Hi, We are Drs. Amelia Swanson and Angela Lawson! We are health psychologists helping people cope with the emotional roller coaster of infertility, pregnancy loss and fertility treatment. Ask me anything!

Thanks for taking the time to do an AMA!

It seems like a lot of people are dismissive of how emotionally devastating pregnancy loss can be, and expect people to simply "get over it." How do we shift societal understanding about this and educate people on the depth of the impact that pregnancy loss can have?

Secondarily, can you list some resources available to support those affected by pregnancy loss?

Thanks for the question! Unfortunately many people are dismissive of people's experiences with pregnancy loss. There are likely many reasons why this happens. Some might include:

1. We don't do a good job of talking publicly about pregnancy loss and so many people don't understand why it could be as emotionally difficult as it is. This also means that we don't have a shared understanding of how to support people who have had a loss.
2. It makes other people uncomfortable when we are sad and they want us to get over it so that they can feel better.
3. They don't know what to say to someone who has had a loss so they either say nothing or say something that they think is well-meaning but is hurtful.
4. Some people who have had early pregnancy losses aren't as emotionally affected by them and this makes other people inaccurately assume everyone just "gets over it".

In order to shift the way we support people going through loss, we have to talk about loss more. Since beginning work in the fertility clinic 15+ years ago, I have seen a shift beginning to occur with more and more celebrities and us regular (yet awesome) folk talking about loss more to our friends, family, and social media. For those who feel comfortable doing so, sharing publicly or within their social circles can help others feel not so alone. Suffering in silence for fear of what someone will say to you if you have had a loss is devastating. We can all use our voices, like Dr. Swanson and I do every day (and we have very loud voices 😁) to help create a culture of love and support for those grieving a loss. Lastly, a good resource for those experiencing loss would be again to find a reproductive mental health professional (either online or through your doctor's office) or looking at some of the support groups on resolve.org or https://pilsc.org/get-help/groups-navigator/.

I agree with all the points Dr. Lawson has made. I wanted to add when people share they went through a pregnancy loss with friends and family, they often find out that many other people have experienced it too and just hadn't told others. This often helps people feel less alone and more support, and helps reduce the stigma of talking about pregnancy loss.

Hi! I had a miscarriage a couple of weeks ago and was shocked by: - How little I knew about the physical process of it (and how vague even the leaflets I was given was). - How many friends had also had miscarriages but had never spoken about it due to shame, grief or not feeling like it was something they could bring up. I feel like part of a grim secret society now.

Just wondering if you know of anything particularly good being done to spread awareness or help people feel more able to speak about it? I'm also considering making a comic about my experience when I'm able to hopefully help others and process my own feelings.

I'm so sorry to hear about your loss. Unfortunately your experience of not being told what to possibly expect with a miscarriage is common. I often see this in OB/GYN clinics but it can also happen in fertility clinics.

The physical process can be extremely painful and traumatic which is why some people may opt for a D&C if possible, although that is not always an option and has its own risks. Doctors, much like other people, don't like to give bad news so are not always direct about what to expect with a miscarriage. Even within a medical setting, professionals can be dismissive of the physical and emotional difficulties of a miscarriage.

I hear from so many people that they had no idea how many people they know had a miscarriage until they had one themselves and shared with others. I think this is slowly changing over time to become more open, but it is still something people often only share in private.

I love your idea of a comic to share more about your experience to help others, I think it would be very helpful! There is an artist on instagram that draws comics that has many about her infertility and miscarriage experiences which I think many people related to and found helpful.

As a psychologist, I try to educate medical professionals about communication strategies and ways that patients struggle through presentations at national conferences, talking to local clinics as well as calling and talking to the medical providers for my individual patients to help advocate for change in this area.

I also was shocked by how ill-prepared I was for mine. It was described in what I read as being like a heavy period. It was so much worse than that.

I'm so sorry that you were also not informed about the possibilities with a miscarriage. I have heard from so many patients that it has been much worse than a heavy period.

"How do I handle my best friend’s baby shower in a month? I want to support her but feel so jealous and cry even thinking about it."

This hits pretty close to home. Also thoughts of feeling like pregnancy won't ever happen for us. Thanks

I'm so sorry to hear that you're going through this! The issue with jealousy is something I hear about from almost all my infertility clients so you are not alone. As the saying goes, infertility is the worst club with the best people :)

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I think of jealousy during infertility as a form of grief. People often forget that grief is not only sadness, but also anger and jealousy. And people feel jealous AND happy for their friends and family, even if it's hard to notice the second part. I find that reframing it as grief can help people be more gentle and compassionate towards themselves. When people feel jealous, they often also feel really down about themselves and judgmental that they shouldn't feel that way, which isn't helpful.

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In terms of the baby shower, or other event, I think it's really important to be brutally honest with yourself and what you can handle. People are often more sensitive during treatment or when getting news like a negative pregnancy test or pregnancy loss. Can you talk to your friend to let them know you are struggling and as much as you want to support them are struggling with intense grief and may not be in a good place emotionally. Sometimes letting them know (if you think they will be supportive) can help so you can both think of ways to be involved that you can handle. I then think about different levels of participation. Can you go and have a good time? Maybe if you take your own car and know you may leave early? Maybe if you have a friend that is a support? Maybe if you take breaks by going outside or to the bathroom? If you don't think you can go and enjoy at least part of it, it's ok not to go. Send a fabulous gift and focus on taking care of yourself.

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It can be daunting to think about if you will ever get pregnant or have a baby. I think it's helpful to focus on your next steps in treatment while also trying to make sure you have a life outside of fertility and trying for a baby. Are you waiting for your next ovulation window? IUI? IVF cycle? fertility doctor appointment? Monitoring appointment? Try to focus on the next step. Fertility will easily take over your life. Trying to have hobbies, interests, friends outside of all of this can help you stay connected to the other parts of yourself. Finally, it is ok to grieve and feel sad and angry. Make time to let yourself feel however you feel.

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Reach out for support too. There are therapists that specialize in fertility issues. You can find them on this national directory: https://connect.asrm.org/mhpg/sectiondirectory or by searching on psychology today. It's best to find a therapist that has been to professional trainings and had supervision in this area. Many therapists have been through infertility themselves and use that as their knowledge but everyone's experience is different and you want someone that has professional experience.

As a friend, how can I best support someone who had a recent miscarriage? I feel like I am walking on eggshells. I’ve been letting her lead on if she wants to talk about it, but don’t want it to look like I’m purposefully ignoring it.

That is such a wonderful question! Just the awareness that this is a sensitive topic and that you are trying to be supportive of your friend go a long way. Everyone has different needs but here are some general ideas:

1. It sounds like you already did this, but either in private when she is not busy/at work or in a text/email, let her know you are thinking about her and this loss, you want to be supportive but aren't sure what would be most helpful to her, and can ask/not ask about the miscarriage or how she is doing. She may not know what she wants or this may change over time.
2. You could offer to go for a walk, go out to eat, watch a tv show or talk about your pets. Maintaining a normal connection can be very helpful.
3. Miscarriage is often not acknowledged as a "real" loss. Keeping in mind any potential dates, like due dates or anniversaries of the loss can be very supportive.
4. Be mindful of talking about other people's pregnancies or babies and if you are in a group, help make sure any conversation includes non-baby related topics.

Thank you for your support of your friend!

Health psychologist? I had no idea there were psychologists that specialize in health issues! Are issues aside from fertility etc also something that a health psychologist can help with?

Lastly how does one find such a person? (Keywords for searching type thing)

Lastly lastly, I'd like to say thanks. I've had friends just torn apart inside over not being able to have children. Sometimes I wish that humans would just stop equating womanhood with reproduction although that wouldn't really minimize the pain of desperately wanting to carry a child.

Thanks for your question! Yes, there are a lot of health psychologists out there! Some people go to specific graduate programs in health psychology and others specialize during the course of their training. For example, I have worked in oncology clinics, bone marrow transplant, solid organ transplant, primary care, consultation-liaison (seeing patients on medical units with a variety of issues), bariatric clinics, and most recently a fertility clinic. GI clinics and neurology are other common places to see health psychologists. Many work within medical clinics or medical hospitals, others are in private practice (as I am now!).

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To find a health psychologist, you can ask your medical provider and they may have one in clinic or one they can refer you to. On many online registries like psychology today, you can specify chronic illness or end of life issues to help narrow down. Simply googling therapist and the medical condition can be helpful. Therapists that specialize in oncology are often in psychosocial oncology or supportive oncology services.

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Thanks for your kids words and your support of your friends with infertility. I agree - separating out our sense of self and gender (womanhood and manhood) from fertility or even desire to have children would be liberating and beneficial for so many people. The support of friends like you can make such a big difference to people struggling with fertility!

Hi, thank you for doing this and for all you do. I wish i had known about this kind of specialized therapy a few years ago. I am a man with azoospermia and have two beautiful daughters, 7 and turning 6, from a sperm donor and my wife. One of the things i don't think people realize is that I was never worried i wouldn't love them he same. Its the fact that i love them so much that it hurts me to not get to have the biological connection. The pain never goes away i think I've just gotten used to it.

Question - What in your opinion and experience is the right age to talk with them about it? Should i have already? Should i not?

Thank you for your question and sharing your experience! I have talked to many men who felt similarly to you - they knew they were going to love their children but the grief about the loss of genetic connection can be profound.

Your experience of loving your kids fiercely and having a positive relationship with them is consistent with the research on donor conceived kids - that they have very similar relationships with their family as non-donor conceived kids.

When to tell kids about being donor conceived can be difficult for parents and is actually one of the reasons that a consultation with a mental health professional with expertise in donor issues is recommendation!

You should tell your kids they are donor conceived! We know telling them they are donor conceived is not damaging to them - but finding out from someone other than you can be damaging to them. The recommendation is to generally tell them early so it is something that they know about themselves as they are growing up. It's not too late or too early to tell them soon.

There are a lot of resources to help you with this. Here are some options:

Free resource:

https://www.varta.org.au/after-donor-conception/telling-children-family-and-others

Telling and talking series:

https://dcnetwork.org/catalog/telling-and-talking-series

Books for kids:

General books you can tailor to your family:

You Began as a Wish by Kim Bergman

What Makes a Baby: A Book for Every Kind of Family and Every Kind of Kid by Corey Silverberg

Heterosexual couple/donor sperm:

The Pea that Was Me: A Sperm Donation Story by Kimberly Kluger Bell

Remember to keep the information simple and straight forward. You can start with a book and ask if they have any questions. Make sure you understand what their question really means from their perspective. A 5 year old may ask "does that mean I have another daddy?" To you that may be overwhelming, but they may be trying to make sense of it and wondering if there will be a new person in their life soon - like picking them up from school. So, try to make sure you are really listening to what their question is and not just seeing it from your perspective.

Remember once you tell them, they are likely to share so you should also consider how you want to talk about this with friends or family.

Talking with a mental health professional specialized in this area can be very helpful! Here is a directory for therapists in the US: https://connect.asrm.org/mhpg/sectiondirectory

I'm off to go get my girls from school so I don't have time for thoughtful thank you that both of you certainly deserve. I will take your advice and very much appreciate you both and what you do. THANK YOU!

You are very welcome!

Thanks for doing this AMA - I wanted to see what your thoughts were on this tragic event https://people.com/abortion-pill-accidentally-given-to-woman-going-through-ivf-8348032 ?

Thanks for your comment! Someone asked below and here are our responses: https://www.reddit.com/r/IAmA/comments/171fec7/comment/k3qh5ur/?utm_source=share&utm_medium=web2x&context=3

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It was so tragic and heartbreaking. I'm wondering if you had any different thoughts or reactions than the ones we posted?

Thank you for doing this AMA. I'm reading through your answers and feel that you care about the subject matter, but most importantly, the people asking these questions. It's made me feel safe enough to ask something that's clouded my mind for over a decade now.

How do you deal with the anxiety of possibly being infertile and/or the inability to have children even with the intervention of fertility treatments? I say possibly, because I know I am somewhat catastrophizing events that have not yet become reality. I developed secondary amenorrhea in my late teens that has progressively gotten worse and some family history that concerns me. I've seen countless doctors who've all run every hormone and blood panel under the sun. (Un?)fortunately for me, they all come back "normal," so there is no diagnosis or treatment. They just tell me it will be difficult to get pregnant, but not to worry about it right now. Doctors just brush off my concerns about infertility since I'm not actively trying to conceive, but that window of time is getting smaller. But I know at 35, you'd be having a medically geriatric pregnancy, and I've been plagued with a constant worry that children aren't in the cards for me. I wish I knew health psychologists were a thing sooner!

Thank you for your lovely comment! We do really care about our patients but part of the reasons we both do this work is because we know there isn't enough support out there for people with fertility issues.

I'm so sorry to hear about your own reproductive concerns. It sounds like there are two issues - an underlying reproductive issue but then also the doctors not taking your concerns seriously. I think many people would be feeling anxious in your situation!

If you haven't already, I would encourage you to continue to seek out medical care so that you have a better sense of what is going on medically and what your options may be in the future. Egg freezing technology has advanced significantly and that can be an option for some people.

Once you think you have done what you can do to address the medical issues, I would then start to think about what your values are and what is important to you. Do you want to try to prioritize parenthood and consider being a single mom by choice and trying to get pregnant sooner than later (knowing that there still may be challenges but giving yourself as much time as possible). Are there other ways of expanding your family that would be feasible like donor egg, gestational carrier, adoption or fostering? Can you imagine a life being childfree that could be meaningful to you?

I would also recommend bringing your focus back to the present - we can't predict the future or always plan/control things. What is meaning in your life now? Spending time with friends/family, engaging in activities you enjoy, even going for a walk, can all be things that bring you joy even if you are feeling anxious about your future fertility. UCLA has some great mindfulness apps that can help us practice being in the present moment: https://www.uclahealth.org/programs/marc/free-guided-meditations/guided-meditations

Finding a therapist to support you in this process can be super helpful too! If you are in the US, some options are https://connect.asrm.org/mhpg/sectiondirectory/telehealth-directory, psychologytoday.com or therapyden.com

u/ameliaswansonphd Please stop tossing out fostering and adoption as options to patients who have not thoroughly processed their infertility losses, have accepted them, and are approaching adoption/fostering as a plan unconnected to infertility losses.

Fostering and adoption should never be a "Plan B". Never. It is disrespectful and emotionally toxic to bring a child into a family with this mindset.

I could write about this for hours, but I will not. You can do research if needed in the r/Adopted or r/Adoptees subReddits and ask the many adult adoptees who were fostered or adopted by families who had not fully come to terms with their losses and how it affected the parenting of those adoptees and their lives.

Adoption and fostering should be centered on finding the best equipped and accepting families for children...not centered on building families.

Thank you for your comment and I agree with your point. I didn't mean to be flippant about adoption or fostering so I appreciate your comment about that.

When I am working with people that have infertility that is not treated successfully with current treatment options, they often hear from many sources to "just adopt" or something along those lines. Clearly, it is not that straight forward for many, many reasons. I often say to people that adoption and fostering are not treatments for infertility - they are their own separate paths and must be treated as such. You highlight the point that is often forgetting in adoption, fostering and donor gametes, that people (parents, fertility clinics/professionals) often do not consider the impact on the future children, which really should be the central consideration.

When someone begins thinking about if treatment doesn't work, they often think if they would want to adopt/foster/use donor gametes. I encourage them to start doing research as well as the emotional consideration of if they can do the emotional work necessary to be the type of parent a child would need in that specific circumstance. Can they manage their grief while also re-centering their focus to the unique needs of the child? Can they approach parenthood in such a way that it would be in the best interest of the child? For example, could they support ongoing relationships with bio family? Can they emotionally handle the unpredictability while maintaining as much stability for the child as possible? Can they handle a lifetime of managing their own grief separately without burdening a child? Can they help their child with their own grief throughout their lifetime? This is a long process for most people and I want to encourage people to begin this shift in thinking if they think they want to consider it in the future.

Hi Drs.

Considering it's related to your field, I was wondering if you were familiar with this story from Las Vegas in 2019 that the media is now blasting out.

First, how might you have to approach a patient like this, where human error from a healthcare professional caused the loss?

And second, do you think that a single instance of two CVS pharmacists in 2019 messing up and providing the wrong medicine to a woman, instead of the fertility medication she wanted, resulting in loss of implanted IVF embryos is good cause to further restrict access to abortion medications?

Thank you for your question!

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I have read the story about the woman in Las Vegas who was pregnant with twins from IVF who tragically lost the pregnancy after being given the wrong medication, here is a link to a story about it: https://www.8newsnow.com/investigators/cvs-abortion-medication-mixup-ends-las-vegas-womans-pregnancy-dreams-all-i-got-was-a-sorry/

People doing IVF often take some type of progesterone after a transfer of an embryo and often this is a vaginal suppository. In this case, they gave her a medication that can be used to end pregnancies, misoprostol. This is so heartbreaking.

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If I was working with a patient going through something like this, I would likely be helping them grieve the loss of the pregnancy, in addition to potentially traumatic experience of losing the pregnancy due to medical error. Many people would wonder if they could emotionally be able to try for another pregnancy or if they could afford more IVF. In this case, she had her fallopian tubes removed due to ectopic pregnancies so would need IVF to conceive. Going through a legal process can also be extremely stressful. I would expect that someone going through this type of experience would need ongoing therapy for quite some time to help them cope and grieve.

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I do not think that this type of case should be used as reason to further restrict abortion access or medication. This was a tragic medical error. But, abortion medications and procedures are used for so many reasons, often for the health and the safety of the pregnant person, and for pregnancies that may be very desired and planned. For example, misoprostol is often used for suspected ectopic pregnancies and can prevent patients having surgical or life threatening complications from ectopic pregnancies, like removal of fallopian tubes. Abortion is nuanced, complex healthcare and people deserve to make their own choices for their own health and wellbeing.

How do you feel about the predatory nature of the fertility industry, and do you have to deal with the fallout of that, often?

Can you say a bit more about your question? Are you talking about all of the "add-ons" to fertility treatment that cost a lot but haven't been shown to be very effective?

One thing I think is important is that patients know that there are differences in outcomes based on clinics and that this information is publicly available through SART: https://www.sartcorsonline.com/members/Search

Hello, and thanks for stopping by for an AMA!

What are some of the ethical considerations that fertility clinics take into account when deciding to accept or reject donations of what I'm going to euphemistically refer to as 'reproductive material'?

Do you think that there are any ethical practices that are not standard that should be standard in this space?

Thanks for your questions! This is a topic that is coming up more and more now as donor conceived people are finding out more frequently that they are donor conceived (often due to at home genetic testing companies like 23andme) and advocating for their rights. Another word for reproductive material is gamete which includes eggs, sperm and embryos.

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Many clinics work with either known donors (someone the recipient parent knows in some capacity and has asked to be a donor) or non-directed or agency donors through an egg or sperm bank or egg donor agency. In this case, the clinics may screen the agencies to see if they are practicing in a way that they think is appropriate. One standard for this is that the American Association for Reproductive Medicine (ASRM) has guidelines for standards for medical and psychological screening of donors, and the FDA regulates gametes in the same way that they do for organs and other human tissue.

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Other clinics may run their own donation program which can very widely in terms of what standards they follow.

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A few things that are not standard that I think should be:

1. Donor conceived people have a right to know they are donor conceived and to information about their donor. This is a human rights issue and often in issues of donor gametes, people forget about the people who are donor conceived. In addition to the importance for identity and human rights, it is medically important that they have this information. This is entirely left up to recipient parents.
2. Clinics, agencies or banks promising that the donation will be anonymous. This simply doesn't exist! With current DNA technology, no one can promise that the donor will be anonymous for any period of time and gives false information to donors and to recipient parents. Additionally, Colorado has recently passed a law that donor conceived people have the right to know the identity of their donor when they turn 18, banks must permanently maintain records on the donor and must cap the number of children conceived. It is likely that this type of legislation will occur on a more national level https://leg.colorado.gov/bills/sb22-224
3. Limit the number of donor conceived siblings. There are guidelines on this but no firm laws and can easily be bypassed, especially by sperm donors. With current DNA testing technology, people are finding huge sibling pods.
4. Reconsidering paying donors. Many people believe that buying eggs and sperm is unethical and can be predatory for donors and not in the best interest of donor conceived people. While FDA does not allow people to "buy" gametes, they are buying them and donors are paid for their time and effort. Many companies do not allow compensation for donors, although a concern is that there will be even more limitations on donors.

There are many other controversial issues. Some donor conceived adults don't think any form of donation is ethical, or that only known donors are ethical. Embryo donation tends to be more complicated as the embryos are not from people that intended to be donors but instead from people that did IVF for their own children. Embryo donation also tends to be run through IVF clinics that may have less infrastructure to manage these programs.

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There are donor conceived people advocacy groups that are trying to change laws around these issues that are active. Unfortunately this is necessary as most clinics focus on the needs of the recipient parents, less on the donors and very little on the impact of donor conceived children/adults.

Hi! I know I'm a bit late here, but I'm hoping you might see this... I have a fertility psychology question, but my situation is sort of the opposite of everyone here. I have gone through a lot of severe medical trauma as a child and absolutely, 100% never ever want to be pregnant, or go through any unnecessary invasive procedures (eg egg extraction) to have a biological child by other means. But I am facing so much pressure to have a biological child, including from my husband, and it weighs on me.

Two questions:

1. Do you know how we can get fertility-tested, reliably, without having to extract eggs? It seems like most people start getting tested after they find they can't conceive, and for obvious reasons, I do not want to try to conceive. I am hoping one of us is infertile, which would obviate the pressure to have biological children.

2. Do you have any other advice for me? I don't want my body to be violated, but I also don't want to deprive my husband of his dream of having fully biological children (no donors involved). Are these health psychology services something he could partake in as well, to process the grief of not being able to have biological children as a practical matter, rather than as a matter of infertility? We're been having this conversation for years, and I feel so stuck. I am aware that at some point, the biological clock will simply run out, but I want the resolution to feel like we came to it together, not like I held the prospective biological child hostage until it was simply too late.

Thank you so much.

Thank you for your question! Your situation sounds very complicated and I am so sorry to hear about your history of trauma as well as the current pressure you are under to have children. In regards to your questions:

1. Typically fertility testing begins with blood draw/lab work and a transvaginal ultrasound to look at your ovaries, and then either a saline ultrasound (with transvaginal ultrasound) or HSG (catheter placed into uterus to inject fluid and dye). I would consider these all potentially difficult and invasive if you have a history of medical trauma. Typically egg extraction or retrieval is part of IVF, which is done after a medical work up when it's decided that it's the best treatment options, so it is a treatment not a diagnosis tool.
2. I think if you start a fertility work up, they are likely to recommend a treatment option even if they find a cause of infertility.

I would generally recommend couples therapy for people in your situation, I'm not sure if your husband would be willing to do that or if that is an accepted thing where you live. I have seen many couples where one partner does not want to have children for some reason and it is usually a long process of understanding each other and coming to an agreement about next steps. I posted links on the main post about links to finding a therapist.

Finally, I just wanted to say that it is so difficult to get so much pressure over this issue, especially given your history of trauma and that you would have to do all the work of treatment, pregnancy and postpartum recovery. I hope that you are able to explain to your husband why this is not possible for you and that your husband and family come to accept this.

I’ve only just seen this now and totally bummed I missed it when you guys were live on here.

But, if you happen to read this, I’d love more insight into my situation. I am 33 and just been diagnosed post menopausal after going through chemotherapy within the last year. As it is chemically induced menopause, I’ve received conflicting information on the likelihood of whether or not I will be able to fall pregnant in the future. Is this something that would be unlikely for me?

I'm glad you still posted! I'm so sorry to hear about what you've gone through with chemo and now menopause. I'm not sure of specific statistics about how likely it is that you will be able to get pregnant in the future with your own eggs. Here are some online resources:

https://www.cancer.org/cancer/managing-cancer/side-effects/fertility-and-sexual-side-effects/fertility-and-women-with-cancer/how-cancer-treatments-affect-fertility.html

https://www.mdanderson.org/cancerwise/7-things-to-know-about-menopause-and-breast-cancer.h00-159306990.html

If possible, it would probably be helpful to see a fertility specialist to get information tailored to your specific medical history/current medical status. Some fertility clinics are more used to working with cancer patients, often if they are affiliated with a large medical center (at least in the US). I am used to seeing people that aren't able to get pregnant after chemo so I'm not sure how many people are able to get pregnant without fertility treatment.

I have had patients with a history of cancer decide to pursue donor egg or embryo if they are cleared to carry a pregnancy and think that's a good fit for their family.

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can you say more? I'm not sure if this is in response to a specific comment or situation.

When was the last time you actually heard elevator music while on an elevator?

hmm, I can't remember if I ever have!