Taking Baby Steps. Jody Lyneé Madeira

FIGURE 4. How Women Feel across an IVF Cycle, Qualitative Interviews (by % of participants indicating each emotion during each cycle component). Source: Jody Lyneé Madeira. Note: Emotions indicated by fewer than 5% of participants during each cycle component are not reported.

      Moreover, in treatment, patients’ emotions are linked to specific IVF cycle phases. Individuals undergoing IVF for the first time generally feel most daunted in the beginning. “I think some patients get overwhelmed by the process; [they say] ‘I don’t know if I can take my shots, … I don’t know if I can be sedated,’” Nurse Gabi Simpson explained.

      This roller-coaster pattern is evident in Figures 3 and 4, which aggregate hundreds of patient responses. Patients experience “positive” emotions most strongly from egg retrieval to embryo transfer, peaking at that point. Men are more nervous than women at this time, but they tend to become more hopeful following embryo transfer, whereas women remain nervous throughout the cycle, even after a positive pregnancy test. For both, excitement peaks following embryo transfer, during the agonizing time known as the “two-week wait.” Predictably, both men and women are saddest following a negative pregnancy test. Surprisingly, women’s anger and frustration generally remain low until a negative pregnancy test, belying the stereotypically wrathful and bitter infertile woman. Thus, the Attempt more accurately captures this emotional “roller-coaster” than the Expedition, although both layers are necessary to fully illustrate infertility’s emotional complexity.

       Sinking Feelings: From Diagnosis to Descent

      Standing on infertility’s precipice, most individuals feel many more negative than positive emotions and often experience emotions in “clusters”—from most to least common, they are sorrow, jealousy, inadequacy, and surprise. The sorrow cluster (which 71 individuals, subsequently represented as “n,” reported) is comprised of depression (n = 27), sadness (n = 20), devastation (n = 10), disappointment (n = 8), and grief (n = 6). Jealousy (n = 47) encompasses pain from seeing pregnant women (n = 27), envy (n = 16), and unfairness (n = 4). Inadequacy (n = 39) includes feelings of insufficiency (n = 15), failure (n = 8), self-doubt (n = 7), abnormality (n = 5), and bodily dislike (n = 4). Finally, surprise (n = 24) consists of shock (n = 14) and the sense that infertility has hijacked life plans (n = 10). Other emotions like frustration, anger, guilt, and determination also play significant roles. Figures 1 and 2 depict the emotional experiences of both interview and survey participants; these charts list different emotions because survey participants selected all applicable options from a lengthy list, while interview participants described emotions in their own words.

      1. Sorrow

      a. Experiencing Sorrow on the Precipice. Most individuals are sorrowful following an infertility diagnosis. Grappling with infertility’s consequences brings sadness, an umbrella concept often encompassing frustration, anger, jealousy, introspection, and anxiety. As Maria Craig described, it was “not like a clinical depression, but maybe a little bit sad or depressed. Like, why me?” Women frequently describe this reaction as grief over the delay or potential demise of their hopes, life intentions, parenting identities, and, often, pregnancies. Tracey West recounted, “Right after we got the actual diagnosis, … you kind of go through the stages of grief. And because the cause was male infertility, I think my husband took it a little bit harder.” Sylvia Nelson’s sorrow was quite intense: “I have no control over what happens… . I’m one of five kids, my husband’s one of four kids; we’d always thought we’d have a large family. I think just the fact that that might not happen is really devastating.” These are mourning reactions; patients are keenly aware of what they might lose.

      Sorrow also affects romantic relationships. Sometimes both partners experience depression, either as a mental state or clinical diagnosis. As April Gonzalez explained, “I became very anxious and, at times, depressed. Started going to therapy myself… . We kind of isolated ourselves from some of our friends … feeling like we didn’t really fit in.” For Lily Ellis, depression caused “a lot of tension” with her husband, while Ashley Carpenter’s husband worked to alleviate his wife’s depression: “it was tough to … keep both of us focused and more upbeat about it.” Coping with infertility is especially difficult if one’s partner is also in need of support.

      b. Experiencing Sorrow during the Expedition. Sorrow’s root causes persist in Attempts, only now the most sorrowful experience isn’t diagnosis, but failed treatment cycles or miscarriages. If a positive pregnancy test proves elusive cycle after cycle, disappointment is all but inevitable. As Darla Clarke asserted, “I supposedly have these follicles, I get all these shots and do all this stuff, and I don’t get pregnant, and then it wears into, ‘OMG we’re spending all this money with no return.’” Individuals had to manage their own disappointment alongside their partners’. Even friends can trigger sorrow; Shelley Lawrence felt let down by “how people in my life responded” to infertility. These feelings often overlap with isolation.

      Sorrow compounds over time, as sadness from an infertility diagnosis acquires layers of grief from unsuccessful treatment attempts. For Rochelle Rowe, infertility was “the most devastating thing that’s happened to me, including my mother having cancer and everything else. It’s definitely changed my world view.” Deep sorrow reflects individuals’ profound commitment and efforts to conceive. Lauren Mack observed, “[A]ccording to my insurance, I have four IVF cycles for a lifetime… . all my girlfriends who have infinite chances the rest of their lives, I have four, and when one fails it’s just devastating… . You work so hard, and you’ve put so much effort and hope into something.” Here, even though Lauren had insurance, jealousy still crept in, deepening this emotional pain.

      Depression can be both a synonym for sadness and an actual clinical diagnosis. For many, depression is a mental state; Nicole Bell said she’d “slip into” depression, and Brittany Watson described how infertility “spiraled me into a bit of depression.” Depression can be debilitating, particularly in combination with other emotions and events. For David Reid, “there have been times I’ve been so angry I can’t see straight, so depressed I can’t barely lift a pen, … our first IVF cycle was around Christmas, … we got a positive result, and I kept singing in my head ‘All I Want for Christmas Is You.’ And then came New Year’s, and we had a bad beta/HCG, and we had everything fall apart.”

      Infertility experiences might also aggravate clinical depression; as Marisa Sims related, “I’ve had problems with depression most of my adult life, and I think the infertility certainly exacerbated that.” Patients in this situation might not be as surprised at infertility’s effects and may have preexisting resources to cope with them in healthier ways.

      2. Jealousy

      a. Experiencing Jealousy on the Precipice. After receiving an infertility diagnosis, women and men most commonly experience jealousy from seeing others conceive without apparent effort. Their worlds seem suddenly overpopulated with pregnant women and unwanted pregnancies, engendering envy, feelings of unfairness, and pain. Tanya Rivera explained, “[F]or a year at least while I found out I was infertile and then had to wait [for insurance coverage], I was possibly more