Miscarriage is a unique and often stigmatized experience. Because of the lack of conversations about it in society, the emotional burden is not well understood and often underestimated. Although a miscarriage is common and not necessarily a medically serious issue (it can be, but not always), it can still take a huge emotional toll on someone. 

Many people struggle with getting the support they need from friends and family, and the trauma is often not only rooted in what happened, but also in how the experience was (or rather wasn't) validated or dignified by others. 

Therefore, if someone you know has suffered a miscarriage, it may be valuable to understand how the you can support them. 

Miscarriage can be very lonely because although it feels like a loss for the person it happens to, society has traditionally not allowed it to be grieved openly; there are few norms or ceremonies honouring this kind of loss. You may worry that you will say the wrong thing ot think that it’s best not to say anything. However, simply acknowledging the loss can really help. Let them know that you’re sorry for what has happened and that you are there for them. 

In fact, it is often appreciated if you treat it like any other loss and do the same thing you would if someone for example lost their father, for example sending flowers or a supportive text message. 

Listen, don't give advice - and choose your words carefully

When someone you love is sad, it’s natural to try to help out by giving them advice or trying to encourage them that it could be worse and will work out in the end. Despite these comments coming from a good place, what people in mourning need the most is someone who just listens.  

Unsolicited advice or stories about other people's miscarriage experiences, even when it’s meant with good intentions, can be triggering and even condescending, and backfire for you both. Try to only share information if your friend has vocalised that this would be helpful.

And avoid comments like "“I’m sure it will work out for you” (how can you be?), "At least you weren't farther along", "You can always try for another one”, "You're still so young", "Stay positive" or "Everything happens for a reason". You may be trying to say something comforting, but it will most like come off as though you’re not taking what’s happened seriously, and just make the person feel alone. 

"After a while of being told what I should be feeling (positive and hopeful), I just stopped telling people how I was actually feeling (hopeful but really sad) - it was much less triggering to just cry alone on a park bench."

Try to remember that it can be difficult for people who have lost a pregnancy when others become pregnant or have babies.

There’s no need for you to feel guilty about sharing happy news, but if you know that it can be triggering and that it can remind them of their loss, you can be sensitive about these feelings. You can let them know that you understand and don't expect them to be interested or involved if that's tough for them. 

A miscarriage can take time to heal, so even if the person stops talking about it you can check in to see how they are doing even after a while.

Should they become pregnant again that will also be a time of worry, and it's appreciated if friends acknowledge that. 

How to support someone after pregnancy loss or miscarriage

How to support someone after a miscarriage

At Tilly, we’re passionate about helping anyone who is struggling to have children. Together with Linn Heed from Coupleness, we’ve put together the guide "Doing anything to have a child; how do you take care of your relationship?" which contains a number of concrete tips for couples facing infertility.

2. Elin - what do you like most about Mario?

His humor. We laugh a lot together and that's really important, especially when you go through something difficult.

3. Mario - what do you like most about Elin?

Boring perhaps, but the answer is the same for me. Not a day goes by without us making each other laugh and that's absolutely magical! 

4. When did you realize that having children was not going to be easy? Did you react the same way? 

After about nine months, Elin began to suspect that something was wrong. She started reading up on how how we could optimise our fertility on our own while we waited to get help from the health system. Each cycle and round of PMS became worse than the last because they all meant that we hadn't become pregnant - again. After a year and a half (it took a little longer due to the outbreak of the pandemic) we finally got to do a fertility investigation at the Reproductive Medicine Center in Malmö. They told us that Mario didn't have any sperm in the semen, so-called azoospermia. It was a huge shock for both of us. Mario felt that life was drained of all meaning and both of us just felt it would never work out for us. We would never have children. It took a while to get past that shock and eventually we began to look into which help was available.

5. Fighting for a child can mean a lot of stress and grief. What are your best tips for supporting each other? 

It's been really special to struggle with infertility while there is also a pandemic going on in the world. Infertility is one prison and the pandemic yet another. Still, we tried to stay activated and to continue to make fun memories. Of course, that's easy to say and harder to do - we were also very sad and talked to a lot to each other about that.

We went to the summer cottage and renovated, we started a sauce club and cooked us through all the classic sauces, and we went on a road trip. Our best tip is really to try to create great memories. If, for example, a day is filled with anxiety - accept it but try to do one little thing like driving to the ocean for a dip or have a cup of coffee in a park. Then you can remember that one little happy thing instead of the anxiety even though you actually cried on the sofa most of the day.

Another tip is to make time for walks that you dedicate to talk about the fertility process, your feelings around it and your relationship.

"It's easy to assume you understand how the other one is feeling because you know each other so well, and therefore forget to ask. But a question can open so many thoughts and bring you closer together."

6. Is there anything you've felt completely different about along the journey and how have you handled that?

More than feeling differently, many times we have been at different phases of our process. When something felt ok for Elin, Mario struggled and vice versa. 

It can be both positive and negative not to be synched. Positive in the sense that you can support the one who is feeling down, negative because it's easy to come off as you don't understand. You simply have to try to really listen and understand each other, let each other feel anything.

Did you know that couples who go through multiple fertility treatments are up to three times more likely to separate? Scheduled sex, feelings of inadequacy and shame, and different ways of dealing with with the challenge are some of the problems that many face. Elin and Mario tell us about their journey and share their tips for how to nurture love and a healthy relationship when you're forced to fight infertility and IVF.

Elin & Mario - How to take care of the relationship when you struggle with infertility

Almost 3 years. And we've been doing IVF for half of that time. 

2. Amanda: What do you like most about Magnus?

Magnus is an incredibly warm and kind person, and he's truly great to talk to. He's a really good listener, never judges and gets along with just about anyone. He's also very funny and make people around him feel at ease. One thing that's been important throughout our IVF process, is also his ability to focus on the way forward and what he's grateful for, regardless of the situation. He makes me feel seen, valued, and loved every day.

3. Magnus: What do you like most about Amanda?

There are  many things I like about Amanda, one being her ability understand other's perspective and situation.  That's not only very attractive, but also reassures me that we can always sort things out between us. I also love is her social skills. She can have fun with anyone, but also love deep conversations where she's equally curious about others as open with her own experiences. Also, Amanda's mischievous side should not be forgotten. I love her sarcastic humor as well as fiery outbursts. The contrast between her serious and integrity side and her humorous and mischievous side is absolutely amazing!

4. When did you realize that having children was not going to be easy? Did you react the same way?

We knew from the beginning that children would come easy for us. I (Amanda) have known since I was about 20 years that I would need help if I ever wanted to become a mother. 

I didn't have a period and when I go tested, they found a sky-high FSH value (100 in several measurements). They first suspected POI (premature menopause), but then they saw that I had tons of follicles on my ovaries so that wasn't it. Over a year, I did a large number of examinations, from brain CTs to lots of blood tests, but they couldn't find an explanation for my absent period and high FSH values. 

I met Magnus when I was 31 and it was the first time I felt that I met someone I wanted to start a family with. Already on the second date, the question came up and I told him about my challenges. At that point, Magnus was mostly happy that I shared this with him and I don't think any of us really understood the width of my issues and what an IVF journey would mean at that point. 

We continued to date, and partially because we knew we needed help, we started planning for real quite quickly into the relationship. After about 8 months I (Amanda) contacted my diabetes clinic to understand if there was something I had to consider since I have type 1 diabetes. And a couple of months after that, I went off the pill (which I was on due to low estrogen levels). 

For the first 3 months, we both had some kind of naive hope that it might work without any help. But then I read my journal and started to understand what my diagnosis means for real, and only then did I understand that we should seek help as soon as possible. After three more months we got an appointment at a fertility clinic and go to start IVF immediately. 

At that first meeting with the clinic, when the doctor told us about our odds and that we may not succeed with my eggs, is when it hit us both for real. I (Amanda) felt afraid and sad, I gelt guilty and I guess some kind of suffered from fear, sadness, guilt, and a kind of existential anxiety. There were many questions about what life would look like without children and I very much felt like less of a woman and that Magnus deserves better. I started to educate myself and became very focused at "fixing" the problem as soon as possible. I ended up in a mild depression for a short period of time, and I was very jealous of my pregnant friends making me feel isolated. 

Magnus did not react as strongly, partially because the issue was not his in the same way. For him, the focus was to support me (Amanda), and he tried to stay strong in front of me not t make me feel more guilty. 

After a few months, we got out of the worst crisis and grief and I started to feel better. We found our way of handling the whole thing and some kind of acceptance. Now we share both joy and sorrow, and Magnus dares to show all his feelings which is so much better. 

It may sound obvious, but we think the most important thing is to talk to each other, and share all thoughts and emotions. Don't ever take for granted that you understand what the other person feels, it's always better to ask. 

"When you're not feeling great, it's important to feel that your feelings are ok, to feel seen. For me (Amanda), it's been very important that Magnus has always tried to understand even when he hasn't felt the same way." 

And remember to share positive emotions too - like when you feel joy or hope. It's been really important for us to actively verbalise what we are grateful form and to continue to do things we like and that gives us energy. Like arranging romantic dinners, working out together and travelling. To touch each other, sit close to each other on the couch, and continue to have sex has also been important to make us feel like a team. 

Lastly, we've felt it's been incredibly valuable to talk to people around us about what we're going through. One person can never give you everything you need, and it's important to have other people to talk to as well. 

6. Have you introduced any new routines that have helped you?

We've made sure to ask each other how we feel - a lot. And we've made a habit out of booking a small trip close to the test date - to give us time to be together and either celebrate or mourn together. 

Another thing is that Amanda always calls Magnus immediately after each visit at the fertility clinic to debrief Magnus about how it went. In this way, Magnus has felt a little more involved even though he wasn't allowed to come along due to covid. 

7. Is there anything you've felt completely different about along the journey and how have you handled that?

“We have very different experiences of guilt. I (Amanda) have felt very guilty because I'm the reason we need to go through this - a feeling that Magnus hasn't experienced. We have handled this by talking openly about it and simply allowing and accepting the guilt. Magnus has listened, confirmed that he understands and that it’s ok to feel this way. And only after that, he's said that I don't have to worry because I'm the one he wants to live with, and that he knows that our issues are beyond my control so he doesn't see it as being my fault at all. Much better than just saying “Don’t feel that way”.”

There is a lot of talk that having children can pose challenges for relationships. But strangely enough, there is almost no discussion at all about what a challenge it can be to try to have children, and what that can mean for the relationship. This is despite the fact that there is a lot of research on the high stress levels infertility causes and the pressure it puts on the relationship. In this article, Amanda and Magnus tell us about their journey and how they take of each other throughout all their challenges. 

Amanda & Magnus - IVF and relationship challenges 

In this article we will go over a few different topics:

1. How many days should an embryo grow for?

When you conceive naturally, the fertilized egg takes a short but crucial several-day journey through the fallopian tube into the uterus. Throughout this journey, it develops more cells, and once it reaches the uterus, it makes its way to the uterus’s wall (the endometrium) where, if all goes well, it should attach.

During the IVF process, it’s up to the laboratory to grow the embryo before transferring it back into your uterus. To do this, the clinicians need to replicate the environment within the fallopian tube and uterus so that the embryo grows as it would inside the reproductive system. It’s not an easy job and until just a decade or so ago, laboratories could only grow (or ‘culture’) embryos to the ‘cleavage’ stage during which it has just five to eight cells. 

Today, it’s possible to grow embryos to the ‘blastocyst’ stage, which is reached around day five to six. At this stage, the embryo has developed at least 60-100 cells and can be differentiated into a cell mass, which will become the fetus and an outer layer (or trophectoderm) which will become the placenta. 

Only the most resilient embryos make it to the blastocyst stage and so it’s a good way to ensure your embryo has good developmental potential. However, it can mean losing a lot of embryos that cease to grow in the petri dish (known as ‘arresting’). 

Having the option to grow your embryos to blastocyst stage does not necessarily mean you should. Despite knowing what we know about the journey the embryo takes before implanting, the debate is still ongoing over whether or not patients are more likely to succeed with blastocysts.

That most IVF cycles produce more cleavage embryos than blastocysts is where the difficulty lies. Of course, each embryo presents a possibility for a transfer and ultimately, one hopes, a pregnancy. The fewer the embryos, the fewer opportunities to transfer. 

With that said, if you look at a single transfer then transferring a blastocyst does tend to increase chances. Below, we explain why this is.  

Blastocyst stage is reached at approximately five days and can result in a higher success rate per transfer; multiple studies have found it to be about 1.5 times more likely to succeed. And we all know boosting odds as much as possible is preferable. Even if the transfer itself is not medically complicated, it can be emotionally draining and you want the greatest possible chance each time.

Embryos that have chromosomal abnormalities will most likely not lead to a live birth. It is possible to genetically test the embryos before the transfer, and this is best done at the blastocyst stage. 

To screen the embryos, the clinic has to remove one or more cells from each embryo to test. It is more harmful to take cells from a cleavage stage embryo than a blastocyst embryo and so, if you choose to genetically test your embryos, they should be grown to blastocyst stage. If a clinic offers to test your cleavage stage embryos, this should set alarm bells ringing.

Whether genetic testing is the best course of action depends on a variety of factors. You can read more about that below.  

More likely to be lost along the way when growing them to blastocyst stage. For those who produce fewer eggs and embryos, this can increase the risk of a canceled IVF cycle. In other words, you may end up with no transfer at all.

While many doctors have suggested that blastocysts are sturdier and therefore more likely to survive the freezing and thawing process, none of the data is convincing enough to guarantee this.

Essentially it comes down to whether you choose to have more attempts or optimize a particular one. Studies so far that have used a broad patient group and all their attempts (i.e. haven’t looked separately at groups with different issues), don’t draw strong enough conclusions about which route will increase your chances. Day five is typically preferred if the egg retrieval has resulted in many eggs and there are more embryos to work with, otherwise, cleavage is recommended. Before you make a decision, have an informed discussion with your doctor taking into account your history and diagnoses. 

You may hear the argument that if an embryo doesn’t make it to blastocyst stage in the lab then it wouldn’t have resulted in a live birth if transferred to the uterus at cleavage stage. This is hypothetical because there’s simply no way of knowing what would have happened had the embryo been transferred earlier.

For those who don’t have the good luck to get pregnant quickly, you will soon realize that there is a degree of subjectivity with IVF. The decision about which stage to transfer the embryos can very much be based on your personal preferences, both physically and psychologically. Something that cannot be argued with is that a canceled cycle (when no embryo is transferred) will not lead to a live birth, and so it stands to follow that any transfer is better than no transfer at all. Or perhaps you have many failed transfers behind you and want to focus on optimizing chances for a specific transfer. 

To summarize - it comes down to whether you would rather grow your embryos to blastocyst stage knowing you risk the entire IVF cycle being canceled (but will have insight into why it failed as you will know the embryo likely wasn’t “competent” enough); or rather maximize the number of attempts (including waiting the grueling two weeks to hear the result). If you opt for the latter, you’ve at least had a shot at pregnancy; however, if it fails you will be none the wiser about whether it was your uterus or embryo that was the problem (perhaps even both).

Aside from deciding at which stage to transfer the embryos, the grading of the embryos is also a factor to consider - especially if you’re lucky enough to have many embryos to choose from.

Even if the grading can be expressed in different ways, clinics look at the same factors; two or three criteria are used by clinics to ‘grade’ an embryo to determine which one to transfer first. The criteria include looking at how fast the embryo is dividing and its morphological grading. This type of grading is somewhat subjective because it’s done by a human being, an embryologist, who could of course be more or less picky so to speak.   

Following successful fertilization, the sperm and egg grow into an embryo. From this point, the cells of the embryo should begin to rapidly divide; it’s the number of cells that determines the stage it has reached in its development (like cleavage or blastocyst). Most experts agree that the faster an embryo reaches a given stage, the higher the chance of success. For example, if an embryo reaches blastocyst stage in five days this is seen as a positive sign. However, embryos that reach blastocyst stage at six days shouldn’t be ruled out as they have been found to lead to live births. The same applies for patients considering a cleavage stage transfer: the quicker the embryo reaches cleavage stage, the more likely it’s considered to result in a live birth.

Morphological grading refers to an assessment of how “expanded” the embryo is and how many cells comprise the inner mass and trophectoderm. This is often graded on a scale that includes one number followed by two letters:

Expansion might be the first grade to be listed but that doesn’t make it the most important. The inner cell mass - the mass of cells that will eventually become the fetus - is the grade that best indicates the likelihood of success.

The nomenclature may differ between clinics but at the end of the day, they all refer to the same thing. If you feel unclear in any way, ask your clinic to explain it to you in simpler terms.   

So, on the whole, how indicative are these three morphological scores of a successful pregnancy? It’s not an easy question to answer because there is a certain amount of interpretation when it comes to the grading. And other factors than embryo grading of course also play a role. That said, studies that have looked into this do tend to offer two conclusions:

The better the embryo’s morphological traits, the more likely it will result in a viable pregnancy and live birth

Despite this, it is possible for embryos with a high morphological grade to fail while less morphologically perfect embryos can succeed

Grading the inner cell mass and trophectoderm is subjective and different laboratories may have different guidelines for grading. For this reason, there is no way of generalizing how often an embryo will result in a live birth - only your clinic can explain what your grade means according to their system. It’s always possible to request an image of the embryos if you want to seek a second opinion from another laboratory.

It might be frustrating but there are no definitive answers. Morphological parameters are often subjective and as we have discussed, don’t necessarily predict with much accuracy whether or not your embryo will result in a live birth. If you have PGT-A results (which you can read more about below), these can give you an additional indication of success.

Preimplantation genetic testing for aneuploidy (often known as PGT-A, and previously known as PGS) is a genetic screening test performed on embryos to check for abnormalities in the number of chromosomes. Any chromosomally normal embryos are deemed fit to transfer.

Before we get started, it’s good to know that if your doctor hasn’t previously mentioned PGT-A, this is likely because it’s not allowed in your country of residence. For example, it’s not available in Sweden where doctors argue there is no proof that it improves pregnancy rates. This is true when you look at a broader group of patients; however, this may not be so if you break down the group into subgroups of patients with different ages and reproductive issues. 

As is the case when deciding how long to grow an embryo, deciding whether a method is right for you is about weighing potential benefits against risks and costs.   

When the embryo has reached the blastocyst stage, a few cells from the trophectoderm are carefully removed by embryologists and sent to a genetics laboratory for assessment. The lab will use a machine to predict the number of chromosomes for each embryo and report back to the fertility clinic. The report will show whether an embryo appears:

‘Euploid’: it has the right number of chromosomes and is more likely to lead to a live birth so should be transferred first

‘Aneuploid’: it has an incorrect number of chromosomes, in which case will not lead to the birth of a healthy baby

‘Mosaic’: the test was inconclusive and it couldn’t be determined whether the embryo was ‘euploid’ or ‘aneuploid’ but may still result in a live birth (although there may be risks)

Any results will be relayed back to the patient and this information can be used to decide which, if any, embryos should be transferred. If the decision is made to transfer an aneuploid or mosaic embryo, the risks and implications should be discussed with a genetic counselor.

Not all eggs and sperm have normal chromosomes and thus can’t lead to a viable pregnancy. It might be that sometimes they don’t fertilize or that the embryo ceases to grow, but some still become blastocysts. These are unlikely to implant and if they do, the pregnancy is likely to result in a miscarriage. 

The number of eggs with normal chromosomes naturally declines as we age which is one of the reasons that it becomes harder to both conceive naturally and with IVF the older you are.  

Better odds of a successful transfer and implantation: Embryos that have been PGT-A tested and approved are likelier to result in a successful transfer and subsequent implantation. 

Less chance of miscarriage for older women: When it comes to older women in particular, who are more prone to having a higher share of chromosomally abnormal eggs, there is also less chance of a miscarriage if the eggs have been screened. This decrease is not as apparent among younger women.

Helps doctors diagnose other reproductive issues: If an embryo has been tested and approved at blastocyst stage and yet the transfer still fails (which most do), this may tell your doctor that the embryo was not the issue. They can then turn their attention to finding the true culprit, for example, an issue with the uterus.  Keep in mind: If an embryo grows only to the cleavage stage before the transfer, it’s not guaranteed that it would have made it to the blastocyst stage. It could be that the embryo had a chromosomal abnormality, but it’s impossible to know with any certainty as it won’t have been tested. As a result, there’s no way to determine why the transfer may have failed.

It’s just a test: Ultimately, the PGT-A is a test and not a way to improve the quality of the embryos. While it can help to determine which embryos are best to transfer, genetic screening does not increase your chances of getting pregnant.

It may impact the viability of the embryo: While the data has been somewhat reassuring, there is still no definitive answer to whether PGT-A testing harms the embryo. The jury is still out, especially when you weigh up the risks of this technique against its benefits.

No test is 100% accurate: There have been concerns raised that the test may mistake a euploid embryo (a good-quality embryo) for an aneuploid (a low-quality embryo). If this occurs, it can be particularly problematic for older patients who already have difficulties producing good-quality eggs.

It’s expensive: While it would be wonderful if money was no object, most often it is. PGT-A can be costly which is something to be aware of when considering this option.

Taking all of the above into account, it can be concluded that PGT-A is normally recommended to women over the age of 35 or to those who have suffered repeated implantation failure or repeated miscarriages without any obvious cause or explanation. 

It’s not unheard of for an embryo to fail PGT-A testing but show other positive signs, such as growing quickly and reaching blastocyst stage at day five, and being graded highly on its morphology. And vice versa, an embryo might be assessed as good quality by the PGT-A test but receive a low morphological grade and be deemed unpromising by embryologists. In these instances, the consensus is that PGT-A testing is more indicative of success and that euploid embryos give the best possible chance.

Growing embryos. Embryo grading & PGT-A. How many days should an embryo grow for?

It can be concluded that age affects a woman's fertility in two ways; by reducing the number of eggs and their quality, and by changing hormone levels, which affects your menstrual cycle.

Your egg reserve and egg quality decrease

You are born with millions of eggs, but these gradually disappear over the years, and when you reach puberty and begin to ovulate and menstruate (and become fertile), you have only around 400,000 ovaries left. It is often said that when you are around 30, you have about 12% of your original egg reserve left and at 40 the percentage has dropped to 3%.

This might sound scary and there is often a high focus on the number of eggs when talking about fertility, but staring blindly at your exact egg reserve is the wrong focus. The number of eggs is just one of the things that matter and, to get pregnant, you only need one healthy egg – it is more common that you have problems ovulating than that you have too few eggs. With that said, of course, a very low egg reserve means that the odds per menstrual cycle decrease. Especially considering that not all eggs can become a healthy baby. For an egg to be able to lead to a healthy pregnancy, it needs to have the right quality, meaning it has a normal number of chromosomes.

Just like all other cells in our body, the egg cells age and the proportion of healthy eggs decreases over time. Just like our skin becomes wrinkled with age, the egg quality gets poorer. If the egg or sperm does not have the right number of chromosomes, then either no fertilization takes place at all, or you get an early miscarriage. Not only does it become more difficult to get pregnant with age, but the risk of miscarriage also increases.

When you are around 25 years old, about 75% of the egg systems have a normal set of chromosomes. When you reach 35 years the proportion is 50% and at 40 years it has decreased to 10-15% – on average.

You can get an indication of your egg reserve by measuring AMH and by ultrasound. Egg quality is more difficult to measure proactively. With an IVF you can get more insights, but you would not do an IVF just to measure egg quality. So when we talk about proactivity, age is the best indicator.

Your hormone levels change along with your ovulation and menstrual cycle

The very last period, the end of a woman's fertile life, is called menopause and occurs on average at 51 years. The phase that leads up to menopause can start from a few years before menopause to more than ten years before and involves changes in hormone balance and the cycle.

This also has to do with the eggs, because as the number of follicles in your ovaries decreases, so does for example the amount of estrogen, as it is produced by the follicles. This in turn affects other hormone levels. When the pituitary gland in your brain senses that estrogen and other hormone levels are lowering, it tries to compensate by instead increasing the production of follicle-stimulating hormone (FSH), especially in the early follicular phase of your menstrual cycle. An FSH test that in that phase shows lowered values can therefore be an indicator that you are approaching menopause.

During these changes in hormone levels you can experience symptoms such as spottings between ovulation and your next period, and changes in the length of the menstrual cycle – usually the cycle first becomes shorter and then longer. This does not mean that you are not fertile at all, but it is a sign that it gets harder and harder for the body to ovulate (hence the irregular cycle), and ovulation is crucial to be able to get pregnant. A changed ovulation pattern is thus another way in which age affects fertility.

Do you feel like your days of being a social butterfly are behind you? Saying "yes" to attend certain events fills you with dread instead of excitement. Even a phone call or coffee with a friend feels like more social interaction than you can take right now. You daydream about crawling into a pile of blankets where no one can reach you.

Infertility can have that affect on you. Struggling to conceive and going through fertility treatments can be a life crisis, and during difficult times, socializing often becomes daunting and triggering.

It's okay to feel this way. You are not the only one, and you are not alone. And chances are, these feelings will not last forever.

Do you feel overwhelmed by social interactions?

We're going to look at some reasons why socializing or attending events feel hard these days. And then help you figure out when it's okay to hunker down at home, and when it's a good idea to step outside your comfort zone. 

Let's start by clarifying one thing: when we experience something difficult and feel overwhelmed, it can be healthy to want to be alone in order to feel our feelings and think our thoughts. Slowing down and turning inward instead of trying to get rid of emotions by doing a million other things might be a good idea.

Also, you may be naturally introverted or don't particularly enjoy small talk regardless of how you feel.

But there'a difference between taking space to nurture yourself, and completely isolating yourself. Infertility can amplify any hesitation that you have when is comes to social gatherings and reaching out for support. Why?

Even though infertility affects 1 in 8 couples, it can be hard to find people who have gone through it, or are going through it now, who are open about talking about it with you. That is, if you even want to talk about it in the first place.

You might have friends who have multiple children, or friends who are years away from trying to conceive. If the people around you are in different stages of their lives, you might feel alone in what you're going through.

You might want to be totally distracted from infertility, but your friends and family keep wanting to talk to you about it. Or the opposite might be true: you really need to talk about what you're going through, but no one in your life seems to be up for the conversation, and they keep changing the subject.

Also, when your life feels anything but ordinary, sitting around and listening to "ordinary conversation" may make you feel even more alone.

2. Avoiding invasive questions and advice you didn't ask for

Regardless of how open you are with your infertility journey, you might come across questions and advice from others that are triggering. Just anticipating these questions and conversations might make you want to stay at home. For example, if your treatment recently failed, you may not be ready to respond to questions about things are going. 

Do people ask you, "When will you have kids?"

People love asking timing questions. They want to know about your schedule and timeline for having kids, especially as it relates to other milestones in life.

"When are you going to give us a grandchild already?!"

"You've been married for 3 years, isn't it time you have kids?"

Unfortunately, it doesn't occur to most people that you might already be trying and are having trouble.

These often come from a good place, wanting to be helpful, but can come off as condescending or ignorant.

"Have you tried this new herbal supplement?"

"Why don't you try just not thinking about it?"

"Do you think fertility yoga would do the trick?"

"Have you considered surrogacy, adoption, or [something else unrelated to your experience]?"

You have likely spent hours and hours educating yourself about your treatments and options, so the idea of having to educate people who likely have no idea what they're talking about probably doesn't appeal. 

3. Many social events concern babies or pregnancies 

Being around pregnant people and babies can be triggering because it's a reminder that you don't have something that you long for so deeply. And even if you don't know other people's journeys to parenthood, it's easy to assume that they all had a much easier time than you, leading to feelings of envy and resentment.

It is completely understandable that being invited to events for other people's children can make you want to run for the hills.

4. Anxiety and depression make social settings daunting

For most of us, infertility causes feelings of despair and anguish, and studies show that between 25-60% of people with infertility have symptoms of anxiety and depression at some point.

It may be comforting to understand there could be clinical causes behind your lack of desire to be social. Anyone experiencing depression and anxiety is simply less likely to want to socialize. 

With anxiety, being out in the world and around people can be overwhelming. When it comes to depression, the tasks required for interacting with people - like leaving the house - can feel insurmountable.

Forcing yourself to go to baby showers, or spend time with a friend who has no concept of boundaries or respect, is most likely not going to be good for you.

Setting healthy boundaries with the people in your life is about honoring what you need. We are social beings, wired for human connection. And for social and romantic relationships to thrive, communicating what we need is key.

If we can't tell others what we need and set healthy boundaries, then anger, resentment and guilt easily build up.

It's important to be in tune with yourself, and to be okay with saying "no" to social events that you know won't serve you. Setting boundaries and saying "no" to things might feel selfish. But when you are expressing what will be best for you, that is an act of kindness for everyone:

You are honoring yourself by knowing and expressing a need.

You are demonstrating to the other person that you value your relationship by actively investing in shaping it.

So when you believe an event or social experience is going to push you out of your sense of safety, or trigger you into feeling overwhelmed or out of control, it's okay to stay home.

But we can't always stay home. Supportive social interactions are key when you have to cope with something difficult, and isolation can increase the difficult feelings you already have with infertility. You may find that with the right tools, preparation and circumstances, social events can give you energy, even if it doesn't feel like they will before you go. 

It's true: many people simply don’t know how to be sensitive or supportive when it comes to infertility. But this doesn’t mean that you can’t still have a relationship with these people. 

You can maintain relationships with people you like without inviting them into your infertility process, or without them being your go-to people for support.

It can be helpful to remind yourself that different relationships can have different purposes. When you face infertility you may have to set boundaries with some people that you generally consider close, and instead find a different support network from your usual one in online forums or support groups.

You may have to challenge yourself when you find an urge to isolate yourself. You can try using journaling to help you distinguish between things that are likely to trigger you into feeling unsafe, and if there are things you can do to make the setting more comfortable for you. Perhaps you can text your friend beforehand to let them know that you don't want to talk about your fertility, or be asked how the last treatment went.

You can also try these tools in the app to prepare yourself and make social events feel less overwhelming:

Preparing responses to triggering questions

Validating your own feelings (instead of seeking validation from others)

Do you feel overwhelmed by social interactions? Why don't I want to go to social events?

Why we struggle to socialize and attend events

While there are many things that have to function for pregnancy to happen, there are also a few things that can go wrong. It’s natural that pregnancy might not occur every month even when you time intercourse correctly, but some things can make it harder than it should be.

Remember - things are seldom black and white when it comes to fertility. Most of these issues don’t make it impossible to conceive, but can make it harder. That’s where fertility treatment and lifestyle changes come in - they can help optimize chances if something is not working as it should. But before rushing into finding a solution, it is key to identify the issue first.

To get pregnant, the presence of an egg is vital - without it, the rest of the reproductive process can’t happen. Ovulation is therefore crucial - without it, no egg is released and there would not be an egg to meet the sperm in the fallopian tube.

Although being vital, ovulation is a sensitive process that depends on the right hormonal balance at each stage of the menstrual cycle. Ovulation issues are in fact the most common reason for female fertility issues. 

That said, it’s important to highlight that we are referring to recurring ovulation issues because the occasional missed ovulation is not something to worry about. It is when ovulation is irregular that it becomes a problem. Irregular ovulation makes it very difficult to track and to time sex correctly, not to mention that it reduces the chances of fertilization. Anovulation, or not ovulating at all, makes it impossible to become pregnant. 

There are different reasons ovulation may not happen, and most of them are connected to hormonal imbalances: 

If the hypothalamus is not secreting enough Gonadotropin-releasing hormone (GnRH), the pituitary gland will not receive signals to produce the luteinizing hormone (LH) and the follicle-stimulating hormone (FSH) needed to stimulate follicle growth and eventually, ovulation.

It is possible to identify ovulation issues yourself by tracking your cycle and ovulation. The most obvious sign to look out for is irregular periods, or amenorrhea, which is to not have periods at all. A regular cycle is a good sign that ovulation is working as it should - it’s not a 100% guarantee that ovulation issues are not present, but a regular cycle without ovulation is uncommon.

If you have an irregular cycle, a blood test measuring your hormone levels should be taken to try to identify the cause. A hormone blood test can also be taken proactively to exclude issues such as PCOS, low estrogen, or high prolactin, for example. 

A depleting egg reserve (low AMH) or early menopause

Women are born with all the eggs they’ll ever have, so the egg reserve - or the number of available eggs – naturally decreases with time. Menopause is when you have your last ovulation and period. When you reach that point, you basically have no eggs left. On average, menopause occurs around the age of 51. But for up to 10 years before that, you may experience symptoms that happen due to a declining egg reserve and related changes in hormone levels, otherwise known as the climacteric period. 

There is often a lot of focus on the number of eggs and the Anti-Müllerian Hormone (AMH) value. The AMH value is a hormone value that indicates how large your egg reserve is, but it is really only one part of the equation. Studies show that a woman with a lower egg reserve, with no other issues, has the same chance of conceiving during the first year trying as someone with a higher egg reserve. But with maturing age and a declining egg reserve, the hormonal balance also shifts. On top of having fewer eggs, maturing women generally ovulate less often, and the share of healthy eggs declines – read more about egg quality below.

A significantly low egg reserve evidently decreases the chances of getting pregnant, and it can also make an IVF treatment more complicated as it may be hard to stimulate the growth of many follicles. 

For about one in a hundred women, the egg reserve declines at a younger age than average. In “early menopause” or primary ovarian insufficiency (POI), some women have no symptoms other than being unable to become pregnant, while others have menopausal symptoms such as a changing menstrual cycle, hot flashes, or night sweats.

Depending on how far the process has gone, the eggs may not have been depleted completely. Becoming pregnant may still be possible, but is more difficult. IVF is often needed even if stimulating follicle growth with hormones can be a challenge. 

Detecting a depleting egg reserve or early menopause

AMH, a hormone that indicates the size of the egg reserve, can be measured via a blood test. Normally FSH and estrogen levels are also considered since these hormone levels are also affected when egg reserve declines. Along with your age, menstrual cycle, and symptoms - it’s important to get a full picture to conclude whether the change is natural for your age and how far the process has gone before deciding on the next step. 

Considering that a simple blood test can exclude a major risk factor, more proactive screening of women’s AMH-value would be preferred. But just remember - a high egg reserve is no guarantee for high fertility. Other factors play a role as well.

Unfortunately, not all eggs have normal chromosomes and can develop into healthy embryos that result in successful pregnancies. 

During egg maturation, the crucial process of meiosis takes place. An egg needs to shed half its DNA blueprint, going from 46 to 23 chromosomes, making room to combine with the sperm’s DNA. Healthy eggs, therefore, have 23 chromosomes, the same as healthy sperm. A successful embryo, or fertilized egg, is created when there are 46 chromosomes which are the same as all other cells in the human body. 

If an egg is not of high quality with healthy chromosomes, three things could happen: either it does not fertilize, the embryo does not implant or an early miscarriage occurs.

One of the reasons that pregnancy isn’t always successful, even with correctly timed sex, is that not all the eggs in the egg reserve that a woman has are healthy. When doctors say that a miscarriage is generally “bad luck” that’s what they mean - you were unlucky enough to become pregnant with a low-quality egg, or sperm. Egg quality declines with age, which is one of the main reasons that the chances of pregnancy decline each cycle, and the risk of miscarriage increases.

Unfortunately, there’s no test you can take to measure egg quality proactively. Usually, it’s identified while undergoing IVF and embryologists watch the embryos develop in a lab.

If you are undergoing IVF, it is also possible to conduct a pre-implantation genetic diagnosis (PGT-A). This test screens embryos for chromosomal issues before they are returned to your uterus. 

At the root of it, age is the best predictor of egg quality. The egg cells go through the same process as all other cells in the body that makes us wrinkle when our skin cells age. The number of healthy eggs will also naturally decrease with age.

In your 20s, the chances of getting pregnant within a month of having sex during the fertility window are about 25-30%. In your 40s this drops to 5%, which is largely due to deteriorating egg quality. The risk of miscarriages also increases as you get older. 

In general, you can see that when at around 25 years old, about 75% of your eggs have a healthy set of chromosomes. However, that proportion is about 50% when you reach 35 years and is only 10-15% when you reach 40 years of age.

Of course - these are average numbers and all women are different. There are lifestyle choices that can speed up the decline in quality, but there’s nothing you can do to completely stop the aging of eggs. 

Like the egg, the presence of sperm is also non-negotiable in the process of getting pregnant, and must not be forgotten when considering issues related to fertility. There can be many underlying factors, but issues can be broken down into 3 types: 

Insufficient sperm production - ie: not enough sperm.

Reduced sperm quality and motility - ie: not enough normal or motile sperm.

In theory, only one sperm is needed to fertilize an egg. In reality, though, the journey of one sperm to meet an egg is long and arduous. Did you know that only 1 out of 14 million sperm actually make it to the fallopian tubes to meet the egg? The distance from the cervix to the fallopian tubes may only be around 18cm long but for the sperm that is about the distance of a person swimming from California to Hawaii… and back. Basically, only very few of the sperm ejaculated reach the egg. 

Issues that can prevent pregnancy. Why ovulation might not occur. A depleting egg reserve (low AMH) or early menopause. Sperm issues. Hormonal imbalances. Damaged fallopian tubes.

Fertility Facts