An egg and sperm meeting is central for a pregnancy to take place and for it to happen, ovulation is required. As we described above, ovulation is dependent on several events and hormones that need to be balanced. If not working properly, it can lead to completely absent ovulation or irregular ovulation, which in turn leads to a or irregular period. Without ovulation, it is impossible to get pregnant and if ovulation rarely occurs, the number of chances you have will decrease. Irregularities can also make it more difficult to identify when your ovulation is coming and thus schedule sex in connection with it.

Getting an egg fertilized is not all it takes to get pregnant. As we described above, the fertilized egg (embryo) also needs to attach to the uterine lining and develop there – the first time is critical. This requires that the uterine lining is receptive, has the right thickness, and so on, and the hormones estrogen and progesterone ensure this. Progesterone is secreted by the collapsed ovary and if it does not secrete enough or long enough, the uterine lining collapses "prematurely"; you get your period "too early". By "too early" we mean that the embryo does not get the time it needs to be able to attach and this is the reason why you want this part of the cycle to be at least 11 days long.

Why does an irregular cycle make it harder to get pregnant?

Jenny Ann Johnson is the founder of Tilly. She’s spent a decade working on digital educational products prior to founding Tilly. After struggling with infertility and miscarriages for many years she finally found her path forward and is today blessed with four children. She is now creating the supportive and educational tools she herself was missing while going through fertility treatments.

Experiencing pregnancy loss is more common than we might think, yet the profound impact it has on individuals often goes unrecognized by society and even healthcare providers. The Institute of Reproductive Grief Care is addressing this gap through their dedicated efforts to bring research and education on this crucial topic to a broader audience. Today, we're shedding light on some pivotal findings from "The Trauma of Perinatal Loss: A Scoping Review", a study that one of their Healthcare Task Force Members released during one of their quarterly Research Reveals series. This study delves into the research surrounding the trauma of baby loss(*) - here are 5 key takeaways which summarizes the main findings:

1. Baby Loss as a Real and Long-Term Trauma:

It’s probably not a surprise to all who have suffered from baby loss, but the research in the review makes it clear that baby loss is a real and long-term trauma for many parents. Research indicates that up to 60% of bereaved parents undergo post-traumatic stress disorder (PTSD) following baby loss. Contrary to the belief that time heals all wounds, a study revealed that 44% of women reported PTSD up to four years after the loss, emphasizing the long-lasting impact. In fact, the effects can extend for up to 12 years, dispelling the notion that one should be "over" the loss quickly. So if you have experienced loss and are not “over it” yet - know that you are not alone.

The study also acknowledges that the trauma of baby loss is something that affects many parts of the parents' lives and that it’s not uncommon to feel stuck and unable to move forward with life. The trauma of baby loss can lead to feelings of anger, hostility, and social sensitivity. Additionally, affected individuals may experience sleep disturbances, eating disorders, dizziness, and headaches. Recognizing the holistic impact of this trauma is essential for providing comprehensive support.

The study underscores the significant influence of social support in navigating the emotional aftermath of baby loss. Friends and family play a crucial role in providing understanding and empathy, particularly during vulnerable milestones such as learning about the diagnosis, sharing the news, and the days, weeks, and months following the loss. So for anyone close to someone experiencing loss - you being there, listening and not downplaying the loss can make a huge difference for your friend. And, please remember that anyone, regardless of gender, who experiences baby loss is affected by it. The study revealed that men reported that they rarely received emotional support from their healthcare providers or their own social circle. Often the task of conveying the news of the loss also became that of the father, something that was itself.

Healthcare providers can significantly influence the intensity of parents' emotional trauma. Acknowledging the loss and normalizing emotional responses are essential steps. The study advocates for follow-up care for at least a year after the loss, recognizing the enduring nature of the trauma. It also highlights the added emotional and psychological challenges during subsequent pregnancies after a loss.

Specific moments during the journey of loss, including learning of the diagnosis, birth (if relevant), and the days, weeks, and months following the loss, are particularly vulnerable times for bereaved parents. Being aware of and providing support during these milestones can have a profound healing effect.

We extend our appreciation to the Reproductive Grief Institute for illuminating these critical findings. Understanding the trauma experienced by those affected by baby loss is vital, and the study offers valuable insights and practical advice for friends, family, and healthcare providers. By collectively embracing this knowledge, we aim to make the challenging journey of baby loss a little more manageable for those who endure it.

Note: *Perinatal loss is the academic term for a pregnancy loss sometime between conception and birth, or of the loss of an infant up to 28 days after birth - but we have chosen to use the term “baby loss” here instead.

Pregnancy loss is more common than we might think, yet its profound impact is often overlooked. The Institute of Reproductive Grief Care aims to bridge this gap by promoting research and education on the subject. In this article, we will highlight some of the finding from their recent study, "The Trauma of Perinatal Loss: A Scoping Review", which sheds light on this important topic.

Navigating the Trauma of Baby Loss: Insights from Reproductive Grief Research

Maya Maria Brown, M.A., is an infertility mental health expert. She has a master’s in Counseling Psychology, and has worked with individuals and couples on infertility and relationships. She also has personal experience with infertility and is currently in treatment.

Struggling to conceive is a daunting and, undeniably, stressful journey. But could stress itself be sabotaging your chances of achieving and sustaining a pregnancy? This question can intensify the emotional load for couples and individuals grappling with fertility issues. In today's article, we will delve into the research behind the relationship between stress and infertility.

The belief that stress plays a role in fertility issues goes a long way back, and unfortunately, more often than not, women and women’s minds have been blamed for it. In the 1940s, unexplained infertility was linked to psychological causes attributed to women, assuming factors like their (lacking) desires for motherhood, marital relationship troubles, or even childhood traumas as potential sources of "sterility".

Thankfully, our understanding has evolved significantly. We've acknowledged the role of men in fertility issues and have gained a more in-depth understanding of the complexity of the mind-body connection. However, the myth linking mental stress to fertility issues persists, leaving us to ask: does stress and anxiety truly affect fertility negatively?

One thing is clear: common advice like "just relax, and it'll happen" doesn't help (if something they probably do the opposite, as comments like that can create feelings of anger and hurt).

What Does Science Say About The Impact of Stress on Fertility?

Recent research does, however, suggest that stress may influence fertility, although the relationship between stress and infertility remains intricate and not fully comprehended. 

For instance, a study involving over 500 women in the United States revealed a potential link between high levels of silvery α-amylase, an enzyme released in response to stress, and a prolonged time to pregnancy and infertility. Other studies have also indicated an association between long-term elevated levels of cortisol, known as a "stress hormone," and delayed time to pregnancy. 

Another study involving 135 in vitro fertilization (IVF) patients, using hair samplings to measure cortisol levels from the preceding 3-6 months, found that heightened cortisol levels correlated with lower pregnancy rates. This led the study's authors to suggest that interventions aimed at reducing cortisol levels before fertility treatment might enhance treatment outcomes. 

Moreover, this scientific study involving stressed rats demonstrated a lower fertility rate in those, compared to their non-stressed mates. However, blocking a specific stress hormone led to equivalent pregnancy outcomes in both groups. (This potential “blocker” of the influence of stress is still a long way from being available to humans though).

5 Ways Through Which Stress Can Negatively Influence Fertility

The research delves into various factors through which stress potentially influences fertility:

1. Disruption of Hormonal Balance: Chronic stress can disrupt the normal hormonal balance, potentially affecting menstrual cycles and ovulation, complicating the conception process.

2. Negative Impact on Implantation: Mental stress during early pregnancy might hinder the endometrial lining's function, making healthy implantation more challenging to achieve.

3. Impaired Immune Response: Studies suggest stress could negatively affect the immune system response, critical for reproductive outcomes. However, the role of the immune system in pregnancy outcomes remains an area of debate.

4. Impact on Sperm Quality: Self-reported long-term stress among men has shown correlations with sperm quality. Ironically enough, certain stressful events, like leaving a semen sample, seem to also adversely affect semen quality.

5. Stress & Libido: It's widely acknowledged that stress and sex don't mesh well, and in fertility cases, it's a combination that's far from favorable, potentially affecting the time taken to achieve pregnancy.

Measuring stress accurately remains challenging, with inconclusive or unsupportive results in some studies. Nonetheless, research implies that therapeutic interventions might enhance fertility treatment outcomes, a finding that indirectly supports the idea that mental health and stress influence fertility.

Does Therapeutic Support Improve Fertility Treatment Outcomes?

Could therapeutic support decrease time to pregnancy and increase fertility treatment outcome?

Several studies suggest it might! For instance, a comprehensive 2015 analysis encompassing 39 studies and involving over 2700 women and men highlighted the potential efficacy of psychosocial interventions, particularly Cognitive Behavioral Therapy (CBT) and mind-body techniques (techniques that link the body and the mind, e.g. yoga, meditation, guided imagery). This analysis found that those using psychological strategies to manage stress were twice as likely to achieve pregnancy compared to couples who did not use such methods. While these findings are promising, researchers underscore the need for more extensive studies to establish a definitive link between therapy and fertility outcomes.

Regardless of the exact link between stress and fertility, it’s clear that working on your mental health while struggling with fertility can have a positive impact on your mental well-being and quality of life. And, that potentially it might even up your chances of success on your fertility journey!

As a former fertility patient, I absolutely don't want to add stress by sharing the above findings. I myself have wrestled with worries about how stress might affect my chances of having a baby while I was trying to have a baby. When I founded Tilly, one of my main goals was to support others through the tough journey of fertility struggles, equipping them with research-based information on mental well-being and fertility (while acknowledging ongoing debates). My intention with the above is thus not to scare you but to shed light on pressing questions you might already be pondering about how stress impacts fertility. On a brighter note, once you (hopefully) get pregnant, and if you, like I was, are freaked out during the whole pregnancy, research actually suggests that high levels of the stress hormone cortisol in the third semester might positively impact the language development of your children.

Struggling to conceive is a daunting and stressful journey. But could stress itself be sabotaging your chances of achieving and sustaining a pregnancy? This article seeks to answer this question by delving deep into the current body of evidence on the relationship between stress and infertility!

Can Stress Impact Fertility? Unraveling the Complex Link Between Mental Health and Infertility

In a recent seminar organized by the European Fertility Society, Tilly's founder, Jenny Ann Johnson, shared insights on the transformative potential of artificial intelligence (AI) to improve patient care during fertility treatment. 

In the seminar, hosted by Prof. Johnny Awwad, at Sidra Medicine & Research Center, Jenny Ann together with Cecilie Hvidberg Jakobsen, Founder and CEO of Wawa fertility and Alina Latus, Founder of the Hope App, explored the various applications of AI in fertility care, shedding light on how this technology can revolutionize the medical and emotional aspects of infertility treatment.

1. AI Optimization of Fertility Treatment

AI's ability to analyze large datasets presents a groundbreaking opportunity to optimize the medical side of fertility treatment. For a medical professional this means that instead of asking a few trusted colleagues when you come across a tricky case - you can ask thousands of colleagues. By processing patient data from thousands or even millions of patients, including medical history, genetic markers, hormonal levels, and lifestyle factors, AI can assist in accelerating new findings and personalizing treatment plans, significantly improving success rates. For instance, AI algorithms can enhance embryo selection in IVF procedures, leading to more successful outcomes. 

2. Personalized Emotional Support with AI

AI's role extends beyond medical optimization to personalized emotional support. Through analyzing user data, AI algorithms can deliver tailored content and support individuals in coping with the emotional challenges of infertility. In addition, by freeing up time for medical professionals through streamlined processes, AI enables medical professionals to focus on patient relationships, ensuring a more empathetic and personalized treatment journey. 

AI-powered chatbots offer accessible self-help options, complementing traditional therapy and providing immediate support. Studies have highlighted the beneficial impact of chatbots in therapy, making emotional and mental support available 24/7. This digital support ensures that patients feel acknowledged and supported throughout their fertility journey. 

4. AI Complements, Not Replaces, Human Connection

While AI provides personalized support, it cannot replace the human connection and expertise of medical professionals - in the end it still has to be the medical professional that makes the decisions together with the patient. AI should be viewed as a complementary resource. Prof. Johnny Awwad emphasized the importance of maintaining human connection in fertility care, with AI assisting medical providers in obtaining actionable data and spending more quality time with patients. 

5. Addressing Risks of AI in Infertility Treatment

AI's ability to provide personalized predictions introduces a potential risk of creating a false sense of certainty. Patients need to be educated about statistics and risks associated with fertility treatments. Despite high success rates, there is always a chance of failure, and patients should be informed that infertility is not their fault. Balancing hope with realism is crucial for managing expectations and providing comprehensive support. 

As AI continues to evolve in the realm of fertility care, it holds great promise for optimizing medical treatment and delivering better, more personalized emotional support. At the same time, it is essential to keep in mind some of the inherent limitations of AI, and maintain human connection to ensure patient-centred infertility care. 

For anyone interested in learning more about how AI may impact patient care during fertility treatment, the full seminar has been made available to watch here. 

In a recent seminar organized by the European Fertility Society, Tilly's founder, Jenny Ann Johnson, shared insights on the transformative potential of artificial intelligence (AI) to improve patient care during fertility treatment. Jenny Ann together with Prof. Johnny Awwad, Chair of Women's Services at Sidra Medicine & Research Center, and other FemTech entrepreneurs within the fertility healthcare sphere, explored how new AI technology can be implemented in fertility care and revolutionize the medical and emotional aspects of infertility treatment.

Revolutionizing Fertility Care: 5 Ways AI Transforms Patient Support

Infertility and pregnancy loss is a deeply personal and often stigmatized issue that affects millions of individuals and couples worldwide. In fact 

1 in 6 couples struggle to have a child . For women over 35, up to 34% are diagnosed with infertility.  

Up to 1 in 4 pregnancies ends in miscarriage.

While the emotional toll of infertility and pregnancy loss is well-documented, its impact on employees in the workplace is a topic that often goes unnoticed. The journey through fertility treatments, emotional ups and downs, and the societal pressure to start a family can significantly influence an individual's professional life. 

There are several ways infertility affects employees in the workplace, highlighting the importance of employers creating a supportive and inclusive work environment.

Dealing with infertility is an emotionally taxing experience. Employees facing fertility challenges may grapple with anxiety, depression, and feelings of isolation. The demanding nature of fertility treatments, coupled with the uncertainty of success, takes a toll on an individual's mental well-being. In fact, fertility patients experience stress levels equivalent to those among cancer patients. In the workplace, these emotional struggles may manifest in reduced productivity, increased absenteeism, or difficulty concentrating on tasks. Studies have shown that up to 63% feel decreased engagement at work. Unfortunately, mental health issues are not only associated with the period of fertility struggles - former fertility patients are also at a higher risk of postpartum depression.

2. Balancing Work and Fertility Treatments

Fertility treatments often involve a rigorous schedule of appointments, medications, and procedures. Employees may find it challenging to balance these demands with their work responsibilities. Frequent medical appointments and the need for flexibility can create stress for individuals who may fear judgment or professional repercussions. Employers who offer flexible work schedules, remote work options, and supportive policies and tools can help ease the burden on employees navigating fertility treatments.

Infertility is often surrounded by societal stigma, which can seep into the workplace. Employees may fear disclosing their fertility struggles due to concerns about judgment, discrimination or disrespect. In fact, 1 in 2 of those struggling with infertility choose not to tell their employer. One in five has considered leaving their job because of their experience at work in relation to fertility challenges. Fostering a workplace culture that prioritizes inclusivity and empathy can create a supportive environment where employees feel comfortable sharing their challenges without fear of negative consequences. 	 

Employees navigating infertility may experience that this is also impacting career timelines. The pressure to align personal and professional goals can lead to delayed career advancements and decisions to postpone promotions or job changes. Employers can support employees by providing mentorship, guidance, and open communication about career trajectories that accommodate both personal and professional aspirations.

It is important not to make any assumptions about who may be struggling

While age has a negative impact on fertility, especially for women, infertility also affects young people looking to build a family. Also, someone can be “fit and healthy” and still struggle with infertility or baby loss. In addition, fertility issues are something that both men and women are experiencing, and both partners can be equally burdened by the emotional and mental health impact of undergoing fertility challenges. Secondary infertility, where someone has a child from before, but is struggling with having a sibling, can also have a devastating impact on someone's mental well-being. Fertility challenges can also affect same-sex couples, and individuals looking to start a family on their own, so not making assumptions about where someone is in the process of building a family and if they might be struggling is very important.	 	 	

Infertility is a complex and deeply personal experience that extends its reach into various aspects of an individual's life, including their professional endeavors. Employers play a crucial role in fostering a workplace culture that recognizes and supports employees facing fertility challenges. By implementing supportive policies, destigmatizing the conversation around infertility, and providing resources for emotional well-being, workplaces can become more inclusive and compassionate spaces for those navigating the often-silent struggle of infertility.

Studies have shown that for someone struggling with fertility issues feeling supported by their employer, line manager, and colleagues has a positive impact on:

The employee's ability to perform well on the job.

The employee's intention to stay with his or her employer.	

The employee's likelihood of recommending his or her employer.	 	 	 	

Creating a supporting workplace for those struggling with infertility is hence not only a compassionate choice - it is a sound business decision!

If you want to find out more about why organizations like Frost use Tilly to support their employees and discuss how Tilly can help support your organization reach out today at hello@mytilly.co

Four ways infertility and pregnancy loss impacts employees in the workplace

The holidays are upon us, which means a whirlwind of parties, gatherings, and more logistical juggling than a circus act. But here's the thing: for those dealing with infertility, all this planning and socializing can hit differently.

Trying to plot out your holiday calendar when you're in the 'fertility challenged' club is a minefield of emotions. Will you be pregnant by then? Is it a good call to be in a crowd? A bazillion questions pop up, making the whole ordeal stressful. And if you're in the middle of a treatment, traveling might not be a walk in the park.

Let's face it, holiday bashes and mingling with friends and family can stress out anyone. But for those facing fertility battles, it's like cranking the stress dial up to 11.

Know that you are not alone though! At Tilly, we've been there. We get it. That's why we've whipped up a guide on surviving the holidays (check it out here). And you don't always have to choose between rocking around the Christmas tree with loved ones or holing up solo (or with your partner only). Balance is key! You could swing by your family's place for a couple of days instead of the usual week-long marathon.

For those extra days, try to carve out some "me time." Whether it's hitting up a daily yoga class, sweating it out at the gym solo, or just taking a solitary stroll. Oh, and if you're crashing at your family's, make sure to snag moments away—lock the door, dig into a book, or why not dive into the Tilly community for some support? 😉

Sure, these festivities will probably not be the best holiday season you’ll ever have, but with a bit of thought, they could be pretty okay. It might even recharge your batteries.

It's that time of the year, about infertility, the holidays and how to cope

Grief is a weird thing, as sometimes you can feel fine - and then suddenly it hits you again. Although we understand that grief comes in many forms during an infertility journey, today we are focusing on miscarriage and grief. We have gathered some learnings from the clinic perspective on how to approach bereaved parents, and how the clinic can help in supporting patients through grief. 

Did you know that up to 1 in 4 pregnancies ends in a miscarriage? This means that there are up to 1,000,000 miscarriages in the United States  per year. In the United Kingdom, the number is approximately 200,000, and in Australia, 147,000. Despite how common miscarriages are, and how traumatic the experience can be, the emotional impact and grief of miscarriages and other types of baby loss are often overlooked. So if you have experienced pregnancy loss and are not feeling okay, you are definitely not alone. In fact, baby loss has been shown to have a large psychological impact, and is associated with post-traumatic stress, depression, anxiety, and sleeping disorders.

So how do you deal with miscarriage and grief? There is no easy answer to that - and it’s important to recognize that grief is always a personal process. However, research does point out that the support given by the health care provider following the miscarriage has an important role to play and that the interactions with health care professionals have a large influence on the intensity of the parents’ emotional trauma. In fact, patients who are satisfied with the support from their care provider following a loss are less likely to suffer from depression, anxiety and long-term grief.

Here are a few things that impacted how satisfied bereaved patients were with the support of the care provider:

Insufficient information; regarding the medical and physical implications, next steps, what to expect mentally/emotionally, and the grieving process. 

A lack of acknowledgment of their loss, and not feeling listened to.

A worsening factor in how women and their partners (in general) are affected by miscarriages is having had this unfortunate experience before - as is the case with recurrent miscarriages. 

We have thus invited someone who has a lot of experience from working with bereaved parents having undergone several pregnancy losses: Lorna McErlane, Deputy Clinic Manager at the Center for Reproductive Immunology and Pregnancy Miscarriage Clinic, CRP Clinic, a UK clinic with two clinic sites that specializes in treating recurrent miscarriages.

Lorna, you are meeting with patients that have experienced recurrent miscarriages on a daily basis. What is usually the emotional state of the patients when you meet them for the first time?

Going through one miscarriage is emotional, going through several is very tough. Normally our patients have been through a lot when they come to our clinic, and can sometimes be in a very heightened emotional state. We try our best as a team to ensure our patients feel listened to and cared for, to try and make a difficult time a little easier. 

Research suggests that one way to support women and their partners is for them to feel that the care provider is giving enough information, both orally and in written form (as oral information alone can be hard to process in a heightened state). How do you address this, and are you doing anything differently than a regular provider? 

We make sure to set aside enough time to sit down with the patient(s) and go through the information with them. It can be about the causes of a miscarriage, what are the next steps and why are we suggesting them, etc. Our nursing team is available to speak to via phone or email if patients have any queries outside of clinic times. We also have an app where patients can access their personal data and information about the procedure afterwards.

There is data showing that patients value not only information around their treatment and physical health, but also on what to expect mentally. How do you enlighten the patient around this aspect? 

At the CRP clinic, our patient-facing staff have an understanding of common mental health issues and also have knowledge of grief and its potential implications. We also have digital support tools that our patients have access to and a counsellor associated with the clinic to whom we can refer our patients. 

Lack of acknowledgment from the provider can negatively affect how the patient deals with the grief according to research. Anything from word choice when speaking about the loss as well as body language. When patients come to you, they have often been through several losses. Do you recognize them feeling that their loss has not been acknowledged before? How do you work differently with this?

Unfortunately, we meet many patients who have not felt supported enough by their clinic or local hospital. This can be due to lack of time or training regarding fertility and miscarriage, but many raise that they have not felt heard, and that their losses have often not been acknowledged. At the CRP clinic, we meet with patients every day who have experienced multiple losses, so this is something that we have all made our professional focus. We’ve done this through training, but also through daily experience we have gathered experience in what to say and when/how to say it, and are not afraid of the emotional side of our patients’ history. By being compassionate towards our patients and having an in-depth understanding of the emotional challenges, as well as having tools that we can refer the patients to, we are able to customize the support for patients to a large extent.

Thank you Lorna for sharing your experience and knowledge of working with bereaved patients!

Psst: Did you know that all patients at CRP Clinic get access to Tilly? If you are interested in making sure your patients get the mental and emotional support they need during a tough fertility journey, please do reach out to us at hello@mytilly.co to learn more about our services.

Did you know that up to 1 in 4 pregnancies ends in a miscarriage? This means that there are up to 1,000,000 miscarriages in the United States. We have gathered some learnings from the clinic perspective on how to approach bereaved parents, and how the clinic can help in supporting patients through grief.

Understanding the Impact of Care Provider Support on Pregnancy Loss Grief

Why does an irregular cycle make it harder to get pregnant?

Ovulation

Luteal phase

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