Welcome to IVF This, episode 134, IVF and Anticipatory Grief. Hello, hello, my beautiful friends. I hope you are all doing so, so well today. I am doing well. Some things happened in the IVF This world this past weekend that prompted this episode. So you might have heard me talk in some passing episodes that two cats that I've had since I was 21 years old, They've been here 18 years. But my beloved kitty, my heart kitty, Tiger, he's just been the more affectionate one. He's the one I had the closest bond with. I still love his sister. It's not an issue of favoritism, but he definitely held a bigger place in my heart. He's been very sick over the last few weeks. And this past Sunday, it'll be a couple of weeks from the time that you're hearing this episode, but for the purposes of recording this episode.

this past Sunday, we had to put him to sleep. He was very old, it seemed like maybe the couple of days before that, that he had possibly a stroke, we're not really sure, but it really, really impaired his movement and just getting around and he was already old and he had arthritis. And I went through the experience of anticipatory grief because it was, again, like I said, a couple of weeks, we thought we were gonna lose him a couple of weeks before.

He had a really bad case of cat colitis, which was a fun treat to learn that cats can get colitis. And I went through a lot of anticipatory grief. And it dawned on me, while I was going through that process, that is not an aspect of grieving that I have talked about specifically on this podcast. I may have mentioned it in passing, but I had never really dedicated time or effort or an entire podcast.

to talking about anticipatory grief, what it is, what it can look like, and why we do it. So that's what this episode is about. So again, the antithesis of this episode was, antithesis? No, that's not the right word. Again, the catalyst for this episode was specific to my experience of losing my cat, but that doesn't mean that I didn't experience anticipatory grief along the way throughout my journey, whether it was when we were trying to conceive spontaneously, when we were going through IUIs, and then when our failed transfer back in the summer of 2020. So anticipatory grief is exactly what it sounds like, right? We kind of get it from the title, but... What I really want you to understand is it's grieving ahead of time, okay? It's anticipating a perceived loss, which grief is the emotional experience of a perceived loss. So it's grieving that ahead of time. Whether you know for certain that the loss is coming, like I knew for certain that Sunday around three o'clock the vet was gonna come to our home and Tiger would no longer be with me. He would no longer be with my arms.

or if you are pretty sure, right? Maybe you are a couple of days from beta and you don't feel anything, you don't really wanna test, you know that your beta is coming up, but you really just don't feel pregnant. And so you start the grieving process then. Now, all of us, of course, are welcome to be pleasantly surprised about that and be wrong about that. But for a lot of us, when we kind of start anticipating maybe this didn't work, or maybe we're about to experience a pregnancy loss or a miscarriage, we will start to grieve ahead of time and that's what we're talking about today. I think the reason that anticipatory grief is misunderstood is because the loss hasn't actually happened. And for people who are just kind of thinking that the loss could happen, right? That the transfer failed or that we're not gonna get any blastocysts or the doctor's not gonna see a heartbeat things just aren't progressing the way that we want them to or expect them to. There is this belief of like, well this hasn't happened yet, so why are you upset? Now, anticipatory grieving, number one is a very natural, normal, expected part of, again, that perceived loss. Whether the loss has happened yet or not doesn't mean it's less valid or less of a normalized experience, because both of those are true. It is still incredibly, it is still an incredibly valid emotional experience, a valid grieving experience and it's also a normal experience for anyone who loves something. Which yes, people who have never experienced IVF, never experienced infertility, maybe they don't even have kids, there is an attachment that we form even to just our M babies, right? We go through this entire process and you know, we had our M baby on ice, the transfer that failed in the summer of 2020. We had that baby boy embryo on ice for a couple of years. It would have been like February of 2017 when he was frozen. And so from February of 2017 to July, August ish of 2020,

That was a long time for me to kind of build up this story, that build up this life and this expectation of having that baby in my arms eventually, right? It almost felt like an eventuality. And so I'll tell people, you know, like, it doesn't matter how long you were attached or what that relationship was, if they were still an M baby, if the transfer failed or if you were miscarried. Like a loss is a loss is a loss.

And no one can tell you that what you're experiencing is wrong or good or bad or anything because it is yours. Grief is an intensely, innately, personal experience. So even for my husband and myself, our grieving experiences are very different. Not good or bad different, they're just different. And so I think that is probably one of the first things I want to make sure I hammer home for you guys.

that anticipatory grief is a thing, and it's an okay thing. It's a sign of how much this means to you. It's a sign of how much you are bonded and devoted and longing for that little person, for that part of your family to be here.

Now, you may have already experienced anticipatory grief at some point in your life and maybe didn't have the language to know that one, it's anticipatory grief or a way to describe it to yourself. So let me give you some emotions or signs of what anticipatory grief looks like. So there's the emotional side, right? It's denial or disbelief or shock, guilt, anger, numbness, helplessness maybe even a preoccupation or a disassociation, difficulty concentrating, and of course anxiety and depression, right? Those are experiences that we have during bereavement or grief that has, the loss that has already occurred. So we can clearly have them anticipate, anticipate.

Emily (08:03.622)

Ellie's just making up her own words and shit. Okay, I lost my train of thought. So clearly we can have them in anticipation of the loss. Some physical symptoms, crying, crying all that God, I spent so much time this weekend crying, crying as if I had lost, well, he was, he was very much one of my best friends. He was, him and his sister had been a constant companion in my life for 18 years.

So I cried, I cried my heart out, I wailed. I wailed similarly to when we had the failed embryo transfer. Like those experiences are so similar, even though the circumstance was very different, clearly, but the emotional and physical experience. So there was crying because of the shock and the disassociation or the.

because of the shock and the... See, this is the problem. You got me hooked without doing the scripts and now we're in this bubble together. So, ha ha, joke's on you. What is the fucking word? Not disassociation. Ah, okay, I got it. So there will be crying and you might even feel a little bit dizzy because there is that disorientation that occurs in shock and denial and disbelief, right? Fatigue, fatigue, fatigue. And that is I know we talked about stress responses in a couple episodes past. That is very much that freeze stress or trauma response that's happening when you just wanna shut down, when you just need to power down, okay? Upset stomach, oh my God, I didn't eat, I don't think I ate truly for like 48 hours, right? And that was from like the Saturday morning when we discovered that there was something wrong with him, like that we feared he had a stroke through Sunday night. When the failed transfer happened, the only reason I did eat within 24 hours was because the next morning, I'd gone on a long run, I'd gone on like a, I think like a six mile run. And so I just, I had to feed my body, otherwise I was gonna pass out. But you lose your appetite. Maybe it feels like you have a knot or a bowling ball or a hole in your stomach. Those are physical sensations of grieving that are completely normal tightness in your chest or tightness in your throat. Right, anything that you can imagine that you would be experiencing during that phase of bereavement, the after loss grief, you can expect to feel in that anticipatory phase of grief. Right, so and that's why I wanna make sure that you understand that anticipatory grief is just as valid and just as normal as bereavement grief.

Emily (11:15.538)

as bereavement grief, okay? Now, one of the things that's really difficult for people to understand who are outside of IVF, outside of infertility, outside of trying to conceive, is that a lot of the losses that we experience are what we would consider to be invisible losses, right? Like for the sake of this episode, my cat, that was a visible loss, right? He was a cat who...roamed around this house and now he is no longer here, right? That is a tangible, visible loss. For IVF, failed cycles, like maybe we got to the end and we don't have any embryos, or we tested the embryos and none of them are normal. We had a failed transfer, we've had a miscarriage. Those are invisible losses in that there's nothing tangible for people to see or experience or something like that. And that's what makes these uniquely difficult.

because there's not a grieving...

Emily (12:20.446)

So we're again, now I have to go back to.

Emily (12:35.982)

And that's what makes these so difficult because there's not a grieving process in the way that we think about like the death of a loved one where we have a funeral or a viewing or a celebration of life or whatever you want to call it or whatever your faith or culture calls it. We don't have that for infertility. We don't have that for failed cycles. We don't have that for failed transfers. We don't have that for miscarriages, right? Especially early miscarriages And so without these kind of rituals, it makes it seem sometimes like inconsequential, not necessarily inconsequential, I think that's maybe too harsh of a word, but less consequential to the outsider, right? And that doesn't mean that they're a horrible people or that, you know, it just means that they don't get it. Thankfully, because it means that they probably haven't experienced it yet but it doesn't mean that your experience is less valid or that your experience is less intense or that your experience is anything less than. And so when we talk about anticipatory grief, much of what we discuss is how we would manage regular grieving, regular grieving. What we discuss is much how we would handle bereavement, a post-loss grieving process, right? So the first thing is, is that

You're gonna name it. I know this hasn't happened yet. Maybe you're waiting for beta, the example that I gave at the top of the episode, maybe you're waiting for beta and you just have this intuition telling you it didn't work. Whether the intuition is right or wrong, that's irrelevant because we're always happy to be surprised. But maybe that intuition is telling you this didn't work or didn't work again or something like that. And so you start experiencing those grieving symptoms. You gotta name it. I know this hasn't happened yet, and I really feel like it is gonna happen this way, and I'm sad and I'm scared, and I'm feeling all of this grief all at once. It doesn't mean that you don't want it to happen, right? Again, happy to be surprised, happy to be wrong. I would never be happier in my life to be wrong than to be wrong about that, right? But it just means...

Emily (14:56.962)

that you're still gonna experience some of those or all of those physical, emotional sensations of grief ahead of time. So we gotta name it. First and foremost, we have to create awareness. We can't fix or manage or deal with, attend to what we don't look at, what we don't see, what we don't notice. So we gotta create awareness. This is what's happening. I was talking to a client a little bit ago who her transfer was successful and she had a good first ultrasound. Everything was where they wanted it to be. It was a little bit early so the doctor didn't see the heartbeat at that time but that was expected because she had to do the ultrasound early and then when she had a repeat ultrasound when they would expect to see the heartbeat they did not and she's about to go for you know a DNC a procedure to remove the products of conception and One of the things that she was talking about was like, did I imagine this? You know, it's almost like your brain is trying to play tricks on you like, oh, silly girl, you were never pregnant. This is, it never worked, it never happened. And that is one of the tricks that our brain plays on us during anticipatory and bereavement types of grief. Our brain thinks that if we can minimize the experience, if we can find a way to blame ourselves or if we can try to like play a shell game, right? You know, where you're hiding a shell and you've got three cups and you're trying to move them around. If we play a shell game with our emotions and with our thoughts, then it will hurt less, right? So when we name it, when we create that awareness around what's happening, then we're allowed, we're facing it head on. There's no smoke and mirrors, this is what's happening, I can accept what's happening, I get it, right? And that's what we wanna do. We want to name it. We wanna create awareness. The second one is, is we're not gonna judge. We're gonna hold space. And if you're not familiar with that term, it is prevalent in the coaching and therapeutic industries. Holding space just means that you're allowing a feeling, emotion, a thought, whatever, to be there without judgment. That's all that holding space is. You can hold space for someone else. You can hold space for yourself.

Emily (17:24.278)

Both of them can exist at the same time very often. Most of us are holding space for at least one person in our life at a given time and we're holding space, well, we can hold space for ourselves. I think that that's a part of our experiences as people and certainly as people socialize as women. We probably could do a better job of holding space for ourselves more often, but that's the key. That's the second part. When you are aware of what's happening, That's when you have the best ability or the best chances of holding space respectfully for yourself, right? Because you're not telling yourself, oh, this flight of fantasy, I'm stupid, I'm ridiculouswhatever, whatever the nonsense is in your brain that you're trying to tell yourself, you don't have to do that. You don't have to go through those layers because you've already created the awareness that I'm grieving ahead of time. I'm anticipating this to be grief. I'm anticipating failure. I'm anticipating loss. And that's what is happening.

then you get to hold space, right? So the third one is to let those emotions come, right? I always talk about grief in waves. I'm not the only one, but for the sake of this podcast, I talk about grief in waves. At the very beginning, when you're first gonna be experiencing the symptoms, the physical and emotional symptoms of grief, whether it's anticipatory or bereavement, cross the board, the waves of grief are going to feel very violent.

almost like you are being thrashed in the middle of a hurricane, okay? The waves are gonna come very close together. It's like you're not gonna, it's gonna feel like you don't even get a moment to catch your breath before the next wave hits and you're screaming and crying and wailing and beating on pillows and things like that. That is how grief is supposed to look.

Right, that's grieving. You're not crazy, you're not anything other than someone who is experiencing a tremendous amount of pain, which is taking in the form of grief, okay? So.

So the third one is to allow all of those waves, right? It does not feel good. I'm not gonna sit here and tell you, oh, if you do this, it's gonna make you feel better. No, there's not actually a lot that's gonna make you feel better. But the only way out is through. So allowing yourself to follow those waves as best you can, like there are gonna be some times that it's not the most appropriate, like if you're at work might not be the most appropriate time for you to scream and cry and thrash and wail, I get that. But as much as possible, allowing yourself the opportunity to ride those waves, feel those feelings, kick, scream, wail, whatever your body needs to do to get that out, because when you're grieving, whether it's anticipatory or bereavement, your body is getting flooded with adrenaline and cortisol, which is why you feel that extra anxiety, that extra layer of anxiety, it's because you're being pumped full of anxiety producing hormones, right? Anxiety hormones are adrenaline and cortisol, grieving hormones are adrenaline and cortisol, okay? So whatever your body needs in that moment, right, I told you, I got up the next morning and ran like six miles. It would ordinarily take me about an hour, I'm not the fastest runner in the world, but I do love doing it would take me about an hour to run six miles, ish, depending on the run, right? If you're a runner, you know, you know. But on that particular day, it took me close to two hours. On that, I think it was like a Saturday morning, I think we found out the negative beta on a Friday. So Saturday morning, I woke up, laced up, and I think within the first, I don't know, minute and a half of my run, I had to stop and just cry, let it all out. And then when that wave passed I ran for a little bit more, I think I got a little bit further than a minute and a half into my run, and I stopped and did it again, because that is exactly what my body needed. If you've ever seen, no, what was I gonna say? If you've ever experienced grief, and most of us have before this time, some of you may not and that's okay too, but if you've ever experienced it, it is very easy.

Emily (22:01.614)

to say there's something wrong with me, I'm going crazy, I'm losing it, but you're not. So when you allow yourself to ride those waves, what you're gonna find is that the waves start getting a little bit more separate, you get a little bit more distance, a little bit more space to catch your breath. And all of a sudden the wave, the tip of the wave is maybe not as violent, right? Maybe it doesn't feel so overpowering, so overwhelming, so all consuming Maybe the top of the wave gets a little bit smoothed out. And this is why at the very beginning and those violent waves are hitting you, it's so important for you to let that happen and listen to what your body needs. Because when you do, you're gonna change the experience of your grief. Again, it's not gonna feel so overpowering. It's not gonna feel so all consuming. And that's the goal The goal isn't to be devoid of emotion. I'm gonna say I want to be sad about losing my precious tiger. That cat meant so much to me. That cat got me through my divorce from my first husband. We don't need to talk about that. Helped find the love of my life, the man I'm married to now. 10 years of infertility, this cat was with me, day and night. I want to be sad about that. I wanna be sad about that loss. I wanted to be sad about the loss of that embryo, that em baby, that little boy that I had pictured in my mind, right? Because the alternative is that I would be happy about it. And that is just not possible. And so I wanna invite you to, that sadness is okay. It doesn't feel good. You're never gonna hear me say sadness is like.

I pursue sadness at all costs because I love how it feels. No, but it's an invaluable emotion. It reminds us what's important to us. It reminds us of what we have loved and what we have lost. Doesn't feel good, but that doesn't mean that it isn't important. It is an important experience, an important emotion for us to experience. So if that is you, if you are experiencing Emily (24:24.75)

grief ahead of time. I want you to know that's normal. And it's okay. Like it might not feel okay, but it's okay that you're experiencing it. It's okay that those that you're crying on a whim that you can barely get through a sentence without bursting into tears. That's how it's supposed to be when we lose or think we're about to lose something that we love very dearly.

and it doesn't have to be a materialized thing because I guarantee you that M-baby that I had grown and nurtured for three years before we found out that transfer failed, I had already seen to that little boy's high school graduation. I already saw it in my head. So you're not just grieving what...

is actually happening, whether it's the loss of the transfer, the loss of the embryo, whatever, you're grieving all of the things that you had imagined, all of the fantasy, all of the feel-good imaginings and pictures that you had in your mind, and that is painful. And so I want it to be okay that you're in pain and know that it will not last forever and that if that is you right now, my heart is with you and you are not alone And so that is what I have for you today, my friends. I hope you have a wonderful week and I will talk to you soon.