There’s always good news and bad news, isn’t there? First the good news: egg retrieval went excellent. They retrieved 12 eggs! I was shocked and happy. Really I was riding cloud 9 for the rest of the day, feeling confident and excited. Then I waited for my fertilization report the next day. Last time I had a great fertilization rate so it didn’t occur to me to expect anything less. But then the call came and I was hit with the bad news. Of my 12 eggs, 8 were mature (not bad) but only 4 fertilized and are still alive. I literally lost my breath. How could this have happened? My nurse explained that 3 of the other eggs died immediately after being fertilized and the other one is barely hanging on so they don’t expect it to make it. Given these outcomes, she said they believe it’s due to egg quality. And there it is again – my age.

After I got this news I started to go through some familiar reactions. I remember feeling these ways at various points the last time I did IVF too. I’m going to call this the Stages of Grief – IVF Style. These are not based on research, just my personal experience as a mindful psychologist. But I venture to say that if you have ever been through infertility treatment, you will no doubt recognize some, if not all, of these stages.

Stage 1: Emotional Tidal Wave.  As soon as I heard the bad news I was hit with a wave of intense emotions. I could literally feel them hit my body. Sadness, fear, disappointment, shock. I went from confident that IVF will work to the stark realization that I may not get a baby from this. In fact, it felt like I had already failed. My heart pounded, heat flooded my body, my stomach and throat tightened. It was like the floor fell out from under me. These are uncomfortable feeling. Really uncomfortable. Because it’s so uncomfortable it’s easy to slip past this and move on to the Second Stage: Anger. Anger is a secondary emotion that often masks primary emotions that are felt in Stage 1 because anger, although far from pleasant, is easier to deal with.

Coping in Stage 1: First I want to note, that these stages may not always be linear. I found that I actually circled back to Stage 1 after I moved into Stage 2. And that’s a good thing. It’s healthy to feel and work through the tidal wave of emotions. So even when I moved on to anger, eventually I circled back to deal with what was actually underneath my anger. And I had a good cry. The release felt good. It’s important to acknowledge and sit with these hard emotions. We need to feel to heal. That doesn’t mean that we want to get sucked in despair for long periods of time. When these feeling become overwhelming for too long, there is an increased risk for depression and anxiety, which is understandably common with infertility. Some other things that can help in this stage are talking to a supportive person, creative expression of grief (e.g., writing), mindfulness practices, and meditation , to name a few. These are all practices that help you experience emotions without hiding, denial, or escape and can help process the emotions to lessen their power.

Stage 2: Anger.  I switched gears to focus on anger. This change happened automatically as I pushed past my sadness. Anger that my supplements didn’t work better. Anger at my age. Anger at my reproductive endocrinologist (RE). Anger at the embryologist. Anger is a fiery emotion. It’s easier to deal with because the other emotions can be really dark, scary, and isolating. Both feeling and expressing anger is highly influenced by culture, gender, and religion. For me, in my culture, anger is acceptable. Due to the intense energy of anger, people are often motivated to action. Anger made me second guess my doctor’s protocol for me. Why didn’t he include HGH during my stim cycle since he knew egg quality was an issue? Would my eggs have fertilized better if we used natural fertilization like we did during out last IVF rather than ICSI? Did the embryologist damage my eggs during ICSI?

Coping in Stage 2: When anger is front and center, it’s important to funnel that in a healthy rather than destructive manner. Don’t lash out at your partner. This isn’t their fault. Similarly, don’t take it out on yourself. You really didn’t do anything wrong and you don’t deserve this. For me, getting out in nature helps me diffuse my anger enough to help me focus it productively and move into stage 3. I find going for nature walks, taking some calming breaths under the moon, walking a labyrinth or using my hand labyrinth, or talking a bath can help calm my anger. Any healthy distraction will do.

Stage 3: Research and Planning. Fueled by anger and armed with 100 questions, like every determined IVF patient, I rushed to the internet. Google and Facebook groups are both a blessing and a curse for IVF patients. I found support and comfort from women who had experienced just what I had. I read stories of women who similarly had just a few embryos and those embryos made it to biopsy and were found to be normal. These stories were comforting, reassuring. I also saw so many women that had canceled cycles due to poor response or ended up with no embryos after retrieval. These stories made me feel grateful for the chance that I still have. I learned that a 50% fertilization rate for a practically 40 year old is actually really good. Why didn’t my RE tell me that ahead of time? But not all of the things that I found on the internet were helpful. I discovered that, contrary to what my RE had told me, ICSI isn’t necessary for PGS testing. In fact, the newest biopsy technologies allow for either type of fertilization. I was irritated that my RE hadn’t informed me about that option. One women even suggested that my RE’s motives were questionable for recommending ICSI without a sperm quality issues (suggesting he did the procedure for the money) and recommended I find a new clinic. Wow. I had to step back. Literally back away from the computer. I had to stop jumping to conclusions and acknowledge that there are several reasons why my clinic prefers ICSI, and that the internet did not know all of the factors in my infertility. But I did learn some new and good information, so I wanted to be productive with that. I turned all of my second guessing and research into reasonable questions that I tucked aside to discuss with my RE if we end up needing to do another round of IVF. I turned my anger into something productive, and I set the product aside for later. For later. Because there is nothing that I can do about it now.

Coping in Stage 3: I think the trick to this stage is finding that balancing point between constructive and destructive, and staying on the constructive side. I can use the support I find from others in online infertility communities to help me manage my reactions in stage 1 and 2, and use the information I learn from them to help me compose a list of questions for my RE. Armed with a list of questions and ideas for things to try differently next time (should we need a next time), I feel empowered. The trick, however, is knowing when the internet becomes your enemy. And it does eventually happen. People give “advise” and don’t have all of your medical history and may be making recommendations that are beyond their training and qualifications. It’s easy to catastrophize and self-diagnose with infertility problems that you don’t actually have. At some point, I think it’s important to make a decision about whether you trust your RE or not. Certainly some clinics are pretty questionable and it’s important to be your own best advocate. But at some point, if you decide your RE is qualified and good, you have to put your trust in them, and remind yourself of that when times get tough. Asking questions and being educated is important, but you also have to be able to be honest with and trust the person that you are working with.

Stage 4: Acceptance. That brings me to acceptance. The realization that what’s done is done. I cannot go back in time and change anything. I’m not even sure if changing anything would have led to a better outcome. So I had to let it go. The fact is, I have 4 embryos growing. I know they might not all make it to day 5 or 6 for the biopsy. I know that drop off is normal from day 1 to day 5. I certainly experienced that before. If we are lucky enough to have some continue to grow and be biopsied for PGS testing, I don’t know what the results will be. I do know the statistic that 60% of embryos at my age are abnormal, but that is an average that does not tell me what my results will be. So there is nothing I can do but accept what has been done, and wait for what will be.

Coping in Stage 4: Once you have your list, it’s important to set it aside and focus on the present. There is nothing you can do to change the past. Regrets and worries won’t change the future. All the worry in the world won’t change the outcome, it will just drive me crazy. I remind myself of that to find acceptance.

Stage 5: Hope.  At some point during IVF we find ourselves in complete despair. Hope is absent and no glimmer of it can be seen. We don’t know how we will ever find hope again. Yet we do. It’s what keeps us going. Somehow, after I accepted where I was in this, stopped trying to change it or fight against it, I’ve found a way to regain my hope. I’m focusing on my 4 little possibilities. Hoping that one of those 4 embryos will be strong and healthy to become my baby. I remind myself that it only takes one.

Coping in Stage 5: How do you find hope? How do you hold on to it once you’ve found it? I’ve heard many women in this simply say that eventually it comes back. They just found hope again. It might be that mysterious. Some people find hope in their believes – spiritual, religious, or simply their unyielding desire to have children. Personally, I find a lot of my hope through my spiritual beliefs and connections. It’s something I hold on to or come back to when I’ve veered away. It’s familiar and comforting.

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So now I sit here, the day before I will find out how many of my embryos grew into blastocyst stage and were successfully biopsied for PGS testing, and somehow I managed to make it all the way to stage 5. I’m hopeful that I will get good news tomorrow. I’m hopeful that one of those tiny 4 embryos will eventually become my baby. And I wait.