Not pregnant: How to cope with the news of infertility

According to the World Health Organization, approximately 17.5% of the adult population — roughly one in six worldwide — is infertile.

At the same time, the indicators in the report are comparable for high-, middle-, and low-income countries: 17.8% in high-income countries and 16.5% in low- and middle-income countries. That is, it is a serious health problem all over the world. At the same time, the authors of the report note that there is a lack of statistical data on infertility in many countries and some regions.

WHO considers infertility "a disease of the male or female reproductive system defined by failure to conceive after 12 or more months of regular unprotected intercourse."

According to the WHO report, infertility "can cause significant suffering, stigma, and financial hardship, affecting people's mental and psychosocial well-being."

At the national level, there needs to be better health policies and public funding for infertility treatment to improve access to such services, says Dr. Pascale Alloti, Director of Sexual and Reproductive Health and Research at WHO.

Ukraine has a state program for infertility treatment using assisted reproductive technologies (ART) with budget funds. According to the program, women aged 19 to 40 who have absolute indications can receive the first fertilization attempt free of charge, which will be paid for by the state.

The number of participants in this program is extremely limited. Only women with several specific pathologies (and there are dozens of them) can take part in it, and it can be only one attempt at extracorporeal fertilization (IVF). At the same time, this method of becoming parents is only suitable for some couples, and its success rate is not at all 100%. In a private clinic, one such attempt will cost tens of thousands of hryvnias.

Some couples go through adoption, which is also not easy.

If all attempts are futile, ultimately, the solution is to live with your pain, accept the actual state of affairs, and continue living life to the fullest.

Rubryka spoke with Nataliia Lazarenko, a systemic and family psychologist, art therapist, and consultant in an integrative approach, and a writer, the author of the books "Not Pregnant" and "Mom" based on real-life events Karina Savaryna, about how this can be achieved and how to reduce the level of stress in the case of infertility.

"Now, my condition was starting to scare me. I was slipping more and more into the unknown. For some reason, everyone around me got pregnant, but I didn't. Maybe it was really necessary to turn to God or Mercury? To the stars? Do you need to rethink everything and look inside yourself? I did something different than everyone else. Why can they get pregnant, and I can't? Why doesn't anyone count the days of the cycle, think about the best hours for conception, and throw their feet up to the ceiling after sex? Some don't even know what the word "ovulation" means. And I knew. I now know almost everything about my body. I control everything. I'm writing it down. I count, but I have no idea why I don't get pregnant" — an excerpt from the book "Not Pregnant."

Savaryna wrote her first book, "Not Pregnant," when her adopted daughter Marusia was already one and a half years old.

"I had a pregnancy planning diary, and occasionally, I wrote some stories there. She was not going to show it to anyone. At some point, she unfolded it again. And suddenly, I realized that I was changing, and I was a different person, and the previous person was floating away from me somewhere far away. I have to do it now. To write a book from which people will understand how people who plan pregnancy live. After all, thousands of women put leeches and other things because they don't know what to do after evidence-based medicine, after everything they've been through," says Karina Savaryna.

This book is about how a young girl tries to become a mother. She unwittingly turns five years of pregnancy planning into a personal hell. It is, as the abstract says, "a story about visits to doctors, healers, fortune-tellers and psychics; double life in social networks; operations and artificial insemination; adoption thoughts; emigration to Montenegro and return to Ukraine."

"…The column sang quietly, and these vibrations found their destination. I began to switch from thoughts about the sofa, Instagram, Facebook, gynecologists, and psychics to some stream of inner consciousness. I felt how tired, exhausted, and tense I was. A thought about love for the world, of which there were two or three drops left in me, flashed by. I hated every pregnant woman around me and this injustice that fell on my shoulders. Why not me and why me?" — an excerpt from the book "Not Pregnant."

Savaryna wrote it in 60 days, during the hours when the child was with the babysitter.

"After 60 days, I lay on the floor like a dead fish for three hours. I couldn't say or do anything because having written everything from the beginning, I myself was in shock, how I survived," Savaryna shared with Rubryka. "I am a very emotional and hypersensitive person, and this was explained to me later by a psychotherapist. It was tough for me to go through all this. It may be easier for some. Maybe another woman who can't get pregnant finally says, okay, I won't do this anymore. I'm going to live my life. I'm not like that. That's why I recommend writing these diaries, because every day it frees you a little bit, it will make you feel better."

But this does not remove the need to work out the problem with a psychologist or psychotherapist, says Savaryna. She is glad she found a specialist who helped her overcome this challenging experience.

Everyone's situation is different, so Savaryna gives advice only to herself, as she was during five years of unsuccessful pregnancy planning:

"First of all, Karina, you don't need to quit all your jobs and obsess over this issue. Continue to work, do something, add new hobbies, learn a language, and unload your brain from this problem."

Secondly, she advises doing regular sports so as not to go into depression. This helped her later, and now it has become a habit: swimming pool, running, and some physical exercises at home —something she constantly does because she doesn't want to return to depressive episodes.

Savaryna brought herself to a difficult state by simply freezing, doing nothing, losing all her friends, not working, not doing sports, and just going deeper and deeper into this well.

Therefore, do not give up on life.

Thirdly, if there is an opportunity, she advises finding a psychotherapist or psychologist. It is individual, but if you don't like the psychotherapist, please don't stop and look for someone appropriate for you. Therefore, first of all, help yourself physically and mentally.

Fourth, of course, talk to your partner. Savaryna also wrote in her book that she did not immediately understand that she was not the only one here. And then sit down and assess the situation based on the financial situation.

Systemic and family psychologist Nataliia Lazarenko first advises the couple to undergo all the necessary examinations, rule out biological dysfunctions of the body, and contact a reproductive specialist.

"Let the gynecologist and reproductive specialist be your best friends. You should have your own verified contacts, those doctors with whom you feel comfortable and nice to work," Lazarenko addresses the women.

You can ask for such support during visits to doctors if these visits are emotionally exhausting and a woman doubts herself and her ability to have children, says Lazarenko.

The help of a psychologist is also needed, the specialist adds, when a woman is diagnosed with infertility, but she really wants to have children and cannot realize this, understand, live, and let go of this situation, find herself, and develop in some other direction, eventually switch to something different.

You always need to support and love yourself, the psychologist reminds. You should accept yourself as you are and know your weaknesses and strengths.

In a situation of infertility, you can allow yourself to cry for a while.

Those tears are not so terrible as stress and feelings that can live inside a woman, but she does not want or cannot, due to some circumstances, give vent to these emotions, Lazarenko warns. "I always promote self-love because it means loving yourself in the moments of your glory and when we are not at your best: when we have fallen, we are hurt, when we want to cry, and when we are angry or annoyed."

That's when you need to show this love for yourself as an understanding of your emotions and needs here and now. What am I missing? What do I want now? What am I striving for? Such self-analysis and self-reflection are self-knowledge and self-perception.

A psychologist will help in understanding and experiencing emotions.

Lazarenko, as an art therapist, uses appropriate techniques. For example, use a metaphor to depict yourself: What do I look like when I want to but cannot have children, like a cuckoo or a bird without a nest or a bee without its hive?

You should always remember that this is pain, and it is important for a person to talk about it and live it. A psychologist's support involves helping a person accept pain, not suppress it or disguise it as something else. Living through pain, we climb to a new level of our development and grow up. And when we grow up, we no longer perceive this situation so critically, explains the psychologist.

In a situation of infertility, a woman can imagine herself as empty, incapable, as if she has no continuation, that she is somehow defective, inadequate, not feminine, says the psychologist.

"I suggest women look at this situation from a different angle. A woman's task is primarily to build relationships, not to give birth to children. 'I' and my needs come first, my relationship with my husband comes second, and our joint children come third," Lazarenko says.

Motherhood is one of the possible social roles of a woman, along with businesswoman, worker, daughter, sister, or many others.

Femininity and motherhood are not related to each other, and this again needs to be realized and separated, says the psychologist:

"As a woman, who am I? As a woman, how do I feel? What is my purpose as a woman? What other plans do I have in life besides wanting and not being able to have children? What do I want to do?"

You should not just write these points but start implementing them in your life.

It is worth remembering that sometimes the desire to have children is imposed on us, and we need to monitor: do I really want to have children and why do I want to have children, emphasizes Lazarenko.

When a woman fully realizes herself, it can be her decision not to have children.

The psychologist highlights one more factor. Sometimes we think, 'Well, we'll still have time to have children.' And when a man or a woman learns that he or she cannot have children, it becomes like a forbidden fruit — the desire to have a child increases, and they become obsessed with it. What is not available to us usually increases our interest and motivation — this is how our psyche works. The forbidden fruit becomes the most delicious. This factor must be taken into account.

"It's hard to explain your desire to become a mother to a man. They don't get pregnant. He looked at me with frightened pity. Perhaps I have already crossed the line and entered the stage of becoming a mother at any cost" — an excerpt from the book "Not Pregnant."

In addition to biological motherhood, a woman can provide psychological support to others who need it — it can be both children and adults.

Lazarenko explains that the function of psychological motherhood is to give what we want to give to our children: kindness, care, feeling needed. Sometimes, women themselves say: "I want to give birth to a child because I want to feel needed." This is not about the need for motherhood but the need to be needed. These needs should also be distinguished. A psychologist or psychotherapist also helps to figure this out."

In addition, many illusory ideas about motherhood are imposed on us from social networks (and, by the way, the book "Not Pregnant" is also partly about this), from films that broadcast the image of a happy mother, for whom being a mother is pure pleasure and joy, says the psychologist.

But it's hard work: getting pregnant, carrying a child, feeding it. Very often, women who have children burn out in this daily work. A woman mustn't idealize motherhood.

The psychologist also says that some women refuse the option of IVF (extracorporeal insemination) as if they consider themselves incapable of getting pregnant, saying: "It's not my destiny to get pregnant." But then, after working with a psychologist, they change their view to a different one: "Why not? And why is this not an option?" There is always the option of adopting children. The specialist also reminds: "It's about acceptance: 'I accept this situation, I will have it differently, in a different way, but I will achieve this goal.'"

The psychologist emphasizes that it is worth remembering that you should not impose yourself if a person does not ask for help. We must believe that a person will manage on his own. If they don't succeed, we can give them some idea of how to survive and overcome this situation, but in no case do not impose your help in the sense of "let's talk, you will cry to me, oh you poor thing." In no case should you feel sorry for this person and thereby create an inferiority complex for them.

Savaryna's book lists 15-point phrases that she does not recommend to spouses, women, and men who do not have children. Of course, this also includes the question "When are the children?" and expressions like "Everything will be fine," "God's will is for everything," and so on. The author says: "A question about children is ALWAYS INAPPROPRIATE." If a person decides to share their difficult situation with you, just say: "I'm very sorry that this happened to you." But inappropriate expressions still happen. What to do so as not to react painfully to them?

Lazarenko advises: "Write down all the variants of phrases that affect you emotionally: everything that hurts or annoys you. We count on our awareness: when I write down and read these phrases, they will no longer seem annoying. It's about changing your attitude."

Working with a psychologist can help you find inner resources and support, so other people's comments will not destroy your sense of self-worth.

The heroine of Savaryna's book, published in 2020, claims: "We sit in the corridors of hospitals, on pregnancy planning forums, many clinics have been built for us, where IVF is performed, we roar, looking at one strip on the test, but we are not we appear in the spaces of beautiful Instagrams, they don't write about us on the covers of magazines, I haven't seen a single article about a happy life with a long pregnancy planning."

What is the situation after the book is published?

The first is the largest and purely non-public. There are about a thousand such reviews, private messages, and long letters.

"These people will never publicly write that they have read my book because they live in it and don't want to show it to anyone else. Almost all of these letters begin with the words: 'It's like you wrote a book about me' because their path is very similar. These feelings that you are somehow wrong, you are not a woman, not a person, and everything else," shares Savaryna. These reviews helped her to persevere.

The second type is feedback from public people. For example, there are book bloggers who empathize with such stories, and their comments are quite warm. "This is a smaller part, but they also help me," says the writer.

The third type of feedback is purely public.

Savaryna shares: "I did not receive a single personal letter with the words: 'Why did you say that we cannot get pregnant?'. And these people come publicly and say that this terrible person wrote a terrible story about a terrible woman. Like, you are childish. You are fixated on the child as if there is nothing else. I have been a mother for six years, but people reading this are living like this right now. And this offends them."

Another category of people who read the book and advise others, according to Savaryna, are psychotherapists, psychologists, obstetricians, reproductive specialists, and gynecologists.

The writer adds: "My psychotherapist has been with me for three years. She is a former psychiatrist. So, she tells me: 'I recommend your book not only to people who cannot get pregnant but also to those who are fixated on some problem. People who read to the end find a way out in their own way.' I had clinical depression, and it was a fixation on some problem, which I got out of."

Savaryna shares that when doctors tag me in these posts, she gets hopeful she has made it easier for someone and sticks to that.

"I was sitting in a cool half-dark corridor of the city hospital with other unfortunates. Here they are, my kindred souls or, rather, bodies. Bodies that do not want to give us the dream child. Bodies we'll do anything with just to see that second strip. They were tired women without joy on their faces. It was as if we were dying — pale faces, swollen eyes from tears. It was us — the other side of the pregnancy planning coin. In a very short period, cute girls turned into nervous, prickly people" — an excerpt from the book "Not Pregnant."