The journey towards parenthood can be arduous at times, fraught with challenges and difficulties. A diagnosis of infertility, an experience of miscarriage or even repeated unsuccessful attempts to conceive can be devastating for a couple. However, just as every individual is unique, so is the way each person will navigate through this challenge.

The stages of infertility grief are identical to the five stages of grief which were first introduced by psychologist Elizabeth Kubler-Ross. Grief takes on various forms and can manifest in different situations throughout our lives. Infertility is one such situation. What's crucial is to recognize first what is happening within an individual who faces a situation like this and then embrace it as a process of internal healing.

As we present each stage, we will analyze the emotions, the reactions, and the thoughts accompanying it. We will follow the journey from receiving the diagnosis, acknowledging the problem, to accepting it, and ultimately, to emotional recovery. At the same time, we will explore the role that the social cycle and the family play by offering support and guidance to their loved ones throughout their infertility journey.

It's noteworthy that individuals or couples who experiencing such a transformative and sensitive period might face challenges in fully comprehending what is happening. Hence, the counsel and support of the broader circle are essential. Recognizing the different stages and their characteristics can assist other people to provide supportive assistance, allowing the person to express themselves without fear, shame, or criticism and giving them the space and the time they need.

Subsequently, by describing each stage, we will strive to understand the internal processes that define each of them. This will provide us with a useful framework to offer the appropriate support, gain a deeper understanding, and guide the couple to receive the assistance and specialized help they might need.

1.Denial

Upon receiving the news about infertility, an automatic reaction of questioning arises within the individual. They might struggle to accept the reality and consequently, they might doubt the accuracy of the tests, seeking a second or even a third opinion from other doctors.

The emotions that surface during this stage can include shame and self-

loathing, which can lead the individual into isolation. This way, they disconnect themselves from potential sources of help and realistic problem-solving.

The phase of denial is a temporary psychological response to unpleasant news. It functions as a defense mechanism, compensating by freezing the feeling of the initial shock and distress, while concurrently granting the individual time to prepare themselves to confront the situation.

During this stage, the individual gradually progresses towards acknowledging their condition.

2.Anger

The initial denial experienced by those involved gradually gives way to the realization of the reality. In this stage, the emotional pain can become more intense and evident.

As it's not easy for the person to fully comprehend and accept their emotions, the feeling of anger often gets triggered. The individual becomes exceptionally sensitive and irritable, often expressing anger towards the situation and frequently seeking someone to blame. This anger can manifest as hostility and aggression towards their partner, family, friends, life, God, doctors, the clinic, and even with a tendency to criticize other parents. Simultaneously, internal questions arise, such as "Why is this happening to me?", and “What have I done to deserve this?” and a strong sense of injustice.

At this point, it is particularly important for the broader family and social environment to recognize what their loved ones are going through and to provide them the space to express themselves freely. This way, they can assist them in releasing the energy generated by anxiety and stress, enabling them to move steadily toward healing and recovery.

3.Bargaining

In the following stage, anger gradually diminishes and emotions turn inward. Feelings of guilt and remorse about the situation begin to arise, along with thoughts about the steps that were taken or not to address the problem. This is the stage of negotiation.

During this process, the individual or the couple may attempt to control and alter the situation. This can be expressed in various ways. Changes might occur either on a cognitive level, involving bargaining and making internal promises like, "If I have a child, I will change, I will become a better person…" or on a spiritual level, involving a profound turn towards religion. Additionally, during negotiation, changes can manifest even in everyday habits and activities, such as better dietary choices, exercise, alternative forms of therapy, and more. Introspection is also prominent during this stage and the next.

4.Depression

Following this stage, the individual or the couple begins to perceive the reality as it is and comes into contact with their emotions. The emotional pain that was suppressed in the previous stages is now fully manifested.

The emotions that characterize this stage include grief, sorrow, withdrawal, physical and mental exhaustion, despair, isolation, and a sense of emptiness. Introversion, social withdrawal, and physical symptoms are particularly intense in this phase.

During this specific time, it is more likely for physical symptoms to emerge, such as sleep disturbances, fluctuations in body weight, headaches and dizziness, fatigue, weakness, palpitations, gastrointestinal discomfort, weakened immune system, and impaired concentration.

Throughout this period, the individual strives to come to terms with what is happening and regain their footing.

At this point, it is especially important to distinguish between grief and sadness as a healthy and normal response to a significant life change such as infertility and depression as a chronic and enduring condition where the reasons and causes are deeper, requiring more targeted and specialized psychological help.

5.Acceptance

All the above gradually lead to the final stage of this journey. The individual now accepts the situation and is ready to invest in the present and plan for the future. At this point, they can seek the best possible solutions for their case, having found their own resilience.

The journey towards acceptance usually includes all the previous processes. These are entirely normal reactions that should not scare us. Of course, we must not forget that since each of us is unique, the way one reacts to the possibility of infertility is experienced and expressed subjectively.

The stages presented above are more of an attempt to explain certain emotions and behaviors rather than to simplify such a challenging situation. Knowledge is always an ally and when we know where we are heading, what is happening to us, and why, then the path becomes smoother and less intimidating. We must never forget that this shall pass and we must always remember to accept our feelings without shame or fear.

The dream of parenthood can still come true and awaits our pursuit to make it happen.

Maria Poupalou Psychologist

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