Few things are as devastating as a chemical pregnancy. A pregnancy is termed a “chemical pregnancy” when a woman has a positive pregnancy test but miscarries before anything can be seen in the uterus. For couples in the midst of the physically and emotionally demanding process of infertility treatment, a chemical pregnancy can trigger intense feelings of loss, hopelessness and sometimes depression. After rejoicing in the news of a positive pregnancy test, a couple is told mere days later that they are no longer expecting. Unfortunately, there is often little space given for grieving as couples are asked to make more complex medical decisions. Sadly, even the term “chemical pregnancy” seems reductionistic for what is often a profound loss.
Depression and anxiety are quite common in both men and women facing infertility (Fassino, Piero, Boggio, Piccioni, & Garzaro, 2002). Many couples report that infertility is one of the most stressful events in their lives, equivalent to the death of child or spouse (Kedem et al., 1990). It is quite common for people who are undergoing treatment for infertility to feel as though they are on a roller coaster of hope and despair and a “chemical pregnancy” typifies this experience. The psychological stress of a failed cycle is one of the main reasons that couples drop out of infertility treatment (Domar, 2004).
When a couple experiences a “chemical pregnancy” it is common to suffer intense grief as a result. Often couples have developed strong feelings and vivid fantasies while waiting to hear the results of the pregnancy test which only increase with a positive test result. Intensifying the grief of the pregnancy loss is the knowledge that getting pregnant again is likely to be difficult. Unfortunately, the grief associated with a “chemical pregnancy” can be overlooked. In many instances of infertility, particularly with older couples, time is of the essence and there is little room for a lengthy mourning process.
In addition to feelings of grief, it is not uncommon for emotional reactions such as anger, blame and shame to emerge. Some couples may report anger for their unlucky fate. Other potential targets of anger are healthcare providers, particularly in instances when their is no identifiable explanation for the couple’s infertility, which occurs in approximately 10-20% of cases. It is also quite common for couples to place blame on one another, especially if one member carries the infertility factor. Feelings of shame and defectiveness are often reported by women following a “chemical pregnancy” or treatment failure.
Rituals can be very helpful for allowing couples to grieve after experiencing a "chemical pregnancy". Rituals bring formality and solemnity to the passages of life. They play a critical role in the process of grief and mourning and can provide the opportunity for a couple to empathize and support one another. Both partners should take an active role in planning the ritual and agree on the various elements that will be included. It is sometimes helpful to include special items such as baby clothes or a memorial object. Some couples planted trees or gardens to represent their lost child. Questions to consider when creating a meaningful situation include:
- What do you need to say to your child?
- What preparation is needed?
- Who would you like to include in the ritual?
- Is there a location where you can hold the ritual that has meaning for both of you?
In some cases, the cumulative losses and stressors associated with infertility become too much to bear and many women and couples find the support of a couple or individual therapist or infertility group very beneficial. Signs that you may have depression and need to seek professional support include:
- Daily tearfulness
- Not enjoying things as much as you used to
- Difficulty sleeping and/or eating
- Feeling guilty, hopeless or irritable
- Having difficulty concentrating or making decisions
- Worry or feelings of anxiety that are interfering with daily life
Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention, which she uses in the treatment of patients who are struggling with infertility. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives.
Please feel free to call the Rowan Center for Behavioral Medicine for further information 818-446-2522 or contact us.
Fassino, S., Pierò, A., Boggio , S., Piccioni, V., & Garzaro, L. (2002). Anxiety, depression and anger suppression in infertile couples: A controlled study. Human Reproduction 17(11), 2986-2994.
Kedem, P., Mikulincer, M., Nathanson, Y. E., & Bartov, B. (1990). Psychological aspects of male infertility. British Journal of Medical Psychology 63, 73-80.
Domar, A., Seibel, M., & Benson, H. (1990). The mind/body program for infertility: A new behavioral treatment approach for women with infertility. Fertility and Sterility, 49, 246-249.