperate to feel normal again or to find joy in their lives like they once did. I will have clients who come in tears, begging for the pain to go away. My heart breaks for them because I wish I could take the pain from them. I know you relate to this.
The truth is, as long as they’re deeply immersed in the process of trying to conceive, the pain doesn’t just disappear. The goal of coping isn’t to erase the pain. It’s about finding small moments of relief, periods of distraction, glimmers of gratitude for other parts of their life, and connection with people who care about them.
Here’s the thing with coping. It looks different for everyone. It requires effort, which can feel so unfair because you’re already putting everything you have into this journey. I often will have people come in saying they want coping, but when we talk through strategies, they dismiss them or say they’ve already tried. I never blame them. Coping is hard, and sometimes staying in despair can feel easier or safer. It might even be a way for them to punish themselves for what they see as a failure of theirs.
For those ready and wanting to put in that effort who are like, “I need to find relief,” there are things you can do. One that everyone always talks about is finding some kind of stress relief. This is going to be different for everyone, so you have to experiment with them. It could be meditation, yoga, or journaling, or even something as simple as playing with your dog. I’m also a very big proponent of fitness and believe maintaining a fitness routine is an amazing way to reduce stress. It could be a word search or crossword puzzle, something where their mind is engaged.
Another strategy is to connect with others. You can do this by joining a support group. It’s comforting to be surrounded by people who truly understand what you’re going through. If they’re online groups, like Facebook, and you’re going through them, just try to be mindful that they can also be extremely triggering and they can keep you focused on your infertility instead of allowing you space for relief, so just check-in on that if you’re going to be on those and make sure that they are truly adding relief and not increasing stress.
Also, I would say keep as much of your routine as possible. When you’re going through fertility treatment, it’s easy to let everything else in your life fall by the wayside. Maybe find an outside activity, sign up for an art class or a cooking class, or volunteer. You might, and probably will, dread going when the time comes, especially if you’ve had a rough day, but you’re almost guaranteed to feel better afterward, like a weight has been lifted, even if it’s just for a little while. What I like to tell people is that coping in a stressful time is kind of like exercise. Think about all of the times you don’t feel like doing it, but once you’re done, you feel better.
During downtimes of your fertility treatments, give yourself permission to enjoy things you’ve been avoiding. Have that deli sandwich, drink a glass of wine, move your body in a way that you weren’t allowing yourself out of fear.
Dr. Aimee: Drink the coffee. I promise you that coffee will not hurt your chances. Don’t deprive yourself of the things that bring you joy. Find joy in every single day, every moment, and really prioritize your mental health.
I have couples that come in, and the husband will sit in front of me, “I tell her to relax and it’s going to be fine,” and I’m like dude, that’s not how it works. The only way it’s going to be fine is if she gets pregnant and has a healthy baby. I know that hole will stay in her heart and it will not be filled until I help her reach that goal. Until then, we just need to hug her heart. My newest thing is I tell guys to kiss their wives’ ovaries, and they look at me like I’ve lost my mind. I learned this from an acupuncturist, and he tells his patients to do that, kiss your own ovaries, where you kiss your fingers and then you put the finger on your ovaries. So, I tell the husbands to kiss their wives’ ovaries and uterus. It’s a great technique.
Rachel Goldberg: I would add, though, if you’re going to be doing that, don’t also expect something.
Dr. Aimee: That’s right. Don’t get too frisky after that.
What about the grief or disappointment after someone has gone through a failed cycle or a miscarriage, what are some coping mechanisms for people that they can rely on?
Rachel Goldberg: This is a tough one. Grieving a failed cycle or a miscarriage is deeply personal, and there is no right way to cope. What’s important is giving yourself room to feel whatever comes up. Try to acknowledge the loss without rushing to move on. Most people’s first thought is, “I need to try again now.” Maybe they start researching new methods or doctors or the next steps.
Allowing themselves to slow down and lean into whatever helps them get through the moment can help them move forward in a more calm way. Just sleeping more, spending a day or many days in pajamas binge-watching TV without guilt, asking others to step in and handle things for them like cooking or errands, maybe having their previous life escapes like wine, tequila shots, or sushi. It’s okay to retreat for a while. People will worry that if they let themselves think into it, they’ll never come out, but that’s rarely the case.
Most people find that after giving themselves time, they naturally start to want to re-engage in life again. A really important and helpful step that I will tell people if they’ve suffered a miscarriage is to find ways to honor the loss. Maybe creating something tangible, such as wearing a necklace or a piece of jewelry that symbolizes what you’ve been through, planting a tree or a flower garden, maybe writing a letter or journaling about the experience. These small acts can provide a sense of connection to the love and the hope that you had for the pregnancy.
Really important is asking for help. When everything feels overwhelming and the world around you is still moving as if nothing happened, ask for help. Whether it’s asking for someone to bring you a meal or cleaning your house, talking to a trusted friend, getting someone to babysit your child if this is secondary infertility, whatever is, ask.
Also, allow yourself to have moments of joy without guilt. That’s the last tip. Finding moments of happiness doesn’t mean you’re forgetting or minimizing your loss. It means you’re human and you’re alive. If something brings you a moment of laughter, that’s fantastic. These moments won’t erase your pain, but they remind you that you can have multiple feelings at the same time.
Dr. Aimee: Such great advice. What about for communicating with a partner during fertility treatment, if there are misunderstandings or conflict, or how to avoid those kinds of things, do you have any advice for people who are partnered?
Rachel Goldberg: One thing I tell all couples is to schedule regular check-ins and also free time. Couples should set aside 20 minutes, have it really structured, 20 minutes a few days a week or everyday if needed, with no distractions, check in with each other emotionally. The goal is for each person to know that there is going to be space to discuss it and it doesn’t have to take over every conversation. Because it’s a set time that each person is prepared for, they can reflect and have a more meaningful conversation than just talking about it in front of the TV or in the background, or if one person is thinking about work and not prepared for broaching that topic.
What’s also important is scheduling time without any talk of fertility. It can be as simple as watching a movie together, going to dinner, or playing a card game. The thoughts may still be present in the background, but not bringing them to the forefront, hopefully, reminds you of why you’re in this together and allows you to reconnect as a couple.
It’s also important to honor each other’s feelings, even if you don’t share them. Make room for each of you to express how you’re feeling without telling them how they should feel. As you said before, suggesting that they need to be more positive or that it will work out, to just be hopeful. Remember, that’s not always helpful for them. You likely have different ways of coping, and that’s okay. This is a struggle you’re both facing, so try to be mindful of the other person in this.
Lastly, ask for what you need, but be very specific. It’s common to feel unsupported by your partner during fertility treatment. Not because your partner doesn’t care, but because they may not know what you need. Take time to think about what you would genuinely need and what you want. Some examples could be to ask for them to deal with the insurance or to make sure that you never run out of medications, prepping your meds for you each evening, administrating them, taking over certain chores so that you can rest, rubbing your feet for 10 minutes a day, whatever resonates for you. Remember that your partner can’t read your mind. Also, sometimes you don’t even know what you need. Really think about it, and try to recognize your partner has needs as well, and he might have a different perspective. Perhaps they’re bottling things up because they think they need to stay strong for you, so let them know their vulnerability is okay.
Dr. Aimee: Sometimes it’s the extended family as well that can cause conflict within the relationship. Let’s say your partner’s family doesn’t understand what’s going on and why it’s not working, and then they’re in your partner’s ear, and that can sometimes create a lot of conflict. I wish I had good advice for that. That’s a hard one. What do you usually recommend to folks who are dealing with extended family being a little too nosy?
Rachel Goldberg: I think that again goes back to the we’re in a partnership and so I’m going to ask you for what I need, and what I need is for you to set boundaries with your family.
Dr. Aimee: Love it. When should someone come to see someone like you? If it were up to me, it would be at the beginning of your journey, from the outset, not when things aren’t going right. What are some signs that more support might be needed?
Rachel Goldberg: Yes, it would be great in the beginning. But if you’re just starting out, I understand people may not feel like they want to, they’re feeling hopeful and they’re relatively steady, so therapy might not feel right for them. That’s okay. However, as the process unfolds, especially after multiple cycles or setbacks, it can be helpful to have someone already in your corner.
Many people will wait until they’re in complete despair before seeking help, but then finding a therapist, especially one who understands infertility, which is extremely important, can be really challenging and stressful. If you’re proactive and you’re starting earlier, you have a chance to build a relationship with someone who is there and knows your story if things get more intense. Also, therapists with experience in infertility often have insights and resources that can help you fill in the gaps when your doctor is too busy to address them with you.
Keep in mind that there are those definite signs you should not hold off on. If you feel no joy doing things that you used to relish in, if you notice a big increase in your irritability so that you’re snapping at everything, withdrawing from people, struggling with daily tasks like keeping up with work and household responsibilities, eating well, taking showers, sleeping. Also, if you’re having decision fatigue. If you’re having a hard time making decisions related to treatment, or even other things in your life like what you want for dinner that night, you’re at your limit and you can’t make these decisions, your body is telling you, “I don’t know. I’m at my limit right now,” so you need to pay attention to that. Definitely, of course, if you’re experiencing persistent thoughts of self-harm, you should really seek help.
Dr. Aimee: Definitely. What are some techniques for building emotional resilience during treatment, and how can people maintain a sense of identity beyond just their fertility journey?
Rachel Goldberg: Fertility treatment truly consumes your life. If you find small ways to reconnect to who you were outside of the process, that can go a long way. Try to stick to parts of your older routine. If you loved working out, keep your fitness routine as much as the treatment allows. If you used to do happy hour with friends, go for dinner, or coffee, or a walk instead. Plan a date night where you and your partner first met. Go on a short weekend getaway as a reminder that life does exist outside of fertility.
Here is my most important tip of all. Focus on what you can control. So much of this journey feels completely out of your hands, and to be honest, it is. But you do have control over some things, like eating nourishing foods, finding ways to work on reducing your stress, keeping up with your work, maintaining friendships that matter and setting boundaries for those that are causing pain, and definitely asking for help. Again, it’s also important to notice that you’re struggling to maintain these things, or if someone brings it to your attention. Getting support can get you to regain those things that you have control over.
Dr. Aimee: I would also add that you have control over the music you listen to. Music is a big part of my life. We actually have a great sound system in my office. Before patients get here, I get to choose what we listen to, which is EDM. If anyone knows me, they know that I love EDM. Then during the day, we play anxiety and stress-relieving music all day long. My patients just comment about how soothing the music is and how good they feel when they’re sitting in the waiting room. We try not to let patients wait very long, but they really like the music. I hope people can find music as another way of helping them emotionally.
Rachel Goldberg: Yes. To back that up, think about all the times that you were in your car or just had music on because you were getting ready for something, you’re dancing and feeling good. It does bring that feel-good energy.
Dr. Aimee: Absolutely. Rachel, you are such a delight. I want everyone to see you. Tell us where people can find you if they want to work with you.
Rachel Goldberg: Super easy, RachelGoldbergTherapy.com is my website. I post lots of blogs that you might resonate with or find informational, so definitely check them out. I’m also on Instagram, @RachelGoldbergTherapy.
Dr. Aimee: Awesome. Rachel, is there anything else that you want to add today?
Rachel Goldberg: I just want to also thank you, Dr. Aimee. You are so amazing. I hear great things because sometimes I see your patients. I just want to say that the information you give people and everything is amazing. You are a unicorn in my mind. I appreciate you.
Dr. Aimee: Thank you, Rachel, for saying that. Thank you for spending time with me today. I really appreciate it. I hope you’ll come on again and we’ll talk about something else that will change just one person’s life, and that just makes this all so worth it. Thank you.
