The deep distress and angst caused by infertility and miscarriage can often be exacerbated by a lack of understanding bordering on downright ignorance on the part of friends, family and workplace colleagues. Many couples having difficulty conceiving live in dread of the seemingly innocent phrase, “any news?” And the breath-taking insensitivity exhibited by many people in relation to miscarriage makes the bereavement that much harder to bear.
The Future of Fertility special report looks at how the pandemic affected IVF services, and the people availing of those services.
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For couples who find themselves in those situations, hope is precious and often hard to come by. That’s where IVF and other treatments come into play. They don’t come with any guarantees, but they restore people’s hope of having a successful pregnancy.
Dr Ahmed Omar, medical director of Beacon Care Fertility, describes the emotions experienced by couples dealing with infertility. “Before the couple comes in, they have already suffered emotional stress,” he says. “They have probably already been trying for a year or two and may be experiencing feelings of inadequacy and a sense of failure. There is the anxiety of not getting pregnant and the fear that they are not going to have a child. There is a big mix of emotions there already.”
There can also be courage, he adds. “Fertility patients tend to be healthy. Many of them have never even been to a GP. So sometimes it takes courage to walk in to seek help. Sometimes they come in with an element of hope. They need to understand why it’s not happening for them, and they hope that the treatment will help them to achieve what they are trying to achieve.”
And there can be fear and a sense of guilt during treatment. “There can be issues with the male or female partner and sometimes there is a sense of guilt or shame for one of them,” Omar explains. “We try to explain to them that it’s a collective issue. The treatment itself can help. Sometimes it provides the answer on where the issue lies. That can bring hope as well. If you are able to understand the barrier, you might be able to bypass it.”
And that brings a new set of emotions including the fear of failure. “Expectations become higher during treatment and there can be disappointment if it doesn’t succeed. There is a sense of expectation and fear that their hopes are going to be dashed. There is a certain pressure that comes with treatment. There is also the financial aspect, that brings more pressure.”
Physical and emotional impact
It is a very stressful time for individuals and couples, says Damien O’Dowd, group clinic director with Sims IVF. “They may have been trying for some time and seen their hopes repeatedly dashed. It can have quite a dramatic impact on them both physically and emotionally. IVF helps take them through a journey. Where there are issues, a diagnosis can help them emotionally as well as inform the treatment plan. It’s about having hope. That’s really important.”
Communication is also important. “We have an excellent team of counsellors who interact everyday with our patients,” says O’Dowd. “We also have an out-of-hours helpline for people to be able to get support throughout their treatment journey. They can speak with a doctor or other members of the team on a regular basis throughout their treatment. Many people have lots of questions that are very important to them. People are trying to react to families and workplaces while undergoing IVF and the trauma of explaining an unsuccessful cycle or a miscarriage can have an emotional and physical toll.”
Difficulties dealing with family, friends and social circles is also noted by Dr Omar. “Close family might be wondering why it’s taking so long. People can become conscious of that at family gatherings and might start giving them a miss to avoid the questions. It can be the same with friends. They might become socially withdrawn. The other problem is the wider circle in work. Some of our patients are nurses who are seeing babies every day or schoolteachers seeing young children every day.”
Miscarriage is different, he says: “People dealing with infertility are anxious until they have a pregnancy. For them, hope starts with pregnancy. For people who have been through a miscarriage, the worry only starts when they become pregnant. They don’t know when a miscarriage can happen. Could it be in one week, two weeks, three weeks or three months? During the crucial first three months, it’s really, really hard for them. You can sit with them and tell them that their chances of having a full-term pregnancy are still higher than miscarrying. The main thing is that they don’t want to go through that.”
Understanding why
Helping people understand the reasons why they are not getting pregnant or failing to have a successful pregnancy can help them deal with the stress and emotional turmoil, Dr Omar says. “The next step is the treatment. About 70 to 80 per cent of miscarriages are due to underlying chromosomal abnormalities. We are now able to screen embryos for chromosomal abnormalities. That helps reduce the risk of miscarriage.”
Psychological and emotional support is one layer, and there is also a medical side. “We know the issue is difficulty in having a baby and one way to deal with it is by helping them to have a baby. The other is by helping them to deal with lows and to be resilient. People may have to deal with setbacks and disappointments during treatment. We prepare them psychologically to be resilient.”
“We understand the hopelessness that patients can feel from time to time,” says O’Dowd. “Patients describe how their hopes for the future, for the family, for that child are gone and don’t know how to start again. It’s important to help individuals and couples find the answers and give them the information they need to know where they are going on their treatment plan. It’s important that they fully understand the risks. It can often be a difficult journey, in particular when they have already been through an unsuccessful programme. Continuing on the journey with renewed hope is very important.”