Hello and welcome back to the podcast. This week is the first of two episodes that I am dedicating to the topic of trauma. This week we are going to talk about infertility trauma (what it is, what it looks like, and why it’s a thing) and then next week we’re going to talk about where to go from here.

I did a lot of trauma work during my Social Work career. I say in the intro that I am a social worker but I haven’t really talked that much about my experience, yet. So, I have a master’s degree in social work and a master’s degree in health administration. The entirety of my social work career has been in healthcare, either direct practice or administration. I have worked in three different trauma centers, in my work throughout Texas. In addition, I have experience in acute rehab which is also called physical, medical rehabilitation – where inevitably we saw some VERY traumatic injuries for some of our patients (brain injuries, spinal cord injuries, burns, gunshot wounds, falls, all kinds. Imma be honest, I’ve seen some shit). I have studied trauma and walked many people through some of the worst moments of their lives. All this to say, trauma is one of favorite places to be of service. I love it. 

Now, the first few years of my infertility journey, I would NEVER have considered my experience to be traumatic. Because THAT was my context! Everything that I had seen and experienced was my “trauma” reference point. And I think that is a lot of people’s context. It’s either what I have described, or we also think of abuse, assault, or something like that. How many of you think like this? How many of you view trauma through that lens? 

So, per usual I am going to turn to the Googles to get us started with a definition- psychological trauma is defined as damage to the mind that occurs as a result of a distressing event. Trauma is often the result of an overwhelming amount of stress that exceeds one’s ability to cope or integrate the emotions involved with that experience. 

1. Making the case of infertility trauma

Ok, who listening doesn’t think that infertility qualifies on every single effing level of that definition? It checks all the boxes, right? 

Infertility is a trauma. And a compounding one. We experience the trauma every cycle, whether that’s every round of assistive reproductive technology or even when we’re between those and trying to conceive and we get our periods. We always have that little bit of hope, even when we tell ourselves that there’s not a chance. We try desperately to modulate or temper our hope but it’s always there. Like that scene from Dumb and Dumber where Lauren Holly’s character tells Jim Carey’s character, “The chance isn’t good; I’d say one out of a million.” And he responds, “So you’re telling me there’s a chance?” If you’ve never seen the movie, you’re not really missing out on anything, but it does illustrate how our brain works when we’re trying to conceive. I know for one, that I could’ve missed my ovulation window completely, like my husband could be OUT OF THE COUNTRY, and STILL be disappointed when I get my period because of that tiny shred of hope. And every month or every cycle that hope is shredded, and we are gutted. And every passing month, every failed cycle, every trigger compounds our trauma. 

Compounding trauma is a concept that I teach my clients. It’s a way to help them understand how trauma functions for us in the midst of infertility. This is not to be confused with the medical model’s framework of “complex” trauma, which is described as the exposure to multiple traumatic events, this is common for war-time veterans and children that have suffered abuse and neglect. Compounded trauma is the trauma we experience after every cycle, transfer, or miscarriage. I want you to think of it like a volcano or a mountain, ever millions of years, the tectonic plates that our continents sit on smash together and force rocks upwards. Now, we don’t feel or see the plates shifting and smashing into each other but we have the evidence of the mountain in front of us.   Your trauma, too, grows over time. Here are some of the compounding events (some might call these things triggers, if that helps to give it context):

• Tests (bloodwork, scans, etc)

• Procedures (HCG’s, egg retrievals, transfers, IUI’s, if you’ve ever had a laparoscopy)

• Provider visits (seeing happy, pregnant bellies everywhere)

• Baby showers

• Gender reveal parties

• The realization that you may not be able to have children spontaneously

• The realization you will require medical intervention to have children

• The realization that the medical intervention might not work

• Poorly responding cycles (that’s when your body doesn’t respond to the medications to induce follicle stimulation)

• Failed IUI’s

• Weight gain associated with fertility treatments

• Getting your period (either after a failed cycle or even when you are not doing an active cycle) Although there is some evidence to suggest that menstruation following a failed cycle is exponentially devastating because of the medications we have to take make us “feel” pregnant. So it’s like a double-slap to the face. 

• Conversations with other people about your infertility (you know what I’m talking about, the ones where people say the asinine things that people make tactless comments and give unsolicited advice)

• Visiting a store and finding yourself upset while passing the baby clothes section

• Seeing your clinics/ drs name pop up on an incoming call

Now, to someone that has never experienced these events within the context of infertility, they might seem small or even insignificant. However, when viewed through the lens of infertility it is the accumulation of these events that is traumatic. It’s not necessarily one specific event but the numerous events that occur over and over again during infertility diagnosis and treatment. When you couple that with traumatic events such as failed cycles and transfers or miscarriage, the result is incalculable trauma. A trauma that is real and visceral. 

These things build over time. Our first few blood draws, scans, or drs visits probably weren’t terribly distressing. Awkward and uncomfortable, sure, but not distressing. But every month, every cycle, every year that compounding effect intensifies. The longer we are on this crap-ride, the more is compounded. 

The path to potential infertility trauma is laid out YEARS before any of us actually start trying to conceive. Women are socialized, from a very young age, to desire children (I talk about his in the previous episode about shame). We tend to play with dolls, play “mommy” and “house” as fun games when we are young. As we get older, many of us begin fantasizing and dreaming of our future with children. We imagine ourselves as parents and playfully talk about it with our friends and partners. We picture ourselves passing along family traditions or imagining new traditions that we would like to begin with our children.

We create stories in our heads of what that future will look like. 

There is a standard expectation of life that most of us have: attending school/ career development, dating, marrying/partnering, having children, raising children, growing older, then grandchildren. Infertility doesn’t just make you question the immediate implications of your life without children or your continued fight for children. No, the implication is much larger than that. Most of us have imagined a distant future that is childless, cold, lonely, and devoid of joy and happiness. 

When we experience infertility, we are not just experiencing the physical or social implications but also the divergence from the long-standing narrative that we created. The beautiful and wholesome image that we carefully cultivated in our minds for YEARS. We feel the gut-wrenching, life- altering loss of this imagined path; of the life we planned for.  THAT’S the trauma. Infertility trauma infringes on our sense of control and reduces our capacity to integrate situations or circumstances that someone without this trauma, could do with relative ease. 

I do want to make it abundantly clear that this is true for primary and/ or secondary infertility. It’s not exclusive to one or the other. 

1. So, what does that trauma look like?

We all react to trauma in different ways, experiencing a wide range of physical and emotional reactions. Let me be clear: There is NO right or wrong way to think, feel, or act. Judging yourself during your trauma does nothing to serve you. Your responses are NORMAL reactions to ABNORMAL events. 

Common emotional trauma responses are:

• Shock, denial, or disbelief

• Intrusive thoughts that come out of the blue

• Confusion, or difficulty concentrating (I call this the IVF Fog and I will discuss it in a future episode)

• Anger, irritability, mood swings (Which is 100% one of my go-to reactions)

• Anxiety and fear

• Guilt, shame, and self-blame

• Withdrawing from others

• Feeling sadness or hopelessness

• Feeling disconnected or numb

Common Physical trauma responses are:

• Insomnia or nightmares

• Fatigue 

• Difficulty concentrating

• Racing heartrate

• Edginess or agitation

• Aches and pains

• Muscle tension

I can personally attest to experiencing pretty much ALLLL of these symptoms at some point in my journey. If you’re anything like me, you might have considered these commonplace during infertility but had never associated them with trauma. That’s ok. I was right there with you. Remember what I said earlier in the episode about how we traditionally view trauma? That’s why most of us don’t equate the two; infertility and trauma. But it is, nonetheless, trauma. 

1. The naysayers

One aspect that additionally compounds infertility trauma is the discounting of it. Whenever people talk about trauma there will always be individuals that go to extremes. They will say “it’s not like you were kidnapped, watched someone you love get murdered, or are a holocaust survivor.” And I will always respond, that’s correct. Because I am not drawing 1:1 comparison to those things and infertility- they are not the same things. Those are extreme circumstances. But extremes also don’t make the trauma of infertility less traumatic. Extremes don’t make our trauma less real. It is human nature to go to extremes, but we don’t often live in extremes. Also, there is not some objective barometer on what does and does not constitute trauma. There is no judge or jury that is handing down decisions on what counts and what does not count as trauma. It doesn’t exist. 

And even if the trauma is not acknowledged by the general population, doesn’t mean it’s not there. I didn’t acknowledge my own trauma for YEARS. There were a lot of things that I justified to myself. 

That I dismissed. 

Things that I didn’t want to consider.

I was living in the midst of infertility and when you are, it’s VERY difficult to see the world through a wide-angle lens. That objective view of things is nearly impossible when you are in the trenches. 

1. Why people have such a hard time understanding the trauma factor of infertility?

Given that those of us experiencing infertility have a hard time recognizing or acknowledging our trauma, it stands to reason that individuals with no point of reference would find it extremely difficult to understand it. 

Infertility and miscarriage don’t really have any rituals or public ways to honor these events. And so often people just don’t talk about them. We turn it on ourselves. We believe there is something wrong with us. Remember the shame aspect I talked about in episode 4? That plays such an enormous role in how we experience and perceive our trauma. The shame tells us that we “deserve” how we feel. Then, if we feel like we “deserve” it, then that is like to final nail in the “never talking about this” coffin. To make matters worse, there is still a social “prudeness” factor that stipulates that these things are not discussed. That they are “private” matters and should stay in the home. 

People that are outside of the immediate situation often have expectations for how and when someone should quote “deal with” stress and trauma. This is pretty universal with all trauma. 

It only adds to the horrific experience of the person and/or couple. Other people expect someone to experience issues in as specific pattern, in a specific way, within a specific amount of time. 

Since a huge part of infertility is the loss or potential loss of a complete identity, it is very difficult for those around us to fully understand how and to what degree these losses are so painful. It’s also not visible. The emotional and physical pain is typically not seen and therefore is much harder for others to feel empathy towards. 

1. The lasting effects of trauma

The last thing I want to talk about is the lasting impact of trauma. What so many of us believe is that we will feel differently once we have that positive pregnancy test, we have that ultrasound that confirms a normal pregnancy, or once we have that baby in our arms. But the truth is, that for many of us, the trauma lingers. Getting pregnant, having the baby, or adoption does not erase the trauma we endure. We will experience the joy, excitement, and love that we imagine we will, but we will also still experience our trauma. 

For me, it manifested itself in not being able to really embrace a lot of my pregnancies. For my first pregnancy, I was so terrified at every appointment that they wouldn’t be able to find the heartbeat. During our 12 weeks scan I was trembling. My husband kept asking me if I was ok and why I didn’t seem more excited. That’s because I was scared of being excited. Now, this was before I was really involved with and understood thought work, but it makes total sense right? When you’re finally pregnant or have the baby, your trauma might look more like constantly waiting for the other shoe to drop. An expectation that your happiness will be ripped away from you at a moment’s notice. A happiness, that for many of us, we don’t feel we truly deserve. 

Now, I have spent a long while talking about trauma. There was a lot to unpack in this episode and I wanted to cover those many aspects BEFORE we move on to the question, “what do we do with our trauma?” That’s the next episode and I can’t wait to share that with you. 

Until next time, remember, I adore you and you have got this!!