I recently caught myself aimlessly researching graduate nursing programs and fantasizing about inserting IUDs. Other days, I consider selling the jewelry I make for fun. While my professional dreams ebb and flow on a regular basis, I’ve always felt sure of one thing: I want to be a mom. As a kid who dutifully and lovingly rocked her Barbies to sleep each night and chose to become a birth doula later in life, “mom” is a role I’ve never wavered in desiring.
Therefore, I can’t begin to imagine how I would wrap my head around infertility. This issue is so real for some, in fact, that many mental health professionals specialize in reproductive and infertility counseling. But as someone who has never battled infertility, I can’t begin to truly understand. To cultivate more knowledge and compassion, I sat down with two psychologists who work with individuals and couples coping with infertility.
The scope of reproductive therapy
Both Dr. Landon Zaki, a psychologist who specializes in helping patients with infertility at Bloom Therapy in San Francisco and Dr. Madeleine Katz, another Bay Area psychologist that works with patients dealing with infertility in her private practice, work with individuals and couples who are in various stages of their journey. Clients may be exploring options like adoption or assisted reproduction methods like egg freezing, IVF, sperm or egg donation, and gestational surrogacy or carrying. Common challenges experienced by their clients might be adjusting to their new role as a parent, struggling with postpartum depression, post-cancer treatment, grieving a miscarriage, primary ovarian insufficiency (POI), endometriosis, cancer treatment, polycystic ovarian syndrome (PCOS), or another issue.
Let’s talk the nitty gritty
Therapy sessions typically take place at the doctor’s office. But it’s not like your typical doctor’s office, complete with stirrups or an examination table. There may be couches, chairs, pillows, and beverages like tea or water to make patients feel welcome and comfortable. A single session can range anywhere from 45 to 90 minutes for individuals and couples, but this varies depending on the the practitioner.
Cost can be influenced by geography and a professional’s training. Cost can be influenced by geography and a professional’s training. Dr. Katz says that In a city like San Francisco or New York, expect a rate of $150 and $250 per hour.
Therapy may be covered by insurance, however, you may have a hard time finding an in-network provider with expertise in infertility. To help clients with the cost, some therapists offer a sliding scale or a statement for reimbursement.
But what’s this type of counseling actually like?
“During the first talk therapy session with a client grappling with infertility, I want to understand what’s going on for them and what’s brought them here, but I also want to know about their childhood, job, relationships, sex life, and more,” says Dr. Katz. “I don’t treat infertility as an isolated symptom. By truly learning who the person is in mind, body, and soul—not just through the lens of infertility—I can pick up on any challenges that are contributing to how they are understanding and relating to their infertility.”
Dr. Zaki relies on a framework known as the “reproductive story” when working with clients. The concept was developed by prominent researchers Janet Jaffe and Martha Diamond to offer guidelines for processing reproductive events like infertility, loss, or trauma. “This means working with clients to validate their experiences, make sense of and accept what has happened, and ultimately integrate it into a new and different reproductive story,” Dr. Zaki explains. “Within this framework, I provide education, emotional support, concrete problem-solving skills, and decision-making guidance around specific reproductive challenges.”
Here’s an explanation of how the reproductive story technique actually works from the International Association of Cognitive Psychology (IACP):
“...reproductive losses are traumatic in that they represent a deviation from clients’ ‘reproductive stories,’ their conscious and unconscious mental narratives about themselves as parents...people’s identity as parents begins long before they actually have children and is influenced by early childhood experience, culture, and the developmental tasks of adulthood. Since the reproductive story is a crucial piece of a person’s identity, when it goes awry...the loss is perceived as an enormous narcissistic blow, a trauma to the self that can affect adult development and all other areas of one’s life. The reproductive story forms the basis of assessment and treatment. Jaffe and Diamond suggest that assessment begin by asking, ‘How was your life as a parent supposed to be?’ Treatment then consists of helping clients rewrite their reproductive stories to acknowledge and incorporate the loss and then imagine a new ending—whether trying to conceive with or without medical assistance, adopting, or choosing life without children.”
Is counseling right for me?
To give us a better idea of who might benefit from their services, the doctors offered a few hypothetical client examples. “A typical person might be a single unpartnered woman in her early forties, or a couple who married later in life or decided to postpone childbearing for career or other ambitions,” says Dr. Zaki. “They may not have been aware of the impact that age and other factors can have on the chances of getting pregnant. They are likely undergoing IVF or have been advised to use donor egg, donor sperm, and/or a gestational carrier depending on their specific circumstances.”
Dr. Katz offered another example: “A woman may be in her thirties and with unexplained infertility. She may have had one or more miscarriages and/or unsuccessful IVF cycles. She didn’t realize that getting pregnant would take this long, cost so much, or be so emotionally draining. She’s exhausted, feels guilty for relying on her partner for support, and wants to feel better now.”
Dr. Katz adds that, “My clients are incredibly resilient people, many of whom are in therapy for the first time. The men and women I work with come in to regain their sense of self and to get back in touch with the strength that has guided them in the past. Couples, especially, are sometimes surprised to find themselves closer and stronger after going through infertility.”
What to do if you’re struggling
Of course, both doctors recommend seeking counseling from a mental health professional with experience in and knowledge of infertility. If you decide to go this route, Dr. Katz emphasizes the importance of finding someone you truly connect with. “While the quality of therapy should absolutely be a consideration, the therapist-client relationship has proven to be one of the most significant factors to feeling better.”
But therapy isn’t the only way to get support, especially when it can come at a such a high cost. “I am a big proponent of group support, especially when it comes to concerns like infertility that tend to be invisible, isolating, and sometimes even stigmatizing,” says Dr. Zaki. “The universality present in a group can be very healing, so I advise searching for local infertility support groups.” Whether you choose to meet individually with a counselor or with a group, releasing the taboo in a safe, confidential space can be truly freeing. The American Society for Reproductive Medicine (ASRM) and RESOLVE: The National Infertility Association have excellent online resources, too.
I want to be supportive, but what do I even say?
If your loved one is hurting, it can be hard to know what to say—if anything at all. “Make space for the conversation about family planning once or twice, but don’t nag,” says Dr. Katz. In other words, open the door, but don’t remind them that the door is open each time you hang out. By doing this, Dr. Katz explains that they won’t be left wondering if you care and experience resentment towards you. Instead, they’ll feel in control. She explains, “It’s vital for people to feel this sense of autonomy, since infertility has taken control away from them.”
We followed up by asking Dr. Katz exactly what to say, just to make sure we’re being as sensitive, compassionate, and supportive as possible. She recommends the following words: “I’m here if and when you want to talk and out of respect for your privacy, I’ll wait for you to come to me. But I’m here.”