Wednesday, September 10, 2014

Infertility, childlessness and mental health

The article from TIME magazine popped up on my Facebook feed tonight, bearing the provocative headline "Why Not Having Children Makes Some People Crazy."  (And of course we all know that "some people" = women, right?) (Gateway Women, which shared the article, helpfully added the hashtag #notcrazybutgrieving.)

The Daily Mail's headline was better, albeit still "duh" inducing:  "Infertility really does cause heartache."

Despite the groaners, these articles do highlight an interesting new study about infertility and childlessness that was published this week in the journal Human Reproduction. I'd encourage you to read the abstract and/or full text of the study itself (about 9 PDF pages), which followed up with 7,148 women who underwent fertility treatment 11-17 years earlier at one of 12 IVF hospitals in The Netherlands. Here are a few of the highlights: 
  • The study suggests that it's not so much how badly you wanted children that affects your mental health, but how successful you are at letting go of that dream (whether you have children or not).
  • Women who already had children but wanted more had worse mental health than women who wanted children, didn't have them, but were able to move on with their lives.   
  •  Infertility patients need to be better informed about all possible treatment outcomes -- including possibility of failure -- and better supported with non-treatment options, coping strategies and other resources when treatment ends. "An anthropological study focusing on daily practice in reproductive care suggests that currently this does not happen," the study says.  "...Indeed, childless couples coping with ending treatment express the need to find new role models who can help them realize how to live a life without children." 
  • "It is easier to let go of a child-wish if women find other things in life that are fulfilling, like a career,"  says Dr. Sofia Gameiro, one of the chief authors of the study.
The TIME article concludes (and I totally love this):   
The paper, which was published online on Sept. 10 in Human Reproduction, recommends sustained psychological counseling for people who did not conceive after fertility treatments and a lot of frank talk about the possibility of failure during the treatments. The author also throws some shade on those “I-can-do-anything-if I-try” types (cough, Americans, cough). “There is a moment when letting go of unachievable goals (be it parenthood or other important life goals) is a necessary and adaptive process for well-being,” said Gameiro. “We need to consider if societies nowadays actually allow people to let go of their goals and provide them with the necessary mechanisms to realistically assess when is the right moment.”
This fits entirely with the book I recently read & reviewed here, "Mastering the Art of Quitting."

I also liked some of the stuff in this article/video clip from the Today show about the study (even though -- spoiler alert & warning -- it ends with a stereotypical "miracle" pregnancy after adoption story).



  1. Thanks for the links to the abstract and article. Will be some nice bedtime reading.

    Though I agree with the need for talking about the reality of failure with fertility treatments, I think limiting counseling only to those who come to the end of treatments without bringing home a baby is limited. Truth is, I believe counseling should be prescribe for anyone who is diagnosed with infertility. Too often, I see women come out the other side of the process, with or without a baby, and they are show signs of PTSD. Without help, it can be a downward spiral.

    And now I have a post in my draft folder I need to dig out and dust off. ;)

  2. Mhmmm, finally a headline not dismissing male heartache caused by infertility and it is still not right? I haven't clicked over to the article yet, so maybe I should read more before I type.
    But reading on, it seems like men might have more role models, and a general coping strategy of throwing themselves into work/career.

    Only slowly I start to realise I was fortunate to receive counselling when treatment failed, and that even years later I can go back to that counselor to hear I'm not Crazy.

  3. I'm so glad that someone is finally taking the time to collect and publish longitudinal data on the mental health outcomes of those who've battled infertility. I think that their conclusion that there needs to be more and better mental healthcare for patients undergoing treatment is spot on, and their suggestion to discuss the potential for treatment not succeeding is even better. Unfortunately there is just so much stigma attached to mental health.

  4. I'm so glad that someone is finally taking the time to collect and publish longitudinal data on the mental health outcomes of those who've battled infertility. I think that their conclusion that there needs to be more and better mental healthcare for patients undergoing treatment is spot on, and their suggestion to discuss the potential for treatment not succeeding is even better. Unfortunately there is just so much stigma attached to mental health.

  5. Good point, Cristy. The study actually says, "Promoting positive treatment experiences for infertile patients implies not only creating the optimal treatment conditions to meet parenthood goals but also supporting patients in adjusting to all possible treatment outcomes." I would assume that "all possible treatment outcomes" would include parenthood, and parenting after infertility certainly has its own challenges. Unfortunately, they don't make that quite clear, & the focus is more on those who don't achieve parenthood.

  6. @Valery: Sorry, maybe that's just the chip on my shoulder showing. ;)

  7. I absolutely agree. Mainly because there's also this assumption that bringing home a baby is the "cure." Yet too often, I see bloggers talk about how they still are struggling after the excitement of bringing home baby wears off. Frankly, I think those who go through adoption or choose not to parent do better because you have to face this head on. Yes, it still hurts and there are still triggers, but by not pushing it to the side, you are allowing yourself to heal.

    For Valery, my observations have been that men and women process infertility differently. It isn't that men don't suffer (they most certainly do), but our society doesn't measure a man's worth base on ability to be parent the way it does with women. For men, there's also career/work as well as sexual desire. Hence it's different. Unfortunately I don't think this will be addressed anytime soon as this is so taboo (not like infertility isn't, but there's still the focus on women).

  8. thank you for the link.

    I loved it. Especially the quote:
    "...not having children only makes infertile women unhappy if they are unable to let go of the idea of having kids."

    So true! I could get my old happy me back only after I had let go the dream of having a child.

  9. Loribeth, thanks for the link to the article. I love the bits you've pulled out. These pretty much repeat the sentiments included in a post I've had drafted for months, and will now go and post!

  10. Loved the study, have thus far hated the coverage. No surprise but the media is mis-reading or making assumptions on the study.

    I hope the study itself helps change the way the emotional side of infertility is treated along with the physical side. Especially if it makes counseling easy to get and par for the course rather than something the patient needs to seek out via Resolve.

  11. I did read the article. Mel talked about this as well. I always thought it was odd that there was absolutely no counselling offered at fertility clinics. I mean after all the money you spent, you'd think they'd throw in a few counselling sessions. After our first IVF ended in failure, I was devastated and I scheduled a follow up appointment with doctor who didn't have anything to offer other than, yeah, it didn't work. We moved on to a fancier clinic who had nothing else to add after those failures as well. No counselling offered. No follow up questionnaire. It's all just talk about being positive and imagining you're pregnant and then when you're not, it's sssh, go away or pay us more money.

  12. Thank you for posting the article. When my previous spouse and I were going through IF and decided to move forward with adoption, one of the adoption companies either offered or suggested counseling for the adoptive couples. Many offered it to the birth mother, and shared this with those seeking to adopt as a way to feel that the birth mother is being cared for. I thought it was compassionate of the one company to offer at least one session for the adoptive parents because the lady with the company said you are all going through a lot. It was a welcoming and validating surprise. And I had this gut feeling like something was being skipped over in the process. When I asked another company about possible counseling for all involed, the representative said, "Why? You are not the one giving up your baby." She also said at some point, "beggars can't be choosers." I felt horrible and nearly hung up on her. Needless to say, that was one company I had no interest in using or recommending. Hopefully this research will shine a light on the emotional impact of IF.

  13. Finally got around to putting up a blog post on this very same topic. Like you, I liked the Time close. That was definitely the pay back for the less than enlightened headline.

  14. Thanks for the post! I did kind of cringe at the sentence:

    "So it’s not just whether they had kids that made people depressed or content, it’s how badly they wanted them."

    Am I paranoid or does it kind of imply that if you could move on with your life it's because you didn't want those kids as badly as someone who ends up jumping off the bridge? It's unfortunately what too many people (the ones with kids and too often the ones who had successful infertility treatments) tend to think.