There is an all-too-common pain that many hide. It affects emotional well-being. It affects self-image. It affects health. Now that the new year is upon us, advertisements for “new year, new you” aren’t far behind. That can spur people to make health care appointments that they’ve been putting off. This is a good time to address this pain that so many carry silently. This silent pain results from infertility, pregnancy loss, being childless not by choice and, by extension of childlessness, being grandchild-less. The truth is that even though you may not have experienced any of these yourself, you probably know someone who has. One in five women experiences infertility. About 15 percent of pregnancies end in miscarriage. It has been estimated that about 10 percent of women between the ages of 40 and 44 are childless, not by choice. Last year the U.S. Census Bureau released its first-ever report on involuntarily childless adults. The study found that nearly 1 in 6 adults aged 55 and older are childless. Infertility, pregnancy loss, and involuntary childlessness are situations that cause immense pain. If you don’t know someone personally experiencing these heartbreaking issues, you definitely have patients dealing with this. For so many, the holiday season highlights the sense of grief coming from loss. Generally, the pain of loss after the death of someone is well understood. For some, it can be hard to move past the concrete view that a loss is only of a human you can touch and feel. So, it can make it very challenging for some people to understand the pain of loss if the loss is of someone who didn’t exist. But that pain is present, real, and devastating. Add to that guilt because there are often messages from different sources that are then internalized — messages that someone else has it worse. And those messages turn into “just think positive.” There is an unfortunate consequence that results from this demographic that is growing. Often there’s a lack of support from family, friends, colleagues, and even mental health professionals, some of whom are unaware of the emotional trauma that comes with infertility, pregnancy loss, and involuntary childlessness. Part of the pain of undesired childlessness is the loss of the future that was planned. For some, that future is actually in the here and now. For those who are aging without children (AWOC), the pain is accompanied by fear. Fear of who will take care of them if they get sick. Fear of being alone, of feeling like an outcast. It can be incredibly lonely. A common situation for those who are AWOC is isolation. The holiday season compounds this. Why does this matter? This all has far-reaching consequences. As we know, emotional pain can manifest as physical symptoms. That’s true for the pain of fertility challenges as well. It can result in anxiety and depression, but women will often remain silent about the underlying issue. Unfortunately, there still remains a stigma associated with anxiety and depression. That stigma and shame are compounded in women who have infertility, pregnancy loss, and unwanted childlessness because women are still wrongly judged by fertility status. As a result, this emotional pain is frequently hidden by women. Talking about infertility, pregnancy loss, and involuntary childlessness isn’t easy. It’s also not always clinically relevant. In fact, when it’s not clinically pertinent, then probing questions, particularly biased ones or judgemental comments, shouldn’t be part of the discussion with a patient. When it’s clinically appropriate, though, address the issue of reproductive history in a nonjudgmental way. The point of this isn’t that a deep dive is necessary for each patient. Ask first if it’s something your patient wants to discuss. The point of asking is to gain an understanding as to whether anything about reproductive history is having an impact on your patient. Are they AWOC? Do they have support? For those patients who are struggling as a result of their fertility history, there is support available. There are support groups, therapists, and coaches who can assist. A few gentle, considerate questions can make an enormous difference in helping your patients. What’s the significance of this when it comes to your colleagues? Almost 1 in 4 female physicians experience infertility. Awareness is now being raised about the toll on reproduction as a result of long work hours, work stress, and sleep deprivation. In addition to the effects on fertility, these same stressors also play a role in adverse pregnancy outcomes. I’m not suggesting that you press your colleagues with questions about their fertility status. But recognize that they, too, may be among the group of women dealing with these issues and are suffering as a result. The work environment may be a contributing factor. More attention to the concern about fertility health among female physicians is needed — as are compassion and understanding. The statistics regarding infertility and involuntary childlessness reveal a great need for your patients and colleagues. Acknowledging this loss and the associated grief is vital to providing help. Empathy and kindness are essential. Source
